This reflection on current medical student attitudes is attributed to a named individual who is not related to the Anon family.
At the very beginning of her medical career, Olivia says: “ I am more than happy to share what I wrote and I am happy to be named. I am keen to avoid the temptation to distance oneself from one’s beliefs. In order to create any space in the prevailing ideology, it seems important to alert individuals to their own agency. The only way I can see to do that, is to be explicit and unapologetic with your own (easier said than done).” And continues:
I can attest to the overriding belief amongst students that admitting struggles with mental health or any other indications of supposed weakness will have a detrimental effect on career prospects and peer status. Personally, I have had fellow students ask me if going to a GP to discuss the possibility of depression goes on their medical record and know many who have avoided seeking help for this very reason.
For me, this is part of a much larger issue. Whilst these same students would accept the basic premise that we too are fallible and vulnerable to the same problems as everyone else, it is impossible for them to engage with this truth any further than that, because to concede this is totally inconsistent with the necessary and self-sustaining belief they have had more strongly to possess in order to engage with medicine as a career at all: that we are able to cope and succeed in adversity to a greater extent than others.
Whilst it is not necessarily a pleasant belief to recognise in oneself, it is not helpful to ignore that this central feature of how doctors perceive themselves to be and are perceived is inevitably internalised to some extent. Without buying into that core narrative of being exceptional from the outset, it would be impossible to enter into a profession so profoundly associated with endurance and perseverance in every circumstance of healthcare interaction and service provision.
This central tenet of self-belief and what is believed about doctors is reinforced and encouraged in the public domain: “let the GPs handle commissioning – they are an all-knowing, endlessly capable body of people”; by those applying for medicine – “ it’s very competitive, are you sure that’s what you want?!” And is constantly reinforced by doctors we encounter in many different guises – “this is a career like no other, you will be in situations where you are too tired to cope, you will suffer, you will be out of your depth, your other colleagues will not always want to help you…But it will all be immensely rewarding. Are you prepared for this?!”
Part of the identity of a doctor lies in the stories shared of handling catastrophe in the middle of the night and marshalling the idiosyncrasies of human frailty when we ourselves are at our most frail. These are the stories people want to hear and like to tell. Perhaps it is a necessary narrative, one which comforts both patient and doctor and protects them from the obscene reality. Perhaps to explode it would cause a great deal of dis-ease? I am not sure on this, but what is clear is that it cannot co-exist with a system which systematically mistreats its doctors – often including its student doctors – whilst leaving individuals to sacrifice themselves silently to the narrative.
Perhaps if the story we could be told were to be – “but don’t worry, we respect your commitment to this profession, we do believe you are up to it, we will work to ensure you have the support you need, you will only ever be required to work a reasonable number of hours, with the proper supervision you require” – that is, “there are systems in place to safeguard your wellbeing” – perhaps then the disconnect between reality and perception would be less horrifying. Legitimate struggle would be recognised as the obvious adjunct to such an exceptional profession and provided for.
I fear that many believe that the monetary benefits received for being a doctor in a nationally owned system de-legitimatises claims of poor working conditions, poor work life balance, intolerable expectations and workloads. As individuals who generally entered the profession for other reasons, guilt surrounding the acceptance and enjoyment of these monetary benefits, as well as a privileged status in society, prevent us from really taking ownership of this issue.
However, if we are to be anything like the doctors the public expect and deserve, this has to change.”
Aligned to Dr Kate Granger’s excellent campaign “Hello, my name is”, everyone working in the NHS should be able to add “and my candid concern is.”
Action for NHS Wellbeing maintains a confidential peer-support group for those working in health and (increasingly) social care. Olivia is one of our collaborative and recently shared her thinking and experience with us about the effects of current medical training on the many buried feelings and beliefs of her fellow graduates and unhesitatingly agreed that it should be shared widely.