Surviving medical school with depression [PODCAST]

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“I was first diagnosed with major depressive disorder as a preteen after my teenage sister died. I attempted suicide three years later. This would be the first of several attempts and the first of countless times I felt my life was not worth living. But I am not unique.

According to the Centers for Disease Control (CDC), 1 person dies by suicide every 11 minutes.

My depression is like a chronic autoimmune disease — constitutively present at a low level with flares. But there’s no Humira for depression.

At baseline, I am exhausted, anxious, lacking motivation, and full of self-doubt. When severely depressed, I am at the bottom of the sea, struggling to breathe and unable to swim. I am paralyzed by a high-pressure, heavy and humid darkness. Through physical or mental isolation, I may not see another living creature for hours, days or weeks. I can look up and see the sun shining beyond the water surface, but the surface is miles beyond my reach. I must physically force myself to breathe as my mind tells me to stop. Trying to take a test, see patients or study can prove impossible.”

This anonymous medical student shares her story and discusses her KevinMD article, “Surviving medical school with depression.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have an anonymous medical student, and she wrote the KevinMD article “Surviving medical school with depression.” Thank you so much for joining me on the show.

Guest: Thank you for having me.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you just share your story and journey to where you are today?

Guest: Sure. I am a Black woman and a current medical student applying for residency. I personally have had depression for several years, including during medical school, which has been a challenge to deal with, but I’ve been able to overcome that to get to this moment. So I was really happy to share my experience in the article and hopefully share what other similar students may be experiencing.

Kevin Pho: We talk a lot about mental health in the medical profession on KevinMD. It’s been an ongoing issue, and over the last few years it has been getting more prominence. I talk about it on my blog and on my site a lot, and I’m interested in hearing your story, which you summarized in your KevinMD article, “Surviving medical school with depression.” So tell me about some of your experiences during your medical school journey.

Guest: I’ve had depression for a long time. I knew coming into medical school that I should probably get a therapist, which I did early on. But the scheduling made it pretty difficult to see a therapist and go to class, and then also rotations, and so that was a struggle.

And then, as I mentioned in the piece, there were actually some times when the school used my mental illness against me in academic settings, as a way to say that perhaps I was not prepared for things, or not able to do things that I would have been able to do had I been able to have the time to get the help that I needed. That’s part of the reason I wanted to write the piece, because I haven’t really seen a lot of writing from a medical student perspective about mental illness. We are in such a high-stress environment, which makes us more prone to it, but which also potentially makes it more difficult to find proper help.

Kevin Pho: Can you give us an example story or a case study of how your depression affected you, whether in the preclinical years or during your clinical rotations?

Guest: For me, my depression comes in waves. Sometimes it’s pretty tolerable, and other times it makes it really difficult to get anything done. I remember in preclinical, for example, waking up and having a really hard time, just not wanting to get out of bed, and knowing that I had a full day of classes in the morning and then anatomy lab, I really struggled to go.

I’m fortunate that in many of our preclinical courses, we can do online lectures, and so I was able to watch the lectures. But that still meant I had to get out of bed and go to lab. That lack of motivation really affects not just getting out of bed, but studying and interacting with people. And so that made it challenging when rotations started, in terms of getting up at 6 a.m. or earlier to go to the hospital, and writing notes. It makes everything a bit more challenging.

And then it also affects my desire to be really successful. It gives me a lot of self-doubt and lowers my self-confidence, and so it makes it hard to recognize when I’m being successful in something.

Kevin Pho: You’re in your fourth year, and congratulations on making it this far. What are some of the things that you did to overcome some of the obstacles that you mentioned?

Guest: Like I said, I got a therapist. The week before school started, I went to the on-campus counseling center and just told them, “I’m starting here. I have this history, and I’d like to see someone.” So that was helpful.

I also really know myself pretty well, and I know when I’m having days where things are going to be more difficult and I need to just have some grace. Those would be the days that I would stay home and do my lectures from home, as opposed to going into class in person. In terms of getting things done when I couldn’t do them from home, it was about doing small things and celebrating small wins, like getting up and making breakfast.

And then in terms of when rotations started, I did take the onus upon myself to talk to my clerkship directors and just tell them that I have an appointment once a week that I have to go to, and they were very open and willing to accommodate that. I would say that was from knowing myself, and knowing that I felt comfortable enough to say that without going into specifics, but knowing that they probably would know what it was for. I felt comfortable saying that at this point.

I know that’s not the case for most students. Most students don’t even want to say they have to go to the dentist, and so we don’t go. And I think there’s a culture in medical school of minimizing our needs, because patient care comes first. I really hope that by writing something like this, we can shift the priorities to be that we are also people, and we also need to take care of ourselves in order to take care of other people.

Kevin Pho: One of the things that you mentioned earlier was that you felt that the academic institution used your mental health diagnosis against you. What did you mean by that?

Guest: Sure. I had a particular struggle in preclinical with one or two classes, and I was essentially told that perhaps the reason I wasn’t doing well was because of my depression, and that, given my history, perhaps I wasn’t built for medical school, or I wasn’t cut out for medical school, and maybe it wasn’t the right place for me. That was hard to hear, even knowing myself.

This was just a topic that I had no experience with, and academically, I just struggled to understand the concepts. I think a lot of people assume that we have a background in all of the topics that we learn in medical school, but sometimes it’s simply that the topic is just difficult. Medical school is hard academically. They were aware of my mental illness and felt that it precluded me from being able to be successful in medical school, which was hard to hear, because I already felt that way sometimes, even though it may not be true.

Kevin Pho: Did the academic institution offer any support services? You did mention that you went to an in-house counselor, but what other support services were available to you?

Guest: That was it. And that counseling is through the undergraduate campus that’s affiliated with our medical school.

Kevin Pho: How much emphasis did your medical school place on the behavioral health and wellness of its students?

Guest: Little to none. I can’t remember anything outside of them saying, “The undergraduate campus has this counseling. You’re free to take advantage of it. It’s free or low cost for you.” It was not something that was really focused on.

A lot of the focus was on preventing burnout through all the things that medical schools and institutions like to highlight: building your resilience, making sure you have time to sleep, and getting proper exercise. Those are all things that certainly do promote wellness, but they don’t necessarily really treat mental illness. So I think there’s a focus on, “Well, what can we do to prevent burnout?” And the two don’t always go hand in hand.

Kevin Pho: So if you were in charge of a medical school curriculum, what would you do differently to help those with a history of depression or behavioral health issues?

Guest: I think my hope, and ideally, I would like for counseling to be available at every medical school, not just through the undergraduate campus. Undergraduate campuses are large, usually much larger than medical schools, but they also have to have enough counselors to meet that need, and sometimes they don’t. They’re understaffed already. And so then you add between 200 and 800 medical students and their specific schedules, and you have a population that really isn’t able to have its mental health needs met. So I would want counseling to be available specifically through the medical schools, obviously with a separate EMR.

I would love for there to be some education for faculty and students about mental illness, and about their own mental illness. Not just what’s taught in your psych block or in your psychiatry clerkship, but specifically about dealing with stress and mental illness in high-stress environments like medical school, and the resources that are available to them, either locally or, if the medical school has some, specific resources that it makes available.

I think some residency programs are doing a good job of addressing this by having opt-out therapy, which I think would be interesting to do for medical schools. I understand we have a larger population than residencies, so that may be difficult, but I think medical schools really have the funding. It’s just not a priority. And given the stats that I mentioned in my article, that medical students have a rate of depression of 27 percent and of suicide of 11 percent, respectively, this should really be a priority for medical schools.

Kevin Pho: Now, what about your peers? Did you notice any of your peers also struggling with behavioral health issues?

Guest: Absolutely. And many of them felt uncomfortable coming to the administration about that, or if they did, they were not actually routed to the counseling services. That’s a two-part issue, which is why I mentioned that some education needs to be happening for faculty as well. Because if the resources are there but students aren’t taking advantage of them, is it because they just don’t know? Are they going to their advisors, and the advisors aren’t sending them to the right place because they don’t know about the resources? I think that certainly could be a barrier that could be addressed pretty easily.

Kevin Pho: We’re talking to an anonymous medical student, and she wrote the KevinMD article “Surviving medical school with depression.” If you were to do this medical education journey all over again, is there anything that you would have done differently?

Guest: There are a lot of things I would have done differently. I honestly probably would have paid more attention to the types of students that my school accepts, or that schools in general accept, and to the resources that are available for students who struggle academically, as well as financially and emotionally. I would have paid more attention to the actual costs associated with medical school. But I think, ultimately, I knew for a long time that I wanted to be a physician, and so however I could make that happen, I was going to make that happen.

Kevin Pho: And if you were to advise your fellow medical students who also may be struggling with behavioral health issues, what kind of advice would you give them?

Guest: I would say it can be really hard to reach out, even to people that you trust, but there are free and cheap resources online. I would also highly recommend contacting your insurance company to see what kind of resources are available to you locally through that plan that are covered by your insurance. I, for instance, have Medicaid, so there are lots of free counseling and psychiatric resources available to me through my insurance. And then if you are able and willing to use the resources on campus, that’s just another resource for you.

I think a big problem is feeling like you don’t have anyone to talk to, or that you are feeling bad and don’t want to reach out to other people, or want to isolate, and that can be really hard to overcome. So having friends or family that you’re able to talk to as well, who can point you to resources or tell you that what you’re thinking is not a reality, that it is a mental illness, will benefit you, not only in medical school but in the long run, because we can’t really take care of other people unless we take care of ourselves.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Guest: Sure. I think too often people forget that medical students are people, that we’re humans first. We get lost in the hierarchy, but the system isn’t really set up for us to be able to live our lives and succeed in medicine. For example, working 80 hours a week and trying to study for a shelf exam is pretty incompatible. I think in many ways, medical training has come a long way in supporting trainee well-being, but mental health is not a priority, and I think that it should be.

Kevin Pho: Well, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

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