Projecting competence

Sometimes one of the harder things to do during medical training is projecting a reassuring sense of competence while performing a procedure that you have only done a few times before (if ever) and may not be well-trained in. You may not, in fact, be competent. But it's important not to freak the patient out. For example, I haven't started a lot of IV catheters yet. Today I did one for a patient whose spouse expressed concerns to my resident about the med student performing the procedure: "you're going to let HIM do it!?" That helps you relax and stay focused, lemme tell ya. Fortunately, my resident was great at "explaining" what I was doing (i.e. giving me a heads up before I made a mistake), everything worked out great, and patient, spouse, and med student all ended up satisfied and in no pain.

Things are not ever thus, however. A few months ago a guy came in with an interesting hand laceration. Staff said that I might get to sew it up myself, but the patient tended to be squeamish and we'd have to see how comfortable he was. So I put on my best medical-scholar-contemplating-the-diagnosis face, buttoned up my short white coat, and tried to project cool, confident competence to both the patient and my attending.

Unfortunately, the front pocket on one side of my white coat was loaded with reference books and instruments, pulling that side down, and when I buttoned my coat I failed to notice that I was one button off. Stood there in front of the guy the whole time with an oh-so-serious expression on my face while looking, well, not entirely competent. As things turned out, I didn't get to do any sewing.