 Being a doctor may sound glorious on paper, but there's definitely some parts that absolutely suck. Let's break those down. Hey friends, welcome back to channel. In case you're new here, my name is Lakshman, internal medicine physician. And here at the MD journey, we make content to help people like you succeed on your medical journey wherever you are doing it with less stress. And while most of my content tends to be like me on the optimistic side, today I'm going to talk about the parts about medicine, particularly about being a physician that makes the job a lot more tougher, things that people don't really talk about. Try to give you guys a full spectrum of what the job's actually like. Let's break it down. At any point during the episode, you feel like you're getting some value when you want more of where that came from. Make sure you check out some of the free links down below, including our med school success handbook. It's an entire handbook that I've created for all my favorite lessons and strategies that I used in med school and now a residency that I love to share to students like you. So if you're interested, that'll be linked down below. Now challenge number one is accepting that you can't help everyone. And now this is a lesson that I've definitely learned over my three years of residency, particularly when I do more difficult rotations like an ICU month, where I realize that there are some patients who are just beyond both mine, as well as the medical capability that we have at this time to take care of the people who have end stage liver disease, kidney disease, heart disease, or people who just have a really nasty infection and don't respond to the antibiotics or the fluids or the multiple different medications that we give them. And so when they get sick, they get sick really fast and they crash really fast. And the challenge is that sometimes it doesn't matter if it's somebody who is older, who has a chronic disease, you kind of knew was heading in a direction of eventually passing away from that said disease, or somebody who is unfortunately just has bad luck and maybe a young individual who medical treatments interventions may not be working. And as an example, I recently finished a month in the ICU and I had its unfortunate situation where I had a 20 to 30 year old who came in with an infection. And despite all the antibiotics, all the fluids, all the pressures, all the interventions, patients still succumb to their disease. That's the first challenge is realizing that there are going to be patients that despite you doing everything, they may not get better. But once you're able to accept that, this is really where my optimistic side comes out, you can then take off your medical doctor hat of just doing all the things and put on the hat that requires a lot more soft skills. And those soft skills include things like listening and being there for the both the patient and their loved ones. So you can just really understand what their goals are once they hear such difficult news. And sometimes that means that the physician, you can now actually do something because as you hear the goals of the patient, if their life expectancy is in the span of hours, days or weeks, you can say, well, what are your goals? And if they say, I want to be comfortable, I don't want to suffer. You can do things as a physician to help take care of those things to make it a little bit smoother for both the patient and their family. Challenge number two definitely has to be documentation overload. Now you definitely see this as a medical student, as you're writing notes on your clinical rotation, but really just multiply this by 10X when you're in residency or you're attending, because you're writing a variety of notes, whether it be your history and physical notes. And when you initially admit a patient, your progress notes, any procedure notes, discharge notes, discharge instruction for the patients, it really starts to get overwhelming. And when you have a panel, for example, an internal medicine of anywhere from 10 to 20 patients, it really starts to get overwhelming. And that doesn't even include extra notes, such as if I call the family, I may write the updates and the conversations I had with their loved one. Or if I wrote my note and then I got called by a nurse because a patient wasn't doing so well and all the different things that I took care of at that point, that may be a new update now. And so the challenge is that there's going to be lots and lots of documentation. And unfortunately, you're also going to have hounds of people that are behind a wall or a computer screen, are going to be sending you emails and requests when you forget to do something or don't do something exactly right. And it really does take a toll on you, especially if you're having a really busy day. And it's part of going into medicine that people don't highlight enough of how much work you do behind a computer and less work you do at the side of the patient. Challenge number three is that patient care is usually built within a business. And you probably experience this at some level, whether you're a medical student or your resident, but as you go higher up the chain. So for example, next year, I'm going to be in attending. I'm going to be graded or essentially evaluated on specific metrics. How happy are my patients? How quickly are they getting out and other things such as how quickly I'm writing my Asian peas, my discharge summaries and making sure that there's no patients who are coming back to the hospital. That is a lot to keep track of. And sometimes not all of those are going to be in my controls. So for example, if I discharge a patient, but they chose not to take their meds and they came back to the hospital, it may look bad on me and may look bad on the metrics. But again, that's not all within my control. And so the unfortunate fact is that all of these policies, all these metrics, all these things that you have to follow as both a student, a resident and an attending are often made by people who don't take care of patients or haven't taken care of patients for quite some time. And you just have to accept it. Because again, at the bottom line of it, it is really all about the bottom line. So if there's something that you can do to make the hospital a little bit more money, unfortunately, that comes down to the physicians and the nurses to discharge a patient on time and to illustrate this challenge a little bit better. If I saw you in an outpatient clinic and I spent my time making sure that you understood everything about your care, like what type of things to eat, how to exercise, why to stop smoking, why these medications are important to you, what side effects you should be expecting and doing a lot of counseling. Before just a few years ago, if a physician was to bill for that, it wouldn't seem very productive. They were spending an excessive amount of time for the care that that patient was getting. And it was really just determined based off of how many patients you could see. This is a reason why 10 to 15 minute visits in the outpatient setting became so unpopularly popular here in America because a revenue model was designed where you had to see more patients to be able to pay for your clinic bills, your staff and yourself. Now, thankfully, the outpatient compensation model now does include time as a factor. So physicians can go back to spending quality time with their patients providing counseling as needed. But you can see how rules made by often people who don't practice or take care of patients, start to affect how and what care I provide to the patients that are in front of me. Challenge number four is that you're always proving your worth. Now, this is something I'm going to learn a little bit better. But as you go through your journey, as you're going through medical school, you know, it's hard, it's hard and you finally figured out and then suddenly you go into residency, then you go into residency and you have no idea what you're doing, maybe a little bit more, but still kind of confused. And then by the time that you're getting close to being at upper level and about to graduate, you finally feel comfortable. That's where I am. And then sure enough, I'm about to work and get my first job in attending and I'm going to feel super overwhelmed. I'm already ready for it. I'm already prepared. But every single phase, you're feeling like, Tank, do I belong here? Like I have to do even more to prove that I'm good enough to be at the stage. And there's this constant battle of proving to your patients, your peers, and most importantly yourself that the training, the experience that you've had is good enough for you to be at this point. And that gets into challenge number five, which is that imposter syndrome never goes away. This is definitely a principle that we talk about in medical school where you always feel like you trick somebody. Like I got into medical school, but probably just because I wrote my personal statement this way or maybe they didn't see this grade for my organic chemistry class, because let's be real organic chemistry destroyed most of us. But that imposter syndrome never goes away. You always feel like you just got away with something and you trick people to believe that you're good enough to be the stage. Even now, when I take a step back, like I know I'm a good physician, I know that there are things that I know to be able to take care of majority of internal medicine problems. But if you put me in a room with other physicians, I don't feel like I'm smart enough to be with them, although we have the same amount of experience. If you put me in a room with a patient, I could easily get flustered internally and feel like, man, maybe I should have known that I should have studied that you start to beat yourself up and that process never goes away. Again, when I'm about to be in attending in just a few months, I'm definitely going to start feeling it when there's going to be a lot on the table that I just don't feel comfortable with. So take comfort in the fact that that challenge never goes away, because if you're early on your medical journey, understand the people who are higher up on the hierarchy or on the ladder or on the staircase, whatever you like to say, those people feel the same thing as well. It never goes away. You just learn to deal with it and accept it and then go forward. But those guys are some of my biggest challenges as a full-time physician, things that I deal with on a daily basis, things that I hate doing, things that I accept and really change what kind of care I can provide to my patients. But all in all, as I always say, I freaking love, love, love this job. I love working with people. I love using my knowledge and my experiences to help people. That's exactly what medicine allows me to do. Now, if you guys are interested in why I picked internal medicine, then go ahead and check out this episode right here on my favorite reasons of picking internal medicine and especially after three years of internal medicine, a why I would do it again. So if you guys are on the fence and considering I am, that'll be linked down below. And as always, if you got value out of this episode, you're like, I want more of what that guy is addition out. Go ahead and check out some of the free resources. So a few that I recommend include the Med School Success Handbook. Those are all of my favorite lessons and principles and strategies that I myself, as well as I've seen other top students use that hopefully after just going through them really quickly, you can start seeing a different change in your approach and your studying, your time management, your stress management and so much more. And I'm constantly also adding to it on a weekly basis. So make sure if you do get access to it, that you bookmark it so you can come back to it and saying, what other lessons have Lux put there? I promise you there'll be more. In addition to the Med School Success Handbook, there's lots of other free resources like how to study better, how to get better grades using our three step program or the same study method that I use in medical school. Those will be linked down below. But if you got any value out of this episode, all I ask is that you hit that like button down below. If you're new here or if you haven't joined quite yet, consider hitting that subscribe button and that notification bell to be notified when new videos like this one go out live. If you're listening to this as a podcast, I love it. If you'd first quickly go hit in that follow or subscribe on your favorite platform and then it would be super appreciative. You just go to iTunes, even if you're not an Apple user and leave an honest review of the TM day show on iTunes. But that being said, my friends, if you have any questions or comments, make sure you add them down below. If you did enjoy this episode, you'll enjoy this episode on how and why I picked internal medicine and why I recommend you do in the same as well as this episode right here, where I talk about how I study as a full-time physician step by step. So check these out. And as always, thanks for being a part of my journey. Hopefully that was a little help to you guys on yours. I'll see you guys in the next one. Peace.