It’s hard to imagine having someone’s life in your hands. It’s also hard to imagine what could possibly prepare a person for the emotional cost of such as endeavor as an occupation.
And we often don’t. “Much of what we require doctors to do is shielded in secrecy,” writes Caroline Elton.
However, their stories need to be told. “As a psychologist, I saw how medical training often fails to acknowledge that doctors are people too, with their own thoughts, feelings, fantasies, and desires,” writes Elton.
In her new book, Also Human: The Inner Lives of Doctors, Elton takes us inside the world of medicine, sharing the emotional complexity, suffering, and the impossibility of balancing competing human and professional demands.
It is a world unlike what we might imagine. Elton points to the New York University dean’s response after a final-year medical student jumped to her death: “Referring to research from the mayo Clinic, he described a ‘national epidemic of burnout, depression, and suicide among medical students.'”
Uncertainty, unimaginable challenges, and a turnstile that never stops demanding ever more perfection often result in long hours, work related anxiety, and despair at a clinical load that is well beyond saturation point.
Elton describes the tragic death of Rose Polge, a junior doctor in the UK who walked into the sea and drowned: “This tragedy received widespread newspaper coverage at least in part because it occurred when junior doctors had taken the unprecedented step of going on strike — the first in forty years — in protest against the imposition of a new working contract.”
While stories like that of Rose Polge shock us, for Elton, a psychologist who has spent years working with doctors, being at the “edge” is all too familiar.
She writes, “Aren’t there better ways of training our future doctors? Ways that mean they don’t need to phone twenty-four hour helplines, or send desperate emails to unknown psychologists in the hope that someone out there will listen.”
The first Wednesday in August — the day when all first-year doctors start work — is just one example. For Hilary, one of Elton’s patients, it also happened to be the day when she was left alone on her ward, with no supervising consultant to turn to while treating a patient that appeared to be dying — an experience that colored her feelings about her profession even ten years later.
The month of July — when medical students become junior doctors and take their first jobs — is another telling example. Elton quotes a recent commentary in the journal, Academic Medicine: “Length of hospital stay, duration of procedures, and hospital charges peaked during the month of July. Of note, rates of patient mortality also increased during this period.”
The transition from medical student to doctor is particularly fraught with challenges. For one, students may excel academically while scoring poorly on their Situational Judgement Test (SJT), which often plays a role in determining their final placement, meaning they may end up living in a part of the country where they know no one.
Aside from judgement, medical students’ mental health is highly scrutinized, and receiving a formal diagnosis (of depression for example) can mean being singled out as weaker and vulnerable.
The question Elton asks is: “What does the fact that it is nearly impossible to declare a history of previous psychological difficulties say about medical school culture?”
It is a problem the profession doesn’t seem to want to admit. While a major international review of fifty-four previous studies involving seventeen thousand physicians in training and published in the Journal of the American Medical Association found that the extent of depressive symptoms in trainee doctors was extraordinarily high, an accompanying editorial argued that there is a fundamental mismatch between the system of training for doctors and the current practice of medicine.
“Death, dying, distress, and disease are inescapable components of a doctor’s work,” writes Elton.
Psychological stress such as this often overwhelms our capacity, and yet the medical profession seems to give little attention to how to detect psychological stress, exhaustion, or overload. One example Elton notes is certifying the death of a baby.
She writes, “A list of instructions is ideal for putting together a piece of furniture or guiding one through a new recipe, but it doesn’t begin to address the emotional complexities of certifying the death of a baby.”
Doctors often want to satisfy the expectations of their families and avoid their disappointment while also struggling with the desire to remove themselves from the burden of clinical responsibility. And yet, as Elton writes, “There’s not a single study in a medical journal that describes how doctors can be pulled in two directions simultaneously.”
Medicine has advanced dramatically in recent years and, for many of us, this has meant longer, healthier lives. For doctors, however, advances in medicine have created an unimaginable burden while ignoring the tremendous psychological toll doctors now contend with.
Also Human is a haunting, poignant, and urgent reminder of just what it takes to bear the burden of saving lives.
Also Human: The Inner Lives of Doctors
Basic Books, June 2018
Hardcover, 366 Pages