Every few months, the mental health of doctors/medical students makes it to popular media. It seems like these spikes in attention occur, and everyone shouts YOU SHOULD CARE FOR YOUR DOCTORS! and then we write blogs and we tweet and we make youtube videos and eventually we go back to work, and nothing has changed.
I think we are the missing link. And by “we”, I mean qualified doctors. And also, you, the older doctors. (Yes, I called you old. It’s not a bad thing.)
Hospital administrators are not our colleagues, and they are never going to care in the way we want them to. WE are OUR community. Medical Students are our community. And interns. And medical officers. (You get it.)
You have trained them. You teach them patient care. You take responsibility for their readiness to practise in real life. You offer them clinical guidance. Not to say they aren’t autonomous, but the nature of medical training is that future doctors are shaped by current doctors.
We are not simply the seniors to our juniors. We are their guides. We are their mentors. We see them enough that they may as well be our family. We become primary influences in their careers, if not their lives.
We invest SO MUCH into the training of young doctors. How can we not care about their mental health, when poverty in mental health may very well undo all our hard work in raising them?
And I think we do care. We do. But we should be advocating for them.
My suggestion is not that every doctor offer counselling to their juniors, or invites them to dinner (though you’re welcome to do that).
When I was a medical student, our campus of around 2000 undergraduate medical and allied health students had a single therapist, who wasn’t even employed to work every day. The waiting list to see her was absurdly long. Sessions were paid for by the university, but very few of us actually had the opportunity to utilise it.
A single therapist CANNOT serve a campus of two thousand students, not even on full-time basis. These are students who have sacrificed a lot to study medicine. Students who have left home for the first time. Students who are overwhelmingly A-type. Students who have to face the reality of illness, and patients dying, and being exposed to HIV through their studies, and have to grow up overnight.
It is not the minority who need therapy, it is the majority. And if we won’t enforce debriefing and/or therapy in the name of autonomy, we have to at the very least ensure that it is available and accessible to all medical students.
We asked for this when I was a student. We asked and asked, and we were diplomatically turned down. Maybe we should have demanded. But really, medical students don’t have much clout when it comes to their universities.
But doctors do. Alumni do.
Don’t tell me there are no funds. I’ve served on student government and faculty boards and the Senate of the university. I’ve seen what the budgets look like, and how excuses are found for surplus funds. I’ve seen how quickly funds can be made available for new projects.
If it matters to the university, they will find the funds.
So what I’m saying is: as professionals, we have been absent. We have voiced our concerns, but we’ve done very little to bring about systemic change. Maybe because we so often work in systems where we don’t have the ability to change anything.
But now it’s time to wake up, and to advocate for our “babies”.
I really believe that a medical student who is comfortable with therapy, becomes a physician who is comfortable with therapy; one who is comfortable with addressing the mental health of their colleagues, and one who can identify when their own mental health is spiralling out of control – and then do something about it.
I don’t think that focussing purely on the doctors who are already qualified, and already traumatised by their education, is enough. That is really a form of tertiary prevention and it is not enough.
We all know that primary prevention is what changes health at grassroot level, and our grassroot level is our saplings. If we really want to see systemic change when it comes to mental wellness for healthcare workers, we need to demand mental health services for medical students.
And we need to take the lead, because nobody else will.
Thank you very much for such a powerful post!
I am currently a first-year student at a medical university in Cape Town, and I can totally relate to what you are writing, even at such a very young age/ early point in my career. Mental health is quite a big concern for many of my classmates as their university feels like a major change from the normal status quo. Most people are 1 000 km away from home and combined with a tripled workload it can take its toll. Unfortunately, the university only has a counsellor available two afternoons a week, and the senior students and staff get preference, and even if you are lucky enough to get a consultation you still need to pay for it out of your own pocket. What probably exacerbates this is the mentality that we are too young to try and make a change and confront the university about it.
Luckily we have strong peer-support structures in place where older students act as “mentors” to us, but unfortunately, some of them are only into it for the extra money it seems.
Thank you for keeping this blog still going, in a way it inspired me to study medicine, or at least work harder towards my goal.
All the best!
Thanks Francois, it’s always nice seeing long-time readers here. We also had mentor systems but they were just never a safe space for me. Some mentors are really good, but very often they’re so busy trying to stay alive and to deal with their own issues, that it’s actually not fair to expect them to keep an eye on a junior. Ah, well. It’s hard to change the system, especially with all of the other problems students are trying to address at the same time. I hope it will improve. I’ll keep making my voice heard. Or seen, online, I guess.