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.
Help Wanted…Inquire Within
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 firstname.lastname@example.org.
- 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.
- 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
- 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