Wednesday, April 22, 2015

Knowledge



Recently a patient brought his daughter, a 4th year medical student, to the appointment with him. She nervously asked me about making her imminent, and bizarre, leap from medical student to doctor. She felt like someone was going to tell her she wasn't really qualified to be a doctor, that her whole 4 years of med school were some sort of trick, and that she was really a fraud.

And... I agree. Not that she's a fraud, but that it's how I think most of us feel at that point. Actually, it's how ALL of us feel. It's just that some won't admit it. I will.

Attention medical students and residents: THIS IS NORMAL. You just don't realize it until you're actually going through it.

As a 3rd year medical student this terrified me. I was seeing REAL (OMG! REAL!) PATIENTS and had no idea what I was doing. The attendings would point out the substantial gaps in my knowledge and I'd feel like there was absolutely no way in hell I'd ever know that much.

Toward the end of my 3rd year was a rotation with Dr. Griffith, an absolutely brilliant internist. He was a nice guy, but always made me feel like I knew little, simply because he had all the answers I didn't. Seated next to him at an end-of-year lunch, someone pointed out to him that he'd now been an attending for 6 years (yeah, in retrospect, he's not that much older than me). I quietly asked him "and do you still feel like you don't know anything?" He laughed and said "I don't know anything."

And, folks, it never goes away. I've now been an attending physician for over 15 years, much longer than Dr. Griffith was at that time. And I still feel like I don't know anything.

I think the issue is that inwardly we're still the same people who went to college, made it through medical school, survived residency... but we're still ourselves. Somehow we expect that, by being given the title of "Doctor" we're suddenly endowed with a sort of medical omniscience... and it doesn't happen. I don't feel any smarter today than I did when I stepped out of grade school, or high school, or college. Even though I KNOW that through learning and training I've amassed a decent amount of medical knowledge, it's not something that any of us is consciously aware of.

In my experience, the only way any of us realize how far we've come is when we compare ourselves to someone at a previous stage in our training. When I have the occasional medical student or resident spend a few days with me, I'm amazed at how much more I know about neurology than they do, even though I don't feel any different than I did at their stage. It's only in comparison to those behind us that we realize how far we've come.

And, if they ask me if I ever feel like I don't know anything, I tell them "always."

Good luck, Haley!

22 comments:

Anonymous said...

This is essentially Imposter Syndrome, and it's very common among professional occupations, freelancers and entrepreneurs.

http://en.wikipedia.org/wiki/Impostor_syndrome

Don said...

I think that this applies to other professions as well. I've worked for over 30 years as a mechanical designer/drafter, going from manual drafting to high end Unigraphics CAD software in a variety of industries. I've gone from about $16,000 per year to over $100,000 at times.
And yet, every time I see a new piece to be modeled, I have a bout of nervousness and anxiety: Can I do this?
Good luck to her.

Anonymous said...

13 years in vet med and I still have to remind myself "Hey, I'm a licensed professional!"
One of my favorite lines from a doctor who helped train me, when I felt I was never going to be able to draw blood, was a sarcastic "Well, I was born with these skills." Dr. A, you're awesome.

Anonymous said...

It's the whole "the more you know, the more you know you don't know" thing.

I'll bet you put that young lady's mind at ease, allowing her to continue gaining confidence in her skills and abilities. Nicely done!

(and hahahaha at the recaptcha...I had to select all soup pictures)

Officer Cynical said...

Is it too late to cancel my appointment for tomorrow morning?

Anonymous said...

No matter how much you know the practice of medicine will always humble you. The best you can hope for is to have a working idea of what you don't know. It also helps to always have a healthy doubt about what you think you know.

Packer said...

I have been deathly ill for a couple of months, my doctor doesn't know shit either, but somehow he is getting me better, funny how that works a lot of the time. Thank God it does.

Anonymous said...

The trick is never to let the yaks smell your fear.

Ms. Donna said...

I don't know what to think

Seriously,I'd rather have someone tell me, "I don't know, and I am looking it up" than someone who goes ahead, possibly making things worse.

Anonymous said...

And after 32 years in medicine, the saying that "half of what we are teaching you is wrong, we just don't know which half" is closer to truth than we like to think. The people who think they know more than a professional in whatever field after 15 minutes on Google are terribly arrogant and ignorant, and ultimately do not even know what they don't know.

KYMS3 said...

Fake it til you make it.

Anonymous said...

You never make it. That's the point. I'm chair of my department and I still get anxious every day before work wondering if today will be the day that everyone will notice that I don't know shit

John Woolman said...

Been qualified 42 years. It really is "ars longa vita brevis". One key to happiness in medicine is life long learning And that makes the best thing you can give a young doc is a subscription to NEJM. That make Thursday, the day it pops thru the letterbox, the best day of the week.

Kate Cumming said...

Wow, I am a nurse in my first year of practice and I feel like this. It amazes me how much knowledge the senior nurses have about absolutely everything. And I wonder what I will have to go through to gain that knowledge.... I am looking forward to that journey!

clairesmum said...

I'd rather see a doc who knows how little he/she knows than see someone who believes that he/she knows everything! The arrogance of the second sort of doc creates a highly trained and powerfully destructive force! Staying humble helps you stay human...and in the long run, that's what makes you 'a good doc.'

Anonymous said...

Dr Grumpy. I'm an electronic engineer (who does firmware as well). And I've been qualified for 30 years and fiddling in the shed for 40. And EVERY DAY I think I'm inexpert, unqualified, don't know things. And I'm in awe of a couple of people who are just geniuses - who have The Insight and who can leap the the (right) conclusions that take me hours.

And then if the conversation changes to a field where where I do know things, I can say what to do, and where, and how, and whats going on and what happens. The leap is instant, and the response is (usually) right.

The thing here is, I don't feel quite as ignorant and gormless as I did when I was 40 (then I felt like a nitwit of about 22). These days aged 50-mumble, I feel like I'm about 35 - with the experience and qualification and knowledge that I think a 35 year old should have.

Of course this is all silly. I'm well paid and respected and get results in the things I'm good at. I just keep thinking that one day somebody is going to figure out I'm a fraud. Its silly but thats how it is.

SOME people have loads of confidence and can charm or blarney their way through anything. Those are the ones you should really worry about - because they bullshit their wait through anything. And in the medical field thats the biggest worry of all.

Give me a guy ANYDAY who says "I don't know" over one who purports to know everything.

homebru said...

This is not and has nothing to do with Imposter Syndrome. In that syndrome, the individual believes they are a fraud. None of us believe we are frauds, we're just humble enough to know that we don't know squat. 'cept for Dr. Oz.
homebru

Moose said...

Late to the party (hahaha, been traveling) but I'll say this, FWIW.

If there's one thing that makes me run screaming from a doctor it's the attitude of "I went to Medical School; therefore I know everything about medicine."

My favorite doctor knew a lot but when she didn't know something she wasn't afraid to say, "I don't know, but I'm going to find out." THAT's the sign of intelligence and competence you want in a doctor.

lyndat. said...

Packer, Packer now you have me worried. Please feel better! You've made me laugh for a long time...

peace said...

I love you doctor Grumpy!

Kelly said...

@Kate Cumming, this is exactly what Patricia Benner is talking about and I am going thru every day. I am at "proficient" on the continuum but I can absolutely relate to that feeling of being asked questions or being in a situation where all you can think is "what the hell am I doing and why don't I know more than I do." The healthcare professionals who are chiming in here to say that lifelong learning is the key are so very right about that.

Anonymous said...

Ive been an official Registered Dietitian for just over a year now an have interns following me at times, I definitely feel like were in the same boat, except I have passed the exam already. I know they will too.

 
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