Intern at top IM program jumps off a roof

[MLT2MT2DO]

One thing I will say is that it is wrong to call this depression, which is the running theme here. This is not psychopathology. Suicide ≄ depression. These people are having normal psychological reactions to very stressful work conditions that have eroded their personal lives to a shadow of what once was. Most of us go into "survival mode" and just try to take things one day at a time, anticipating the next day off when we can shop for groceries and wash the bathtub. Some of us are not able to do that, we find the future in medicine so bleak, the trials thus far so isolating and daunting, that we end up taking our own lives.

Suicide is never a "normal" psychological reaction.

---

Members don't see this ad.

 

[rokshana]

Most of them don't have 6-figure debt they're trying to pay off on these salaries. And yes, I know plenty of residents choose to defer during residency (whether that's smart is a whole different discussion), but at the very least someone making $50k/year with 2-8x that much debt looming over them probably shouldn't be/isn't spending a lot.

they however may have a mortgage so they can have that amount of debt as well...

 

[username456789]

they however may have a mortgage so they can have that amount of debt as well...

A lot of residents do too. The rest still pay rent.

 

[wholeheartedly]

I'm on the fence about whether or not the debt thing could play a role. I racked up some pretty heft student loan debt, but nothing I'll be paying back on for at least a year, I'll qualify for IBR, and PSLF if they don't discontinue it. But that along with my house nickel and dime-ing me is still pretty overwhelming even though it isn't going to impact me any time soon.

If someone has massive debt and decides they want out of medice that can definitely lead to a no way out feeling.

 

[michaelrack]

Suicide is never a "normal" psychological reaction.

Suicide can be normal/rational (if one ignores religious issues, which I don't). Not everyone who opts for physician-assisted suicide is depressed. Ignoring issues of God, heaven, hell, and the intrinsic value of human life, one can make a rational argument for suicide in some cases.
(this is not to say that if one has traditional Christian ethics every case of suicide is a sin/evil; I believe some cases of suicide are neurologically driven or otherwise out of a person's direct control).

 

[Mad Jack]

Come now. People don't jump off of roofs 6 weeks into internship because they have existential angst over a lack of dating opportunities. And given that student loan repayment doesn't kick in until 6 months after graduation, I highly doubt it was crushing financial pressure, either.

People jump off of roofs 6 weeks into internship because they think their lives have become a black horror and are unable to imagine a future where things could be better. I suppose it is up to the psychiatrists to decide if they meet criteria for major depression or if it can only be an adjustment disorder due to the extraordinary set of life circumstances intership/residency entails.

My greatest fear in life is losing everything in the process of becoming a doctor. At the end of the day, no job is worth losing touch with your friends, family, and significant other, being buried in debt, and being hundreds or thousands of miles from anything familiar in a place where you slave away for 60-80 hours a week. He might have just reached the point where he just had nothing left except a massive emotional void and a future of years and years of hard labor, sleep disturbances, and soul eating debt. Couple that with a little bit of underlying depression and you've got a recipe for suicide.

 

[MLT2MT2DO]

Suicide can be normal/rational (if one ignores religious issues, which I don't). Not everyone who opts for physician-assisted suicide is depressed. Ignoring issues of God, heaven, hell, and the intrinsic value of human life, one can make a rational argument for suicide in some cases.
(this is not to say that if one has traditional Christian ethics every case of suicide is a sin/evil; I believe some cases of suicide are neurologically driven or otherwise out of a person's direct control).

Agreed.

 

[Rothbard]

Suicide is never a "normal" psychological reaction.

I don't know what that means. I can easily dream up situations in which most people would choose suicide, I'm sure you can too.

To think that suicide must always be associated with psychopathology is not accurate.

 

[MLT2MT2DO]

I don't know what that means. I can easily dream up situations in which most people would choose suicide, I'm sure you can too.

To think that suicide must always be associated with psychopathology is not accurate.

In most cases I'd disagree, I guess I shouldn't have made such a blanket statement since I'm now back pedaling into the word "most". In this case I'd vehemently disagree.

 

[mercaptovizadeh]

In most cases I'd disagree, I guess I shouldn't have made such a blanket statement since I'm now back pedaling into the word "most". In this case I'd vehemently disagree.

There were people in concentration camps and imminently about to be massacred/executed who committed suicide. No evidence of mental illness there.

It is dangerous to buy into the claptrap psychobabble they teach us in medical school without a little more careful consideration to the context.

 

[Raryn]

Suicide in the context of devastating suffering that is surely going to result in death regardless (terminal illness, etc) is completely and utterly different than in response to temporary stressors. One is, with the right circumstances, somewhat arguable; the other is, regardless of your feelings about "claptrap psychobabble", pathological. Not entirely sure why we are arguing about the former when this is a clear case of the latter.

 

[Law2Doc]

Agree with Raryn, the decision of eg a terminal cancer patient enduring terrible chronic bone pain can't be lumped in with a physically healthy intern at a top program.

I think while there's perhaps some comfort in saying that these decisions could be driven by a feeling of being trapped by massive debt or being too broke and time pressed to find a relationship, I seriously doubt these notions are on target.

This is a hard isolating stressful job. You see a lot of death and disease. A lot of sadness. And your bosses sometimes treat you harshly. You emerge from med school where people still told you you were great and the future of the profession, and into intern year where you are the scut monkey on a steep learning curve and even though you are working hard for 70+ hours a week you can't ever seem to do anything right or make your attendings happy. And you are sleep deprived and isolated. Most people tolerate this rough year -- we bend but don't break. Heck, some of us even kind of liked intern year because it was such a test of our mettle.

But I still think there are people out there, and some we even see on SDN as I alluded to above, who were already struggling in life without these extra parameters. Maybe some added screening wouldn't be a bad idea.

 

[oldbearprofessor]

But I still think there are people out there, and some we even see on SDN as I alluded to above, who were already struggling in life without these extra parameters. Maybe some added screening wouldn't be a bad idea.

What would you propose?

 

[MLT2MT2DO]

There were people in concentration camps and imminently about to be massacred/executed who committed suicide. No evidence of mental illness there.

It is dangerous to buy into the claptrap psychobabble they teach us in medical school without a little more careful consideration to the context.

So there was no evidence of depression in these people in concentration camps? I'm pretty sure even Mr. Rodgers would have needed his morning Paxil if he were in Auschwitz.

I get the point of ending suffering. I'm just having a hard time believing concentration camps and intern year are that similar.

 

[MLT2MT2DO]

This is a hard isolating stressful job. You see a lot of death and disease. A lot of sadness. And your bosses sometimes treat you harshly. You emerge from med school where people still told you you were great and the future of the profession, and into intern year where you are the scut monkey on a steep learning curve and even though you are working hard for 70+ hours a week you can't ever seem to do anything right or make your attendings happy. And you are sleep deprived and isolated. Most people tolerate this rough year -- we bend but don't break. Heck, some of us even kind of liked intern year because it was such a test of our mettle.

This sounds like the recipe for depression, not suicide.

 

[MLT2MT2DO]

Suicide in the context of devastating suffering that is surely going to result in death regardless (terminal illness, etc) is completely and utterly different than in response to temporary stressors. One is, with the right circumstances, somewhat arguable; the other is, regardless of your feelings about "claptrap psychobabble", pathological. Not entirely sure why we are arguing about the former when this is a clear case of the latter.

Yeah, I already mentioned my words were hasty chosen and agree with the above scenario.

 

[mvenus929]

This sounds like the recipe for depression, not suicide.

Suicide is generally a result of depression with poor/inadequate coping skills.

 

[Rothbard]

Suicide in the context of devastating suffering that is surely going to result in death regardless (terminal illness, etc) is completely and utterly different than in response to temporary stressors. One is, with the right circumstances, somewhat arguable; the other is, regardless of your feelings about "claptrap psychobabble", pathological. Not entirely sure why we are arguing about the former when this is a clear case of the latter.

You've defined suicide as pathological in an arbitrary fashion: "suicide is always pathological unless death is certain, just because". Even in the concentration camp example, death in many cases wasn't certain, the only thing that was certain was continued suffering.

What is a temporary stressor? 70 years in a concentration camp, vs 20 years, vs 1 year? Obviously there is no cutoff, and temporariness doesn't have much to do with what is a rational suicide. We call suicide pathological in general because there are psychotic/manic/depressive symptoms that lead to SI. This is true for most suicides, but there are some suicides that are "rational". Eg dishonor, altruism, martyrdom, suffering, debt, mass suicide.

40% of residents meet criteria for MDD at some point during the year, point prevalence is about 25%. I doubt nearly half of residents have a strong tendency to depression. MDD at baseline is 3%. The suffering is legitimate, not necessarily exaggerated by mental illness. Most residents don't kill themselves, partly because they believe in the path they're on, even if it's tough.

http://www.internisten.nl/uploads/Qx/I3/QxI3OMAhoRGrlACeGKlLAA/Arch-Gen-Psychiatry.pdf

I think while there's perhaps some comfort in saying that these decisions could be driven by a feeling of being trapped by massive debt or being too broke and time pressed to find a relationship, I seriously doubt these notions are on target.

What happens if you don't believe in the path you're on? If you're working 100 hours/week for a hedge fund and hate your job, you can just leave. There are going to be residents who dislike medicine, just as in any other field. If you can't visualize a good future for yourself, suicide becomes a tempting option. They could just leave medicine, but often can't because of the debt. You can do a google search to see how many people want to leave medicine but are trapped by the debt. I'm not sure if this has been addressed in the literature. This is a problem that is kind of unique to medicine.

This is a hard isolating stressful job. You see a lot of death and disease. A lot of sadness. And your bosses sometimes treat you harshly. You emerge from med school where people still told you you were great and the future of the profession, and into intern year where you are the scut monkey on a steep learning curve and even though you are working hard for 70+ hours a week you can't ever seem to do anything right or make your attendings happy. And you are sleep deprived and isolated. Most people tolerate this rough year -- we bend but don't break. Heck, some of us even kind of liked intern year because it was such a test of our mettle.

As you are saying, many of us experience this. 40% experience an MDD episode at some point during the year, and SI was the PHQ symptom that increased the most in that study I linked. So, using these variables wont really help us figure who is killing themselves and why.

But I still think there are people out there, and some we even see on SDN as I alluded to above, who were already struggling in life without these extra parameters.

Certainly that's true, but I am skeptical that this is the problem. The point prevalence of severe depression prior to starting intern year was 0% (about 1000 participants), and increased to ~2% during the year. MDD in general increased ~10 fold.

Maybe some added screening wouldn't be a bad idea.

I don't think screening would accomplish much, given the high prevalence of depression. Especially in medicine, no one wants to admit to their boss that they can't do the job.

Even if you could identify these people, what could you do? Their thinking is not irrational, so how effective will CBT be? Antidepressants have not been shown to reduce suicide. Even if they did, would Paxil reduce suicide in a concentration camp?

The solution for suicide in a concentration camp is to release the prisoners who want to leave. The solution for suicide in residency is...?

 

[rokshana]

There were people in concentration camps and imminently about to be massacred/executed who committed suicide. No evidence of mental illness there.

It is dangerous to buy into the claptrap psychobabble they teach us in medical school without a little more careful consideration to the context.

does this count as Godwin's Law?

 

[Law2Doc]

Although it is beyond question that most people who commit suicide do have a mental disorder (including addiction), there isn't really good evidence that depression itself (at least alone) is on the causal pathway to completed suicide. And we know that treating depression doesn't do anything to prevent suicide, and in fact some our treatments may even increase suicidality in some people. The over-emphasis of suicide as the result of mental illness is essentially a tacit moral condemnation of an act of self-destructive that we find so hard to understand, or to accept can ever be rational. Suicide was once a sin, now it is a sickness. But this isn't a very helpful way to look at it because by narrowly focusing on mental illness we forget to look at the more important causes (that may be shared between suicide and mental illness). And like I said, treating mental illness doesn't seem to make much difference to suicide rates.

Someone committing suicide weeks into intern year is somewhat different than in the middle or end of it. I would be less inclined to automatically jump to the conclusion than a major mental illness was present. Perfectionism, experience of failure/narcissistic injury, and humiliation are much more likely to play their part. When people experience some feelings as unbearable (such as having failed, or publically humiliated) then they may commit suicide within minutes quite impulsively. When you are quite exhausted, your prefrontal cortex is probably not in check - you're more emotional, your executive functioning is shot, your impulse control is not as good. In short, your ability to tolerate extreme emotions resulting from perceived failure or humiliation is much lower, and in those with the personality traits we select for in medical students, it can be a recipe for disaster.

First, I question whether the perfectionist who can't bear life once being humiliated isn't mentally ill. Maybe not depressed per se, but there are issues there. Second, one potential conclusion to your second paragraph is that maybe a good preparation for residency would be a series of milder failures throughout med school. But that assumes these guys never had their share of failures and hardships. The couple of professionals I know who passed away in this way actually were kind of the opposite -- they carried a lot of baggage under the surface. They were in fact depressed, or at least had very good reason to be.

 

[mercaptovizadeh]

First, I question whether the perfectionist who can't bear life once being humiliated isn't mentally ill. Maybe not depressed per se, but there are issues there. Second, one potential conclusion to your second paragraph is that maybe a good preparation for residency would be a series of milder failures throughout med school. But that assumes these guys never had their share of failures and hardships. The couple of professionals I know who passed away in this way actually were kind of the opposite -- they carried a lot of baggage under the surface. They were in fact depressed, or at least had very good reason to be.

The question is why we are using the term depression - that is to say, referring to mental illness - when the individuals in question have objectively valid reasons to have depressed/anxious mood? We are psychopathologizing valid emotion. I can't tell how many times I have seen it where (and this is incredibly annoying), a widow who is barely coping with the death of her husband 12 months ago, or a man who is incredibly down because he lost his job and income 2 years ago and his marriage fell apart is "depressed." That's not depression, that's not mental illness.

I think it would be true to say that there are some, possibly many, times in residency where anxiety and/or depressed affect are normal responses to the circumstances, whether it's the outright humiliation by superiors, guilt incurred by making mistakes in managing a patient, sleep deprivation from the long hours, etc. However, we're supposed to recover in a matter of days or weeks, not languish, lose all hope, and commit suicide. That requires both internal adjustment to the chronic circumstances, but also adjustments made to objectively ameliorate the circumstances - doing the appropriate workup so the superior doesn't criticize, not forgetting to do XYZ for such and such a patient, becoming more efficient in documentation so you can go home earlier and go to sleep earlier, etc.

 

[Law2Doc]

The question is why we are using the term depression - that is to say, referring to mental illness - when the individuals in question have objectively valid reasons to have depressed/anxious mood? We are psychopathologizing valid emotion. I can't tell how many times I have seen it where (and this is incredibly annoying), a widow who is barely coping with the death of her husband 12 months ago, or a man who is incredibly down because he lost his job and income 2 years ago and his marriage fell apart is "depressed." That's not depression, that's not mental illness.

I think it would be true to say that there are some, possibly many, times in residency where anxiety and/or depressed affect are normal responses to the circumstances, whether it's the outright humiliation by superiors, guilt incurred by making mistakes in managing a patient, sleep deprivation from the long hours, etc. However, we're supposed to recover in a matter of days or weeks, not languish, lose all hope, and commit suicide. That requires both internal adjustment to the chronic circumstances, but also adjustments made to objectively ameliorate the circumstances - doing the appropriate workup so the superior doesn't criticize, not forgetting to do XYZ for such and such a patient, becoming more efficient in documentation so you can go home earlier and go to sleep earlier, etc.

I am not using depression to describe the acute aftermath of an event -- I'm talking about remote events ie longstanding emotional baggage.

If you look at some of the questionnaires on clinical depression, which ask about sleep deprivation, feelings of isolation, etc. the typical intern probably can answer yes to every question -- that doesn't mean he has mental illness , he's just in a world where the reality kind of matches the frequent perceptions depressed people might have. My point is that the guy who isn't as well grounded is going to have a tough time getting his bearings when the perception and reality are one and the same. Sort of like sailing with no compass, but also not able to see the horizon or stars. So maybe the person who is already struggling with issues before he embarks on a medical career is at a much greater risk, and perhaps even should be dissuaded. That's really all I'm saying. It's a hard year for anyone, but absolutely it's harder for some than others based on their wiring and internal defenses/supports.

 

[doc baller]

I am not using depression to describe the acute aftermath of an event -- I'm talking about remote events ie longstanding emotional baggage.

If you look at some of the questionnaires on clinical depression, which ask about sleep deprivation, feelings of isolation, etc. the typical intern probably can answer yes to every question -- that doesn't mean he has mental illness , he's just in a world where the reality kind of matches the frequent perceptions depressed people might have. My point is that the guy who isn't as well grounded is going to have a tough time getting his bearings when the perception and reality are one and the same. Sort of like sailing with no compass, but also not able to see the horizon or stars. So maybe the person who is already struggling with issues before he embarks on a medical career is at a much greater risk, and perhaps even should be dissuaded. That's really all I'm saying. It's a hard year for anyone, but absolutely it's harder for some than others based on their wiring and internal defenses/supports.

I have MDD and GAD. I've also had 2 panic attacks in my life and I kind of agree. My problems began in ms2 which resulted in a 2 year LOA after ms2. I am 3 months away from completing ms3 currently and I've been doing fine. I love medicine and I want to continue but the real test for my remission will be intern year. Looks like my options are to apply for residency or accept a assistant physician role in Missouri. Honestly this is a tough decision to make. Especially when many physicians including yourself are opposed to the whole assistant physician idea. I honestly hope a nation wide law passes that allows for all MDs who are American citizens/permanent residents to take the PANCE as an alternative to applying for residency.

 

[Law2Doc]

I have MDD and GAD. I've also had 2 panic attacks in my life and I kind of agree. My problems began in ms2 which resulted in a 2 year LOA after ms2. I am 3 months away from completing ms3 currently and I've been doing fine. I love medicine and I want to continue but the real test for my remission will be intern year. Looks like my options are to apply for residency or accept a assistant physician role in Missouri. Honestly this is a tough decision to make. Especially when many physicians including yourself are opposed to the whole assistant physician idea. I honestly hope a nation wide law passes that allows for all MDs who are American citizens/permanent residents to take the PANCE as an alternative to applying for residency.

I'm not sure the assistant physician discussion is one that needs to be brought into this thread, but I see how avoiding intern year might benefit you personally. However I'm not sure this alternative is going to be less stressful -- it probably will be worse because you won't have the same degree of oversight.

 

[CrimsonKing]

I'm surprised this is coming from you, not exactly evidence based. Probably a lot of selection bias. People with depression might be more likely to post with advice questions, but it doesn't mean there are more of them or that they are drawn like moths to a flame.


But yes, this is sad. Be there for your friends and classmates and never look down on someone who asks for help.

Evidence based: http://jama.jamanetwork.com/article.aspx?articleid=186586

Pre-meds, medical students, and residents all have higher levels of depression than the general population. Putting those higher baseline rates of mental illness together with the intensely long and stressful training regimen of medicine and you have a recipe for our increased rates of suicide.

 

[QofQuimica]

I'd argue that there is a correlation between higher analytical intelligence/education and depression because being more intelligent/educated breeds greater awareness of the disconnect between one's expectations and reality. If you don't know there's anything different out there, you're less likely to be dissatisfied with the status quo. So while in general education is a good thing, and analytical intelligence is also a good thing, there are some significant downsides to both as well.

 

[michaelrack]

I am not using depression to describe the acute aftermath of an event -- I'm talking about remote events ie longstanding emotional baggage.

If you look at some of the questionnaires on clinical depression, which ask about sleep deprivation, feelings of isolationts.

There is a difference between vague questions on a screening questionnaire and meeting DSM 5 criteria for MDD or another depressive d/o. A good (or even mediocre) psychiatrist should be able to differentiate sleep deprivation resulting from work requirements from insomnia.

 

[Neuronix]

For an internal project, I queried my internship class on some questions related to depression. Despite the general wording of the questions, interns on hard rotations reported overall less happiness and less sense of well-being than those on light rotations. Most medical students and residents are under near constant stress, and so I suspect that any increased rates of depression on surveys from year to year or compared to the general public reflects more about environment rather than innate factors.

 

[Bearrie]

Since when was NYU a "top" IM program?

I read your pathetic attempt to regain credibility. The thought that you are a physician only makes your "joke" all the more nauseating. Mods ban me if need be but this needs to be said: go **** yourself.

 

[calvnandhobbs68]

I read your pathetic attempt to regain credibility. The thought that you are a physician only makes your "joke" all the more nauseating. Mods ban me if need be but this needs to be said: go **** yourself.

Way to necrobump a thread for no reason but to tell someone to **** himself.

 

[rokshana]

I read your pathetic attempt to regain credibility. The thought that you are a physician only makes your "joke" all the more nauseating. Mods ban me if need be but this needs to be said: go **** yourself.

really? if you had bothered to read this thread, he apologized for his tasteless post…and people gave him crap about it weeks ago...

 

[SouthernSurgeon]

For an internal project, I queried my internship class on some questions related to depression. Despite the general wording of the questions, interns on hard rotations reported overall less happiness and less sense of well-being than those on light rotations. Most medical students and residents are under near constant stress, and so I suspect that any increased rates of depression on surveys from year to year or compared to the general public reflects more about environment rather than innate factors.

There was actually a recent study on surgery residents who quit. What was really interesting/disturbing was that most frequently they quit because of a particularly difficult month/rotation - that is, not because of long-term unhappiness but rather short-term stress.

 

[gutonc]

There was actually a recent study on surgery residents who quit. What was really interesting/disturbing was that most frequently they quit because of a particularly difficult month/rotation - that is, not because of long-term unhappiness but rather short-term stress.

That doesn't surprise me actually. It's hard enough to see the forest for the trees when you're a resident in any specialty, but when you're standing smack in front of a 300 year old sequoia that's 50 feet around, it's that much harder.

Although I'm not sure how they controlled for the continuous minor indignities piled on residents that led up to that.

 

[DermViser]

Suicide is never a "normal" psychological reaction.

Really?

 

[DermViser]

There was actually a recent study on surgery residents who quit. What was really interesting/disturbing was that most frequently they quit because of a particularly difficult month/rotation - that is, not because of long-term unhappiness but rather short-term stress.

Or is that why they just told them?

 

[mercaptovizadeh]

I read your pathetic attempt to regain credibility. The thought that you are a physician only makes your "joke" all the more nauseating. Mods ban me if need be but this needs to be said: go **** yourself.

I have to admit I laughed at this post. Have a nice day, Bearrie.

 

[mercaptovizadeh]

There was actually a recent study on surgery residents who quit. What was really interesting/disturbing was that most frequently they quit because of a particularly difficult month/rotation - that is, not because of long-term unhappiness but rather short-term stress.

This rings true. I was thinking I was generally hating all of residency, period, but I've noticed that my mood is best on elective months, OK on ward months, and worst on ICU months. Must be something to it.

 

[Arcan57]

This rings true. I was thinking I was generally hating all of residency, period, but I've noticed that my mood is best on elective months, OK on ward months, and worst on ICU months. Must be something to it.

Residency is like any other long term, non-familial relationship. In order to make it work you pour significant time and energy into doing what you think is expected of you. On the good days this is reciprocated and you see a bright and rosy future together. On the bad days, it feels like you're getting nothing out of the relationship. String enough bad days together and you start thinking that there's some innate, terrible flaw in the relationship that means you'll never be happy together. There's probably an ideal schedule that minimizes the string of bad days (having vacation after ICU month, going from night-float to an outpatient rotation, etc) and would reduce attrition. Also, someone could set-up an Ashley Madison like site where residents that are curious about other specialties could "investigate" them further.

 

[DermViser]

This rings true. I was thinking I was generally hating all of residency, period, but I've noticed that my mood is best on elective months, OK on ward months, and worst on ICU months. Must be something to it.

Yeah, mostly correlating with sleep deprivation. Not at all surprising. Surgeons are no different than the rest of us in terms of physiology.

 

[VA Hopeful Dr]

Surgeons are no different than the rest of us in terms of physiology.

Don't tell them that

 

[DermViser]

Don't tell them that

Yeah, I know. The last thing you want to tell a surgeon is that they're only a mere mortal.

For many of them to think they are somehow immune to basic sleep neurophysiology is hilarious. The science in this area is very clear and it's not even denied. We'd laugh if it was a climate change denier or someone who denies evolution, etc. but for some reason if a surgeon states that they don't need sleep and see it as a weakness, it's ok. I've never understood that in their culture.

 

[Neuronix]

There was actually a recent study on surgery residents who quit. What was really interesting/disturbing was that most frequently they quit because of a particularly difficult month/rotation - that is, not because of long-term unhappiness but rather short-term stress.

When reporting on surveys, I think people do have difficulty estimating their overall happiness over the past year or some other period of time. They tend to overemphasize their current state of emotion.

But when it comes to major life decisions, I think quitting is more of a straw that broke the camels back phenomenon. If you hit a difficult rotation and you haven't been happy anyway, you quit. I'm coming off a difficult rotation that a resident quit because of in the past, but I had reserve built up to tolerate it.

 

[SouthernSurgeon]

But when it comes to major life decisions, I think quitting is more of a straw that broke the camels back phenomenon. If you hit a difficult rotation and you haven't been happy anyway, you quit. I'm coming off a difficult rotation that a resident quit because of in the past, but I had reserve built up to tolerate it.

Yes, that's what they theorized in the discussion

 

[ItsSurgicallyComplicated]

I relive this topic, so we can remember those who left. Think about what is important. Our career is a noble pursuit. Neglecting personal relationships is a mistake.

Residency is like any other long term, non-familial relationship. In order to make it work you pour significant time and energy into doing what you think is expected of you. On the good days this is reciprocated and you see a bright and rosy future together. On the bad days, it feels like you're getting nothing out of the relationship. String enough bad days together and you start thinking that there's some innate, terrible flaw in the relationship that means you'll never be happy together. There's probably an ideal schedule that minimizes the string of bad days (having vacation after ICU month, going from night-float to an outpatient rotation, etc) and would reduce attrition. Also, someone could set-up an Ashley Madison like site where residents that are curious about other specialties could "investigate" them further.

Not a bad idea at all.

 

[Crayola227]

I remember this thread. Suicide is always sad. I personally find the suicide of medical students and physicians particularly sad. Hits close to home.