Columnist
Washington University in St. Louis
Austin is an MD/MPH candidate at Washington University in St. Louis (WashU) who is taking a year off of medical school to complete a Doris Duke research fellowship in Malawi through UNC - Chapel Hill. After spending the last eight years in St. Louis as a WashU undergrad (chemistry, music) and graduate student, Austin is loving the opportunity to experience a new culture and explore his interests in global health. His column seeks to illustrate a raw, human, vulnerable lens on the joys and struggles of working abroad.
Lessons in Lilongwe
Global health work can seem glamorous, exotic, and noble. Lessons in Lilongwe presents introspection and critical observations to illustrate what global health research and living in Africa are really like. Come join Austin on his year off of medical school for a research fellowship in Lilongwe, Malawi.
Shortly before returning to the United States for the holidays from Malawi, a truck full of police and military men pulled up next to my car as I was driving and demanded my driver’s license. They claimed I was “dangerously parked” while stopped in a long queue of traffic to let my friends hop out across from a bus station and would, therefore, be fined K10,000 (approximately $18).
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.
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.
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.
In class they ask me / What is love? / To prompt a philosophical discussion.
Throughout medical school and especially during our clinical rotations, students are often told to keep an open mind about choosing a specialty. This is sound advice, especially since many people change their minds once they are exposed to other fields. However, that does not mean that all specialties are perceived as equal — even in a primary-care focused medical school, third-year medical students often run into prejudice against FM. Worse, they may run into stereotypes about family med which could be enough to sway them away from the specialty they would really love.
With more applicants than ever, and a relatively static number of medical school and residency spots, there has been an increase in the use of metrics such as standardized test scores, GPAs and research publications to differentiate between applicants. Unfortunately, an emphasis on the unquantifiable attributes of physicians — the qualities that actually differentiate great clinicians from good ones — seems to have fallen by the wayside.
Doctored: The Disillusionment of an American Physician is Dr. Sandeep Jauhar’s second book. In keeping with good narrative nonfiction, Jauhar offers a mix of personal stories, thoughtful interludes and an obvious effort to back up claims with facts and statistics. He offers compelling anecdotes, which allow the reader to situate him or herself into the context of health care in New York City. These personal vignettes are especially helpful for highlighting concepts difficult to discuss; an ethical dilemma or complex criticism of the health care system becomes much easier to understand when tied to a tangible person or place.
In the UK, there is currently a dispute over the new junior doctor contract. “Junior doctors” are defined as anyone in training and who is not a consultant. Many have deemed the new contract neither safe nor fair, and despite doctors striking, the Department of Health are intending to impose this contract in August 2016. On April 26, there will be a 48-hour full strike including emergency care — the first of its kind in the history of the National Health Services (NHS) — in the hope that the government will change their mind.
Medical students are subjected to a barrage of advertising that inevitably leads to a physician-industry connection that can be harmful to our health care system. Medical students’ exposure to pharmaceutical marketing begins early, growing in frequency throughout their training.
Contributing Writer Emeritus
University of California, Irvine School of Medicine
Born and raised in Cincinnati, OH. Studied Bioengineering at UCSD and now finishing medical school at UC Irvine. Applied for residency in Otolaryngology-Head and Neck Surgery.
