Physician, Heal Thyself

Physician, Heal Thyself

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SANTIAGO SANCHEZ Each year we lose 300-400 physicians and 150-180 medical students to suicide¹. That’s one medical student lost for every medical school in the United States. Simply, we will all most certainly lose a colleague to suicide at least once in our professional careers and even more likely to succumb to depression ourselves.

Among males, the suicide rate for physicians is 70% higher than it is in the general population; among females, the rate is 250-400% higher. Medical students, regardless of gender, have a depression rate 30% higher than the general population.

Before reading this interview, I strongly encourage the reader to take a look at Dr. Gunderman’s original article on physician burnout, “For the Young Doctor About to Burn Out” which appeared in The Atlantic in February earlier this year.

An Introduction: Minute Betrayals of Purpose

In his article, “For the Young Doctor About to Burn Out”, Dr. Richard Gunderman defines professional burnout as “the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice,” – what I feel is a wonderfully articulate and apt description of the problem at the dogmatic center of the discussion in this article. He can (and will, if you read on) elucidate on the medical and professional aspects of this idea far better than I ever could; consequently, I wish to build on this idea from the ground up by providing a perspective on these minute betrayals of purpose are now, even as we speak, working against you. The position I take is stubbornly cynical. It has to be and I will briefly explain why. Firstly, consider the prevalence and gravity of the medical burnout problem – reread the first two paragraphs in this article until you are convinced. It follows, then, that this is a systemic problem and not a personal problem, albeit one that is hard to source. Thus, what we’re looking at is a needle in a haystack and while searching mildly through the stack is a more balanced approach, setting fire to the stack makes it perfectly obvious where the needle is.

For the past twenty or so years we have been riding what I can only presume is the proverbial hamster wheel of affirmation and success. Individually, you are exceedingly talented and in aggregate the level of potential in an elevator full of you and your peers would inspire a prayer that the cables on that elevator hold under any weight lest a significant pool of humanity’s intellectual resource be obliterated in one cruel and deeply unjust circumstance.

This is about those cruel and deeply unjust circumstances.

The honor student is the fox-terrier of education. You are perfectionists battle-hardened – intentionally or by accident — in the art of hitting the numbers that will get you to the places you want to be. So far, you have succeeded. But now you are entering a far more demanding and far less forgiving arena filled with more random pitfalls than ever before. The “pre-med” moniker carries with it the elitist association of a secure, high-paying job complete with a presumptuous prefix that not only accepts the end goal as a given but as so much more valuable than the current educational experience that the purpose of the undergraduate career is usurped by the self-importance of achieving that goal. Every exam you will be reminded of the possibility of “not getting in”, and when your first set of letter grades roll in you might feel hopelessly behind. In fact, you will always feel hopelessly behind. Someone else is always getting ahead, getting involved with this, getting an internship, joining some program, invited to some conference, etc. You will feel like you have to constantly work just to keep up the pace and even when you out-score 80% of the class you will still be average in the oppressive face of medical admissions statistics and the pressure will only heighten with the innate, barking desire to blaze through the path you have carved out for yourself. You will involve yourself in far too many things and not care about nearly half of them only to maintain the impression of being a well-rounded individual. You will volunteer for no reason, study for any reason, shadow whomever, do whatever research – all in the name of not leaving one box unchecked for the faceless committee of individuals who will one day decide if you get to become this thing you have always wanted to become based on some numbers on a spreadsheet and some words on a piece of paper. In all likelihood, you will do all of these things without giving a single moment’s thought as to why you are doing them at all.

University is the first and maybe even last opportunity most students ever have to step back from the world, on their own, and look, I mean really look, at the world around and inside of them from a distance. In primary and secondary you were chained inextricably to your parents or caretakers by the umbilical cord of circumstance and convenience. After you graduate in what the university administration makes clear will be four years, you have a life of endless responsibility, cyclical frustration and tedium boiling under the pressures of continuing your species and meeting every career milestone from now until your corporately sponsored retirement. This will be your life, superficially.

At least that is how a cynic would look at it – and we don’t have to look at this way. You could take a look and say that none of those critiques are about medicine and they aren’t. They are facts of life. So why do members of the medical community seem to fall into one or all of these psychic pits with such frequency during their careers? The answer is not in the core of medical practice or education, or in its mission, but hidden in the quietly whirring machinery ticking behind every study session, every rushed shower, every standardized exam, every patient interaction, every spilled cup of morning coffee.

To read the original full article and interview, please visit the original article at The Pulse

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