I was recently interviewed by the Trauma & Mental Health report. I spoke about what's causing mental health issues in medical students and physicians, and what is being done to address these issues. Here’s the interview.
Q: What are some factors that lead to the increased mental health issues within students?
It’s multifactorial and interconnected, but here are three things that I think are most impactful.
First, there is an identity shift that accompanies starting medical school, and it is not a healthy one. Since everything is set up as a series of exams, students begin to feel as though their worth, as humans, is based upon the test scores they achieve. Working so hard to prepare for test after test after test makes it almost impossible not to get caught up in the outcomes. And since there is no time for anything else, there is no other part of their personalities to fall back on. They feel as though they are their tests scores — which is a surefire way to make smart and dynamic people feel stuck in a one-dimensional system.
Second, not having time for the things that make us unique starts to accumulate until there is this feeling of disconnection from the world. We have less time for our hobbies, creative outlets, friends, family, and relationships; even things like being outside and sleep and grocery shopping turn into anomalies. The schoolwork is continual—there is always, always something to be studying or working on. Therefore it eats into any time that we might set aside for a partner or for ourselves: We feel guilty for “taking a break.” The amount of work that needs to get done pulls our thoughts away until we are no longer present in the thing we’re trying to do.
Third, imposter syndrome. It’s a phenomenon where someone feels like they don’t belong where they are, despite external evidence of their success. This is ubiquitous throughout the medical profession—from students to physicians and every position between. Each person feels like he or she is the ONE who doesn’t belong; the one who is a misfit; the one who doesn’t know the secret that everybody else knows. It truly is a haunting feeling. Many, many people have disclosed to me this sentiment that they feel everyone else is “better than them.” I have to remind each one of those people that “everyone else” is telling their friends the exact same thing.
Q: What are some factors that lead to the increased mental health issues within physicians?
The mental health of physicians is affected by same things affecting medical students plus many additional factors. I’ll list a couple here.
One is an added pressure of debt. Its magnitude makes physicians feel like they have no choice but to stay with the profession that has proven to be less fulfilling and rewarding than advertised. The majority of students graduate medical school with $200,000 to $500,000 dollars in debt, so they fear leaving or switching careers and risking not being able to pay it off. That pressure, and perceived loss of choice and autonomy, can make physicians feel helpless and trapped.
Another contributing factor is more psychological: There is an image of a happy, caring, thriving doctor who truly “helps people.” That is the image that propels people to get into this profession. What people tend to find, however, is a different system altogether. It’s a system where they spend less than 15 minutes with each patient, are ruled by patient-satisfaction scores, and spend twice the time documenting information on electronic health records than they do face-to-face with patients. Many of the physicians who do leave cite their reason as not feeling like they are helping anybody. They begin to realize that their lifelong dream that took 12+ years of education to obtain (and hundreds of thousands of dollars) is not what they had imagined—and that is devastating.
They also realize the concept that they, as physicians, are sacrificing their own health (with regards to sleep, family time, exercise, etc) in order to take care other people’s health. It’s a paradox that starts to consume their daily thoughts and makes many want to leave the profession.
“So why don’t they get help?” — It’s a common question, and the answer further shows why mental health problems occur at such a high rate. Getting care could mean career problems for doctors. If they seek help for mental health issues and if someone decides they are “unstable” and shouldn’t be seeing patients, that physician is out of job (and would have a really hard time finding another one). So they suffer in silence.
Q: What is being done to address, improve, or treat the mental health crisis experienced by physicians and medical students?
The majority of medical schools really want to help their students. There are well-intentioned programs in place that include reflecting, meditating, exercising, and taking breaks; some schools have built-in downtime; most schools have counselors on staff to help their students with any mental health issues.
However, on average, a medical student is 5x more likely to be depressed than someone in the general population, so something is missing the mark.
I have a mentor, Pamela Wible MD, who says “You need systemic answers for systemic problems.” The solutions we try to implement now are on a personal or program level. The problems are pervasive among the entire structure of healthcare education and delivery— but now we put the burden of wellness on the individual to “meditate more” or “exercise.” To which most medical students and physicians would say: When?
We need to redesign how we implement medical education. The culture of medicine should undergo amazing and radical transformations.