Why do people develop depression in medical school?

[Noisewater-TDX]

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Glad my school doesn’t put rankings on mspe (or so we’re told).

Our rank is def on our MSPE. Its broken down by non-clinical years rank, 3rd year rank, and then 4th year rank (i guess up to ERAS app).

 

[Matthew9Thirtyfive]

Our rank is def on our MSPE. Its broken down by non-clinical years rank, 3rd year rank, and then 4th year rank (i guess up to ERAS app).

Yikes.

 

[sanfran256]

I was lucky enough to only get "a little dysthymic". Here's my take:

-Isolation- biggest factor
-Everything is so damn competitive- you essentially have to do well to have any sort of say in your residency placement (which you don't have anyway)
-We are all in MASSIVE amounts of debt , even though we probably will be able to pay it off , the mental burden is huge

There are a subset of us (CA transplants) who get extra depressed because:

-A lot of us are FAR away from family - like 7 hour multi-stop plane rides away . A lot of my NE friends are states away from family but can drive home at least.
-Its exceedingly competitive to get back into the state at a half-way decent program for any residency/very limited options in surrounding states- extra anxiety/pressure to succeed

 

[Sleepingdoc]

because life there just sucks... for 4 years you get the most grueling training ever filled with anxiety... then you go into residency which is that anxiety which is 10 fold tougher... then attending life which is at a different level.

 

[xoxo111]

Anybody cries during vacation because you don’t wanna go back to school? I’m surprised I’m admitting this because it makes me sound like a preschooler.

 

[xoxo111]

P=MD my friend.

Thank you for acknowledging that. not a lot of people like it when we use podiatry and MD in the same sentence.

 

[softball2344]

I was lucky enough to only get "a little dysthymic". Here's my take:

-Isolation- biggest factor
-Everything is so damn competitive- you essentially have to do well to have any sort of say in your residency placement (which you don't have anyway)
-We are all in MASSIVE amounts of debt , even though we probably will be able to pay it off , the mental burden is huge

There are a subset of us (CA transplants) who get extra depressed because:

-A lot of us are FAR away from family - like 7 hour multi-stop plane rides away . A lot of my NE friends are states away from family but can drive home at least.
-Its exceedingly competitive to get back into the state at a half-way decent program for any residency/very limited options in surrounding states- extra anxiety/pressure to succeed

^this 🙁

 

[Matthew9Thirtyfive]

Thank you for acknowledging that. not a lot of people like it when we use podiatry and MD in the same sentence.

lol. Not what I meant.

 

[Noisewater-TDX]

Anybody cries during vacation because you don’t wanna go back to school? I’m surprised I’m admitting this because it makes me sound like a preschooler.

I was like this for my 1st year of med school. Once you get out from underneath the Phds and start learning from the DOs and MDs things start to get more interesting and clinical. I'm a 3rd year now, i'm glad to be on break, but don't really mind going back. All i do is go to work, do my job, come home.

My peak of overall crushing stress was somewhere around the end of MS1, with another peak before boards in MS2. I'm sure i'll start spazzing out again before our step 2/level 2 this summer. I'm just more annoyed than stressed now days, mostly by busy work that doesn't serve much of a purpose in terms of me learning how to care for patients.

 

[Angus Avagadro]

Students I see and recommend to student counseling have several common issues.
I'm not smart enough....all med schools have some super smart students. They may be in a DO school due to cost or location to family, spouses job, etc., rather than a higher tier school hours away. Some students dont adjust well to being in the middle of the pack in a class of very smart people. They realize they aren't quite as smart as they thought they were.

They enjoy academics and the nuts and bolts of studying, test taking, etc. When they see that clinical medicine can be very mundane and repetitive at times, and not every case of jaundice is Wilson's disease, they become disenchanted with the routine of taking care of patients on a day to day basis.

Much of medicine is long days and paperwork/documentation. Its hard. Some academically gifted people aren't used to doing hard work. They complain about mundane daily chores and think performing those tasks is beneath them. When I have had residents complain about the workload, I would respond," What do you think is going to happen when you are an attending? You may have to do all of this without residents or partners to assist."
These are some common issues i have found with disenchanted students and house staff that i have referred to counseling.

 

[Angus Avagadro]

Crazy how an experience like that can make or break a rotation.
We as students, never hurt anyone. I don't get why some preceptors think they can abuse us

Medical students NEVER hurt anyone? My wife on her first day as a 3rd yr was told to take off every dressing, inspect the wound and reinforce the dressing back in place. She removed a compression dressing and the patients leg swelled up like a balloon. Her resident should have been supervising her, yet she got screamed at for the error. I had a medical student respond to the patients question of " What do you think it could be?" His response? "I think its cancer." When I arrived in the room, I practically had to peel the lady off of the ceiling. It wasnt cancer. Medical students require supervision as they are learning their trade. Otherwise they can be put in situations they are not yet ready to handle.

 

[hallowmann]

Unfulfilled expectations. That's the simplest reason I see people less than happy about med school. For me, the key is resetting those expectations and being happy with the reality vs the idealized vision I had as a premed.

I'd call that a component, not the whole reason. The bolded is very important for medicine and life in general.

...I'll also second what someone said above about all the minutia the school requires that really adds up to eat huge portions of your time. "Only 4 hours of required activities a day, everyone! Also, we need you to sign up for a 3 hour physical exam skills session. Don't forget you need to sign up for a mandatory 1 hour meeting with your adviser. Plus, there's a 1 hour mandatory session about how to get involved in research. By the way, you have 2 hours of pre-reading before your small group session tomorrow at 8 AM. Please don't forget that you have 55 structures on the anatomy hitlist to memorize this week. And we finally sent out the list of possible anatomy questions for the written final - it's 27 pages long, so you should make sure you start memorizing those ASAP. There's also the 6 hours of research we need you to do for your small group sessions every week. Remember to do your weekly essays and reconcile your answers from last week's essays." I can keep going, but that seems sufficient to get the point across...

Love this. Unfortunately it doesn't end in med school, but you just get better at it.

 

[Angus Avagadro]

I'd call that a component, not the whole reason. The bolded is very important for medicine and life in general.



Love this. Unfortunately it doesn't end in med school, but you just get better at it.

Agreed. When medical students complain about the amount of information they need to master, they dont yet understand that it's this information and experience that separates them from PAs and NPs. I always say, "Do you want to be the Dr I pick to take care of my wife and kids , or the Dr I choose to take care of my Mother in Law?"

 

[honey0102]

Medical students NEVER hurt anyone? My wife on her first day as a 3rd yr was told to take off every dressing, inspect the wound and reinforce the dressing back in place. She removed a compression dressing and the patients leg swelled up like a balloon. Her resident should have been supervising her, yet she got screamed at for the error. I had a medical student respond to the patients question of " What do you think it could be?" His response? "I think its cancer." When I arrived in the room, I practically had to peel the lady off of the ceiling. It wasnt cancer. Medical students require supervision as they are learning their trade. Otherwise they can be put in situations they are not yet ready to handle.

You're right...I guess I haven't seen any example of this, but wow.
However my point is rather-there are some preceptors who will be abusive even if a student didn't hurt someone-which is wrong.
But I do agree that students need supervision, and I'd not feel comfortable with things I'm not certified to do.

 

[Obnoxious Dad]

They get depressed because they stop exercising.

Exercise is an all-natural treatment to fight depression - Harvard Health

Antidepressants aren't the only solution for depression. Research shows that exercise works as well as antidepressants for some people, although exercise alone isn't enough for someone with severe ...

www.health.harvard.edu

Furthermore, as one poster noted above, they also can't tolerate not being the smartest person in the room. I once played golf with a Harvard Law grad. He had a classmate who hung himself because his self image was destroyed by the knowledge that other people were just as smart as he was.

 

[Matthew9Thirtyfive]

They get depressed because they stop exercising.

Exercise is an all-natural treatment to fight depression - Harvard Health

Antidepressants aren't the only solution for depression. Research shows that exercise works as well as antidepressants for some people, although exercise alone isn't enough for someone with severe ...

www.health.harvard.edu

Furthermore, as one poster noted above, they also can't tolerate not being the smartest person in the room. I once played golf with a Harvard Law grad. He had a classmate who hung himself because his self image was destroyed by the knowledge that other people were just as smart as he was.

Wow really?

 

[Sagebrush]

They get depressed because they stop exercising.

Exercise is an all-natural treatment to fight depression - Harvard Health

Antidepressants aren't the only solution for depression. Research shows that exercise works as well as antidepressants for some people, although exercise alone isn't enough for someone with severe ...

www.health.harvard.edu

Furthermore, as one poster noted above, they also can't tolerate not being the smartest person in the room. I once played golf with a Harvard Law grad. He had a classmate who hung himself because his self image was destroyed by the knowledge that other people were just as smart as he was.

Gosh, I wish someone had told me earlier that I just need to stop being lazy and egotistical. Thanks!

 

[Noisewater-TDX]

I prefer my SNRI over exercise. If i go outside there is chance i might have to interact with a human. I can't have any of that.

 

[OrthoTraumaMD]

Gosh, I wish someone had told me earlier that I just need to stop being lazy and egotistical. Thanks!

It isn’t about being lazy or egotistical. That’s not what they were trying to say. The person who hung himself had the same issue I see a lot— It’s about having unrealistic expectations of yourself, and allowing the perceptions of others to affect your psyche. That said, I have seen a small proportion of students who come in expecting things to be handed to them because everything was easy up til this point, and they don’t have any resilience or self-understanding. They are fragile. They take instructors calling them out on lack of knowledge or preparation as a sign of toxicity or “abuse,” instead of the challenge that it usually is. But the vast majority of students are not like that, and are normal people who just have very high expectations of themselves that are not flexible enough to survive the fact that they are now in a situation where they may never be “the best” again no matter how hard they work...and more importantly, that it’s okay to be average now because you’re among your peers and you’re still great.

 

[Angus Avagadro]

It isn’t about being lazy or egotistical. That’s not what they were trying to say. The person who hung himself had the same issue I see a lot— It’s about having unrealistic expectations of yourself, and allowing the perceptions of others to affect your psyche. That said, I have seen a small proportion of students who come in expecting things to be handed to them because everything was easy up til this point, and they don’t have any resilience or self-understanding. They are fragile. They take instructors calling them out on lack of knowledge or preparation as a sign of toxicity or “abuse,” instead of the challenge that it usually is. But the vast majority of students are not like that, and are normal people who just have very high expectations of themselves that are not flexible enough to survive the fact that they are now in a situation where they may never be “the best” again no matter how hard they work...and more importantly, that it’s okay to be average now because you’re among your peers and you’re still great.

Thank you. Well said!