If patients knew how psychologically unhealthy their doctor might be, many would not proceed with the treatment, says study author.
Some professions are often idealized, or in other words, romanticized for the value they hold in society. Medicine is one of them. Healthcare professionals are hailed as ‘heroes’ across nations. While this might not sound worrisome, studies are showing the contrary. Among the idealized aspects of a medical student’s life are their mental health and their threshold to deal with everyday stress. Mental health disorders are far more common among medical students than estimated. Studies advocate an urgency in understanding the depth of the situation and providing necessary support.
It is a common assumption that healthcare workers are healthier than the average population. Surprisingly, this might not be true. On the contrary, studies are showing that many of them are in a far worse state than the average population. The recommended time duration for quality sleep is 7 to 8 hours a day but most medical professionals fall way short of it.
Medical professionals represent a working population that is under extreme pressure. Their academic responsibilities are a major cause of stress and anxiety amongst them. As per a study, while a moderate amount of anxiety amongst students helps them achieve optimum performance, high levels on the other hand can have a deleterious effect on their physical as well as their mental health.
Dr Rishi Gautam, MD – Assistant Professor of Psychiatry, GWU School of Medicine (Washington, DC) led a study to understand the levels of anxiety among medical students. He worked alongside co-researchers Dr Kunal Bhatia and Dr Dhruv Gupta to study the various factors that might be causative of rising anxiety among medical students.
About the study
The study, Anxiety Levels in Medical Students (IJCP – Gautam, Bhatia, Gupta et. al ) was conducted on medical students of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. It involved the participation of 310 medical students who were asked to fill out a standard anxiety questionnaire. Based on their scores, the participants were graded into various levels of anxiety, ranging from very low to very high.
The objective of the study was to study the levels of anxiety among medical students and to see if these levels varied with factors such as examination, sex, place of residence, schooling and others.
The study found that around 48.4 per cent of the participants had abnormally high anxiety, with maximum anxiety levels (66 per cent) seen in the third semester followed by the ninth semester (49.3 per cent). It was also found that anxiety levels were found to be higher among female students than their male counterparts and it was more for hostelers than day scholars.
To get an in-depth understanding of the situation, the Health site spoke to the study author Dr Rishi Gautam who elaboratively explained the factors that might be contributing to the problem.
Sleep takes a back seat in medicine
Sleep issues are more prevalent among healthcare professionals as compared to those working in other industries. Most young doctors are falling short of the recommended hours of sleep required to maintain optimum health. Studies have shown that sleep disorders such as insomnia are common among doctors. Responding to this, Dr Gautam said that sleep is an undervalued need for most people, and in medicine, it might enjoy the least priority.
He said: “As doctors, who can understand the vital functions of sleep better than us? It consolidates memories, prepares for the next day, de-clutters our minds and boosts our attention. As medical health professionals, we need these mental constructs to work optimally and only then we might be able to cater well to the needs of our patients. Unfortunately, the exhaustive duties and stretched working hours have a direct impact on the quality of a student’s sleep and it gets badly compromised.”
For genuine answers, look up studies, not opinions
There has been a concern raised that if young doctors fail to receive vigorous training in the initial years or if their working hours are limited, it might lead to the birth of doctors who might struggle to work under real-time pressure. Hence, vigorous training and tight schedules are often glamorized by many seasoned doctors.
Responding to this, Dr Gautam said: “Human bodies don’t work differently, do they? If prolonged sleep deprivation affects a patient adversely, it might do the same to a healthcare professional. Medicine is a demanding field, there is no doubt about it. However, when looking up for the right approach towards training these students, personal biases must be put aside and all decisions must be taken based on study findings that are objective and evidence-based. A well-established psychiatric support system and a decent time for recuperation are the need of the hour for medical students.”
Burden of being hailed as ‘Gods’
Gautam explained that many professions including medicine are often idealized and this distorted social perception can be a source of psychological stress for doctors who are obliged to live up to that idealized role.
He said: “Most young doctors are under monumental stress. They stay in the hospital for stretched hours. In parallel, they might have problems in their personal lives as well. The pressure of study and work, fear of living up to the expectations they and others might have set for them and battling personal hurdles are factors enough to cause a decline in mental health. Unfortunately, most of them have no healthy sources of verbal outlet. All this stress keeps bottling up inside them. By outlet, I don’t mean scattered and isolated support systems but systematic mental health initiatives specifically designed for them and initiated at both national and local levels.”
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Gautam said laughingly: “If patients knew how psychologically unhealthy their doctor might be, many would not proceed with the treatment.”
The author explained that many medical students might find unhealthy ways of coping with stress and might engage in alcohol, drugs and other unhealthy sources of instant relief.
Gender disparity in anxiety might not be true
Females were found to be suffering from more anxiety than their male counterparts as 61.3% of them had high anxiety levels, in comparison to males, of whom 43.2% fell in this category.
When asked what factors might cause female students to rank higher on the anxiety scale, the expert explained that when the results were obtained in a controlled environment, both men and women showed equal levels of anxiety. Men’s inability to express emotions and vocalize anxiety or sometimes express failure could have caused them to score less on the anxiety scale.
Hostellers are at high risk
Gautam explained that in times of extreme stress, staying in the vicinity of loved ones can ground a person. According to him, medical students living in hostels are often those allocated seats far away from their hometowns. These students, Gautam says, might be suffering from more stress and loneliness and are also at a higher risk of attempting extreme steps like suicide. According to him, day scholars might be at an advantage as they might be heading back to the warmth of a family who might ground them if they had a rough day at work.
He said: “The seat allocation system can also implement some changes that can be beneficial for a medical student’s overall health. Instead of placing students according to rank, numbers and tests, they can also be placed in good colleges near their homes. Sometimes, language also becomes a barrier that can add challenges to the already stressful curriculum.”
Some semesters can be harder than others
Dr Gautam explained that stress varies across all semesters in a medical school. As per the study, the students of the third, fifth, and ninth semesters having higher anxiety levels as compared to students from the first and the seventh semesters, as they have their examinations around the corner. The expert said that this might also be in correlation with higher clinical responsibility.
Medicine attracts high achievers who can’t handle failure
Gautam explained that high-stress fields like medicine attract certain personalities. According to him, these students are mostly high achievers who have difficulty adjusting well to failure. They have high expectations of themselves and many of them also come from homes where relation to failure is not very healthy.
Warriors without trauma training
Dr Gautam said that even seasoned medical practitioners are taken back when a patient passes away. According to him, the hurt is more for young medical students who unlike military people have no prior training in handling trauma.
He said: “Hospitals are full of physical and emotional chaos. Having an evolving, sensitive mind, the probability of these young doctors coming back with a mental wound is very high. Whether it is death or violence, many young students do witness life-threatening situations from close by. These situations can cause irreversible psychological damage if not resolved promptly.”
Gautam also said that cases of medical negligence must be treated at microlevels where the student is not intimidated but rather given a space where he or she can own their error and learn from it. This will prevent them from frantically searching for a scapegoat.
Lower hanging fruits
While changes in the curriculum, flexible working hours and comprehensive testing are long-term changes, Gautam suggested some initiatives that could be initiated promptly.
He said: “Whatever things I am going to suggest already have an infrastructure. No heavy sums have to be spent on them. We have an infrastructure for clinical services and public health messaging already. We just have to use this already existing infrastructure for medical students. We suggest the installation of a psychological support team in such institutions which would help the students healthily tide over these stressors and assure them of full confidentiality regarding their problems. However, these implementations must be systematically implemented at a national and as well at local level.
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