AMSA's 2015 Annual Convention
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February 26 - March 1, 2015 

Overcoming the Blues

The New Physician May-June 2001
If you’re feeling down and not sure if medicine is for you, don’t fret. These lurking doubts are common, and, yes, they can be overcome.


“I was trying as hard as I could,” says Thom Bollinger of his first year at the University of Miami School of Medicine. Buried in neurophysiology and neuroanatomy, only getting average and below-average grades, Bollinger was frustrated. Then, one day, he began to wonder…. “I was sitting outside one afternoon just looking at the trees,” recalls the now second-year medical student. “I just started thinking, ‘What the hell am I doing here? What have I done?’”


When he started medical school he assumed, as many medical students do, that he would be in the top of his class as he was in his undergraduate days. He also expected to have some free time—to be able to exercise and to be able to spend time with his wife and newborn son—but it wasn’t happening that way. And that afternoon, while he relaxed under the shelter of the tree, it all hit him: Perhaps he made a mistake in deciding to attend medical school. Maybe getting a medical degree wasn’t worth all the sacrifices, hard work and frustration. Perhaps becoming a physician wasn’t for him.


Bollinger’s reaction to his first year in medical school is not unique, says Dr. Rachel Goldstone, the director of the Medical Student Well-Being Program at the University of California, San Francisco, School of Medicine (UCSF). “It’s extremely common for people to have doubts all along the way,” she says. Through group or individual sessions, medical students in UCSF’s Well-Being Program can explore their reactions to the process of becoming a physician, and this helps, Goldstone says. She says it’s normal to question your decision to go to medical school at some point during your training. Some of you may do it transiently as a response to a bad grade or a negative comment from an attending, while others of you may slog through months of lurking second thoughts. But having reservations about medical school doesn’t imply that you won’t end up practicing medicine. “It doesn’t differentiate the people who finish from the people who don’t, because everybody has doubts. Medicine is a huge commitment,” she says.


THE PEAKS OF UNCERTAINTY


According to Dr. Phyllis Carr, an associate dean for student affairs at Boston University School of Medicine, there are two distinct peaks in medical school yielding the highest level of doubts in students. She says the first peak occurs in the preclinical training years—the first two years of medical school—during which time you may start to think the material you’re studying is irrelevant to what you want to do. “It’s not always easy to see the connection between biochemistry and taking care of a patient,” Carr says. The road to becoming a physician is long and winding, and it’s easy to become shortsighted when you’re studying so hard, paying large tuition bills and yet still can’t see the endpoint. Add to this a few poor grades or failed tests and some of you end up under the trees like Bollinger, wondering if it’s all worth it.


Pediatric ophthalmologist Charlise Gundersen remembers having second thoughts during her early medical school days. She says toward the end of her first year at Texas A&M University College of Medicine she started to think, “Was this really what I wanted to do or did I just sort of follow the system and here I am?” But she endured, graduated in 1991 and now fully enjoys her professional life.


If you get bogged down by the preclinical curriculum, Carr recommends taking an elective or shadowing a physician in a specialty you’re considering. She encourages you to balance the rigors of learning the basic sciences with a clinical experience in an area of your choice. Joining student organizations, especially specialty organizations in your field of medicine, can also be helpful, she says, allowing you to connect with other people who have similar interests. Goldstone emphasizes this point as well, saying it’s important for you to try to keep in touch with the reasons why you came to medical school.


And just when you think you’ve overcome that first uphill battle of doubt, here comes another. Yes, the second peak typically occurs during the clinical training years, Carr says. During your third and fourth years, you’re busy taking care of patients, which is typically what you ultimately want to do, but the hours are long, strenuous and demanding. “Sometimes, usually after several rotations in a row, people begin to feel incredibly fatigued and begin to wonder whether this is really what they want to be doing,” she says.


Compounding this fatigue can be issues of unrealized expectations. For example, some of you may discover you don’t like clinical medicine or working with sick people. These situations can be particularly disturbing when you’ve already spent two or three years of your life and tens of thousands of dollars toward becoming a physician.


Child psychiatrist Andrew Hudson,* who graduated from medical school almost a decade ago, remembers hitting the wards and hitting an emotional wall at the same time. He had always intended to become a pediatrician but when he started taking care of patients day in and day out, he wasn’t so sure. “It wasn’t what I thought it was going to be, and I started to question whether I could be happy doing it,” he says. Hudson became so discouraged that he took a leave from school to sort things out. He taught science to children for two years, then felt re-energized and ready to tackle medicine again. So he returned to medical school and found his niche in child psychiatry.


If you’re like Hudson and have serious doubts, Carr suggests that you give yourself enough time to reflect on your feelings about medicine, even if that means doing what Hudson did—taking a leave of absence. This will help you avoid making a hasty decision about your future. But if you’re a student who feels miserable all the time and extremely hopeless about your prospects in medicine, you should be screened for depression. Depression and anxiety in medical students is common, Goldstone says, and it’s important to get appropriate treatment that may include therapy and antidepressant medication.


But many of you won’t need to take time off from medical school; all you may need to do is seek out mentors who are in practice. “Not a resident, not an intern,” Carr says, “but someone who has a lifestyle of doing medicine and also another aspect of their life.” Spending time with a practicing physician will allow you to see the difference between working on the wards and working in the real world, and it should quell many of your concerns, she says.



While doubts may be common during a student’s medical school tenure, you shouldn’t be surprised to hear that every individual’s experience is different. This is mainly because each of you brings your own unique personal and family history to your medical school interactions. For example, a lecture on a serious illness may trigger painful memories if you have a family member with the same illness. And this may cause you to doubt whether you’ll be able to handle the responsibilities of being a physician. Others of you, however, may not have this problem. Goldstone says it’s important to understand your doubts in the context of your life.


But while your uncertainties about medicine may be disconcerting, they can also be productive, she says. “Doubts help people to have an informed decision. If students go ahead blindly, then they are more likely to be hit down the road with big questions. But if they question it all along, then they may have a better idea of what they are getting into and be more realistic in their expectations,” she says. The more prepared you are, she says, the better you’ll be at dealing with the real challenges of medicine in what will likely be a lifelong career.


FINDING SUPPORT AND RESOURCES


A medical school’s office of students or student affairs can be a place for you to raise your concerns in a confidential atmosphere. Bollinger met with his dean of student affairs to review his courses during his first year, and the experience was very positive. “The dean was fantastic. He just made me feel like: ‘We’re just concerned about you. We care about you, and we want to make sure everything is fine and that you’re coping fine with everything,’” he says. Feeling reassured by his dean, Bollinger found a compatible study group and finished out his first year with strong marks.


Carr says medical school administrators want to see their students graduate, so they make great resources. “We really do want to see [students] succeed,” she says. “And there’s a lot more these days in terms of accommodations for students who are having a hard time.” Many schools offer academic tutors, stress seminars and peer advisers.


Most medical students who talk to their dean of students or student affairs find the experience helpful, but some of you may be afraid to talk to your dean or a faculty member who may have influence over future grades or letters of recommendation. UCSF’s Well-Being Program was established independently from the dean’s office so it could be a secure refuge for students who suffer from a wide range of difficulties. Although medical schools with a well-being center are still in the minority, most institutions provide access to free counselors and therapists who can offer comparable confidential environments. So if you think you’re in need of these types of services, you should inquire about similar offerings.


Other schools try to address in their curricula the potential stresses of becoming a physician through introduction to clinical medicine or interviewing classes. At UCSF, Goldstone offers an elective course called “On Doctoring” that allows for small group discussions of students’ responses to the process of medical school. When the topics of doubts or difficulties arise, many students are relieved to hear that they are not alone. “It’s hard to carry those feelings yourself and to worry that it means there is something wrong with you,” she says. “It’s extremely helpful to talk to other people about it.”


While you may be afraid to admit your hesitancy about medicine to proud parents and friends, a strong support system is key to making it through the challenges of medical school. Bollinger says he relied heavily on the encouragement and assistance of his wife and friends. “I really felt I had to turn to the people who knew me and whom I love and who care about me, too,” he says. And with this support, Bollinger is able to approach his second year with more clarity and focus.


And, yes, this further reinforces the fact that life outside of medicine is crucial to success. Carr says it’s important to return to your personal pursuits, the ones that gave you comfort and pleasure in the past. She often advises students to focus on their hobbies and interests outside of medicine, such as playing the piano or visiting an art gallery. A fresh perspective can often revitalize your attitude.


So if you’re experiencing similar uncertainties, you should feel reassured: Even though many students have doubts along the way, most realize that medicine can be a good career after all. In fact, the majority of medical students graduate and find productive careers. As Carr says, “Medicine offers a tremendous amount in terms of intellectual stimulation, people contact, humanity and science. It’s a wonderful blend of a lot of different abilities and talents.”


Bollinger’s sentiments seem to mirror that perception. As he sat under that tree, reflecting on his life, he realized there was nothing else he’d rather be doing. “I really couldn’t see a future that was as enriching or offered as much as medicine,” he says. So with new-found resolve, Bollinger picked himself up off the grass and forged ahead toward becoming a physician.
Monica Zangwill is a medical writer based in Newton, Massachusetts.