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Being a medical student or a doctor is a furiously busy, sometimes overwhelming task. Yet, however alone some of us may feel, it is never an endeavour that we undertake on our own. Several students and doctors have shared their views and stories on mental health, to remind us all, that when we are feeling down, or alone, we will always have people with the same experiences, and people to look out to for support. All you have to do is ask.
It is also there to remind us all: students, doctors, academic staff, heads of medical schools, to support each other in whatever way we can. It is thirdly a call to action, to all medical schools and trusts to make sure that the support and education needed to understand mental health is there for all students, doctors and staff.
If you wish to share your story, and/or feel passionate about the issues and wish to share your view, then please e-mail: [email protected]
“Sometimes what it takes is for you to step back and just try to look at the bigger picture”
Lisa, FY1, London
My third year of medical school was a particularly tough time for me. The year started off with personal issues and bereavement that meant the beginning of my first clinical year had gotten off to a horrible start. Add in the fact that it was the first year I was properly on the wards, plus it was the longest academic year (we only had a brief summer break before restarting fourth year), and you can see why it was a matter of when I was going to crash and burn, not if.
I had enough self awareness to know that I was not myself throughout most of my first placement of third year. I sought help from the student counsellor and talked through a lot of my problems, but whilst it was useful, I still wasn't quite myself. I knew deep down I probably had depression but I had no motivation to do anything about it. I went through waves of being okay and not being okay, and if wasn't for my amazing support network (something I am so, so lucky to have) I could've spiralled down a dark rabbit hole. I managed through sheer will to get through the rest of my third year, passed without problems and surprised myself at how well I did. However, it wasn't without working really damn hard and pushing myself to do it. As a result, by the time fourth year rolled around, I was burnt out.
Everyone in the years above me kept telling me how fourth year was notoriously difficult. You rotate through a hundred specialities a minute and have to stay on top of things to pass exams. My first placement in trauma and emergency medicine did not help. I hated it, and I started to hate medical school. I dreaded going to placement everyday, I dreaded being on the wards. Every morning was a struggle and there were days where I just couldn't get up. I became cynical about it all and was looking for a way out. I started googling "dropping out of medical school" and "alternative careers with medical degree". I went so far as to getting myself a job interview at a medical communications company and actually got offered the position of junior medical writer. Then came the decision whether to take it. I deliberated for over a month. I talked and cried and talked some more with those around me. I knew I didn't want to do medicine right at that moment but most of the medics around me (both peers and seniors) were telling me to just push through and at least finish my degree.
In the end, it was my partner who was a non-medic that nudged me to have a conversation with my university about taking some time off. I think he could see medical school was crushing me slowly and knew it would do me the world of good to take a break. Uni was super understanding and allowed me to take the rest of the year out and come back the following September, if I wanted to. So I took the job and felt like a weight had lifted off my shoulders. I felt free and so much happier in my 9-5 office job than I ever did at medical school (probably because I got an all expenses paid trip to a conference in New Orleans - not something the NHS tend to give out..) I ended up working as a medical writer for nine months and gained a completely different type of work/life experience. I came back the following September with a whole new mindset towards medicine - I still didn't love it, but I knew that if I didn't practice as a doctor after qualifying, it wasn't the end of the world. Fourth and final year flew by and I passed all my exams without issues. I recently got confirmation of my MBBS and am due to start F1 in a month's time.
The point of this very long story (sorry!) is this: sometimes what it takes is for you to step back and just try to look at the bigger picture. My story is probably more relatable to medical students but my point could apply to anyone. It's so easy to get stuck in the pressures and stress of medical school/work. Sometimes what it takes is time away or just a little distance to see things clearer. Don't be afraid (like I was) to seek help sooner, to ask for some time off - there's no harm in asking! Utilise your support network - don't ever feel like you are burdening them with your problems because if they truly want to help you, they will always listen.
“Sharing [your] own ‘shame’ story is one of the most powerful ways to truly connect with others"
Karyn Joss, Medical Student, Edinburgh
For me, it began during the second semester of my third year at medical school. Soon after starting back after Christmas, I had come to realise that everything had begun to seem a bit darker - a lot darker, in fact.
Concerned that what I was experiencing might be depression, I sought help from my local GP. He was wonderfully supportive; however, he had to explain that my university could only offer me a maximum of four counselling appointments, and that accessing NHS-funded support would involve a substantial wait. Thus, weighing up my options, I made the decision to start on antidepressant medication.
In the beginning, I sadly found that my SSRI prescription came with its own challenges, in the form of rather unpleasant side-effects. Put simply, I felt blank, and was therefore faced with the choice of weighing up darkness and blankness, and which might make it easier for me to study. Furthermore, the experience of submitting an extension request for my coursework in some ways felt more like a criminal record background check, rather than any form of reassurance. Thus, at times it felt that in trying to take responsibility for my illness, I was being met with a series of closed doors.
Before sharing my experience of depression with the delegates of the 2018 BMA ARM, I distinctly remember the voice in the back of my mind still questioning whether, by speaking up, I was making ‘too big a deal’ out of this? That, by sharing my story, it would come across as attention seeking, selfish or unprofessional. Walking across the stage, in many ways it felt as if the stakes had never been higher and that I might be about to single-handedly sabotage my career before it had even begun. Since speaking to many of my peers following my ARM speech, I know for a fact that these crippling fears are shared by many and form a large barrier to others speaking out and asking for help.
The thing that cemented the necessity of speaking up in my own mind was a reminder of what was at stake. We as physicians, in either training or practice, are very accustomed to discussing risk and, in the case of mental illness, the statistics speak for themselves. Every year, the lives of students are tragically being lost to mental illness - lives which had the capacity to be incredible doctors of the future.
It is my feeling that, although we have taken large steps towards acknowledging the negative effects of the social stigma that still surrounds mental illness, we have yet to truly appreciate the impact of that which is perhaps the most insidious aspect of mental illness – the impact of self-stigma. In my experience, this refers to my previously-held personal belief that in being unable to ‘fix’ myself, I would never be able to help future patients. Thus, it is my concern that the way in which we sometimes discuss or portray ‘professionalism’ within Medicine can in itself be damaging, leading to students feeling pressure to be ‘invincible’ in dealing with challenges that may arise in either a professional and personal capacity.
This seems especially saddening as, through speaking out about my depression, I have found that sharing my own ‘shame’ story is one of the most powerful ways to truly connect with others. It might sound entirely clichéd to say that taking ownership of our own shame is one of the best ways to comprehend our own true strength but, in my case, nothing could be more accurate. The experience of being a mental health patient and experiencing the isolation, fear, frustration and confusion that this entails I truly believe is one of the greatest lessons I will ever learn throughout my medical career.
This lesson in humility, trust and acceptance I feel is, in a sense, especially relevant for students of today, who are entering the NHS at a time where burn-out seems at an all-time high. My peers are all fiercely intelligent, conscientious, selfless, determined and compassionate, and these qualities will ensure that they make incredible doctors of the future. However, this is also a toxic combination with regard to self care. In this way, I believe that what students today lack is not resilience or skill; they lack the ability to say no. We’re working in a climate where for many young, ambitious people, ‘busy-ness’ is worn as a badge of honour and not a serious health risk.
This isn’t helped by the fact that much of ‘self care’ is still talked about as if it is intuitive or ‘common sense’. I strongly believe that more needs to be done to ensure that self-care education is embedded within the medical curriculum and is not simply regarded as a ‘tick-box’ exercise. I would put to you - what example are we setting for our patients, if we ourselves fail to properly value and nurture our own mental and physical wellbeing? It is also vital that more research is done to attempt to understand how the complex intersecting aspects of race, gender, sexuality and socioeconomic status influence mental wellbeing, and to explore future options for treatment and support.
Currently, it is the case that the level of support medical students receive is left to chance; of where you study and who you know. I would stress that the mental wellbeing of our future cohort of doctors is too important to be a lottery matter. I want to thank everyone for their wonderful support and for bravely adding their voices to this cause, and hope that this has set wheels in motion to ensure that there is a larger cultural change away from fear and judgment, in favour of openness and compassion.
“Mental health is a fact of life – stress, anxiety… that is a part of being human.”
Ryan Devlin, Medical Student, Edinburgh
There will be a message of hope in this. But 1st – Edinburgh, Newcastle, Oxford, Swansea, Bristol, Manchester. These are places where medical students have committed suicide these past 18 months. You only have to go back a few years to put every medical school on that list. This is not a generational issue, it is an institutional one.
Mental health is a fact of life – stress, anxiety, especially in this profession; that is a part of being human. But no-one should burnout and no-one should die from it.
Medical schools should appreciate this fact. We get stressed, we get anxious. So how do we deal with it? In a furiously busy profession, people can forget to look after their own mental wellbing, or even lack the knowledge – The knowledge to understand their mental health, to recognise when stress is getting to you, where to go for help, who to confide in, to appreciate that the world doesn’t end when you stop and take a breath.
This education needs to be a core part of the curriculum, a sustained programme from 1st to Final Year. Why from the very start? A 1st Year died at Edinburgh, who had it been anyone in my year, would have had just one lecture, barely 50 minutes on mental health stigma and nothing else. Concerning is an understatement.
So why is it that despite people losing their lives, those same medical schools have no serious concerns according to the GMC? The GMC’s requirements are archaic and negligent.
So do you want to give a message of hope today? We’ve said enough is enough, so act. Campaign for that vital part of the curriculum, make a holistic approach to mental health an explicit requirement, to make medical schools move quickly, act decisively, because to support the students, the juniors, the GPs, the consultants, and beyond in this room and out actions speak louder than words and save far more lives.
“Having difficulties doesn’t automatically mean that you are a failure or a bad doctor”
SHO from the BMA Junior Doctors Committee
For much of my adult life I have suffered from low mood. Including some suicidal ideation and some consciously and intentionally self destructive behaviours. It has gradually worsened since I started medical school, and then worsened again since I became more involved in the BMA. I attribute a large chunk of this to the fact that I, like many medical students and doctors, was high flying at school. This resulted in a large part of my self worth being dependent on me being successful.
However, when I went to medical school this dramatically changed and I went from bouncing along the top, to bouncing along the bottom. I think this was partially because I was now surrounded by a cohort that was academically high flying, but also because I hadn’t had to put that much effort into being one of the best at school and so had never learned how to work effectively. I ended up just accepting that I would scrape through as I couldn’t see a way to rise up from the bottom. This became a vicious cycle; because my self worth was linked to success, I was scared of giving my all because then, if I still failed, I wouldn’t be able to deal with it (where as if I only half tried, and failed, I could justify to myself that it was because I didn’t try, rather than because it was actually beyond me). Because I wasn’t trying I inevitably failed, which damaged myself worth further and so made me even more scared of risking trying and failing.
This cycle continued after I graduated with occasional improvements when I found something that I could excel at, only to be set back when I encountered something that I struggled with (or I felt that I was achieving at something, but it wasn’t being recognised by my peers and seniors). I feel that another problem is that the impression is given that everyone else is managing fine, and so I felt like a failure and all alone in being a trainee in difficulty. Recently I have been more open about how I have been feeling, and I have discovered that actually MANY trainees are struggling in various ways, so having difficulties doesn’t automatically mean that you are a failure and a bad doctor.
My mental health took another set back when I became more involved with the BMA. I think that part of this is a similar problem to before; as I have always been good at political organising, I struggled and felt intimidated being put in an environment where there were many excellent organisers. Also, I have previously taken more of a leadership role and so been able to go off and do my own thing and not had to justify what I was doing to my peers; they have just accepted that what I was doing was the right thing. This has not been the case in the BMA, and I have felt quite alienated from my regional colleagues over the past year. I think the other problem is that it seems that MANY of my BMA colleagues also struggle with various mental health issues. Therefore we are not always as gentle with each other as we could be, as we all have our own problems to deal with. My feeling is that there is a higher incidence of mental health problems among BMA reps than among the general medical population (at least at a junior level). I am unsure whether this is just my perception, or whether it is a genuine phenomenon. Assuming it is a genuine phenomenon, I don’t know whether it is because people with issues self select for being interested in BMA activity, or whether it is something that we as an association are doing to our reps.
Although my time in medicine has not been a happy one, I feel that things are improving. Over the past few months I have been attending private counselling. I initially went at the insistence of my partner, and didn’t have much faith that it would help (as I felt that I already had insight into my problems). However, I have been surprised and have found this helpful. It is true that I do have session where the counsellor tells me nothing that I have not already worked out for myself, and there have been periods where I have considered stopping due to it not offering me anything new. However, I have continued as the counsellor does sometimes offer insights that I have not thought of, and these insights have had a dramatic positive impact on how I think about and approach problems in my life. Although my mental health is still not perfect, I am still a trainee in difficulty, I still feel that I could be a better BMA rep and I still have periods of suicidal ideation; I feel that a combination of the counselling, the realisation that there are many more people struggling than just you, and honest support from some of my fellow BMA reps has helped me at least start to head in the right direction.
“Mental health affects all areas of a medical student’s life”
Lekaashree Rambab, Medical Student, Edinburgh
Historically, medicine has been a discipline where mentorship between seniors and juniors play a crucial role during training and beyond.
In medical school, tutors/mentors take different roles- you could have a personal, academic tutor or a clinical supervisor. Regardless of their assigned role, they also possess an inherent responsibility to role model in front of their students. They are- us medical students in 5 -10 years! And sometimes they are who we aspire to be.
But, do we want our medical students to become doctors who are too busy to pay attention to mental health?
The Scottish Medical Students Committee conducted a survey to analyse the effectiveness of student support systems across Scotland. Comprehensive surveys based on the one we did in Scotland are also going to be carried out in the other devoloved nations, with questions tailored to suit the specific local student support structures in these regions.
Mental health affects all areas of a medical student's life- it affects academic performance, attendance, personal and professional development. However, a majority of students who participated in the survey felt that they couldn't discuss mental health problems that affected their studies with personal/academic tutors who are often also the first point of contact in most Scottish medical schools for problems that are likely to affect their studies. And more often than not, it was because tutors themselves are too busy or students fear being seen as unfit to practise.
More than 60% of respondents stated that they had faced mental health issue while being in university, and only 20% of them received support for it- which is obviously a serious concern.
Students also voiced their concern regarding the lack of support during particular clinical placements such as palliative care and psychiatry.
According to a study conducted by Rotenstein and colleagues, 1 in 10 medical students experience suicidal thoughts. This is a nation-wide issue. We need mental health training for doctors who take up such mentorship roles, better support during clinical placements that are more likely to cause distress, and continue similar research in this area.
“I’ve become much more open about my history; it is a part of me”
Paediatric Trainee, London
I developed an eating disorder during my second year at medical school and was later diagnosed with depression during my training. I have always been aware of my weight and felt that being “the skinny one” was very much part of my identity. I gained a few kilos during my first year and became more aware of what I was eating. By the time I was half-way through my second year, I was cutting out whole food groups and significantly restricting my calorie intake. I lost weight, developed lanugo, and struggled to concentrate. Being a sensible person (ha!) with some insight I went to see my GP who was pretty dismissive; and sought help from my medical school who were sympathetic but unable to offer any concrete help. When I started clinical placements, I quickly realised that I couldn’t do a whole day on the wards and continue to restrict as much as I had been. I managed to eat enough to function throughout medical school – it wasn’t a solution or a cure, just a way of managing.
I stumbled along until the end of my SHO years. Things deteriorated very gradually and it was 12 – 18 months before I realised that I was restricting quite so much. I sought help from occupation health, my educational supervisors, and my GP – she referred me to the Eating Disorders unit, and I saw a consultant psychiatrist for three years as an outpatient. I started purging as a way of coping with eating. I was also diagnosed with depression and took fluoxetine (Prozac) for a few years. During this time, I kept working as an academic trainee and completed most of my PhD.
Things were OK for around 18 months, and then again deteriorated after a lot of challenging life events – including moving to a new city to continue my training. Occupational health provided me with psychology input but things just got worse and worse. Eventually, I was advised to take sick leave. My GP re-started me on fluoxetine and referred me to specialist help. I took 4 months off work to recover and went back to work less than full-time. I currently work 80% of a rota – effectively giving me a day off each week to regroup and analyse what I’m doing. I’m much more effective at work since doing this, and things feel like they’re back on track.
Impact on Life and Work My mental health has had a significant impact on my personal and work life. At times, I feel as though I’ve lost half my life to my eating disorder. My overwhelming memory of my second year at medical school is that I spent most of it curled up in bed, exhausted through lack of food and unable to sleep because my joints were pressed into the mattress. I’ve spent most of the past 17 years feeling cold. On a bad day, getting dressed is a major dilemma – there were times when it would take me four or five hours to get dressed because I was so scared that my clothes wouldn’t fit.
It’s not much fun living with an eating disorder – but it’s pretty rubbish for the people around you as well. It was a major factor in the end of one very long-term relationship. It’s incredibly isolating – social events that involve food can still be really difficult. I’ve cancelled dinners, nights out, birthday parties. I didn’t turn up to one friend’s wedding and spent two hours at another wedding hiding away in my room.
Meetings and conferences revolve around food – including a lot of the work I do for the BMA. The easiest thing is to escape at mealtimes – but a lot of the conversations and decisions continue during these times, and I risk being left out if I’m not there. Trying to stay well when I don’t feel that I have any control over what I’m eating is incredibly tiring. I’ve had to accept that weeks with a lot of meetings are “danger zones”.
Support from Health Services I’ve had very varied experiences with health services. The response I had from my GP when I first presented as a medical student was so dismissive that I didn’t seek help again for another eight years. But when I’ve sought help since then, the response has been great.
I’ve been lucky in some ways – the input I received from the Eating Disorders service I was initially referred to was brilliant. But that service isn’t available everywhere. I’m still on a waiting list for specialist therapies in my current city – it took four months for my initial assessment to take place and I’ve been told it’s at least another six months to wait for treatment. I’ve had some sessions through the BMA and I’m filling the gap by paying for a private therapist – it’s expensive but it’s keeping me healthy. It’s a luxury that many others don’t have. We don’t expect patients with physical health problems to wait for months for an assessment for life-threatening conditions – but that’s what happens in mental health.
Support from Trainers I’ve also had a really varied response throughout my training. I’ve been told by one Training Programme Director that I should hide my diagnosis, not disclose it to my supervisors, and keep it hidden because it would affect how my competence was perceived. (I’ve chosen to ignore this advice! It’s not exactly a professional approach…)
My medical school were supportive – but didn’t really follow-up. I think that because I managed to get through exams and placements and an intercalated degree, it looked as though I was better. My current post is fantastic – I’ve had amazing support at a LETB level from the Head of School, and at a local level from my consultants and educational supervisor. I feel that we share the same goal – to keep me working to the best of my ability while maintaining my mental health. It feels very much like a partnership approach – they’ve really listened to what’s important to me and recognise that I know what keeps me well.
Things I Wish I’d Known There’s a lot of stigma and fear amongst the medical profession about mental illness. I’ve always been open about my history with educational supervisors: about half the time, I can see the panic building in their eyes, and I end up reassuring them! I’ve had the same response from Occupational Health staff at times, and GPs… It’s not great when you’re the one asking for help.
Things are changing – but very slowly. We’re getting more comfortable talking about resilience and well-being and burnout – but not about depression, or bi-polar, or eating disorders. My experience is that healthcare professionals are less accepting of mental illness than the general public: it’s common to hear colleagues making dismissive comments when teenagers are admitted with mental health problems. I still hear medical students saying things like “the GMC won’t let you register if you have a diagnosis”. When I’ve made it clear that I have a mental illness, I’ve had those same colleagues come to me in private and disclose either their own or a partner’s history. That fear affects how we care for patients and ourselves.
Looking back, that stigma affected both how I sought help and the response from professionals. I used to feel very resentful that I’d not had help when I asked for it initially and blamed myself for not being more demanding. But I don’t think that my GP wanted to label a second-year medical student with a diagnosis that he felt would affect their future career; my TPD didn’t want me to be seen as the “trainee with problems”.
I’ve become much more open about my history: it is a part of me, and it can affect how I work – so I need to make sure that my colleagues are aware. I’d do the same if it was a physical illness, so I don’t think I should hide a mental health one. It does change how people see me and how competent I am – but all I can do about that is prove them wrong!
“It is so much more acceptable now to disclose mental health difficulties as a doctor.”
Student in the Late 80s, London
I took a fairly determined overdose in the second term of medical school. I was seen by a trainee psychiatrist and I don't remember a diagnosis being discussed, or a plan or an offer to do with my parents. I certainly wasn't offered antidepressants. I was referred to occupational health, and was told in no uncertain terms that I had an 'inadequate personality' and would never be able to be a clinician. In retrospect I clearly had a depressive disorder, and have continued to have further episodes to this day.
During my house jobs, (now FY1) the occupational health consultant discussed many aspects of my case with the consultant supervising me, including their opinion of me, without my agreement. I just about managed a brief period of 1 in 2 on-call, long weekends on call and 100+ hour weeks.
I carried on studying, did an intercalated BSc in psychology and my 'prognosis' was changed to 'never going to be a consultant'. I weathered failing finals - a good thing for me in the long term, as I developed more expertise and confidence than I ever would have if I'd passed first time
During my house jobs (now FY1) the occupational health consultant discussed many aspects of my difficulties with the consultant supervising me, without my agreement. I just about managed on-call, including a period of 1 in 2, long weekends on call and 100+ hours.
I found my home in psychiatry, in which I had been interested from before medical school. I passed my membership first time. I'm now told I'm a very empathetic and effective consultant, and trainees are kind enough to say they value my supervision and teaching.
Recently I have had superb care and support from my GP and consultant psychiatrist. At the beginning of my career I think I was poorly served by the medical school and services generally. I strongly suspect that I was discriminated against trying to get an SpR number.
Overall I think mental health services are more humane and more effective, although more stretched than they have ever been. I am incredibly lucky to have mental health officer status enabling me to work part time soon, which will, I think be much better for my mental health. It is so much more acceptable now to disclose mental health difficulties as a doctor. I would like to thank Mike Shooter, , a past president of the Royal College of Psychiatrists, for his example in destigmatising mental health problems in doctors.
“You have to open up. You have to be vulnerable... Things get better.”
Chelcie, Junior Clinical Fellow A&E, North West
I am a very highly-strung person. Forever busy; a workaholic. I thrive on pressurized environments; never able to get any motivation to do anything productive unless there is a deadline looming. Working in A&E now, makes that trait a strength. I class myself as having a “stress problem” – in that I need it to function.
Unfortunately, there is a fine balance between the functional pressure I find myself under now, and the pressure becoming too much. During medical school, the pressure of many different aspects of my life, on top of finals fear, piled up to a level which I could not deal with. I started to suffer with panic attacks.
The potential threat of not achieving my dream of becoming a doctor was extremely scary for me. Becoming a doctor has been a huge part of my identity since… forever – it still is. I think I was five years old when I told my parents that’s what I wanted to be when I grew up (though of course you’re not allowed to actually admit that during the admissions process). If I was to fail, what would people think of me?
And that right there is the underlying root of my anxiety issues. I’ve never been formally diagnosed by my own doctor, but my own knowledge has helped me categorize my problem as a social anxiety.
I have always worried about what people think about me. Am I smart enough? Pretty enough? Athletic enough? Am I enough? I can link these feelings way back throughout my life but I had always masked them – be that with a sullen teenage attitude or the more effective binge drinking prior to nights out. I took fresher’s week far too seriously.
When I turned 21, I made a conscious effort regarding my student lifestyle. I’d put on a lot of weight; my self-esteem was at an all-time low and I decided the boozing had to stop. My body was getting healthier, but my mind was becoming more and more tangled up with thoughts about other people’s thoughts.
So, what did I do about it?
I started exercising properly again. A friend of mine (who is even more anxious than myself) introduced me to running. I cannot recommend this enough. It gave me time to think things over logically whilst getting a top-up of endorphins – setting targets for my running made me feel like the kind of person who can achieve anything.
Following on from running, I started practicing yoga once or twice a week. The philosophy of yoga and mindfulness is fantastic for anyone dealing with anxiety. I continue to partake in both activities, in addition to other forms of exercise. I prioritize this “me time”. I need it.
Sometimes exercise alone is not enough. During my finals exams, I was barely sleeping due to anxiety. The same friend recommended I go see student support services. I attended 3 hour-long sessions with the counsellor there. All I did was rant about everything going on in my head and it was such a release. Talking is the best medicine for anxiety in my opinion. I’ve never been back to a formal counsellor, but I’ve recommended it to people I know. I talk to my friends (many of whom deal with anxiety themselves), my parents, my brother and my partner.
Being aware of what causes my anxiety does not mean I do not like being around people. In fact, I love meeting new people and if you met me you would have no idea that I find the judgement of others so terrifying. I have not had a panic attack in years now and I class myself as healthy both mentally and physically, but there are still situations where I struggle with worry. However, I try and push through it; get out of my comfort zone and even put myself in situations where I feel uncomfortable. I recently joined a book club by myself and I am so proud that I joined a new group as an outsider. It’s scary and it’s taken me several years of deconstructing my fears and actively working on myself to get here, but I have.
My advice is nothing new, it is what any GP will tell any patient in the early stages of a mood disorder. I know my anxiety is not as debilitating as others, but it was (and still is) very real to me. The road to recovery from mental illness is not easy and unlike antibiotics for a chest infection, you have to work at getting better. You have to open up, you have to be vulnerable, you need to talk and articulate your thought processes so that you can differentiate between what is fact and what is feeling. It is not easy, but it is doable.
You will get better. Things get better.
“Don’t forget that we are humans too.”
As a graduate entry student, I had tried 3 times to get into medical school before finally getting a place. I was so motivated and ready for the hard work ahead. What I wasn’t prepared for was the effect the actual content of Medicine would have on me.
I have suffered from mental health problems since my parents split, and my official diagnosis is chronic dysthymia with pre-menstrual exacerbation.
As a result of my family problems, I’m very close to my mum and my gran. My gran has COPD and my mum drinks quite a lot of alcohol in the evenings. I myself also had health problems; slipped discs and chronic pain for many years.
So, sitting in a lecture theatre in my first term at medical school, a psychiatrist starts his lecture on chronic pain with “pain is all in your head” and goes on to say how the medication I was on at the time do nothing for pain... great! It’s hard enough being a young person in pain and on strong painkillers, but to be told by someone it was in my head and that the drugs were pointless really hit me hard.
1 month later, we have a lecture on COPD, where the consultant says “if you have COPD, it’s likely your fault because you smoked, you’ll get right sided heart failure and you’ll die”. The next time I visited gran I was so paranoid I kept looking at her for signs she was headed this way.
Some months after that we have a lecture entitled “how to destroy your liver” which was all about alcohol.... I worked out the number of units my mum drinks a week and according to the doctor stood at the front, she should have cirrhosis and not live past 50. I felt awful! Should I talk to mum? I’m not qualified to talk to mum. I’ve not succeeded before when it comes to encouraging her to get help. I couldn’t just shrug it off.
I understand I have to learn about these things for my future patients - it’s fundamental of course!! But I’m still a human. Maybe I am more sensitive because of my existing mental health problems. But I went on a downward spiral and ended up failing an end of year exam (I passed the resit).
I think people forget doctors are humans and that we or our brothers, sisters, sons, daughters and best friends might be sick. I tried to find some support for how I felt, I told someone what had been said in lectures but nothing came of it.
I felt guilty for being angry at the doctors who had come in and been so abrupt - I felt soft! I felt like I should toughen up! But this was my first year and I wasn’t ready for these types of comments.
My message to others is: If you’re giving a lecture to students, especially first or pre clinical years, don’t forget we are humans too. We have feelings and we have a body. Our family members have bodies. Our anatomy is the same and it can go wrong, just like your patients. We are your patients!
“We need to tell students and doctors that it’s okay to not be okay.”
Dan, GP trainee, studied in the South West
When I was in medical school I suffered with bouts of anxiety and low mood throughout. During my third year I began struggling academically and received two 'borderline' exam results in a row, but did manage to pull it back by the third exam. Around 3 weeks before the final exam of the year, in May, my paternal grandfather was admitted to hospital due to severe anaemia. I went home to see him and within a week he had been transferred to a community hospital for comfort care.
Alongside this, my maternal grandmother was slowly losing a long battle with metastatic breast cancer and so I also made time to see her. I went back to medical school having said, what I expected to be, my last goodbye to both of them. I sat my exam a few days after returning from Easter break.
The Saturday after my exam I was hit with a double whammy of bad news. My grandfather had passed away, and my girlfriend also received life-changing bad news. On the Monday I approached the local admin team at my medical school who were the ones to suggest that I take some time off to be with my girlfriend and our families. So we did that, taking time to be with our families and to also attend my grandfather's funeral. It all happened so suddenly that I did not give any thought to how the exam had gone. After returning to studying after the funeral I was contacted by the central admin office for my medical school and was asked to produce both a GP letter and a copy of the order of service as proof of why I had been off. My own GP described this policy as "f*****g ridiculous" but wrote the letter to ensure that I would not be penalised. And then I had to phone my parents to ask if they had kept a copy of the order of service. How do you ask your grieving father if he has a spare copy of the last link he has with his own father? The small piece of paper that represented his final chance to say goodbye? Well it's hard, but my father came through for me. He wanted to ensure that the medical school could make no accusations of falsifying a bereavement to get time off (believe me, it happens).
About a month after the funeral, my grandmother also passed away, but this was pretty much at the end of the academic year and so I chose not to take time off. I thought I was emotionally resilient having just come out the other side of one bereavement.
Over the course of 8 weeks I went through a whirlwind of emotions. I felt numb, devastated, lower than I ever had until that point, and then relieved when we were through the funeral; only to have my world come crashing down again with the funeral of my grandmother. And then I slowly started to rebuild again.
I was offered counselling by my GP, but given the scarcity of resources there was an 8-12 week wait time for initial assessment. The medical school could offer me some counselling but this would be either during the summer break or on returning in September. The former would be over 200 miles from my family home and I didn't drive, so I would have to take a 5-hour train journey each way ruminating on what was discussed, with no-one to talk to. I politely declined and did what any headstrong 21-year-old would do, I went out with friends drinking and staying up late.
Fast forward to July of that year and I received the final exam result of the year. My mark had taken a nose-dive and I was awarded an 'unsatisfactory' exam result. The left me short of the pass mark for the year by 1.4% and I was informed by my medical school that I would need to resit the entire year.
I appealed the decision on the grounds that I was not thinking straight at the time of the examination due to the health of family members, and the impact that this was having on my own mental health. This was not enough for the medical school, who informed me that I should have applied for extenuating circumstances within 7 days of sitting the exam. When I was grieving my deceased grandfather; with my family; 220 miles away. Not exactly the supportive approach you would want from the academic office. The official letter from the dean and appeals board did not even express sympathy at my loss.
I returned to medical school that September with mixed emotions. I was looking forward to seeing my friends and girlfriend, but was dreading the fact that they would all be the year above me whilst I had to go through the same 12 months again. This made me feel inferior but also made me anxious as I did not know how the consultants I had previously met would react to me repeating the whole year. Would they pity me? Think less of me? Treat me like an idiot? Overwhelm me with sympathy?
This is only one example of what life was like as a medical student struggling with their mental health. It was probably one of the two lowest points that I suffered in medical school, and even 7 years later it still hurts to talk about. Depression and anxiety were two demons that I battled with on a semi-regular basis throughout the 6 years of medical school, and they still rear their heads on rare occasions 4 years after graduating. I know other student and junior doctors who have battled with their mental health, and who have contemplated ending their lives. I have known doctors and medical students who have tragically taken their own lives, unable to carry on.
But how do we fix the problem? Maybe first off by not saying it's a problem nor that it can be fixed. Fixing implies that something is broken. If we describe the mental health of our medical students and junior doctors as a problem then how does that make them feel? Some of the terms I've heard are "useless", "inadequate", "real doctors don't have these problems." Let's acknowledge that mental illness affects healthcare professionals as much as it does any other group. Let's not brush it under the carpet and hope it goes away. Let's stop telling students and doctors that "it's a part of life" and maybe they "should consider an alternative career." We need to address the lack of mental health support available for students and doctors, educate them on appropriate and inappropriate coping techniques from day one. We need to remove the stigma that still exists around mental health amongst healthcare professionals. We need medical schools to show humanity not just as a subject on their curriculum but also in how they manage students in crisis.
Most importantly though, we need to tell students and doctors it's okay to not be okay.
“There is help… this is only temporary, and there are ways to complete your studies even when this seems impossible.”
Antoinette, FY1, East Cheshire NHS Trust
I was diagnosed with severe depression in my 4th year of med school (which was my intercalating year). I was started on medication and I also undertook a course of CBT. Depression is something I still deal with but over time it has become more manageable and most importantly, it hasn’t prevented me from completing med school. It can easily feel like you are the only one suffering when you look around and see other students thriving in clinical placements and acing exams, but please remember you are not alone. Mental health problems are very common in the general population and even more so amongst healthcare professionals. The most important thing to remember is that there is help, that this is only temporary and that there are ways to complete your studies even when this seems impossible.
Thanks so much to the people that shared their experiences. Especially "Lisa" from London - I have an almost identical story to you so far and my plans are similar to you as well. I found your story really relatable and it's encouraging to see that you're now doing well. I hope I will be in your shoes too in a few years time.
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