Courtney Bercan is community health nurse at a clinic in the Downtown Eastside of Vancouver
Years later, I still don’t want to think about it, let alone type it out. Three children, babies practically, dead before me. Their parents, dead beside them.
It has now been two years since I was on a Doctors Without Borders search and rescue vessel in the Mediterranean and it’s been a slow path, at times, to finding healing and peace for the things I saw and experienced there. As my life settled into a predictable rhythm, the memories started coming out of the blue and with intensity. They demanded attention. Normally, in Canada, the process of finding closure for a patient’s death, while not always easy, is not usually this difficult. There are mitigating thoughts and phrases to help you along the way:
Sarah Tulk is a family physician in Hamilton, Ontario
Despite earnestly advocating for physician mental health, my own story has remained cloaked in secrecy. As a medical student, I felt far too junior to risk such a revelation. I watched as stigma, perpetuated by the hidden curriculum, kept my peers from seeking mental health care. Still, I kept my head tucked safely in the sand, and swore to break my silence in residency. However, as a resident the fear of jeopardizing job prospects maintained my mutism. I vowed to speak up when I was staff. Unfortunately, early in my staff career my advocacy efforts were smothered by fierce judgment and harsh consequences. I wholeheartedly renewed my vows with the ostrich approach and reconciled to start talking about mental health when I was protected by more seniority. I hated the secrecy and hypocrisy, but at least I was safe. Then I heard of another resident suicide. Then a medical student. Another resident. A staff physician. ...continue reading →
Austin Lam is a medical student at the University of Toronto.
The importance of mental health has rightly been emphasized in recent times. The stigma surrounding mental illness ought to be dispelled. However, I wish to take a closer examination at the conceptual elephant in the room: the mind-body problem — a philosophical issue that strikes to the core of continuing disparities between how the healthcare apparatus as a whole addresses “mental” versus “physical” health conditions.
As medical historian Roy Porter pointed out in his book The Greatest Benefit to Mankind: A Medical History of Humanity (1997): “psychiatry lacks unity and remains hostage to the mind-body problem, buffeted back and forth between psychological and physical definitions of its object and its techniques.” This was a prescient remark. In 2018, the editor-in-chief of Dialogues in Clinical Neuroscience, Florence Thibaut highlighted the mind-body problem and the challenge that it poses for psychiatry: “recent advances in neuroscience make it more and more difficult to draw a precise line between neurological disorders (considered to be ‘structural brain disorders’) and psychiatric disorders (considered to be ‘functional brain disorders’).”
Danielle Penney is a medical student in the Class of 2021 at McMaster University
“Doctors are jerks.” It was a statement that I had always steadfastly believed to be true; a matter-of-fact statement, just like saying the sky is blue. Though I had no shortage of concrete personal examples to justify my belief, the irony was not lost on me as I stared out from behind the glass of the nursing station, ready to begin my first clinical experience as a new medical student.
I was in the child and adolescent psychiatric ward. From the nursing station, I could see the ward’s common area: the bolted-down tables and chairs, the colourful pictures adorning the walls, the patients scattered about the room—some in groups, some alone. It was a scene that was familiar, yet different. This was far from my first time in a psych ward, but it was my first time being on this side of the glass. ...continue reading →
Rashi Hiranandani is a medical student in the Class of 2019 at the University of Ottawa
Medical school is a stressful time in students’ lives. There are emotional, physical, and mental stressors; particular daunting is the stress of being in new clinical environments on a weekly or even daily basis and having patients’ lives in our hands. Medical students are sleep deprived and over-worked. We have the stress of not matching to the residency of our choice or even not matching to a residency program at all. Medical students also experience significant burnout and compassion fatigue, with burnout rates ranging from 27 to 75% . It thus comes as no surprise that medical students suffer from rates of mental illness higher than the general population. This is not ideal for the health of the medical students, nor is it optimal for the health of the patients they care for.
A 2016 systematic review published in JAMA reported that, on average, 27.2% of medical students deal with depression or depressive symptoms . Among students who suffer from depression, only 16% receive help . ...continue reading →
Mohamad Matout is a Psychiatry Resident (R1) at McGill University
The debate regarding what should future doctors be learning during medical school is sensitive and convoluted. During the four years in which students learn basic sciences and acquire basic clinical knowledge, due to lack of time, little is taught with regards to major topics such as nutrition1, lifestyle changes, oral health2 and basic computer literacy3. One could argue that psychology is another field in which future physicians lack structured education. Our curriculum is usually centred around understanding the biology of pathophysiology and, when possible, the neurobiology of psychopathologies. While we may be introduced to the area of psychology and an understanding of pathologic defense mechanisms, the world of psychotherapy remains mysterious to medical students and physicians in general. ...continue reading →
Once an elastic band is stretched beyond its limits, it is difficult for it to return it to its unstretched state. Burnout represents a similar phenomenon: an erosion of one’s sense of self and a reflection of emotional over-exhaustion, leading to disinvestment and depersonalization. Years of intensive training, long working hours, increased managerial responsibilities, resource limitations, emotionally-involved patient and family encounters, fear of limited job prospects and litigation, and mounting clinical and non-clinical responsibilities, among other demands: physicians and other health care professionals represent a highly vulnerable group susceptible to burnout, with some estimates suggesting close to 50% of physicians being affected. Evidence suggests that physicians experiencing burnout are more likely to make poor medical decisions, share more tenuous relationships with co-workers, experience more individual and personal relationship challenges, and suffer higher risks of anxiety, depression, and suicidality. Physician burnout has also been associated with differences in overall quality of care, system-level costs, and rates of staff turnover and absenteeism.
This piece focuses on the compromise some residents and physicians make in placing themselves second while dedicating themselves to the care of others, and the silence that some encounter while struggling with burnout. It is encouraging to observe that dialogue around burnout and mental health is growing at individual, institutional, and systemic levels over time. This piece is part of that conversation....continue reading →
Hilary Drake is a medical student in the Class of 2021 at the University of British Columbia
On my first day in a new family practice, my preceptor asked me to take a history from a patient who had listed their “reason for visit” as a sore throat. I stood in the hallway and made a mental checklist of questions to ask and observations to make. Have they had any sick contacts? Does their voice sound hoarse?
When I opened the door and asked them if they could tell me what brought them in today, they responded as expected: “My throat is sore.” When I asked what they thought might be causing the pain, they unwrapped a scarf from their neck and stated, “I think it’s because the noose didn’t work.” At that point they started crying.
They had tried to come in before. They had recognized their pain and wanted to reach out for help, but they were unable to out of fear that their physician would not believe the pain if they could not see it.
Mitchell Elliott is a medical student in the Class of 2019 at the University of Toronto
Doctors are amongst the intellectual elite of society. In many cases, with decades of training and continuing education in clinical practice, our expertise grants us the opportunity to do things that would be deemed invasive and inhumane if performed outside of the context of medicine. Selectively poisoning people with chemotherapy; carefully dissecting fascial planes and removing organs; asking invasive and personal questions... all in the name of symptom management, remission of disease, and prolonging the inevitable: death. For physicians, these daily rituals become almost routine. In many cases, we have spent the majority of our lives training for the uncertainty of each day, rigorously memorizing each disease presentation and management principle, habituating to these processes and procedures. With the heavy clinical demands on physicians, it may be difficult to fully realize the impact of our actions on each patient. ...continue reading →