The ugly duckling syndrome

What do you want to do when you grow up?

I never really knew the answer to that question. What I really wanted was to go to acting school, but that never seemed like the right answer when I talked to my teachers or to my parents. I’d tried my hand at work experience in physiotherapy, at an advertising company and someone once told me I would make a really good lawyer. I had no idea. But eventually, after a great many conversations and no small amount of luck, I ended up at medical school and now I find myself in a position where I’m a Paediatrician who likes critical care, a doctor who likes management and a Clinician who is just as comfortable working outside of a hospital as within it. That’s an “Ugly Duckling” of a situation – a strange combination of things that just don’t quite seem to fit.

We’re all different

My combination of interests was never the same as other people, and when I looked at my peers I was never quite like them. A square peg in a round hole with different interests and different perspectives that made me wonder what I should do and where I would go with my career. I never really wanted to specialise in research. I used to dread going to clinic. I liked problem-solving and was happy in leadership roles. At some point, I realised that’s just me – a unique combination of interests and experiences that suited me but might not suit others. Maybe I’m just like you.

Starting work as a doctor can be a little bit like going back to high school. We are all different, but like the teacher said way back then – we do still all have to play together nicely. And most of the time we do, but I wonder, how often do you find yourself thinking – why am I so different to them and what am I going to do about it?

Find your ugly duckling tribe

Things get better when you feel like you have found your tribe. Your flock. Some of you may already have done that – feeling right at home with your neonatal colleagues or ducking into theatre with the Gastroenterologists. Some of you might be like me and float between a few tribes before you work out where you belong – but that’s ok. On the road to becoming a specialist doctor, you may feel you are on a pathway designed to create you all as equals, but at some point you realise the road will turn and divide and sometimes go different ways, leaving you nowhere near the buddies you started travelling with.

There may be hard decisions along the way. Will you do procedures or not? Will you work in hospitals or not? Will you look after old people young people overweight people thin people those with acute disease or those with chronic illness? Some of these things may be yet to be decided but if you stop and think and ask enough questions you will choose the path that is right for you.

It’s exciting, this journey of discovery. I very nearly became a country GP when I came out of medical school and wanted to be generalist. And then I got interested in the details of specialty medicine and was going to be a Paediatric Endocrinologist – and then somewhere along the way I contemplated leaving medicine altogether. I guess all that time I was really just looking for my flock. And then one day I walked into an Emergency Department and saw a whole bunch of ugly ducklings just like me. People who had broad medical interests, short attention spans and a propensity for chaos. And I realised I might be a swan. But more about that later.

Challenges of working in medicine

My reflection after being a doctor for 20 years is that it can be the best of times and the worst of times. As an acute care Paediatrician I hope I have saved some lives but we have also lost some. I have made great diagnoses but I have missed diagnoses. I have always worked with an excellent team but I have not always been an excellent team member. This is the challenge of medicine. I have come to realise the most important lesson is to be kind to myself and surround myself with people who are kind to me. If we don’t look after ourselves, how can we expect to properly look after our patients?

So my challenge to you, as you consider your training options, is be alert but not alarmed. It’s great if you feel like you know where you are going with your training but it’s equally ok if you do not. If you’re terrified of the question “So what are you going to specialise in?” – you are not alone.

And even if you do know where you are heading, you just have to accept that things don’t always go to plan. You may jump on the fast train to specialist Cardiology practice and then discover you’d rather spend all day doing benchtop research and not seeing patients much at all. In fact, some days you may not like medicine much at all. You may not pass exams. You may not get the job you want. But that’s part of the journey and it happens to all of us. The ups and the downs of the adventure.

Career plans and bumps in the road

One of the hardest things that happened in my training was not getting a job that I really wanted. In many ways it was my dream job – it was exactly what I wanted to do and provided a unique opportunity for me to gain critical experience for the next phase of my career. Everyone thought I would get it, I even started to imagine myself working in the role and getting excited about the possibilities it would bring. But I didn’t get it. I was devastated.

That’s when I nearly left medicine, after that. At the time I thought it was the worst thing that could have ever happened –  I distinctly remember eating far too much chocolate for days on end. I was drowning in the “Imposter Syndrome” – the certainty that everyone had suddenly found out I was nowhere near as good as I should have been. And that they saw the ugly duckling.

Ironically, I look back now and think how that was probably one of the best things that could have happened to me. There is absolutely no doubt that it was hard at the time and it took a while to recover – but that bump in the road set me on a course that I may not have discovered if things HAD gone to plan. Resilience is hard to learn and harder to teach but all of us have more than we realise or we wouldn’t have made it this far.

So, what advice can I give you about travelling along this long and winding road to specialty practice? The best approach I can think of is to use the language of my flock, the Emergency Care people out there. Everything starts with ABC…

Follow Sarah on Twitter @DrSarahDalton