WE HAVE MOVED TO: A Theory of Living
Today I thought I'd write about stress in medical school. We've all seen it. We've all had it. Even the rosiest and happiest people in school can still feel it from time to time.
This article may come across dark, and that's okay. It's not supposed to be an indictment of hospital life or anything like that. I just want to recognize the stress, take a look at some sources, and reach out. There are a lot of medical students and healthcare professionals that let it get to them, let it get them down. This article is for them more than anyone else, to say that yes it's there. And in future articles we'll explore some coping mechanisms.
Medical school and medicine in general is a stressful career choice for a variety of reasons. I think that is only more true in the hospital environment that most medical students are in for the majority of their training. It's the nature of the best, and I want to look at a few of the major players in this setting and see why they might naturally contribute to it.
The patients are largely unhappy, if only transiently, because they are sick. It is hard to blame them for this. In my life, I have been on the other side of this.
A few years ago, I came down with Salmonella colitis from raw chicken I had handled. I was incredibly sick and in pain. On the patient side it can feel like a solitary experience, with nothing but the TV and family members to keep them company. It may be several hours between visits from a nurse or doctor. Even though those on the medical side know that doesn't change the fact that everything that can be done is being done, and nobody would benefit from the doctor or nurse sitting in there for hours (in fact, that would be a negative for other patients) it can change that perception for the patient.
I am proud of the fact that I coped with it well, because I have well developed coping skills and a high healthcare IQ, but I do not fault others for lacking those same skills. I also recognize that the experience is ever more difficult for those with a low healthcare IQ.
On the flip side, some patients are just assholes. Like any random population of people, some are lovely, and some are jerks. Unfortunately, when you take someone who is already a jerk and catch them at their worst when they are sick and miserable, you're in for a spectacular combo.
The healthcare practitioners are sometimes stressed out, because they work long hours in a challenging and legislation/paperwork dominated environment. The topic deserves it's own article, but the amount of paperwork that is done in hospitals is absolutely crushing. It is approaching the point where more time is spent on paperwork than actual patient care, and I only forsee this getting worse in the future. Even on my psycho rotation, you know, the rotation where talking to the patients is the most important part, we still spent more time hammering away on the computer than on talking to patients.
Also, there is the long hours part. Medicine, particularly hospital medicine, is by definition a 24 hour business. People don't magically get better at night, and newly sick or injured people don't magically stop coming in when the sun goes down. In fact, that's usually about the time the drunks decide to get in their cars in order, before they magically show up in the ED/trauma bay.
The natural hierarchy of medicine also ensures that someone is going to be annoyed at least some of the time.
Nurses are often pissed off because they end up doing most of the crappiest jobs for the least money, and they have the least autonomy. Seriously, as a side note, be nice to your nurses. They are overworked and underpaid. Even if you're not a nice person, at least appreciate that they have the power to make your life suck more if you're an asshole.
Doctors - some are happy, don't get me wrong - are often stressed because they work night and day to help people, despite the fact that people refuse to help themselves. This might be what I have hated most about medical school: the patients who refuse to stop doing crack, who keep rolling in with A1Cs that are over 14 and the machine can't even read despite hours of diet counseling, the ones who won't quit smoking. The ones who's failings have more or less ruined the lives of others (fetal alcohol syndrome?). It is really, really hard to deal with that. I'm on a family medicine rotation right now in a rural area, and it has really been beating me into the ground to have the same conversation every day with 10-15 obese, diabetic patients. The worst part is knowing that this conversation has been had before. I can see that a lot of it is not their fault but due to their upbringing and a lack of quality health maintenance education, but that doesn't make it hurt me any less.
Mid level providers can be stressed because they have acquired a lot of knowledge that can be used to help patients, but they sometimes find themselves overruled by a doctor. They are also subjected to a lot of the "scut work" that doctors don't want to deal with. To be fair, though, most of them are pretty happy with their sizable paychecks, holidays, and good hours.
Residents are unhappy because their lives are terrible. They are essentially a captive audience. They need to complete their residencies to become doctors, and they need to do it well for recommendation letters. They often have profound piles of debt that their 45k/year salary doesn't even touch. In fact, at 80 hours per week for 45k, their hourly wage comes out to somewhere around 12 dollars an hour, which is absurd when you consider that the average doctor has an average IQ of 125+. Not only that, but only about half of the work they do actually requires MD level thinking, while the rest of it is obvious scut work that the hospital uses them for. It sucks feeling as though a lot of the work you're doing is not challenging you; in fact, I would suggest that the feeling of being challenged is one of the greatest, if not the greatest, motivating factor for excellence and fulfillment.
Now, now. Don't get up in arms saying that I'm being dark, and it's not all that bad and all that.
Because you're right. It isn't all that bad.
The picture is not always as stressful as I am presenting it. Many of the people in these various positions are happy most of the time. Really. I have had many fantastic days where I felt like the patients and staff and I were all in a loving and happy little bubble. But we are human, and the bad days just naturally hurt us more than the good days help us, and I'm writing this for those medical students who let the bad days hurt them. Because there are many medical students who let the bad days or bad people or bad patients or bad feelings get to them. And they should know that they're not alone and that they can cope. I have some suggestions on how.
Over the next few weeks, I'm going to be posting a few articles with what I think are some good "Survival Skills" for a medical student.
Spoiler alert: the first one is exercise.
I know. It's been written about a thousand times before. Yet still not everyone does it.
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