I am currently a categorical internal medicine intern, and becoming severely depressed. I enjoy internal medicine but really am more passionate about rheumatology, and right now am having a really hard time getting through the day. I am on ICU, and despise it. I really don’t find anything interesting about critical care medicine (I think I would enjoy it if my position were more about learning and less about being everyone’s bitch) and I’m constantly demoralized every day because
I work 14-16 hrs/day 6 days/week
I’m always getting criticized. I don’t objectively think I am a bad intern, maybe not the best, but I am really bad at handling criticism and take it very heavily. I have this nagging fear that I am actually incompetent and everyone is better than me at everything and everyone is talking behind my back about how bad I am at this.
I think I could handle one or the other, but both together are almost breaking me. I am baseline pretty dysthymic, and have had episodes of significant depression during intern year before, but this is worse than anything else.
I know intellectually that this will pass, that I shouldn’t consider ending my career (or in moments of melodrama, my life) over a 4 week rotation that was hard. Last month I was on rheumatology, which was delightful and I loved life. I had to stay late some days (although not as often as my current 80+ hour weeks) but I enjoyed it, and felt fulfilled. So i know that I don’t hate all fields of medicine, but I have TWO MORE YEARS of internal medicine (which is mostly inpatient medicine, about which I am lukewarm) before I get to move on.
Also I live in a wonderful city and love my life when not working, so I know intellectually I have things to live for, but still. . .
Could anyone offer any advice? I know you all have been through this (and worse). I really need some coping tips. On top of all this, I am starting to hate myself more for getting so easily depressed and upset and being so sensitive.
Thank you for reading.
Also I would love to see someone professional, but honestly with my schedule it’s almost impossible.
Talk to your attending and/or program director. They’re there to help you, and not just with the whole “developing your medical skills” thing. They will make time for you to get the medical care you need. Believe me, you’re not the first person to have these sorts of issues. You’re not even the first person in your program to have these issues. I’d lay even odds you’re not even the first person in your program to have these issues this year. Helping people deal with this is old hat for the people running any residency.
Great advice CrazyCatLady! I’ll add that you do have a light at least part way through your tunnel; intern year is the worst but it is almost over. As you progress, you will have more responsibility to be the one making the important decisions and not just being a scut monkey. Your knowledge and experience will be an asset instead of your inexperience being a liability. Other physicians (next year’s interns) will begin to look to you for advice and there will be fewer people ahead of you who can criticize you.
I did an ER residency, so we spent time in just about every department in the hospital (Ob, Peds, Surgery, IM, ICU, Cards, Neuro, etc). The months we had doing shifts in the ER were the best, but some of the others really sucked. The mantra of every ER resident everywhere may help you here: “I can do anything for a month”. No matter how much a rotation sucks, it will be over soon and then you’ll be doing something different; maybe something you enjoy as much as Rheum.
How do I know I’m not really The Worst? That’s my biggest fear . . . that I’m truly not very good at my job, and at the end of the rotation my ICU attending will take the rheum attending aside and say “yeah that gestalt, she wasn’t really very good in the unit . . . I would think twice about writing her a letter.” Or that it will just get out that I am bad, and I’ll have trouble advancing my career . . . I work in a very small hospital, and one of the downsides is that EVERYONE knows everything about everybody else.
Because the thing is, there are other people that everyone knows just aren’t good to work with . . . are lazy, or unrealistically demanding, or both, or have a poor font of knowledge, or disorganized, etc. I would just HATE to be one of those people . . .
Also my current attending is kind of terrifying. He is one of the older docs in the department and very particular, and everyone is always tripping over themselves to please him. I have constant anxiety about presenting in the morning, about missing something important and him getting mad, to the point where I can’t sleep sometimes. And he is a Big Deal, and I don’t want to get on his bad side and get a Reputation.
At this point I’m just sort of rambling and venting. But I really do appreciate everyone’s input. Thanks for reading.
I can tell you right now that you’re not The Worst. How do I know that? Firstly, because you’re worried about the possibility. People who are terribly incompetent never seem to consider that they might be doing anything wrong. Secondly, because as much as scut work sucks your seniors are trusting you with these tasks. A couple of months ago we had a rotating resident who truly was dangerously bad. We didn’t let him do anything without supervision. Some attendings stopped letting him write discharge prescriptions because they didn’t trust him not to screw it up. But if you’re that worried about it set up a meeting with your adviser and/or program director and ask them straight up if your skill set is appropriate for your level of training. While you’re at it ask if there is anything in particular you should focus on to make yourself more competitive for a rheum fellowship.
I happen to like critical care but mainly in the setting of the ED. Sick patients are interesting. I get to figure out what’s wrong, resuscitate and stabilize them. What drove me nuts on my ICU rotations was rounds. ED rounds take half an hour max. In the ICU rounds on 9 patients could take until 2 in the afternoon. And so much of it was wasted time, talking about the same thing over and over. Blech. But as USCDiver says, you can do anything for a month.
By the way, if you’re really working weeks with 80+ in house hours (as opposed to 79.9 hours in house and then you go home and study) your program is violating work hours restrictions and that should be reported.
Intern year sucks. But in less than 4 months there will be a new crop of interns who are guaranteed to be more clueless than you. And at that point as you watch them flounder through rounds, dealing with difficult patients and everything else - that is when you will realize how much you learned in a year.
This far in, you’ve surely already had some evaluations. If those were bad, I assume you’d already have mentioned that as part of your overall anxiety/exhaustion/depression load. So I have to assume they were at least okay, which means you’re not doing a bad job. If you were doing a bad job, your attendings or program director would have talked to you about it already. Learn to take yes for an answer, okay?
You might as well accept that you’re going to miss something important on someone at some point. And every single attending who has been an attending for more than, say, two weeks expects you to miss something at some point. Interns miss stuff sometimes–that’s why they practice under supervision, ya know? If you were supposed to already know everything, you wouldn’t be required to have more training. Your attending might be angry; some folks are wired that way. But if he’s the kind of guy who’ll lose his shit at you, everybody in the whole hospital knows exactly what he’s like already and you’ll just the latest in a long, long line of people this guy has blown up at.
And if you haven’t talked to your director yet, DO IT NOW. This sort of thing is part of what that person gets paid for.
Peds not internal med but I suspect the same principles hold true …
The ICU nurse is your god/goddess, not your attending. They know all and usually will be a font of appropriate constructive criticism.
If you suspect you are fucking up then humbly ask one of them for constructive advice. Hell ask for advice even if you think you are doing great. Very few will tell you anything but the truth and as noted, the truth is unlikely that you are The Worst as The Worst usually thinks they are the hottest shit around. They can help guide you how to be more efficient and are the best ICU teachers you will ever have. They also know the local truths: what is true when Dr. X rounds and what is true when Dr. Y does. ICU truth is an ephemeral beast. Properly respected the ICU nurse is your lifeline to survival. Only The Worst disrespects her or him and they are not smart enough to realize the mistake they have made.
Some atendings are bullies btw, get off on making interns squirm. Just accept that such is how they get their jollies and hang tough. Don’t think so much of yourself as to think you be so bad as to rank the attending spreading bad rep about you. You are unlikely to rank the effort. The worst case is that you will rank like a bit of dog shit on the ground and despite the old joke* all an attending does is avoid stepping in shit; they then forget that it was ever there.
*The old intern’s joke? What is the difference between dog shit and an intern? No one goes out of their way to step on dog shit.
Internist and full-time residency faculty here. Trust me when I say I’ve been there.
You really should be talking to your program director, or whichever of your attendings you feel most comfortable talking to. It’s OK, and in fact necessary, to show a little vulnerability and express your doubts about yourself. If you’re actually doing OK (as I suspect you are), they’ll be happy to reassure you. If you’re not really doing OK (which I strongly doubt), then it’s important to show that you’re self-aware.
It’s unfortunately true that attendings (especially those who aren’t full-time faculty) have a tendency to keep their mouths shut rather than give negative feedback, which they’ll save for the evaluation they’ll turn in three months after your rotation is over. You do need to ask for feedback directly around the middle of the rotation; even if they still hold back, at least you tried (and can tell your program director so).
But, again, I suspect you’re doing fine. That fear that you’re not good enough? I’d love to tell you that goes away, but I’ll be sure to let you know if mine ever does.
I try to remind interns that what they’re being asked to do is impossible. Sometimes you’re literally required to be in two places at once. You’re often asked to do three hours of work in the next hour. Hell, occasionally a pager goes off and you’re expected to run somewhere and bring someone back from the fucking dead. “All I can do is all I can do” is the mantra that got me through (and still does today). You just have to be satisfied that you did everything you could today and that tomorrow you’ll be able to do a little more.
It really does get better. Most programs concentrate the misery in the first year, and the new work hours rules seem to have made it especially hard on the interns. But it won’t be long until you’re an attending, stacking paper to the ceiling and rolling on 24-inch chrome. OK, maybe not quite, but whenever people tell me they wish they were back in residency I want to strangle them with my stethoscope.
Now go see some patients or something. You’re going to be fine.
I would second all that was said above. The most important is to listen to the ICU nurses. They will keep you from hurting people if you let them. It also helps to keep repeating that you can do anything for one month (although I’m not sure how you got through med school without learning that one). Also remember that everybody has different strengths and weaknesses and the attendings know this. Even if you suck at ICU, it doesn’t mean you won’t be praised in Rheumatology. Personally, I loved ICU because I love to discuss every system in minute detail and I hated ER because I was terrified of missing something by focusing too much on the chief problem. See if you can find a mentor (a resident, intern, fellow or attending-not necessarily on your current rotation) who you trust and can give you some objective feedback. Talk to the other interns-they likely are feeling as overwhelmed as you. Finally, know that the interns that get bad evaluations are not those that worry and ask questions, but those who push ahead blindly without knowing what they are doing. Criticism is hard but know that you are actually learning, especially if you listen to the criticism.
Internal medicine R2 here. Actually posting from the call room. There’s not much to add to what has already been said, but the meat of it bears repeating; you can do anything for a month. A lot of being an intern was doing scut work, reporting daily labs, etc, but it gets so much better. The first call days of your senior residency years will be terrifying, but also liberating in that you finally get to make the calls. Will you make the wrong calls sometimes? Definitely. Could a patient suffer because of what you do? Again, almost definitely. It’s an imperfect system but there’s no better way.
It’s easy to say don’t be so hard on yourself, but that’s pretty tough to do in practice, especially on ICU or other tough months when the pressure is always turned up. Look to your program directors or your seniors for help, or even just to have somebody to commiserate with. Chances are very good that the way you feel about your attending is probably shared amongst a good 90% of your class.
It really does get better. If you can push through these terrible months you have great blocks ahead of you, and ultimately a career you will love to do.
The head of Emergency Care in my province’s healthcare system flunked Obgyn six times. He’s still the head of EC for five hospitals and several dozen smaller medical centers. He’s also very much not attending any deliveries if he, or anybody else within about 200 miles (it’s a small province) can help it.
You don’t have to be good at every specialty, part of the purpose of rotations is to help people figure out or confirm which specialties they’re attracted to / best suited for / best at. Sometimes people find themselves liking a specialty they hadn’t considered before, sometimes they discover that they loathe the one they’d been aiming for, sometimes they confirm that what they already had in mind is a good fit (as it appears to be for you and rheumatology). My sister in law confirmed that Family medicine was what she wanted to do; her cousin switched from Ped to Oncology (she specializes in bone cancers: she’s the petite blonde with the big saws).
Thank you all SO MUCH for the outpouring of support. It really meant a lot.
So I think I figured out a solution. I just restarted my antidepressants. I had d/c because I thought I had a grip on things, but I think I picked too stressful a time to try and do that. Anyways, it’s like night and day. Not that I don’t get frustrated, but when I do it’s manageable. Thank you all for taking the time to reply to me. I really appreciate it.
Yeah, trying to d/c psych med during a time like residency generally goes really badly. Now you know not to try that again, and to counsel any patients who are considering weaning off something like antidepressants or ADHD meds not to try the experiment during times of stress and upheaval. See, you’re learning stuff that will make you a better doctor without even trying.
I’m glad you’re feeling better, hon. I think you’ll feel even better in a few months when you’re a second year and are only working 70 hour weeks. And I’m not being a smartass; as ridiculous as it sounds, that fairly modest reduction in the hours makes a disproportionate difference in your ability to cope. When DoctorJ hit his second year, there was a visible difference in his stress level by the end of July.
I’m glad that restarting your antidepressants seems to have made a difference.
Can I suggest that you should still act on some of the other suggestions in the thread in the interest of long-term health and knowing you are not alone (and not the worst)?
Well, it happened. I had the sit down, “you are not where you need to be on this rotation, I do not trust the report you give me in the morning, are you ready to be a second year” talk. Except nicer.
I’m so depressed. This has never happened to me before. I was told to work on my efficiency (how do I do that?) and to read more. The attending and I agreed that the issue is my lack of interest in the field.
I am just an inherently disorganized person. I don’t know how to get better at this. I’m fine on general medicine wards, and I get good evals otherwise.
Did you ask? As someone who used to be told her descriptions were “poor” and who’d get “just describe better” as a response to “so how do I make them richer?” you have all my sympathy… if you did ask. And before deciding you’re “disorganized”, consider that it’s possible you’re “differently organized” from some of the people around you: can you find things? Can others find things that have gone through your hands? The phenomenon of “damnit, I could find things just fine until my mother / my spouse / the cleaning lady organized them!” is well-known.
(In the end, the guy who taught me how to write good descriptions wasn’t a language/lit teacher but a computer programmer)
Oh God. OK, you were visiting me in Spain while she was being disemboweled.
A suggestion from someone who’s very efficient:
be as sistematic as possible. When there are protocols in place, follow them in the order in which they’re set; don’t worry about learning them straight away; focus on following them exactingly and eventually you’ll discover you’ve learned them by heart.
When there isn’t one, create your own.
Could your “inherent disorganization” be undiagnosed inattentive ADHD? My husband just started on Vyvanse and the difference in his mood and productivity in nothing short of amazing.
One salient point to add to the good advice above:
your hospital likely has an employee assistance program, or something operating under a similar name, under which you can get access to free counseling, legal advice and the like - talk with your benefits folks or the GME office
To reinforce the good advice:
talk to your program director. This is what he/she gets paid for. Or one of your chiefs - whomever you feel you have some rapport with. It’s a crap situation, but at least you actually got the feedback now, instead of months later. The programs that I’ve been involved with (peds) all put together extensive programs for any residents having problems, including very explicit identification of what was lacking and who was going to address what to fix the issue. Frequently the attending who identified the problem was not the best person to help with remediation.
