Photo taken from Medical News Today
Medicine, the logical choice for any straight A student who has a penchant for the sciences. I mean, who wouldn’t want to be a doctor? You get to learn lots of cool science, you get to make sick people better, you earn loads of money, and if that wasn’t enough, your status as one the kindest and best people in your social circle is guaranteed for life!
Obviously, different aspects of this oversimplified and unrealistic job description appeal to different types of people and personalities. However, all medical school applicants tend to have one thing in common. They’re all overachievers. I’m talking international conferences, record breaking sport achievements, award winning humanitarian work type of overachieving. Gone are the days when stopping Doris absconding from the local nursing home once a week would secure you a medical school interview.
On the surface, this makes sense. Of course we want our doctors to be well rounded individuals with the communication skills, motivation, resilience and whole host of other buzzwords that medical schools think sound like an appropriate description of a good doctor. But in reality, only 5 out of the 33 medical schools in the UK will accept students with less than 3 As at A-level. So even though medical schools give a lot of holistic chat, they are actually only interested in how clever you are. And this is not lost on medical school applicants. These clever little beans are used to being at the top of the academic pile and they revel, often subconsciously, in all the praise and self-worth that comes with it. Way before they even realised it, being “the clever one” became their identity. And they were cool with that because they were smashing it and they were winning at life and everything was cool.
However, at some point during your medical career, this changes. It happened for me during the 5th week of my first term at university. I had gotten into one of the best universities in the world for medicine, and as a black girl of Afro-Caribbean heritage with a Brummie accent this was a pretty big deal. I had a lot to prove, but I would tackle it with my usual work ethic and I would soar to my rightful position at the top of the pile. As the “clever one of the clever ones”. As you’ve probably guessed from the opening of this paragraph I didn’t so much soar as hover above the ground for a short while before crashing unceremoniously back to the ground. All my essays were coming back with major corrections. I was taking longer than my peers to understand complex concepts. I was not smashing it. It was very much smashing me. And I didn’t know what to do. After a particularly crap tutorial I called my mom in floods of tears stating “that I didn’t belong here” and that “the tutors who let me in had made a mistake”. She talked me down, reminded me of how awesome and strong I am and told me to allow myself the space to settle in. At the time I was still devastated, but with hindsight I am glad that I had this realisation relatively early on in my journey to becoming a doctor. Because even if you jump through the hoops of medical school with great aplomb, the world of medicine takes no prisoners.
In a hospital setting, all the attributes that made you a great medical student turn against you to make you an “awful” doctor. Your attention to detail means that you agonise over whether your discharge summaries are good enough, so you spend ages writing them and everyone gets arsey with you. Your carefully honed critical thinking skills make you over complicate every procedure which results in you screwing up almost every practical task you’re assigned. Your great communication skills mean that you always spend too long taking a history, so your senior comes in and finishes it off to save time. Your work ethic means that you always stay late because you can’t sleep easy if you haven’t finished your jobs list. Your emotional intelligence means that you pick up on every potential sign that the people around you think you’re useless. Your resilience means that you rarely speak to anybody about how you’re feeling because you’re strong enough to cope with this by yourself. Years of academic praise have taught you that you are only doing well if someone says you are, but in medicine the words thank you and well done are hard to come by. And your self-reflective nature means that you go back home every night and ruminate on all your mistakes and the fact that the thing that once defined you, a significant source of your self-esteem, is no longer true. You are not clever. You are not excelling. And it sucks.
But I have a secret for you. Contrary to the thoughts swimming around in your head, as long as you put in the effort and try to do what’s best for your patients, then you’re a good doctor! Remember that you are a trainee and are therefore still learning. So yeah, you’ll have days where your skills are on point and you feel like a boss. Then you’ll have other days where it feels like you know nothing and you starting questioning whether all the knowledge you lack lay in that 9am lecture series at med school that you could never quite drag yourself out of bed for. And that’s ok. It’s all part of the learning process and helps you to develop your skills as a resourceful and dedicated clinician. Furthermore, there is no such thing as perfection in medicine. This is important so I’m going to say it again, there is no such thing as perfection in medicine. Consultants miss cannulas. GPs send home sick patients. Professors agonise over the wording of clinic letters. It’s all part of the highs and lows of this wonderful yet intense profession.
So, how do we stop this apparently never-ending cycle of critique and work induced low self-esteem I hear you ask. I unfortunately do not have the panacea, but I do have a few ideas and things that I find useful in my day to day life that I thought I’d share.
Check in on your self-esteem: self-esteem begins to develop in early childhood with some studies arguing that it is fully established by age 5[1]. It is therefore a very difficult thing to try and alter, especially after years of socialisation. However, just being more aware of what makes your self-esteem low may help you identify triggers and make it easier for you to assess and address any emotions they elicit.
Focus on the process: this great article by The Atlantic describes an interview with Professor Carol Dweck and her research into the growth mindset. For those who like that short, snappy handover, the growth mindset focuses on the process of learning and places praise and emphasis on that rather than the outcome. This can be a super helpful cognitive tool for medics who have a fixed mindset and tend to be goal directed, sometimes to a fault.
Talk to people: although communication skills are taught ad nauseam at medical school, doctors often shy away from having emotional conversations with each other. However, the power of sharing your struggle has recently been made apparent to me after having a number of revelatory conversations with medic friends of mine in Australia. Just knowing that other people felt the same as me lifted a weight off my shoulders that I didn’t know was there and is one of the main reasons for me writing this piece. In other words, sharing is caring.
Give positive feedback: medicine can be an exceptionally thankless job at times and when both your boss and your patients seem to be conspiring together to make you feel like the worst, a little bit of positivity from a colleague can go a long way towards boosting moral and helping you power through the remainder of your shift. A message after work is also great as it can help nip the cycle of post-shift rumination in the bud.
Look after your mental health: your mental health is one of the most important things you possess, and unfortunately medicine likes to use it as a bit of a punch bag. Doctors have a higher rate of suicide than the general population, with a 26% higher risk in men and a 146% higher risk in women [2]. So please make sure you do everything in your power to keep your mental health in tip top shape. This could be anything from self-care, to mindfulness, to seeking out formal psychological support in the form of counselling or therapy. There is no shame in seeking help for your mental health so please feel free to have a look at the mental health support links at the end of this post.
Be kind to yourself: being reflective and analytical of yourself and your actions is good as it enables you to grow and develop as person and a physician. However, this can become damaging when the process becomes too negative or too critical. Remember that you are only human and that as long as you’re doing your best and learning from your mistakes then you’re doing a grand job! Sometimes, having a little note on your phone with positive things you think about yourself, or that people have said about you, can be a nice little reminder of how great you are, and something you can quickly access and look at for an emotional pick me up.
There quite a few points there, and although they seem super simple, they can often be difficult to put in to practice. Nonetheless, if even a few of these tips get incorporated into the wider medical community they have the potential to positively impact a number of physicians. Which while helping the doctors of today, will also help create a psychologically safe space for the vulnerable medical students of the future.
Links for mental health support
Australasian Doctors Health Network - contact phone numbers for immediate help and support, for doctors and students, and for families and colleagues of doctors in Australia and New Zealand.
Health and Wellbeing of Junior Doctors - self-assessment tools, information and support for junior doctors in Australia
Beyond Blue Support Service - talk through your concerns with trained mental health professionals in Australia
Lifeline - free, confidential, 24-hour telephone and online crisis support service.
Doctors Support Network - peer support for doctors and medical students with mental health concerns in the UK
NHS Practitioner Health Programme - health professionals specialising in mental health support for doctors in England
References
Cvencek, Dario & Greenwald, Anthony & Meltzoff, Andrew. (2015). Implicit measures for preschool children confirm self-esteem's role in maintaining a balanced identity. Journal of Experimental Social Psychology. 62. 10.1016/j.jesp.2015.09.015.
Norris S, Elliott L, Tan J. (2010). The mental health of doctors: a systematic literature review (Health Technology Analysts, Pty Ltd).