Rattling Around My Own Skull

[ladysprite]

I thought when I left the last job, that that would be the end of it. I thought that leaving the building would get the poison out of my system, that I could move on from there as if it were over and done. I am rapidly realizing I was wrong.

I'm a good doctor. I don't make mistakes, I don't miss diagnoses. But I have been, and it's getting me in trouble where I am now. I don't know if I'm just having a run of normal bad luck, or if something is wrong with me, but as best as I can tell my worst problem is second-guessing myself.

I'm trying so hard to fit in and be a shining star that I'm ruining everything. This new place is... different, in a way that's neither good nor bad. Their style of practice is unlike anything I've ever experienced before, and they're not so much interested in letting me practice like I'm used to. When I do something one way, they look at me funny and ask me why I didn't do it another; and so when something new comes up I try to guess how they'd want me to do it based on what they've said before, and I always guess wrong, and something goes wrong, and I either miss something or piss them off by making a mistake in patient care. And now they're concerned that my level of medical skill isn't up to their standards.

I'm good. I just can't predict what they want me to do, and when I try to I screw up. I can't practice their way, it's just not how my mind works. So I just need to figure out how to do things my way, on my own, without looking to them for support or backup. And hope that I don't ruin things, and that it works, and that they don't decide I'm putting their patient's lives in jeopardy with my very presence.

You know, when your lack of self-confidence is the problem that's leading to your mistakes, and the mistakes are digging at your self-confidence, it's really hard to get enough confidence to short-circuit the cycle....

Comments

[sabine791110.livejournal.com]

You know, when your lack of self-confidence is the problem that's leading to your mistakes, and the mistakes are digging at your self-confidence, it's really hard to get enough confidence to short-circuit the cycle....

Amen.

*hugs* Good luck. I know how hard it is to try to stop the self-destructive doubting. If you ever need to bitch to someone who can't really do anything other than offer support, my AIM is jlf1110, or there are other ways to find me.

[corwyn-ap.livejournal.com]

I suggest letting them know that the questioning is eroding your confidence. Ask that they not ask why you didn't do something different for a while; unless it is a question of patient health. Often, when trying to get established with new people, someone will ask question about why they did something, even when that thing was the _right_ thing. It is a way of increasing their confidence in you. Letting them know that it is shaking your confidence, may help.

[spiritdancer]

Sit down and talk to both the owner and the other associate. You're coming into a practice that has a (presumably) good working relationship - right now you are the third wheel (or third member to the marriage, so to speak *grin*).

Between y'all, you need to set some guidelines - medical protocols, even. For the basic stuff, to begin with (when and how often to do puppy/kitten vaccs, what vaccs all will recommend/not use, when to talk with owners about senior pet stuff, etc). Then work up to more involved stuff. This can help ALL of you to know what to expect from and of each other.

Have you seen "First Choice Medical Protocols" by Hoskins and Whitford? It is a VERY good place to start, if not the be-all-and-end-all. Dr Lech and I both reviewed it when she started with me (and looking thru the copy I've got here, we should likely go thru it again - a refreshed wouldn't hurt either of us).

You can get the book via VIN or AAHA (actually, it looks like you can buy it via VIN without a current membership; you just get a discount if you are a member; same for AAHA - the prices at the two places are the same to within a few cents). Try http://store.vin.com/custom/edit.asp?p=82539&c=19737 and http://www.aahanet.org/common/products/productdisplay2_v2.cfm?PRRFNBR=984&CGRFNBR=4&CRPCGNBR=3&CI=&TextMode=0

You don't need the CD unless you want to modify/edit and print your own versions :-) (yes, the no-CD version is cheaper, and -at least last year- I was told the newer print edition had no significant changes on the CD)

Helpful?
_M_
(and yeah, I get discounts both places. Actually, you qualify for AAHA, since your membership was renewed thru my place for the upcoming meeting)

[jtdiii.livejournal.com]

I have to second this statement. While my experience is in software design, when a new person is added to the team you have to sit them down and work out what are the standard procedures so that people do not butt heads and get in each other's way.

This is something they should have done with you when you joined the practice. As they did not, you have to take the initiative to ask them what their policies are. You can also describe why you have gone the way you have in the past and explain why you went that way and ask how they prefer you act in those situations.

Communications are vital. Hope they improve.

[starcat-jewel.livejournal.com]

What She Said. After reading this:

When I do something one way, they look at me funny and ask me why I didn't do it another; and so when something new comes up I try to guess how they'd want me to do it based on what they've said before, and I always guess wrong

I was about to suggest that you speak to them about it, using pretty much that exact phrasing. But spiritdance said it first and better. You can't very well improve if you don't know what the expectations are.

[sdorn.livejournal.com]

What spiritdance said, with various handwaving to signify that I'm not an expert in this at all.

[pagawne.livejournal.com]

The last two posts actually say it all. Beki, you are good, you are very good, don't doubt that. Yalk to them and tell them what is going on with you and ask for thier input. Maybe it will help. I sure hope so. You know how to reach me if I can be of any help at all.

[vettecat.livejournal.com]

Trying to read minds will just lead to frustration. Find a quiet moment, and ask for clarification of the ways in which their practice differs from what you're used to. At least then they'll know that you're trying, and have reasons for what you're doing.

[bardling.livejournal.com]

Another one with experience of the self-assurance issue & cycle chiming in with Spiritdance, she said it so well & with relevant background.
When the guessing is counterproductive for *you* and hurting you, it's time to start talking, find a quiet moment and ask, instead. Talk to them, talk *with* them. It's in all your mutual interest.

*hugs*

[new-man.livejournal.com]

Several people have said this already, but I'll cast my vote for talking to someone there (your boss, a co-worker), rather than trying this by trial and error. Simply say "Hey, I was going to tackle thus and such this way. Do you guys have a way you do it here?". You may learn something -- but they may also. They sound like decent people, so someone may come back with "Why were you going to do it that way?" which gives you a chance to demonstrate that your medical expertise is indeed all that.

[dornbeast.livejournal.com]

I just can't predict what they want me to do, and when I try to I screw up.

Rhetorical question: Is their opinion more important than the patient?

Real question: When you say, "I did it this way because X," do they say, "That's not the way we do things around here," and tell you The Way That Things Must Be Done?

Real question: Why change before you know you need to change to suit them? And why do you have to do all the changing?

You know, when your lack of self-confidence is the problem that's leading to your mistakes...

Don't forget where the loop starts. Whether they're aware of it or not, questioning you the way they do is undermining your self-confidence. I don't have the whole picture; maybe they just think you know something they don't, something that might be a better way, or at least a different way that they can use.

Or, maybe they forgot to tell you about SOP, and don't realize that you're doing what you know, not what they expect.

Regardless, the people who got here first have better suggestions than I do on what to do. Good luck sorting this out.

Peter Eng

[johnpalmer.livejournal.com]

Well, it's clear that the guessing has to stop. You should definitely (as some folks have suggested) talk to the other doctors.

If the problem occurs because you're asking questions that are making you question your own judgement, you need to make sure that they understand that. Maybe they have good suggestions for you, or maybe you know something they don't. In any case, you need to make sure you know the three types of questions. Asking why you do something a certain way could mean:

1) could you explain, because I'm curious
2) I have a suggestion, if you want it
3) I'm giving you an order, but in an indirect fashion.

(And, I'm sure there are other possibilities, but these are the three that stick out) I think you're assuming they are type 3 questions only... leading to you trying to anticipate the question, and answer it before it's asked (hence, before an order is given). But, I'd be surprised if they aren't primarily the first two types.

If they *are* giving you questions that are really orders, it seems that the problem is that you're not seeing the pattern that links these things together... so you need to ask some questions yourself, until you can understand that pattern.

[ladysprite.livejournal.com]

If they were asking questions, this would help. Unfortunately, they're not so much asking as telling - repeatedly telling me that I missed something, or made a mistake, or left something out, or did too much. Always with the benefit of hindsight, and there's no way for me to prove that I didn't do whatever they're accusing me of.

I've tried talking with them; they're not so good at talking. When I ask for a protocol, I'm told that there is none and I'm free to do whatever I want (a position which lasts until 'what I want' clashes with 'what they're used to,'), and when I ask any questions I'm told that I shouldn't need to ask questions and they're not interested in babysitting me and I should be able to handle things on my own without constantly questioning them. Any other requests to discuss our professional relationship are met with long rambling stories about my boss's previous jobs as an associate before she started her own practice.

I'm trying my best to communicate, but I can't do it all by myself....

[johnpalmer.livejournal.com]

Well, keeping in mind that analyzing things and thinking up possibilities is my way of doing the "grandmother feeding" thing (Grandmothers feed people because it's a solid expression of caring/affection; I think/analyze/talk for the same reason), and keep in mind that I don't know the situation, but...

The ugly part of this is that they don't see a problem with the situation... which means something has to change, ASAP, or they'll assume the problem is you. Don't use that to panic yourself; you're good at what you do, and, in the end, that truth will shine through. Use it to recognize that you can't hope that it'll go away if you give it another week or two.

Maybe they'll understand that you communicated differently with other mentors in the past? ("other mentors" is a good way to put it; it suggests that you're looking up to them as people who will give you guidance.) Maybe if you can say that you've worked best in a situation in which X-type-of-guidance was given, while you acclimated to the specific practice you were working at.

Another thing that might help is to simply stubborn your way out of things. Close your eyes, pretend that whatever is before you is a test question, and mentally answer it. Then, do what you said you would do in answer to the test question. If anyone asks you any questions, defend it. If someone doesn't like your defense, pretend that they're seeing if they can make you back down, and make a mistake, rather than hold firm.

Remember, they have some experience, but *you* are an expert, too. If they refuse to back down on the attack, try to turn it into a teaching experience for them... make it so they feel they must explain *why* they think you're wrong. If they have a valid point, you want to grab it, in a way that makes sure they understand that you're acknowledging that they were right.

Remember that "they were right" doesn't mean you were *wrong*; it means you were good, and they were better. If you learn something new, now you're better, too.