The dumb doctor

“Do you ever feel dumb? Like, so, so dumb?” I asked my physician friends over Zoom.Most of them stared at me, waiting for more information. But two friends looked me in the eyes and nodded vigorously.“You mean at work?” one asked.“Yup. I don’t think anyone ever told me that if I’m maxing out my pressors, I should treat acidosis more aggressively.”Now that I’ve had time to reflect, I could have figured it out since acidosis is one of the causes we troubleshoot in pulseless electrical activity, among others. And it’s possible that a preceptor mentioned that hot tip during my ICU rotations, but my brain was full between ventilator settings and one-in-two call.This time, the accepting physician at the ICU told me to give two amps of bicarb, and we were able to back right off on the norepi. Mischief managed.Doctors are supposed to be super brains. The smartest kids on the block, if not the country. My entire pre-med and med career, I stressed out, trying to answer every question precisely and correctly before I intubated and installed central lines on 20 minutes of sleep. Better, smarter, faster. Always.But was that the wrong approach?“I’m scared,” one of my classmates admitted to her colleagues when we graduated and started managing the emergency department as full-blown staff.Her admission of weakness shocked me on all levels. She is brilliant and efficient, and she’s scared? When she told me about it, I shook my head. “I would never say that.” It wouldn’t even have occurred to me.“I used to be like that,” she replied, “but then they try to break you. If you say you’re scared, they say, ‘Aww, I’ll take care of you.’”That made sense. I’m sure it worked, especially if you’re a cute little femme-presenting doctor. I suspect guys get less of a pass on that.Regardless, I believe medical culture is changing for us all. When I was in med school, they told us we’d make mistakes. They emphasized that we didn’t have to be perfect.In some ways, I think it’s easier to admit imperfection now. My little ER used to have solo physician coverage day and night, year after year, with no formal sick coverage.Fast forward to 2026, when we currently have funding for a second doctor to help for up to four hours a day, and a system for an on-call physician (although everyone’s maxed out, so the schedule can be left as “open”). Still, as long as the funding holds, we have a second ER physician for a few hours of respite. A respiratory therapist comes two days a week. We need all hands on deck because patients are often sicker and more complex, on top of ever-higher volumes. “We intubated every day during the holidays,” commented one nurse.Our ER also has two newer “call a friend” options. It means we can call an intensivist for critically ill adult patients and or an ER doctor for patients of all ages and acuity. Neither system is perfect, mainly because they take time. Our chief of ER encouraged us to call more, explaining that “critically ill” doesn’t have to mean death’s door. We’re under-utilizing that service.What a relief compared to the olden days where you had to fend for yourself!On the other hand, the standards have shot up as well. The Canadian Medical Protective Association mentioned that the number of complaints skyrocketed by 12%, year after year—and that might have been five years ago, which means that rates have probably gone up even more.One program director told me that the family medicine residents are supposed to top their cohort in every rotation.I blinked. “You expect them to be better than the surgeons on surgery, better than the dermatologists at dermatology, and better than the radiologists on radiology?”“Yes.”“That’s not possible.”“We think it is.”So okay, MDs are still held to impossible standards. And no one wants a dumb-dumb doctor.“Because when we make mistakes, people die,” a doctor said at the Canadian Women in Medicine conference. I nodded along. This is what I’ve said and heard for years. Until Dr. Mamta Gautam pointed out that most of the time, this isn’t true. When we make mistake, normally, they’re not life-threatening. Normally, patients are okay.Of course we don’t want to make mistakes. I feel stupid, incompetent, name your poison. But this is how we learn, right? Acknowledge, troubleshoot and learn to do better next time.The last thing you need is to beat yourself up.I’m not good at this, but I have friends wiser than me.So, give yourself grace. Once you finish your training, you have more leeway to pick somewhere to work that’s a good fit. Surround yourself with friends and colleagues who will not only help make yourself a better doctor, but also understand you as a person. And just do your best.

The dumb doctor

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Blog Author

Dr. Melissa Yuan-Innes

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