Studying medicine affected my mental health—here’s what I learnt
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3664 (Published 21 September 2020) Cite this as: BMJ 2020;370:m3664
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Dear Editor,
The account of depression and burnout and the underpinning mindset that perpetuated it, is very enlightening. It is also brave for Dr Perry Crofts to say it as it is. Many students and doctors and nurses feel the same. They are caught in a trap and are insightless as to what is happening to them. The medical system, the pressures to achieve and perform, and the adulation of people who think "he or she is great" are a web of drivers that force the person to progress more and more into a state of desperation and illness. The points Dr Crofts makes about duty of care and responsibility of mentors and trusts and medical schools are crucial. Medical students and young doctors are vulnerable altruistic people exposed to the powerful pressures of the health machine. The morbidity and mortality figures for doctors and nurses is way higher than matched peers, and this should be a fundamental teaching point for anyone starting out in a medical career.
We talk about care for the carers, but have a blind spot about our very selves. It should be compulsive for all entering medicine and nursing to pass a module in self care and renew it every year or so. This article should be read by medical students and doctors and nurses and those whose responsibility it is to care for them - is anyone responsible for caring for the medical and nursing carers?
Competing interests: The last talk I gave to new interns was exactly on this topic.
Dear Editor,
Right from the very start, even before medical school, we are told studying medicine is incredibly competitive, and this is constantly reinforced with family and friends reminding us how competitive it is (albeit with a sense of pride if we are lucky enough to be enrolled in a medical school, as Crofts rightly mentions). However, this competitive nature only seems to get worse throughout your time at medical school. As a final year medical student, I am currently in the process of thinking about my application to the foundation programme, a system that is entirely based on our competitive nature with one another. If you want to give yourself the best chance of working in the deanery and trust of your choice, you need to outperform your peers. It is only by consistently “beating” my friends and peers throughout medical school as well as performing better than every other medical student in the county in my situational judgement test, that I will obtain a foundation post where I want. This constant comparison to others, as mentioned by Crofts, is what can lead to many medical students struggling with their mental health.
There are countless stories of students in medical school trying to get one up on each other, and to any medical students reading this, they will know exactly what I mean. The student who tells you the wrong time or location for a teaching session, the student who does not share excellent resources in order to get ahead, the student who will not tell others about extra teaching sessions, we have all come across them. It saddens me to think that medical school fosters behaviours like this and that instead of doing everything we can to help each other, our inherent competitive natures can get the better of us. One study has even suggested that competition and the associated stress can lead to substance misuse in medical students. (1) De Bruyn et al highlighted that the more students perceive medical school as competitive, the more stress this caused and the greater the likelihood of substance misuse.(1) This cannot, and should not be, the future of medical school.
I was saddened to read of Crofts’ experiences of medical school, a time that should be filled with happy memories made with friends and not with the memories of the negative impact it had on their mental health. But this experience is becoming all the more common and I hope that we can reach a point, as students, where we become more supportive with each other and put the competition to one side. We all need to think about the consequences of our actions on other medical students. We are in a prime position to empathise with the struggles of medical school and the stresses of being a doctor and we must use this support each other. I would like to thank Crofts for sharing their story, highlighting the importance of talking about these issues, openly and honestly. I would encourage every single medical student and doctor to do so, only then can we begin to tackle these issues and create a healthcare workforce comfortable with talking about their own mental health.
References
1. De Bruyn S, Wouters E, Ponnet K, Van Hal G. Popping smart pills in medical school: Are competition and stress associated with the misuse of prescription stimulants among students? Subst Use Misuse. 2019;54(7):1191-202.
Competing interests: No competing interests
Re: Studying medicine affected my mental health—here’s what I learnt
Dear Editor
The Rapid Responses are as troubling as the article. Here we are in 2020 still putting bright young brainminds through the ringer of medical training and then the pig-pens of competition against each other. The rates of mental and stress-related ilness are throughly documented and report follows report on the vital importance of wellbeing and, at worst, the prevention of suicides
So, here's a few questions:
- What specifically is each medical school doing to address the issues raised by Perry Crofts and the Rapid Responders?
- What specifically and likewise are the GMC, Medical Royal Colleges (and Academy of), HEE and relevant alia doing?
- What is being to done to design curricula and learning that assist future doctors to self-care and care for each other far more effectively? This would also align to dumping physical-mental dualism in the curricula and helping furture doctors to appreciate that they are 'wired' in exactly the same way s the patients they are going to encounter.
- What is available in the public and research domains that would help researchers and health leaders to get an evidence-informed and continuing (especially longitudinal) research grip on the experiences and 'fates' of students from all UK medical schools?
As Professor Sir Michael Marmot has it: "Medicine is failed prevention" (https://overloadbook.wordpress.com/2014/07/14/medicine-is-failed-prevent...).
We could now add that stressed and burning-out medical students are "equally failed".
Yours
Dr Chris Manning MRCGP
Competing interests: No competing interests