Like poker, medicine has certain rules — patterns of clinical symptoms and lab findings each correlating with a specific spectrum of prognoses that vary in likelihood, the differential diagnosis. Physicians are like seasoned card players, trained to maintain composure and incorporate numerous variables into logical, calculated decisions at what seems like a “dealer’s table” of outcomes. Sometimes, we hedge our bets that the patient will self-resolve, so we elect not to treat; other times, we act conservatively with a battery of tests and pre-emptive therapy.
A fellow student writer recently wrote that she wondered if depression were “just part of life as a medical student.” One of her professors had given a lecture on depression asking students to “think of how many people we knew with the signs of depression listed on his lecture slide” — excluding medical students of course, “because you’ve all got some of these.” There is something so terribly and inherently wrong with that statement.
I have always toyed with the idea that I may have depression. Numerous times I have looked over the various depression diagnoses and their criteria. But then I settle on the idea that my thoughts and emotions and struggle are not severe enough. Everyone experiences sadness. Everyone experiences grief.
Medical schools and hospitals across the nation proudly claim to be “starting a conversation” about mental health in medicine. I could lose the residency of my dreams for taking part in it.
It should be no surprise that when I asked my fellow medical students their suggestions for ways to de-stress, one of the first answers I heard from all of them was: “Yoga.” I should admit that I have always been a bit skeptical of yoga — I enjoyed cardio-based workouts far more. However, after doing some research, I found a study by Bansal et al. which found that medical students in India who did yoga every day for just one month showed significant improvements in both their general and mental wellbeing.
My medical school, Indiana University, is one of the largest in the country with over 300 students in each graduating class. Sadly, each year it seems we lose one of our classmates to suicide. The surprising part? These numbers might be lower than the national average. In the United States, approximately 300 to 400 physicians commit suicide each year. A 2009 study in Academic Medicine reported that 12 percent of medical students had major depression and nearly six percent experienced suicide ideation. To visualize these numbers, in my class alone, statistically, 18 students have experienced suicide ideation and approximately 36 have major depression.
Medical school is a notoriously challenging experience during which students undergo tremendous personal change and professional growth. Though the stressors that come along with this are varied and unique to each student’s context and experience, they may be categorized within a few common themes. Harvard psychiatrist Raymond Laurie has previously described the concept of “role strain” with respect to negotiating relationships with their families, friends, partners, peers, attending physicians and patients. Additionally, with regard to students’ concept of themselves, individuals who have high achievement may be challenged in new ways both intellectually and emotionally.
On March 4, 2015, JAMA Psychiatry published an article entitled “Depression and Suicide Among Physician Trainees: Recommendations for a National Response” calling for “[a] national commitment to support residents and fellows throughout the challenges of medical training.” However, we believe that the term “physician trainees” should also be inclusive of medical students.
Friendship is a powerful force that offers one celebration in one’s happiest moments, and solace in one’s most difficult times. Just as when two ducks meet to chat about their respective plights and offer each other support, medical student groups foster the same collaborative environment where students exchange ideas, challenge each other, and ultimately grow into better and more competent physicians. This important ideal binds all living things and gives them the strength to tackle life’s toughest obstacles.
I am a medical student, yes. I am also a survivor of sexual violence. With the recent Columbia University commencement, the surge of articles surrounding the narratives of Emma Sulkowickz and Paul Nungesser prompted me to reflect on this latter identity. When histories of sexual harassment at my school emerged last November, my survivor status edged its way into my path toward doctorhood. I know I will always carry the mark of my trauma with me, and I am learning how I will better empathize with patients because of it.
As medical students we’re told over and over to treat the whole patient, emphasizing unity of body, mind and spirit, recognizing the things that make us unique: upbringing, culture, values and beliefs. But on the way to achieving this holistic view of our patients, we often lose ourselves in the process. Barraged with metabolic pathways, pathological markers and exams, medical school tends to become a zero sum emotional game.
For most medical students, the third year of medical school is their introduction to life in the hospital. This results not only in exciting learning opportunities, but also emotional tolls — grief, fear, anxiety, exhaustion — that can lead to serious problems including burnout, depression, and anxiety.