When you cross borders in clinical practice, there is a likelihood that you take a status cut to pursue whatever dreams you are after. It can be quite difficult to wrap your head around the people who are now your colleagues, bosses, etc. You may find that the dynamics of the relationships with allied healthcare professionals are different as well. One recurrent theme amongst my friends who have also made this move, is the feeling that you are inadequate to perform your job. Or the being spoken to in manners that leave a lot to be desired. How do you deal with all of this calmly whilst you are learning the ropes?
Arrogance and bad attitudes can put people off and you want to learn as much as possible in the first few years of working in a new environment. Learning makes you a safe doctor. The question is how do you stay humble in the face of what can often feel like persecution or if I make it sound less dramatic condescension?
I digress and tell a story. I was asked to see a patient being managed by my team who was poorly on day one post an open reduction and internal fixation of a long bone. It was unclear what was wrong. On arrival, the doctor on the ward was listening to the right upper quadrant of the patient’s abdomen. I was perplexed. The reason I had been asked to see this patient was postural drop in blood pressure, reduced urine output and chest pain. The patient was known to have ischaemic heart disease. In short it looked like she was in shock and the question was what was causing it? Without boring you with the details, the nursing team made suggestions which I listened to but modified based on my experience. I am proud to say that this lady survived. There was a lot of disagreement over my choice of treatment subsequently but even the medical team struggled to diagnose her and accepted what I had done prior to their arrival. Imagine my shock when minding my business a few weeks later, my clinical supervisor asks me to tell my side of the story. The doctor who had been listening to the right upper quadrant of a patient in shock’s abdomen had reported me, as she felt I was not competent to care for patients. This she said was supported strongly by the nursing team. This is a special case, because the consultants involved were kind and wise enough to ask for my side of the story. There will not be many situations where you have the opportunity to understand why you are being treated differently or where you will be given the opportunity to explain your actions or even when you will feel like your bosses are supportive. But when you are in those lucky situations, make sure you make the most of it.
As I have pointed out you will not always have support. So what do you do in situations where you can feel condescension dripping all over you? How do you handle the frustrations without giving in to them? How do you ensure that you remain humble yet confident? Here is my toolkit
- You are a skilled person. It was a requirement for your employer to demonstrate that you were skilled before you got your visa. Do not doubt for a second, the skills you bring to the table. You may never have seen a blood gas machine, or had to review images without physical films but you are highly capable of making good decisions in caring for patients and in the end, that is what is important
- Get that cv out. I had lived here for a while before I had reason to review and update my cv properly. It was a life altering experience. I suddenly went from self-doubt to self-confidence. If I had achieved all the things on my cv, then no one could convince me that I was not worth my weight in gold
- A bad attitude will not get you very far. It is easy to focus on experiences that are unpleasant and project that displeasure to everyone, but it is not necessary and it only turns more people against you. A lesson from this Ted talk by Leila Hoteit recommends “turning their s**t into fuel”
- Find yourself someone to laugh it off with. This may be at work or at home. But you have to laugh at that pain.
I can tell at least a hundred stories from my experiences ranging from the colour of my skin to the mere fact that my degree was obtained in a foreign country. Every IMG has these experiences. It is worse for some than for others. The important things to know are that you are not alone; you are not being singled out for torture, others have been through it before you, it is a phase and it will pass.
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