Starting this blog, I wasn’t expecting 2000 views in 48 hours. After a few sleepless nights, I almost deleted the whole thing and swore to live out my days under a bed sheet. Then I received messages from students dealing with the same issues. I realized it is important to share my story. So thank you everyone – for the emails, support, and most importantly, your own stories. Behind the boasting and ‘I’ve got it all together’ image, the community of students struggling is bigger than you know!
On to this week’s post: The Five Steps to Burnout
1. Aim for scores. Know your desired Step 1 score to the last digit? Good! You’re on your way. Every time I received a ‘just ok’ exam score, I’d bang my head against the wall and decide something needed to be fixed. I went from First Aid to flashcards to Anki to books to FA. Stopped going out on weekends. Listened to lectures in my car. Suddenly, medicine wasn’t a fulfilling exploration of learning. I studied for the sake of studying. Those of you who get your drive from the heart and beauty of learning – beware the score motive.
But under the firehose of information, how do we gauge progress? We have little other reference data. When our only comparison is a bell curve of the nation’s top 5% of academic achievers, the conclusion is I’m doing something wrong. If I’d just skipped that party last Friday.. that fifth House of Cards episode …
2. Multitask your free time: Most schools discuss burnout avoidance. Go out with friends, watch a movie, exercise. That’s great – if you’re mentally engaged in it. If your mind is ruminating on things to be done, time away feels brutal.
This was common at the ‘Professionals in Crisis’ program. We had mandatory play therapy. Art, music, crafts. One patient wore business attire every day. It was amusing to see a large man, ready for the boardroom, beading bracelets for his wife.
But, we complained, what are we doing to get better? A lawyer got so annoyed he declared that he was leaving. “This is ridiculous. Do you know how much it costs us to play Taboo for an hour?” The moderator smiled. “I know that you do, and that’s why were doing it.” He stayed.
Because the path to burnout is losing the ability to live in the moment, and count the minutes by hours billed or flashcards studied.
3. Engage the stress cycle: Med school small talk goes like this: Do you use flashcards? No, I memorize the lecture notes. Well, I only use First Aid. it’s the only way…
I imagine these non-productive conversations drive us all insane, but we get sucked in. It’s a common interest with classmates we don’t know well. It’s also anxiety provoking. Like discussing the weather, if the weather was El Niño and you wanted to determine who is most likely to save their home.
This reduced my first year stress: I wrote a list of alternative topics, and used them whenever conversations veered to studying or negative hospital rants. If that didn’t work, I’d recall something important and politely step away. It takes effort. Awareness is the key.
4. Be pathologically perfectionist. Perfectionism is a sub-category of OCD. Many physicians meet the criteria – would you want your surgeon not to be a perfectionist?
- Devoted to productivity to the exclusion of leisure activities and friendships.
- Preoccupied with details or organization to the extent that the major point of the activity is lost.
- Perfectionism that interferes with task completion (is unable to complete a project because his or her own overly strict standards are not met).
UpToDate: Personality Disorders
The italics highlight the line between strength and disability. Now, I don’t know what it’s like to get kicked in the cojones. Based on how it looks, this is what I felt receiving a bad grade or negative feedback. At Menninger, I learned I met the requirements of perfectionism based on my struggle with being ‘average.’ This became amusing later, when my doctor had concerns about my clinic feedback. I considered it positive – 7 out of 10 (ten being an outcome not requiring me to be at said clinic).
“The scores you gave us were about average,” he told me.
“You mean,” I laughed, “you don’t like to be average?” He grinned sheepishly. We had a conversation about the prevalence of OCD/perfectionism in medicine. Had I been the top of my class, I might have never known I had a problem. When I wasn’t, my brain went on strike.
5. Don’t allow alternatives: This is a critical one. When I became pre-med, I knew admittance could be a crap shoot. But if I didn’t get in, I reasoned, the education and research experience would be applicable in other careers. Shoot for the moon, and you’ll land among the stars. The problem was I got to the moon and the stars were no longer acceptable. After reaching the top, how could I possibly do anything else?
Then there is student debt. A recent study found medical school debt is tied to depression, burnout, and alcohol abuse. I can see why – debt steals our ability to choose not to finish school. Becoming a physician loses some magic without the freedom of agency. As neuroscientist Paul Kalanithi wrote in When Breath Becomes Air, it is too much work to be just a job, it has to be a calling. (If you haven’t read his book, put down those flashcards and do it now.)
This last one is unique to each of us. You may not experience it. But I think it is why I couldn’t even consider re-opening First Aid before I allowed myself the option to not going back.
There is a sixth factor in medical school burnout. It’s complex and important, so I’m saving it for another post: The environment of cynicism. Where does it comes from? How do we deal with it? Does it really get better after medical school? I’ll be asking docs across the spectrum.Until then..
Have other burn out factors affected your life? Found ways to deal with them? Comment below!
Confessions of a Medical School Dropout 
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