As a medical student, I have encountered more emotional and psychological pain as a direct result of my training than I could have previously anticipated. My pain may not be physical (though sometimes it is secondary to sleep deprivation), but it is real. I look around me and am reminded of who I do not want to be, and the kind of person I would dread becoming. At first, I thought this was a result of primarily surgical rotations, where the focus is not patient interaction. I figured this was why I was experiencing such disconnect within myself.
But now, as I finish a month of inpatient pediatrics, I see that the hurt has not gone anywhere. Daily, I watch health care providers treat one another with passive aggression, distain, and frustration. I watch resident physicians consistently complain about patients, families, and nursing alike, filling the workroom with such a heavy fog of negativity that it becomes impossible to see. Repeatedly throughout the day, I excuse myself from the workroom — to check on patients, to go to the bathroom, to fill my water bottle for the twentieth time that day — to refocus my attention on the actual patients and escape the negativity.
I have watched as my resident has spoken about children with psychiatric diagnoses with judgment and resentment, stating “there is nothing to do for those kids anyway.” I have watched her mock me for choosing to spend time with children with psychiatric diagnoses, implying that it’s a poor investment of my time. Then, I have watched her complain about having to work with children with special needs, as if their needs are somehow an inconvenience to her. I have witnessed questionably unethical and unprofessional behavior on a fairly regular basis, knowing that if I were to speak out about this behavior (something I feel very comfortable doing in my personal life), my final grade may pay a price.
My heart is breaking. It is broken at the current cultural state of medicine, and at how I am treated, daily. I feel a sense of heaviness that wasn’t here prior to medical school, and trust me, the heaviness has absolutely nothing to do with patients or patient care. The heaviness does, however, affect my patient care. How can I provide my best patient care when I, too, am hurting? How can I fully listen to and support my patients when I am just trying to make it through the day without screaming or crying in frustration?
The heaviest part of it all is the loneliness. When I look around at my peers, their hearts don’t seem to be breaking the way mine is. I’m not sure if they don’t see some of these issues the way I do, if these issues do not bother them, or if they ignore them in order to cope. What I do know, however, is that my daily struggle is not because I’m “too sensitive.” Sensitivity is independent of human rights violations, unethical behavior, and unprofessionalism. The fact of the matter is that none of us should tolerate the behaviors and attitudes that are perpetuated from providers in medicine. If I’m being “too sensitive,” then we should all feel “too sensitive.” As medical professionals, it is our responsibility to take ownership for our profession, and policing our profession when necessary.
I’m not sure why it feels as though I’m the only one truly feeling these shortcomings daily, but I do know that I expected different and more when I entered medical school. I expected medical students, residents, and attendings alike to conduct themselves ethically. I expected providers to treat each other with compassion and understanding. I expected providers to, likewise, treat their patients with compassion and understanding, providing emotional support when necessary. I certainly expected them to respect patients, and not dismiss patients because of a psychiatric diagnosis or special needs.
Sometimes, I’m beyond angry at the things I witness daily while on the wards. I wonder why I’m having some of the experiences I am, and how they can possibly be used for good. I wonder how one person can possibly change a system and culture that continues to perpetuate itself? I wonder if the emotional pain of medical education and training will ever end, and if I will finally be able to have my work actually be about my patients?
For me, I know it eventually will be. I know that beyond the negativity, beyond the unethical behavior, beyond the abusive culture that is medical education and training, I will eventually be at a point where my work can be exclusively about my patients. I will spend my time investing in them while at work, and find fulfillment and joy. I will daily be reminded of why I decided to pursue medicine in the first place.
Until then, in the midst of my hurt, I’m grateful that I’m feeling these experiences the way I am. In fact, I sympathize with my peers and superiors who are simply suppressing all their experiences, who are choosing to remain silent in speaking out against unethical behavior. At the end of the day, I cannot fully control the culture of medicine; I can, however, choose how I respond and conduct myself in light of it. I can take the emotional pain and suffering I’m enduring now and use it to help my patients later. I can be grateful that I am seeing the system for what it is, for in order to mend what is broken, there must first be light shed on the cracks. I am grateful that light is being shed on these issues for me, and that I will have an opportunity to address them in medical school and beyond. Although it sometimes feels like a task much larger than what I could possibly accomplish, I know it is my ethical to help change the culture of medicine and medical education. I know that I cannot possibly sit back and remain uninvolved. For those in which much has been given, so, too much is expected.
The author is an anonymous medical student.
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