OCD affecting your job

Hi guys!

I’m new to this forum, but I’ve already read some of your posts and I found some great advice and support given to other members.  I have thus finally decided to share my experience and I’d like to have your insight.

So here it goes… I’m 22, I’m a medical school student and I have developed OCD over the last 6 months during my internships. I have a lot of trouble with doubts: I fear I have missed something while questioning or examining my patients so I may repeat myself or have someone else check everything after me, or after a patient is sent back home I think of a dangerous diagnosis they could have that I get convinced I have missed, I think I might have made an error on a prescription, I have once asked a patient to come back at the clinic because I thought I had not done her vaginal swab for chlamydia right (which I was 99% sure was not the case, but I couldn’t live with the 1%)… These are doubts that my colleagues might have too, but for me, they are multiplied by a thousand and I constantly check everything and when I can’t, I have terrible anxiety and feel extremely guilty that I might have missed something and that the patient will die. I also have some sort of reverse contamination thing, in that I fear I may have contracted HIV or HCV while on the job and that I might contaminate others with it, so I’m always checking my hands to make sure I don’t have a scratch that might bleed, I wash a lot of things after I touch them… During the last week, I have also started having some problems while driving, fearing I haven’t paid enough attention and that I might have hit someone and not noticed. So, basically… I fear that I might hurt people.

Obviously, the past few months have been hard for me. I’ve started taking meds (I’ve been on cipralex for two months now) and I see a psychologist weekly for CBT. So far… I’m a bit better, but I’m still far for being how I was before.

Now, I’m at a crossroad. I’m in my last year of medical school, and we have to choose our specialty (which would be pediatrics for me because I love working with children so much!). The thing is, with all those symptoms, I’m starting to really doubt I want to go on. The anxiety and the guilt associated with the responsibilities I have (and I’ll have even more in the future!) are eating me up and I can’t go on living like this... and I have lost a lot of my motivation. But at the same time I’m really confused… I have worked so hard just to get into medical school, and since then I’ve continued to work so hard during those last five years in training! And during my first year of internships, I liked what I did. Everything went to hell during this second year when the responsibilities started to hit. And quitting is like avoiding my fears, which is not good for CBT… But I don’t want to be unhappy and anxious like I am right now for my whole life.

So, I’d just like to have your thoughts on this. I’d like to know if anybody out there has ever been in a similar situation, when their OCD was troublesome for a job or an activity, and how they decided if they would go on or quit…

Thanks a lot!

[jngemera]

First I want to congratulate you on what you are trying to accomplish so young.  And for being one of the doctors who actually cares.  Now with that said, my name is Jennifer and I work for MHMR (Mental Health Mental Retardation) in Texas.  Sometimes when people get into a jobline that is highly stressful which your profession is, or has any environmental changes, they can fall into mental illness.  I believe ifyou keep seeing someone and continue your medication once you are out of school and on the job slowly because of how much you care abut life you will begin to see how good you are going to be and be able to get past this.  If this isn't the case then after school take a step back and rethink your profession.  In the mean time it is ok to rethink your steps and to want to make sure that it is right especially in your profession. It doesn't sound like it is just your job though it sounds like it is a general OCD and paranoya case.  Ask who you are seeing if he could treat you for paranoya also because some of what you said reminds me of this disorder.

[Poo44clooner]

Your OCD and anxieties make you doubt yourself. I worked in a medical lab and had the very same problem. At one point you have to learn to stand on your own 2 feet with all the knowledge and training you have and rely on yourself for answers. You lack confidence because of the OCD and you have to learn to push those doubts aside and tell yourself that you have made it  thus far with your own brain and thinking so you should learn to stop doubting yourself and become the doctor you have studied to become.
You are a winner, don't let the OCD voices and doubts trouble you. Gain more confidence. You have it in you.
Angela

[miss_umbrella]

Thank you for your kind words. Getting my confidence back is really a challenge though... It is hard when you are responsible for someone else's life, there isn't much place for error.

Also, jngmera, I think (like my psychiatrist) I really have OCD and I don't really see the paranoia. However, I'd like to hear more about your theory, if it could help me. The way I see it, I just have a lot of trouble with doubts and if there is a small possibility, however small it is, that I might have missed something and that an error I could have made could eventually result in danger for someone else's life, I can't bear knowing this possibility exists and I feel very guilty if I haven't checked or done something to prevent it. As most of the time I have my doubts after having seen the patient when I have more time to ponder or when I learn new things or revise things I have forgotten, the anxiety and guilt are often present because I feel I haven't done everything a good doctor would have done. And I think of the possible consequences if I have missed that thing and I can't get it out of my mind, even if I know the chances that something will go wrong are really small, but for me the possibility still exists and it's hard to live with it.

Furthermore, in our formation, a lot of importance is given to the fact that we have to become very alert to dangerous diagnoses and, in a way, we are encouraged to always keep them in mind. Also, I hope this won't shock too many people, but there isn't actually that much certitude in medicine. Sure, we have studies to rely on, we have great facts in out textbooks about classic presentations of some illnesses... But in reality, doctors often joke about the fact that most patient haven't read the book. Not a lot of things are clear cut. So yeah, I guess I'm in one of the best places to develop anxiety problems :-P And deciding to go on or not isn't clear cut either. I will continue to give it a go though. I still want to finish my studies and, hopefully, I will get better by then.

So thanks again for your comments. and Poo44clooner, I am really sorry you had to go through that too, it is certainly hard.

[JGF25]

I agree that you have put a lot of effort and time into your studies and you definitely should continue.  With the right help and possibly medication, you can more than likely put this on the back burner.  I don't think that we are ever OCD free but rather we learn to manage our OCD and live our lives normally.  The more experience you get, the better doctor you are going to become...just like with any job.  

In this day and age you don't find many practices that are just single doctors.  Usually there is a group because let's face it, nobody wants to devote their entire lives to their patients.  It just isn't done anymore.  So in all likelihood when you do get into practice, you will be in one that has many doctors on staff.  Doctors that you can consult with if you really feel there is something going on that you are having trouble with.  

Here is a case in point.  When my son was very young he had RSV pneumonia.  He was about 7 months old.  After that he kept presenting with chest infections which would invariably end up with us going to get an xray and then yet again another diagnosis of pneumonia.  The pediatrician I was seeing wasn't doing anything wrong.  His xray was showing an infection and so it was treated with antibiotics.  The only problem was that he presented all the time with this.  On one of the visits I saw a different doctor in the practice.  I brought up that no child has this many infections and that there has to be a cause.  She sent us to Children's Hospital in DC to a pulmonary specialist.  That is when we found out, after a while, that he had right middle lobe syndrome.  So a collapsed lung is what they were actually seeing on the xray and of course a collapsed lung is a breeding ground for infection.  In my mind nobody did anything wrong here with the information they had.  My son needed to see a specialist.  Parents have a role in their children's care as well.  They need to be good communicators to help the doctors.  It is a two-way street.  So I think to really be a good doctor you need to talk to the parents as well.  Get their ideas if they have any.  

I have had OCD for a very long time.  I am successful, I am married, I have children and I am living very well with OCD and I know that you can do it too.  

[JGF25]

Just one more case in point.  Pediatricians are not experts in everything.  You are not going to be expected to know how to treat every single disease.  Another case is my second son who ended up with strep nephyritis.  Into the ER we go and the pediatrician called me up and said he(practice was taken over by somebody else) was deferring to the hospital physicians because he was not a kidney expert.  It was the right thing to do.  I think knowing your limitations is a good thing.  Isn't that why we have experts in the first place?  

Hopefully I have helped you at least some.  Take care of yourself and just hang in there.    :)