Conversations in Mental Health

By Cathy Jiang

 

As medical students, we are often faced with uncertainty in our studies and in our future as doctors, consequently affecting our mental health and wellbeing. Max* (pseudonym), a first year resident and Matt, an advanced trainee registrar, are both working in major metropolitan hospitals and have kindly agreed to share their thoughts on this topic in the hopes that it will encourage students and junior doctors to not be fearful of talking about mental health and the impact medicine can have on it.

 

Where did you go to medical school?

Matt: Melbourne University

Max: Monash University

 

What were your experiences of placement as a medical student?

Matt: Most of my placements were in a rural hospital and GP setting which meant that I probably had a more hands on experience than if I had been in a larger teaching hospital. My clinical experience was quite variable but in general I found that most placements were not particularly structured, so my experience was largely determined by how engaged I was with the team and seeking learning opportunities, rather than being passive.

Max: To be very candid with you, as a third year I hardly went to placement. Being placed in big hospitals, it’s hard to get involved so I found it of very little benefit. However, as a fourth year I started becoming more involved and by fifth year, I felt as if I was a doctor because I made it clear I was interested and wanted to be there.

 

Did you find studying medicine had an effect on your mental wellbeing?

 Matt: During my training, the increasing pressure of progressing onto a physician program meant having to put a significant amount of extra work in to make myself competitive. The disappointment of not getting through on my first attempt was definitely one of the most shattering moments of my short career with the emotional impact not just on myself but on my family and having to pick up the confidence to try again.

Max: For me, the effect was positive. Largely because, as an undergraduate student, you go into medicine emotionally immature as an 18 year old. When you go into medicine, you are exposed to a wide range of clinical experiences and human interaction, including the more negative end which can be quite confronting. As a result, you gain a lot of professional maturity and overall I found it better for my mental health.

 

What did you do to overcome these hurdles?

 Matt: Probably the most important thing for me was having good friends who were laid back and supportive, and who provided the essential life outside of medicine.

 Max: This is cliché, but have a life outside of medicine. For me, it was my friends, family and Christian faith. In the hospital, I didn’t take things too personally and never forget that you’re a doctor. When you have this level of professional identity and self-respect, the negative opinions of others don’t put you down.

 

What was the hardest thing about working as a doctor? Any particular situations or experiences?

Matt: With the training situation in most specialties being unlikely to get any better in the foreseeable future, I can definitely understand how this will have a negative impact on many trainees’ mental health. We are constantly being pushed to be better, slowly dragging ourselves up the list, and often in the process having to do things that don’t necessarily make us better clinicians.

For me, one of the biggest challenges is dealing with difficult patients and their families as we get very little teaching or experience as students. The art of medicine transcends the knowledge we learn from books and it is essentially about managing the patient in front of you, and this is something that continues to be a challenge for me at times. 

Max: In my intern year, I worked in a major metropolitan hospital that was profoundly understaffed.  Members of my team were unable to cope emotionally due to the workload and job dynamics, and the consultants were unsupportive and dismissive of their teams’ needs. This was particularly deleterious to their mental health. As a junior medical officer, the only way we were able to get through the rotation was comradery with each other.

 

Were you given resources or training prior to/during your medical career to assist with this?

Matt: As mentioned above, what was lacking greatly in my education at medical school was having experience in non-clinical aspects, particularly in dealing with communication and conflict.

Max: We had lectures as medical students and hospital orientations, talking about mindfulness and all that. For some people that is helpful but for me personally, not so. They can provide all this information but at the end of the day, it comes down to individual circumstances to determine whether or not it is helpful.

 

What would you like to see more of?

Matt: Dealing with death is something I have learned to manage, both in terms of dealing with patient death but also having conversations with families. I don’t think it is ever too early to be made aware and to be able to discuss these types of experiences as they are an ever present reality in our lives as doctors. Knowledge is comparatively easy to learn, but these other skills take years of experience, so why not start earlier?

Max: The biggest thing is to have a healthier culture in medicine, and we are slowly getting there. Another thing is the need for more reasonable workloads. When people are overworked, that’s when they are nasty to others.

 

What advice would you give to medical students in terms of looking after mental health and wellbeing?

Matt: Try not to see medicine as your entire life. You really need to reflect on what else is important to you. Try not to compare yourself to others. Be realistic about what you need to do to achieve what you want but don’t feel that you need to replicate what others have done as this will usually lead to disappointment.

Max: The lesson for whoever reads this is that as a medical student, intern or resident, when your senior colleague cries, to have a chat with them. Don’t underestimate the capacity you have to make the work environment more tolerable.