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Dealing with Uncertainty in Residency

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On Saturday, June 30th, as I was driving home from a cookout hosted by another incoming resident, I saw I had a voicemail. “Hey, this is Dr. ____. I’m calling to give you sign out on your patients.” After a few months of resting, relaxing, traveling, and generally enjoying free time spent with family — punctuated by graduating medical school — this message brought me abruptly to my senses. I realized with a jolt that this was it: no more medical student, no more school at all; I’m a doctor now, and tomorrow, July 1st, I’ll have patients counting on me to take care of them. And I don’t feel ready at all.

Impostor syndrome is well-documented in medicine, with studies suggesting that it affects 25–50% of medical students, more commonly in women. Formally defining is a bit nebulous; it’s been described as “chronic feelings of self-doubt and fear of being discovered as an intellectual fraud.” But we know it when we see it, and I would suspect the true number of students and residents who have felt it, at least acutely, nears 100%. As a fourth year student, I hadn’t felt it much at all — I had a confidence associated with nearing the end of an educational phase. In fact, I had been so far removed from the actual day to day work of the hospital, that I had even begun to delude myself into thinking I knew what I was doing, that I would be fine on day one. Suddenly, with that phone call, my carefully constructed walls of self-confidence about beginning residency came crumbling down. What if I’m not smart enough? What if I forgot everything? What if I let my patients down?

Of course this self-doubt is normal, to a degree, and although these questions and concerns are very real, a part of me knows that it is normal and that I will be fine. There’s a healthy level of self-doubt too, I think, which forces new residents to be cautious and conservative in decision-making as they just begin. It’s normal to forget things and have to look them up, even things that I knew second nature a few months ago. And besides, I graduated medical school; I’m a doctor, right? I had consistently performed well on exams and in clinical settings, and my school gave me the green light on graduating. This gives me confidence that I have the tools I need, even if I have a lot to learn in how to apply them.

Yet one of the great mysteries of medicine is how much uncertainty continues to exist regardless of our level of training. Ask nearly anyone who is not a doctor, and they are likely to place supreme trust in their physician’s decisions. Some of this is due to the confidence displayed by the doctor, and some is due to the cultural expectation that physicians are smart, studied, and experts in every ailment of the human body. Having finished medical school, though, I am amazed at how little we, collectively, know. We can push almost any question far enough so that the answer is, eventually, we just don’t know yet. Even seasoned clinicians construct a differential diagnosis, implying that in any clinical picture there is a measure of uncertainty.

I would suggest that successfully managing both self-doubt and the general uncertainty of medicine by the same method: honesty. We can combat uncertainty by telling the truth to our patients, our supervisors, and ourselves. If I don’t know what a drug is, I should ask. If I don’t know what’s causing your headache, I should tell you that and explain what I am considering and why. If I don’t know the basics of a clinical picture, I should spend some time learning about it and then forgive myself, because none of us can know it all; and at the end of the day, people are depending on us, but thankfully we have help. And despite the doubting questions, I’m instilled with confidence at the level of trust my superiors and my patients place in me, implicitly. They feel like I can do it, and that gives me hope that I can.

Brent Schnipke, MD is a writer based in Dayton, OH. He received his MD from Wright State University in 2018 and is a first-year Psychiatry resident at Wright State. His professional interests include writing, medical humanities, and medical education. He is also a 2018–2019 Doximity Author.

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