Dear patient,

I may never get to meet you, which is a real shame. I think I would have enjoyed getting to know you and working together with you to overcome whatever particular medical issue with which you had come to meet me. We might have learned about each other. We might have learned about our community. We might even have made some kind of change together.

I myself am a patient, like you. I suffer from depression, worsened by lifestyle, like so many ailments we treat. I have seen a counselor; I have seen a specialist. I take medication. But it isn’t getting better, and I start to fear that it isn’t just the depression, but medicine itself that has brought me to such a dark and inescapable place.

I’ve worked long hours in training. I’ve been the brunt of archaic Socratic teaching styles that bring more humiliation than knowledge. I’ve recovered quietly in a stairwell after a patient has died, cleaned my face in the bathroom, and continued rounds. I’ve seen a patient suffering from addiction chastised in the next room. My spirit is weakened, patient, and I’m afraid I won’t be able to build it back up.

Dear patient, Medicine is not well. I am not the only one. Roughly one third of young physicians like myself are depressed, with uncertain futures, wondering if we will ever get to meet you.

The profession gives me little encouragement. The ACGME, the body guiding residency programs in the United States has recently declared that interns like myself are simply too thin-skinned, that we ought to withstand not 16, but 24 or even 30-hour shifts, previously reserved for senior residents and outlawed in other professions given the studied limitations of human neurobiology. To the ACGME, an inability to withstand a 24-hour shift can mean only one thing: You simply don’t have what it takes. You are weak. You should not be a doctor.

Complicating matters, if individual residents try to speak out publicly against the new ACGME requirements the ACGME could visit our programs without warning and issue petty violations that would mar the programs for our next application cycle. Our voices are actively being suppressed.

What to make of this, patient? What to make of a profession that prides itself on service, healing,and wellness, but promotes excessive work hours, abusive training practices, and a survival mentality? How am I to ask of patients what we ourselves could not possibly practice: a balanced life.

Dear patient, I am tired. And I am so sorry. I have such guilt in my heart when I think of leaving you and leaving medicine when we haven’t even met. But I do not want to meet you like this. With such sadness, fatigue, bitterness, despondency. The truth is I wanted to meet you so badly, I studied countless hours, I cried countless nights, I lost relationships, I missed family gatherings, holidays, weddings; I lost my sense of self, all because I wanted to meet you and help you. But here we are. Lost.

If I find my way out I hope to meet you and stay in medicine. I know we can work to build something better. For all of us.

Until then,
Your future doctor

The author is an anonymous medical resident.

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