Perception of Competency

During my M1 year, I shadowed a local rheumatologist in the area. She was pretty good at explaining concepts, most of which I wouldn't learn until my second year. I remember talking to her secretary and how she said that this doctor could have done anything she wanted: surgery, other medicine specialties...she was that good. Based on what I saw and heard from my personal conversations with her, I could believe it.

This past year I was able to spend some time in clinic with one of the FPs here in town. He worked at the federal clinic, and though I spent most of my time with my preceptor, I also had the chance to talk to the staff around the office. During my first week in clinic, the phlebotomist (who actually let me stick her because I needed practice drawing blood) remarked that "nothing seemed to faze him." Throughout my three weeks in clinic, however, I couldn't shake the feeling that there were many times where he wasn't sure what to do with certain patients or when I had questions, he didn't have an answer. To be fair, perhaps some of these questions were more geared towards specialists (I mean this is why they have extra training, right?) or the patient he had was indeed a difficult case. I could think of a plethora of variables to consider (town vs. gown, indigenous population, etc.) but the bottom line is that I began to realize that just like any other profession, there exists a wide range of competency when it comes to medicine.

I think this fact disturbed more because, to me, this seemed to insinuate that there are doctors out there who might be better off not practicing. I think about my own classmates and I see a wide range of ambition, competence, and motivation. I look at myself these past years and wonder where along this spectrum I will fall. I sometimes think that if people knew where doctors came from, we wouldn't be nearly as trusting of the medical profession as we are.

The second thought about all of this was the different levels at which people view their doctors. The FP had plenty of patients that had been with him for a long time and loved the guy. Certainly, this not only suggested that he was helping people medically, but that they saw something either about his personality or professional demeanor that led them to believe that he was doing a satisfactory job. The phlebotomist felt like the physician was always on top of things or at least in control. I, on the other hand, saw things differently.