Guest Post from Fiona Scott, MD-To-Be

So recently I was approached by a medical student asking if she could guest post on my blog about burnout.  I was more than happy to take her up on her offer, and not just because it has been WAY too long since I have blogged and her timing could not have been more perfect.  It’s easy to forget that physicians in training are not in any way immune from burnout and compassion fatigue that affects so many of us out in clinical practice.  Fiona shared with me that she had recently lost a classmate to suicide – something I unfortunately also experienced during my training when one of my fellow medical students killed himself during our first year.  If anything, the pressures and difficulties have only seemed to have grown during the time between my and Fiona’s training.

I welcome Fiona’s piece on her experiences so far during medical school – while I remember it like it was yesterday, I am far too removed to comment on the current climate in medical education.  Although apparently…some things don’t change.

As always, thanks for reading.

~Lumi

Help Wanted…Inquire Within

by

Fiona Scott

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I did some pretty crazy things to get into medical school (don’t worry mom, nothing illegal). For several years before applying I became a medicine groupie. I read books about being a doctor, watched documentaries about medicine, shadowed physicians for hours on end so I could imagine what it might be like. I watched many a friend go off to med school…and graduate… and I waited, I hoped. I did research (which involved a little too much rat killing for my liking), I worked in a peach orchard to demonstrate my dedication to migrant farm worker health. I became an EMT, I got three master’s degrees. I got as close to medicine as I could. And I wanted it. I wanted it bad.

So when I was finally accepted to medical school at the ripe old age of 27, I was giddy with excitement at my dream finally coming true. So excited in fact that I ate an entire chocolate cake and finished the better part of a magnum of champagne (the hiccups that ensued were horrendous).

When I walked into my very first medical school class, I thought my excitement would allow me to float through the next four years with ease. I was getting my dream, and damn it, it was going to be amazing. And in many ways, medical school has been really amazing. My classmates are wonderful, kind people most of whom I hope to remain life long friends with. The course work in med school was challenging, but paled in comparison to graduate school. I excelled in my classes and it felt awesome.

But then things started to change. I began to see some of the realities of practicing medicine that I was blind to before. My previous ideas about the kind of power doctors had to affect change were shaken by anti- vaccers and insurance companies. Even my very own University shattered my naivety by refusing to care to a patient with cancer seen in one of its well-publicized free clinics. By the end of my first year of medical school, my heart was so heavy with broken pieces of what once was my perfect idea of medicine, I felt like ripping it out of my chest and drop kicking it across the floor. What the hell kind of profession did I just sign up for?

I started to question whether medical school—and more importantly becoming a doctor was really what I wanted after all. And that scared the crap out of me. Did I make a mistake? Why had I never doubted this is what I wanted to do before? Will I be $300,000 dollars in debt before I realize I should have been a real estate agent?

At the end of my first year of medical school I was desperately trying to figure out how to reconcile the immense challenges and problems of medical care with the amazingly wonderful parts. With over 400 physicians committing suicide each year1—the highest suicide rate of any professional group– I was starting to think that medicine had more misery than anything else. Maybe med school applications should come with a warning label.

For now at least, I am well protected from most of the soul destroying realities of the medical profession, ironically by the school training me to enter it. Medical school is for all intents and purposes is a safe haven to which I can retreat deep into my books, where my patients are just actors (paid professionals working as ‘standardized patients’ to help train us for the real thing) and where the excitement of wearing scrubs and carrying a pager never seems to get old. When things get “too real” I cling to the fact that I am just a student, still in school—not yet a doctor charged with caring for real patients within a broken and frustrating system.

But it scared me when I think about what my career in medicine will look like. I imagine my mentors and professors– kind, loving people who believe that I am worth teaching and humbly guide me- even though its more time and hassle to do so. These are the ones I strive to be like– the ones who show up to help, even though they feel frustrated sometimes, even though they can’t always fix the problems in front of them. These are the heroes I look to to remind myself why I signed up for this. I don’t want to watch any of them turn into burned out shells of their former selves. And I fear more and more that this is happening. And I worry most of all that it is happening to me

But I’m too young, you say. Too early on in my training to have any legitimate claim to feeling burned out and disillusioned with medicine. If only that were true. A study of all medical students in the United States found that about 49.6% of medical students met the criteria for burn out2 and 51.3% for depression3. Trust me—its not all from studying, but from being treated like crap, feeling like we can never make a mistake or ask for help and wondering if anything we do will help to change the status quo or are we just cogs in a wheel trying to crush us.

One of my favorite authors, Anne Lamott, says, “Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work: you don’t give up.” So here I stand. In the dark, unsure about where the future might lead, but clinging to the belief that medicine will give me joy, and satisfaction and hope—in spite of the drawbacks and hardships.

As I grow into my medical career, others who have gone before me will light the way ahead with “I’ve been there,” “It will be okay” and with “screw this, let’s grab a beer.” There is immense power in showing love and support to others in our profession. Sometimes it’s the most powerful thing we can do and sometimes it’s the only thing we can do. And I know. Because the regular author of this blog reached across the time space continuum of the internet to provide me—a perfect stranger– with the strength to continue on in my medical training. It was her graciousness and honesty that reminded me why I was so taken with medicine from the start. Our voices have the power to change lives and, most importantly, to change our own.

Fiona Scott is a second year medical student who blogs at http://nerdseyeview22.blogspot.com, and can be reached at fscott22@gmail.com.

  1. American Foundation for Suicide Prevention. Facts about physician depression and suicide.http://www.afsp.org/preventing-suicide/our-education-and-prevention-programs/programs-for-professionals/physician-and-medical-student-depression-and-suicide/facts-about-physician-depression-and-suicide. Accessed October 1, 2014.
  2. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and Suicidal Ideation among U.S. Medical Students. Ann Intern Med. 2008;149:334-341. doi:10.7326/0003-4819-149-5-200809020-00008
  3. Iqbal S, Gupta S, Venkatarao E. Stress, anxiety & depression among medical undergraduate students & their socio-demographic correlates. Indian J Med Res 2015;141:354-7

Physician Know Thyself

I’ve been thinking a lot about Kathy Caprino’s article that I mentioned in a prior blog post (“Guilt Is Not A Career Platform”). The issue of not knowing yourself really stuck with me. I was actually chatting about it with the hubby the other day, and he asked me, “Well who DO you know in medicine who is really happy with their career and really knows what they want??”

What an outstanding question.

I thought of course I’d immediately be able to come up with a bunch of colleagues that were satisfied and happy in their work. Sadly, as I ticked off the list in my head, I realized that it was much harder than I thought. Most of my friends from my old department were wrestling with a lot of the same things I was, and weren’t winning the battle either.

But finally, it happened.

I remembered the dean of the medical school where I used to work, Gary, who may have been one of the happiest people I have ever met on the planet. This guy literally whistled while he worked. So I asked myself, what was it exactly that he had going on that the rest of us were missing?

And the answer I came up with was that this man took nosce te ipsum to a whole new level.

Gary certainly was as busy as the rest of us, if not more so. In addition to being an extremely active and involved dean (with all of the administration and red tape that comes along with the job), he also still held clinic weekly and carried a regular patient load. Gary had every right to be cranky, put-upon, and unhappy. Except that he wasn’t.

I think Gary had simply found the absolute perfect career for himself.

Gary was the kind of dean who inspired even student he met. He loved to teach. He grabbed teaching moments every chance he got. He personally sponsored an annual award ceremony that acknowledged the best teaching residents in the hospital. Illuminating medical student’s lives was his passion. And he took it upon himself to truly know all of them, every year. They absolutely worshipped him, and he inspired them to become great doctors. But it didn’t stop with his students. He had the same effect on his colleagues. We all wanted to be better doctors because of the way he made us feel. His knowledge and his presence lit up a room.

But medicine was not Gary’s entire existence. He was apparently a real fishing enthusiast too. The only reason I even knew this was because of a random encounter I had with him at the hospital.

I was still a resident, and I had been on call Friday night in the ICU. It had been a really intense call night, and my head had not even come close to touching a pillow. When I was finally free to go home on Saturday afternoon, I stumbled out to the parking garage, squinting in the bright sunlight, to find that my car was gone.

It took me a few minutes in my post-call fog to figure out what had happened, but I finally remembered that I had been forced to valet my car on Friday because the garage had been so packed (this was unfortunately a common occurrence). Over the weekend, that particular garage wasn’t manned, so the valets moved all of the cars over to a central garage where an actual person was working.

I realized I was clear on the wrong side of campus, and started exhaustedly trudging back the way I came, hoping that my car would indeed be in the main campus garage. As I dragged myself back up the hill and passed the Medical School, who should come bopping out but Gary. In full-on fly fishing vest, waders, and floppy hat complete with pinned-on lures.

“Hey Lumi! Where you headed?”

I said I should ask him the same thing.

“Oh, I’m off to go fishing – I go pretty much every Saturday. It’s great just being out there, even if you don’t catch anything!” Truly, the man’s optimism was mildly nauseating.

I asked him what he was doing at the medical school.

“Oh, I like to come in on Saturday mornings if I can, just to get some stuff done. It’s nice and quiet.” (So the man voluntarily comes in on his day off just to catch up on “stuff”.) “So where are you headed? Are you getting out of here?”

I said I was trying, but I hadn’t exactly located my car yet. I told him about the valet situation.

“Yeah, it probably is in the other garage. Hopefully you’ll get home soon – you must be exhausted! But listen, if for some bizarre reason it’s not there, here’s my cell number. Just give me a call and I’ll make sure you get home.”

This is how Gary was every single day. He loved his job. He loved stuff other than his job. And he knew himself. You can’t fake that kind of enthusiasm and kindness for very long without going completely insane.

I drove home from work yesterday after a very long, hard day, and was smiling because I felt so good about my job. For a long time I didn’t realize that you can actually enjoy those really tough, draining days. And maybe you should be able to enjoy some of them. I am knowing myself better every day.

I hope Gary would be proud.