Medical School and Suicidal Ideations

Recently a comment was left on one of my posts about an article in the NY Times. The article was a snippet about an article written by Pauline Chen, the author of Final Exam, a book I read (and enjoyed) before starting medical school.

The article written by Dr. Chen was spot on. It talks about how professors try to “humanize” the first 2 years of medical school and support extracurriculars, but that this doesn’t necessarily help. To quote the article, “Given the fire hose of information medical students must learn in just four years, how does one ever gently take a sip?… Despite my teachers’ efforts, I was about as miserable in medical school as I had ever been. I felt alone. Neither I nor my classmates could admit to failure, and that last thing I wanted to do was to let anyone but my close friends know just how unhappy I was. Success in medical school was the first step to the future of helping other, and I was not about to jeopardize that.”

The article goes on to talk about a general survey of medical students concerning their mental health. Half of the students met the criteria for burn out and 11% admitted to suicidal ideation with the past year.

To be honest I really don’t know where to begin with my thoughts on this article, but I’ll give it a try (and remember I’m currently only a 2nd year student). Please forgive me from my rambling in this post.

It is more than truth that medical school is a lonely time, however, it is a weird loneliness. It is one of the first times that I have been surrounded by so many people who understand me. All through college no one really understood the need to study all the time, or what made me tick. So in that sense, I do not feel alone. But you do when it comes to everything else -- you feel alone in your studies, even when surrounded by all your friends doing the exact same thing. It brings about bonding, but not in the same sense.

I feel that I have been lucky in some regards to have made some very good friends (or at least ones that I can be completely open with), but that does not make failure any less of a lonely place.

This past month has been one of the hardest in my academic career. I had 7-8 hours of class a day and was studying about 10 hours a day on top of that (including eating while studying). The other 6 hours were spent sleeping. Even then there was too much information to actually get through more than twice before the exam…. Sipping from the fire house was and never will be an option. An analogy my roommate mentioned the other day was standing in the ocean with huge waves coming at you and over you, it’s enough of a challenge just to catch a breath before another wave crashes you down.

In that regard you have to wonder what the point is -- you cram information for a month only to dump it the day after an exam so you can cramp another 500 pages of dense information for the text the next day. Are we really learning at that point?

But back to the main point of the article -- burn out and suicidal ideation. That only 50% of those surveyed admitted to burn out means that some people are fooling themselves. Everyone I know in medical school has experienced burnout. It actually becomes a fairly constant friend of most medical students. There is no way a person can be alone for days on end with only their books, studying until they cannot see straight (or need a new contact prescription), and not reach burn out.

This past unit we started psychiatry and some of what we covered were mood disorders. By the end of the unit I had at least 4 of the 8 criteria for an major depressive episode (not including suicidal ideation)… and in talking to many of my friends they were right there with me -- sleep disturbances, lack of energy, overeating or lack of hunger, lack of interest in anything… we were all just going through the motions of trying to learn. I could go on but I think that gets the point across. I think that if we were all honest, we would have been diagnosed as having an MDEs.

Granted one of the criteria for major depressive disorder is suicidal ideation. While I don’t think any one of us would actually admit to having suicidal ideations -- we do joke about it often enough that you have to wonder about some people. And even if there is not suicidal ideation there is enough stress and other issues that are leading people to masochistic actions and impulsive, dangerous behaviors.

Medical school is not a friendly place when it comes to mental health. I would say that most of us need to be talking to psychiatrists, but ironically, we barely have enough time to learn about the material, let alone take care of ourselves (and that does not just stop at mental health). It’s sad when you think about it, but it’s nonetheless true.

Where does that leave us? Something needs to change. Firstly, I think that each medical student should be seeing someone to talk through issues they are having, or at least have time blocked out somewhere for personal maintenance. Secondly, the traditional view of teaching the minutia needs to be revisited. Although it’s important to understand the underlying science, is it really necessary to know what part of what protein interacts with the receptor? Or just that it does? What do we actually need to know before embarking in our true careers?

Decreasing the demands, not only academically but extracurricularly, placed on medical students would improve our health substantially.