We Are In Trouble -- Just Look At Our Medical Students

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Her mother and father are in grief, probably still every day.  Maybe she had siblings who are as well.  She died one morning in August, 2016, when she took her life, jumping from her eighth floor medical school dorm room in New York City.  

The medical school is scrambling to “pledge more compassion,”  according to the dean of the Mount Sinai Medical School in his essay in the New England Journal of Medicine.  

Why would he say that?  People who go into Medicine are typically quite compassionate to begin with.  They care about others.  Most of them. 

Of course, within any group of people, there are those who may be driven more by financial reasons, or who have mental health issues, even severe ones.  But still, why would he say they will pledge more compassion?  He’s on the hot-seat.  His school has lost two medical students to suicide recently. 

So, the spokesperson for the school has to respond.

Let us look at what seems to be going on. 
Firstly: Culture of blame/victimhood.  Our culture has become one of blame - both through our human wish to not think “bad” things are our fault and through our legal system that follows and assigns blame, and quite honestly, punishment, for the blamed. 

Shall we call it blame? 

Or shall we call it victim-mentality? 

We have lost way too much of our sense of personal responsibility.  We are not teaching our children responsibility.  Our culture is rife with children who are not growing up well.  The media is full of information about how the millennials, our young people “need” more support and direction in the workforce, and are not as capable of full responsibility and enjoyment in the working world as their predecessors.

Should a physician not be one of the MOST responsible members of society? The “millennials” are reputed to be sensitive, incapable of the kind of responsibility and commitment that their parents and grandparents exhibit.  They have been called “snowflakes” referring to their fragility.  

Do we want fragile physicians?

Secondly: Belief in mental issues, mental illness, and need for psychiatric counseling. The follow-up to the medical student suicides has the schools looking at how they can provide more support to the students in the area of psychiatric visits for mental health support at discounted fees, and “breaks” after the adult medical students experience the death of a patient.  

Reading a recent Wall Street Journal article (Lagnado L, After Tragedy, Med School Pledges More Compassion. WSJ 2017.03.23), I found myself agape.  

As a 10-year critical care nurse, I not only experienced death of patients on a regular basis, but was responsible for the life-saving measures to attempt to save and prolong life.  Did we nurses feel affected when a patient died? 

Of course.  What did I feel when the cardiologist patted me on the shoulder, and said, “Do what you can,” and left the ICU?  I felt a sense of huge responsibility, commitment, love and concern for the patient and family. 

What did I feel when we had lost a child patient in the emergency room and the attending ER doc said, “Would you go tell the family?”  Huge responsibility, commitment, love and concern.  I knew I could do that well, even knowing I would most likely be teary with the parents, and help them through the first moments.  

And these docs who delegated huge responsibility to a capable and dedicated nurse were not snowflakes.  They were quite responsible with venerable careers in medicine who were sharing shouldering the burden of human suffering.  

​None of my colleagues nor the physicians that I knew well had psychiatric or psychologic counseling or “breaks” when the patient died.  We all grew emotionally, spiritually, and in our awareness of the preciousness of life as well as the limitations of life, medicine — even modern medicine.

For me and my colleagues, in medicine and  in patient care, each day is one full of anticipation and  excitement for what we can bring to our patients.  It is a day full of Gratitude as the day’s operative belief.   

Why are medical school academics not familiar and comfortable for the medical student?
OK - I went to dental school, AND worked basically full-time as a nurse, through my four years of dental school. I have been appointed to faculties at 3 dental schools and taught medical and dental students, and I have been part of admission committees deciding which applicants get an interview, and which of the interviewees get an offer to be a student in that school. 

I have watched my son become a dental school faculty member after his medical school education, and in addition to his huge responsibilities running two clinics, faculty practice, and the other a patient care clinic, he is doing his post-doctoral Master’s in Public Health and being an active husband and father in his nuclear family. (And yes, he has a wonderful wife!)   He loves it all.  It makes for a wonderful life of love of others.

As to the medical education and its academic pressures:  The students admitted to medical school have demonstrated academic ability in the tough pre-med courses, and finish those with high GPA’s, high MCAT scores, and high involvement in extra-curricular activities.  In fact, the committees aren’t interested in students who have not shown a high involvement in extra-curricular areas, including work. 

Why?  Because, the student who has not handled the well-rounded schedule of schoolwork, community work, and other areas of teamwork, will not thrive in medical school.  Other areas of teamwork include athletics, music (choir, band, etc.), volunteer work.  These help show an applicant’s balance and “whole-person-ness.”

Grueling academics?  Sure, it’s top-level academics.  Don’t you want your physician to know stuff?  But grueling?  These students have shown they can handle their demanding academics and still handle life.  There are days, weeks, semesters, in medical school that challenge one, and especially the student with a young family, or with family members who are very ill, or a marriage that is not solid. 

And, the schools might need to improve their support of those students in that the student should be encouraged to take a leave of absence in order to deal with the life-challenges and then come back to medical school if they feel — and are — ready. 

Surely, even our most capable students, admitted to medical school, having grown up in our victim-culture, modern media, including news, movies and social-media, and resultant societal beliefs, are vulnerable to, as the articles suggest, the “burn-out” and depression of being a medical student.  

It is the school’s responsibility to help any students that are not thriving, to be identified and counseled that the fit of the profession may not be for them, to encourage student groups to discuss and help each other in the experiences of medical training.  But to decide that, as Mt Sinai has done, that “honors” should be given to more than just the 25% that earned it, that “high pass” should also be given to a bigger group, is absurd. Their rationale is that the system “PROVOKED  intense rivalry among students,” is the same sort of thinking that leads every soccer player to get a trophy. 

And so, Mt Sinai med school  “hopes to drop these limits altogether.”  Every student will be equal. 

REALLY? 

Isn’t that more of what got us into this mess already?  When the students have no evaluations or performance grading, how will the residencies and post-doctoral specialty programs choose their applicants from the pool.  The suicidal med student will be an equivalent candidate to the most mature med student?

What kind of medical care will be provided by the student who has been told he is “honors” material when he is not, or by the student who believes he is “burned out” when he graduates, or by the student who utilizes the psychiatrist who is treating the mental health issues the young physician believes he has?  Do you want your physician to be one of those doctors?

And, as my husband Claude points out, after his law school education, what a field-day the lawyers will have when a family or patient sues the doctor who has a history of psychiatric /psychologic counseling throughout school and beyond. (HIPAA, you say? 

​There is no such thing as confidentiality today.  Just ask the leakers of the highest level confidential and classified information in the news, no less.  No, on top of burn out, those physicians will have a hell of a time with the lawyers.  

Yes, the medical schools owe their students the responsibility of taking the most ready, capable, mature, mentally healthy applicants, and then monitoring them at every level possible, and guiding, supporting and mentoring them to remain capable, mature, and mentally healthy.  The schools must understand that what we believe is what we become. 

The physicians who are responsible for these medical students must be brave enough to notice, say so, help as they can, including limiting the at-risk student to a leave of absence, or out of school.  That is far better than seeing medical student lives lost to suicide, AND patient lives lost to mentally fragile physicians.  

And we as parents must work on teaching our children responsibility and not victimhood.  Let us have days full of Gratitude as the day’s operative belief.  It is time.