Waiting for My Scariest Moment as a Physician

June 1, 2011

Everyone, whether a medical student or attending physician, has had a scary moment, but my greatest fear is that I have not yet had my scariest moment.

Everyone, whether a medical student or attending physician, has had a scary moment, but my greatest fear is that I have not yet had my scariest moment. I could recount my first time intubating a patient as a medical student, with the very intimidating head of anesthesia breathing down my neck shouting "Do you hear breath sounds?!" I ended up intubating the esophagus and then immediately dying from the shame. Or, as an intern, writing a discharge order for an elderly patient one day, only to have her acutely decompensate and die the next day. Her autopsy eventually revealed she died of undiagnosed metastatic lung cancer.

Scary doesn't begin to describe the time my ICU attending sent me to discuss changing a patient to a do-not-resuscitate status with eight family members who began simultaneously shouting at me that I had given up on Mrs. G and that we were trying to withhold life-saving measures because they were poor. We have all had these stories and sharing them allows us to learn from our mistakes and get past them so we can continue to do our jobs (although sometimes it takes a little more to feel better, like ice cream or retail therapy).

As a recent family medicine residency graduate, one of my scariest moments, however, has been realizing that I am now essentially practicing on my own. No more senior resident or attending physician to look over my orders, offer their clinical expertise, or to say, "No, you have to inject more distally." We're equipped with computers, smartphones (though mine does not always seem so smart), and shelves full of impressive, information-filled hardcover textbooks, but all this doesn't make up for firsthand experience.

I came from a well-respected program with 36 residents, 10 core faculty, easy access to all specialists, and numerous staff - including a "resident mom" whose office was supplied with essentials such as chocolate, Tums, and Advil. Our lives as residents centered around complaining about who got the most admits overnight, bickering over who was on call the most weekends, and cursing being double- and triple-booked in clinic. But as with all things masochistic, we secretly loved it all because we knew we were in an exclusive fraternity and there was always someone who had your back.

Scary is when lawyers from a fancy downtown firm, who try to pretend they're on your side by bringing lunch catered from "Yummy Thai" instead of meatloaf surprise from the hospital cafeteria, tell you over and over, "it's not if you're going to get sued, it's when." You start thinking that your one-page progress note should have been two pages, or maybe you should have written the patient was "alert and oriented x 3" on the consent form for that skin biopsy. Or that you should've made a house call for that patient for whom two certified letters were returned and whose phone is disconnected, to tell her she's two months overdue for her colposcopy.

Scary is also when you Google yourself and now your name pops up on obscure websites like vitals.com and healthline.com and you worry that the patient who paged you Friday night with a "fever" of 99.1 and insists she needs antibiotics because she's been sick for two days, will leave a nasty review because you told her she did not have a fever and probably did not need antibiotics.

Scary is when hospital administration throws around terms like "RVUs," "HMO capitation," and "Medicare lengths of stay" (which, by the way, I've already ruined with my 86-year-old gentleman who came in for a transient ischemic attack and left three weeks later with a CABG, two bouts of post-operative small bowel obstruction, acute depression, and lest I forget, a heel spur).

But, for all the scary moments, there have been some extraordinary ones. I am still fascinated by the medicine and the science, appreciate the perks and prestige my profession provides me, but mostly, I love those days when I feel I have done something for a patient that made a difference.

Like the time an 18-year-old called because she hurt her pinky finger. I was getting ready to dismiss a pinky injury (can we say "buddy tape?") but decided to complete a referral for an X-ray instead of sending her to the emergency room. Turns out she had a comminuted fracture that extended into the joint space requiring urgent orthopedic referral. Somehow, at 4:45 p.m. on a Friday afternoon, I was able to convince an orthopedic surgeon who had already left for the day to return to his office to splint her hand so that she could avoid a $150 copay at the ER. She and her mother were so grateful. Never once did I think I should bring her into the office to at least collect a copay for my time.

Or my 59-year-old diabetic patient, whose HgbA1c was 12 when I met her and is now down to 7.3, who tells me of all the doctors she's ever had, I am one of her favorites because she knows I care. She's not impressed by my college GPA or where I went to medical school, but by my ability to listen and understand that it takes more than state-of-the-art tests and medications to diagnose and heal.

Much of what I do does not require a fancy doctor's office with an expensive mahogany desk and framed accolades on the wall. What I do requires a love and appreciation for my profession, humility in knowing people entrust their healthcare to me, and believing I can always do better. It's the scary that doesn't allow me to become complacent with what I already know or overly confident about what I think I know. I recognize I don't have decades of experience behind me and I realize it will take much more than 500 CME credits to get me there, but what I do know is that when I look back 20 years from now, I will still believe that my hard work and dedication was worth it and I was meant to be a physician (and regrettably, not a "Top Chef"). This is the knowledge that makes waiting for my scariest moment not so scary.

Lisa Liu, MD, is a Florida transplant who moved to Illinois to attend college at the University of Chicago. She completed medical school at the University of Illinois at Chicago and her family medicine residency at MacNeal Hospital in Berwyn, Illinois. She is currently a hospital-employed physician in the Chicago area.