When the Myths of Medicine Meet the Realities of Residency

Alexa M. Mieses, MD, MPH

Disclosures

April 25, 2018

Well, I guess I'm a doctor now...

After 25 years—give or take—of school and studying, I finally graduated from medical school in 2016. Two years into residency, I have already learned so much (about medicine and beyond). I now realize that some myths about medicine are actually truer than others.

People often ask me whether my life is like Grey's Anatomy. It isn't nearly that exciting, although I admittedly have never seen a single episode of that show. I would have to say that my experience in residency so far is more like the TV show Scrubs. That is a show I watched religiously. I promise that it is (somewhat) accurate, and residency training really can be that entertaining (for better or for worse).

Reality: Your Imposter Syndrome Will Fade

We have all heard of imposter syndrome. Imposter syndrome is when an individual has a hard time internalizing his or her accomplishments; he or she feels like a fraud. At times, I certainly felt this way during medical school and even as an intern. I never truly felt like a doctor on the inside. "Doctor" felt more like an external title, a role I was trying to fulfill. I still felt like "me." I realize now that "me" includes being a doctor. When I introduce myself as "Dr Mieses," it doesn't feel awkward. This is not just because I have introduced myself this way hundreds, if not thousands, of times.

It feels more normal to me because over the past 2 years I realized that I am a doctor. I have learned a lot—perhaps not as much as my senior attendings, but I am a darn good clinician and love teaching. This includes teaching patients, families, and learners. I can take care of people and help them take care of themselves. I now "own" the whole doctor thing.

Reality: You Must Own Paperwork

One thing I have yet to happily own is all of the paperwork. In clinic, we always have notes to write for each patient encounter. In the hospital, we write daily progress notes for patients and discharge summaries for those leaving the hospital. We document telephone calls and follow up on lab results for our patients. We fill out forms for prior authorizations for medication and durable medical equipment. Paperwork is part of the job.

Thank goodness for dictation technology. I went through intern year without it. I survived! But having the ability to dictate my notes as a second-year resident made my time in clinic more seamless. Clinically, I am able to see a pretty good number of patients in a half-day. However, the documentation can either slow me down or make me stay later than I would like to finish notes. Thankfully, this has not been a huge issue for me and has gotten easier with dictation. If only I had a scribe to help out. Some residency clinics use scribes. However, I think it is more common in the private practice setting (at least anecdotally).

Related to paperwork, since starting residency, I have realized that no one knows what we do. Family and non-medicine friends imagine me running codes every day, saving lives. No one (friends or family) knows that I spend most of my time doing paperwork. I often find myself also explaining how the healthcare system works. People on the outside don't realize all of the random things you have to navigate to ensure that you get healthcare. Patients obviously know this. However, a lot of behind-the-scenes work is required to make sure that things happen in the hospital how and when they are supposed to happen. I don't know what I would do without our nurses, pharmacists, case managers and, social workers—and that's just to name a few vital parts of the medical team. It really is a team effort!

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