Saturday, 15 December 2007

The Pedestal

I have had one of those periods of my life where my insecurities surface more than usual recently, for various reasons, and one of them reared its ugly head the other night when stressing to mr me at about 1am when we were in bed. This insecurity is one of the worst things about being a doctor.

Rightly or wrongly, when you tell people you are a doctor, they have a certain reaction. Normally it involves the word "wow!", and there is instantly a certain mystique about you that wasn't there before. You have seen babies born, you have seen people die, you have (hopefully) stopped a few people dying, and most people place their trust in the integrity and competence of their doctors. So they suddenly look at you in a slightly different way. Being me, I normally say "I'm a doctor," in a slightly apologetic way, as if to say, "please don't look at me differently" (although I notice I have recently started introducing myself as a doctor, instead of a junior doctor. So maybe I am getting slightly less self-deprecating)

I am getting more able to live with the pedestal that people put me on. Perhaps too much so - sometimes I try to imagine how I would feel if I wasn't a doctor any more, and I realise that I am slowly depending more and more on my career for my sense of self. I am well aware that pride lies that way, and I attempt to "consider everything a loss compared to the surpassing greatness of knowing Christ Jesus my Lord." (Phillipians 3:8) I know that I need to work more with God on finding my sense of identity in Him and not in the things I have or am here in this world.What I still find very hard to live with is the nagging fear that one day I am going to fall off the pedestal.

Medicine is a lot about the way you present your knowledge. E.g. you have a young female patient with a chest pain which sometimes occurs at rest, on breathing in, then goes away again after a few minutes. You ask a few questions and it sounds like a chest pain related to anxiety. That is your diagnosis. You know that there is probably a tiny percentage chance that it is something else. But the risk calculator instilled into your brain by practice is telling you that this tiny risk is not worth investigating for. Do you tell the patient all this? No. She is already anxious, you don't want to make her more anxious. So you tell her in your best reassuring manner to try a few simple measures to reduce her stress and that the pain is nothing serious. To safety net you maybe ask her to come back if things don't improve. For the patient to go away happy and to get better, you need to come accross confident. This "bedside manner" that doctors have to have can sometimes feel like an act. You are taking on the anxiety, so that the patient can stop thinking she is ill. But the general public often seem not to understand that the art of diagnosis is, by it's very nature, a sophisticated type of educated guessing. In many cases there will be some uncertainty. But if your educated guess later proves to be wrong, the patient may forever think you are a bad doctor, even if 9 out of 10 colleagues would have done the same thing.

Then there is the question of knowledge. The volume of medical knowledge is vast. It covers all diseases from prematurity to senility, and from every system of the human body. It is almost impossible for one person to know it all. Especially with some of the questions I get asked in my day to day life, eg "why does my tongue hurt when I drink pineapple juice?" or "is it usual for one twin to be left handed and one twin to be right handed?" But if a patient, or worse, an aquaintance who is asking you medical questions, suddenly finds that you don't know the answer, sometimes they look at you like their world is tumbling around their ears. Because doctors know everything.

Maybe some doctors know everything. Gregory House, for example - he knows everything, and that is very lucky, because he has the most statistically improbable caseload of conditions I've ever seen. I have met a few who seem to remember every footnote from medical school. But the vast majority of doctors know about the conditions we see every day in our chosen field, and for the rest we depend on remembering some of the information, knowing where to find the rest of it, and recognising when to refer to somebody else.

I find it very hard to be under the constant pressure of being expected to be some higher form of human being, who never gets things wrong or doesn't know the answer. It doesn't help that I am naturally rather ditsy, and tend to bump into things a lot. Sometimes I can see people looking at me thinking "well, at least she's not a surgeon!" after I have done something particularly dyspraxic. I am getting better at coming across confident and all-knowing at work, but in my day-to-day life, it's just not me. I'm too honest to pretend I know all the answers all the time. Sometimes I love to be somewhere where nobody knows what I do, and I'm just a girl, just another person on the street. I also regularly fantasise about being a housewife, and not bearing this responsibility that sometimes seems so heavy.

I am well aware that I tend to live my life far too much through other people's eyes, and worry constantly about what others think of me. I think for this reason I feel these pressures more than many of my colleagues. I am also aware that a lot of what I'm describing may well be me projecting my own insecurities onto others, and imagining they are mentally criticising me when in fact they are doing nothing of the kind. I don't think it helped that in my first few years of medical school, my housemates were constantly commenting "I can't believe you are going to be a doctor, you're so dozy/clumsy/I can't believe you're going to skip a lecture!" etc. I know that I am a bit scatty, always have been, and this is something I have to fight daily in order to make sure I practice safely by staying organised. I never go beyond the reach of my competence, and I am honest with patients about this. Maybe if I can deal with my inner critic, I can start to let the rest of the world think what it likes about me.


Mad Medea said...

Too much to say in just a you'll have to check my blog for your own dedicated post.

AdventuringJen said...

:) I know Husbink would be very much with you on the friends/acquaintances assuming you know EVERYTHING front. Of course, he has taken the route of giving outrageously false answers now...sometimes though I still have to point out that he is lying...
And, if this reassures or helps at all, I like a GP (and in other care type roles too) who is not super-human, and does not pretend to be, because then I understand them more, which helps me with what they say. If that makes any sense. Trying to keep it comment lengthed! ;) going to see what MM has to say now :)
lots and lots of love. And really looking forward to seeing you sometime around Feb.

maya said...

I understand why and where those things came from, I hoped to know it would get better with time. people do look different on a doctor, specially a woman doctor, and there is nothing to do about it. (at least thank god you do not need to start dating guys again ;)) but I believe being an humble human being, specially a doctor, makes us better, better human as well as better doctors.
I wish you best of luck ! (actually, I wish us both)
I believe in you!
thank you for this letter
Maya (woman insecure doctor)

doctor/woman said...

MM - how exciting to get my own dedicated post on your blog. I have replied a bit more fully there.
Jen - tee hee - will have to try the outrageous lying option. people don't always seem to notice when I'm being sarcastic. thanks for the support - looking forward to seeing you too!
Maya - it's nice to know others out there are going through the same types of thing. I expect these feelings do get better with time and experience. I wish you all the best as well, and thanks for visiting my blog xx