How to get over the inhumanity, the criticism, the feeling of ineffectiveness?

[xiaxin]

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My wife is wrapping up PGY2 and just signed her contract for PGY3 in Family Medicine. At one point in second year, she had to take a month long break. She was a trooper and plowed through it for a long time but to preserve herself, she took the month to recover. Unfortunately, she just had a bit of a relapse with Depression and everything is getting questioned again.

Her main issues are probably familiar to many of you:
Depression when at work, but fine at home. However, anxious and sad even when it comes near time or day before work.
Struggles with criticism
Feels like she is not making a difference
Struggles with the inhumanity of the world; lots of bad child abuse cases, rape, pregnant mentally challenged patients, sexual assault
Struggles with patients who continuously come to clinic who get angry when you try to help, who do not try anything you suggest, but yet keep coming back week after week.
Lack of confidence in herself.

She is starting to tell me now that it's Medicine that makes her sad but I think it's not medicine but some crappy things about the U.S. health care system, about our society, about life. I don't want to tell her to suck it up and get over it because that's not the best solution either. Her compassion for people is one of her greatest traits.

Does anyone have any advice for how they handled any of the above? Has anyone quit residency and then come back? How do you justify it to yourself? What worked for you when you were depressed during residency? How did you survive it? What tools/mantras/strategies/books/resources did you use that helped?

Unfortunately, the job recruiters and necessary post-residency career planning is making this all the more overwhelming. :\

 

[p30doc]

She needs to see mental health professionals ASAP. She is so close to the finish line it would be crazy to quit now!

 

[ILEMres]

Unfortunately, in my opinion if FM is depressing her that bad, then medicine in general is probably not for her.

 

[xiaxin]

She needs to see mental health professionals ASAP. She is so close to the finish line it would be crazy to quit now!

She is seeing a therapist and on an antidepressant.

 

[xiaxin]

Unfortunately, in my opinion if FM is depressing her that bad, then medicine in general is probably not for her.

She does find joy in specific areas though. It's complicated because some parts of her job are very rewarding but it can all be negated very easily once you get a really bad patient or an attending who reems you for doing something that the previous attending reemed you for doing the opposite of. :\

She is actually very good at what she does and some days shes a rock star it's just having the right tools available to get through the rough spots. She does not appear alone as most of her coresidents are having the same problems and are all struggling.

 

[christiandocj]

I think what you wife is experiencing is something that every resident goes through to different degrees. It is really sad that medical training seeks to raise up healers but a lot of times people end up jaded by the health care system and difficult patients instead. For me my faith was (and is) huge in keeping the right perspective. Here's a post that I wrote on my blog about things that were helpful for me. Hope this is helpful.

http://www.unfailingspring.com/2013/03/25/how-to-cope/

Jack

 

[Psychiatrized]

I agree that she would benefit from psychotherapy preferably with a psychiatrist that could prescribe meds if needed.

I had a time in residency when I was pregnant which seemed to trigger a depression, everything looked bleak and I wanted to quit, saw no future, felt like I hated my job and my patients were unhelpable. It got better.

The way you describe her generalizing her misery with her current job to medicine in general and all of the US health care system strikes me as a form of cognitive distortion that can go along with depression. I've met some really happy FM doctors. Depending on the type of practice she wants to do after residency and the patient population in the area her patients could be different from what you describe above. But I wonder if her perception that her patients are beyond her powers to help is also a cognitive distortion. Sure there are always annoying, devaluing, help rejecting patients and parenting situations that make you sick to your stomach but the ratio differs depending on where you practice.

She's made it this far. Seriously, weekly psychotherapy with a well trained psychiatrist works wonders probably combined with meds.

Keep validating her feelings and praising her for the hard work she is doing on a daily basis and encouraging her to press on. I think you guys can get through this.

 

[cerebral edema]

I think what you wife is experiencing is something that every resident goes through to different degrees. It is really sad that medical training seeks to raise up healers but a lot of times people end up jaded by the health care system and difficult patients instead. For me my faith was (and is) huge in keeping the right perspective. Here's a post that I wrote on my blog about things that were helpful for me. Hope this is helpful.

http://www.unfailingspring.com/2013/03/25/how-to-cope/

Jack

Nice blog. Very interesting

 

[JGimpel]

At some point, all doctors do develop some sort of resentment at their career not going the way they'd prefer; make sure she talks about this to you or someone else EVERY DAY. My advice would be to have her next meeting with the therapist focus on the worst possible scenario with the most jaded opinions about medicine and work through making peace with them in the next few sessions. It can only go up from there.

If the antidepressant isn't working, she needs to up the dose, change to another one or change out of that class ASAP. Having something really powerful for breakthrough episodes at work will help with the transition into a new outlook on life and the bumps in the road that always pop up. I hate to say it, but if she's got anxiety with the sense of "impending doom" she needs to see a psychiatrist immediately and have him/her triage the situation.

I'm only speaking in vague generalities so as not to violate the TOS buy I think you get the general idea. I wish you and she the best of luck and appreciate your willing to be there for your wife, no matter what. That will serve both of you well in the future.

 

[Daiphon]

She does find joy in specific areas though. It's complicated because some parts of her job are very rewarding but it can all be negated very easily once you get a really bad patient or an attending who reems you for doing something that the previous attending reemed you for doing the opposite of.

Not to be flippant, but remember...

Rule #4: the patient is the one with the disease.

Rule #8: they can always hurt you more.

There is much to be gained with empathy & interalization of one's emotions; but it is a double edged sword. These qualities make us physicians, but also make us vulnerable.

Keeping in mind that we can only do so much, and contrary to the American ethos that eschews self-accountability, you need to focus on doing the best possible whilst not dwelling on the patient's choices. Do that and in the long run, the balance sheet will be strongly in your favor. For every gut wrenching child abuse case, there are dozens of WCCs and astute diagnostic saves... etc.

I applaud your wife for seeking help, and you for being supportive. This alone means she will more than likely be fine. Residency is hard, and the attending pingpong will end.

Good luck.
-d

Sent from my DROID BIONIC using Tapatalk

 

[QuaerensIntelle]

She might consider going into women's health or preventative medicine or something a little more uplifting than general primary care. Also sports medicine. I think most residencies tend to serve a sector of the population that is particularly difficult.

As for how to deal with it right now, sounds like she is already doing what she can from a medical perspective (antidepressants). Cardiovascular exercise would probably help. I think if she could make it through residency the actual career would probably be okay.