Burnout and Suicide in Medical School

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MD4Students

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The article in the Annals of Internal medicine "Burnout and suicidal ideation among US medical students" Volume 149, #5, pg 334 2008 has raised serious questions concerning the stress of medical school. In this article, burnout was reported in 49.6 % of the students and suicidal ideation reported in 11.2%. Communication with the authors indicated that there was a concerning difference among the schools evaluated with regards to the suicidal ideation, however the numbers for were too small to draw conclusions and publish a difference.
The article also states that "suicide rate among male physicians is more than 40% higher than among men in the general population", whereas "the rate in female physicians is a staggering 136% higher than among women in the general population".
One of the professors at UMDNJ has raised the issue that medical students should demand and have the right to know the suicide rate of the medical school in which they are enrolled. I am merely writing to bring this to your (the students) attention and to question how you feel about the situation and if you feel anything should/can be done about it.
 
I think having a clear definition of "burnout" and "suicidal ideation" should be spelled out first (and if it is in the article, I apologize for not taking the time to read through it entirely).

I have noticed that the school and the administration (where I'm at, anyway) seems to impose this ludicrous idea in students' minds that "medicine will be your entire life and will always be your first priority". Don't get me wrong, I take medical school very seriously and realize that it is one of those fields where you will face some tough decisions that will directly affect others. However, I refuse to become a slave to my career which is what the medical education system attempts to impose.

I won't let being a physician define who I am as a person because the truth is that being a physician is a part of who I am. Therefore, medicine will not always be first priority for me. And sometimes the school administration/faculty fails to acknowledge this.

Which inadvertently leads to some students feeling sad, depressed, anxious, etc. because they can't figure out how to keep medicine in a list of top priorities without having it consume their entire life.

Also, this is a different topic altogether, but I think one area medical school fails in (or maybe this is an undergrad education issue?) is teaching how to manage time and become more efficient. I think more than half of the stress your average medical student experiences can be eliminated if he was just a little better at managing his time and being more efficient with his studying. Without proper time management skills, many medical students are deteriorating and "burning out".
 
wow! those are some pretty crazy statistics. i know that i have gone through some tough times emotionally.

does anyone think that medicine might attract people with depressive and suicidal tendencies? i wonder about that sometimes.
 
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MD4Students said:
The article in the Annals of Internal medicine "Burnout and suicidal ideation among US medical students" Volume 149, #5, pg 334 2008 has raised serious questions concerning the stress of medical school. In this article, burnout was reported in 49.6 % of the students and suicidal ideation reported in 11.2%. Communication with the authors indicated that there was a concerning difference among the schools evaluated with regards to the suicidal ideation, however the numbers for were too small to draw conclusions and publish a difference.
The article also states that "suicide rate among male physicians is more than 40% higher than among men in the general population", whereas "the rate in female physicians is a staggering 136% higher than among women in the general population".
One of the professors at UMDNJ has raised the issue that medical students should demand and have the right to know the suicide rate of the medical school in which they are enrolled. I am merely writing to bring this to your (the students) attention and to question how you feel about the situation and if you feel anything should/can be done about it.
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My suicidal ideation would go up if I lived in NJ I think
 
I'm not surprised. My school really pushes us to go to counseling if we need help, and we had to watch some videos on physician suicide. It's not a subject people like to talk about. My friend killed himself a month ago, and a part of the problem was his psychiatrist giving him some antidepressants and showing him the door instead of trying to get him counseling. It's a hard subject to talk about, and because of that we tend to ignore it and be very uncomfortable when it's brought up. A lot of people, doctors included, still see depression as not being a "real" disease, and until that changes this is going to continue to be a problem.
 
Fiddlergirl said:
A lot of people, doctors included, still see depression as not being a "real" disease, and until that changes this is going to continue to be a problem.
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Does it need to be a real disease to be a problem? Part of the problem that I have with the tendancy of psychiatry to always treat depression as a 'real' disease, regardless of the circumstances, is that it places the majority of the blame for the problem on the patient's physiology rather than external sources which could be the major contributing factors, which in turn causes them to turn to treatments (medication) that don't address the underlying problem.

Actually I think the fact that so many doctors are depressed and suicidal is a pretty good sign that this is not always a real disease, in the sense that there is something physically wrong with you. Saying you're sick because you're depressed in medical school is like saying you have a skin condition because you get burned every time you touch a hot stove.
 
Does it need to be a real disease to be a problem?
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Of course not. That was part of the problem with my friend. The psychiatrist gave him some SSRIs and assumed the problem was solved because he fixed the physiological problem. From my research (mainly through UpToDate and PubMed review articles) treating depression requires BOTH counseling and medications. It's a mistake to think of it being purely psychological and it's a mistake to think of it as being purely physiological.
One of my professors told us to think of it like diabetes type II. You might be genetically predisposed to DMII, but if you have a BMI of 25 you are less likely to develop the disease than someone else who is predisposed and has a BMI of 35. He told us to think of certain life events as being "hits," and each hit put you a little closer to developing clinical depression. For example, someone who goes through a bitter divorce and then loses a child might be more likely to develop depression.

Saying you're sick because you're depressed in medical school is like saying you have a skin condition because you get burned every time you touch a hot stove.
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There's a world of difference between being "depressed" because medical school is getting to you and being clinically depressed. That said, go back to my previous "hits" explanation. Medical school sucks. It's stressful, you don't have time for the hobbies you used to have to relieve that stress, and chances are you aren't sleeping enough or eating well. If you were predisposed, that would be a perfect set of circumstances to develop clinical depression.
 
Perrotfish said:
Does it need to be a real disease to be a problem? Part of the problem that I have with the tendancy of psychiatry to always treat depression as a 'real' disease, regardless of the circumstances, is that it places the majority of the blame for the problem on the patient's physiology rather than external sources which could be the major contributing factors, which in turn causes them to turn to treatments (medication) that don't address the underlying problem.

Actually I think the fact that so many doctors are depressed and suicidal is a pretty good sign that this is not always a real disease, in the sense that there is something physically wrong with you. Saying you're sick because you're depressed in medical school is like saying you have a skin condition because you get burned every time you touch a hot stove.
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It's impossible to separate psychology from neurology though, in the sense that every thought, emotion, and drive that a human being experiences is directly related (albeit in a complicated fashion) to neuroanatomy and neurophysiology-- no mind without a brain. I would say that treating the brain is a much more "direct" method than addressing external factors which are incorrectly presumed to be primary problems.

If we think about this:
Brain => mind/actions
We have a good idea of how altering the left side of the equation will influence the right side, because brain functions can be changed objectively and the outcome variables are easily measured.

If we address "underlying problems":
Mind/actions => brain
We have to tackle the difficult task of creating a subjective, immersible environment of support and protection, only to guess at the outcome. Besides, people cannot just quit their jobs and leave their families to solve their problems.

Life often sucks, and why shouldn't it? Most species that ever existed are gone, and the ones that are still around are here because they scratched and clawed their way through difficult times. Living things, humans included, are not supposed to be happy all the time. Anxiety and fear are the fuel that life uses to move forward.
 
Fiddlergirl said:
There's a world of difference between being "depressed" because medical school is getting to you and being clinically depressed. That said, go back to my previous "hits" explanation. Medical school sucks. It's stressful, you don't have time for the hobbies you used to have to relieve that stress, and chances are you aren't sleeping enough or eating well. If you were predisposed, that would be a perfect set of circumstances to develop clinical depression.
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This problem(s) of not having enough time for hobbies, sleep, eating, etc. are fixable and I believe that both medical student and the school fails to address it sufficiently and properly.

Students need to realize that there CAN be time for hobbies, for getting good sleep, and for eating a nutritious, healthy diet.

I realize that some people need to study like mad men just to keep up with the material and just to pass classes. Even those students can ALWAYS find time to sleep and eat well if they just plan ahead appropriately.

And the medical school/faculty/administration needs to be more proactive and teach its students from day 1 about how to manage your time effectively and guidelines to help form a proper, easy-to-follow diet plan for the "busy student".

Medical schools shouldn't have a problem finding a nutrition expert to come and talk to the class about how to go about selecting the right type of food. Hell, they can even put together a document and e-mail it out to the entire class from time to time or start some sort of monthly nutrition newsletter which will address these issues.

I realize the point you were making in your post. I just wanted to go off tangent on a different point though so hope you don't mind I quoted you.
 
A childhood friend of mine committed suicide during internship. It was really awful (obviously).

I think if you have any tendency toward depression, medical training is the perfect way to foster it. Med school and residency has all this theoretical help for people who are having depression, but really, none of it actually helps. I think a large number of my fellow med students and residents were pretty depressed at times. I don't know what the answer is though. I guess most people just get through it.
 
I guess most people just get through it.
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Some people don't get through it, though. There are treatments for depression, and I don't see why we can't have access to them just like our patients do.
 
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Rollo I think your 100% right on all your points. I have told my wife numerous times that me being a physician will not define who I am, me being who I am will define what type of a physician I am.
 
Fiddlergirl said:
Some people don't get through it, though. There are treatments for depression, and I don't see why we can't have access to them just like our patients do.
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The problem, as I see it, is not that people who seek treatment don't get it, but rather that the people who need it don't always seek it. For one thing, there's a stigma associated with seeking mental health treatment. And secondly, when you're already feeling overwhelmed with too much work, the last thing you want to do is make time for counseling sessions. And thirdly, most of us think we're tougher than our patients and can push through anything.
 
WashMe said:
It's impossible to separate psychology from neurology though, in the sense that every thought, emotion, and drive that a human being experiences is directly related (albeit in a complicated fashion) to neuroanatomy and neurophysiology-- no mind without a brain. I would say that treating the brain is a much more "direct" method than addressing external factors which are incorrectly presumed to be primary problems.

If we think about this:
Brain => mind/actions
We have a good idea of how altering the left side of the equation will influence the right side, because brain functions can be changed objectively and the outcome variables are easily measured.

If we address "underlying problems":
Mind/actions => brain
We have to tackle the difficult task of creating a subjective, immersible environment of support and protection, only to guess at the outcome. Besides, people cannot just quit their jobs and leave their families to solve their problems.

Life often sucks, and why shouldn't it? Most species that ever existed are gone, and the ones that are still around are here because they scratched and clawed their way through difficult times. Living things, humans included, are not supposed to be happy all the time. Anxiety and fear are the fuel that life uses to move forward.
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I understand where you are coming from, but I don't think that was his point.

If external factors are changing the chemical balances in the brain, then why not go and try to fix the external factors? I find it very hard to believe in most cases that depression can just hit you all of a sudden, without prior external factors building it up.

I don't have any evidence nor do I do research in this field, so my thoughts may not mean anything, but I strongly believe that the main way to treat depression is through giving people different ways of viewing things. Show them that someone cares about them and guide them in thought processes. Show them that there are different ways to dealing with adversity. Of course there are chemical imbalances in the brain (I do not fail to acknowledge this fact), but I feel personality/outlook can help make those imbalances shift back to normal.

Do people need medications? Sure, but if one needs it for an extended period of time, then that's not getting at the cause for most people.

Anyway, I can see how med school can expedite the process of people getting closer and closer to their tipping point. It's very unfortunate.
 
Show them that someone cares about them and guide them in thought processes. Show them that there are different ways to dealing with adversity.
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Someone who is truly depressed will stand there and listen to their family say "We love you, please don't ever leave us" and then go and kill themselves because they don't believe it. I'm sorry, but I really think you need to read up on this subject. You cannot "fix" depression through better thinking. It will not work. Depression is a disease which is linked to a neurotransmitter imbalance in the brain, and that will not magically get better through a better outlook on life. I've watched people battle with depression and lose, and it's the most horrible thing I've ever seen. To say that it is not a disease is to say that some very good people who committed suicide just needed to think themselves better, and that is completely wrong. Actually, it's insulting because it puts the blame on them for not being mentally strong enough.

Of course there are chemical imbalances in the brain (I do not fail to acknowledge this fact), but I feel personality/outlook can help make those imbalances shift back to normal.
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Would you tell a diabetic patient to get their glucose levels into the normal range by changing their outlook on life? Then why the hell would you think that a chemical balance in the brain can be corrected through a personality change? Just because the problem is in the brain does not mean it's in the mind.

I find it very hard to believe in most cases that depression can just hit you all of a sudden, without prior external factors building it up.
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You have a point here. You can often find a reason for someone developing depression. You can also point to smoking as a cause of lung cancer and obesity as a cause of diabetes, and you wouldn't stand there saying "Well, you just need to remove that external factor and you'll feel better." Once you have depression, it needs to be treated and with something other than encouragement.
 
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Fiddlergirl said:
Depression is a disease which is linked to a neurotransmitter imbalance in the brain, and that will not magically get better through a better outlook on life. Actually, it's insulting because it puts the blame on them for not being mentally strong enough.
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Right, once you get to a certain extent, I agree. Meds are needed. I think I said that.

And I'm not blaming people for anything. I just think it's a lot of how people perceive things. That's why growing up with good role models is important. You see how they deal with stuff. Outlooks of life that seem to work. At this point, I can't put all the blame on just chemical imbalances that spontaneously occur.


Would you tell a diabetic patient to get their glucose levels into the normal range by changing their outlook on life? Then why the hell would you think that a chemical balance in the brain can be corrected through a personality change? Just because the problem is in the brain does not mean it's in the mind.
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Bringing up the scenario about diabetics is unrelated in my opinion. Diabetes we know is a very physical disease. We are dealing with the mental aspect with depression. That's why it's an interesting and tricky topic. Some people believe it's a true physical disease like cancer or diabetes. I just think there is more to it than the physical aspect. A lot more mental aspect involved.


Once you have depression, it needs to be treated and with something other than encouragement.
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Again, I believe I said that. I just don't think depression is a "chronic" disease like say, Type I diabetes. Meds are just a quick fix in my opinion. Not getting at the core issue.
 
Some people believe it's a true physical disease like cancer or diabetes. I just think there is more to it than the physical aspect. A lot more mental aspect involved.
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In my original post, I said that the biggest problem with my friends treatment was that the psychiatrist gave him the meds and then didn't follow through on the mental aspect. You have a really good point here. My point was just that there is a physical aspect that needs to be treated. If you're really interested in the subject, I can PM you some of the resources I found.

I can't put all the blame on just chemical imbalances that spontaneously occur.
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I don't think it's spontaneous either. I completely agree that there's usually some sort of initiating event. My point was that there are chemical imbalances after that event occurs.
 
Fiddlergirl said:
My point was just that there is a physical aspect that needs to be treated.
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Never disagreed with you on this. I know there are chemical imbalances.

I don't think it's spontaneous either. I completely agree that there's usually some sort of initiating event. My point was that there are chemical imbalances after that event occurs.
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Never disagreed with you on this either. I just feel that once the meds help with the acute balance of chemicals, that the true problem be addressed. That's why I said outlook and support were important because I feel that these can help in the prevention of depression. Acutely meds, over time outlook. Then hopefully, the person will not have to take meds in the future for depression.
 
I think we completely agree with each other. This why I usually avoid arguments on SDN. It's frustrating to realize that you don't actually disagree with the person you just spent half the day arguing with!


I just feel that once the meds help with the acute balance of chemicals, that the true problem be addressed. That's why I said outlook and support were important because I feel that these can help in the prevention of depression. Acutely meds, over time outlook. Then hopefully, the person will not have to take meds in the future for depression.
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Exactly.
 
Fiddlergirl said:
I think we completely agree with each other. This why I usually avoid arguments on SDN. It's frustrating to realize that you don't actually disagree with the person you just spent half the day arguing with!



Exactly.
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Haha, that wasn't arguing. But whatever you wanna call it. Doesn't matter to me. All I know is, it beats studying for the cumulative physiology final I have tomorrow, LOL.
 
medking said:
Never disagreed with you on this either. I just feel that once the meds help with the acute balance of chemicals, that the true problem be addressed. That's why I said outlook and support were important because I feel that these can help in the prevention of depression. Acutely meds, over time outlook. Then hopefully, the person will not have to take meds in the future for depression.
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See, I disagree with this. I think that clinical depression can be a real disease based on a neurologic condition, or a reaction to your enviornment, but there's not a lot of overlap. I've seen clinical depression, and by definition it doesn't respond to outside stimuli. That's when you use meds. I think also that it's WAY overdiagnosed, with huge numbers of people who are just in crappy situations being told that there is a problem with their neurochemistry. On the other hand depression in response to your enviornment doesn't require medication, it requires you to adress the source of your depression. I think that the 'it's sorta both' mentality of the psyche profession has not necessarily been the best thing for their patients. Just an opinion.
 
Perrotfish said:
See, I disagree with this. I think that clinical depression can be a real disease based on a neurologic condition, or a reaction to your enviornment, but there's not a lot of overlap. I've seen clinical depression, and by definition it doesn't respond to outside stimuli. That's when you use meds. I think also that it's WAY overdiagnosed, with huge numbers of people who are just in crappy situations being told that there is a problem with their neurochemistry. On the other hand depression in response to your enviornment doesn't require medication, it requires you to adress the source of your depression. I think that the 'it's sorta both' mentality of the psyche profession has not necessarily been the best thing for their patients. Just an opinion.
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I agree with you that there are cases when a truly neurologic problem is the cause. Something intrinsically happens in the body that changes your chemical balance. But to me, I feel that these cases are in the minority.

I disagree with you on the bolded part. Like I said in a previous post, I have no evidence so it's just an opinion, but I feel that once you pass a certain level, meds are necessary. It's like a point of no return. I think such a things exists no matter the cause, but that's just my opinion, lol.
 
Perrotfish said:
See, I disagree with this. I think that clinical depression can be a real disease based on a neurologic condition, or a reaction to your enviornment, but there's not a lot of overlap. I've seen clinical depression, and by definition it doesn't respond to outside stimuli. That's when you use meds. I think also that it's WAY overdiagnosed, with huge numbers of people who are just in crappy situations being told that there is a problem with their neurochemistry. On the other hand depression in response to your enviornment doesn't require medication, it requires you to adress the source of your depression. I think that the 'it's sorta both' mentality of the psyche profession has not necessarily been the best thing for their patients. Just an opinion.
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Except high stress loads do lead to a physiologic change and decrease in those fun little dendritic spikes and what not. It doesn't have to be longterm, but there are changes for damn near everything. You treat with meds/counseling for a certain amount of time and then remove the stressors if you can. Depression might be overdiagnosed, but I'd actually lean towards it being way underdiagnosed first.

It has already been shown that addressing one of the areas can help, but it is most effective to hit it on multiple fronts. How would you propose addressing the source of depression for medical school? Dropping out?

External factors and genetic predisposition are intertwined. Soldiers don't have to have a family history of depression or previous experiences with it to have PTSD that plagues them their entire life, yet you removed them from the source didn't you? They don't have bullets flying by or IEDs going off when they're home. Children who were molested may not remember it and may be far removed from the situation in 20 years, but many of them will still have some serious issues.

While every situation isn't as dramatic or clear cut as that, saying it is as simple as cutting the source out is a little shortsighted.

Of course, I have a little bias since I have had two friends commit suicide when the supposed problem was removed from their life...it didn't fix a damn thing in their case.
 
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Perrotfish said:
See, I disagree with this. I think that clinical depression can be a real disease based on a neurologic condition, or a reaction to your enviornment, but there's not a lot of overlap. I've seen clinical depression, and by definition it doesn't respond to outside stimuli. That's when you use meds. I think also that it's WAY overdiagnosed, with huge numbers of people who are just in crappy situations being told that there is a problem with their neurochemistry. On the other hand depression in response to your enviornment doesn't require medication, it requires you to adress the source of your depression. I think that the 'it's sorta both' mentality of the psyche profession has not necessarily been the best thing for their patients. Just an opinion.
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you haven't dealt with depression much on a personal level have you?
the kind of depressed people you are talking about here have to address the source every freaking day. that is why they are depressed.

sometimes it helps to feel better for a while, even if its artificially produced by drugs. it can allow one to look at his life through a different lens. a clearer one perhaps.

the environment and neurochemistry are intertwined in depression, no matter what the initial cause was. many times neaurochemistry is the only thing that anyone can change.
 
i think the burnout and suicide rates are so high, at least partly, because the population of medical students has been changing faster than the establishment can/wants to adapt to it. i mean, medical schools are one of the few old boys' clubs that now has at least 50% female students. there are also many students (both male and female, all races) of non-traditional majors, backgrounds, and different personalities. personality-wise it's gotten much more diverse. however, the people at higher levels are still quite monolithic, so i don't think they realize how to change, and many probably don't want to change. in a way it seems much like a social change where there's bound to be chaos. i think the change is good and necessary, but also very stressful for the students caught in-between. i think the messed up american healthcare system plays a big role too - the issues are countless but altogether they make the career less rewarding.

needless to say, female physicians face some unique challenges because of societal expectations. i could go on and on about this, but just one example: a male doctor is considered a great catch, while female doctors - not so much. not to mention, once they have families there are all the challenges of working moms.

i myself have been miserable for the past two years. for the most part i didn't consider life worth living. it's for several reasons, of course not applicable to everyone. i had a liberal arts major and my study style has always been to cram. i learn mainly by thinking through, and can only memorize impersonal facts in short bursts of time. my college grades and MCAT were very high, but in medical school i've struggled to pass classes. my school is very, very, traditional, both in curriculum and people, and does not accommodate different learning styles. there's hardly any emphasis on problem based learning, clinical skills and exposure. i might not have been as depressed in a more modern school. many of my issues are personal, but med school makes it unbearable. the worst part is, pre-clinical years are nothing like the job so there's no way to be sure if this is the wrong career. and since it gives you no transferable skills or knowledge, you're just stuck for a long time during your best years!

for one, LCME should get tougher on med schools to have mostly problem-based-learning and more clinical exposure. i mean real PBL, not just in name. if the teaching style and curriculum can't be made more active and less stressful, then i think we should start med school after high school like most countries. the reason is, many students don't like the mind-numbing high-school style classes after finishing college and/or working. also, better to get this crap over with early so you can enjoy your 20s and 30s.

the burn-out and suicide topic comes up pretty often, and there are always people who are accepting of the stress and think it's better for really miserable students to quit. but i seriously think much of med school is unnecessary hazing and needs to be changed. i'm tired of hearing that "it gets better" or "it'll be worth it," when there are ways to make the present more pleasant!
 
when talking about burnout and suicide, depression comes up naturally. needless to say depressed students should receive support and treatment. however, many med students will probably not respond to conventional treatment/therapy. a psychologist friend called it "contextualized depression," which she said doesn't change much with medication, but requires change of circumstances or way of thinking.
i went to see a councilor pretty early but they couldn't really understand my background and issues. (the school is non-diverse). one recommended SSRIs for lethargy and lack of focus, but i never felt that the side effects of SSRIs was worth it. don't know if that was the right choice, but i chose that because i didn't think any drug could cure the existential crisis and being a mis-fit in learning styles. on top of that i hated the social environment (or lack thereof) so nothing was going for me, and it wasn't going to change!
that's why i think the ideal solution is to make creative changes to the curriculum and loosen up the attitudes, if med schools are going to continue to accept non-traditional students. as someone already pointed out, our trainers in general need to quit acting like med students and doctors are the only things we are. all supportive advice is just lip service until they make it possible to actually have a life!
 
P.S. don't want to downplay the role of medication just cuz i personally didn't think it was worth it. i think there's certainly a role in modifying neurochemistry to see whether it helps a person even if they aren't severely depressed. and recently i learned that SSRIs helped prevent hippocampal atrophy in depressed people so now i think the weight gain might've been totally worth it 🙁
 
WashMe said:
Life often sucks, and why shouldn't it? Most species that ever existed are gone, and the ones that are still around are here because they scratched and clawed their way through difficult times. Living things, humans included, are not supposed to be happy all the time. Anxiety and fear are the fuel that life uses to move forward.
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👍 To this post. The truth about our reality needs to be something aired more often.

With that said, if there were a way a depressed person could change his or her environment to reduce the biggest stressors on that person, would it work? Are more people depressed because they face a cruel environment lacking the things that they need, or because because of a flaw in their physiology causing them to normally be depressed. (aka if you could somehow make the typical depressed person rich and famous and supplied with all their wants, would they become depressed again after a transition period or not?)
 
I see depression as a persistent neurological state that is originally induced by an external factor. After persistent exposure to an external factor, the neurological state can become self-perpetuating, even when the external factor is removed.

Like the smoking and lung cancer analogy; persistent smoking (external factor) will lead to an accumulation of mutations in your lungs. Eventually you will get lung cancer (clinical depression), which is self-perpetuating and may eventually lead to death (suicide).
 
scorpia said:
i could go on and on about this, but just one example: a male doctor is considered a great catch, while female doctors - not so much.

...

i myself have been miserable for the past two years. for the most part i didn't consider life worth living. it's for several reasons, of course not applicable to everyone. i had a liberal arts major and my study style has always been to cram. i learn mainly by thinking through, and can only memorize impersonal facts in short bursts of time.
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And it's too bad that first thing is true. I'm a guy, and provided she's the kind of person I would want, I'd see a lady doc as a great "catch" -- pretty much de facto proof that she's intelligent, driven, shares a huge part of what I do right off the bat, etc.

My undergrad degree was in a "soft science", and I took a lot of hard science-y classes like we all did, but I'm definitely with you. I usually get really irritated with rote memorization, really quickly, so I'm always looking for ways to connect one little fact to another little fact.

As far as misery, I just finished MS1 recently, and... eh, it was alright, I suppose. I see M2s / M3s / M4s here on SDN say that it just got better from there for them, so I'm hoping that's true.

muhali3 said:
I see depression as a persistent neurological state that is originally induced by an external factor. After persistent exposure to an external factor, the neurological state can become self-perpetuating, even when the external factor is removed.
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Learned helplessness.
 
scorpia said:
i think the burnout and suicide rates are so high, at least partly, because the population of medical students has been changing faster than the establishment can/wants to adapt to it. i mean, medical schools are one of the few old boys' clubs that now has at least 50% female students.

a male doctor is considered a great catch, while female doctors - not so much. not to mention, once they have families there are all the challenges of working moms.

for one, LCME should get tougher on med schools to have mostly problem-based-learning and more clinical exposure. i mean real PBL, not just in name. if the teaching style and curriculum can't be made more active and less stressful,
t
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I think your hypothesis about why females report more suicidal ideation / burnout in med school is interesting. I do agree that your gender seems to have it worse off in med school.

I do not agree with the idea that the LCME should be pushing PBL. I've been fortunate enough to try both PBL and a systems based educational system and the systems approach works much better for me.

I found PBL lots of fun, working through cases in a group of your classmates and facilitator. However, my mind is simply not wired to hold onto information that way. So after spending ~10 hrs in group, and another ~10 hours preparing for group, you still have the stress of having to learn all the required information on your own.

In short, I'm sorry you haven't liked the traditional curricula at your school (I'm sure I wouldn't like it either), but interactive does not automatically mean less stressful. I think we are actually pretty fortunate in our country that we have med schools that try different sorts of approaches to teaching the same material (and that if you are competitive enough, you can pick the one you think will serve you best). 🙂
 
- OMG! Don't jump!
- Don't do it! You have so much to live for!
- Please, come down! We can talk this over!
- This is no reason to throw your life away!
- DO A FLIP!
 
gujuDoc said:
I feel like people need to stop thinking that it is the establishments fault because the truth is it is like this world over. This is the culture of medicine.
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I feel like your post is full of inaccuracies. Yes, some of what you say is true, especially in fields like surgery, IM, and their subspecialties.

But I think too many people are in this mindset of doctor = life of pain, misery, and stress. That simply isn't true. There are plenty of doctors out there who work a normal work-week, in terms of hours. They're called PM&R docs, psychiatrists, dermatologists, ER docs, hospitalists, some anesthesiologists, some family med docs, etc. The great thing about medicine is that it's so versatile. You don't have to put in 90-hour weeks if you don't want to. Yes, that means you'll make less money in some specialties, but most likely you're still making 6-figures, which is more than the majority of people in the U.S.

I think all this constant "it just gets tougher from here" crap is part of what leads students to being so depressed about medicine in the first place. The truth is, as a physician, you have so many different possibilities. You have to pick the right specialty for your lifestyle and then be smart about how to tailor your post-residency career to what you want it to be. It can be done.
 
You're missing my point entirely. I never said it's not a tough field. It is. I'm just saying that medicine is such a diverse field that it is possible to tailor your entire career to your lifestyle. Will you compromise on income? Yes. But with an MD, you won't be poor.

Even IM and FM doctors can work part-time. My own IM doctor works part-time in her practice. One of my adjunct professors at school is a part-time FM physician. One of the doctors I shadowed as a pre-med worked as an IM hospitalist and took off two weeks every month.

That's one of the things that's special about medicine. It affords you opportunities that most careers don't. You just have to be smart and understand that you might have to compromise.
 
My dad is a retired general surgeon. Solo practice and on call all the time. 100 hour weeks were the norm. Never saw him for long stretches and was actually flabbergasted when he showed up for one of my Little League games. Residency on call every other night, lived in the hospital. Needed special permission to take the weekend off to get married.

The point is that there was no burnout because there was no expectation of any sort of work/life balance. Since my mom was a nurse she understood and was on board 100%. Today, when a doctor seeks work/life balance, this imposes tough choices. Choices lead to internal conflict, and the anger can be internalized as depression. Today we need "programs" to help emotionally distressed students. In my dad's case all he needed was his Chief Resident, whose door was open 24/7.
 
Cruzinman said:
The point is that there was no burnout because there was no expectation of any sort of work/life balance. Since my mom was a nurse she understood and was on board 100%. Today, when a doctor seeks work/life balance, this imposes tough choices. Choices lead to internal conflict, and the anger can be internalized as depression. Today we need "programs" to help emotionally distressed students. In my dad's case all he needed was his Chief Resident, whose door was open 24/7.
Click to expand...

Your dad sounds like quite a man, but thank God medicine doesn't have to be like that now.
 
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Cruzinman said:
My dad is a retired general surgeon. Solo practice and on call all the time. 100 hour weeks were the norm. Never saw him for long stretches and was actually flabbergasted when he showed up for one of my Little League games. Residency on call every other night, lived in the hospital. Needed special permission to take the weekend off to get married.

The point is that there was no burnout because there was no expectation of any sort of work/life balance. Since my mom was a nurse she understood and was on board 100%. Today, when a doctor seeks work/life balance, this imposes tough choices. Choices lead to internal conflict, and the anger can be internalized as depression. Today we need "programs" to help emotionally distressed students. In my dad's case all he needed was his Chief Resident, whose door was open 24/7.
Click to expand...

I admire your father and your family for having such a lifestyle. However, lot of my peers don't want this type of lifestyle and I imagine most medical students across the board don't want it either.

You make a great point about having expectations that cannot be met. The way I see it, if I am going to trade off some salary or prestige to gain lot of personal/family time, then that is my expectation and I won't be disappointed if I don't land a high paying or prestigious specialty.

You also make another good point about having the need for special programs and counselors. Don't get me wrong, these are very valuable services and I'm grateful we have access to tons of these types. Though due to the immediate availability of these services, people are less inclined/motivated to emotionally develop themselves which leads to having less and less of emotionally strong individuals like the chief resident your dad had.
 
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