Today I was told that, because of the profession I have chosen, I am at a high risk for suicide.
And so commences the medical ethics portion of medical school. While this was not the line with which the lecture began — which I’m sure would have evoked terror in most of the stern-faced-but-wide-eyed first-years that faced the front of the room — it was stated directly and at point-blank, roughly halfway through the introductory speech.
As medical students, we are told many things. We are warned of the work and stress we should expect, of the rigor and sheer number of hours we must commit to stay afloat. We are warned of the diseases we may see and the tough news we will one day have to give. We are lectured on the importance of material, the significance of care, compassion and communication, and above all, we are reminded every day the gravity of the power we will one day have as physicians simply because our work is on the human being.
We are told that our journey of learning how to care for our fellow man will never end. We are told that we are responsible for doing everything in our professional ability to not only do no harm, but to treat the human condition, to give advice, and to better the lives of others. We are in the midst of a vast and rigorous process to become a physician, to have our knowledge and advice trusted.
This is something that none of us forgets on any given day, but yet it was that simply stated line that made me see a flash of the big picture, the sheer weight of what it means to enter medicine when we stop to think about the effect we will one day have on human lives.
Every career affects human life. Every career has significance to necessary and appreciated aspects to what our lives mean and how well we live. Many fields carry extreme risk, bodily harm, chemical exposure, injury and death. Many fields carry sacrifices, extreme and unbelievable sacrifices that people make for their jobs, for their families, for their country, for the people they serve. These jobs become more than just careers to many individuals. They become a life in itself. A commitment to something bigger than providing for yourself or doing what you love. Whether it is money, respect, professionalism, title, pride, self-worth, passion, talent, skill, history or any other reward that one may achieve in a career, there is often none that quite equalizes the risk some people assume in their fields, that compares to the sacrifice and commitment some people have for what they do.
Yet, there is one reward that breaks through as the reason we have amazing people sacrificing parts of their life for their work: the true and selfless desire to help others in happiness and in life.
What strikes me about medicine is that physicians are trained through a rigorous process and are given a power and a responsibility unlike anything found in almost any other field: to care for someone’s life, through the power of consent, trust, belief, and faith in the knowledge and experience of the physician. The weight of the role of the physician in health care and the belief in the healing ability of a person allows people to follow instructions, to allow their bodies to be poked, prodded, and cut into, to swallow pills of seemingly unlimited chemicals, and change behaviors that are suggested to them — all from the trust they have in their physician to better their lives.
With great power comes great responsibility. A phrase not uncommon to those in positions with significant potential outcomes. From teachers to politicians, police to lawyers, long-lasting consequences can befall those in many fields.
But arguably the most significant potential outcome that can result from a single individual’s hand through their line of work exists within the field of medicine: loss of life. It is this possible outcome that explains the responsibility, expectations, and rigor that is placed upon the physician. This possibility that explains why the highest risks of alcoholism and depression are among physicians. This possibility that explains why the highest risks of suicide are among physicians.
It is not just the number of hours worked — upwards of 90 hours a week in some specialties — and it is not merely the amount of debt after medical school — upwards of $250,000 in some cases. It is not simply the level of knowledge and sheer volume of information that is expected to be memorized, understood, and explained at any point in time. It is not the risk of blood-borne pathogens, of treating contagious illnesses, or any other risk and sacrifice along the road to becoming a physician.
It is the ever-present psychological stress of a job with the power to directly affect the lives of individuals and to be responsible for such actions taken and not taken in the effort to preserve and better life. My friend told me a story about a physician he knows who is presently staring in the face of burnout, a battle that becomes fulminant seconds after its insidious realization. A physician who is amazing in what has been accomplished, with years of experience, whose knowledge is inspiring and abilities that took years to hone, yet faces a severe problem with alcoholism that is threatening the career and livelihood that fueled the sacrifices this physician made. In coping with the stress of a high-powered specialty, this physician is fighting against what we are warned of as medical students, yet still remains to threaten us at every stage in our journey.
Burnout is only the beginning of a road lined with jagged rocks. This road has the tendency to come into our path without us having taken a wrong turn. It begins with getting low on gas and proceeds to fatigue, then exhaustion, then somehow still forcing your car to keep driving every day, even though your needle is well past empty and you’ve ceased running on fumes weeks ago.
This is burnout.
And breakdown is imminent. You can see it in many fields. You hear about it from physicians, and shake your head that it won’t be you, or that they should have done something to help themselves or take time off for themselves, that they shouldn’t have fallen towards alcohol to relax or unwind after a 16-hour work day.
But the way I see it, burnout often occurs seemingly without warning, before our very eyes, and leads to more serious lifelong health issues before anyone realizes it was even happening.
What I realized is that it is not just physicians in medicine that face serious, mentally draining demands, but it is also the medical students themselves who face the same feelings. Feelings of being overwhelmed, overworked, losing control of life, losing desire, losing a sense of oneself, feelings of not being good enough, of disappointment, feelings that lead to behaviors that often develop into the risks that we are all warned of when we committed to the field of medicine, when we realized we would begin a process of sacrificing many things to pursue our passion for helping others through medicine.
I have personally heard of medical students dropping out, of seeking medical attention for depression or anxiety, and other early signs of the tremendous stress that those in medicine face on a daily basis. It is halfway through our first year of medical school, and I cannot think a single medical student I know could say they have not felt overwhelmed with the vast amount of material to learn, on top of clinical experience, clerkships, applications, research, family lives, social lives, and so forth.
It is no surprise that we forget about our own mental health and giving ourselves time to relax, recharge, and do the things we loved before medical school. It is no surprise that this tendency is amplified through the years until what we have worked toward for decades begins to be compromised by the years of stress, psychological turmoil, difficult decisions and losses that have eaten away at our mental state.
In this field, mental state is everything. You can go to work with a headache, or cramps, with back pain or with a pinched nerve, with indigestion, with a broken arm or stitches, but you cannot go to work with depression, or anxiety, or with panic or feelings of failure and exhaustion. In these states, mistakes are made — mistakes that have the potential to cost a loss of life as well as the loss of a career that might have been 30-some years in the making.
This holiday break has made me truly realize how my life has changed in the last six months. From the relaxed pace of a college graduate to a first-year medical student in a grueling, fast-paced environment was a transition I was told about for a long time, but one which only experience could really describe in depth. Using my break to reflect upon the past year, especially the last few months, shows me the importance of making time for oneself. This means being happy with the effort you put in, confident in your motivation, and not letting the pressures of classmates, faculty, looming applications, research programs, clinical rotations, grades, studying, money concerns, car problems or any other worry affect your mindset. Psychological health is, unfortunately, often neglected until it is too late, and signs of burnout and stress have started taking effect. Stories of students becoming stressed to the point of depression or anxiety are common in endeavors of such high responsibility and stress, and as many medical students find out, making excuses and jokes about the rigor of medical school only works for a while.
Despite it all, medical students need to commit to taking care of themselves with the same dedication they have to their studies and passion for the field. It might just be the most important thing one can do to become the best physician possible, to react to stress and unrelenting rigor, and moreover, to avoid the risk of burnout and breakdown.
Contributing Writer Emeritus
Indiana University School of Medicine
Jennifer Evan is a 2011 graduate of Purdue University with a degree in liberal studies and a minor in chemistry. Having interests in a range of subjects, she enjoys participating in a variety of fields and experiences, from art and music, to writing and research. Her professional interests include international medicine and culture, while her academic passion is neurological studies. She is a member of the Indiana University School of Medicine Class of 2016.
