Cheating

How many times in politics are you maddened by someone getting elected who was clearly incompetent.  Why are they elected? Deep down you know it's because they have that social "spark", they are just the right amount of attractive, friendly, and conversational that they carry votes despite how stupid they are.  A similar thing happens with doctors, luckily there is a bottleneck of rigourous testing that keeps the truly stupid out of our field, if you are a doctor, it is likely that in some way you are bright...even if it's not the kind that is going to make you a good physician.  It's been my ever present lament, but rarely voiced complaint that I'm one of those doctors.  I wouldn't go so far as to say that I'm an idiot, but in the mass of doctors out there I am average at best.  Over the years, what I've found, to my surprise, is that this massive heap of intellect fails against an average one with superior social skills ...just to be clear, I'm not the popular kid in school...I'm more like the poorly adjusted kid who got stuffed in lockers, but in this heap of geak, I'm a social power house. 

I remember a conversation I had briefly with my attending over a difficult patient that I treated.  I didn't do anything better than he did, didn't do anything better than the resident that saw them before me, but I sat and talked to the patient, and smiled with the patient, and probably (seemed) to listen to the patient better than they did.  He was telling me how they were singing my praises.  My response was, "They have no idea how incompetent I am." (it was my second month as a doctor).  What he said back stuck with me and has haunted me ever since, "It doesn't matter, you're going to do very well for yourself."  Am I a fraud? Do I do well because I can talk to people better than my peers? Over time I've found the answer to be Yes and No.

There's a hundred ways I can describe this, but these are two examples.  The first is that I'm never going to be a cardiothoracic surgeon, in matters of the "heart", I know I am a weakling.  Over time I've been able to accept my place here and when it comes to the heart I know I will likely over refer my patients to cardiologists to check out benign murmurs and passing out episodes...I'm just not comfortable enough.  What I've realized is that in the areas I'm weak I know enough to know I'm out of my depth and in those instances I swallow pride and send them to someone smarter...that's how I cope with my weakness.  Does the patient notice that I'm an idiot and just sent something totally normal to the cardiologist...No...she likely thinks it's great I found that and will thank me for being safe.

The second is this, a patient has chronic pain with a large component being psychological (in the patients head).  Dozens of capable, highly intelegent doctors have come in to help this mothers daughter.  Nothing helps the pain, the mother is in tears and has fired several docs from her care because she feels they arn't worried about the pain her daughter is experiencing.  The daughter continues screaming despite all the drugs they throw at her.  All of us doctors are thinking the same thing, there is no reason for the patient to be in pain, all the signs are pointing to here using the "pain" for attention...but none of the doctors can say it...or want to say it.  The mother bothers the doctors every hour all night long for three nights of her stay.  Finally when I'm called to deal with the crazy, I ask the mother to step out of the room and then I use my ability to talk to slowly break it to her that her daughter is using this to get her attention (this takes 30 minutes to break it right and not offend her).  As I'm listening I'm writing down all her complaints so she can "see" that I care.  As we role onto 45 minutes of talking, I'm addressing every problem.  Most I'm treating with small things, abdominal pain I'm going to put warm packs on, sleep problems I'm going to give melatonin for, none of my "solutions" have any proven medical efficacy, but in suggesting ways to cut out her daughters attention grabbing behavior, in providing miniscule treatments that I confidently explain, her daughter sleeps through the night without further complaint...the other residents are in awe of what I've done.  The mom put's me up for a patient nominated award at the hospital.  The patients behavior continues and I've solved the problem of what was ailing both the doctor's and the mother, the patients unremitting pain. 

Superficially you'd think I was an excellent doctor...wow all the other doctors looked up to me, I got nominated for an award, I fixed the little girls pain...guess what...I see myself as a fraud.  Deep down I know I'm not the guy who found the brain tumor she had, I'm definately not the guy who took it out, I'm just the guy who used "Jedi mind tricks" to take away a girls "pain"...everytime I'm congratulated on patient care, it's like they are saying, "Good job...Faker!"..."Keep up the good work...Fraud!". 

I can tell I'm likely going to be successful with this "skill" of mine, but it's like I'm winning at a game because I'm cheating...and I really wanted to win fairly...

Newbie Doc