Wayfaring MD
And for the 5,000th time, let me clarify that I am female.
Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes.
Dr. C: How can you know the difference between depression and burnout in residency?
JB: By how you act when you’re on vacation.
I am a senior in high school and I want to become a doctor, but medical school seems… Tiresome and depressing. I feel like once I get there I’ll be so isolated and alone that I will give up. How does one handle that? It just seems so daunting to me. But medicine is my passion and I don’t want to give it up! -scienceofthes0ul
Well friend, you have judged medical school correctly…sort of. It absolutely can be tiresome and depressing, and it is at times (and residency moreso). But the cool thing is that when you’re tired and depressed, most of your friends are probably feeling the same thing.
That doesn’t sound very comforting, but it kind of is. You will be surrounded by people who are just as miserable as you are, and they can empathize with you and you can use each other to get through. It’s funny, I spent less time with my friends in med school than I did with friends in undergrad, but I was much closer to my med school friends, and I think it’s because of this miserable dynamic.
Take my best good friend, for example. We somehow managed to get every 3rd year rotation together, which was a godsend. She kept me sane, for real. And during our 4th year when we parted ways for much of the year, we still called each other almost daily to share crazy patient stories, catch up, and commiserate.
But just in case you’re not lucky enough to find a best good friend in med school, here are some tips to avoid isolation, depression, and burnout.
Yet another picture tagged with #drugs and #depression and #bipolar to shock and gain attention, and yet these are birth control pills. Last I checked, Yaz was not an effective treatment for bipolar disorder.
Today my pastor’s sermon was on depression, and while the overall message was very good, I got a little bent out of shape about one comment. He talked briefly about some folks he knew who had attempted or committed suicide, and he said “and these weren’t single people. They had families and stuff to live for”.
Good to be told I have nothing to live for.
Can you give me tips on dealing with depression? I’m a second year med student (on a international university, so is second year of six) who really loves medicine, especially surgery, but feels that does not have what it takes to be successful, to be a good doctor. I’m constantly thinking, “I’m not good enough, not that smart, I don’t have the abilities…” :S (can you please answer this on anon?)
I once told my mentor (and imo the best freaking doctor in the history of ever) that I didn’t feel like I was smart enough to be a doctor. This was like late in my fourth year of medical school, so I should have felt more confident, right?
Her (very wise) response?
“I wake up every day and think I’m not smart enough for this job. That’s what keeps me reading and learning.”
The point is, none of us feel good enough, smart enough, compassionate enough, competent enough, etc, at least at some point in time, if not all the time. The people who claim they do have everything under control are the ones most in danger of hurting someone because of their arrogance. Shoot, I have the “I’m not smart enough to be a doctor” thoughts at least weekly, and I’m already a doctor.
Lately I’ve been seeing a lot of posts on my dash where people talk about misusing their anti-depressants. Some take an extra because they had a bad day, while others will go without for a few days just to see if they can. These posts really bother me and worry me, and I’d like to clear some things up.
1. Anti-depressants (SSRI’s) are not magic. Please hear me when I say that their purpose is not to make you happy. Their purpose is to treat depression. They are there to get you out of the funk so you can function like a productive member of society. Presumably they bring you back to a physiologic baseline, which you can then improve upon with prayer, counseling, meditation, lifestyle changes, etc. Happiness cannot be found in a pill.
I got so many questions the last week about my thoughts on antidepressants and anxiety medication. And 99.9% of the people I were talking to, were reluctant to seek professional help, because it would mean that they have failed.
THIS!!!
As another example, would you get mad at your immune system if you got the flu? No, you just take medicine and get back to your old self! You can’t kick yourself or blame yourself for not being able to will healing into existence, whether the disease is the flu, cancer, or yes, even depression.
What is your advice for encouraging medical professionals to pay more attention to the patient in front of them and less to their preconcieved notions regarding their diagnosis? (Mostly mental health related)
-sweetnessspokane
- Depression or anxiety can look wildly different in different people. A 75 year old widower will present very differently than a 15 year old girl, 40 year old housewife, or 35 year old businessman. Don’t expect everyone to come in complaining of SIG E. CAPS type symptoms. You have to dig for that
- Don’t assume they’re not taking their medicine just to spite you. Ask them. Maybe they can’t afford it, or they’re having unpleasant side effects, they don’t understand how to take it correctly, or it’s just not working for them.
- Don’t forget that their psychiatric diagnosis can affect their other medical diagnoses and vice versa.
This is why I love primary care: I get to form relationships with my patients, learn about their struggles, and watch them change and grow.
I have a patient who has treatment-resistant depression and multiple medical problems. I’ve seen her 3 times in the office since I started residency in July. Every time I see her, she looks like the “textbook” depressed person we learn about in medical school: slumped over in her chair, slightly disheveled, eyes trained on the floor, making very few facial expressions (flattened affect), talking & moving very slowly—if she moves at all (psychomotor retardation).
The first time we met, I asked if I could pray with her. She was, like many of my patients, both surprised and delighted by my question. At the end of my prayer I looked up and she was smiling. Not a full smile—the type that shows in the eyes—but an upturning of the corners of her mouth nonetheless. She asked if she could give me a hug, and I obliged. Our second visit ended on a very similar note: half grin, hug.
Can you give me tips on dealing with depression? I’m a second year med student (on a international university, so is second year of six) who really loves medicine, especially surgery, but feels that does not have what it takes to be successful, to be a good doctor. I’m constantly thinking, “I’m not good enough, not that smart, I don’t have the abilities…” :S (can you please answer this on anon?)
I once told my mentor (and imo the best freaking doctor in the history of ever) that I didn’t feel like I was smart enough to be a doctor. This was like late in my fourth year of medical school, so I should have felt more confident, right?
Her (very wise) response?
“I wake up every day and think I’m not smart enough for this job. That’s what keeps me reading and learning.”
The point is, none of us feel good enough, smart enough, compassionate enough, competent enough, etc, at least at some point in time, if not all the time. The people who claim they do have everything under control are the ones most in danger of hurting someone because of their arrogance. Shoot, I have the “I’m not smart enough to be a doctor” thoughts at least weekly, and I’m already a doctor.
For those who missed it due to late night posting.
Can you give me tips on dealing with depression? I’m a second year med student (on a international university, so is second year of six) who really loves medicine, especially surgery, but feels that does not have what it takes to be successful, to be a good doctor. I’m constantly thinking, “I’m not good enough, not that smart, I don’t have the abilities…” :S (can you please answer this on anon?)
I once told my mentor (and imo the best freaking doctor in the history of ever) that I didn’t feel like I was smart enough to be a doctor. This was like late in my fourth year of medical school, so I should have felt more confident, right?
Her (very wise) response?
“I wake up every day and think I’m not smart enough for this job. That’s what keeps me reading and learning.”
The point is, none of us feel good enough, smart enough, compassionate enough, competent enough, etc, at least at some point in time, if not all the time. The people who claim they do have everything under control are the ones most in danger of hurting someone because of their arrogance. Shoot, I have the “I’m not smart enough to be a doctor” thoughts at least weekly, and I’m already a doctor.
I’d bet good money that if someone gave medical students depression screening tests every 2 months throughout their 4 years, the scores would peak around Step 1 study time (sounds like a good research project for someone out there… holla at me cuz I want my name in the acknowledgements).
Maybe I should submit this diagnosis to be considered for the DSM-VI.
Step 1 study time was the darkest point of medical school for me and many of my friends. You’re sitting at home (or in a cinderblock, no-windows library study room), in a chair, not moving for hours on end (in my case, getting a nerve compression injury from the awkward way you sit in chairs), studying for what will be the hardest test of your life (so far). You’re already tired from 2 years of reading 10 hours a day, and now they tell you to study twice as hard as you have in the past. They want you to feel dumb so you’ll study more.
“Do ALL the practice questions!” they say. “Read ALL the books!” they say. “Do it ALL without sleep!” they say. “But still have balance in your life!” they say.
They are the gunners, the out of touch professors, and the cracked-out student doctor network anons. And they don’t know what they’re talking about.
taking your depression medication 4 hours late DOES NOT INDUCE DEPRESSION. I’ve discussed this before, folks. Even if you’re on depression meds, you can still have a bad day. 4 hours of being down in the dumps does not depression make.
This has been a public service announcement.
butternutgutterslut Asks:
wayfaringmd Said:
Thanks for letting me answer this publicly. I think a lot more people probably have the same issue as you and don’t know if they can bring it up in an interview.
If you’re ever given a chance to explain a bad grade, take it, especially when you have a legitimate reason.
Whether it affects the interviewer’s opinion of you depends on the interviewer. Some may not be very understanding and may see depression as an invalid excuse. Hopefully, though, your interviewer will be an MD or PhD who understands that depression affects all aspects of life, and that it is not something that you could have prevented from happening.
If I was your interviewer, I would see your struggle with the depression the same as a more physical chronic disease. Both would make studying and keeping up with school work difficult—depression maybe even more so because it affects your concentration and motivation and makes you feel completely blank.
How you approach the subject is important, I think. As an interviewer, there’s nothing I hate more than a canned response to an expected question. Be honest. If you are flippant about it and say simply, “I was depressed that semester,” the interviewer will probably not take you seriously. But if you expand on it and talk about your struggle, they will likely be more understanding.
It’s equally important to talk about how you are managing to deal with your depression. As with any other obstacle in life that could hurt your performance in school, you need to let your interviewer know that you have tools to help you overcome it. Talk about what has worked for you, and if the struggle is ongoing, own up to it. You want your interviewer to know that your depression is under control (if it really is) and that your grades are not going to drop like they did before.
I’m sure you’ve heard that you always want to spin a potential negative thing into a positive thing in an interview, so talk about how you’ve grown from the experience or how you’ve learned to cope, and how those skills will be useful as a medical professional.
I assume your grades are better now, since you said all this happened last year. One bad year, especially at the beginning, can be balanced out in the end. Keep up the good work, and whatever you’re doing to control your depression and anxiety, keep at it.
Lately I’ve been seeing a lot of posts on my dash where people talk about misusing their anti-depressants. Some take an extra because they had a bad day, while others will go without for a few days just to see if they can. These posts really bother me and worry me, and I’d like to clear some things up.
1. Anti-depressants (SSRI’s) are not magic. Please hear me when I say that their purpose is not to make you happy. Their purpose is to treat depression. They are there to get you out of the funk so you can function like a productive member of society. Presumably they bring you back to a physiologic baseline, which you can then improve upon with prayer, counseling, meditation, lifestyle changes, etc. Happiness cannot be found in a pill.
2. There’s a reason why your Zoloft bottle says “take once a day.” SSRI’s do not work like a rescue inhaler. This is why your doctor tells you that you shouldn’t expect results for a few weeks after you start taking them. They have long half-lives, which means they stay in your system a while after they’ve been taken, and over time their effect sort of builds up to a point to where you start to feel an effect. Taking an extra pill is not like a 5 hour energy shot for your mood. That’s just not how they work. If you do feel an extra “boost,” it’s placebo effect most likely. There are drugs out there that can be taken on an as-needed basis for anxiety, but SSRIs are not in that class.
3. If you’re feeling better, good, the meds are working! When it is time to come off your meds, it needs to be done with your doctor’s supervision. Don’t just stop them because you feel better, and don’t stop them for a trial period. These things work slowly. Many doctors taper people off of SSRIs, meaning they lower the dose gradually until you stop, because just like it takes a while to build up, it takes a while to get out of your system. So stopping for a weekend really does you more harm than good, and it’s doubtful that you’d be able to tell much of a change in that time anyway.
So let’s say you are on SSRIs and you have a bad day. What can you do instead of take an extra pill?
How about talk to a family member, friend, or counselor about why you had a bad day? You need someone you can trust to talk to. And I mean talk to someone who will talk back. Blogging and journaling are useful, but feedback and empathy are extremely helpful too. Heck, you can talk to me (Skype: WayfaringMD) if need be. How about write about it, doodle about it, paint-by-numbers about it? How about get some exercise (endorphins are natural mood boosters)?
And what if you’re feeling much better? What then? How about give it longer than a week. Give it a month. If you’re still feeling much better, ask your doctor about how you can come off your meds safely. Believe me, doctors like being able to take people off of medications.
End rant.
