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The Struggle to Acceptance: A Young Doctor's Challenge

Michioki Endo, M.D., Mitoyo General Hospital



In early August this year, two Correspondence I submitted to The Lancet Journal were accepted almost simultaneously, with the first one being published on October 28. Having faced over 20 rejections before, I was expecting the usual email, but this time, I received a different one containing the word "accepted." At first, I couldn't believe it. I meticulously checked the sender's address and repeatedly used a translation app to confirm its authenticity. As a junior doctor in my second year at the Mitoyo General Hospital in western Kagawa Prefecture, I've been balancing my medical training with writing letters, currently working on my 30th submission as of November 27, 2023.


The journey to get my letters accepted wasn't easy. The biggest challenge was my lack of knowledge; university studies alone weren't sufficient for the advanced expertise needed for preparing these papers. I struggled with depicting patients I hadn't encountered and lacked basic knowledge and skills like using research tools, interpreting papers, critical thinking, and historical context. Initially, my only exposure to PubMed searches and reading top journals was in university classes. Learning to effectively utilize these resources was not straightforward. I underwent a process of self-learning, guided by advice from Dr. Kami, President of the Medical Governance Research Institute in Tokyo. Understanding the significance and novelty of the papers I read was also challenging, often leaving me with a superficial grasp and unable to form a solid basis for discussion.


Another major challenge was balancing this with my job as a new doctor, where I felt overwhelmed with the need to constantly learn and the sense of inadequacy in patient care and work relationships. There were times when the struggle with letter writing and lack of results led to a loss of confidence. Lacking peers engaged in similar activities also affected me. The stress and exhaustion sometimes made this pursuit feel burdensome, and without anyone to share these moments with, I often felt alone. My colleagues likely saw me as an odd resident, glued to the computer even on holidays. Their responses to my explanation of my work ranged from indifference to superficial praise, adding to the pressure to conform. Despite my shortcomings, Dr. Kami's continuous remote guidance was a significant support. The acceptance of my letters, overcoming feelings of powerlessness and anxiety about not achieving as much as others, has been a great encouragement. Moving forward, I intend to keep appreciating the support from those around me, persistently work hard, and continue to grow.

* This article has been reprinted and translated from the Japanese original text published in Web Medical Times.

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