Rites of passage of a medical careerBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6987.1144 (Published 29 April 1995) Cite this as: BMJ 1995;310:1144
This is being written on a Saturday night while on call. I have just walked down from the doctors' residence on the other side of the hospital. I first stopped by the other two wards I am covering this weekend; all was quiet, so far at least. The hospital is sprawled out over a large field and the corridors run like a rabbits' warren. By now all the visitors have gone home and the corridors are dark and empty. I remember, as a medical student, being filled with a sense of excitement walking down hospital corridors in the dead of night; it felt special being somewhere where no one should normally be. Now I just feel lonely. My registrar is at home, contactable by telephone. On the ward the nurses are chatting outside; I guess I could join them but I'm not very extrovert, at least not any more.
My social life has plummeted since starting work. You are either on duty on a weekday or weekend night or you are too tired to go out. I am afraid the situation will get worse. I have just moved to a new city and hospital and I hardly know anybody. I hoped that I could socialise with the other new senior house officers but my new job means that I am the only one on this unit and the daily workload is such that I rarely leave the unit to get to the doctors' mess or canteen. What makes things worse is that I shall have to start studying for a postgraduate examination. I dread having to return home after work to textbooks.
I was quite busy this morning and afternoon but things have calmed down this evening. It is either mundane tasks or pure boredom. I really do resent being on call. Why should it be that a young adult should have to work this way to become a doctor? What is so character building about all of this? I remember a unit manager negotiating working conditions with me last year. I complained that I was working more weekends than I was contracted to. She said that my workload during the weekends was not very busy and I was able to leave the hospital at 7 o'clock at night anyway. Can't she understand how a whole two days is wasted by a weekend on call? I remember another manager saying that she was on call one in three. Yes, but what does she do on call? Pick up the telephone from time to time at home and ask the on call registrar to do a discharge round because more beds are needed. What I resent most is that I will be doing this for at least another two or three years of my life. I got really depressed when I talked to a friend of my girlfriend and found out what she was paid as a lawyer. Where does it say that you can train to be a good doctor only by working long hours with abysmal pay and working conditions? The bosses say, “Well in my day.…” But just because they had it rough, does it mean everybody else must too?
The job has really changed me. Before I started my house jobs I had great plans for an academic career. I had done pretty well in medical school and people would say that mine was a name to watch for in the future. Yet 12 months later I am unsure whether I want such a career. I don't even know whether I really want to continue in medicine, the way things are going now. Perhaps I am burnt out. Perhaps I am clinically depressed. But it is so hard finding someone to talk to. You cannot approach your bosses as you do not want to seem weak. I have no close friends to turn to. My girlfriend is just starting her house jobs and she is stressed enough without me offloading my problems on to her. I find it difficult talking to my parents about my problems and my brother is on the other side of the world.
If I did quit medicine I would not know what to do. I have devoted so much of my life to this profession. At one point I even wondered whether taking my own life would be easier. I am feeling tired so most of this is probably senseless rambling. I may feel better tomorrow but it scares me that I am thinking this way now. Does everybody go through a stage like this in a medical career? I still have tomorrow's on call to contend with. I hope that I don't feel this bad tomorrow.
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This is presented as it was written—all at once, on a ward computer, to help vent frustrations. I did, thankfully, feel better the next night. And I am now more settled at work and socially. Yet, some of the above emotions and thoughts do often return, especially on a busy night on call. From talking to senior colleagues and after a further five months of clinical experience, I now realise that many doctors have gone through similar periods. I am not saying that this is right or healthy. But perhaps those who think that similar feelings will not make them good doctors and those who think that they are suffering alone will not think so.