In November, I hated medicine. The gray clouds that watched from the sky followed me day after day — to my car, into the hospital, to my car again, and back inside my home. At times the haze was tolerable; an inconvenience, a bother, but no real trouble. Other times, it was suffocating.
Medical school can be an overwhelming journey for many students as the pace, quantity of content, and work hours far exceeds even the most prepared students’ expectations. The overall demand of medical school makes having a “normal life” very challenging; that is, the ability to attend happy hours or frequent social events, see local professional teams play or cultivate hobbies all become difficult to orchestrate between the endless pages of reading or practice UWorld questions.
The topic of burnout is huge in today’s medical community. Multiple articles and studies have been published demonstrating that burnout is prevalent in all levels of medical training from the day-one medical student to the most senior practicing attending.
On your mat, you struggle to lie on a bent leg, intensifying your stretch as your hip pleads for you to give up. Many yoga instructors describe hip-openers as a “dynamic” pose because the body is in a constant flux between comfort and discomfort. But there is a moment when your internal struggle abruptly ends.
As medical students, we recognize that bias in medicine is doubly damaging: it burdens our peers and it harms our patients. In the opening narratives we see both of these at play: in Micaela’s self-doubt and frustration, and in the intern’s judgment of their older, Latina patient. Such clinician bias has been increasingly shown to contribute to widespread health inequities.
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.
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.
You made it. You were finally there. After thousands of hours of studying, dozens of tests, numerous volunteer and leadership experiences (to say nothing of many other sacrifices along the way), you had reached the pinnacle of your education. You earned the title you had so desperately yearned for: medical student.
Back in April of this year, we came across an article published in JAMA Psychiatry that called to attention the poor state of mental health for many physicians-in-training. We were excited by the publication of this seminal piece, an opportunity for medical educators, students and institutions to have an earnest conversation about the ugly stain of burnout and suicide that tarnishes the healing profession.