The journey to medical school is a long, grueling process. Finding research and internships, long hours of volunteering and community service, studying for the MCAT, maintaining a stellar GPA- not to mention your sanity- it’s hard to find time to have a life in between all of that. It’s not as if the work stops there though. Any informed student on the pre-medical track knows that after undergraduate studies comes medical school, after med school comes residency, then maybe a fellowship, followed by the hardest part: daily practice of medicine. And before you get ahead of yourself, all of this is assuming you do well enough to receive admission to this multitude of programs. As an aspiring doctor and a current pre-med student, I have come to know all too well how the pressure of future success can alter the trajectory of a student’s life- that is, by cutting it short.
My high school experience in Northern Virginia, plagued by “one or more high-profile student suicides nearly every year for the past decade,” (Contrera, 2018) was a difficult, yet enlightening one. The pressure to succeed is palpable in the affluent suburbs of Washington, D.C., particularly within driving distance of the Thomas Jefferson High School for Science and Technology, a STEM-based magnet high school which holds a national ranking of #10. Students struggle to rack up extracurricular activities, leadership positions, and glowing teacher recommendations. I could talk about the expensive preparatory programs with classes of fourth graders studying for the SAT, or the seventh-grader who jumped off a bridge in an attempt to end his life (Contrera, 2018), but just understand that the absurdities of growing up in Loudoun and Fairfax County are endless.
I still remember the two student suicides, a freshman and a sophomore, which occurred within a week of each other at my school during my junior year. Although the trauma and grief that rippled through the school and the entire community will stay in our hearts for the rest of our lives, I have moved on from those experiences with gratitude towards everyone who supports me.
I am aware of how the pressure can get to you- how if just one other thing goes wrong in your life, it can push you over the edge. This understanding is invaluable to me, because, like so many pre-meds, I do rely on motivating myself to continue on this journey that will last at least 12 years and that may be dotted with a couple of failures along the way.
As the daughter of two practicing physicians, I have seen the pressures that the daily practice of medicine weigh on the souls of hardworking people, affecting their families and their livelihoods. My mom, a primary care physician whose irrepressible compassion led her to become a doctor, sometimes comes home melancholy and reticent,
occasionally crying. When we press her to talk about her feelings or ask her why she is troubled in hopes that our discussion would be therapeutic, she brushes us off, citing complications of HIPAA- the Health Insurance Portability and Accountability Act, which protects the privacy of medical information- and how she can’t disclose anything about her patients. I also see the worries of my dad, an orthopedic hand surgeon who worked so much during his residency that my little brother didn’t know we had a father at the time. Although my dad has regulated his hours by going into private practice, he still worries about stories he hears of his colleagues in the Washington, D.C. suburbs, including the case of Dr. Benjamin Shaffer. Dr. Shaffer was a brilliant, world-renowned orthopedic surgeon, who authored over 50 publications, consulted for various national sports teams, and trained surgeons across the world in his 25 years of practice in the Washington, D.C. area (Wible, 2019). Shaffer suffered from debilitating anxiety and insomnia, which were only magnified by his reluctance to receive serious care due to “the stigma attached to doctors seeking help for mental health” (Wible, 2019). Despite his admittance to his therapist of his suicidal thoughts and plan to carry them out, the self-mismanagement of Dr. Shaffer’s care led to his suicide in 2015.
Upon attending a white coat ceremony and gazing over the sea of recent medical school matriculants, it is reasonable to assume that you are currently examining a group of consistent high-achievers and ambitious self-motivators, sprinkled with more than a few perfectionists. What you might not see is the intense need to succeed, driven occasionally by parents, but mostly by the students themselves, who can’t fathom working so hard only to not be the best. Medical students have a suicide rate three times higher than that of the general population in their age group (American Foundation for Suicide Prevention, 2018). The academic stress and pressure to match to a residency after graduation can exponentially increase the rigor of classes and make it hard to balance a personal life with classroom success. The combination of all of these factors have the power to determine the trajectory for the rest of a physician’s life.
With evidence of high numbers of medical students and physician staff exhibiting symptoms of major depressive disorder, where does the pressure and toxic environment begin? My mother’s colleague recently received the devastating news that her son, a wildly successful pre-medical student studying hard in the hopes to be a doctor just like his mother, committed suicide in his dormitory at the University of Pittsburgh. A recent study which examined the prevalence of depression in premedical undergraduate students found that the “sense of perfectionism” and a “lesser tendency to seek support” that these students exhibited led to depression levels of greater intensity and frequency than their non-premedical counterparts (Fang, et al., 2010). These depressive symptoms simmer and burgeon over time through medical school and residency, and they might become dangerously ingrained if left untreated over the lifespan of a medical education and beginnings of a career.
But as I explained before, in medicine, the grind never stops. Physicians have to manage patients with no margin for error, stemming from the heavy responsibility accompanying the nature of the job. The possible sources of depression are endless with patient deaths, threats of malpractice suits, infinite and repetitive bureaucratic tasks of charts and paperwork, long hours and high patient volume, the assembly-line medicine system- in which doctors are only given 15-minute slots to evaluate complex patients, and intense sleep deprivation (Lim, 2003).
Burnout is a term commonly associated with physicians, yet it is also accompanied by more distasteful connotations. Terms like “burnout” lay the blame on doctors for not being enough, not being able to compartmentalize or struggle and emerge on top as effectively as the rest of their peers. Suicide rates among physicians are more than twice that of the general population, at the rate of about one suicide per day (Kane, 2019). These staggering statistics are humanized by “Do No Harm: Exposing the Hippocratic Hoax,” a new documentary pioneered by Emmy-winning director Robyn Symon. It reveals the unhealthy, toxic demands that the medical system asks of its physicians, leading them to care less for themselves and their personal health (Hlavinka, 2018). These demands lead to rampant depression or depressive symptoms and ridiculously high suicide rates, translating the issue into a fundamental wrongdoing by the healthcare industry as a whole.
This problem isn’t only relevant to physicians as a public health issue. When physicians are stressed, exhausted or over-worked, they make mistakes. This consequence was present in the well-known case of Libby Zion, an 18-year-old who died after being treated with a combination of medications, due to the exhaustion of residents and lack of supervision by more experienced doctors (Cohen, 2014). Being a doctor is all about a patient putting their life into your hands and expecting you to do what’s best for them. As a healthcare worker, would you be comfortable following the lead of an untreated, mentally ill physician? Or in the most important scenario, as a patient, would you be comfortable putting your life into the hands of someone who is distracted and struggling mentally and emotionally because they haven’t received the proper care themselves?
About the Author: Amina Khan is a first-year student at the University of Michigan in Ann Arbor, Michigan. She plans to double major in Evolutionary Anthropology and Biology, with a minor in Spanish Language and Culture, and she enjoys combining her passions for medicine, public health, and anthropology towards both computational and clinical research. She aspires to be an orthopedic surgeon who advocates for the healthcare disparities for both the Hispanic-Latinx and formerly incarcerated populations in her community.