Sunday, January 21, 2018

What Residency Looks Like XIV: Truth-Telling

Not too long ago, I woke up in the middle of the night, and my anxious brain decided to enumerate all the ways in which I am a bad resident and will do a poor job leading my first team in a few months. It went on like that for an hour or two before I finally fell asleep again. In between negative thoughts, I flipped through my mental Rolodex of friends in whom I could confide. Then I resolved to seek formal counseling to explore what my rational brain deemed were understandable but unfounded fears. A couple of days later, I finally sat down with a pen and a piece of paper to write a pro/con chart, to see if I could untangle my strengths and weaknesses. It struck me immediately that there are more items in the positive column than in the negative one. This is what I came up with:


Evidence I am a good resident

My colleagues think so.
In the last two weeks, two more-senior residents, one Chief Resident, one program director, and one fellow have praised me for my hard work, skill, demeanor, or willingness to set a good example by sitting in the front of the room when everyone else tries to look inconspicuous in the back.

Voted into Ravenclaw without hesitation.
While inner-tubing with fellow second-year Pediatrics residents last August, the conversation came around to which Hogwarts House each of us belonged. My colleagues all agreed I was a Ravenclaw. I confess I hadn't thought much about this, perhaps assuming I was a Griffyndor. However, I just took the Pottermore Sorting Hat quiz, and sure enough, it lumped me in with the house of "intelligent, wise, sharp, witty, individual [read: weird]" witches and wizards.

"[I] have good clinical judgment."
This is one of my favorite compliments from an attending physician who has literally written the book on diagnosis, given toward the end of a week of nights at the children's hospital, after he had read my notes on new patients.

"[I] can talk to a variety of patients."
Another attending compliment, this one from watching me interact with patients on rounds one or two mornings a week, and one I take to heart, because I was not always so conversational. It also suggests that while I prefer interacting with over-educated people like me, I can modify how I approach someone with different knowledge and life experiences. Current learning goal: how to put reticent adolescents at ease and yet extract useful clinical information from them.


"Or yet in wise old Ravenclaw, if you've a ready mind,
where those of wit & learning will always find their kind."
By Niongi, DeviantArt

Attendings and nurses like to work with me.
As a second-year resident, it has been encouraging to work with attendings and nurses a second time around who know me and what I am capable of.

I write good notes.
Probably my notes are sometimes "too good"--I know I can be a perfectionist, but as a historian and therefore a writer, I judge myself by how well I communicate through text. I often take the time to synthesize and carefully phrase my clinical reasoning in my notes. By contrast, I am not as gifted with on-the-fly oral presentations, and I worry that others judge me for this.

Patients want me to be their doctor because I am honest, thorough, explain things well, and have a good bedside manner.
Getting compliments from patients is the highest praise. They buoy my morale amidst lectures from consultants about what the night team did (or didn't do), the frustrations of the hospital/healthcare system, and the devastation wrecked by pathogens, time, and trauma on human bodies.


Evidence I am not a good resident (I tried to frame the discussion already by avoiding the phrase "bad resident.")

Middling In-Training Exam Scores
The entire time I was in school, I was a/the top student. Now that I am in residency, I am surrounded by excellent students. I've taken three standardized exams so far, and on all of them I have been middle of the pack. My program director and I came up with a study plan to address my deficiencies with practice questions, but I still feel that by the time I have completed four years of residency, I will have learned what I need to know. Besides, while standardized exams are now a constant feature of medicine, they are not the most important part.

"You know you're a Ravenclaw when...
you do not like a person based on their looks
but by how much smarter they are than you."

Pretty much how I fell in love with DH.
Don't feel I know as much as my peers.
This is probably true in some areas and not in others. But I have rarely felt judged for it.

I sometimes take 1/2 histories or give 1/2 plans.
This is an area of growth for me: remembering all the right questions to ask and knowing (or looking up) what to do next. The most important thing I need to do is to ask my preceptors to let me come up with a plan for them to critique, rather than bring them information from the patient and then just trail off, letting them fill in the blanks...

Got little out of M4.
What I did or didn't learn in my last year of medical school while traveling for residency interviews, trying to get an article published, packing up/selling our house, and taking care of Dear Husband is in the past, and I can't let it dictate how I approach present or future challenges. I will be trusted to do the job of leading a team because I can.

Finally, something I realized while mulling these things over is that I have developed an unhealthy relationship to praise. By nature I have high standards for myself and others. By high school, however, I had learned that always being right was off-putting to my peers, and so I started to deflect praise. There's a fine line between gracefully accepted positive feedback and downplaying success to make other people feel better. In the process, I made myself feel worse. I have resolved therefore to change my attitude from embarrassment to humility and to start believing people are telling the truth about me when they say I am a good resident and a good doctor.

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