Wow. I am amazed by how many views and comments my entries on depression and burn out have received. I wasn't expecting it. I thank you from the bottom of my heart for reading my entries and recording your thoughts on here.
I'm writing posts like these a little more because it's been a hard year and also, because I've already seen people quit residency in different programs since I've started intern year.
Since I was a student, I've seen about 4 surgery residents switch into neurology or anesthesiology. I've seen one person quit pediatrics residency. There were 4 suicides of medical students when I was a medical student. I know of a resident who switched from a surgical specialty into something else, then quit that residency.
It's a scary pattern that you start noticing in your training, but as a student you just are so naive and optimistic, and you continue your training.
I'm writing this post partially exorcise my own demons but also let people know they're not alone.
So why do these ultra-intelligent, super-hardworking people burn out, quit, or commit suicide?
1. The hierarchy.
Great! You're a doctor! Everyone respects you now!
Yea, right..You're new, know so little medicine compared to your bosses, you don't know the system and are constantly asking questions or being corrected and nurses think to themselves if you really know what you're doing.
Your upper level will push all the work they don't want to do on you. Your fellow might laugh at your assessment and plan. Your attending will call you out in front of your team and patients for not knowing some mechanism or bit of medical knowledge not relevant to patient care.
The more senior members of the team will either be really hands-off and let you make mistakes and then yell at you (Even though they should be supervising you), or micromanage you and make you think you're not good enough to do patient care.
2. The hours.
Get ready for irregular hours and being treated like an underappreciated factory worker tasked with unrealistic expectations of endurance. We're talking 30+ hours of constantly being awake and working, probably 5+ times a month, every month, until you graduate. For some people, that's 6+ years. There are work hour "limits" but you're going to lie on your duty hours because your program can't save you from the ACGME (governing board for American residencies in a way, they accredit programs). Get used to being cheap labor and being exploited, basically.
3. Emergencies.
So many emergencies. When you'd least expect them. You'll get better at managing them, but many times that one patient who was almost going home develops a pneumonia, PE, a ridiculously resistant infection and only gets worse...
4. Being told what to do by people who aren't doctors.
Frustrating. Being told family members of patients what to do or what not to do when they don't have a medical degree (especially this happens in pediatrics). Care managers, etc, everyone has an opinion and they don't respect how hard you've worked and what you know.
I can't tell you how much agony I've gone through when patients with aggressive stage 4 metastatic cancer who also have cirrhosis and an EF of 15% and ESRD tell me they want to be full code and I have to do "everything" for them despite me telling them all their organs are failing and it might be slightly more dignified and comfortable to go to hospice and have a better quality of life with their family. I just do what they say because its law and we end up breaking ribs during CPR which causes a pneumothorax and they end up intubated and get a chest tube and die sedated on a ventilator surrounded by family they don't even know are there. Day in, day out, one patient and the next.
5. Difficult co-workers.
I wish I had a dime every time a consultant was rude to me over the phone, or even the primary team. Everyone is just oh so busy and important and complete royalty and forget they're getting paid to do their work and see the completely reasonable consult you ask for. I've never gotten over it. I've known so many specialists who think you're some kind of mentally incompetent fool for consulting them. Absolutely terrible.
6. People don't respect each other.
I saw this on a Humans of New York post and I absolutely agree. It might not just be stress your fellow doctors are affected by, many have terrible personalities by default. I thought that medicine would be a world where everyone is nice to each other and helps their fellow man out, but there's so much competition and just blatant disrespect. A lot of doctors talk about each other behind their backs. It's ugly.
7. Being owned by big pharma and also being told to cut costs. Being ruled by the ignorant.
I've worked in hospital systems where they ran out of enough money for generic chemo drugs. I've seen this totally non-superior drug get constantly prescribed by other doctors "because reasons," essentially. I've been depressed that I can't prescribe this one great drug or that this patient can't get this therapy because it's way too expensive. I hate having to argue with an insurance company about a CT scan my patient needs because they have cancer and need to get re-staged.
So what can you do?
Ask people how their day is. Ask if they need any help admitting this new patient or with orders. Stay later with them and help them. Build comraderie. Bring in food, buy lunch for your team, do kind deeds. Go have drinks with the team. So many people in medicine are too proud to say they're unhappy or that they're struggling. People who say they enjoy notoriously terrible rotations likely are showing you their coping mechanism.
Residency especially is a long, dark, uncomfortable voyage through a tunnel that insulates you from the outside world and sunlight. Many people won't be able to handle it well.
More entries on this to come
No comments:
Post a Comment