Columnist
Case Western Reserve University School of Medicine
Neha is a third year MD candidate at Case Western Reserve University School of Medicine. To combat the cold and snow in Cleveland, Neha spends her time napping, exploring art museums, and taking the local brunch world by storm, one sweet confection at a time. When she has saved up enough money, she plans to go on a world tour and visit every single capital of every single country.
Mind Your Mind
A very important but rarely discussed topic is that of mental health in medical practitioners, notably medical students. According to a study in the Student British Medical Journal, 30% of medical students report having a mental health condition—with a majority of 80% stating the level of available support was poor or only moderately adequate. This column was born from these alarming statistics and aims to stimulate conversation on mental health in medical students, from providing suggestions on how to maintain one’s mental health to discussing the taboo and stigma surrounding conversations on mental health in practitioners/students and how to eliminate it.
To me, hitting a tennis ball is a symbol of how we as medical students perceive mental health: we know very well what habits are good for us and which are not. We know that we need eight to nine hours of sleep each night, a healthy diet and regular exercise. We know to engage in positive thinking, to nurture healthy relationships while cutting out toxic ones and to take time to “take care of ourselves” even when we are at our most stressed.
There’s a lot of talk about mindfulness these days — its importance, its effectiveness, the benefits of meditation and even the structural changes in the brain that result from it. (Do you want a less reactive amygdala and increased neuronal density in the hippocampus? Meditate!) It’s one thing to read about the benefits of doing something, but as many know, it’s another thing to actually apply it and understand it. So how can medical students use stress reduction strategies “in the context of the high-stakes, high-stress and time-limited environment of medical school.”
Four years. I had gone four years without crying in a faculty member’s or an advisor’s office. And there I was, sobbing all over myself, as I tried to explain the situation. A couple of days prior, I received a terse email from the training director, saying I needed to come in to meet with her. She was not happy with my most recent feat as a doctoral student.
As I settle into my second year of medical school, I’m confronted with the fact that I’m one-fourth of the way to an M.D. — that an entire year has passed, and unsurprisingly, all those predictions my deans made at the very beginning came to pass: time flew, we learned more than we thought we ever could, and upon close self-examination, we’re very different from how we were this time last year.
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.
When I started medical school last August, I arrived on campus excited to fulfill my childhood dream of becoming a doctor, eager to learn more about the body and its mysteries, and more than a bit nervous. “Medical school,” the physicians in my life told me, “is no joke.” But “everyone survives” they assured me. While I clung to this promise as I made my way through the year, I did so perhaps for different reasons than I first imagined.
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.
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.
There is another reason wellness is now stressed so heavily in medical schools, and it is one that is not often talked about — physician suicides. As many as 400 physicians commit suicide each year. That is equivalent to four medical school classes who take their lives every single year.
One of the things that I have struggled with most in medical school is depression. Not learning to recognize, diagnose or treat it, but actually dealing with the effects of this condition. I soon realized that this problem is much bigger than myself, and needs to be talked about openly. This is my story.
Medical Student Editor
University of Kansas School of Medicine - Wichita
I am a Class of 2016 medical student with an interest in a career in pediatrics. I was almost an English major in college, and I still love to write but don't get nearly enough time or opportunities to do so. In my future career, I hope to be involved in narrative medicine and pediatric advocacy but also want to have time for my family and friends. I also have a cat named Harry, and if you ever meet me in person, be prepared to look many pictures of him!
