#askdx

[dxmedstudent]

hi! i hope it's okay, i wanted to ask for your advice.

i'm eighteen, in my final year of high school. i can tell you a million different reasons why i couldn't become a doctor. i'm extremely neurotic, i have shaky hands, i forget how to work when someone even so much as looks at me over my shoulder, i'm very intense and i am scared of blood (which i think that last one could be the easiest to fix among all of those) and probably more.

i know that doctors have to be almost perfect all the time, they are the opposite of everything i described. and i do not like to admit it but i am very easily stressed. finals have been incredibly stressful and it feels so big and consequential and life-or-death-like in my head, and i know it's only this way because how i do on this matters nearly the most to me, but i cant help but think that future doctors aren't supposed to be this way. they're not supposed to spiral under pressure and have breakdowns over something like a high school exam and yet here i am 😂

don't get me wrong, i dont think doctors are superhuman. but they do handle stress more effectively and i've been this way my whole life. i know i can change, but..

basically i just wanted to ask if you know of any doctors who somehow started off the way i did, i want to know the success rate here haha. i am just really drawn to medicine for family reasons, and i got a taste of it with my anatomy and physiology class which i actually love even if it's my toughest class.

Hey!

Most of the doctors I know started off as neurotic, anxious, socially awkward, introverted 17 year olds at some point, including myself. Sure, there's sometimes this idea that doctors should all be cut from the rich extroverted jock cloth, but whilst some people in the field are like that, plenty of us just aren't. We really don't have to be perfect all the time- I think that's a myth that society encourages. We're human, same as everyone else - and we have personalities, strengths and weaknesses, and actually have mental health issues at rates higher than the general public at large.

I actually think that it helps to struggle a little - to an extent - it helps us understand other people, and gives us a more realistic foundation when it comes to recognising that patients' lives are complex. Many of us have struggled with exams or our mental health at some point or other - many people are open about it on medblr, which is great.

Medblr's answer to this question would be:

I'd argue that a high school exam feels extremely important when that's the only exam you've sat - it's not unreasonable to find it hard. No matter how successful you are and how smart you are and how easy exams in school were, you WILL reach a point where you are challenged academically - where you may fail or at least not do as well as you expected. And honestly? the ones who did super well throughout often crumble the hardest when they suddenly realise they are small fish in a big pond and that everyone finds their limit at some point.

I do also think that the high pressure and intensity of medicine can certainly mean that it's not the best environment for some of us. And that sometimes the cost of trying to exist in these conditions is higher for some of us than for others. It's not always forgiving for those of us who struggle or who are neurodivergent. I don't blame anyone who sees the dumpster fire of medicine, and decides that this isn't what they want for their life - whatever stage of life they are in.

My mum often talks about how surprised she was that medicine treats us quite as badly as it does - I think the reality is something that we can discuss much more openly now than in the past. She's actually remarked that if I ever decide to do something else (rather like my husband left a non-medical job to do something else non-medical that he enjoys much more), she'd completely understand and approve.

But I also don't think anyone other than you can decide whether you are not for medicine.

[dxmedstudent]

in medical shows they often say that every doctor will end up misdiagnosing someone and leading to their death at least once if not more. is this true? i assume it is since doctors cannot be right all the time and everyone makes mistakes. is this something someone should prepare for if going through med school?

Hmm yes and no.

Some people will be that unlucky. But not everyone.

Medical TV shows...aren't written by doctors. They are written by writers who want to build a sense of drama and also build pathos for the medical characters as people. And they want the audience to appreciate the potential stakes. And they are good at that. Normal medical life can sonetimes be bonkers, but usually it just isn't dramatic enough for television.

It's possible for a clinician to make mistakes in diagnosis or management, and this is inevitable to some degree - we cannot know every thing, and even if we did, patients don't always present as they do in books. People can have unusual symptoms. People make mistakes.

But honestly? Most clinical decisions are not life and death... or urgent. You have time to find out more information. You have tine to get a second opinion. You have time to do more tests. You have time to accept that the initial diagnosis was not correct but that you can keep working on finding out what is actually going on. If someone is dying, even if you aren't sure what's causing it, you can still work to stabilise them!

If things are getting worse, that's a sign to keep looking! And of course, most conditions themselves aren't immediately fatal. Or even fatal in general.

I would say that I very much doubt every single clinician has misdiagnosed someone in a way that's led to that person's death. I do think most clinicians, as humans, have made multiple mistakes - but at a lower stakes level.

And most clinical decisions we make, especially in hospital are part of a wider context involving an entire team. One person may make a mistake, but that mistake is usually caught by someone else. When things go badly wrong (hopefully rare but it happens), it's normally the result of the Swiss cheese effect - i.e. multiple team members missing something important.

When a patient feels ill, they experience an entire journey. They present to a doctor, and hopefully have some investigations and maybe have an initial diagnosis based on what is known at the time. Based on the results and also how they respond to the initial treatment, we get an idea of whether the initial diagnosis was correct.

As they and the doctor or medical team get results back or the condition progresses, there is more information to base future investigations and future treatments on.

To put this in context, diagnosis can be a long and sometimes difficult process. It's often complicated by the fact that there are many conditions that are uncommon and unusual - for example there are over 8000 known rare genetic conditions alone. People with unusual presentations or rarer conditions can often experience delays in diagnosis because their teams are less familiar with their conditions. And people with some common conditions can still experience significant delays in diagnosis, particularly if diagnosis tends to require more invasive ir specialised testing. There also isn't always a test that gives you a clear answer. There isn't always a good treatment. There often isn't a cure. Sometimes even the "right" first line treatment may not be best for that patient, people can respond differently to the same drug or treatment. Some people experience a difficult journey or even poor care.

I do think it's definitely true that there's always the risk that we can cause serious harm or even death if we make the wrong call. Working our hardest to make sure it doesn't happen is what gets us through to those long hours of med school and residency. For me, I treat each patient as if they were my family and try to give the care I would hope my loved ones receive. I have to live with the risks of what could happen, if I miss something important.

I also have to navigate the world as a patient knowing that people are fallible, the system us imperfect, and that can affect me as a patient or my loved ones as patients.

[dxmedstudent]

Thank you for being open abt your age! i, too, am a physician in my 30s and still working on my application for residency program (not even started on one yet). I always feel so hopeless and kind of embarrassed about my age (almost all of my colleagues are way younger than me) but then i saw your post :)

I hope you have a good day because you certainly made mine better

You're welcome!

I started studying medicine late by UK standards - after a prior degree, and I retrained from being a hospital medical doctor into GP, so for me, finishing training has been a long process even though I was full time for all of that (it hurts the mental health, I don't really recommend full time hospital training TBH). I also took a couple of years out along the way to try different specialities as well as work on applications because it was what I needed to do at the time due to when I was applying.

Funnily enough, along this winding path I have worked under colleagues who used to be in the same year of training as me, and that feels a little weird. Because you realise you haven't progressed nearly as much as some people even though you've been working pretty damn hard. Some people absolutely zoom through training the fastest they possibly can, but many of us need to take our time. And that's OK.

I did feel in limbo for a little while towards the end of my CMT training as the exams weren't happening (covid) and you can't progress without exams, so they offered to let me continue my training for at least a year (likely two) to get those exams and slot into the new IMT system. I just no longer wanted to be in any of those hospital specialties badly enough to put up with the system as it was, and saw a life for myself in GP with perhaps special interests in certain things. Over time your priorities can change and honestly it can be tiring to do this thing for years.

Life takes us all on different paths. I might have felt a bit old in med school but maybe 1/3 of our year was graduates so it was a common experience. When I was in med school we had people in their 40s in our class - people with grown kids and entire previous lives. And medicine is richer if the people I'm it are more varied or have different life experiences.

Life happens, we can't put it off and wanting to be young forever doesn't actually freeze us at age 25. I'm not sure I'd even WANT to be 25 forever - I like the growth I've had since then. Society REALLY obsesses over youth, but there's nothing magical about being under 25 or under 30.

You just have to do things along the way and fill your life with the things and people you enjoy. The time will pass far faster than we think.

[dxmedstudent]

Hi! I've got a couple of graphic novel recommendations you might be interested in. (I used to be a bookseller.) Caveat that they're all published in the U.S. or Canada; I unfortunately don't have as much knowledge of U.K. publishing.

Fiction:

Far Sector by N.K. Jemisin (writer) and Jamal Campbell (artist) - While this is technically a serialized comic, the full run is collected in a single trade paperback and you don't have to know anything about the universe to read it (I certainly didn't). It's ostensibly a superhero story, but I recommend it as a really effective noir. Gorgeous, lush art, and a well-constructed and satisfying story with a lot to chew on.

Displacement by Kiku Hughes - Magical realism firmly rooted in both U.S. history and contemporary issues. Kiku Hughes's art style is beautiful, and the story is a combination of memoir, history, and fantasy that uses the graphic novel form extremely well. This one is often marketed as young adult fiction, so you may not find it on the shelf in the adult graphic novel section.

Check, Please! by Ngozi Ukazu - This is technically two volumes, but if you don't mind that, it's an absolute joy of a story--a combination of a romance and a coming-into-one's-own story, and also very, very funny. I love Ngozi Ukazu's art style, and her command of both comic paneling and story structure is phenomenal. This was originally a webcomic, and you can dive into the extra features on the original tumblr if you want to, but the published graphic novels stand as a complete unit without needing any of the extras.

Memoir:

March Book 1 by John Lewis (writer), Andrew Aydin (writer), and Nate Powell (artist) - Graphic memoir covering John Lewis's early involvement in the Civil Rights movement in the U.S. This one really digs into both the complex considerations involved in organizing for social change and the specific events Lewis was part of in the 50s and early 60s. The March books are a trilogy, but you can read the first on its own.

Ducks by Kate Beaton - Graphic memoir of the author's time spent working in the oil sands in Alberta. Nuanced examination of economic pressures, sexual harassment, environmental concerns, and the impact of the Canadian oil industry on individuals and communities. This one is on the longer side, but well worth the read.

Let me know if you have any questions!

Thank you, this is really helpful!

NK Jemisin is one of the authors DxDude has read a fair few works by, we have a lot of their stuff on our crowded bookshelves, but I've not picked up any of their work.

I'm intrigued by all of the thorough descriptions you've given, they sound both gorgeous to look at and thought provoking to read. It's going to be hard to choose just one!

I'm not gonna lie, whatever works I don't choose for the club, I'll probably want to read by myself :)

[dxmedstudent]

Question about iuds I am looking to get mirena because I am worried about the future administration and I don’t want to be in an oh shit position if I don’t have it but my mom is asking why I am getting an iud? And she asked if I was sexually active? I forgot to say no I want it for that situation. Is it bad to get if you only have one bad day of cramping and heavy flow periods no having any penetrative sex?

No, it's not bad at all. I'm sorry your mum is being difficult.

Plenty of people start on contraception for hormonal reasons - a lot of people start pills because it's easier, but some do go to the mirena first, especially if their periods are heavy. But you can have normal periods. This is an article in which the author got one as someone who wasn't sexually active and quotes clinicians.

This website is UK based but it goes into a good level of detail in terms of what is useful to know about the IUD and how to prepare.

If your mum can't see your doctor's records, you can tell the clinician the truth - that you're sexually active or plan to be in the next 8 years and want to be covered during that time. It's fine to also get it because you might be sexually active at any point during that time.

I would tell your mum that you've been doing your research due to fears that this administration may take away all hormonal treatments abd BC and want to protect yourself whilst you can.

You can tell her that you've heard it's good for heavy and painful periods, and you'd like to improve your quality of life, and that's your main reason. But also tell her that the mirena lasts up to 8 years and whilst you aren't active now*, 8 years is a long time, and you might want that benefit in the future - because even if you got married** you probably wouldn't want kids immediately - and would take it out as soon as you were ready. But if the admin has banned it, it may be extremely expensive or hard to access that kind of care.

*it's OK to lie to your parents if it's a way to keep you safe. As long as you're old enough to consent and consenting (if not it's more complex, and that's a whole other discussion), it's not their business when you have sex.

**if your parents are conservative and think sex should only be within marriage, it may help to remind them that even married couples choose when they feel ready for kids! Even the most conservative parents should accept that at SOME point you'll probably be having sex- even if they can only imagine that to be in a heterosexual married relationship.

[dxmedstudent]

The "resident doctor" is horrible change, a meaningless Americanism.

If anything, the recent strikes have advertised the broad meaning on "junior doctor" to the masses. A change to "postgraduate doctor" would have been better as it has a British meaning. I've actually read that some are claiming the change is good because Brits know residents from American TV shows?! As if we should be making British medicine MORE American?

Thanks for writing in! It's definitely useful to be able to discuss what people like or dislike about it.

The thing is, "the masses" have always used the term "junior doctor" to denigrate and infantilise staff they see as basically teens. They were doing it when I first went on strike in 2016, and they've been doing it during the past couple of years of strikes - just look at the comments under literally every Daily Mail or Telegraph article about junior doctors. Inevitably people always imagine a lost looking 24 year old house officer/FY1 and never the grizzled middle aged obstetrics registrar with 3 kids of their own.

It tends to go hand in hand with rhetoric about how "we trained you, you can't work abroad/go part time/leave medicine", which is fundamentally rooted in misunderstanding the "we pay X to train a doctor" figures that get touted - the majority of those figures being *doctors' salaries over the course of their foundation, Core and specialist training*. We need people to understand that formerly known as junior doctors are grown adults, and qualified medical professionals who are being paid for their work and are paying thousands of pounds to learn more, as they go along.

And of course, completely not understanding what whilst the government moves a pile of money from the education pot to the NHS pot to, in theory, train med students or postgraduate doctors, very little of that is earmarked or used for actual training - the vast majority of our training us informal and impromptu talking, around actual care. Did I as a med student get tens of thousands of pounds worth of supervision or training? I honestly don't think so. But that's the value the UK government decided my hanging out at the back of a clinic room or operating theatre was worth. The vasy majority of our learning once we enter the clinical years of med school, or postgraduate training, is self directed. Not only that, but I'd argue that poor staffing and toxic work environments at some points if my core medical training actively hampered my learning and progression.

Going back to terminology, I think PD was considered, but Postgraduate doctor would unfortunately include consultants, GPs and SAS doctors as well because we're still postgraduate once we qualify. Ultimately it was put to a vote and "resident" won out over the other options suggested. I voted, but I can't remember what all the other options were.

I think it's hard because our training is longer and has always been subdivided - we've had house officers abd senior house officers and registrars for a long time - and we've loosely rebranded them into FY1 , Core trainees and soecualist registrars. But at alm levels you do pretty different things, are on different rotas and have different levels of responsibility so we can't just call everyone a registrar. Which IMO feels like what a US resident is.

The term "Trainee doctor" has often been used, but IMO that has always looked worse and is often hard to explain that you're not talking about medical students but about paid working professionals who may already have multiple speciality examinations under their belt. I've seen patients confused by this terminology and think it would not have been a better option.

Resident isn't JUST a US term, it is a term used in multiple non-US countries such as Canada, Spain, Australia, Singapore, India and others. And I do think that after decades of series like ER, House MD, Greys Anatomy, etc plenty of people are at least vaguely aware of the term and its implications of "qualified doctor who us not yet a completely qualified specialist". We can have a debate about what it means that US media takes over the world somewhat. But in this instance only, it kind of works in our favour.

I could talk about multiple issues with the US system (nowhere near as knowledgeably as my US medblr friends, so I leave it to them), but the terminology of calling it residency would be extremely low down my list of complaints. I generally believe words matter, a lot. But I don't think that calling trainees residents is going to be what privatises UK healthcare.

Ultimately, whilst it's not my favourite term personally, for me it's a means to an end. I want us to be able to change terminology to make it harder for people to dismiss grown qualified professionals, or to frame us as effectively spoonfed baby students that someone else is paying for, when in fact resident doctors are paying for their own study and carving out their own learning opportunities most of the time.

I'd just as well accept some kind of UK version that wasn't Resident, but I don't think an easy overarching name exists, and I'm not sure if we could reach a consensus on finding one.

[dxmedstudent]

Hi, for the Falling asks I'm interested in your answers for 5,6,7,12,13. :)

5. Do you prefer horror, mystery, thriller...?

Hmm I enjoy all of the above. Jump scares are very effective on me even if I know it's coming. It's hilarious as long as you don't get accidentally thwacked by one of my flailing limbs. Back when I used to play Minecraft on my phone, my family beseeched me to play it on friendly mode because we'd be watching a film or something and I'd randomly scream because a creeper got the better of me.

I don't enjoy unadulterated suffering on screen though. It just feels pointless to me, there's enough of that IRL.

6. What is your favourite fall season film? (Horror film, mystery, fall themed, whatever you like.)

Hmm trying to remember the last Fall themed film I've watched, we do tend to go on a horror binge this time of year.

Growing up, Hocus Pocus was great fun to watch. I've got a soft spot for Practical Magic as well.

7. What is your favourite fall season read?

I've mainly been reading nonfiction recently. I've been feeling like continuing my quest to read all the Pratchett recently. I stalled due to exams and the stresses of working full time, but I've been looking forward to continuing for a long time.

12. Have you ever experienced a haunting?

Apart from the aforementioned creepy hospitals, not really. I've been to a few places that *felt* extremely creepy. Like Sir John Soanes house in London, and when I was going around an old prison in Venice. Both felt somehow much creepier than expected, and it's not surprising when they tell you they are haunted. That doesn't mean they are, it just somehow feels like it tracks.

There are lots of old places with an interesting history or that are reported to be haunted that feelperfectly normal to me. It diesnt stop me going to museums or historical sites. But honestly I hope I have 0 perception these things and never experience anything paranormal.

13. Have you ever had a paranormal experience?

No thankfully!

I have sometimes just eerily lifelike dreams of dead loved ones that I miss, where it feels so real and so emotional that when you wake up you can't help but cry profusely without knowing why.

Thanks for asking :)

[dxmedstudent]

for the fall (autumn) asks!

20. Favourite fall treat? and

26. Favourite ghost story?

For treats, as the days get shorter and colder I start to dust off my collection of herbal teas and settle in to making a lot more hot drinks. That and getting out my Halloween and Christmas sweaters!

Not the most exciting ghost story, but there have been multiple times when I've worked in a hospital and had to go through bays or even entire wards that are closed off at night. It's always extremely creepy. Especially if they are rumored to be haunted, as they often are.

I do remember working in one hospital where almost every department had moved to the shiny new building, but mine was in the old almost derelict one. Most wards were shut down and deserted, even during the day. They looked genuinely abandoned. Now; most hospitals at night aren't busy, but they are either lit up or light up quickly when you are around. And there are often porters or cleaners walking through the corridors.

Walking between departments and down darkened corridors in that empty hospital at 3am was like being in a liminal space. especially since one building I had to go to was accessible via a tunnel that led into the back wards that were locked on both ends and needed ID to let you through. It feels like a long wait in the dark! Ibeing locked in makes it scarier.

Imagine walking through multiple empty deserted wards in the almost pitch dark! Knowing that security are miles away. It was so quiet. And it honestly made you feel like you weren't alone. I heard sounds more than once, on darkened wards reputed to be haunted - and whilst they may have been just a nurse taking a break in a spare room on their night shift, I didn't hang around to find out!

I genuinely walked via the car park most of the time - and you know that's not pleasant either!

The nurses told me that one of the bays on our ward was now used for storing equipment nevsuse the call alarms would routinely malfunctioned, but the electricians could never find the fault. It was rumored that the room in particular was known for how frequently patients die there. I'm sure every hospital has stories like that.