Calling the shots

This past week has been an incredible week.  A year ago I posted about needing to get used to not knowing all the answers.  In the classroom, I felt confident that I had the right answer most of the time.  A year ago I transitioned into clinical learning, during which I felt confident in my abilities but remarkably uncertain about diagnoses and treatment because someone's physical being was dependent upon, in a small way, what I did - how I performed; whether or not I got the right answer.  Clinical year was difficult because of the uncertainty, but excellent in that I had a safety net - a large and proactive safety net that would essentially reach out and catch me if I stumbled.  My preceptors were there, watching over me, monitoring my decisions and consulting with me actively.  I felt uncertain, but grew comfortable with that uncertainty because that was the name of the game.  Last Monday, the game changed again.  Now, instead of having people looking over my shoulder and actively consulting with me, educating me; I am calling the shots - making the decisions - about how to treat my patients.  My patients.  These are no longer someone else's responsibility, they are my responsibility.  Yes, there are doctors, physician assistants, and nurse practitioners to consult with - and I do (especially for dermatology stuff) - but no longer do they look over my shoulder, review my charts, and guide me along actively.  Now, the safety net exists only if I activate it - if I fall but forget to turn it on, the potential exists for me to fall a long way.  And what hangs in the balance?  People.  My patients.  It is both thrilling and frightening at the same time.

I enjoyed every moment - including the discussions about whether or not to send a patient to the ER for abdominal pain, kicking myself for missing something obvious (and taking solace in the fact that I wasn't the only one), fixing children (see a previous post - but there seems nothing more wholesome than having a child come into my office sick and leave with answers and medicine that has made them feel better), and falling back on my training when certainty about the next step avoided me only to have it reveal solid answers.

I am still intimidated, but having survived my first week in the trenches I feel bolstered about the next one and ready to take on more challenges.  Uncertainty is still there, but it has served me well and I think I will grow comfortable with a little bit of uncertainty in my life - as long as I use it to the benefit of the patients for whom I am now responsible.