Insecurity of a Junior Doctor

Being 6 months into the job, I cannot deny that I have learnt things not found in the textbook, and sometimes even being able to share them with my seniors. But the amount of knowledge I've gained at work is definitely way below my expectations, which clearly brings in a lot of insecurity.

I have sat down numerous times, having deep thoughts about trying to figure out what the priority is for me as a junior doctor. I am allowing myself to have ambitious hopes, but also reminding myself that these ambitious thoughts should stay as thoughts for the time being, and I should focus and try to lay a good foundation for my basics first.

I spent time thinking about what these basics are, and have been trying to place emphasis on them. These included mastering my history taking skills, improving my practical skills, drafting a reasonable list of differential diagnoses, and coming up with basic management plans. I know the above sounds very like the priorities of a medical student, but to me, these are the most fundamental skills. I cannot see how I can allow myself to move on to a higher level if I am unable to master these.

I must admit that I have improved very much in the above. I haven't got my diagnoses right 100% all the time, but I think that is reasonable as long as I don't miss a critical diagnosis like myocardial infarction for a patient admitting with chest pain. But I am thinking very much more than when I was a student.

I have begun to appreciate a patient as a whole more and more, and have started to see how one thing can link to another. This resulted in my improved history taking skills, because rather than turning tooooo focussed on a history, I started understanding the nature of the current problem, and am able to fish out even more information just by digging into relevant past medical/surgical histories. By doing these, it also made me realise that I am starting to see the importance and understanding how patients are managed years down the line for certain illnesses. History taking no longer became some chore which I hated whilst my days as a medical student. And even though I don't deny that it can be a pain sometimes since history taking is time-consuming especially when u've got tons of other ward jobs to do and being haunted every few minutes by the nurses, history has somewhat become a beauty I am starting to appreciate.

A Consultant I once met during my first few days of medical school said, "Ask yourself. Do you enjoy taking histories? If u don't, then u r in the wrong profession, because the history is the foundation in Medicine, and it will be something u'll find yourself doing for the rest of your life in the career, regardless of which level of the hierachy you are in. If you don't have the history, you have nothing." I used to think he was bullshitting, and hated taking histories. As a medical student, I curse each time I turn up at the wards to have the doctors in the team I'm attached to giving me a few names, and then get me to bugger off, asking me to take histories from patients. I also felt that something must be wrong with these doctors because Consultants, especially, are obsessed with getting us to clerk patients. I really really hated it, because...

1. It's boring
2. Just one of those excuses to get rid of me
3. What's the point of making me take them and then not going through it with me?

I couldn't see the importance and the valuable lessons I could gain from this boring task then, and thinking back now, I feel silly. Never did I also expect myself to enjoy history taking now.

It gives me a tremendous sense of satisfaction when a few Registrars commented that I take brilliant histories. Many times, they have watched me take the history before the patient to save time asking them again and I do see improvements - from having to supplement it with numerous questions after I've done the history when I was a medical student, to having almost no questions to ask to clarify things. I even had a Registrar who said my history taking skills are the best amongst all the junior doctors he knows.

I think there is still room for improvement with regards to my differential diagnoses, but I'm still quite happy with myself for coming up with some and being able to justify them. Management wise...basics are fine I suppose.

Yet, there are still days I ponder abt my insecurities. I think it's all due to a lack of confidence from lack of experience. I am constantly asking myself if I'm up to standard for a house officer, and compare myself with my fellow colleagues. Got a colleague who is extremely knowledgeable, but each time I chat with her, I start questioning if I'm too complacent with the objectives I have set for myself, and if I should be more ambitious. I don't quite agree with what she is doing at times because being the most junior of the lot, we're still under a lot of supervision and we should try to seek advice even if we think our suggestion is reasonable in terms of managing the patient. For example, if I were to suspect pulmonary embolism in a patient which would render a CTPA, I would speak to a Registrar to get approval for my suggestion, and not taking full charge by requesting a CTPA without informing anyone else in my team. Also, if a patient was admitted with abdo pain and the Xrays were normal, I might suggest an ultrasound to be done, but I won't just fill in a form and send the patient for it without informing my seniors.

I don't know if my friend is doing the right thing. Her suggestions are appropriate, and chances are it will be approved, but sometimes, I do feel that being at our level, we're entitled to doing ONLY basic management and have suggestions about further management, not taking full charge. Our seniors are definitely much more experienced and have a greater and deeper knowledge of which investigations are better, and have clearer understandings of the latest management guidelines.

I am comfortable with starting patients on simple medications and simple antibiotics, but I am definitely not comfortable at my level yet to start things like hypertensives without consulting anyone. I will only do things I am confident in, and have a very clear understanding of.

But when I think abt it, am I actually restricting myself from moving forward? My aunt used to tell me "A good house officer is one who knows how to be a safe doctor", and I guess I'm not being comfortable abt taking things into my own hands because of what she said. I told Dad about what I think, and he went "Learn to crawl before u walk. If u're inexperienced but take things into your own hands and get too keen to prove something, no one will teach u anything." Sigh...if only Dad's a doc, then I'll probably feel very much better.

I was with a Registrar I worked with in clinic yesterday, and I was feeling lousy about myself at the end of it because he had asked me many questions which I couldn't answer. I apologised at the end of the session for being poor in my knowledge, and I was expecting him to tell me I'm crap, but instead, he said "U're an excellent house officer. Your knowledge is good, now it's about slowly linking the pieces together."

And another Registrar I knew, who chatted with me in the library said...

Him: U're the best intern I've seen in my many years as a doctor..

Me: HUH?! REALLY?! I think I'm crap!

Him: I can see the potential in u..so don't say that.

Me: How can u see it?

Him: U got the knowledge and most importantly, u got the stamina and determination to keep yourself going. U aren't like many docs here who sit all day and whine without doing their jobs.

Me: I whine a lot too, ya know?

Him: Come on...we all do. All u need now is to find a good place that will train u. U are shining in this place even when no one is giving u very much guidance, so if u go somewhere else where training is excellent, u will shine tremendously.

ME:!!!!!!!

Piangz....that does scare me...didn't know I am seen as having the potential (I can't even see it)... :X