In my medical school interview I was asked if I had self doubt. Of course I do - I am human. But then I met many doctors who seem to live free of this particular affliction. I still believe that self doubt makes you a better & safer clinician but I can also concede the point others make, that you don't want your surgeon to have doubt when they are cutting you.
As an emergency physician I got very used to every one else doubting me, especially doctors I was referring patients to. My last clinical shift in the NHS the on call surgical F2 told my locum SHO that the Emergency consultant's clinical judgment "wasn't worth a lot" - as I said in the subsequent email to his college tutor, my last act as an NHS consultant - it may well be the case that my clinical judgment is worthless but that's not really the point, the GMC code of conduct is pretty clear on this, there is a whole paragraph pertaining to respecting colleagues & not defaming them. I was quite cross about it at the time - it was 12 30 am on a Sunday night & it had been a long weekend on call. When the F2 came into the resus room to try to tell me that he had accepted the locum's referral so what was my problem, the patient I was then seeing - a man who had jumped from a bridge - was more concerned at my robust request that the F2 left my resus room than he was his bilateral smashed ankles & hips.
Of course although frequent - episodes such as the arrogant F2 would happen on a daily basis when I worked as an Emergency Consultant - nothing could have prepared me for the doubt shown towards me & my credibility here in Cambodia. It is not so much a daily experience but one that taints every single interaction I ever have in work with Cambodian health workers. I have blogged about it many times, it fuels my deep seated anger & frustration with this place & this week I may have just reached my limit.
Cambodian doctors & medical assistants (MA) - especially male - I have grown to expect this doubt from & can brace myself against their scorn. This week one MA got through my defences by flapping his hand in my face & laughing when I suggested a patent could have an iron deficiency anaemia - what a fool I was because apparently the man's daughter was rich! As I had been referring to occult bleeding causing the Hb of 4.7 I was a little confused as to why the daughter being rich had anything to do with the patient's current condition. This only served to make me look even more stupid because I was told iron deficiency anaemia never occurs in rich people. I tried to explain what occult bleeding was & how common iron deficiency anaemia was in high income countries but the hand went up again to silence me & I was told he wasn't bleeding, the MA could see no bleeding - how stupid was I? I didn't really get a chance to define 'occult bleeding' - I knew I wasn't going to get anywhere with this particular ignorant MA so I made my excuses & left the ward. Before I could stop them tears of frustration were running down my face. R was surprised that what is a daily occurrence for me had suddenly made me cry, he tried to console me, telling me I shouldn't mind the MA, he was the stupid one. I tried to explain to R why I appeared upset but was actually very frustrated. This frustration comes not from personal insult - such as the anger I felt with the case of the surgical F2 - but from an immense feeling of failure, failure to advocate for a patient & get them the best care, failure as a doctor.
I am a failure because I fail to convince people that I am credible & have any knowledge or skills. I am frustrated because this failing means that patients don't get the right care & health workers continue to have poor practice. This unremitting lack of credibility & respect has resulted in my self doubt reaching a new all time high. This soul destroying frustration will be the reason I leave - soon.
If I could apportion this doubt to only Cambodian health care workers it maybe would help to restore my faith in myself but unfortunately the expats here share the same behaviour. Although my medical opinion is frequently sought it is very often second guessed or dismissed.
The same day as the anaemia incident an expat - who I have never met before - emailed me for some medical advice. I gave them the diagnosis, probable cause & treatment (none). In their response they told me they had checked the internet & sent me the link to a chat forum to show me what the diagnosis was. They then explained to me how it could have been caused. I was left wondering if they had read my response to them. Did they thank me for my help - no, "Thank god for the internet!" was their parting shot.
Its days like these that make me question why I am even here & why I should bother to persist in trying. Its days like these that make me doubt myself.
As an emergency physician I got very used to every one else doubting me, especially doctors I was referring patients to. My last clinical shift in the NHS the on call surgical F2 told my locum SHO that the Emergency consultant's clinical judgment "wasn't worth a lot" - as I said in the subsequent email to his college tutor, my last act as an NHS consultant - it may well be the case that my clinical judgment is worthless but that's not really the point, the GMC code of conduct is pretty clear on this, there is a whole paragraph pertaining to respecting colleagues & not defaming them. I was quite cross about it at the time - it was 12 30 am on a Sunday night & it had been a long weekend on call. When the F2 came into the resus room to try to tell me that he had accepted the locum's referral so what was my problem, the patient I was then seeing - a man who had jumped from a bridge - was more concerned at my robust request that the F2 left my resus room than he was his bilateral smashed ankles & hips.
Of course although frequent - episodes such as the arrogant F2 would happen on a daily basis when I worked as an Emergency Consultant - nothing could have prepared me for the doubt shown towards me & my credibility here in Cambodia. It is not so much a daily experience but one that taints every single interaction I ever have in work with Cambodian health workers. I have blogged about it many times, it fuels my deep seated anger & frustration with this place & this week I may have just reached my limit.
Cambodian doctors & medical assistants (MA) - especially male - I have grown to expect this doubt from & can brace myself against their scorn. This week one MA got through my defences by flapping his hand in my face & laughing when I suggested a patent could have an iron deficiency anaemia - what a fool I was because apparently the man's daughter was rich! As I had been referring to occult bleeding causing the Hb of 4.7 I was a little confused as to why the daughter being rich had anything to do with the patient's current condition. This only served to make me look even more stupid because I was told iron deficiency anaemia never occurs in rich people. I tried to explain what occult bleeding was & how common iron deficiency anaemia was in high income countries but the hand went up again to silence me & I was told he wasn't bleeding, the MA could see no bleeding - how stupid was I? I didn't really get a chance to define 'occult bleeding' - I knew I wasn't going to get anywhere with this particular ignorant MA so I made my excuses & left the ward. Before I could stop them tears of frustration were running down my face. R was surprised that what is a daily occurrence for me had suddenly made me cry, he tried to console me, telling me I shouldn't mind the MA, he was the stupid one. I tried to explain to R why I appeared upset but was actually very frustrated. This frustration comes not from personal insult - such as the anger I felt with the case of the surgical F2 - but from an immense feeling of failure, failure to advocate for a patient & get them the best care, failure as a doctor.
I am a failure because I fail to convince people that I am credible & have any knowledge or skills. I am frustrated because this failing means that patients don't get the right care & health workers continue to have poor practice. This unremitting lack of credibility & respect has resulted in my self doubt reaching a new all time high. This soul destroying frustration will be the reason I leave - soon.
If I could apportion this doubt to only Cambodian health care workers it maybe would help to restore my faith in myself but unfortunately the expats here share the same behaviour. Although my medical opinion is frequently sought it is very often second guessed or dismissed.
The same day as the anaemia incident an expat - who I have never met before - emailed me for some medical advice. I gave them the diagnosis, probable cause & treatment (none). In their response they told me they had checked the internet & sent me the link to a chat forum to show me what the diagnosis was. They then explained to me how it could have been caused. I was left wondering if they had read my response to them. Did they thank me for my help - no, "Thank god for the internet!" was their parting shot.
Its days like these that make me question why I am even here & why I should bother to persist in trying. Its days like these that make me doubt myself.
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