Excerpt from: The Wayward Diagnostician (working title)
When I look back on my first years of training, I can recall many moments of self-doubt, some more memorable than others. When the sting of those moments were fresh, I was often filled with self-flagellating thoughts: I'm completely out of my depth; I don' belong. It would take the cold light of day to restore my perspective, to remind myself that I'd overcome these setbacks before and I could do it again. Then a solid dose of sleep during humane hours would prove just enough to recover the strength to carry on.
This is not to say that I don't still second or third guess myself from time to time, but I believe I can give myself enough credit to say that these moments are now farther and fewer in between. If they weren't, then that may be an indication that I'm not actually cut out for this. But I also believe that if I stopped having doubt altogether, if I never challenged my own methods and assessments again, then that would be definite proof that I'm in the wrong profession.
Unless you're relentlessly brilliant or utterly oblivious, you will have moments where you're unsure you have the right answer, and may find yourself paralyzed, stuck between the desire for a clearer, more refined approach to the immediate task and the weight of the expectations you had placed on yourself. How these moments come about depends on your particular mix of experiences up to that point or the pure luck of happening to have brushed up on a certain topic the night before. It is not an indictment on your intelligence nor on how you had applied yourself prior to facing that problem. But often, that is not what we tell ourselves. We likely wouldn't be doing this job in the first place if we didn't hold ourselves to a certain standard. One such self-inflicted standard that is all too common among newer doctors is certitude. This is the idea that our work should never be predicated on ambiguity, that we must at all times be in full control of our knowledge and decisions. I'm here to tell you that this is an unrealistic ideal to live up to, and many of the highest achievers in ours and many other fields have thrived because of, and not in spite of, their propensity to ask questions of themselves and of those around them.
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I'd like to think that even the most senior of us, those who have accumulated a lifetime of experience and have seen and managed nearly every problem our job could conceivably throw at us, could still reflect on their formative years and find sympathy for the plight of the young doctor who demands the wrong thing of himself and of his profession. If in our moments of self-disillusionment, we had turned to our seniors who had been through it all and knew what it had taken to build their confidence—to compose their approximation of certitude—we might then have received just the words of encouragement and foresight that we sorely lacked. But alas, that is not the way. Instead, we stew in our contempt for our own perceived shortcomings, convinced that, of all the doctors in the world, we alone must be incompetent and unfit, and that broaching this insecurity with colleagues would invite only derision and rejection.
Once, I was one such meandering soul, hellbent on putting myself down and shutting myself off from the rest of the profession. In the interest of full disclosure, I might even say mine was a rather severe case of the impostor syndrome. The catalyst that set me back on the right path came not from within, which was a downright mess, nor from my colleagues, whom I was determined to hide my suffering from. Rather, it came from another profession altogether, one which may well be far more fraught and exacting than our own.
In this section, I hope to share some thoughts and experiences that helped me get through those early years without totally losing faith in myself. I don't profess to be an authority on this subject, and it's entirely probable that you won't find my interpretations helpful to your particular person or situation. This is just one man's account of how he bent but didn't break. This is the story of how I inserted myself into a party of intrepid adventurers.
