When medical students don their white coats for the first time, they take an oath to devote themselves to the care of their future patients. Unfortunately, for far too many students, this commitment comes with sacrifice -- that of their own health and well-being.
My oath carried a commitment to 'ensure patient well-being as my main focus and my primary obligation.' Although I wholeheartedly appreciate the notion of caring for my patients with all my energy, to state that one's health aside from my own is my primary obligation speaks to the dangerous sacrifices expected of medical students.
On December 6th, a major research study on medical student mental health was published in the Journal of the American Medical Association. Its findings have come as a shock to many -- hitting news headlines across the world. For medical students however, it has simply provided confirmation of what we have long known.
The study combined data from over 180 individual studies -- totaling 129,000 medical students in 47 countries -- and found that 27% of medical students were depressed or had depressive symptoms, 11% had thoughts of suicide, and that 15% had sought psychiatric care.
Sadly, the culture of medicine and medical training is to blame. It has become ingrained in the minds of the established many, that to suffer through medical school is a necessary prerequisite for students to learn. They believe that the status quo, a system of inevitable suffering, is the only way medical training can and should be offered.
The number of times that I have heard senior staff say that younger generations are weak. That we don't want to work hard. That we're lazy.
These individuals take pride in how much they suffered -- as though it's something we should want to emulate. And they have this horrible expectation that we should follow suit. They state that medicine is a calling, implying self-sacrifice as being expected.
"In order to avoid a negative evaluation or develop a poor reputation in the eyes of physicians, medical students stay silent."
There are numerous factors at play which explain the struggle felt by so many medical students. Students are required to work long hours -- including call shifts exceeding 24 hours in length. They are then required to study during the limited hours where they are not working. Additionally, students are required to adjust to being at the bottom of the medical system hierarchy, often disrespected, while in high stress clinical environments.
They are often subjected to abuse -- by jaded physicians or allied health professionals -- seen as an easy target, unlikely to speak up or speak out against such behaviour. Add to this the student's constant need to impress supervising physicians -- to ensure good evaluations, and good recommendations when it comes time for residency applications.
Compounding these stressors are the social implications of being a medical student. High tuition, no income and hundreds of thousands of dollars of debt are the norm. Relationships take a back seat -- family, friends and significant others are rarely seen.
There's often simply no time for hobbies and social activities. Healthy lifestyles are not prioritized -- resulting in poor sleep habits, limited physical activity and unhealthy diets. Furthermore, taking time off from work is a difficult process, often discouraged and where vacation time is structured and not flexible.
Students suffer for many reasons, the above are but a few examples to provide context to the reader regarding the numerous potential factors that can be at play. They may suffer for reasons totally separate or may have relevant reasons not listed. But one can only begin to imagine how negatively these various factors can impact one's mental health if they start piling up...
Most students are unable or unwilling to speak up or speak out. They endure this culture of suffering because they do not want to rock the boat. They don't want to cause any problems for themselves when it comes time for ultra-competitive residency position applications. As such, in order to avoid a negative evaluation or develop a poor reputation in the eyes of physicians, medical students stay silent.
"It's a job. Not a commitment to sign my life away. The end."
There's also the societal pressure placed on medical students. We're considered to be the cream of the crop -- having excelled enough to gain admission into medical school. This plays out in two ways. Firstly, society thinks we're all "smart enough" to be able to handle the challenges of medical school, simply because we were able to meet the rigorous demands required to gain entry.
Secondly, because there are countless thousands of unsuccessful candidates, society expects us to be eternally grateful for the opportunity to study medicine. To be unhappy or to speak out makes us unappreciative or even "entitled".
I don't even know where to begin with this. It's a job. Not a commitment to sign my life away. The end.
The select few students who speak up, or those who are unable or unwilling to withstand this suffering are often labelled weak -- told they are unprepared for a career as a physician.
I'm a bit outspoken on these matters. And even I've been told that maybe I should reconsider career paths. There's this expectation in medicine that we cannot vary from the status quo -- no matter how archaic. The worst part about speaking out is the inevitable condescending responses that follow. I've been told I'm not ready for the real world.
"We treat to heal, we advocate and promote health. Yet, our own health has taken a beating. Forced hypocrisy by systemic design."
The release of studies on medical student health, such as the one highlighted above, are important for advocating for the health and wellbeing of medical students. No profession in the world should accept a 1 in 4 rate of depression, or a 1 in 10 rate of suicidal ideation -- let alone among young learners who are training to become leaders of, and providers of, healthcare.
The devastating irony of this is not lost on us. We treat to heal, we advocate and promote health. Yet, our own health has taken a beating. Forced hypocrisy by systemic design.
When it comes to mental health, we cannot afford to be reactive by trying to bandage this broken culture of medical school. Let us use such evidence as a tool to enact proactive change for our medical students. Let us ensure our future medical professionals are themselves healthy, before giving them the responsibility of ensuring the health of society-at-large.
One can only hope that archaic views of medicine and the need to suffer die out with changes in generations of physicians. That said, we need to continue to openly speak out about such issues in order to ensure that this negative cycle does not perpetuate. We know it's wrong, let's make it known.
And when we become residents and staff, let's remember how horrible the culture of medical school can really be. And please, for the love of all things good, don't be the type of staff that questions why a student wants to go home after their call shift has ended.
Original Post: Medium
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