Doctor burnout starts in medical school

I adapted this from a post I wrote as a medical student:

The Atlantic had an interesting reflection on young physician burnout that cogently argues that burnout is caused by more than student debt or medical systems failures, but losing a sense of why a student chooses medicine in the first place. Gunderman writes, “They soon discover that, instead of expanding their capacity to make a difference in the lives of others, the rigors of medical school have constricted their field of view to their own survival.” He offers Dr. Lydgate from Middlemarch as an example: “I must do as other men do and think what will please the world and bring in money.”

He’s right in pointing out this attitude of having to please other people and not living for oneself as the main driver of burnout. But the real mind-game being played is that many med students THINK that is the prevailing attitude and act accordingly. Everyone else studies 8 hrs/day, therefore I must study 8 hrs/day; everyone else sucks up to the attending, therefore I must suck up to the attending; everyone else only care about themselves, therefore I must care only about myself. Everyone else is a shark, therefore I must be a shark.

However, if you talk with most med students, they’ll show you that they are caring, ambitious people who want to, cliche of cliches, “help people.” But to the rest of the world, we have to invent more spectacular personal stories, more sexy but implausible research and business ventures, just to gain someone else’s approval.

The problem starts from the minute someone decides to apply to medical school. I think many med school applicants are usually eager-to-please, self-conscious, and very neurotic (including myself). Admissions committees reward these behaviors by admitting these students. Medical schools do little to dissuade students from embracing negative behaviors. Instead, we school in artificial environments and pay mere lip service to ethics, history, and the human side of medicine.

The clinical years become one long beauty pageant. The matter of learning humbly by the bedside, of admitting what we don’t know so that we can be taught, of delivering bad news awkwardly to patients and getting critical feedback that fortifies us and makes us better, is lost because we are terrified of getting bad evals.

To which I have said, “screw that.”

I don’t think I’m better than anyone else. I know for a fact that performance-wise, I am in the middle of the pack. But once I stopped caring about impressing people, I became enthusiastic about learning the nuances of practice, the systems questions, the connections between the individual, health, and society. I observed more keenly because I wasn’t worried about how I looked. And I became enthusiastic. I had a sense of purpose. I had a sense of discovery that couldn’t be dampened by anything. I reserved time to learn about non-medical topics, too. When I made the conscious decision to be true to myself, I shared papers with my team on rare syndromes and RCT results, asked questions about treatment plans, and offered myself as a resource to patients. Which ended up impressing some of my evaluators anyway.

I have been able to enjoy my growth over time and know that I have a lot more growing to do.

The business of becoming a doctor should not be a competition to show who is the most saintly, or even who gets the highest test scores–it should be about supporting and nurturing the students who have chosen to give their lives to medicine.

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About the friendly intern

Ask a question: The Friendly Intern My personal blog: Pathos and Pathology
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