I’ve been a medical student for the past three years and a cancer patient for nearly a decade. It’s harder than you think to be both at the same time.
As a student, I hear classmates boast about how many days it’s been since they last slept and how much junk food they eat to stay nourished. I’m expected to put in long hours, and show I’m keen by staying late even after my shift in the hospital has ended. After enough displays of conspicuous self-neglect, I’ll have earned my stripes. As a patient, though, I’m supposed to prioritize my health and pay attention to getting enough sleep, eating healthy food, and exercising. I’m responsible for doing my best to stay well because it’s what health care providers like me expect of our patients.
A 1997 study revealed a widely held belief among physicians: Illness isn’t appropriate among doctors. The two authors conducted in-depth interviews with of 64 British physicians, all of whom had experienced mental or physical illnesses themselves while in clinical training or practice. As one participant explained, “Illness doesn’t belong to us. It belongs to them, the patients.”
The image of invulnerability, of the doctor as superhuman, is a cultural value in the profession. It’s entrenched in the ways medical schools and hospitals organize the work of medicine. In training, it’s widely acknowledged that the hours are long and hard, and that about half of trainees will suffer from burnout and 1 in 10 will think about suicide. But we are expected to cope with the pressure and prove we are resilient enough to soldier on. In this kind of environment, disclosure of illness becomes an admission of weakness — a sign of being unfit to practice medicine. It’s not surprising, then, that trainees and practicing physicians often don’t seek support for health problems. In a recent meta-analysis, 27 percent of medical students met criteria for depression, yet less than 16 percent of those who were depressed sought treatment.
When medical schools and hospitals fail to directly address the stigma of illness among students and health care providers, not only do they endanger practitioners’ (and their patients’) health by discouraging them from seeking support, but they also miss the opportunity to demonstrate just how valuable experiencing life as a patient can be for clinical practice.
A 2007 study of medical students who’d faced personal illness during their training found that while they achieved lower test scores than their classmates, in the clinic they were perceived as being more empathetic, mature, and better learners overall. Medical education doesn’t currently create formal opportunities to acknowledge the value of that life experience. That absence sends an implicit message to learners: Your experiences as patients aren’t relevant or important to the practice of medicine.
Yet every time I take a patient’s history, or perform a physical exam or procedure, I bring my cancer into the room. It’s there when I break bad news — news I once received. And it’s there every time I cry with a patient, much as I wished my doctors could have done with me.
Cancer has shaped my identity as a future doctor by teaching me what it’s like to navigate a confusing healthcare system — a system where I had to learn a new rhythm of regular follow-ups, treatment side effects, and uncertainty about the future. Yet it’s something I generally keep hidden from my classmates and teachers, a privilege that practitioner-patients who carry visible markers of illness and disability don’t share. And any stigma carried by those of us with physical illnesses is minor compared to colleagues with mental illness, whose conditions are seen by the medical community as liabilities that could jeopardize their clinical judgment.
Over time, I’ve learned to navigate my dual roles as a medical trainee and a patient. I’ve also become more vocal about how illness can contribute to medical training. That has helped show me where medical education comes up short in its mission to support students and promote diversity in the profession.
What’s missing in medical education starts at the level of culture. Instead of viewing illness as a source of weakness, we first need to reframe it as a source of expertise. At a practical level, that means making room for new role models in clinical teaching — teachers who inhabit both the doctor and patient roles, and who can describe the ways in which being a patient has informed their clinical practice. It also means including the expertise of people with experiences of illness, regardless of clinical background, both in teaching and curriculum development.
As a participant in the British study I mentioned earlier said, “Doctors need to be taught to be ill.”
As medical schools and hospitals work to dispel the idea that illness is an unbecoming weakness, they must also make concrete commitments to support the health of their trainees and physicians. Without that support, they run the risk of perpetuating assumptions that doctors are invulnerable, and that students must demonstrate superhuman resilience. That means going beyond existing “wellness” initiatives that promote exercise, meditation, and healthy eating, which are often offered as the typical countermeasures against inadequate sleep and constant stress.
Trainees and clinicians also need safe spaces to disclose when they’re unwell, along with the support and accommodations to match. Unfortunately, many who need this kind of support don’t seek it out. In U.S. medical schools, under 3 percent of students registered with their school’s disability office to receive accommodations such as reduced shift hours, deferred exams, and medical leaves — which is likely a profound underestimate of those with disabling conditions, considering the well-established high rates of depression and suicidal ideation among medical students.
Rather than offloading the responsibility of wellness wholly onto students’ shoulders, medical schools must share that responsibility by considering how institutional policies, shift hours, and academic expectations affect students’ health. They must also reflect on how their policies discourage potential applicants with preexisting illnesses and disabilities from entering medicine in the first place.
In its current state, medical education teaches students a great deal about diseases, but it has failed to teach us what it’s like to live with them. The sociologist Arthur W. Frank wrote about his initial experiences as a patient after he had a heart attack at age 39: “I needed some recognition of what was happening to me.” He wanted his doctors to acknowledge how much his understanding of his own body and way of living had suddenly changed. “The point is not that my physician was incompetent,” he continued. “On the contrary, he did exactly what professionals are trained to do.” Medical education has the power to shift that training, so that illness is no longer off limits to a doctor’s professional identity. Until that time, we’ll continue to fall short in moments when our patients need us most.
Erene Stergiopoulos is a senior medical student, education researcher, and writer at the University of Toronto, where she studies experiences with disability among medical trainees.
Absolutely! The schools need to practice what they preach…and a more preventative approach to disease.Functional medicine!
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