When your confidence is shaken

A doctor reached out to me: “My confidence is shaken. I'm second-guessing every decision I make on call. How do I get through this?"

Many of us face this, and I certainly did as a resident and again as a fellow. The fact that you care so deeply about your treatment decisions and your patients speaks volumes about you as a person.

Our confidence as physicians can be shaken at particular times, typically when we are new to a field or after a bad outcome.

As a second-year resident in the ICU, I often second-guessed myself. When admitting a new patient, I'd wonder if I got the diagnosis right. Had I chosen the right treatment plan? When I'd get woken up with a page and make a decision, I'd often lie in bed wondering if I had chosen the right thing to do. Sometimes, I'd have trouble falling back asleep. When I left the hospital, I continued to think about my patients and treatment decisions.

The same thing happened during my fellowship. On call at night, I was making decisions for patients with bleeding disorders and cancer. I'd often double-check my treatment decisions while on the phone with the ER. There were many times when I had to call my attendings in the middle of the night, even though I never wanted to bother them.

If you're experiencing a decrease in confidence after a medical error or bad outcome, know that this can be one of the most challenging times for a physician. It takes time to process and cope with such an event. It can help to discuss this with supportive colleagues, find ways to prevent such an event from happening again, take time to journal, and talk with a therapist.

It's incredibly challenging to make complex treatment decisions that affect the lives of others.

How do you move forward? How do you approach your call shifts when you're questioning yourself? Here are some tips that can help:

1.     Ask for help when you need it. If you're uncertain about a treatment decision, seek support. Medicine is a complex field, and the evidence is continually evolving. Continue to look things up. When unsure, continue to run things by your co-residents, fellows, and attending physicians. When in practice, ask your peers. Medicine is a collaborative field.
 With time and experience, you will build your confidence, and soon, your peers will look to you for advice.

2.     Remember the times you've made the right decisions. It's easy to recall the times when we were uncertain about a decision or when a bad outcome occurred. Learn from these experiences, certainly, and try to recall the times you made the correct choice.

3.     Know that you are qualified and capable. We work in a unique field where we gain skills through hands-on interactions with patients and a slow increase in independence. You’re right where you should be in your education and training. Remember that learning takes time, and be kind to yourself on this path.

Practicing medicine requires practice, and there is no way around this. Confidence comes with experience. In the meantime, continue to lean on others for support, remember that you are capable, and recognize that your concern for patients demonstrates your genuine care.