Wards Survival Series: The Avoidable Cycle of Self-Doubt

By Luke Murray

The Avoidable Cycle of Self-Doubt 1“So, Luke, what do you think could be causing her back pain?” the attending asked as I finished stumbling through an HPI presentation of the patient I just saw.

I was frozen. It was the beginning of my third year of medical school, and after being at the bottom of my class since the first anatomy test, I felt certain that this, like most other situations evidenced by the grades I’d gotten in the last 2 years, was not going to end well for me.

“If it’s a pinched nerve, is that a musculoskeletal thing or a neuro problem?” I thought. “If it’s broken, do I say that it’s the vertebral body or those little things that stick out, or are those the same thing? Maybe it’s a muscle strain, but this doesn’t seem to act like a cramp. It doesn’t fit anything I’ve read before.” My mental ramblings were just as scattered as my presentation.

“Um…,” was all that came out of my mouth. More palpable silence. I could hear myself sweating.

The attending continued to stare at me, trying to be patient, but we both knew there were several more patients to be seen and we were already behind for the day.

“I don’t know which one it is!” my thoughts raced. “Nothing seems to fit! Maybe it’s something I’m supposed to know that I’ve never heard of that totally does fit her history perfectly and I just haven’t studied enough. What’s something that’s obscure and rare that might actually fit?”

“Ummm…is it some kind of cancer?” I finally managed.

“No,” the attending said flatly, physically deflating from impatience and disappointment. She’d been standing there watching me “think” for at least two minutes by then. Count to 120. That’s a long time to do nothing when you’re late to do eight other things. “Just follow me” she said, as she turned on her heel and breezed through the exam room behind her.

I stared down at the ground, feeling like the idiot that the last two years had convinced me I was, and slunk into the room behind her.

The Avoidable Cycle of Self-Doubt 2“Well,” my attending addressed the patient with a sense of confidence and certainty that embodied everything I didn’t feel at the time, “It looks like you’ve probably strained something, so we want you to just take it a bit easy, ice it, and then see us back in a few weeks if it doesn’t get better.”

“Is she kidding?!” I thought. That’s the vaguest ‘diagnosis’ I’ve ever heard! I had, like, 100 more ideas about what might be going on and she’s basically telling the patient she doesn’t know herself but that it’s not an emergency so ‘walk it off’?

That incident should have taught me. I should have learned that even if I don’t know the answer, it’s better to share what I do know or at least the thought process behind my guesses in order to provide the attending a starting point from which to teach me something than to just avoid saying anything for fear of getting it ‘wrong.’

But I didn’t learn. I continued to keep my mouth shut. Thus started a cycle of self-doubt that would encourage withdrawal and disengagement, which would, in turn, keep me further out of the loop and even less knowledgeable, which would make me feel even more self-doubt about my knowledge base, which would make me withdraw even more…it was a self-feeding cycle that was not spiraling upwards.

If I could do it over again, I would have spoken up when asked and shared what little I knew. I would have accepted the fact that I didn’t know and been okay with that so that my attending would then have the opportunity to fill in the gaps in my knowledge.

Or, so she could agree with me – that she didn’t know exactly why this patient had a backache either 😉

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