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    Friday, September 16, 2005

    Med Student Blues: Medical school is a depressing place:

    Medical students are more prone to depression than their nonmedical peers. Researchers recently surveyed first- and second-year medical students at the University of California, San Francisco (UCSF), and found that about one fourth were depressed. Others have suggested that although the rate of depression among students entering medical school is similar to that among other people of similar ages, the prevalence increases disproportionately over the course of medical school.

    .....Students may become depressed at any point in medical school, but Gartrell has found that the period of greatest distress occurs during the third and fourth years, when students rotate through the hospitals and clinics. "In the clinical years, there's just far greater commitment of time, plus as match pressure begins to emerge, it's an extremely stressful time for a lot of people," she said. Students are often separated from friends and classmates and must work with a constantly changing set of residents and attending physicians, which contributes to their sense of isolation. Gartrell said that many of the female students she sees are worried that the mounting demands of training and clinical practice will not allow them time to find a partner, marry, and have children. Haynes noted that the increase in sleep deprivation during rotations may also expose mood disorders.


    That sounds about right. Looking back, I'd say the overall mood in my medical school was blue (both my own, and others.) There was a shocking rate of divorce among my married classmates in those four years. It shouldn't be surprising - medical school is a crucible of change.
    Students leave their homes, their families, their friends. They lose the academic standing they had in college and high school, and with it sometimes, self-esteem and respect. They see and learn things they've never seen or heard of before. They learn, in fact, a whole new way of being. It is a completely transformative process in a way that few other processes (except perhaps joining the military) are.

    It is not a pleasant process. I remember one of my medical school classmates describing it as "the shrinking of her soul." The reasons for this are all those mentioned in the above article, with the exception of one glaring omission - the role of the teaching process. The third year of medical school, when students enter the hospitals and see patients, also marks the moment that their teaching is handed over entirely to practicing physicians - and they are brutal. The brightest and best students are treated as know-nothing scum and burdens to be born by the rest of the medical team. There is never, never, any praise - only denigration. At least, that's the way I remember it, with few exceptions. It's like being stuck in a House episode.

    So, how do we get through it? Our hides grow a little thicker (or is it that our souls shrink?); and if we're lucky we meet some good roll models along the way. But, at some point, we come to the realization that our teachers are not gods, but frail, flawed men and women with bad management and teaching skills.

    There waso one episode in my training that was my salvation. One was an internal medicine rotation with an intern who had been a practicing cardiologist in El Salvador. He had fled his country's civil war and had to go through a residency training program to get a license in the U.S. Even today, I can say his clinical skills were the most excellent I have ever seen. And yet, to our attendings, down to a man, he was like every other intern. At case presentations and rounds, there was never any praise from our attendings, only nitpicking criticism - just as there was for everyone on the team. He used to tell us medical students that it was all an ego game, best ignored. They had to feel they were earning their salaries. Thanks to him, I learned to separate my teachers' medical knowledge from their personalities. And not to take anything they said personally.
     

    posted by sydney on 9/16/2005 08:41:00 AM 2 comments

    2 Comments:

    The recent issue of Physician money digest shows that the average salary offer for a nurse anesthetist was 156K compared to a family practioner who was offered 145K. Internists are also not doing well. Most of the internists work for less than 150K. Those that has been in practice for mor than 15 years now find that they are being forced out of practice as they cannot maintain overhead as the BREAD AND BUTTER of the practice (which pays for the overhead) is taken away. This should be another reason the medical student should be depressed about.

    By Anonymous Anonymous, at 7:10 AM  

    this will cheer you up, hilarious...

    http://www.putbobthroughmedschool.com

    By Blogger Dave Scott, at 1:56 AM  

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