Issue 7 / 4 March 2013

A MEDICAL student’s report about his difficult experience as a patient has raised concerns about support provided to future doctors.

Writing in the MJA, the student detailed the challenges he faced seeking treatment for a leg injury at a private hospital where he worked and the problems he confronted in continuing his medical studies. (1)

Commenting on the Reflections article, Australian Medical Students’ Association president Ben Veness said medical students needed to be supported and encouraged to look after their own health.

“Medical students … should not feel as though their health should be deprioritised behind studying or attending classes”, he said.

Dr Lloyd Reeve-Johnson, a final-year medical student and veterinary surgeon, wrote in the MJA of the difficulties encountered when seeking treatment for his injured leg and the ongoing impact on his studies.

Dr Reeve-Johnson tore his plantaris, soleus and gastrocnemius muscles while playing squash. An informal discussion with a consultant concluded that his leg would heal with immobilisation.

However, after continuing to work while wearing an orthopaedic boot and in considerable pain he went to the hospital’s accident and emergency centre and was diagnosed with a deep vein thrombosis. It was the beginning of a protracted and unsettling round of medical consultations and trying to study while in pain and taking opiates.

“Our university is inflexible — miss 2 weeks and you fail the year”, he wrote.

Dr Reeve-Johnson also expressed concern about the advice and treatment he received inside and outside of the hospital.

“My iconic, high-pressure, state-of-the-art mentors, thriving on challenging cases and for whom every minute is valuable had failed, over many weeks, to notice a person behind the condition”, Dr Reeve-Johnson wrote.

Mr Veness told MJA InSight the most concerning aspect of the report was that the student felt he wasn’t able to seek a proper consultation with a doctor to assess his leg.

However, Mr Veness said he believed the experience outlined by the medical student was not uncommon and cultural change was required to ensure medical students were given appropriate support.

“All doctors need to make sure they’re looking after their own health. You can’t have healthy patients without healthy doctors”, he said.

“You need to start with the tone from the top”, he said. “You need medical school deans supporting their students to ensure that they’re healthy when they’re studying medicine.”

Mr Veness said medical students with mental health problems could often be the most adversely affected as they often did not show visible signs that they were struggling.

Medical students were often also very hard on themselves. “It’s hard to know whether this student is a victim of some difficult medical school or whether he was imposing some of this pressure on himself as well — it’s probably a bit of both.”

Dr Reeve-Johnson told MJA InSight his experience as a patient had made him more attuned to the needs of those he will be caring for as a doctor.

“It is very easy to stop caring, or to care less, due to the pressures of time, the pressures of finance … and as much as anything, the pressures of self-protection”, he said. “The caution for all of us as we specialise is not to forget there are other aspects to medicine apart from our own specialty.”

Dr Reeve-Johnson said continuity of care was something he had taken for granted in his work as a veterinarian where the surgeon, physician, emergency doctor or intensivist roles were often performed by the same veterinarian or a small number of specialists who often knew each other.

“When human patients move between medical disciplines the challenges are far greater, but so too is the importance of clear communication and follow up if outcomes are to be holistic and successful”, he said.

Mr Veness said many medical schools had adopted curriculum initiatives to help medical students gain a greater perspective into patient challenges. He noted a clinical education initiative at Harvard University in the US in which students maintained close contact with patients over the course of a year. (2)

– Nicole MacKee

1. MJA 2013; 198: 228-229
2. Academic Medicine 2007; 82: 397-404

Posted 4 March 2013

4 thoughts on “Students need better support

  1. wendy webb says:

    I wonder if Dr Reeve-Johnson attended his own GP for a referral to a specialist for treatment, in the usual manner. The GP or the specialist could then provide a certificate to allow time off university. If a student or doctor approaches a consultant in the course of work rather than by taking on the patient role, it is not surprising to me that their treatment is patchy and unco-ordinated. Both doctors and students need to take responsibility for their own health and be patients when they are unwell.

  2. Sue Ieraci says:

    Yet another reason for medical students to be managed by their universities as clinicians-in-the-making rather than just degree candidates.

  3. Rich says:

    wendy webb, I think you missed the part that said “Our university is inflexible — miss 2 weeks and you fail the year”.

    My own medical program has similarly concrete rules. It doesn’t matter how many certificates you get, you still need to repeat the entire year!

  4. Bill says:

    Wendy’s point is well made. Casual consultations of any type are fraught with risk. It seems it is always very tempting for a doctor (or med student) to seek these type of “favours” or consultations at the same time expecting “professional courtesy” in terms of fees. (And it can be very difficult for the one approached to say no). In the end both can look foolish.
    I wonder how much of Ben’s bad experience and bitterness would not have occured if he had initiated a “proper” Doctor – Patient “contract”.

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