Dear Dr. Wible,

We’ve talked before. To catch you up, I’m in my clinical years now and I keep waiting to feel the same starry-eyed excitement I felt during the first months of med school, when I thought that becoming a doctor would finally give me a tangible purpose and make me a better person by helping me do right by others in a way that is meaningful. Back when I thought “Yeah! This is awesome! I can do this!”

In hindsight that was naive. I went in hoping to develop into this clever, proactive, healthy, and well-balanced physician by the time I graduated. But what ended up happening was that I became obese, started having chronic pain with no specific cause, became sedentary due to lack of will to do anything besides breathe, lost the abilities to focus, remember details, multi-task, (you know, basic cognitive skills needed to be even a mediocre doctor), and developed some kind of anxiety-depression maelstrom that blindsides you and pins you down for months at a time.

This year has been particularly difficult: I haven’t been in the same state for longer than two months, and this isn’t even the year I’m supposed to do Sub-I’s. Aside from housemates, I don’t see any of my other classmates. The isolation (and, by extension, my inability to communicate with my colleagues, and my inability to stay abreast of any school or residency information that my colleagues have easier access to), and the rapid-fire change in care settings are so disorienting. Just the idea of applying for residency with this history of such unforeseen environmental instability makes me want to cry/vomit/dissociate/throw things. And in the midst of all this, the slow-blink of limited patience seen in my attendings makes me sure that they must think I’m the biggest idiot ever to darken their doorstep. And this is supposed to be the easy part of becoming a doctor.

I find myself wondering what the hell the admissions committees ever saw in me when they decided to let me in.

The other day I had a patient with a PHQ-9 score of 6 vehemently insist that I couldn’t possibly understand how he felt. “You’re right, I probably can’t,” I said. I take the questionnaire every month—self-surveillance. My baseline is 19, historical max 24. I can’t even begin to imagine what a 6 feels like. Are there really people who don’t constantly loathe themselves or fantasize about going to bed and just never waking up again?

I see my coat and stethoscope hanging on the door each morning, and I feel like I don’t deserve them. I’m not intelligent enough. Not clever enough. Not charming enough. This is supposed to be a uniform worn with dignity and honor, but it feels like a daily-wear Comic-Con costume with authentic accessories, worn by someone who can only hope to play at being a doctor. I can’t stop feeling like I’ve let myself down or that I’m failing to meet the expectations of my field. I keep trying to tell myself I can improve and still be the person I wanted to be: “Success is not a matter of willpower, it’s just discipline. Do you want to be better? Go do better.” But mustering the will to “be better” is like a person with no tongue trying to verbally describe the flavor of cake.

And yet, in spite of all this, my patients seem to like me. But making a sick person smile isn’t enough. Smiles help, but they don’t heal. Medicine heals, and despite my greatest efforts, I’m just not good at it. So what’s left?

I honestly don’t even think my particular med-ed environment has been abusive, really. For all its logistical shortcomings, it’s actually been quite nurturing. I think that’s what concerns me the most—what I’m experiencing now is probably nowhere near as difficult as it will be during residency (if I get in). In residency, I imagine it’s not cute or okay for you to get pimp questions wrong, and people are running around overworked and sleep-deprived, unable to take sick/maternity leave, etc. In some programs, based on testimony on your site, it sounds like if you’re still alive by the end of training, it means you’ve won—for the moment. If I’m this run-down now, what’s it going to look like when that begins?

What you do for other doctors, health professionals, and students is really great. Feel free to share if you like. Not sure what good it’ll do, but it’s there if you want to use it for anything.

~Ben

Hey Ben,

I totally relate to the loss of joy you are feeling as most of us start med school with the same fervor and excitement. Then reality hits. Half of us soon fall to the bottom half of the class. With all the studying, we’ve got no time to develop deep friendships. Instead, we develop trauma bonds with one another through all the bizarre things we experience together.

My first year of med school was the worst year of my life. Since I’m not a great test taker, I studied far more than most and found myself feeling very isolated too. Lack of any free time made it nearly impossible to develop close relationship as did the competitive environment that seemed to pit us against one another unnecessarily. I felt maybe I was just the sensitive, idealistic oddball; however, I now know that many students felt the same way.

My medical education seemed totally inhumane and barbaric. I was most distressed by the dog labs. I was on the verge of quitting med school over these labs. Thankfully I was granted an exemption based on my vegan lifestyle. Killing dogs and torturing sheep and other animals as part of the curriculum is absurd. How does that help us maintain compassion and empathy for others? Amid my complete devastation, I somehow managed to pass my tests. No idea how I survived. Seriously. I actually did sign the papers to quit. My tuition and apartment were paid for, and I had nowhere to go, so I sat on the bench outside the medical library. My anatomy partner (who later died by suicide) sat down next to me and convinced me to stay. His advice: “just keep taking tests and see what happens.” I did. And I graduated.

Like most students, I felt this deep calling to pursue medicine—my soul’s purpose—so it took me by surprise that medical training itself would cause me to lose touch with the very part of me that was so devoted to this career. Like you I developed depression. I spent most of my first year crying. In fact, I cried so much that when I woke up one morning my eyes were actually sealed shut. I literally had to feel my way to the bathroom and couldn’t leave my apartment to go to class. I’ve never cried so much in my life. I felt like my soul was being slaughtered.

Ben, your travel schedule is insane and would have put me over the edge for sure. On top of all the other stressors, now nomadic students are drifting state to state, hospital to hospital, EMR to EMR. My friend lived out of her car and took showers at campgrounds to save money during her third-year rotations. Very disorienting. You are having the normal reaction anyone would have to this crazy schedule. Who could thrive in such circumstances? At least at my med school, I did all four years in one location (and didn’t even own a car)! Just walked to school in the pre-EMR days. I consider myself fortunate that way. Hey, one good thing is that in many residencies you won’t need to travel as much as med school. And just so you know, for me residency was way less stressful than med school. I actually loved residency! Always interview current residents to see if they like their program. Life can get better!

You’re essentially suffering from imposter syndrome. Do you realize everyone feels the same way you do (to varying degrees)? Doctors all struggle with self-doubt and low self-confidence at times. Totally normal. Many of us wonder if we really belong in medicine. We feel somehow we don’t deserve to be physicians because we’re not smart enough. Don’t worry. You are amazing to have made it as far as you have! Seriously. Most people in the world don’t have the stamina, patience, or brain power to survive one year of med school. You’re a winner. The admissions committee wouldn’t have let you in if they didn’t believe in you.

My best advice is that you remember why you’re doing all of this. Dig out your personal statement. Remember your dream. What images or thoughts led to your “starry-eyed excitement” on day one? What kinds of patients did you want to serve? Focus on your dream. It’s the antidote to your despair.

I actually read your letter to an intern tonight, and he was nodding along because he could relate to everything you wrote—almost as if your letter was his own. I’m thinking all med students will relate to at least a portion of your letter. Let’s see. I’ll publish it.

I’m here for you Ben. So glad you wrote me! ~ Pamela

So many medical students suffer like Ben. Impostor syndrome happens frequently in high-achieving individuals who lack the ability to internalize their accomplishments and develop a persistent fear of being exposed as a “fraud.” Remember: Nobody knows what they’re doing when they start medical school.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Physician Suicide Letters — Answered and Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor. She hosts the physician retreat, Live Your Dream, to help her colleagues heal from grief and reclaim their lives and careers.

Image credit: Pamela Wible