It was a twilight summer game, and I was parked as usual in right field among the weeds and snake holes. There was no outfield fence, so muffed balls could roll forever. Not gifted with athletic skills, I also had a secret problem. I was blind as an especially myopic mole rat and couldn’t even see the second baseman. This would be discovered five years later. I knew one thing with certainty every game. Eventually, a ball would be hit my way, and I would miss it. I would then have to chase it for about a century and bring it back to the howls and snarls of my pack after the other team scored precisely 94 runs. I experienced abject terror, as the only unknown was the timing of my humiliation.
It was a twilight summer evening, and I was a surgical intern. Medical school had been a wonderful experience as for the first time I was in a culture of “people like me” and my intellectual specialty of briefly memorizing then quickly forgetting vast piles of information was just what was needed. I went into surgery because it was my “best” third-year rotation. I did better at performing long lists of very specific “scut” than reeling off medical journal citations on rounds or answering unexpected rapid-fire questions. This July night, I was alone at a community hospital, the only “in-house” surgeon. All I was sure about was that whatever happened I would not be able to handle it. Sure, I could see all right with my glasses — well enough to see that I was back in right field.
Everything that came my way would get by me. As the year went on, I put in a subclavian catheter after six tries over four hours, thereby documenting on six X-rays a horrible lobar pneumonia that I didn’t recognize due to tunnel vision. The patient was rescued from the OR by my chief resident who carefully listed my faults, over the hospital intercom or, at least, very loudly. I sewed up a vein harvest site in the OR with prolene suture then watched with the attending as the leg “unraveled” at the end of the case. I was locked in a bathroom after a case “didn’t go well.” When a resident operated on the wrong lumbar disc, the attending swung the overhead light in the OR in anger and struck me so hard with the lead counterweight I was knocked to the floor. He then stomped out, and the nurse got me back on my feet and handed me a retractor. I concluded that I was helpless to prevent calamity and expected to “take my lumps” after every event. This kicked the constant free-floating anxiety into overdrive.
It was a twilight summer evening around 6 p.m., and I have “worked in” a lady with a rash. In case you have been in panic mode, rest assured I switched to internal medicine. She is mentating normally and has no fever or headache. It was usually my practice to give “summer rashes” doxycycline, but I didn’t this time, probably because I was tired and stressed out.
The next day, she was admitted to the local hospital almost moribund with Rocky Mountain spotted fever. Fortunately, she survived. But two years later, I am hit with a malpractice suit.
The eventual trial lasted three weeks. The experience confirmed all the self-blame and doubts that I hear in my head every day. Experts seemed to appear from all over the globe to testify to my incompetence. I spent three days on the stand while the plaintiff attorney accused me of almost every sin previously described in classic literature — possibly not fornicating with rabid cats. I won the case, probably, because the jury thought I looked too goofy to be as bad as all that. I had hit on a strategy of complimenting the plaintiff attorney repeatedly for her skills which seemed to throw her off. My own wonderful attorney instructed me that if I won, I should run out of the room, run down the steps and hide behind a tree in the courthouse yard. I followed his instructions but if any of you know why he told me that — let me know.
It is a summer twilight evening and forty years have passed since I added M.D. to my name. I was scared every day that I worked. I always thought I would have to quit prematurely, but I never gave up — and I made it. I retired just a little while ago. I can’t tell you how many ground balls I bobbled, but I always got the ball back to the infield somehow. Each time I walked into a clinic room I was sure this would be the patient that would cause my inevitable failure and lead to my permanent benching. Or maybe just sue my pants off. But that patient never came. My dad — long-dead God bless him — used to tell me, “It’s stupid to worry about things that will never happen.” I concluded that meant that worry would prevent bad things.
Maybe I worried enough about thirty doctors so that means you won’t have to. Tell yourself that.
Medical malpractice stress syndrome has been described extensively. By age 65, 75 percent of doctors in low-risk specialties and 99 percent in high-risk specialties will be subjected to a malpractice claim. In my opinion, every one of these men and women have various levels of PTSD from the experience. But even just taking on the physician role causes severe free-floating fear and anxiety right from the beginning.
Early in training we a learn to approach every new problem by “faking it” and trying to ignore our uncertainty. If we pretend to have expertise, then eventually we will. The joke about the doctor on one side of the office door and the patient on the other both going on WebMD to find out what is wrong is completely true if you substitute UptoDate. We share a fundamental belief that the “doctor” is all knowing. Since none of us actually are, there is a constant anxiety about being found out. I don’t know what to suggest, except stick with it. That thing you are terrified about will probably never happen. You can’t tell, but everyone else is scared too. Also, try to laugh if you can.
Scott Younkin is an internal medicine physician who blogs at Simple Doc.
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