Sanjay Gupta. John Locke. Jill Stein. Charles Krauthammer. What do they all have in common?
If you guessed that they are all physicians, then you’re right.
Less salient, however, is the fact that all of them pursued passions outside of medicine. (Dr. Gupta is an Emmy Award-winning medical reporter. John Locke was a physician-philosopher. Stein and Krauthammer both made their mark in politics.) In doing so, they avoided an existential trap that many of us in the medical community, including medical students, residents and seasoned physicians, unfortunately, fall into. That is, they did not let their profession as physicians define their entire personhood. They allowed themselves to be more than just their title.
I’m a first-year medical student. A “non-trad” like many of my peers, I didn’t go straight to medical school after college. In the years after receiving my bachelor’s degree in 2014, I taught high school science in the South Bronx, earned a master’s degree in education, co-founded a stroke wellness startup and designed e-learning solutions for a major health care system in the Washington, DC region. During those four years, I witnessed the inequities in our public education system, discovered the power of meditation, got bitten by the entrepreneurial bug, published my writing and launched (unsuccessfully) two Kickstarter campaigns.
When I entered medical school, I knew what I signed up for. After all, I had many friends forewarn me about it, and I’ve read multiple Reddit threads on med school life the summer prior to matriculating. And they weren’t kidding. It didn’t take long before I would subject myself to hours upon hours of studying while internalizing imposter syndrome and lugubriously commiserating with distressed classmates. Elevated levels of cortisol, bouts of sleep deprivation and information overload, which can be best described as drinking from a firehose, were all but inevitable. After our first exam, just three weeks into the school year, it became apparent that our self-worth for the next few years would be tethered to the number of questions we get right on a three-hour exam that we take every couple of weeks.
Our identities would gradually fall by the wayside. In lieu of passion projects, hobbies, a healthy social life, and unbridled introspection, I would now be chasing after good marks on exams, lest I feel unworthy and undeserving. In this trek to become healers of the human body, my classmates and I would unknowingly chip away at aspects of our personhood that do not fit the schema of the idealized physician the medical community wants us to embody. Creativity, extraversion, discomfort, uncertainty, vulnerability — all of those are to be avoided and not embraced. Why would they be if our health care system doesn’t foster a culture that acknowledges such things constructively and empathetically?
I’m fortunate to be at a medical school where we are taught a variety of topics and skills that would, in theory, make us well-rounded physicians, ready to tackle health care issues of the 21st century. To name a few, we have comprehensive lectures on race in medicine, LGBTQIA health and self-care. During our first week of school, we were even trained to improve our listening skills using mindfulness techniques. However, many medical schools still lag in this aspect of medical education. And while a handful of medical schools, like my own, are paving the way for a more holistic, socially-conscious, and interdisciplinary medical education, the health care system as a whole still has a lot to catch up on.
In her book In Shock: My Journey From Death to Recovery and the Redemptive Power of Hope, Dr. Rana Awdish highlights the problematic culture of medicine. “To do what needed to be done, we believed we had to be superhuman,” she writes. “And there was sadly an implied superiority in those achievements. Doctors, we believed, were just different.” The perception that physicians are different from the other members of society pervades the minds of many. I remember having a debate with a friend, a medical resident, who insisted that doctors have the right to feel superior because, without them, society would not function. “What about social workers, teachers, policemen, and firefighters? I’m pretty sure society wouldn’t do so hot without them,” I retorted.
Don’t get me wrong. Doctors are indeed noble for what they do. Their work is undoubtedly physically intense and emotionally taxing. But the notion that they are “superhuman” and “different” from the rest of society is exactly the trap that we fall into the moment we don our white coats as medical students. It is because of this trap that we get tunnel vision and let mistakes during our medical school training define our self-worth. We forget that there is a world outside of our flashcards, PowerPoint slides, exams, and clerkships teeming with people, adventures, and stories that, if we so choose, we can enrich our lives with, intellectually, physically and spiritually.
There’s a reason depression, anxiety, and burnout is disproportionately higher among medical students and physicians. In fact, nearly 400 physicians commit suicide a year, the highest of any profession. Might it be because we are anchored to one thing and one thing only? Those of us who pursue medicine have built our entire personhood around the goal of becoming a doctor. If that is all that is meaningful to us, should we really be surprised at the statistics on mental health?
I would say though that I am cautiously optimistic about the future. Medical schools nationwide are increasingly emphasizing student well-being and interdisciplinary learning. For example, many schools are now pass/fail during the preclinical years. Some take it a step further like the Cleveland Clinic Lerner College of Medicine and Yale School of Medicine, where medical students do not get grades during the first two years and can take exams anonymously. At these schools, they are encouraged to take on intellectual pursuits and scholarly work of their own choosing. Even hospitals have changed their work hours by adding caps to alleviate the high workload of medical residents.
So maybe the tide is turning. Maybe it’s not quixotic of me to imagine a culture of medicine that embraces, not shuns, humanness. A culture that allows doctors and medical students like myself to be more than just their title so that we can define medicine — not the other way around.
King Pascual is a medical student.
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