Sunday, June 26th, 2011
It’s amazing how six months can seem to fly by when you’re looking through the retrospecto-scope. I have been a doctor for over half a year now. A part of me remains in disbelief at that fact, but surprisingly, it’s only a small part. That new-skin feeling I mentioned before has largely faded to the point that being a doctor now feels… ordinary.
My journey thus far parallels my journey with the rectal exam. Yes, you heard me right, the rectal exam.
I still remember my first rectal exam. A bewildered and do-eyed fourth year at Urology Outpatients Clinic, the Locum Urology Consultant asked me if I had done a rectal exam before. No, I replied. After briefly talking me through the process, he asked his next patient if I could do the examine as well. With the patient bare from the waist down and the consultant looming behind me I stood there with my gloved finger up another human being’s bottom and all I could think was, “HOLY SHIT [no pun intended] I HAVE MY FINGER UP THEIR BUM!!!! OHMYGOSHOHMYGOSHWHENCANITAKEITOUT?!” “Do you feel the prostate?” My consultant asked me. “Uhhuh,uhhuh,” I replied, having no idea what was what, just wondering when it would all be over.
I never had many opportunities to do rectal exams through medical school. It’s impossible to overcome the awkwardness of asking a patient (after a “proper doctor” has already examined them), “Do you mind if I have a go?” During my General Surgical rotation last quarter, as I talked to my Physician’s Assistant and friend about this lack of confidence, she told me something that, quite frankly, changed my life. “Rectal exams are easy! This[lightly tapping her chin] is normal, this [lightly tapping her nose] is BPH, and this [lightly tapping her forehead] is cancer.” Since then it has required conscious effort to dull down my enthusiasm for rectal exams during lunchtime conversation. My enthusiasm could be taken the wrong way I guess, but why it makes me so happy is because for me it reflects my growth as a doctor these six months past.
Becoming a doctor does not happen overnight. When you first start out it feels arbitrary because, it is. One day you’re a student (something you’ve become fairly good at) and the next day you’re a doctor. Yet let me assure you now, it is not an overnight process. It is only now, after six months, that it no longer feels as strange, I no longer feel as scared, and life no longer feels as overwhelming as it once did.
This past week I attended a workshop for first year house officers on Wellbeing. A small group of us sat together and learnt about practical ways of dealing with stress, shared personal experiences on what we’ve found difficult, and learnt how to apply the “theory” of looking after ourselves to our everyday lives. What really stood out for me during this workshop was the importance of setting boundaries at work.
The unique pressure of being a house officer is that you are the first-line of defence. When on call, you are the filter of what is the truly “sick” sick patient verses the “well” sick patient. During the day, you are the one “others” (i.e. non medical people) go to with any concerns or issues, the filter of what is relevant verses what is irrelevant. And always, you are the hands and feet of your team, the one who ensures the decisions that get made are followed through. That is MORE than enough to keep you busy, believe me. And thus the importance of setting boundaries between what is your problem and what is not. It is easier said than done when first starting out because at that point, (a.) you’re not sure what SHOULD be your problem, and what is not; and (b.) you tend to lack the confidence to be politely assertive. Yet I’ve come to learn this skill is so key to not only doing the job well, but to your own well being.
Discerning what is your problem comes with experience. Unfortunately, this will take time. But as you start to learn don’t be afraid to be politely assertive with those putting pressure on you. Ultimately your “allegiance” lies with keeping your patients safe, well, and alive. We can so easily get distracted, pressured, or way-laid by those around us and by momentary situations that we lose sight of the end-game. Sometimes keeping that allegiance will feel thankless: you bust your ass for sixteen hours, juggling four or five wards, and as you leave the nurses might make a snide remark about how inefficient house officers are, not realising you were tied up with a sick patient elsewhere. You’re reaching your Day 12 and a patient’s family is angry at the lack of doctor face-time they’ve had this week and the fact that their scan is delayed once again. You’ve been leaving late every day that week to ensure all the jobs are done, and then your registrar chastises you for being five minutes late that morning, with no mention of your coming in early for the past two weeks.
These are but a few examples. Yet at the end of the day, the not-so-nice nurse who does not understand the bigger picture is not your problem; the inpatient family should not be blaming you and if they are, you owe them professional courtesy and the rest is not your problem; and as for the angry registrar with impossible demands, remember that you are an employee of the DHB and if you’re busting your ass, it shows to those around you. Have faith in that.
Don’t get me wrong. I’m not advocating being mean, I’m not saying don’t listen to those around you whom you work with, or to avoid frustrated families. Simply that, most of us are by nature overachieving pleasers – we work hard to please others. Just don’t forget that a part of growing as a doctor is growing in our professionalism and that involves being aware of what our role is, what is expected of us, how to do our job safely, and with all that, how to set professional boundaries whilst still respecting and working alongside other health professionals and our patients.
It’s okay to say, “I’ll do it later, let me deal with x, y and z first.”
It’s okay to say you’ll talk to the family tomorrow because you talked to them yesterday and could you please stop paging me about it because we’re still on post-acute rounds.
And it’s okay to say No.
Especially when you know it’s not right to say Yes.
