But I'm fourth year medical student and I'm wondering if i have a diagnosis of an anxiety disorder..

My problem is that I get extremely nervous during public speaking situations.. ie: giving formal presentations etc. Also, sometimes even presenting patients to my attending when I realize someone is listening (makes it hard for me to focus). I'm fine in informal presentations, presentations ot people im relatively close to (i still get nervous as heck.. but i can usually get through it in one peice), and presenting to attendings if its one on one. When I'm presenting I can feel my sympathetics firing like mad... tachy, dry mouth, not sure if im tachypnic.. but sometimes i get tingling.. so probably am... the biggest problem is that my mind goes blank and its very hard for me to concentrate on the task at hand. Sometimes even if im smoothly presenting a patient to an attending (not even a hint of being nervous), and i see someone else listening in, ill lose my train of thought and get nervous.. (i'm fine in social situations with strangers etc.. i can carry on a conversation with just about anyone)

I've always hated presentations, but i've just attributed it to 'fear of public speaking' like 50% of the population.. but its starting to interfere with my work.. I was put in charge of running a simulated trauma code today and i totally froze up.. even though i knew exactly what to do (ie: ABCDE) i couldn't really bring myself to say it.. my mind was all over the place.. like what should i do etc. (ive also had a few situations in recent presentations where although I was adaquately prepared, i couldn't really get through it without stuttering like crazy and then just reading the material from the slides .. very poor form)

I've tried to get through it by telling myself that its an irrational fear and that i'm well prepared.. but usually i go to pieces right before i present or have to speak.

i've thought about the various treatments associated with this (ie: systematic desensitization, which ive tried on myself but its hard because its difficult for me to replicate the exact set of circumstances that'll make me anxious.. but maybe self treatment isn't the best solution).. im thinking maybe some beta blockers will help tone down my sympathetic drive when im working as a short term solution?

The reason this is becoming an issue now is that I'm about to apply to residency soon, and I'm concerned that I won't be performing up to par on my Sub-Internships to secure the necessary letters of recommendations... i've considered in the past that i may have a specific anxiety disorder in the past (especially during my psych clerkship), but I assumed either i was being a regular hypochondriac med student (who thinks they have every new/rare disease they learn about, until they learn about a new disease) or that my fear was normal... and I've always assumed that I can get by by just winging it (which has gotten me through 3rd years of med school with pretty decent grades and evaluations), but im beginning to think that is not the best idea going forward.

My question is.. if this is indeed a psych problem and not just me being overly worried (im not a worrier by nature).. is this a problem i can solve (or cope with) in a short period of time, or is this something that'll take much longer? (ie: months- years). My first Sub-Internship is in 2 weeks!

(another issue is that my school health insurance sucks and i don't even know how soon i'd be able to see a professional much less afford all the copays and fees (since it is summer, i may need to pay out of pocket).. so thats another reason that i'm hesitant about going to the doctor)

any advice?