What to Do When You're Second-Guessing Every Clinical Decision
Every clinician knows this feeling…
You finish a session, and suddenly your brain starts replaying every choice you made.
Did I choose the right medication?
Should I have asked one more question?
Was I thorough enough?
Did I miss something?
Second-guessing shows up quietly at first, then loudly when you are stressed, tired, or carrying too much on your plate. It can make even the most experienced PMHNPs question their competence. And if you are newer in your career or navigating private practice for the first time, the pressure can feel even heavier.
Here is the truth most people do not say out loud:
Double-checking yourself does not make you weak. It makes you conscientious. But when self-checking spirals into doubt, that is when it becomes a problem that needs tools.
Here are a few ways to find your footing when you feel stuck in your own head…
Start with the basics you already know
When anxiety kicks in, your mind jumps to the worst-case scenario. Bring yourself back to the foundation by asking a simple grounding question:
Did I follow clinical reasoning based on the information I had?
If the answer is yes, then you made an appropriate decision for that moment. You are not expected to predict the future. You are expected to use sound judgment.
Most clinical doubt comes from forgetting what you already know. Anchor yourself in the basics and build from there.
Use structured frameworks
Having a consistent approach reduces emotional noise.
Ask yourself:
• What symptoms was I treating
• What evidence supported the plan
• What safety checks did I complete
• What is my follow-up plan
This gives your brain a clear path to follow instead of bouncing around in fear.
Take the pressure off perfection
No clinician gets every decision perfect every time.
Not physicians, not psychiatrists, not PMHNPs.
Your job is not perfection. Your job is thoughtful care, follow-up, and a willingness to adjust when needed.
The belief that you must never make a mistake is one of the biggest drivers of clinical anxiety. Let yourself be a human clinician, not a flawless one.
Consult without shame
Every provider consults. Every single one.
Yet many PMHNPs feel embarrassed to reach out because they think it reflects weakness. It does not. Consulting is not a sign of incompetence. It is a sign of responsibility.
A quick conversation with a trusted colleague can settle your nervous system and give you clarity in minutes.
Pay attention to your nervous system
If you are tired, overwhelmed, emotionally stretched, or not taking care of yourself, clinical doubt will always grow louder.
Your brain becomes overprotective.
Your fear center becomes more reactive.
Your thinking becomes more rigid.
Sometimes the problem is not your decision-making. It is what your body is carrying.
A rested clinician is a more confident clinician.
Build trust through small evidence
Confidence does not come from waiting.
It comes from recognizing the hundreds of safe, effective decisions you make every week.
Start tracking them.
Make a list of the wins.
Notice the patients who improve.
Notice the adjustments you make that lead to better outcomes.
Your brain needs real evidence to balance the fear-based stories. You already have the evidence; you just have not been collecting it.
Second-guessing is not a sign that you are unqualified. It is a sign that you care deeply about your work. But caring should not turn into fear that paralyzes you. With structure, support, reflection, and a little nervous-system awareness, you can learn to trust yourself again.
If you’re feeling overwhelmed, stuck, or unsure where to start, join us inside Strong Roots Mentorship. We take you step by step from ground zero to seeing patients and beyond, without the overwhelm.