Medical School Burnout and Depression

The top line: Love yourself, take care of yourself, and don’t ever be afraid to ask for help.  In medicine and in all walks of life. 

It is coming to light in the general public that the burnout, depression, and suicide rates in the medical field are very high.  This has been known for some time by those in the medical field.  In fact, at my medical school we had a very tragic suicide occur.  His parents come to speak to all of the medical students every year now about seeking help if we are depressed or suicidal.  We also have a burnout and depression module one week of the year that we must complete.  Why in the hell is burnout, depression, and suicide so common in the medical field that they have to teach us how to deal with it? …It is as if they expect us to experience one of these things…not if but when.  Although I cannot verify this statistic, one source states that in any rolling 4-year period, there is a 25% chance of a suicide at any given medical school.  I am not sure if that includes just students or all involved in teaching, learning, etc…

Grades

I could list a hundred reasons as to why medical school drives students to be depressed.  It is easy for me to make such a list because I experience these stressors on a daily basis, and I believe I am clinically depressed from time to time.  One major reason that students become depressed is the idea of failure.  Note that I did not say failure, only the idea of failure.  All medical students are exceptional scholars.  Let’s face it, if they hadn’t made perfect grades all of their lives and excelled in academics then they would not have made it to medical school.  Once they enter medical school, many students are no longer the top of the class.  The problem is that now everyone in the class is the brightest of the bright, the cream of the crop, the valedictorian.  When 50% of the class ends up in the bottom half of the class, it is often the very first time ever that those students have been in the bottom of the class.  And of course, the “bottom half” is associated with failure in the mind of the high achieving student.  The important thing to realize for every student is that you are no longer competing with average Joe for grades, but you are competing with the next Enrico Fermi.  The logical thing to do is adjust your expectations, but students cannot “settle” for being second best.  Many students see it as the end of the world to get a “C” on an exam.  In fact, this is such a big problem that many schools have switched to a pass/fail grading system in hopes to decrease student stress.  If you don’t believe that is why schools switch to these systems then just take a look at my school…after the suicide of one our students, the very next year we switched to an Honors/High Pass/Pass system.  I wouldn’t be surprised if they simplified that further to Pass/Fail in the coming years. 

Perfection

Aside from striving for perfect grades, students are also encouraged to strive for perfection in immediate recall of knowledge on the wards.  This really is one of my biggest knocks on medical school.  We are here to learn, not to show that we already know everything.  Regardless, residents and attending physicians will “pimp” students with a barrage of questions on a particular topic all the time.  If the medical student does not know the answer to a few of the questions, then he/she can expect to be made to feel like an ass for not knowing everything.  A lot of students take the criticism to heart.  They will go home and study the topic until they know it like the back of their hand.  The problem is that it is impossible to know everything in medicine, so the student may go back the very next day and be made to look like a fool on a different topic.  The culture of medicine is such that you should strive for perfection.  You don’t know the answer?…Well you are an idiot.  You are taking a one hour lunch break?…Well you are the laziest student ever and you will not make it.  You showed up at 6am instead of 5am?  Well, I am going to give you a bad evaluation.  You only rounded on 4 patients while this student rounded on 6?…You need to do more work.  You get the idea.  No one is perfect, yet in medicine they brainwash you into thinking that everyone should be perfect.  Only in medicine can they brainwash smart students to believe that the impossible is the expectation.  Striving for a goal that cannot be reached stresses many students out.  Some students buy into the belief of perfection and kill themselves physically, mentally, and emotionally trying to get there.  It isn’t worth it.  It will only result in depression. 

Debt

Are you tired of being stressed out with the expectations and culture of medicine?  You should consider alternative careers or even just drop out of medicine, right?  Unfortunately for most students, they can’t drop out or move on with their lives even if they wanted to.  This is simply because the cost of going to medical school leaves students with so much debt that it would be impossible to pay it off if they fail to go on to become a “high-earning” doctor.  This is the vicious cycle that traps students in a profession that they may come to hate.  Most students will not make the decision to walk away from medicine only to be left with a couple hundred thousand dollars in debt and no immediate job opportunity.  On top of that family and friends will consider you a failure if you drop out of medical school.  I have thought hard on leaving the field of medicine.  Luckily, I have enough money that the debt consideration is not a big one, but even I have decided to stick it out until I graduate.  I am so far along that it would not make sense to quit.  Future employers, family, and friends would only see my lack of graduation from medical school as a colossal failure.  Everyone jumps to the conclusion that you just couldn’t cut it and you aren’t smart enough.  Never do they think that you just didn’t enjoy your life in medicine.  All of these thoughts go through the minds of medical school students at one point or another.  It is something like 4 out of 5 students have thought about quitting medical school at one point or another (these statistics are questions on our suicide module quiz at school).  The idea of failure and the lack of perfection goes a long way in medicine towards making students feel depressed.

Lower Expectations

The best way to combat high expectations from every single direction is to simply stop pushing yourself too hard.  If my resident wants me to read a 50-page chapter overnight and give them a synopsis the next morning, then maybe I will read the first couple of pages and the conclusion.  If I just barely pass my shelf exam, then it is not the end of the world.  This is the mindset that you have to adapt if you want to take a load of stress off yourself in medical school. 

Of course, the gunner student will say that this unloading of stress is inappropriate because it is at the expense of your future patients.  I disagree.  If you successfully pass through 4 years of medical school, then you have the foundational knowledge to succeed as a resident.  The only thing that can truly prepare you for practicing medicine is the practice of medicine itself.  No amount of books or absent-minded shadowing can prepare you for the real practice of medicine.  It has to be experienced.  And that is what residency is for.

Don’t Let Medicine Take Over Your Life

Lowering your expectations and taking everything and everyone in medicine less seriously will only alleviate some of the stress.  You still have to be at the hospital for half of the day and then study for the other half of the day.  I seldom get to see my family.  I will visit them on random weekends that I get off and on holidays but otherwise I only get to talk to them on the phone.  You will miss your family a lot in medical school even if you thought you never would.  Undoubtedly, you will get on Facebook only to see your friends with their new jobs and careers making a lot of money while you are still in school.  Also, many of your friends will get married and have babies while you are stuck in medical school with no money and no time to start a family.  Many students cut out hobbies from their life to study more. 

I say that in order to have a great career and mental wellness, you must reserve time for other activities in your life.  I always go to the gym and play basketball regardless of how close the test is.  I have sacrificed enough of my life to be in medical school, and I have drawn the line.  Medicine is a big part of my life, but it is not my entire life.  Unfortunately, you will continuously have to fight off the field of medicine from becoming a bigger part of your life than you want it to be.  The lack of free time, lack of family time, and pressure to allocate more and more of your life to medicine is a never-ending fight.  Sometimes it can be the tipping point in depression and suicide. Don’t be afraid to push it back and make time for yourself.

Get Help

If you ever feel like you need help, then do not hesitate to seek out counseling or tell a friend.  I can assure you that you are not the only one who feels depressed sometimes, and it is very common.  A lot of students will not speak out because it is a sign of “weakness” on the path to perfection.  Don’t listen to that kind of talk; its dangerous and wrong.  If you go through medical school without ever feeling like shit, then you simply are not human. 

A mentor of mine, an OB/GYN attending, gave me and my peers some of the best advice we would ever receive in medical school.  She sat all 8-10 of us down in a conference room and went around the table asking us a simple question: “Who do you care most about in your life?”

There were various answers including my wife, my husband, my parents, my patients, and my children.  She looked around the room and pointed out that none of us had answered, “Myself.”

She went further to say that even though medicine teaches us to care for others first and foremost, there is nothing wrong with loving and taking care of yourself.  And that in fact, if we do not, then we won’t be able to take care of the people we just mentioned in our answers.  

The bottom line: Love yourself, take care of yourself, and don’t ever be afraid to ask for help.  In medicine and in all walks of life. 

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