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Let the Confidence Come

November 19, 2023
by Mark David Siegel

Hi everyone,

Interns tell me one of their main goals is to develop confidence. But what is “confidence” exactly? Is it a state of mind, knowing your decisions are right? Is it a behavior, signaling you know what you’re doing?

It’s a lovely notion. Who wouldn’t want to be confident as they write those Lasix or prednisone orders? Who wouldn’t want to radiate confidence as they plunge needles into swollen bellies, discharge the paddles, or guide families to gut-wrenching decisions?

But confidence isn’t like that. Senior physicians are rarely certain about their decisions. We know that the antibiotics we start today may need to be stopped tomorrow. We extubate patients knowing some won’t be ready. The outward confidence you think you see doesn’t match the uncertainty most of us feel inside, particularly when we have to make decisions rapidly with incomplete information.

True confidence is the comfort you feel as you gain experience: as you examine more patients, make more presentations, place more lines, run more codes, and lead more family meetings. It’s also the comfort you feel with nuance and evolving practice as you read, attend conferences, and wrestle with hard questions.

Your confidence will grow as you learn to embrace uncertainty. Every case is messy in its own way. Emergencies unfold quickly and sometimes the most we can hope for is to gather enough data to act—or refrain from acting—knowing that most situations clarify themselves over time.

Let the confidence come. Our interns have grown rapidly since June. Seniors say many of them are already functioning like PGY2s, making big decisions, facilitating family meetings, and teaching students. The most important step interns can take right now is to assume increasing responsibility, to enter orders independently, orchestrate discharges, and take the lead in emergencies. Interns should ask seniors how they deal with uncertainty. You’ll find that most of our wonderful seniors are humble: they’re comfortable saying “I don’t know,” they learn from mistakes, and they know when to consult an expert or go to the literature.

Confidence isn’t a quarry to pursue. Rather, as you do the work, take on leadership roles, and embrace the support of your seniors, the confidence will come to you. It always does.

Enjoy your Sunday, everyone. I’m heading out into the sunshine!


P.S. Please send me your Thanksgiving gratitude messages if you haven’t already. Deadline Tuesday night!


Submitted by Mark David Siegel on November 19, 2023