I wonder if there will ever be a time when I feel confident in my abilities to take care of clinic patients. Hospital patients, even though they are sicker and more complex, don’t bother me (too much. Don’t worry, there’s no an ounce of cockiness in me. Except that I know more neurology here at the private hospital. But that’s not hard). I have the labs, the xrays, the ancillary support and the time to figure out what’s going on. When a patient is admitted to me, I can concentrate on that problem and the one or two other medical problems to go along with it and everything else, I can, if not ignore, document and not worry about it. I have pharmacists to consult, time to look up articles, time when I can go back and ask the questions I didn’t get to the first time. I’m very efficient at it; I can see a new patient and have a good idea of what’s going on within 20 minutes.

It seems like an entirely different world in clinic, where I have a limited amount of time to get the patient’s entire history and yet pressure to produce answers right away. Symptoms that have been going on for years, I have to address and I’m expected to have a solution right then. I have no labs, no supporting procedures that I can order and have done by the next day. I feel like a fool because I haven’t done pelvic and breast exams, prostate and rectal exams, except for very specific cases, since I was a medical student. I don’t know the subtlities in how to treat erectile dysfunction or allergic rhinitis, because those patients don’t get admitted to the hospital.

My classmates don’t seem to struggle with this. I’ve never “belonged” in the clinic world and I feel it more and more acutely every week. I’m enjoying the medicine clinics much more than the neurology clinic, but I think that’s just because I’m new. Every week, I’m so drained and discouraged afterwards.

I keep waiting for that someday when it’s supposed to get easier.