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The little voice tells me that I am fraudulent. All the other doctors know more. They understand renal tubular acidosis. Even the residents (trainees) knew about ADAMTS13 antibody in TTP (Thrombotic thrombocytopenic purpura, a blood disorder). Now, an article later, that fragment is addressed, but an ocean of ignorance beckons. How dare I do consultations in the ICU when I have never intubated anybody?

Every APRN, every MD, every PA, hears this little voice, unless he or she is an arrogant sociopath. But this is a little voice to be recognized and resisted.

I have urged one good resident after another, and new attendings, and my students, to recognize the origin of the little voice: it is our own insecurity, born of our wish to do well in this infinite and open-ended and not-ever-masterable domain of the care of frail, vulnerable human beings who are at a minimum frightened, and at a maximum fatally ill. If we felt up to it, we would resemble those subspecialists who know everything about almost nothing. ("Practice limited to the left lobe of the thyroid”). Our discomfiture can serve as a bulwark against complacence, another reason to remain a lifetime student even though there are not enough hours in the day.

The truth is, we are not frauds. We are only fallible, imperfect human beings, striving to rise to the challenge, utilizing our skills and knowledge to help another person. We cannot afford to squander our too-sparse time and resources and emotional energy on this insubstantial delusion. We are good enough; and we will get better at the work tomorrow. We need to cultivate the divine discontent in ourselves, and reject the destructive discontent that has us feeling that our uncertainty, our frequent need to improvise, is mere pretense or fraud.

Henry Schneiderman
Bloomfield, Connecticut