COVER STORY
The hardest thing about medical school isn’t learning medicine. It isn’t the hours spent cramming information that you’d forget a month later. And it isn’t the continuous tests either. It is actually you signing away control over years of your adult life.
When I started my final year last January, I felt like I was stepping onto a conveyor belt and would not be allowed off for twelve long months. For the entirety of 2019, my days were planned for me, my hours spent at the hospital and in classes were set, and my attendance was mandatory. My classmates and I were marching through a pre-determined set of rotations, the lowest-ranking members in every department we were a part of. What this essentially translates to was a year in which we no longer even had control over when we went to the bathroom or get tea (read: chai) break. We often joked about the kidney injuries we had undoubtedly sustained rounding and retracting for hours. We joked about it because there wasn’t really anything else we could do. It felt better to take a hit to our creatinine than take the risk of complaining to the senior doctors who were evaluating us. It was, in every way possible, a happening year.
As we approached the year end, I watched my classmates grow increasingly disenchanted with and frustrated by their experiences in the hospital. A friend who was dead-set on going into OB/GYN had to rethink her future after spending six weeks being belittled and ignored on her OB/GYN rotation. Multiple classmates had been blindsided when they discovered that consultants who’d given them nothing but praise during their medicine rotation had absolutely slammed them in their final evaluations. Another person has been so put off by the lack of concern for our well-being that he very well might not do a residency at all. I was myself unable to decide what specialty I wanted to pursue for residency. Ironically, the increase in variety of clinical exposure and setting in final year had left me more confused than clear, and any sense of decisiveness that I possessed earlier regarding my choices dissipated by the time final exams began. Much to my chagrin, I am still undecided about my future in medicine.
There’s no reason it has to be like this, and yet it seems like every month we see a headline about a medical student or resident committing suicide. It’s no secret that depression and anxiety are common in medicine, but that knowledge has yet to spark any meaningful discussion of what is driving members of our community to take their own lives and what we can do to change that. We continue to operate in a system that denies us any control over our own time and offers us little reprieve short of dropping out of it entirely. It’s a system in which one feels very small and powerless to question the way things are done. More often than not, junior doctors and residents are subject to unsolicited attention by the general public and media, continuous threats by patients’ families, attacks by lawyers, medico-legal cases in the court, and being held accountable for things that are not in their domain and complications and deaths of patients not under their care. It is no longer a surprising revelation that some people feel there’s no way out.
“Burnout” has become a bit of a buzzword in medicine, but that hasn’t translated into substantive changes. While schools have made an effort to reduce stress and adopt new teaching methods during the pre-clinical years, the basic structure of the final year has gone unchanged for over two decades. After three years in which theoretical knowledge and basic sciences are medical school’s primary focus, we found ourselves experiencing a very different educational model. As final year students, we were shunted from team to overworked team, filling a role that was typically redundant and frequently unclear. It was difficult to stay focused on the task at hand — learning to be a doctor — with the sense that you are ultimately rewarded not for your ability to care for patients but for your ability to meet the often conflicting expectations of the senior members of your department. This gradual, but unavoidable shift in our focus often made us feel that our education was the lowest priority. At the end, it boiled down to studying to pass the exams and get out of this rat race whilst still keeping our sanity intact rather than studying to actually save lives.
Medical students become easy victims to an arbitrary and opaque system of evaluation. Their grades can be more dependent on whom they work with rather than their actual performance. There is plenty of evidence demonstrating bias against women (and sometimes men) and minorities in these subjective evaluations. However, there has yet to be any real movement to improve that system and protect young doctors against these biases, and ultimately reduce the student burnout they engender. This only gets worse when junior doctors and residents work under Senior Registrars and Consultants who are ruthless and don’t do their part of the job. In a country like ours, where primary health care is almost non-existent and inefficient, most of the consultants earn big through private practice and their duties in public hospitals aren’t deemed worth their time. This lack of professional and specialist care in public hospitals leads to general patient dissatisfaction. After all, only two percent of our population can afford going to private clinics for “specialist doctor”, whilst the rest of the patients go through an arduous process of waiting, and not getting enough time and attention from doctors. Organizations such as YDA (Young Doctors Association) do their part in raising the issues surrounding unfair wages, extremely long working hours and lack of support from the health sector, but these protests are immediately shunned.
With multiple problems to grapple with, as medical students and health professionals, it is hard to imagine a time when our country will have an organized health care system. There is no one to directly blame in this process. The government needs to prioritize healthcare on an emergency basis, or else competent doctors will keep on moving out of the country permanently.
I still love medicine. For every negative experience I have encountered, there were many more positive ones. I have worked under seniors who genuinely cared for and prioritized our learning, helped take care of patients, something which has reinforced my faith in medicine as this was why I was drawn to medicine in the first place. I learnt more in the several months of ward rotations than I would have thought possible. However, medicine’s surrounding culture, its unforgiving nature and the over demanding senior doctors in the field, present something I find hard to assimilate.
My classmates and I still talk about how we would treat our medical students once we are residents: fairly and compassionately. Although I can’t imagine that the residents we are working now with had dreamed of becoming capricious and desensitized. So what changes between now and then? Will we lose sight of our values and perpetuate the same unfriendly system as we begin to ascend the ranks? What will it take to change the prevailing view that medicine is something you have to suffer for? I have no problem with hard work, but as a very tiny cog in a very large machine, I have never felt like I had so little autonomy. It is that sense of disempowerment — more so than endless ward tests or 5 a.m. wake-up times — that is beginning to wear away my love for this field. I don’t think I’m the only one.
The author is an aspiring doctor in Lahore.