Should We Encourage People to Become Doctors?

Recently, a friend of mine approached me and asked if I would help her with her MCAT studying.  She would be a non-traditional med school applicant after taking a few years post pre-med to do great and wonderful things, including organizing cancer research at a local academic centre.  Because of a few gap years, she felt the need to ACE this standardized test to prove she still has the academic chops to both herself and prospective medical schools.

Immediately, I froze

Over the course of my career, I have served as mentor to med students, interns and residents along their path in medicine.  To be there at someone’s Aha! moment has always been something I’ve enjoyed, and the thought of me paying it forward in homage to my personal mentors always leaves me with all the sentimental feels.  We’ve created a community around ourselves – we are all in this together!

But this was different.

She hadn’t been drawn into the medical machine yet – she wasn’t yet fresh meat that was going to be chewed up and spit out (and booed off stage – Eminem anyone?).  She wasn’t yet trapped into a life that compelled my colleagues and I to band together in an effort to support each other for our survival.

Seeing that I’ve just been pulling myself out of burnout and in the process have heard from so many of my colleagues sharing their own burnout stories with me, I looked at her and thought:

Do I have a moral and ethical responsibility to protect you from yourself and your idealism?

However, at that moment I couldn’t yet find the words to explain my hesitancy.  Of course I wanted to support my friend in her efforts!  She’s brilliant, caring and warm-hearted; the perfect mix to be a great physician.  I used to teach for Kaplan’s MCAT prep course, and after 10+ years of taking standardized tests after another, I know a thing or two that could be of benefit.  So against this swell of discomfort rising within me, I agreed to help her.

In the two weeks leading up to our planned study date, I kept trying to dredge up what exactly was telling every fiber in my being to tell her NOT to move forward with a career in medicine.

Then, a Facebook post from one of my old med students snapped everything into clear view – one of her friends from med school committed suicide during her second year of residency.

It laid out like every other physician’s obituary I had read before.  She had a sunny disposition – perfect as her name is Sunny.  Always there to lend a helping hand, a smile or word of encouragement.  Pillar of her community.

Nobody saw it coming.

The Cost of a Career in Medicine

Everyone thinks about the cost of medical school – student loans, the duration of time spent studying and training to become a physician.

But no one talks about the cost to self.

Why do over 40-60% of doctors describe feeling burned out, and why doesn’t anyone want to talk about it?  Why do anywhere from 5 to 9 out of 10 doctors NOT recommend going into medicine, going back as far as 2012?  What happens to us over the years, turning us from bright eyed, idealistic and compassionate people to people who feel the only way out is to take our own lives?

Why do over 400 doctors a year commit suicide?

The process

As I think of my friend and her journey into medicine, I see the systematic dehumanization that will happen to her.

I see her guilt at not studying during Christmas and Thanksgiving because she has now started to prioritize her education and career over time with family and friends.

I see the arguments that will happen on her days off when her significant other wants to go out and do things with her, but all she wants to do is crawl under her comforter and finally get some rest.  But she won’t, because she has to study.

I see her crying at work after a bad outcome as an intern, but her senior resident tells her to get ahold of herself because patients and their families aren’t there to help her manage her emotions – she’s there to help support them through theirs.  If she wants to cry, she can do that on her own time later.

I see her joy and warmth stamped out by the misery that will eventually consume her as she’s working on her 70th hour at work that week, currently on her 18th day out of 21 scheduled in a row.  I see her dreading next month because it’s another hospital rotation with only 4 days off in 4 weeks.

I see patients become obstacles to her getting home – she doesn’t have time for their absurd questions that don’t change management anyway.  She’s got so many other things on her to do list right now, and these patient interactions are not a priority.

I see her getting into a silly argument with her significant other when he’s trying to take her out to dinner after a hard 16 hour day, putting out fires left and right at the hospital.  He keeps pushing for her to tell him what she wants, but she can’t come up with one thing.  She’d rather starve than make one . more . effing . decision.

I see her at Thanksgiving/Christmas again, trying to function through being up the last 21 out of 24 hours from a horrendous overnight call.  She doesn’t want any part in conversations with family that want to talk about her “great job” that she has been secretly contemplating quitting.  What she wants is a nap and her mother in law’s apple pie.  She can’t sneak away to sleep, so she takes two pieces of pie to stuff her face with, hoping it will keep the bitter irony down as well.

I see her telling her fellow residents to not let anyone on their patient list die, because the list is full and we don’t want to deal with anymore paperwork for new patients.

I see her making check boxes on her to do list, making note of all the discharge summaries she has to do before she goes home.  I see her weighing the pros and cons of putting in details in these summaries, especially the death summaries – they’re dead so does it even matter anyway?  She can get home faster if she doesn’t.

I see her make the comment at someone’s death, “It’s about damn time.. that family was hanging on and prolonging the misery for everyone involved.”  Or at another’s death, “Glad we could artificially keep that patient alive so their long lost son could relieve himself of his guilt.  Great use of $20,000.  I’m sure they’ll be paying that themselves.”

I see her cynicism increase exponentially and the joy, compassion and warmth she used to have snuffed out by the same margin.  Now the only emotions she has become comfortable with are frustration and anger, because grief and sadness from caring too much were unacceptable.  She would rather punch holes into the wall and scream obscenities than ask for her loved ones to hug her while she cries prostrate on the floor.

I see her emerge from residency and try to reclaim her humanity and compassion like putting together the shards of a broken vase – the pieces may fit, but the vase will never be the same.

She wants to mourn the death of a patient, but doesn’t remember how.  So she lets his death summary from the hospital sit in her document box for 2 weeks so at least he still exists there.

She wants to cry when the ER doc calls her to let her know the 2 year old patient she just sent in has leukemia, but instead she calmly thanks the doctor for the update and finishes watching a TV show with her husband without any mention of the turmoil in her heart.

She wants to remember what it was like to be inspired, so she tries to write inspirational messages.

She wants to reclaim that idealism, but it’s gone forever.  She has seen too much.

She’s asked by a friend to help her on her journey into medicine.

She freezes.

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Do I perpetuate the cycle?

These are all things that happened to me or things that I did to others during my 11 years in medicine.  My story is not unique and is not the worst story I’m aware of, by far.

Dare I hope by the time my friend gets there, things will have changed?  Am I not giving her enough credit to wonder if she may not have the strength to withstand the changes that will happen?  Do I live in fear of her obituary plastered on social media because of my support during this early hour?

Would the cost to her life be different than the cost to mine?

Ultimately, people should pursue medicine if they truly believe it is their calling.  But they should know along the way, they will lose bits and pieces of themselves due to the process.  They may emerge as a different person than they expected to be.

I know I did.