Med school is tough not because of time management and long hours. For me it was tough because I was always reminded of how I was being reduced to a number – score on an exam, an evaluation, a grade – that would potentially play a huge role in where I would end up for residency.

This is a huge problem even before getting into med school. We all say to ourselves “we need young docs who understand the importance of bedside manners, who communicate well, who have humanity.” And yet what we do is select for students who are motivated to nurture polished resumes and high test scores. And in med school, the struggle to be perfect, top of the class, even intensifies. I don’t know how this translates into patient care skills. I doubt it does.

First, to the med student who thinks time management and exercise are the answer. You are overlooking what is at the core of depression. Feelings of guilt, hopelessness, worthlessness…while exercise and good sleep can give you a nice little burst of endorphins and make it easier to cope with these feelings, the feelings of low self-esteem don’t just go away. You’ll learn that a hallmark of depression is difficulty sleeping, especially staying asleep. It’s a vicious cycle. I hope you don’t experience it. But hopefully, you will change your attitude about depression and not see it as “the patient just isn’t exercising and sleeping”. Now, on the other hand…patients need to take an active role in their care (just like any chronic disease) and start doing all the things you mentioned. They do help.

Second, stop punishing doctors for seeking help. Again, we must be perfect, right? Every time I have to fill out an application for credentials, licensure, etc. they want to know if I have seen a psychiatrist. I also broke my ankle and had surgery but no one asks about that. Am I somehow flawed? And yet, still no one has questioned my competence or character…so stop asking abdout my antidepressant. Let me have my privacy. It discourages us from seeking help.

Third, my opinion on where depression (probably adjustment disorder with depressed mood) comes from with physicians. We are used to making people happy and proud. We are used to doing well. We have learned to derive our happiness from making other people happy. As physicians, you can’t make everyone happy. And some days, you can’t make anyone happy. Patients aren’t happy with you (you took too long, you didn’t explain things well enough, you didn’t listen to everything they said, you were running late), patients’ families aren’t happy with you, nurses are frustrated with you, consultants don’t want to see your patient or treat you like you’re stupid, admin isn’t happy with you because you forgot to document the severity of malnutrition…..and the list goes on and on and on. Sometimes none of these things happen, sometimes they all happen on the same day. Hopefully you have enough self-esteem to know that you are doing your best and that is all you can do. Until you get sued, then you should have done better…

- From a doctor with depression

But did Cope go by the wayside for abdominal pain, or did I just get a unique set of medical students.

I mean the original book goes back to the 1920′s, but it’s been updated frequently, and the basics remain unchanged.

The only reason I asked. In private practice now, don’t see med students that often.

A couple years ago, I mentioned the book to some senior med students and got a blank look. They’d never heard of it. Not sure if that was a function of a particular group of med students, or if the book has gone by the wayside.

Even with decades of revisions and more technology that needs to be covered, the book is fairly small and tells you what you need, at least for the belly.

Second year was a breeze.

Or adjustment disorder with depressed mood?

As a current second year, I don’t think that the stress is the long hours of studying. You’ll find out very quickly that medical school is only crammable if you are that special, rare breed that can swallow half a textbook in three days. There will be someone in your class that can do this. You should ignore them; that’s not a solution for the rest of us.

I think it has more to do with all the responsibility that suddenly drops on your head in 2nd year. The boards are months away. My standardized patient physical diagnosis exam is next month. In the meantime, I’m studying for next week’s exam. I came back from the hospital today with the growing realization that while I know all the motions of a physical exam, I know nothing about its practical applications to diagnosis — and starting in July, will be expected to have mastered that ability. And passed the boards. And presumably started lining up a specialty. And my loans are piling up. And my friends from college are all making decent salaries, and discussing kids, and live in real apartments.

We all feel poor, and pressured, and we’re starting to have the you-will-kill-people-if-you-do-not-memorize-this-by-tomorrow meme thrown at us hard. It has a counterpart, the everything-but-perfection-is-a-huge-malpractice-suit. A newer one is the doctors-are-evil-and-make-too-much-money meme (I call it the NYTimes Well Blog symptom). None of these make us feel good.

That’s where I think the depression comes from. I don’t think it’s time management.

FWIW, I sleep eight hours a night, study 2-4 hours a day outside of class, exercise 5 days a week and have mandatory dinner with my husband. My depression, oddly enough, was first year.

…at least I hope I’m right.