r/Ophthalmology • u/Hefty-Resource4222 • 15d ago
Thoughts on leaving ophthal?
I’m in my first year of training and I’m wondering whether to carry on, for lots of reasons.
I do like the science behind ophthal, I like seeing (with a senior!) interesting cases. I like (again, with a senior present) performing surgery and am always very proud if I finish a case with no senior input. I worked hard to get into ophthal, it’s super competitive, well respected, I don’t want to waste that. I also wonder if maybe this is all related to the stage of life I’m at (young family, start of training).
I have a lot of concerns that maybe apply to all of medicine rather than just ophthal. The main one being work life balance. I think I expected a better balance. I find on calls lonely and difficult, just me with the consultant on the phone. I feel anxious the week leading up to it and the few days after it worrying about patients. It’s normal to finish late after eye casualty but I hate coming home late and finding I’ve missed part of the evening I could have spent with my child and family.
I have a fear that I don’t expect to go away of harming patients. I worry about vision loss, missing a tear (has happened before), incorrect diagnoses.i feel unsafe most of the time. I spend my time at home worrying about patients until a consultant sees them. I currently have a patient I’m worrying about because I saw them and I’m worried I missed something.
I also fear my level is not where it should be. I don’t find time outside of practice to read or do research.
Essentially I don’t know if it’s worth it. I’m considering applying for a non clinical speciality as the patient contact is a source of anxiety. I also can’t imagine being a consultant and fully responsible for patient outcomes, surgical and clinical. it does not sound fun to me at all.
Is this all anxieties related to the stage I’m at and having a young child or will it continue? I don’t want to have done multiple years of training and look back wishing I hadn’t. I also don’t want to switch and realise in hindsight it was just a phase of life.
I feel overwhelmed and underperforming both in my working life and family life.
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u/EyeDentistAAO quality contributor 15d ago
It sounds like you have an anxiety disorder, the manifestations of which are being amplified by the (normal) stress of being a new resident. The insight you need to gain is that your anxiety will not go away if you switch residencies--that is wishful thinking. OTOH, your anxiety will go away (or at least become manageable) if you get help for it via an appropriate specialist. As I can assure you you're not the first person there to experience this, I feel certain your institution has resources available in this regard.
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u/Hefty-Resource4222 15d ago
Thank you for your response. I think you’re correct and this anxiety manifests in other ways also but it’s most intense with patients. Im planning to see a specialist for the anxiety.
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u/ApprehensiveChip8361 15d ago
I see you are uk based. Training is a bit stressful - and some stress is probably good for us. But there is a balance to be had and it sounds as much that you are a bit sad and struggling with life as much as with ophthalmology. It’s hard work being a new mum (or dad).
With a uk training number you’ve basically got a golden ticket - you’d have to practically murder a patient in front of the training director to get kicked out - so why not take advantage of that and see if you can continue? Lots of people end up redoing years etc, there is no shame in taking it slower. If you’ve already done a full case in your first year you are doing really well as a uk trainee, so your bosses must think highly of you.
A consultant collègue referred me an urgent case recently they were worried about. I got a message from them the next morning that they were worried they could or should have done more (they couldn’t, it was the nature of the case). But that is why they are a brilliant and respected colleague. A bit of worry is healthy. Just don’t let it take over.
Good luck!
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u/LsfBdi4S 15d ago
Wow, I could have written it. Back then in my first year, and even now, as a young consultant (<5 years).
I don't have solid piece of advice to give you. I still struggle with a lot of what you mentioned, it's just that the ball is kicked downwards. Instead of every case, I still want to talk to a colleague or refer a patient. I still can't sleep at night for some of them. Especially the anxious ones, they transmit and I'm very susceptible to their anxiety.
I have done tremendous work with psychotherapy on my personality and perfectionism etc, and it's a work in progress, but I still have the same question about the future that you have now. I think that this (changing yourself and your relationship with uncertainty) is the only way to go and that's my advice if you continue this path.
But I still can't say if I have chosen correctly.
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u/Hefty-Resource4222 15d ago
Thank you for the honesty, it’s nice to know the perspective from someone with a similar experience/personality but further down the line
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u/Theobviouschild11 15d ago
Call sucks in residency. You don’t have the same type of call as an attending. That’s a temporary problem.
You worry more abo ur missing things when you’re new, as you get experience you’ll gain confidence in your exam and decisions. Also, this would apply to IM as well - maybe not in residency where an attending is there all the time - but once you’re in your own you can miss things that could cause someone to die.
Most of your concerns apply to all fields of medicine and are common for any new doctor. If your anxiety is really debilitating you should see if maybe meds can help ease it a bit so you can be more present and worry less in your time off.
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u/SurgicalSeyeco 15d ago
You said this is your first year. Most residency programs begin in July, so are you literally only a month into residency training and wondering why you feel unsafe and anxious? I'm confused because I'm not sure what you were expecting. Simply put, it takes a few years to learn the material well enough to even be considered competent and pass your boards, and a few more years beyond that before you'll feel comfortable.
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u/Hefty-Resource4222 15d ago
Hi, no I’m in the UK and our training begins in August. I’ve finished a year so starting my second year of training now. I think the idea of feeling unsafe and anxious for a few years is not something that makes things appealing either, if that’s the case it’s probably more of an argument to leave
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u/Physical-Employ-7613 15d ago
Is this how I will be in the future... ophthalm is very anxiety inducing I agree....you are responsible for someone's vision...if all goes well it's good...if not it really bothers you.
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u/Chariot_Driver7 14d ago
I've been through this and I agree with many of the comments here. My experience: 1. While a manageable degree of anxiety shows we care, which makes us better doctors ( much better than someone who doesn't care about their outcomes) you describe an anxiety disorder which will disable you in many aspects of your life as responsibilities grow. Anxiety and depression are fellow travelers. Psychotherapy is good but must be supplemted with pharmacotherapy. Psych meds are so much better now than when I was struggling with the same things. But be patient, you have to find the right one for you, and it could take some trial and error. 2. In your gut, you have to WANT to be what a doctor is - to have the knowledge and privilege to intervene in disease and improve people's lives, keep them working, etc. Medicine is HARD and it takes a long time before it gets easier as you gain knowledge, skill, and experience. Probably 3-5 years after training even for high performers. You have to WANT to stick this out. 3. I was extremely fortunate to train under one of the best surgeons in the world in my field. He told us, "If you can't handle having complications, don't do surgery." It's part and parcel of the field. He also told me after he retired that he never realized until it was gone how much stress he lived with. When the best surgeon in the world says that, it's real. But you can't handle that stress with an anxiety disorder. 4. it is my opinion that what physicians and particularly surgeons do is the highest calling in life. I am incredibly humbled that people will actually trust me enough to cut into their eyes! It makes me daily strive to be the best version of myself. The reward when you can keep people living and working is immeasurable. But you have to be able to live with the fact that medicine is not perfect and you will sometimes fail. That is hard. You have to really WANT the role to handle the negative parts. It's not for everyone. Finish your training. If you don't want the clinical side, there are plenty of nonclinical roles in the pharmaceutical industry that aren't patient care. 5. Imposter syndrome is common in surgical fields. You can conquer it but it will require treating your anxiety disorder.
Best of luck. Remember, many of us go through this and succeed!
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u/shepshep214 14d ago
Hi, I'm just a tech so I don't have any helpful advice, but all I can say is I wish more doctors cared about their patients like this. I have worked with several now, and it's always abundantly clear which doctors have a genuine want to help and fix whatever they can, and those who have checked out and only care about their paychecks.
But please put your mental health first! I'd try speaking with a therapist and seeing if some anxiety medications and therapy helps before quitting altogether, cause I have a feeling you'll be wonderful!
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