On becoming a physician

JAMA this week is a semi-theme issue on the evils of medical education. Most of it is behind the paywall but they are letting you read this on the high rate of depressive symptoms among physicians in training.

It isn't really surprising. I've had a couple of friends go through it and, first of all, the all consuming demands on medical students and residents lead to a lot of breakups with spouses and partners. Second, there are those all consuming demands themselves. And, perhaps most important, there is the unprecedented encounter with suffering and loss. All day and night you're working with sick and dying people, and watching them die, and telling them they will die, and seeing their loved ones suffer, and sometimes you think you screwed up and it's your fault and sometimes you really did screw up.

On top of that, as the issue also recounts, there is still a tendency for preceptors to be abusive and to humiliate trainees. It's just very hard to root that out of the culture.

The huge challenge for physicians is to compartmentalize -- to really be compassionate and empathic when dealing with patients and families, to really care, and then to leave it behind, at least enough to live with yourself and have a happy life. Not everyone can do this. Physicians sometimes burn out, and in addition to depression, they are at risk for addiction (the drugs are right there) and suicide. Yeah, they make the big bucks, or at least bigger than most. (Less so primary care doctors, who also work very hard.) And its no excuse for misbehavior or mistreatment of patients.

But it's not an easy job. Never forget that.