I have realized I am an incompetent doctor and need help.

First, I know this isn't the most appropriate place to post this, but I genuinely am desperate for advice and couldn't find any other forums.

I have realized I am incompetent and need help.
Hi, I'm a junior doctor in a developing country, working at a tertiary hospital. I work both in the wards, (internal medicine) and ICU (under supervision of an attending). I've been working for almost a year now and I still feel very incompetent, even compared to peers who joined after me. This is not a residency, so there isn't any formal training on the job. I feel like my situational awareness is low. Like I might notice new issues or events that a patient has, but not really know what to do with that, or I might not notice there's any issue at all, while my peers do. I desperately want to improve, but I don't even know where to start. I also suffer from low self confidence, so I'm not even sure even when I'm right, and feel fearful of being judged so can't take the initiative to suggest a treatment plan. I really need some advice, specific ones on how to tackle this. I know I need to read more etc, which I try to but I honestly just don't know where to start. We deal mostly with peumonias, other infections, sepsis, ARDS, NIV and MV settings, weaning, sedation, nutrition, AKIs, PEs, COPD, asthma, blood sugar control etc. Help me figure out what I need to actually pay mind to, from when a patient is admitted to when he can be discharged. I know how to start the treatment, but I'm so lost when it comes to knowing how to adjust it, is the patient getting better or worse? How do I know when I should step up or down things like steroids, antibiotics, diuretics, anticoagulants, etc. I feel stupid writing this, because I should know by now. So I'd really appreciate help and not stating the obvious that I suck :frown:

Reply 1

Damian88

4

This is probably fairly common. To be honest, it's better than someone who is overconfident. Maybe you just need more time, maybe consider part-time. Ask questions, write stuff down...

Reply 2

appleorange909

OP

4

Thank you for replying. I know this is a common feeling, but I'm referring specifically to the fact that given the time, I haven't been able to improve and learn as my peers have. So I'm looking for advice on how to do it.

Reply 3

AF2Dr

12

Have you been getting feedback from other doctors in your job? I think that would probably be the most useful thing.

Reply 4

appleorange909

OP

4

Original post by AF2Dr

Have you been getting feedback from other doctors in your job? I think that would probably be the most useful thing.

The way it works here is that since this isn't a residency there isn't much feedback. I haven't caused any patient any harm from incompetence, so I haven't received any warnings or such, but I am reasonable enough to notice that I am far behind my peers, in recognising new issues that arise, or knowing whne it's time for eg to start weaning a patient off mechanical ventilation, while my peers do know how to do that.

Reply 5

AF2Dr

12

Original post by appleorange909

The way it works here is that since this isn't a residency there isn't much feedback. I haven't caused any patient any harm from incompetence, so I haven't received any warnings or such, but I am reasonable enough to notice that I am far behind my peers, in recognising new issues that arise, or knowing whne it's time for eg to start weaning a patient off mechanical ventilation, while my peers do know how to do that.

Ask your peers for advice/feedback? Eg you could ask them what they'd do differently for a particular patient you are reviewing. Or you could ask them to explain why they've made certain decisions for patients that they've seen.

Or I'm sure you could still informally ask a senior for feedback, even if they aren't really volunteering any?

Reply 6

Democracy

21

Original post by appleorange909

First, I know this isn't the most appropriate place to post this, but I genuinely am desperate for advice and couldn't find any other forums.

I have realized I am incompetent and need help.
Hi, I'm a junior doctor in a developing country, working at a tertiary hospital. I work both in the wards, (internal medicine) and ICU (under supervision of an attending). I've been working for almost a year now and I still feel very incompetent, even compared to peers who joined after me. This is not a residency, so there isn't any formal training on the job. I feel like my situational awareness is low. Like I might notice new issues or events that a patient has, but not really know what to do with that, or I might not notice there's any issue at all, while my peers do. I desperately want to improve, but I don't even know where to start. I also suffer from low self confidence, so I'm not even sure even when I'm right, and feel fearful of being judged so can't take the initiative to suggest a treatment plan. I really need some advice, specific ones on how to tackle this. I know I need to read more etc, which I try to but I honestly just don't know where to start. We deal mostly with peumonias, other infections, sepsis, ARDS, NIV and MV settings, weaning, sedation, nutrition, AKIs, PEs, COPD, asthma, blood sugar control etc. Help me figure out what I need to actually pay mind to, from when a patient is admitted to when he can be discharged. I know how to start the treatment, but I'm so lost when it comes to knowing how to adjust it, is the patient getting better or worse? How do I know when I should step up or down things like steroids, antibiotics, diuretics, anticoagulants, etc. I feel stupid writing this, because I should know by now. So I'd really appreciate help and not stating the obvious that I suck :frown:

Perfectly appropriate place to post this.

I suspect this is a case of expecting a lot from yourself very early on. Nearly a year of postgraduate experience is really not long enough to be confidently making decisions about starting and stopping treatments in ICU. I did four months of ICM and anaesthetics as an FY1 years ago and I definitely did not have the expertise to decide when to wean a patient off ventilation. I doubt you're actually incompetent given you care enough to actually post about this.

Do you know what you want to do eventually?

If there isn't much in the way of feedback from seniors in the country you're training in, you may have to take a more self-directed role in your training (which isn't ideal of course, especially if you're already prone to lack of self-confidence). I don't have enough experience to advise on learning about intensive care medicine, but for general internal medicine do you have an up to date handbook you can study and learn more about common conditions, the most recent guidelines, evidence base etc?

Really though a lot of this will come with time and seeing more and more patients. You can't rush the "learning by experience" side of the job.

Try not to compare yourself to your peers. Pretty much everyone feels like they've been thrown into the deep end at first even the people who appear very confident.

Good luck :smile:

I have realized I am an incompetent doctor and need help.

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