What are we training medical students for?
When young people go to medical school they are called medical students. They know that they are to learn about medicine. Everything about medical school is about learning about medicine. In fact, every waking moment is about learning about medicine.
We learn about anatomy, physiology, statistics, how to read a research paper, how to do a research project, we learn about diseases, pathology, histology, how to examine patients. We learn the right questions to ask in the right way to get the information that is needed.
We endlessly learn about rare diseases, treatment protocols and how to do various procedures and operations. Our whole lives are consumed with medical information.
But is this all that there is to medical school?
Of what value is all the medical knowledge in the world if the person holding that knowledge is miserable and unwell themselves, struggling to work and struggling to cope with people?
Students graduate at the age of 24 (at least) after the most intensive periods of their lives where literally every moment is dedicated to learning as much information as possible.
It has even been said that medical school is a prolonged period of adolescence where life skills are not learned, but one simply has to learn what other people tell you.
There is no time to notice anything else about life. Finances, relationships, property, politics, community engagement……sleep….. everything comes a distant seventh to medical school and learning. Life itself is an afterthought, something that one attends to only if one has to.
Our medical students are not taught about how to conduct or engage themselves in an empowered way in day to day life. They are taught how to recall information, pattern recognise and survive ward rounds.
But how to be in all aspects of life determines how well we are in life, not how much we know about facts.
Medical students and junior doctors are not taught how to take care of their own health and well-being, and in fact the very nature of the setup of medical training encourages and fosters them to ignore their own health and well-being.
- Medical students are not taught how to take care of finances.
- They are not taught how to be empowered and to run a business.
- They are not taught the basic skills of marketing and business administration that people in engineering or even beauty school are taught, even though finally after a prolonged period of education and working they will be working in businesses in the community.
- They are not taught how to have relationships with people that are equal, loving and caring that go beyond the arrangement of role of doctor and patient.
- They are not taught about the importance of caring for their physical bodies, and indeed much of medical culture in fact promotes the stressing of the human body and mind, asking it to go beyond its limits without care for how it needs to be literally cared for.
- They are not taught how to take care of their mental health, with instead judgement and criticism, condemnation and the drive for unattainable perfection being the daily ingrained forms of communication in medicine, none of these building self-esteem or self-worth.
The health and well-being of us doctors is poor. We are not happy; over 50% of us are burnt out. Our suicide rates are at least 2 times higher than the general public, with some studies pointing to 5.7 times higher, and these are only the suicides that we know of. We have higher rates of anxiety and high psychological distress than the general public.
The pressures on us doctors are very real and put simply, in the health care profession we are barely surviving, and most certainly not thriving.
We know medical facts, but we do not know how to take care of ourselves and keep ourselves well in life.
Doctors are disempowered as people and do not consider themselves as human beings with equal human rights, and instead in the role of ‘doctor’ in training learn to simply accept and put up with the circumstances that they find themselves in.
They agree to working arrangements that would not be accepted anywhere else in the corporate world, with many of them seeing bullying as so normal that they don’t even realise that they are being bullied, or that they are engaging in bullying.
Working relationships in hospitals are toxic between doctors and between doctors and other health care professionals. And let’s not even begin with the relationships that doctors have with administration!! This is accepted as ‘normal’ and something to ‘survive’.
Toxic relationships build bad teams and are bad for our mental health and well-being. This has a knock on effect on patient care.
We know that there are multiple determinants of health and well-being. We need to address all of these in our lives to build health and well-being
- How are we in relationships? Are we loving and caring?
- How are we with food? Is it for indulgence and coping with life, or nourishing the body?
- How do we take care of our bodies?
- How are we with our finances?
- How are we with taking care of ourselves, valuing and empowering ourselves?
- How are we with sleep?
- How are we with our self-talk, our emotional and mental health?
- Do we know how to be who we truly are in all aspects of life? Or are we boxing ourselves in, acting in different ‘roles’ in different circumstances?
As health care professionals we need to be the ones to lead the way in the health and well-being stakes to inspire our patients.
Instead at present as a whole we are more anxious, stressed and suicidal than the general public. Something is wrong here.
There are many reasons that our doctors are not thriving.
Rather than focussing on developing doctors who are simply minimally ‘resilient’ to the current stresses and strains, I propose that as part of our care and responsibility for those we train, that we prepare people to be well in life as a whole, in both medical school and in doctor training in hospitals.
If we don’t prepare our students to be well, then we are leaving them vulnerable with an incomplete education in the world. And thus far the statistics are speaking for themselves.
We need to prepare our students to be well. And we need to design our systems to support our doctors to be healthy and well and not simply ask them to put up with systems the way that they are when they are not honouring of dignity, decency or respect of general human rights.
Care for people is the foundation of health care. To move forward as an institution that leads the way in health care we need to place care for all people firmly at the foundation of our training and our work ethos, beginning with our medical students.
As part of that care, it is important for us to design programs that not only teach students about the nitty-gritties of medical knowledge and information but arm them with the tools to thrive and to live well in all areas of life; how to take care of themselves, value themselves and empower themselves in all areas of life.
Our educational processes and health care systems themselves need to empower our doctors and our students.
Only then will we have a profession that is healthy, well and able to consistently care for others in all avenues of life.
Dr Maxine Szramka (pictured above) is a Sydney-based consultant rheumatologist. She blogs regularly at Dr Maxine Speaks.
Doctorportal hosts a dedicated doctors’ health service providing support in the medical community.