Conscious Incompetence
“Tell me about your patient.”
“I, uh, well. She’s here to get #30 out. Uhh. She has hypertension and is taking medication for it.”
“Like?”
“Hydrochlorothiazide.”
“Which is?”
“Err… a loop diuretic.”
“Nope.”
“A potassium sparing diuretic.”
I was wrong the second time, too. HCTZ can be paired with a potassium-sparing diuretic, but it’s only a calcium-sparing diuretic. It’s really really not a loop-diuretic. Anyhow, that dialog is from today, up in oral surgery: our current surgery doc loves to pop quiz us… hard… in front of the patient. If you get it right, he may just keep asking things until you get it wrong. I simply am not quick enough on the draw — so, I can’t remember what I DO know, and I can’t even put forth a good guess when I do NOT know. I get flustered when these things happen:
- I don’t have enough time to think (3-4 seconds would be nice).
- I see a patient for the first time.
- I anticipate doing something I’ve never done before.
- I’m intimidated by a dominant personality in a position of absolute authority.
Oral surgery puts all these together, and I turn into a wreck. For every question like this:
“Patient is on Celecoxib.”
“Which inhibits COX-1 or 2?”
“COX-2.”
Or this:
“You didn’t ask your patient if they smoke, but I would guess they do.”
“I… I’ll add that to the history.”
“Which automatically makes them ASA what?”
“ASA II.”
I get things like this:
“And what’s the name of the position when you raise the patient’s feet above their head to help them recover from vasovagal syncope or orthostatic hypotension?”
“I… well, I just… I mean, I was studying it in the… it has this name which”
“The Trendelenburg position.”
Or this:
“Good. You remembered that Coumadin is a Vitamin-K dependent coagulation inhibitor. Which factors does act on?”
“Umm. IX and…”
“Nope.”
Interestingly enough, I would have SWORN I said IX, which on further investigation appears to be correct. But that doesn’t matter. This surgeon really seems enthusiastic about helping us; I appreciate this. I really do. Also, his expectations are high. Very high. Thing is, I absolutely can NOT get a read on whether he thinks we’re all total screw-ups (what are they teaching the kids these days), or if he thinks I’m a screw-up and need remedial education.
I can’t tell if I bother him or if I’m giving myself too much credit, and I’m simply like a fly buzzing around the head of a hiker, only deserving of a reflexive swat to clear the field of view for more interesting things ahead.
I really suspect it’s the latter.
I’m way too easily crushed by doctors like this — I’m not looking to be coddled, but I can’t help but seek out affirmation. I know it’s not a good way to learn, but I can’t help it. Somehow, some way, I just have to forget that I might bother this surgeon, and that he’s going to make me look foolish in front of patients (justified or not, in search of education or a reminder of seniority). After figuring out how to ignore these distractors, I need to learn.
After all, you have to look down at rapidly rising pool of blood in an empty tooth socket, the surface of the deep red liquid pulsing with a heartbeat due to the size of the vessel that was injured, and think clearly enough to figure out how you are going to achieve hemostasis, close, and get on with it all. I’m sure all of my colleagues aren’t even phased by this, and simply go on with their lives when they get home.
As for me, I’m a little bit shaken up.
I still wonder where I stand with the attending surgeon. I know it doesn’t matter, the surgeon absolutely couldn’t care less about me, and that this over-thinking just gets in the way, but it all makes me worry.