UT Counseling & WorkLife Services

Medical Students Never Get the Blues
(Or Do They?)

Of course they do. I’ve seen many of them over the years. I’ve also seen them use counseling effectively to go on and become successful and happy physicians.

There’s a myth in the medical community that says that physicians (and by extension, medical students,) can handle anything that happens. Doctors are the ones with answers; patients are the ones with problems. This neatly divides the world into “Us” vs. “Them.” I suspect that this myth prevails because it is actually so tough to be a doctor. Any doctor faces so many painful things in his or her practice that some defenses are only practical. There are times when denial is useful.

However, this defense can backfire. It is especially dangerous for medical students who are socialized into believing this myth, and may have bought into it even before med school. When a medical student runs into some perfectly understandable feelings of depression or anxiety, if he or she believes that having such feelings would indicate inadequacy to be a physician, how can the person deal with them effectively? Especially when counseling is needed.

Consider medical school. It is both a fabulous, exciting opportunity, and a frightening, grueling ordeal. The things to be learned are fascinating. At the same time, there is so much information to be covered. That’s not the school’s fault. The explosion in medical knowledge means that every year there is more that needs to be learned. Yet we still have the same number of years to learn it. No wonder students frequently feel overwhelmed.

The pace is faster in medical school than the student has ever faced before. This is true of any graduate school. In medical school, however, students are often expected to progress in “lock-step.” There are few provisions for going part time.

Any student who has a scintilla of self-doubt (as all people do) will find that self-doubt activated and magnified at times in medical school. The student finds himself or herself asking, “Can I really do this? Am I good enough?” Then there is the realization sometime before rotations that these are actual live people about whom you will be making decisions. Even though there is a thorough back up system, this is an awesome responsibility. It is a rare student who does not question himself or herself at that point. In my experience, those students who worry about the responsibility make the best physicians, but they go through a rough time first.

Medical students are bright. That goes without saying. But because of that, they are used to being at the top of their classes. For the first time, everyone else in the class is also very intelligent. A student often finds himself or herself working harder than ever before, only to receive grades that are merely passing. This can be discouraging.

Attending physicians and residents vary in how gently they correct students. Some truly believe they should be tough on students “to make sure they can take it.”

In the meantime, life keeps on happening. There is no way to put all the other problems on hold for four years. When a student starts medical school, he or she is in a new school setting, and maybe in a whole new city. Wonderful friends from college are now far away. The student is faced with making new friends, and in a very competitive environment in which he or she may not know who is safe to confide in. For a while, the student will suffer a lack of effective support. And “for a while” is normally much of the first year, sometimes even a little longer.

The student may be in a relationship and struggling to find time for both school and the relationship. The relationship may be rocky, or it may end, adding this stress to that of school. Those without a relationship usually wish they had one. Some students are married, even have children. These ties can be helpful in keeping perspective, yet is it hard to balance the needs of family and school.

There may be family worries. Parents may be fighting, or divorcing. A grandparent may be severely ill or dying. Someone in the family may have trouble with alcohol or other drugs; perhaps the rest of the family tends to lean on the student, who has little time or energy to help yet feels guilty for refusing.

Some students are shy and not easily sociable. They tend to worry about not having enough friends. Others naturally surround themselves with friends, and are frustrated that there is less time for friends than ever before. Hobbies or other major interests fall by the wayside, even though the relief they provide is needed. How do you choose between playing basketball and studying for exams?

More students than would admit it find themselves not passing at least one test. This is a shock, and often the first time it has ever happened. Even if the student is passing everything, it is common to compare oneself to others – usually unfavorably. Many med students are perfectionists. And some students play mind games, pretending to be farther along in their studying than they are, or the like. Many students wonder if they will make it. Compounding this worry is the knowledge that probably “everyone” knows the student is going to med school. The student may worry about what to tell people if he or she leaves, or has to repeat a course or a year of study.

I hope by now I have convinced you that it is reasonable for many med students to have feelings of depression or anxiety, or both, at times during their career. That is why every accredited school has a student counseling service, which is either free or very low in cost. Feeling depressed or anxious doesn’t mean you are weak or inadequate, or that you cannot be a good doctor. It just means that you have run into something you need help with. The positive side is that medical students are bright and determined to make something of their lives. That is a good description of the ideal counseling patient. It often doesn’t take long before the student is thriving again. However, the longer you wait before getting help, the worse you are likely to feel, and your academic performance may suffer. I wish I could somehow let you inside my mind when I see a new student, and feel the respect and concern I feel, and how satisfying it is when the student goes out doing well.

If you would like to talk to someone about coping in medical school, feel free to call us at 713.500.3327. We will be happy to see you.

UT Counseling & WorkLife Services