Do We Have Autistic Physicians Here?

[Darwin]

Hey there,

I am still a student, but am worried about when I will have to deal with patients in the future.
Tell me about your experience when you first started dealing with patients. How well could you mask?

 

[Nitro]

If you are educated and qualified to do your task, why would it matter how well you hid your condition from others?

It never once crossed my mind to ask a medical professional anything about their neurology.

 

[Bolletje]

I’m an Aspie physician. I have no trouble with my patients. I just put on my pleasant professional face and I’m in doctor mode. I feel like the amount of communication training in my curriculum prepared me very well for this part of my job. I have good bedside manner, I’m good at communicating clearly yet friendly with my patients and I’ve got a knack for discussing bad news with patients and their family (since one of the departments I worked in was pulmonology, this came in pretty handy)

Something I wasn’t prepared for was the constant interruptions. When working as a physician in a hospital, your phone will be ringing constantly, and if it isn’t ringing someone will be interrupting you in person. You will rarely get a moment to work on your vast mountains of paperwork. You will rarely have time for a lunch break, coffee breaks don’t exist and you will spend the evenings you’re supposed to be off catching up on paperwork, unpaid, in your own time. You will not have a social life.

You will be overworked, understaffed and underpaid. Chances are you'll be made to work night shifts way too soon after starting your job and you could end up having little to no supervision. I hadn’t been on the job for two months and I was suddenly faced with a situation in which I had to take charge and direct a huge team in the resuscitation of a young woman with a massive pulmonary embolism. I knew all the steps I had to take, but when there’s 12 people standing around you waiting for directions while a woman is dying on the table, and you haven’t even seen real life CPR before, well, chances are you blank. I was happy I had a cheat sheet for the correct steps in my pocket.

And while I was trying to coordinate these efforts I got two more emergency calls because two other patients on two different wings were also critically unstable, but since most of our capable personnel was tied up with the resuscitation efforts in our A&E wing, I had to make do with one nurse and I had to physically run all my bloodwork to the lab myself. I burned so many calories working the nights, running all over the hospital and putting out fires all through the night.

The first few months as a medical doctor, especially in a hospital, are incredibly overwhelming. Pretty much everyone has a breakdown a few months in. After that, they either continue down their path at the hospital, or choose a different path. There’s no shame in either.

I don’t mean to scare you off at all, I just mean to paint a picture of what it was like for me when I started as a physician. Even though my work in the hospital was hard for all the reasons I described before, I loved my job. I had to quit for health reasons and I’m still mourning the loss of the career I had planned for myself. If you’re interested, you can read about some of my experiences as a junior doctor on my blog on these forums, I wrote those while I still worked in the hospital. Or PM me if you have specific questions.

I’m a physician for the government now. It’s less glamorous, not as intellectually stimulating and there’s no heroics to the job, but I have regular hours, I’m in charge of my schedule, I get paid better and I can really make a difference in my job. I can’t cure or treat people, but my assessments can determine whether someone gets disability benefits for the rest of their life, or whether they’re cut off and expected to go back to work (those are extremes, there’s a lot in between). It takes an analytical and logical approach and that suits me, but I still really miss the hospital.

Best of luck with your studies, and feel free to hit me up if you have any questions!

 

[Darwin]

If you are educated and qualified to do your task, why would it matter how well you hid your condition from others?

It never once crossed my mind to ask a medical professional anything about their neurology.

I meant putting on a mask to deal with patients appropriately.

 

[Darwin]

I’m an Aspie physician. I have no trouble with my patients. I just put on my pleasant professional face and I’m in doctor mode. I feel like the amount of communication training in my curriculum prepared me very well for this part of my job. I have good bedside manner, I’m good at communicating clearly yet friendly with my patients and I’ve got a knack for discussing bad news with patients and their family (since one of the departments I worked in was pulmonology, this came in pretty handy)

Something I wasn’t prepared for was the constant interruptions. When working as a physician in a hospital, your phone will be ringing constantly, and if it isn’t ringing someone will be interrupting you in person. You will rarely get a moment to work on your vast mountains of paperwork. You will rarely have time for a lunch break, coffee breaks don’t exist and you will spend the evenings you’re supposed to be off catching up on paperwork, unpaid, in your own time. You will not have a social life.

You will be overworked, understaffed and underpaid. Chances are you'll be made to work night shifts way too soon after starting your job and you could end up having little to no supervision. I hadn’t been on the job for two months and I was suddenly faced with a situation in which I had to take charge and direct a huge team in the resuscitation of a young woman with a massive pulmonary embolism. I knew all the steps I had to take, but when there’s 12 people standing around you waiting for directions while a woman is dying on the table, and you haven’t even seen real life CPR before, well, chances are you blank. I was happy I had a cheat sheet for the correct steps in my pocket.

And while I was trying to coordinate these efforts I got two more emergency calls because two other patients on two different wings were also critically unstable, but since most of our capable personnel was tied up with the resuscitation efforts in our A&E wing, I had to make do with one nurse and I had to physically run all my bloodwork to the lab myself. I burned so many calories working the nights, running all over the hospital and putting out fires all through the night.

The first few months as a medical doctor, especially in a hospital, are incredibly overwhelming. Pretty much everyone has a breakdown a few months in. After that, they either continue down their path at the hospital, or choose a different path. There’s no shame in either.

I don’t mean to scare you off at all, I just mean to paint a picture of what it was like for me when I started as a physician. Even though my work in the hospital was hard for all the reasons I described before, I loved my job. I had to quit for health reasons and I’m still mourning the loss of the career I had planned for myself. If you’re interested, you can read about some of my experiences as a junior doctor on my blog on these forums, I wrote those while I still worked in the hospital. Or PM me if you have specific questions.

I’m a physician for the government now. It’s less glamorous, not as intellectually stimulating and there’s no heroics to the job, but I have regular hours, I’m in charge of my schedule, I get paid better and I can really make a difference in my job. I can’t cure or treat people, but my assessments can determine whether someone gets disability benefits for the rest of their life, or whether they’re cut off and expected to go back to work (those are extremes, there’s a lot in between). It takes an analytical and logical approach and that suits me, but I still really miss the hospital.

Best of luck with your studies, and feel free to hit me up if you have any questions!

A bit scary, but I kind of knew that. The hardest part for me would probably be “acting normal.”
I haven’t dealt with patients yet (only books,) but I think I will have to in a year.
I will check your blog, and would contact you if I had questions. Thank you!

I think I will start reading books about clinical medicine. Do you have any suggestions? Surgery and operations scare me. Are there reliable applications to virtually learn to do operations?

 

[Nitro]

I meant putting on a mask to deal with patients appropriately.

How would be doing the job you are qualified or trained for have anything to do with how a patient views you?

Once again, if you know your job and can do your jobm, what difference will it make?

Your patients for the most part won't be neuropsych professionals with enough face to face time with you to do an assessment on you, so in the bigger picture will it really matter?
Your sheepskin and passing your boards are the most important part that you should be focused on, not how you may come off to those you are caring for.

I met a few doctors that had horrible bedside manners, but were also considered the top in their chosen field.

 

[Darwin]

How would be doing the job you are qualified or trained for have anything to do with how a patient views you?

Once again, if you know your job and can do your jobm, what difference will it make?

Your patients for the most part won't be neuropsych professionals with enough face to face time with you to do an assessment on you, so in the bigger picture will it really matter?
Your sheepskin and passing your boards are the most important part that you should be focused on, not how you may come off to those you are caring for.

I met a few doctors that had horrible bedside manners, but were also considered the top in their chosen field.

I agree. Unfortunately, we, as students, are assessed for our bedside manners. That’s what concerns me the most, grades. I am not actually concerned with how well my bedside manners are/will be because I am more interested in becoming a researcher.

 

[Nitro]

I agree. Unfortunately, we, as students, are assessed for our bedside manners. That’s what concerns me the most, grades. I am not actually concerned with how well my bedside manners are/will be because I am more interested in becoming a researcher.

I'd say just act like the professional you wish to be.
I believe you are putting too much pressure on yourself.

 

[paloftoon]

Doctors are stereotyped for their lack in social skills kind of outside of their technical know-how for medical generally speaking. You could end up being one of those socially awkward doctors that can meet enough patients needs to get the job done right and also a person to not get in a lawsuit too. It's definitely possible :/

 

[Aspychata]

Medical school first, then you will do different rotations in hospitals and clinics,(PGY-1) This will give you the ground work to determine where you want to work.

You will feel more comfortable as you continue. But you have very long hours in residency, like Bolletje kindly filled you in on, this can make or break you. Long shifts back to back unless you head straight to research. Relationships are difficult to maintain at this time.

Do you need a state med license for research? For feds, you only need one state license, they will accept any state license. They also cover your malpractice insurance and they usually have one DEA number for scripts. If you are private then you need to get updated on that. Federation Board out of Texas will keep all your records for a fee, and then you can use them when applying for jobs, they also speed up applications for certain states licensure.

 

[Tetreg]

I suppose this conversation refers to the American healthcare system, not that the NHS is currently a barrel of laughs either. I'm learning to deal with patients (I'm in my last few months as a medical student) the same way I have adapted to all social scenarios in which I have acquired at least some competency, which is by observing the behavior of my peers and integrating it into my own approach. Even if you are awkward at first if you can get onto the course in the first place you can almost certainly learn to do the above. I suppose one additional point to note is that it may help to adopt a degree of ruthlessness regarding the errors you will make, i.e. to acknowledge that in medicine (and in life in general) your mistakes in your interactions with others may hurt and upset them, but that the best response to this situation is not to descend into paroxysms of regret and anxiety in response but to calmly memorize and avoid repeating any incidents, which will probably be better for you and anyone you interact with going forward

 

[Bolletje]

A bit scary, but I kind of knew that. The hardest part for me would probably be “acting normal.”
I haven’t dealt with patients yet (only books,) but I think I will have to in a year.
I will check your blog, and would contact you if I had questions. Thank you!

I think I will start reading books about clinical medicine. Do you have any suggestions? Surgery and operations scare me. Are there reliable applications to virtually learn to do operations?

There are a lot of great books. I used to have Oxford's handbook of clinical medicine with me at all times during my internships. It's great for quick reference, but you're going to need a bigger book for thorough studying. When I was a student I had Kumar & Clark Clinical Medicine. I liked the book a lot, but I'm not sure whether it's the best. I just bought it because it was required reading.

As for being nervous around patients, I think that's the same for everyone when they start doing their clinical rotations. I was very nervous around patients at first too, but when I explained that I was still learning to be a doctor, most patients were very friendly. I used to be incredibly nervous when I had to insert IV's. I had this great patient, very friendly, who noticed how nervous I was and he coached me through the whole thing. It took me three tries, but he was so kind about the whole thing that I managed to calm my nerves and do it correctly.

As for apps to learn surgery, I honestly don't know. I used to ask surgeons the day before surgery which approach they would use for the procedure and what plan B and C were. If I was lucky, they'd make a quick sketch of what these approaches would look like in surgery. If I wasn't, I'd spend the night watching videos on youtube. Still, you probably won't be performing any surgeries during your internships, at least that doesn't happen in the Netherlands where I work. Surgery internship was mostly holding clamps in the OR or standing behind the surgeon on a footstool and looking at the operation from a safe distance. I've only wielded a scalpel twice, both times to relieve an abscess. A tip for surgery rotation: study anatomy vigorously.

If you're not looking forward to patient care and would prefer to do something that requires less patient contact, research is a great idea. If you hadn't considered it, I'd also recommend looking into radiology. It's my passion in medicine and I was planning to become a radiologist, but I can't do it for health reasons, which sucks.

 

[Pats]

@Bolletje mentioned that knack for discussing bad news. I'm not a physician, but I'm a nurse and worked in a hospital for 15 years. I think we have an advantage in some areas, and this is one of them. That and handling emergency situations. Because we can stay in professional mode and remain calm when others might not. This is actually the part I miss. I dealt with a lot of death - between working with Aids patients and geriatrics, that's just the way it is. I was good at being able to help the family members during the time of death - "What do we do? What do we say?" questions. And I feel like if the family member felt they helped the patient at the end and did what they needed to do, it helped them handle the death without guilt that often follows.

That and the difficult situations. When there was an angry patient I was often the one they would send in to talk to them, believe it or not. Because I could just be calm and matter of fact and not let emotions get in the way of the information they needed. Plus I didn't talk down to them, just would sit down and talk person to person and give them the facts.

And, @Bolletje those intern nights at the hospital - were the nurses not helpful? I remember once a new intern was on call and I called with a high ptt so he gave me an order to increase the heparin drip. I knew not to give interns a hard time or anything, so I just asked if that was what he wanted or did he want me to decrease it. He said he would call me back, then called back with a correct order. You probably will learn quickly which nurses you can trust and count on also?

Anyhow, Darwin, best of luck - you can do this.

 

[Bolletje]

And, @Bolletje those intern nights at the hospital - were the nurses not helpful?

Some nurses were great. There were a few I worked really well with and I still miss working with them. But the hospital I worked with was trying to cut costs by giving temp contracts to inexperienced nurses and firing them after a year, so most of the nursing staff was not very seasoned. I treasured working with the good ones though. When I saw there were working night shifts with me, I instantly felt relieved because I knew my night would be a lot easier.
Some nights were terrible though. I once had a nurse call me because she had been unable to find a pulse or a measurable blood pressure on a patient for over half an hour and she couldn’t wake the patient either. She didn’t think to sound the alarm or even call me the first time this happened, she waited for that long. When I arrived I found a clammy, gray patient in deep deep shock. Had to ship him off to ICU immediately and he didn’t survive in the end. Or a nurse on the pulmonology ward that gave a huge supply of oxygen to a hypoxic COPD patient without consulting me, leading to serious hypercapnia before I caught it. I had a lot of near-misses and calamities because of inexperienced staff. I didn’t blame them, I blamed the hospital, but I still got angry sometimes because they made serious errors that seriously compromised patient safety.
Putting inexperienced doctors with experienced nurses and vice versa works as long as there’s good communication and people stick to protocol, but a lot of our inexperienced staff just panicked and did whatever they thought of at the moment, instead of following protocol.

Anyway, I have fond memories of hanging out at the nursing post with my favorite nurses at night. Working with them was smooth sailing and we got along very well. We worked very well as a team during bad news conversations as well, making a plan for the patient together before going into those talks and making sure we were available for the family afterwards.

 

[Pats]

Yes, I have to say that some of the nurses I worked with - I wouldn't want them taking care of me or any of my family for sure. Had a nurse once call a code before bothering walking down the hall to put the leads back on a patient - patient was fine. And had a boss that I wanted to beg her to please not do anything with my patients.