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racticing medicine is a rare privilege that requires discipline, dedication, and sacrifice.

Yet those traits are often incompatible with our social and emotional needs as human beings, and when we’ve reached our brink, it challenges that decision to heed the call. A few months ago, a friend and fellow resident in another program told me that after a long and stressful day at work she had to pull over on the highway because she couldn’t fight back the overwhelming urge to cry and didn’t want to drive at the same time.

Nearly 400 physicians die by suicide each year. As the medical profession starts to look closely at burnout and depression among its ranks, the signs, the symptoms, the fallout have been all around me. I’ve spent the past few weeks tracing my own path to physicianhood, and diving into its toll on my well-being.

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During my residency orientation at the Cambridge Health Alliance, I remember our program director telling us to look out for one another, to make sure that we psychiatry interns, all eight of us, had one another’s backs. Instinctively, I was worried — what did we need to protect one another from?

But I knew.

After successfully matching into the fellowship of her dreams, another friend told me that her terrible residency experience taught her how strong and confident she could be. She’s learned from the adversity and grown as a result of the challenges she faced, but I wonder, what was stolen from her in the process? I wonder how much more she could have blossomed as a physician if this growth was driven by support rather than survival.

While interviewing for residency programs, I was repeatedly asked if I liked medical school — the grueling hours, the vast amounts of information I needed to have at my fingertips, the trial by fire when starting clinical work. My diplomatic answer: I was thankful for the opportunity but was happy I never had to do it again. It belied the dirty little secret that medicine is the best and worst thing that has happened to all of us — that we’ve survived the extremes of loneliness, anger, humiliation, or sadness because, “Hey, it’s OK. I’m going to be a doctor.”

And now, as a first-year resident, I was being warned to keep an eye out for my colleagues — to become my co-intern’s keeper.

This time, I told myself, I would get it right.

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Toward the end of my third year of medical school, a classmate tearfully confided her demolition at the hands of a cruel supervising physician. I told her it was OK, that it happened to all of us. I steeled myself against her sadness because it was too hard to think about the harsh realities of training. I’d lost my empathy to a plight that could very well have been my own.

I was one of the young fish David Foster Wallace described in his commencement speech to the graduating class at Kenyon College. When asked by an older fish, “How’s the water?” the young fish wondered, “What the hell is water?”

The young fish can’t see beyond their circumstances to appreciate the bigger picture. When it comes to our training, I was the next in a long line of physicians that would struggle to see what’s normal and healthy, and what is not. We don’t see that we are all in this mess together, and we deny ourselves the chance to see the pain for what it is, because we’ve collectively accepted it as part of being tough, being clinical. Being a doctor.

In chronicling her long battle with brain cancer, the late writer Alison Piepmeier reflected on her experience in hospice care and asked: “How can I exist in this place, where I’m so grateful and so sad?” It’s the perfect articulation of a question I’ve wrestled with in one form or another every day for past 10 years as I progressed from a premedical student to a newly minted MD.

While the medical profession can adopt policies to reduce the incidence of depression, I think, all of us, as members of a community, must take ownership of our collective mental health.

Earlier this year, I wrote about finding joy in medicine. Two doctors facetiously tweeted at me that they looked forward to an update after that first year had crushed me. “Losing joy” is an experience that is not uncommon.

As Wallace said, “It is about simple awareness — awareness of what is so real and essential, so hidden in plain sight all around us, that we have to keep reminding ourselves, over and over: ‘This is water, this is water.’”

This is our water — my profession needs to care for its people. We need to care for ourselves. But mostly, we need to look out for one another, to be there, in empathy and understanding. Support over survival. Be one another’s keeper.

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  • i have certainly seen the experience of medical training turn idealistic young people into angry disillusioned intolerant physicians. and there is certainly a lot in medicine to be disillusioned about. but i can’t but believe that part of the decline of the physician from near demi-god status to easily replacable asset is partially self-inflicted. How can we expect society to treat us with the respect so often denied to fellow colleagues? Perhaps we should look for examples of where positive training is done well, and emulate it rather than perpetuating boot-camp methods that may very well be inferior and harmful. I would like to offer a positive example from my own residency training program at Indiana University. Under the leadership of a chairman who just retired, this large obgyn residency program provided four years of challenge, growth and mutual support that I remember with fondness. Excellence was expected, and encourage through positive example and active direction. Friendships between colleagues crossed the boundaries between year of training and faculty and students. We knew our attendings as people, and vice versa, and frequently spent time with them outside the hospital and formal department events. Residents who graduated came back to visit, and frequently called for advice and informal consultation. I never saw a resident eviscerated during morning report, or subjected to abusive tirades as I have at other programs. Yet I would contend that the quality of residents graduating from this program is among the highest and I certainly would consider any of my colleagues from there to be among the best due to the quality of their experience. I hope this program is not completely unique in its positive approach, but perhaps it could serve as a model for programs plagued by negativity, abusiveness, and burnout.

  • I want to put this very carefully because I do understand the emotional trauma you are describing.
    It might help to understand that doctors are not the only ones to experience it, and also to understand that this is the result of our having a very caring culture.
    There are many other career paths that involve daily exposure to the horrific trauma of other people’s lives.
    For ten years, I represented victims of domestic violence, handled hotly contested custody cases, and was a “guardian ad lite” to children entangled with the Juvenile Court system. I stopped because it was making my husband unhappy, especially my waking up every morning worrying about whether all of my clients were still alive. But I always knew there were plenty of other people whose jobs involved just at many horror stories.
    Maybe it would help doctors to know the same thing.

  • i’m in the middle of a horrendous mdphd program right now and wondering if there are articles like this about grad students – the culture of abuse extends all across medicine and science. also the author mentions telling a resident that it was ok that the resident got crap from an attending cuz everyone gets it. but that’s just it. it’s not ok. just because it happens to everyone does not make it ok. it instead points to the severity of the problem that being treated like shit is the norm – it is not ok to be dehumanized as a health care provider regardless of who you are. we have come so far in medical advancements, and yet the culture is still what it was 40 years ago… let’s remember that also “back in my day….” people died of polio and women couldn’t work, so that’s clearly not a good reason to continue to do as was done before. … and we have all heard the “back in my day…” stories to make us feel like we have it better.

  • A wonderful piece!
    “we look out for others(patients) but forget to look out for ourselves(practitioners)”. This is the statement my Psychiatry professor told us the first day we rotated at the mental health unit.
    Am in my final year of medical school now and I have to say am not the same excited jolly kid I was when I first heard I was admitted to med school. Alot changes, but how best can we keep up and live the dream?! Looking out for others and being looked out for is the pain answer in my opinion.

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