Are You a Real Doctor?

They hand you your diploma and you are transformed from a medical student to a physician even though you don’t feel any different and you probably consider yourself to be something of an imposter. I know I did. For months after I graduated I had to suppress laughter whenever somebody called me “Doctor.”

This is natural. You will feel more like a real physician during the end of fourth year than you will at the start of intern year. A fourth year medical student is the dominate predator in his own isolated food chain. You don’t have much real responsibility, your residents take all the heat, and you actually do know a lot of medical trivia, much of which you will forget by the middle of intern year. Not only that but you can look with contempt at the ignorant first and second years running around and justifiably feel that you know a whole heck of a lot more than they do, both practically and philosophically. As an intern, you start with less knowledge than you had in fourth year(because medical facts have a short shelf life) but suddenly you are not only responsible for for patient care but everybody from the nurses to the techs expect you to make decisions.

You do actually exist in a parallel environment with the house staff when you are in medical school. If every medical student called in sick no one would probably notice. If the residents went on strike the hospital would grind to halt. Only the nurses are more important to actual patient care.

In fourth year you also have plenty of free time giving you ample time away from the hospital to imagine what a great doctor you will be. It’s no wonder that you feel pretty good about yourself most of the time. This has a lot to do with it being more enjoyable to pretend to be a doctor rather than being one.

So sometime early in your intern year a patient is going to accuse you of not being a real doctor and this is going to hit mighty close to home. You could lecture them about the validity of your doctorate-level degree which legitimately confers on you the title “doctor.” Deep down, however, you’ll have a suspicion that they are right…that you are some kind of poseur who slacked his way through medical school and is not worthy of the public trust.

The public who are largely ignorant of how doctors are trained fall into three broad categories. One group believed you to be a physician even while you stumbled your way through first year medical school. Parents and relatives fall into this category. My in-laws started asking me for medical advice the day after I was accepted to medical school even though pretty much everything I knew was gleaned from watching ER. They have never stopped asking me for medical advice and I find that the more I know the less I tell them, my typical response to a questions being, “You need to see your doctor.”

I’m more confident in what I know but paradoxically more humble in the realization of what I don’t.

The other group confuse medical students with residents and will never cut you any slack. These are the people who come to the hospital and ask that no residents be involved in their care under the assumption that residents don’t know anything and an attending will be better able to manage their day-to-day care. The attendings find this amusing because one of the reasons they went into academic medicine is to have a team of residents helping them with the more mundane aspects of patient care leaving them more time to devote the big picture. Not to mention that a good upper level resident is at his peak of medical knowledge. There are doctors out there who haven’t read a book or journal article since the Carter administration.

I had a patient insist that only the attending put in her central line even though I have done many of them recently and all relatively effortlessly. The attending hadn’t done one in years. He was eventually able to convince her to let me do it while he supervised.

The third group are largely ignorant of anything to do with medicine and will pour out their chief complaint to the phlebotomist if she’s wearing her white coat. It’s all the same to them. They trust authority to the point that anybody who works for the giant hospital is automatically able to solve their problems. I once walked into a patient’s room and found the patient berating a student volunteer for not writing her a prescription for pain-killers despite his protests that he was just there to get her a pillow.

So stand by. If your self esteem totally depends on what others think then you are in for a rough time. You jsut can’t please everyone. My brother-in-law who has something of a complex where I am concerned will never admit I am a doctor. He keeps moving the goal post and now insists that I will only be a real doctor when I am out of residency, not just licensed.

He’s an ass. The point is not to let this bother you. If you act like a physician, people will treat you like one. This means that you must be confident. But not reckless. If you don’t know something, admit it. It is no crime, for example, to ask the respiratory therapist for his advice. He’ll be happy to give it to you. He will also appreciate if you make a timely decision on his advice, even if it is only to consult with your senior resident or attending and get back to him quickly.

Those of us who are older have a considerable advantage because the grey hair doesn’t hurt. On the other hand I have a friend who looks 16 but has such good bearing that if he told his patients he ran the hospital they’d believe him.