A study of medical students in Brazil found that 38% of them had at least 10 of a list of 63 depressive symptoms during their internship years –
Affective symptoms represent the core symptoms of a depressive mood, based on students’ reported levels of sadness, dissatisfaction, episodes of crying, irritability and social withdrawal. The cognitive cluster assessed pessimism, sense of failure or guilt, expectation of punishment, dislike of self, suicidal ideation, indecisiveness and change in body image. Finally, the somatic cluster assessed the presence of slowness, insomnia, fatigue, loss of weight and loss of sexual interest
Such study results are both shocking and no surprise. A junior doctor’s job is highly stressful for a host of reasons. Pretty much every doctor I know would identify with the symptoms highlighted by the Brazilian researchers. When I read this I wondered these two things –
Does such a training make for better doctors? I doubt it. Such an experience is something to be survived and whilst I’m well aware that difficulties and even illnesses can teach us a lot about ourselves and even contribute to our growth, I wouldn’t recommend dysfunction and disease as the best teaching methods!
These experiences are more likely because we pay insufficient attention to the humanity of the real people who are health carers (the parallel to paying insufficient attention to the humanity of the real people who are patients). We practice a system of medicine which is focused on tools and techniques, not least on drugs, because our clinical focus is disease (lesions, pathology), not health. The rise of something called “Evidence Based Medicine” has made this worse. “EBM” is based on the statistical analyses of experimental “controlled” trials. The design of these trials is intended to “control for” the human factors in order to reveal the specific treatment factors ie the effects of the prescription, not the prescriber. It is virtually impossible to read in any significant clinical trial who the actual carers were. It’s as if they don’t count. They are irrelevant. But they aren’t. And until we change our values in health care and give a higher priority to the fact that health care is delivered by real people to real people then we aren’t going to change the outcomes.
Is it impossible to imagine a medical training which doesn’t cause depression in a third of the people who embark upon it?
Heroes Not Zombies 
Excellent article, Bob – really hits the spot! Isn’t the problem, though, more widespread amongst doctors than just amongst those that are undergoing their training, and isn’t it also evident in other professions? I’ve known GPs and other doctors, well into their careers, who display the same depression-related symptoms because of the pressures they’re under. And in my (admittedly brief) time in private practice in the legal profession, I’ve seen lawyers who suffer the same, because of the pressure to work inhuman hours, rack up the fees and win new clients, knowing if that they make mistakes or fail to meet their targets, they’ll be out of a job. And I’m sure it’s the same in other professions. As well as the problem which you identify, of the kind of medicine doctors are expected to practise, there’s the constant pressure on everyone to make bigger profits (private sector) and/or to cut costs (public sector). Another way in which we as a society fail to pay enough attention to the real human beings who do the work and provide the service.