"L-i-s-d-e-x-a-m … Uh-oh … Oh no … Is it ph or f?"
A quick glance up at the patient awaiting his handwritten prescription confirmed everything I had hoped this situation would not become. As I fumbled through writing one of my first non-digitized prescriptions, I could feel him watching my anxious scribbles.
In that moment, I silently cursed my malfunctioning desktop printer, which until today, had always been so reliable. I then turned my blame to the electronic medical record, which for years required me to type only "lisdex" before populating the rest of the medication name. I then blamed whoever decided that lisdexamfetamine should be spelled with an f (or is it ph?). This was their fault too.
However, in that same moment, my frustration quickly turned to something else: I became fearful. Fearful that this patient would realize that he has a doctor who can’t spell. Fearful that he would realize I had to refresh myself on lisdexamfetamine dosing just moments before he walked in the door. Fearful that he’ll realize that I’m just a resident.
Feeling the heaviness I created from this situation, I cautiously finished the prescription: lisdexamfetamine, 40 mg capsule. I handed him the piece of paper with a sense of unease and guilt, as if I had just provided him a check that would soon bounce or a coupon that I knew was expired. The session ended before I could reveal any further signs hinting at my perceived incompetence, and as soon as he left the room, I spun around to my desktop computer and consulted Google: "l-i-s-d-e-x." The magic of the Internet populated the rest of the search in the same dependable way that the electronic medical record always had for me: lisdexamfetamine.
My brief moment of spelling hesitation indicates how even trivial mishaps of residency can instigate feelings of anxiety and self-doubt. As psychiatry residents, we are trained to identify and treat unhealthy cognitive patterns in others, but we may not be as adept at doing the same for ourselves. We all have these moments; however, it is not often that we speak about them. Intrusive thoughts of self-doubt can linger throughout much of our training and career, but they can become much more manageable when there is an understanding that many others share these experiences. As students and residents, we may feel expected to appear composed, without a hint of vulnerability throughout this entire process. This not only makes disclosure difficult but can also discourage help seeking.
As we continue into another academic year, I would like to encourage as much transparency and honesty as possible regarding feelings of uncertainty, doubt, and apprehension that you may have. Medical school and residency can be challenging, but they are even more so when you believe that you are the only one who struggles. I look forward to working with you all this year, and please do not be too hard on yourselves if you have any trouble spelling. We all do sometimes.
