Medicine From The Trenches

Experiences from medical school, residency and beyond.

Everybody is doing better than I am doing…

Well, for most people, it’s nearing the end of the first semester of school for this particular year.  It’s a time to complete the projects, papers and assignments that are needed to complete the year strong and it’s a time to start getting organized for those final exams that are looming in the future. This is not the time for berating yourself for not performing up to the standards that you created when you began the semester. For all students, there is quite a bit of “life” in between the start and end of any semester (or any period of time) in the educational process. Over any period of time, distractions and immediate needs/problems will get in the way of your learning. How you manage those distractions/problems is something that you can change to help you in the next semester. In short, as soon as you are done with your work for this semester, take an honest appraisal of what you would like to change and keep the things that worked for you.

Every person has a tendency to compare their lives with what they perceive as the life of another person. That other person might have been your sibling as you were growing up. ( I thought my sister was smarter, more beautiful and more talented that I could ever imagine).  That other person might be someone in your class (I see that X or Y is at the top of the class and he/she doesn’t even have to study) or that other person might be someone you see on the telly or in the movies that you perceive would have a better life or greater abilities than yourself. This practice of comparison is a huge time waster because the only person that you can compare yourself to (in any way) is your previous self. Only you know how to live your life and only you know what you need to succeed in getting what you need to live your life. It’s always easy to believe that others are somehow innately “better” that you are but in reality, they can’t live your life as well as you can live your life and you can’t know what challenges them.

The stress of school, especially medical school or any professional school, can send many students into behaviors that they would not even consider if academic stressors were not present. Assignments, tests and projects seem to be endless. The time that you thought you would have at the beginning of the semester, at this point, seems to have evaporated faster than dry ice. You find that you feel overwhelmed and rushed to complete things often feeling less satisfied that you have been able to give your work your best efforts. When this happens, stop and take a minute to prioritize the upcoming tasks. This is a good time to make a very simple list of the things that have to been done immediately and the things that can wait until you have a bit more time. This is also a good time to pencil in at least 30 minutes of time daily to just reward yourself for keeping up with your semester/academic tests as best you can. That daily 30-minute reward should be something affirming (not self-destructive) that you can keep coming back to when you need to take a short retreat.

Why is it so easy to believe that everyone else is doing better that you are doing at this minute? This happens because you project your feelings of inadequacy into your thoughts about others as you compare yourself to them. You are no more inadequate than the next person in your class but you may be making decisions that are not productive in terms of getting your academic work under control. Just allowing distractions to eat up your preparation time for study and completion of projects can be counter-productive to doing  your best work. If something is so distracting that you can’t concentrate on things that you need to be working on, then take that daily 30-minute reward time and use it to indulge in your favorite distraction (social media for example) as a reward instead of “beating up” on yourself for procrastinating on Facebook.  This means that you use your Facebook time as a reward for getting your other work accomplished rather than something that takes you away from what you need to do. In short, make a better decision not to deprive yourself of indulgences but to limit the amount of time that you participate in them.

Another thing that you can do in this minute, is to replace your belief that you are somehow inferior to others with the affirmation that they would have no idea of how to live your life. Only you can live the life that you are living. You were born with all of the tools that you need to make a success of what you would like to be successful in. All skills can be mastered if you put yourself in a position to master them and take each step needed toward a goal on a daily basis. Success is more of a habit rather than something that is “conferred” on a few “lucky souls”. Success in little daily tasks always adds up to overall success in the “big” items. If you attempt to “rush” or “short-cut” your way through your academics/projects, then you WILL run out of time to do your best work. Objective and thoughtful planning, with daily adjustments, works better than waiting until the last minute because you have the idea that “working under pressure” will spur you to work better. Adding pressure to an already stressful situation adds more stress and does little to get your tasks accomplished. Remember, people who are stressed tend to exhibit behaviors that add to stress rather than relieve it.

The other problem with constantly comparing yourself to others is that under stress, you always believe the negative thoughts first. In stressful situations, it’s aways easy to believe that you will “never” understand all of this or that you will NEVER get everything done that you need to get completed. In reality, if any student in the past was able to get the work completed, you will be able to get the work completed. You have all of the tools do your best under any circumstances. There is no other human out there that can life your life better than you can live your life.  You make a list of what needs to be done and you plan how you will do it. This doesn’t apply to anyone except you because only you can figure out what you need (and how much time you need) to complete your list. Yes, it’s true that there are only 24 hours in each day (and you have to sleep) but look objectively at your priority items on your list and do the most important items first. This is how we triage patients (we treat the sickest patients first and take care of the less acute patients in turn). If you don’t get everything completed, then you examine how you would change things and take action so that you get the most out of your academics.

Finally, telling yourself that you have “passion” for something is not the same as putting yourself in a position for being successful with something. Passion does not overcome or offset daily work toward a long-term goal. If you seek a long-term goal, realize that these long-term goals are reached by taking regular/daily small steps toward them. There is a path toward a goal and the steps along that path are the challenges that you have to meet. Meet and greet each challenge with the idea that you will figure out what each challenge requires and get the job done in your unique manner.

Put comparison terms out of your mind and replace them with action terms such as ” I can” and ” I will” do what I need to do along with asking for assistance at the first sign of trouble. Asking for guidance or assistance is not a sign of weakness but a sign of logical and careful evaluation of that you need for success. If you needed to lift a car, would you keep struggling alone or would you enlist the assistance of 10 others to help you lift that car? Anyone can lend you a hand along the way because most people are willing to help others if asked. You just need to be able to swallow your ego, ask for assistance if you need it and affirm that you will live your life, taking care of your needs without comparison to others and what they are or are not doing. In reality, those people that you believe are so much better than yourself are more like you than you would believe and have the same challenges that you have. In the end, you are equal to them and better in living your life.

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7 November, 2013 - Posted by | academics, organization |

2 Comments »

  1. This is true during the game, but once the finish line is crossed, then one can only compare themselves to their peers. You all start from the same point, but only some can win the race – the true definition of a contest.

    The finish line is the match. Your peers are those going for the same thing that you are. Those that match well are winners. The rest are losers. It’s zero-sum.

    If one matches poorly, or doesn’t match at all, then one is unabashedly doing worse than his peers. One is less prestigious, less competent, less intelligent, less likeable, and less accomplished,; at least that is the outside assumption. Steps are lower, grades are lower, personality is flawed, and one’s worth is, for the most part, lower. The chips have fallen. It is public knowledge: you failed. Your betters will look upon you with scorn and snobbery in the workplace. They will know that, since you are in family, or pathology, or whatever, that you were unable to be better; that you had to settle, or aim low, because you had no other choice.

    At that point it is difficult to put in as much work as one requires to “shine” because the opportunities to shine have passed, and one has proved himself tarnished. Going from having lofty yet unrealistic goals to doing family medicine in Keokuk makes one lose their drive to do his best work. The focus changes to only do what is adequate, standard, or required – nobody is going to win any medals for being the best family resident in Keokuk, so why bother?

    The bright side is that, should time permit, the tarnished failure can focus time on things that are pleasurable to himself; get back to hobbies or foster personal relationships that may have eroded during medical school. It is also an opportunity to explore other avenues of success, since medicine has proved to be a failed endeavor.

    The game is unforgiving. The profession is petty and cruel.

    Comment by Elliot Yevod | 13 November, 2013 | Reply

    • To Elliot Yevod:
      All accredited residency programs in the United States are regulated by ACGME (or AOA) in terms of standards. In this country, there are no “substandard” residency programs that are accredited. If a program doesn’t meet ACGME (AOA) standards, it’s placed on probation. Johns Hopkins found out about this first-hand when they violated work hour restrictions and one of their residency programs ended up on probation.

      You should know the characteristics (academic and personal) before you attempt to enter a particular speciality. Finding this information is not difficult and should be one of the first conversations that you have with your academic adviser early in your first year of medical school. Items like “prestige” and “less competent” do not enter the picture except in the mind of those who would believe that they are somehow “lacking” because they made choices that would not allow them to enter the program or specialty of choice. In short, if your academics are not sound in medical school, you will have fewer choices that those who have excelled academically. In short, you can’t expect to follow the “P = MD” mentality and match into Dermatology at Harvard or Hopkins. If one waits until they are filling out the ERAS application to find out that they are not getting the interviews where they “thought” they should be getting interviews or worse getting no interviews, then it’s too late.

      In the United States, we don’t have a system of “betters” in terms of human beings. If you constantly have this type of mindset, you are going to run into problems with your peers and with those who are more experienced in your specialty. There is no “shine” or “not shine” in the process. Either you have the skills and academics to do the job (as evidenced by your course grades/board exam scores) or you do not. No residency program is going to seek out people who can’t pass licensure steps or can’t pass in-service exams. Long before one gets to the point of application for residency, one has ample opportunity to show excellence in academics. In short, if you can’t self-evaluate and self-assess in order to take steps to improve your performance on anything from sports performance to academic performance, then you are likely going to have difficulty in any profession especially medicine.

      Finally, it’s easy to complain about how “unforgiving” the “game” is and how the profession is “petty and cruel” but only you make sure that you put yourself in the best possible position to achieve what you want to achieve by the choices you make on a daily basis. This isn’t done by “wishing and hoping” but by achievement of a constant high level of work. If something gets in the way of that achievement, you alter your plans and work around whatever is the problem so that it becomes a strength rather than a barrier. That’s called being PROACTIVE and not REACTIVE which is the essence of a strong performance in anything. A thousand people can tell me “no” but I will find that one “yes” and keep on moving forward. You might also want to stop “thumbing your nose” at Family Medicine which offers many opportunities to practice excellent medicine.

      Comment by drnjbmd | 13 November, 2013 | Reply


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