Being an incompetent physician

[IncompetentDoc]

Hi,

New here. Just finishing fellowship, but deeply worried about my ability to competently practice medicine and seeking advice on what to do next.

I'm finishing fellowship (non-surgical, non-procedural) soon. I was the average medical student, a below average resident and a below average fellow. I test well, but in terms of clinical practice, have been told by former attendings that I am more 'book smart.' I'm shy with poor communication skills (dread any kind of goals of care conversations). In residency, I was never told I was doing poorly by anyone directly, but did have a few evals with comments about poor performance. When COVID hit, and we were given back-up roles, I noticed that I was placed on furthest reserve, meaning least likely to be called in to do anything. I know my PD ranked me as below average in my fellowship letter. Although I was not aware of it at the time, I was probably roasted by my Co-Residents behind my back for doing poorly.

In fellowship, my last rotation had me kicked off an outside rotation for presumably 'stress,' (first rotation back after maternity leave) from what I was told in eval but I was kicked off in the first week without any chance to make changes, etc. which makes me think this was thought to be a non fixable personality issue. Evaluator told me that they thought I would make a good physician in future--lol, like I feel that way after you just kicked me out in that manner.

Overall weaknesses that I believe that I have: poor clinical knowledge/skills, misses things on exam/history. Poor communication skills. Very slow/inefficient in both chart checking and taking history/physical. Also embarrassed to admit (although my specialty isn't procedural) - unable to give vaccine/do blood draw.

I want to continue practicing medicine, but I feel that I'm going to harm someone if so. I want to improve, but now that training is complete, not sure how to do so. Feeling really depressed about the whole situation.

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[NewYorkDoctors]

What do they call the person who graduates last in his/her class? Doctor

While it seems like you may not thrive in the dog eat dog world of academic medicine, I am sure you will find your niche in the community. There are tons of sh it doctors out in the community who just do not give a sh it about their patients and just want to get to the next one ASAP to bill.

I find to be a good community doctor it's not so much about knowing everything so much as it is giving a da mn and crossing every T and dotting every I. Be thorough, keep checklists, keep good records, know what you know, try to learn more, understand what you don't know and just do your best. you will find your niche

 

[dozitgetchahi]

What do they call the person who graduates last in his/her class? Doctor

While it seems like you may not thrive in the dog eat dog world of academic medicine, I am sure you will find your niche in the community. There are tons of sh it doctors out in the community who just do not give a sh it about their patients and just want to get to the next one ASAP to bill.

I find to be a good community doctor it's not so much about knowing everything so much as it is giving a da mn and crossing every T and dotting every I. Be thorough, keep checklists, keep good records, know what you know, try to learn more, understand what you don't know and just do your best. you will find your niche

My thoughts exactly.

Academic medicine is often a nasty, dog eat dog rat race. Also, IMHO academic medicine tries to act like every doctor needs to be absolutely elite, and that good clinicians are dime a dozen. (And good clinicians are actually fairly uncommon in my experience, but that’s another story.)

In the real world, you’ll be surprised to find how many doctors actually suck, and how many are mediocre at best. You may also be surprised to find that you can do patients a lot of good by hitting the fundamentals consistently - delivering straightforward good care and not doing overly stupid things. Following guidelines. Listening. Being thorough. Much of being a good doctor isn’t about being a diagnostic genius, or remembering every last obscure thing that the academic doctor types obsess over - it’s about consistently delivering solid care to patients. And if you do that, you will outperform a lot of your colleagues - many of whom you will find are lazy, grossly behind the times in knowledge, not thorough, etc.

What did they call Tim Duncan? “The Big Fundamental”. He wasn’t flashy. He just played consistently great basic basketball. It took him all the way to the Hall of Fame.

 

[IncompetentDoc]

Appreciate the responses. I'm still hoping to do research (basic bench) in addition to clinical work--can that be done in a non-academic position?

 

[scootad.]

The equation is simple.

Graduating medical school, residency and fellowship + passing all the required boards and licensing + caring about the quality of care you are providing = you will be a very good physician.

The above is really all that is required. You will do great. Give yourself time.

 

[scootad.]

I think your question about bench research in a non academic setting is the more complicated question. I’m not an expert but I’m almost positive that won’t be easy. If bench research is important to you, why are you excluding yourself from academic positions?

 

[IncompetentDoc]

I think your question about bench research in a non academic setting is the more complicated question. I’m not an expert but I’m almost positive that won’t be easy. If bench research is important to you, why are you excluding yourself from academic positions?

From prior feedback about difficulty surviving in an academic environment

 

[dozitgetchahi]

Appreciate the responses. I'm still hoping to do research (basic bench) in addition to clinical work--can that be done in a non-academic position?

Doing basic bench research outside of academia is almost impossible - you won’t have grants, lab space, etc. It is hard even for MD/PhD scientists to get grants and make it all work *inside* academia. It is not a realistic goal for probably 95% of physicians.

Clinical research is a different story.

If you have the concerns described above, I wouldn’t spend any effort on trying to pursue bench research.

 

[anonperson]

Hi,

New here. Just finishing fellowship, but deeply worried about my ability to competently practice medicine and seeking advice on what to do next.

I'm finishing fellowship (non-surgical, non-procedural) soon. I was the average medical student, a below average resident and a below average fellow. I test well, but in terms of clinical practice, have been told by former attendings that I am more 'book smart.' I'm shy with poor communication skills (dread any kind of goals of care conversations). In residency, I was never told I was doing poorly by anyone directly, but did have a few evals with comments about poor performance. When COVID hit, and we were given back-up roles, I noticed that I was placed on furthest reserve, meaning least likely to be called in to do anything. I know my PD ranked me as below average in my fellowship letter. Although I was not aware of it at the time, I was probably roasted by my Co-Residents behind my back for doing poorly.

In fellowship, my last rotation had me kicked off an outside rotation for presumably 'stress,' (first rotation back after maternity leave) from what I was told in eval but I was kicked off in the first week without any chance to make changes, etc. which makes me think this was thought to be a non fixable personality issue. Evaluator told me that they thought I would make a good physician in future--lol, like I feel that way after you just kicked me out in that manner.

Overall weaknesses that I believe that I have: poor clinical knowledge/skills, misses things on exam/history. Poor communication skills. Very slow/inefficient in both chart checking and taking history/physical. Also embarrassed to admit (although my specialty isn't procedural) - unable to give vaccine/do blood draw.

I want to continue practicing medicine, but I feel that I'm going to harm someone if so. I want to improve, but now that training is complete, not sure how to do so. Feeling really depressed about the whole situation.

You probably aren't as bad as you think you are but at least you have some self awareness that there are some areas of improvement.

Regarding knowledge:
No one is born knowing medicine. You have to sit down and read/study. Use audio lectures on your commute or walks if that is easier. This is a lifelong process as guidelines etc are often changing based on latest evidence.

Be thoughtful and thorough when dealing with patients. Make a checklist until you get it down cold.

I am in a procedural specialty and have actually never given a vaccine or done a blood draw ever, even in medical school.

Not sure why you would equate that with being a good doctor

 

[NotAProgDirector]

You learn 50% of what you need to know during training.
You learn the next 25% in the first 6 months of your 1st job.
You learn the last 25% over the rest of your career.

 

[aafisahar]

Lots of bad doctors doing bad **** out there. If you recognize your shortcomings, you're already ahead of the game.

 

[AlbinoHawk DO]

Hi,

New here. Just finishing fellowship, but deeply worried about my ability to competently practice medicine and seeking advice on what to do next.

I'm finishing fellowship (non-surgical, non-procedural) soon. I was the average medical student, a below average resident and a below average fellow. I test well, but in terms of clinical practice, have been told by former attendings that I am more 'book smart.' I'm shy with poor communication skills (dread any kind of goals of care conversations). In residency, I was never told I was doing poorly by anyone directly, but did have a few evals with comments about poor performance. When COVID hit, and we were given back-up roles, I noticed that I was placed on furthest reserve, meaning least likely to be called in to do anything. I know my PD ranked me as below average in my fellowship letter. Although I was not aware of it at the time, I was probably roasted by my Co-Residents behind my back for doing poorly.

In fellowship, my last rotation had me kicked off an outside rotation for presumably 'stress,' (first rotation back after maternity leave) from what I was told in eval but I was kicked off in the first week without any chance to make changes, etc. which makes me think this was thought to be a non fixable personality issue. Evaluator told me that they thought I would make a good physician in future--lol, like I feel that way after you just kicked me out in that manner.

Overall weaknesses that I believe that I have: poor clinical knowledge/skills, misses things on exam/history. Poor communication skills. Very slow/inefficient in both chart checking and taking history/physical. Also embarrassed to admit (although my specialty isn't procedural) - unable to give vaccine/do blood draw.

I want to continue practicing medicine, but I feel that I'm going to harm someone if so. I want to improve, but now that training is complete, not sure how to do so. Feeling really depressed about the whole situation.

You are not going to harm anyone because you see yourself as being someone with limits. That means you'll care and do whatever it takes to be safe. Sure, you may not be the best of the best, but I've seen the best of the best be the worst by not caring. Continue to care and you'll raise above. Not every patient needs Einstein-level physician. They just need someone that cares enough to find out their problems and give them good treatment. You have this qualities innately, so continue to hone them

 

[Ubba]

You are not the only one who has had trouble translating theory to practice. I would advise reading a bit more slowly and visualizing real-life scenarios and patient presentations as you study.

Specific recommendations could be given if we knew which specialty you've chosen, but there may be a possibility for you to focus on specific niches within your specialty, at least until you've developed some muscle memory and are more comfortable with branching out.

Starting with low patient volume when you graduate also sounds like a good idea in your case.

If it makes you feel better, I guarantee that every single doctor reading this thread has had other doctors shake their heads and grumble at least once about his/her care, documentation, etc.

 

[hotsaws]

The fact that you recognize your perceived weaknesses is an advantage. It might be helpful for us to know what specialty you're in. It might also be helpful to know a little more about your bench research history. If you have a history of bench research and a desire to do more (which is rare among graduating fellows), then that would likely be a good opportunity for you. I trained with an MD/PhD who wanted to do niche onc research. He was not a great IM resident but I bet he's going to be a fantastic basic science guy and probably do 1 or 2 half days of clinic in a niche area of onc. In fact, what you're describing is not uncommon in the crowd who gravitates toward bench research but also went the MD route. I can think of another who went into rheum (also MD/PhD) and she hated clinical practice. It was a means to an end for her. I'm sure she also is now working in an environment where she has only a small clinical practice and most of her time is spent in research.

Residency and fellowship are hard. I hated many aspects of fellowship and I didn't really get along with most academic types. It can be hard to flourish as a doc when you've got attendings who are difficult to please or seem like they always want a different answer ...or that your plan just isn't quite right.

There's always a place for a caring doctor who is self-aware and willing to take extra time for patients. The challenge for you is that you might be spending alot of extra hours outside of clinic working on fine tuning your patient care. That's ok. It's actually good. There's no shame in looking at charts when you get home and calling patients back the next day and saying "hey actually, I have a few things to add and we are going to order X, Y, and Z." The more you do that, the better you'll get. There's also no shame in reaching out to colleagues and friends and discussing cases. Hopefully, you are able to enter a work environment where you have more experienced physicians that will readily discuss cases with you. I've learned alot in private practice and I'm constantly reading up on things and consulting with other docs (including my wife...big bonus to be married to a smart doc, even if they're not in your field). I also regularly text and call friends in different fields for input on things. Sometimes I've got my laptop opened to uptodate while a patient is talking to me and I'm looking things up on the fly so I don't feel like an idiot.

You will need to be careful about what kind of job you take. You probably don't want to jump into some practice that expects a high volume from you right off the bat. The hard truth about medicine is that you have to bring money in and that means you have to see a certain amount of patients. The beauty of medicine is that you can always refer things out. Even as a specialist, you can easily just send the patient to other specialists or kick it back to their PCP if you want a second set of eyes on something. Most of us in PP are hungry to see patients and will welcome referrals.

 

[IncompetentDoc]

I appreciate all of the feedback. I'm in infectious disease. I was just given the opportunity to do additional weeks on the ID service at our hospital as a fellow--plan to take advantage of this to build knowledge and confidence.