This week’s blog post comes from Caroline Christianson, a second year medical student at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA.
‘Write down something about yourself that has to be put on hold while you train in medicine.’
During what had so far been a passive group exercise, this prompt felt like an alarm. Everyone else calmly started writing; like a reflex, each medical student seemed to know exactly what it is about themselves that just doesn’t fit. And despite my own shock delay, so did I—the answer so obvious, it had physical representation on my chest in the form of four bright, frivolous necklaces.
In the shadows of this prompt is a persistent cut-throat culture of medicine that has long crippled the mental health of its doctors. New research, published in The Journal of the American Medical Association, suggests that this effect begins in medical school.1 Researchers analyzed nearly 200 studies of 129,000 medical students in 47 countries. They found that 27% of medical students had depression or symptoms of it, and 11% reported suicidal thoughts. Medical students are two to five times more likely to be depressed than the general population. The fast pace of overloaded coursework keeps medical students from their lives, to the point where I’ve often felt like I’m not living at all. Family is neglected, friendships suffer, and hobbies shrink in practice, skill, and eventually energy until they completely disappear.
But I still need to get dressed each morning. Fashion is a hobby of mine that will always be protected, so I’ve become increasingly invested in colors, prints, designs, and textures—behavior that feels grossly irresponsible and materialistic when contrasted with my medical education. Still, nothing has been more satisfying to me during this time than an outfit that perfectly says everything about me that I don’t have time to say otherwise. I used to regularly take ballet classes, go to art museums, and read non-fiction. While I still make small slivers of time for some of these things, my identity feels increasingly difficult to point to. Self-expression no longer has its natural choice of outlets: for me, at this time, I am my outfit that day. And if I get that just right, it feels like enough.
Intentional clothing, however, receives cautious if not negative attention in medicine, where our culture’s toxic glorification of busyness, exhaustion, and self-neglect (all, somehow, prerequisites to be taken seriously) reigns. And is this my subconscious goal—to refuse one avenue of conformation in an attempt to protect myself from medicine’s reality? This profession is threatening to suffocate me—and by all accounts, it’s not a matter of ‘if’, just a matter of ‘when’. Is my use of sequined shoes and pompom earrings a desperate scream of denial (and if so, has there ever been a greater fall from innocent fun to despair)? When will I run out of color, or when will it not be enough? When will I be told that I don’t fit? (Is today the day I accept that I definitely don’t?) Or, solemnly, am I pushing the boundaries of convention in the hope that someone will finally dismiss me from somewhere I don’t belong?
My struggle for identity in medicine as a cisgender, heterosexual, upper-class, white student of medicine is puny compared to that of others who must do so with less representation and validation from the field, but people from a wide range of classes, ethnicities, and gender expressions share my deep personal investment in the construction of identity through how we present visually in the world. So I hope that my point, even from its privileged position, at the very least presents solidarity with those groups who don’t believe that expression should have to be hidden for the sake of society’s comfort. This includes a lot of people in marginalized identity categories who don’t always receive the best health care because of bias, implicit and otherwise—a fact that forces the consideration of honest self-expression by physicians, in the stiff context of medicine, to transcend personal benefits. I don’t claim that an outfit’s bright color scheme can override generations of distrust between marginalized communities and the health care system, but I know that the white coat and other formulaic normalcies in medicine are not helping.
Our patients have long been begging this from us: How many times do we have to hear the exhausted frustration that ‘all doctors are the same’ before we wake up? From our self-involved focus on training to those neglected interests, hobbies, relationships—all that makes us human. In fact, I believe that doing so shows the highest respect for a field that imposes and demands values fostered through individuality: fallibility, humility, and empathy. It is tempting yet false to offer people at their most vulnerable, struggling with sickness and uncertainty, an absolute savoir of clarity and purity: a white coat. Instead, patients deserve to recognize and relate to the person sitting across from them, with whom they place their blind and hopeful trust. They deserve to be met with truth and humanity in all of its colorful expression.
1Rotenstein LS, Ramos MA, Torre M, et al. ‘Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis’. JAMA. 2016;316(21):2214–2236. doi:10.1001/jama.2016.17324