The Anxious Doctor – Checking

Clunk.

That sickening feeling in your gut as the adrenaline kicks, when you suddenly panic that you’ve missed something important. The hairs up your spine tingle on end, your stomach starts to squeeze and churn, palms become clammy, breathing more shallow. Immediately the ritual begins, as you start recounting, retracing your steps through the events of the day, trying desperately to find the mistake, the thing you did or didn’t do that now seems to be of such dire importance. Did I check those blood results? Did I document accurately about that sick patient? Did I prescribe those medications correctly? On more than one occasion I have driven back to the hospital well after my shift has ended to reassure myself that something wasn’t missed.

If you’re reading this, I promise you’re doing better than you think.

I never find it, never pinpoint what that thing was that I’m now apparently so worried about as I walk back towards my car through the cold evening mist at the end of another day that until now was going reasonably well.

It’s peculiar, because all day I had happily been plodding on with what I had to do, and didn’t at any particular point feel like anything was awry or out of my control. Sure it got stressful and busy at times, but eventually each job on the list was gradually ticked off in turn, each with its own check and double-check (of course), and I checked and double-checked that there was nothing left to be done at the end of a long day. Yet here I am, five minutes down the road having left at the end of thirteen hours of work, and I can’t rid myself of that feeling that something wasn’t quite right. My mind seemed hellbent on convincing itself that I screwed something up for sure, and that I’d be in serious trouble as a result, or even worse – a patient would get harmed. That crushing fear that something terrible will happen and I’ll be to blame isn’t new. I’ve had it my whole life, that baseline fear gnawing away at my insides. That anxiety.

I’ve heard it aptly described as the feeling when you realise you’ve leaned too far back in your seat, and you desperately grab onto something to stop yourself falling, but instead of a momentary thrill, this panic is there all the time, grumbling away. It’s quite a good description actually, and it sucks. It really sucks. It sucks because it feeds off your checking behaviour. You check something once, twice, and briefly reassure yourself that it’s fine and dandy. Then late you worry about it, so you do the obvious thing, and check again.

What makes the anxiety so tenacious is this – Your brain should realise that because nothing went wrong, it doesn’t need to keep checking stuff all the time, because hey, it was fine! What actually happens is that your brain associates the checking behaviour with the positive outcome, and therefore decides the the checking was in fact a really good idea, and that it prevented the bad stuff happening. The result? More checking, more worrying.

I don’t pretend to know the definitive answer to dealing with this, especially given the fact that everyone is likely to experience their own nuanced version of the problem. All I know is that for me, it gradually gets easier the more confident I become with a procedure or task. Every time I have had to learn to do something knew, such as learning to drive, I would start fretting about all the little things that might go wrong. Did that speed camera flash? Was that light yellow or red? Was I too close to that other car? It was only after many miles of worry that I finally trusted myself to go past a speed camera without looking in the mirror to make sure it didn’t flash, and it’s only embarrassingly recently that I’ve stopped shitting my pants the second I see blue lights headed my way.

My solution? I force myself not to check.

And my god it’s hard. To trust in the fact that when I did (and of course double-checked – I’m not a lunatic) something the first time, I did it properly, and to see how it turned out. Mental idea right? And I’ll be completely honest it made me worry more for the first few days, but then something magical happened.

It worked!

Ridiculously quickly I started to feel a sense of relief, like the stress was melting away. By trusting myself, and seeing that things weren’t going wrong when I didn’t repeatedly check them, my brain slowly started to loosen its grip just a little, and that incessant need to continually reassure myself that everything was okay gradually started to dissolve. I mean it makes sense right? – by removing the checking behaviour and showing myself the outcome was still the same, the value of continually checking things was reduced, and I became more comfortable with the idea of doing things right and doing them once. So if you’re in a similar situation and find yourself continually checking and checking again, it might need that leap of faith to set you down the path of trusting yourself to do the things you know you’ve trained to do.

But it’s not yet gone completely, I still get it, every so often…

Clunk.

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