Perry Crofts shares how the competitive culture of medicine and his worries about the stigma of “not coping” took its toll on his mental health
In medical school, while acquiring the knowledge I would need to be a doctor, I also picked up some bad habits. Habits like not taking time for doing the things I enjoyed, not getting enough sleep, comparing myself to others, and excessive rumination. Medical school equipped me with the skills to diagnose and treat my patients but not, as I would go on to discover, the ones I would need to deal with the stresses that the job was going to place on me.
During one of my many marathon study sessions in my third year, my bleary eyes took in the diagnostic criteria for depression. It was almost an exact description of how I felt and behaved, not just for the two weeks needed to make a diagnosis, but for the past year or longer. I went cold as I read it. I thought that I was weak and wouldn’t be allowed to be a doctor if I mentioned this to anybody. I read that as a young man the thing most likely to kill me was myself. I wrote this down on flash cards and carried on studying. I had just realised that I had depression and that, statistically, it was the biggest threat to my life—and I used it as a revision aid.
In hindsight, I realise how extreme this seems. Yet the competitive atmosphere of medicine and my worries about the stigma of “not coping” forced me to carry on as I was.
After graduation, these pathological thoughts and attitudes continued. I felt that being a doctor was all that validated my existence. It deserved every ounce of effort, every second of my time. This coupled with the enormous systematic and personal pressures I was exposed to as a doctor left me floundering in a sea of stress, depression, and anxiety. All the while, I kept thinking that the answer was working harder, staying later, studying more.
Unfortunately, my story is not unique. Cases abound in the media of healthcare professionals (not just doctors) buckling under the strain of their jobs and, tragically, in some cases taking their own lives. I was completely unaware of the need to care for myself and of the support services that are available both as a medical student and after graduating. Perhaps if trusts were as interested in my mental health as they seemed to be about my manual handling training, I would have felt that it was something hospitals were prepared to help with. If this was something more openly discussed and that you were signposted to support for, it would have reassured me that professionals had experienced this before, that I wasn’t an anomaly, and that help was there for me and I wasn’t weak by asking for it.
I now recognise how the pathological thought processes that exacerbated my depression began in medical school. My family would beam with pride at “how hard he works” and how “he’s always studying,” and I liked it. I constructed a narrative in my head of the selfless medic who sacrificed their own free time for the betterment of their patients, placing more pressure on themselves, and I tried to live up to this ideal. This archetype has permeated popular culture as well. When was the last time you saw a TV doctor taking time out for lunch?
Medical schools have a responsibility to deliver a curriculum that sets students on the path to becoming safe and effective doctors. They also have a real responsibility to equip graduates with the skills to prevent the pressures of the job taking a heavy toll on them—not as a tokenistic, tick box exercise, but in a real and engaging way. I feel that this is an area in which my medical school failed me, and I doubt that I’m alone in this.
The prevalence of burnout and depression among medics, its consequences, and ways to prevent it weren’t discussed with us in anything more than a superficial way. If we were presented with the facts and taught about this illness, which affects us and our patients, in a more honest, personal way, then it could have made all the difference. Having our seniors and people we respect teach us about this as a hazard of the job rather than an abstract headline would remove some of the stigma. To hear another doctor—somebody I could relate to—talk openly and frankly about what they went through, how they overcame it, and the lessons they learnt would have helped me so much. To see the human consequences instead of the statistics would have done a far better job of piercing the illusion that this only happened to “other people.”
So to any medical students or junior doctors reading this, I’d like to say study hard and be prepared for long hours and night shifts. They’re unavoidable and not always fun. But don’t forget to look after yourself. Take a break from studying. Don’t compare yourself to other people. There’s so much more to being a doctor than the knowledge you need to pass exams, I promise.
Depression and burnout took so much from me, including my appreciation for being a doctor. For a while, it stopped me from giving my very best to patients and I will always regret that. If I had learnt to care for myself, built the self-care habits I needed earlier on, and sought help sooner, I may have prevented some of this fallout.
Medical students are the future of medicine. We have to take the initiative and build and maintain helpful habits and attitudes. Put yourself first once in a while, learn to get medicine out of your head for a few hours, and keep doing it.
Medicine is a huge part of my life, but my life no longer revolves around it. Being a doctor is more than a job to me, but I know that there’s more to life than practising medicine. And I’m a better doctor for it.
Perry Crofts is a GPST1 at the Princess of Wales Hospital.
Competing interests: None declared.