Tuesday, March 29, 2016

Humiliation of the Medical Trainee

In three short months I will be starting my residency. I will be Dr. Vieve, the lowly intern,with a batch of third- and fourth-year medical students to supervise every day. My job will include serving as their instructor while keeping up with the notorious, over-sized workload given to physicians in their first year of practice. I'll be evaluating my students' performance and making comments that shape the Dean's Letter they will use when applying to residency. Most importantly, I will have the opportunity to model what professional behavior can look like. They will inevitably hear me misspeak or say something that is incorrect. They will watch me be corrected by my seniors and attendings. And there will most definitely be times when I will need to correct them. Medical training is known for hazing--for instruction edged with humiliation. I hope to rise above it.

Dr. Pamela Wible is a family physician who has found herself in the unintended role of physician advocate. She speaks directly of the culture of humiliation in her recent TEDMED talk Why Doctors Kill Themselves. It is sobering to listen to, reminding me of the need to watch-out for my coworkers and students while also safe-guarding my own mental health. There is a stigma associated with depression, and it seems to be even worse for those whose are entrusted to care for other people's health. Unfortunately, there are systems in place that perpetuate that stigma and stand in the way of physicians seeking treatment for themselves.

My unpleasant experiences with difficult physicians has been limited. Part of that has to do with the good-hearted people I work with, and part of it has to do with having a well-formed identity prior to starting medical school. No doubt about it, med school is a beat down! I count it a blessing that I have  endured enough challenging experiences in my life that have taught me resiliency. Not all of my peers have yet mastered this. For many of them, it is the first time that they have been publicly challenged. Situations that have left me mildly embarrassed, have made others feel utterly humiliated.

Life is challenging enough without getting a little endemic humiliation handed to you.

My divorce was an "easy" one, but it still made me feel hurt beyond belief. I knew that I wanted it, but that didn't stop me from grieving the loss of the if-not-happily-at-least-not-sadly ever after I dreamed of. I knew that something would have to give, and I so desperately didn't want that something to be my sanity. I saw a psychiatrist and was treated with antidepressants for a few lonely months (and appropriately for a few more months after those lonely feelings disappeared). I'm so grateful to be on the other side of it and recognize that I weathered that storm more easily than others.

As I began the process of applying for a provisional medical license, I was shocked to discover that seeking treatment for my episode of depression could have required me to sign over my right to privacy. I was confused then I read the line on the application that asked "In the past 5 years have you been treated for schizophrenia, alcohol or other substance abuse, bipolar disorder, pedophilia, or major depression?" Which bureaucrat determined that these disorders were similar enough to be lumped together in one question?

I asked my residency coordinator what would happen if someone said yes. She just shrugged her shoulders. "Yeah, you probably should just send the state office your entire medical file." And then she added, "I don't really know. No one's ever been treated for mental health stuff." If that's true, then countless physicians are struggling with untreated depression in an effort to save face and preserve their privacy. Perhaps unknowingly, that question sends the message that getting help for depression is similar to seeking treatment for pedophilia. And placing your privacy before the review of Ms. Baker at the State Office Building is an insufferable humiliation.

What would the repercussions have been if my depression was more serious than adjustment disorder? After all, when I was in the midst of depression, it simply hurt, and I didn't find myself thinking, Gee, I'm so lucky that I have a 'legit' external cause to blame all this on and I bet the pain will end super-duper soon so as to qualify as acute. No. I was simply depressed. But the question didn't even ask if I was depressed or if I used alcohol or if I had schizophrenia. The question asked if I sought treatment.

It frightens me to think of how my decision might have been different if I had known that two years ago. Would I have had the courage to take care of myself? Would I have told myself that seeking help was "weak" and I needed to suck it up? I knew Medicine's reputation for putting trainees through public embarrassment. I never imagined that a physician's personal medical records could be put on the line.

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