Episode 15 - Developing My Practice of Medicine

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Hello. Hello, and welcome back to another episode of Emotional Millennial. My name is Annie, and I am very grateful that you are here hanging out with me today. This podcast is all about sharing authentic thoughts, ideas, vulnerabilities, insecurities, just things that I'm going through that real people deal with that they just don't like to talk about. And here I am, volunteering, and I'm willing to talk about these things because I think it's so important that we share our stories so that we're able to connect and feel like we're not alone, because you aren't alone.

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So I'm officially done with my first month of residency, which is absolutely insane, simultaneously exciting, simultaneously terrifying. I just really can't believe that this is my reality and that this is happening. And I'm still immensely grateful to have this position and to be able to have the opportunity to develop my own practice of medicine. It's something I've been looking forward to, I feel like, since I was in middle school, to actually be a physician and develop that practice and develop my patient panel and develop those relationships with my patients. So this past month has been really cool for me.

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My first patient of the month is the same patient as my last patient of the month, if that makes sense. And it was super cool to have that continuity between those two visits at the start and the end of the month. And it really felt full circle for me. Like, I saw this patient, we got results, we fixed a problem, and now I have this relationship that I'm developing with that individual. And I had a moment during that last appointment where I just really felt like, this is real, this is happening, and kind of like a nod from the universe that I'm on the right path.

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And I feel like what I'm doing right now is what I was meant to be doing. And so that was a very empowering feeling. Given what I've been doing over the past month. Seeing a couple of patients in clinic, I think I've seen a total of, like, eight or so. My program did a really great job of spacing them out and giving us enough time so that we don't feel super pressured and super rushed, so we can actually take the time to get to know our patients and do a really good job with the notes and making sure we address all of their problems.

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So given this, what I've been doing the past month, I've been doing a lot of self reflection as to how I have changed as a provider just within this past month and how comfortable I was at the beginning of the month or honestly, how nervous I was at the beginning of the month until now. Kind of like the changes I've seen in myself and also some of the things that I've noticed inside my own brain while I'm acting as a physician. I mean, I am a physician, you know, but while I'm in the room with the patient, some thoughts that go through my head. I don't really know how to explain it, so I'm just going to get into it, and I guess we'll see how it goes. So first things first.

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Being a doctor is hard, and learning how you want to be a doctor is even harder. I'm used to being in a room with a patient, but I'm not used to being the only one in there. And so it puts this extra level of pressure on you, because in my head, I'm thinking I don't want to miss anything. I don't want to make the patient feel uncomfortable. I want to create an environment where the patient feels comfortable, they feel seen, they feel like I'm listening to them and that I can build a connection with them.

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However, this can be a little bit challenging for someone like me because I do deal with people pleasing. I always want to make sure that the person that I'm with is, like, happy. And it's not realistic to always have that be the case, but I do always feel that pressure. And then also, since I deal with social anxiety, that's kind of like another factor that's at play when I am taking care of a patient. So there's the social aspect to being a doctor, and then the other two parts of it are both medicine related.

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But the first is clinical practice. How are you practicing as a physician? And the other part of it is your intelligence, your medical knowledge. I had a moment when I was in a patient room where I just felt like these three different parts of my brain were, like, trying to learn how to intertwine and work with each other. I'm so used to during medical school and such, having that part of my brain on, like, for example, the intelligence, medical knowledge, that part of my brain is on when I'm taking a really intense exam or step one.

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Step two. You know the drill if you're in medicine. While that part of my brain is on, the clinical practice and the social practice are completely off right now, what I'm learning to do is how to turn all of those on simultaneously. And let me tell you, it's challenging. It's very challenging because when I think I usually look in the distance and take a second, but when I'm in a patient room and I'm in an encounter, I don't necessarily feel like that's appropriate.

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So I'm continuing to look at the patient, but my mind is doing its own thing and, like, thinking about other medically related topics while I'm also trying to listen to them. And I hope that makes sense to me, it makes sense, but there's a lot of different parts of my brain that are all trying to fuse into one and work together. And I think at the very beginning of the month. I felt extremely overwhelmed by that. And don't get me wrong, I mean, it's still challenging and I'm still struggling with it.

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And I'm sure that it just takes practice and getting better and better at it over time. But I feel so much more comfortable and confident in my practice as a physician in that patient room than I did on the first day. To see that growth within myself is just a really cool feeling. It's very empowering and cool and aspect of medicine that has taken me by surprise a little bit. The amount of tasks that you have to accomplish for every single patient on the computer, it really sucks.

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And I mean, it sucks from the perspective of the physician and it also sucks from the perspective of the patient. Because I know I've been a patient before and when I feel like my provider is just constantly looking at the screen or not really looking at me and making eye contact with me, I don't feel like they are listening to me or like they care about me or like that they really see me as the individual that I am. It tends to feel like you're just a number, you're just another person and kind of dehumanizes the entire interaction. And now that I'm on the other side of it, I really understand why some providers do choose to use the computer in the room a little bit more. But that being said, I don't want to be that provider.

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I'm really trying to stay away from that. And if I do bring a laptop in the room with me, like barely look at it, I'll write down a couple of words just to remember certain specific things that my patient might tell me. But holy crap, every single encounter there is so much that has to be recorded specifically for insurance purposes. When I realize that, especially for my first few patient encounters, I realized that in my brain, I was kind of seeing the interaction with the patient or like the entire patient encounter as more of a transactional thing. Like OK, check box, check box, make sure I get, check their allergies, check their meds, make sure everything is all correct and accounted for and documented in the chart because it can come back to bite you if it's not documented properly.

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So I noticed myself paying more attention to that rather than the person in front of me. And so I'm sure that there are other people that struggle with a similar thought process. I'm a perfectionist and I'm the type of person where if I have a task, you know, I want to not just do it, but do it really well. And so that part of my brain is struggling too when I'm in a room with a patient or even when I leave the room. Because sometimes I can forget like oh, this is a person, this is a human being.

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It's not just make sure you finish that, make sure you finish that, make sure you finish that and move on to the next one. It's like. I need to remember to take a step back and tell myself. Okay. Yes.

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We do need to document these things. But also. Like. Bigger picture. This person is coming to see you.

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And they're coming to see you for this reason. And you want to make sure that you treat them first and take care of them first as an individual before checking off the things we need to do. And that's, I'm sure, much easier said than done because a lot is expected of us as physicians, and we only have a specific amount of time in each room, so it feels like a losing battle. But I know that I'll get better at balancing those aspects of my brain. It's really important to me to be in the present moment with my patients and connect with the person in front of me.

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It's definitely challenging because when I'm in the room, my mind is super busy. I want to make sure I didn't miss anything. I'm running through, like, some algorithms in my head or something like that, and my confidence is not as high as it could be. So there's definitely a lot of swirling feelings and thoughts every time I'm in the room. And I've had it where I leave the room and as soon as I'm going to talk to my attending, I'm like, shoot, I should have felt her sinuses, or, oh, crap, I didn't check for edema in the legs.

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And so I'm happy that with my preceptors, I'm able to go back in the room and anything that I felt like I missed, I can take care of at that time. A question that I have asked myself probably since I started medical school is what kind of doctor do I want to be? And when I think about that question, I want to be a doctor that my patients go to and that they trust, that they feel seen, they feel heard, they feel cared for. Similar themes. As to this podcast, that's really, like, my life goal or my mission, I guess, is like, that's how I want to make people feel.

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And so to accomplish that in a patient visit is my ultimate goal. But at the same time, I want to be professional, and I want to be timely and thorough. And so there's a lot of pressure that I'm putting on myself through all of these things that I want. And so realizing that I can't be those things, all of those things right now, but I'm going to challenge myself and continue asking myself throughout residency like, okay, what kind of doctor do you want to be? And reflecting, is that what you've been practicing?

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And I think it's okay to be like, you know what? No, I haven't been doing that. And that's something I want to work on. It's so important to me to be a good physician and take great care of my patients. And so I'm really trying to constantly reflect and improve myself because I think that really is how you develop your practice of medicine self reflection and asking for feedback and knowing that sometimes you're going to be wrong or sometimes you're going to do something that maybe doesn't vibe with the patient, and that's okay.

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You learn and you continue and you keep trying to improve. I think another source of my anxiety with practicing medicine right now. I mean, I'm not super anxious about practicing. I don't want to make it sound that way, but maybe I have a little bit more anxiety than I would have if I matched my first year. But I've been away from my practice of medicine for a year extra than most of my co residents, and having that time away, I do think, impacted me or set me back a little bit because I haven't been seeing patients as often as I would have right out of fourth year of medical school.

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And so I think knowing that in the back of my head adds a little extra layer of insecurity, maybe a little bit more anxiety. Like, I don't want to miss something because I know I've been away and because I know that there's a possibility I will miss something. So I'm working on building up my self confidence and trying to be patient with myself too. I'm also trying to give myself permission while I'm in a room with a patient to take a second and let there be silence if I need to gather my thoughts or something, that's okay. Since I am a people pleaser, and since I do want people around me to feel comfortable, I'm constantly trying to fill silences so there's no awkward moments.

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But sometimes there has to be a quote unquote awkward moment if that means that I'm going to be taking really good care of my patient. And if that means that hold on, I need to double check something really quick. Let me just gather my thoughts. I would rather be that physician that has an awkward moment and does a thorough work up on my patient rather than the one that's rushing the visit because I don't want to make myself or my patient feel uncomfortable. If you've been in my position before or if you felt that, hopefully you can relate to what I'm saying.

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But sometimes it's hard to stop the encounter for a moment or take a second to be quiet and think because you feel like you're letting your patient down. But I'm trying to give myself space to do that because it's okay to take a breather, take a moment, gather your thoughts, and then get back into whatever you guys are talking about. Being a physician is not easy, and I always knew that that would be the case. But now that I'm here as a resident, making decisions, placing orders, ordering blood work, making choices, and counseling on lifestyle. It's a lot of pressure, and I don't want to tell someone the wrong thing or order something that's not necessary.

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We all have these insecurities, I think, as residents, and that's why it's such a beautiful thing that I'm in such a supportive program where I feel like any questions I have, I'm not afraid to ask them because I know that all of my faculty and co residents are super supportive and there's no hostility, which I am incredibly grateful for. And for those of you who are going to be entering residency, that is something that is so important, in my opinion, and so really asking about that culture in the workplace, to know that you'll be comfortable enough to ask questions that may feel silly to you, but that aren't, because nothing is silly in medicine. These are people's lives we have in our hands. We'll talk about self reflection. This was quite the episode of the things that have been going on in my brain as I develop my own art and practice of medicine.

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Thank you times a million for listening and hanging out with me today. If you have any questions, concerns, if you relate to some of the things that I'm talking about, I would really love to hear from you. I love getting emails from you guys. It's like just the best thing in the world. I print them out and I have them right above my desk because they just make my heart sore.

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As always, transcripts are available on my website, Emotional Millennial.com. And yeah, I hope you have a wonderful rest of your evening, day, whatever time of day it is for you. And you're amazing. You're cared for, you're not alone. And I'll see you next time.

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Bye.