It’s funny. You’d assume starting a training programme is when you’ve made it, when you feel like you’re getting somewhere. It’s that sign that you’ve achieved what you’ve intended to and are well and truly en route to reaching that consultant post in the specialty of your dreams. Rosy.
I think the best way to put it is that the job is great. But there’s something that keeps nagging at the back of your mind. Like a small voice saying
“They’ll catch you out, just you wait”.
and
“You know you don’t actually belong here”.
A shake of the head and you’re back, answering bleeps just as you had done before.
Yet, this little nagging feeling persists. You stop and decide to finally appraise it. We are expressly taught to reflect with impulsive regularity on our thoughts, actions and feelings, and it was during one of these deeply introspective moments where I commenced the process of unpicking exactly what I was feeling.
It all started with a patient I reviewed in A&E whilst on call (all clinical details herein are fictional bar the nature of the circumstances). The handover I received was sparse to say the least, with an unconvincing history/examination and an even more unconvincing diagnosis. However, I accepted the patient under surgery for a review in Accident & Emergency (A&E) as bed availability on the surgical assessment unit (SAU) was zilch.
The shift was exceptionally busy and when I eventually reviewed the patient they had been seen by the A&E team who assessed their problem to be a minor urological issue and easily treatable with antibiotics. I proceeded to review this patient, taking a full history and performing the relevant clinical examination, and concurred with the A&E team that this was most likely a minor urological issue which could be treated with antibiotics. I decidedly conveyed this to the patient and allowed him to be on his way, feeling positive about the sense of thoroughness and confidence I felt throughout this encounter.
A few hours later, the consultant urologist on-call arrived on SAU and I keenly accosted him to discuss the urology patients I had reviewed during the day to check whether he agreed with the plans so I could develop my learning. When I arrived at the patient I had so confidently discharged from A&E, he peered at me through his spectacles with consternation.
“The pain does not match your diagnosis. It normally occurs in a different location to where you palpated. I’m not certain you have made the correct diagnosis”.
I felt the colour drain from my face and my mouth turned dry. Could this be true? I stammered for a response which would hold at least some shred of conviction but couldn’t formulate any such articulation. After the confidence I had felt in A&E whilst reviewing the patient, this was the last thing I had expected to hear.
Fortunately, the diagnosis which it could have been wasn’t severe enough in nature to call the patient back to the hospital. But this conversation left me with two things: a knock to my confidence and a sense of perspective. Alluding to my previous point about thinking you’ve made it; you’ve never really made it. There is always something new to learn and hubris is undoubtedly the worst enemy of any medic. This lesson, as minor as it may seem to some, left a stark impression on my mind about throwing caution to the wind when it comes to diagnosing and managing patients, particularly as a junior doctor with only a couple of years under my belt. This is an obvious aspect that’s impounded into our respective cerebral cortices at medical school, but it can come speeding round the corner to bite when you least expect it. Whilst I may feel as though I harbour greater responsibility than when I was a foundation trainee, it is crucial for me to remember I am still finding my proverbial feet.
So, to come full circle, that aforementioned nagging feeling at the back of my mind is in fact a very powerful safety net that needs to be acknowledged and above all respected.
Be cautious, be safe, and always ask for help when unsure.
Vasudev Zaver 