Medical School

Are We Raising Humane Physicians Through Inhumane Training?

Have you ever wondered how doctors get to become doctors?  I mean, obviously they go to medical school… But what does that mean?  If you think that medical school is just about going to lecture and learning about disease, and then following patients and learning about the diagnosis and treatment of disease, then you’re really only imagining half the picture – Maybe even less than half the picture.  Let me show you a little more of the picture:

Professional Development IS your first (and only) priority

Medical school assumes that students live in isolation. Have you ever met someone who has no family, no friends, no interests, and no ambitions in life?  I haven’t either.  Unfortunately, being a medical student (and even a medical resident) usually means that you should have no family, no friends, no interests, and no ambitions – aside from medicine, of course.  Maybe they don’t mean for you to have none of these superfluous adjuncts to life, they just want you to understand that all of those come after the all important “medical education.”

Sleep is for the Weak

When was the last time you stayed awake and worked for 24 or 30 hours (or more) straight?  When was the last time you did this every 4 days (or more frequently) for weeks on end?  You may think it’s a little crazy, but that’s the normal in the world of the medical student or junior resident.  Working call shifts is an important and integral part of medical training:  you often see the most interesting cases on call, and you get the benefit of continuity in patient care, especially in places like labour and delivery or emergency.  Nonetheless, we all stop occasionally and wonder who we’re really helping by working these long shifts.  Chronic sleep deprivation has never done anyone any good… isn’t that what your doctor tells you?

Pimping

Yes, I said Pimping.  This is probably a medical student’s biggest fear.  Urban Dictionary gives a pretty accurate definition of pimping: “The act of singling out one person of the group and testing their knowledge by asking them a series of intense, difficult questions in front of everyone.”  Pimping wouldn’t be so bad if they asked reasonable questions (and some physicians do).  But inherent to pimping is the idea that the physician asks obscure or challenging facts that they are almost certain the student won’t know.  Maybe it’s a good way to teach because then it allows the physician to offer the answer when the student feels sufficiently incompetent; often enough, however, it becomes an opportunity for the physician to shame the student for not knowing the answers to the questions.  The idea of pimping leads me to the next point:

You are stupid, unless you prove otherwise… which is never.

It doesn’t matter how much you study and cram into your brain in the pre-clerkship years, there is never any way you will remember everything you are supposed to know.  I know that, and the staff physicians know that, but that reality doesn’t seem to stick in real life.  I will not pretend to know everything, and I am always grateful to learn something that I don’t know.  It doesn’t help, however, to be made to feel like an idiot when you don’t know the answer.  It is also a very rare occasion that you get recognized positively for knowing the answers to the questions.  As medical students, we don’t expect a pat on the back every time we answer a question correctly (after all, we should know something), but a little positive reinforcement in a sea of criticism is always extremely welcome.

Sick?  What doe you mean you’re sick?

In clerkship at my medical school, we are entitled to 5 sick days in 18 months.  While that doesn’t sound like many, most medical students do not use their sick days anyway.  Ironically, in this profession, sickness implies some kind of weakness or inability to meet the requirements.  Having to call your resident or attending physician to say you’re sick is almost like saying: “what you have to teach me is not so important that I can’t drag my sniffly, headachy, drugged up self out of bed to come and learn from you.”  There is also a fear that people will always wonder “how sick” you really are to not come in for work.  This is not just a medical student thing, though.  I heard in a recent physician wellness presentation that 87% of physicians will come to work when they are sick.  So, maybe they are training us now to want to come in despite whatever virus might be ravaging our bodies.  This also applies to any kind of medical appointments you may need time off to attend.  It seems that telling someone you have a “medical appointment” usually earns you a strange stare of confusion: “you have to go to the doctor?  What’s wrong with you?”  Better to save it for your day off… that you might get 3 weeks from now… if you’re lucky.

The second-rate citizen

In medicine, there is a hierarchy.  Senior physician, junior physician, senior resident, junior resident… then medical student.  This is not just a hierarchy of knowledge, but it is also a hierarchy of respect.  In exactly the opposite way that the medical student must show increasing levels of respect to the people higher up in the hierarchy, medical students get less and less respect from the people above them… The higher up the hierarchy your preceptor is, the less respect you should expect to receive from them.  I wouldn’t say this is true for every resident and physician, because there are many who engage in a mutually beneficial and collaborative working relationship.  However, it is true for enough people that they completely poison the environment and make it a suspicious surprise when you come across someone who treats you with the respect you deserve.  And, when I say “respect you deserve,” I mean just basic common, human respect.  As students, we know we’re still learning, and we really don’t mind (most of the time) doing the boring scut work if we are asked.  But what’s so difficult about saying “thank-you,” or using a kind tone of voice rather than being condescending or passive-aggressive.  Yes, there is a hierarchy of knowledge and skill, but that doesn’t change the fact that we are all adults, we are all people, and we all have one common goal: to work together to improve the lives of our patients.

Burn-out is a chronic state of being

Constantly tired with never enough time to sleep.  Always criticized but never having enough time to study.  Always feeling inadequate and beating yourself up about it.  Choosing between sleeping and studying.  Choosing to study and then falling asleep.  Then being on call.  Using your post-call day to do your laundry and grocery shopping and banking and maybe even to go to the dentist, even though you really should be sleeping. Exams.  What about your family?  Has it really been a month since I called my mother?  My closest friend has stopped calling because I never return her calls.  My partner is angry again because [insert the thing you did wrong, or what you forgot to do, etc. here].  Has it really been 4 nights since I gave my kids a bath.  Shameful parenting.  You look up the criteria for a major depressive disorder and you meet every single one of them.  You think about giving up more often than you should.  And there is no end in sight.  Every medical student reaches that feeling of burnout somewhere in the middle of their education.  And there is no way out.  There is no time to recover.  You can only learn to function as effectively as possible while in a state of burnout.  You get a small sense of satisfaction for making it through another day, or week, or rotation, and running on empty becomes the thing you are most proud of.  In any other situation or profession, you would take a break or reconsider some of the choices in your life when reaching such a profound level of burn-out.  But in medicine, it’s the culture to just keep on going.

 

Medical school comes with many, many challenges and I would argue that the biggest ones are not those associated with learning about disease and management of illness.  Getting through medical school is about navigating and mastering the psychological and emotional  mess that becomes your life.  At some point we all stand back and wonder why such a highly respected and glorified profession is actually rooted in such unhealthy and somewhat barbaric practices.  If you ask any physician, they probably won’t deny that medical school was one of the most difficult times in their lives.  Yet at the end of the day, the practices persist and we as a profession push ourselves and our peers to the very breaking point on a very regular basis.

On and daily basis I am forced to wonder what we are trying to accomplish by fostering such an inhumane method of training.  Medical students lose empathy (studies prove it), they become bitter, jaded, cynical, self-doubting, dispassionate, and they might even lose sight of why they wanted to study medicine in the first place.  Is this what we want in our future physicians?  There is a lot to be learned in medical school: we learn about the medicine, we learn about life and death, we learn about patients and management of their care, we learn about what we love and we learn about what we hate.  At the end of the day, most of us wouldn’t change our mind about our choice to study medicine because truthfully (despite the tone of this post), there are many amazing lessons and experiences to be had in medical training.  It’s just really unfortunate that all of these amazing lessons and experiences have to be dragged down and overshadowed by the ways in which we are forced to learn.

3 thoughts on “Are We Raising Humane Physicians Through Inhumane Training?

  1. This is so true, and sad. I’m pretty sure it’s the same in Australia, although I’m very out of touch. I’m amazed that anyone becomes a doctor. I wonder if it’s the thought that you’ve made it thus far and it would be a waste to now throw it all away is what keeps many of them going. And, of course, the fact that the desire to become a doctor is an altruistic one, and those are the hardest dreams to relinquish.

    Good luck with the rest of your journey.

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  2. I feel your frustration. We just were presented with all the information on Step 1 in a not so great kind of way. How do they expect us to interact with patients in a calm and sympathetic way when they begin scaring us at the earliest steps!?

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