When I graduated from high school in 2012, I did not expect that I’d still be in training 13 years later. Not only that, but l still sometimes wonder if I am ready to care for the patients I see every day.
I distinctly remember how unprepared I felt at the end of medical school. It’s easy to say now that, of course, I didn't know what I was doing; I was a medical student! But have I ever stopped being a medical student? And it’s not easy to prove that my capacity now is higher than many of the undergraduates I interact with. Impostor syndrome is a real thing. But how do you know that you’re not an impostor? The syndrome presupposes that capability is there, but confidence is lacking. And believe it or not, I didn’t feel confident in my capabilities.
After medical school, I went into pediatrics and completed three years of residency. That ought to prove that I’m capable, right? I survived the hardest three years of my life, and came out the other end able to diagnose and treat real illnesses. Except, of course, when I find a case I can’t diagnose, or worse still, I miss a diagnosis I correctly caught in the past. Then, I am not so confident anymore.
I am now a PGY-4 fellow in medical genetics. A cynical part of me says that I continue training because I am not confident enough to be a “real doctor.” I don’t know what that means. I never stopped being a student, but I have also always been a real doctor.
A physician’s job is logistically repetitive. A patient is sick, I take their history and perform examinations, create a differential, decide on investigative tests, make a diagnosis and prescribe management plans. But the core of every experience is very different. There is an art to it. This art is not learned in lectures. It comes not from knowing and following guidelines and algorithms, although that’s part of it. It comes not from being smart and/or lucky, although that’s part of it. It comes from experience, repetition and the conscious effort to do the best thing for the person in front of me.
Because every time is different, every time is interesting, and every time teaches me something I did not know before. I keep revisiting familiar scenarios, but now I know a little more. That’s great, because this time is a little different and requires knowing more. As I ascend this spiral, I gain confidence, learn more and continue to be challenged.
I don’t think this spiral is going to end. My patients are going to keep challenging me, and I will continue to learn from them. Perhaps that is what I am seeking. The more I do it, the better I am at it, and the more comfortable I feel in my shoes. With this in mind, I will continue to spiral into control.
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