Thursday, March 19, 2009

Patients telling me I'm "the best doctor [they]'ve ever hard" makes me very uncomfortable. For awhile, I joked, privately, that statement on its own was diagnostic of a personality disorder. (There's some validity there; patients with personality disorders, especially borderline, have a tendency to pick out "best" and "worst" doctors, and especially will pick trainees to be the "best" because we're easy to manipulate.) However, last week, one of the most psychologically stable patients I ever had expressed how grateful he was to have me on his team and praised my knowledge and compassion.
On the one hand, I know I'm skilled clinically. On the other, medical school is nothing if not liminal. I can be a great medical student, but that means nothing. A medical student, by itself is not a state of being. Who's ever heard of telling a caterpillar that it's beautiful -- or worse: that it's good at being a caterpillar? Of course, I strive to be a good doctor, but that doesn't parallel with being a good doctor, or at least not completely. When patients tell me I'm the "best," it's scary; I want to respond with all of the things that I don't know, all of the mistakes that I make every day. Most of the time, though, the urge is overwhelming to hide things I don't know, to avoid admitting my weaknesses and above all, not to let anyone see my mistakes. Being a good medical student involves admitting these things; using them as stepping stones, growing through self-examination. I know, but at the same time, I want to be a good DOCTOR, and I worry that my weaknesses aren't acceptable.
I was stressed in the lab -- I'm having trouble writing my first first-author papers; I'm behind, because stress makes me procrastinate, and I'm getting overwhelmed. The more time that passes, the less I want to talk to my PI, because the more I feel that I haven't done enough. One of my coworkers said "well, what did you think? You would cure cancer all by yourself as a med student?" It's true -- I'm a student. I'm supposed to make mistakes and lean on others, but it's hard to remember. I tell myself "perfect is the enemy of good" nearly every day, but we're encouraged so strongly for so long to look good on paper so that we can get into a good college, good med school, good residency, good job. Liminal -- trying to be something else, never settling. I worry that I'll spend the rest of my life constantly focused on the future, rather than trying to optimize the present. I don't have an answer for that.
My mentor told me a story about when he was in training, he received a call about a patient with an eminent medical emergency. His attending was detached and discouraged questions and had left for the night. My mentor was new, and he knew that he couldn't manage the case on his own and he knew that mismanaging the case would result in permanent disability to the patient. He called another attending, who was not on service, in the middle of the night to discuss the case and the patient did well. It takes a lot of courage to do that. It takes being able to admit that you have a lapse of knowledge to a boss. It's clearly the right thing to do -- being a doctor isn't about the doctor; it's about the patient. I adore and respect my mentor...but I'm scared that I don't have the courage; that I'm too concerned about my own self-image that I would be too diffident about getting yelled at for asking a "stupid" question that I'd try to manage it on my own, and I'd never forgive myself if something bad happened. To be totally honest, I'm scared of even writing that in a public forum -- scared that you're all going to judge me for being too self-absorbed for doing the right thing. The only defense I have is that I hope that by knowing this, by thinking about it and by being honest about my barriers, I will prevent myself from actually making the mistake when it's not just a thought experiment.