I figured, with the recent start of medical residency programs, it was appropriate timing to discuss support for our physicians and physicians-in-training. When July 1st rolled around, a mix of feelings bubbled up as I watched those in medical classes below me start their residency journeys. I wished them luck, saying silent prayers of support. I also watched ever more cynical senior residents trudging through residency glad that their intern year was over.
I will preface the following blog by stating that I don’t deny that I am biased in my opinions of the medical system. As someone who quickly found in residency that being a doctor was not the career I envisioned for myself, I hope to paint a realistic picture of medical training today for many trainees. Perhaps, on some level, it will resonate with someone else and if enough people speak out it will create change.
Ask anyone practicing medicine today this simple question : “Knowing what they know now, would they do it all over again?” and more often than you would surmise the answer is no. This is not just a hypothetical for me; I have actually done this before to several wonderful doctors that I know. “Oh no, I couldn’t do that again”, or “medicine’s gone to sh**” they reply.
STRESSES OF TRAINING
So what has happened to the once peppy and enthusiastic trainees that enter the field? Trainees (including residents and medical students) have always been at the bottom of the large hierarchical medical system. Residents experience many of the same stressors as previous generations, but the context of the medical system in which they work has changed (in my opinion for the worse) Note: this is US specific as that is the only experience I have.
Medical students and residents continue to battle large workloads, sleep deprivation (despite duty hour restrictions), difficult patients, poor work environments, financial concerns, and the list goes on. Beyond that, most of us are our toughest critics and it is very hard to balance all of the things listed above, along with having a personal life. I always admired the doctors who seemed to have things figured out, of course later realizing that I put on a smile everyday despite the pain. Therefore, you never really know how hard that person is struggling to keep all the balls in the air.
Healthcare professionals see some terrible sh**. I won’t sugar coat that. Not only people coming to terms with debilitating illnesses and dying, but families struggling to support them. Children from broken homes, subject to unspeakable abuse or neglect.
It’s no wonder that beyond the pressures of studying constantly and working long hours, medical students and residents have depression and suicide rates that are alarming. Trainees suffer from symptomatic or diagnosed depression at a rate of about 30%. Physicians in general suffer from depression and substance abuse at rates higher than the general population. Rates of completed suicides among male and female physicians were almost 1.5 times and more than 2 times the rate of the general population, respectively.
INHERENT PROBLEMS WITH THE SYSTEM
Where do I begin with systemic issues? Many of you may already be familiar with these issues. These are things that bodies like the Accreditation Council for Graduate Medical Education (ACGME) are trying to change by implementing policies such duty hour restrictions (80 hour workweek), standards for resident education and supervision, and resident wellness initiatives.
However, how far do these wellness programs really go? Sure, I can run around all day taking care of patients, and then I can go pick up a chocolate bar or get a 15 min break to do some craft project. Yes, they can occasionally make a crappy day a little brighter and perhaps that is the only intention. Yet if we want lasting change we will have to discuss what is demanded of doctors on a daily basis beyond the medical care they are providing and examine what “follows” them home at night making their quality of life worse.
I remember at one point in my training visiting my primary care provider during a particularly difficult time. We had already switched my medication for depression and tried a few different things. I requested to see a “specialist” so to say, possibly a psychiatrist to discuss my mental health history, family history, and to try to get my feelings of burnout under better control. My doctor responded, “as a doctor that kind of thing will go on your record and they will be able to see it in the future, you don’t want that do you?” I felt confused, helpless, and a little angry. So even when people reach out, there is no solution for those in healthcare?
Why is there a stigma associated with mental health conditions, and an even more dangerous one that suggests that health care providers are either immune from, or terrible human beings for having one? I understand the concern that a mental health condition could interfere with the treatment of patients. Medical licensing bodies in each state ensure physicians are fit to practice. To a physician the most dreaded outcome is to take away their license to practice after all their hard work and training, which is why I think so many trainees and practicing physicians suffer in silence.
One of the principles in the Hippocratic oath is first do no harm. I know this is aimed at our patients, but I believe that in order to fulfill this we also have to practice no SELF-HARM by taking care of ourselves. We can’t truly help others to the best of our ability until we recognize our weaknesses and help ourselves. I see time and time again that not only doctors, but individuals in other service professions, such as nurses, teachers, EMTs, taking care of others and putting themselves last, to the detriment of their physical and mental health.
Denial can be a strong motivator for the status quo. “If I just keep going like this and taking it one day at a time maybe I can handle it.” Yes, short-term goals are great, but not if that is what you are doing to simply survive because you are miserable. Change your circumstances! No matter how trapped you feel, you always have a choice to move toward a life of happiness for yourself. Currently the burden for changing the mental health stigma lies in personal actions and responsibility. However, I hope as more physicians speak out there are social and systemic changes that lead to more support for physicians and trainees, or we will continue to lose far too many unnecessarily.