I hate myself. I don’t deserve to be a doctor.

DearDr.Wible-Impostor-Syndrome

Dear Dr. Wible, 

We’ve talked before. To catch you up, I’m in my clinical years now and I keep waiting to feel the same starry-eyed excitement I felt during the first months of med school, when I thought that becoming a doctor would finally give me a tangible purpose and make me a better person by helping me do right by others in a way that is meaningful. Back when I thought “Yeah! This is awesome! I can do this!”

In hindsight that was naive. I went in hoping to develop into this clever, proactive, healthy, and well-balanced physician by the time I graduated. But what ended up happening was that I became obese, started having chronic pain with no specific cause, became sedentary due to lack of will to do anything besides breathe, lost the abilities to focus, remember details, multi-task, (you know, basic cognitive skills needed to be even a mediocre doctor), and developed some kind of anxiety-depression maelstrom that blindsides you and pins you down for months at a time. 

This year has been particularly difficult: I haven’t been in the same state for longer than two months, and this isn’t even the year I’m supposed to do Sub-I’s. Aside from housemates, I don’t see any of my other classmates. The isolation (and, by extension, my inability to communicate with my colleagues, and my inability to stay abreast of any school or residency information that my colleagues have easier access to), and the rapid-fire change in care settings are so disorienting. Just the idea of applying for residency with this history of such unforeseen environmental instability makes me want to cry/vomit/dissociate/throw things. And in the midst of all this, the slow-blink of limited patience seen in my attendings makes me sure that they must think I’m the biggest idiot ever to darken their doorstep. And this is supposed to be the easy part of becoming a doctor. 

I find myself wondering what the hell the admissions committees ever saw in me when they decided to let me in. 

The other day I had a patient with a PHQ-9 score of 6 vehemently insist that I couldn’t possibly understand how he felt. “You’re right, I probably can’t,” I said. I take the questionnaire every month—self-surveillance. My baseline is 19, historical max 24. I can’t even begin to imagine what a 6 feels like. Are there really people who don’t constantly loathe themselves or fantasize about going to bed and just never waking up again?

I see my coat and stethoscope hanging on the door each morning and I feel like I don’t deserve them. I’m not intelligent enough. Not clever enough. Not charming enough. This is supposed to be a uniform worn with dignity and honor, but it feels like a daily-wear Comic-Con costume with authentic accessories, worn by someone who can only hope to play at being a doctor. I can’t stop feeling like I’ve let myself down or that I’m failing to meet the expectations of my field. I keep trying to tell myself I can improve and still be the person I wanted to be: “Success is not a matter of willpower, it’s just discipline. You want to be better? Go do better.” But mustering the will to “be better” is like a person with no tongue trying to verbally describe the flavor of cake. 

And yet, in spite of all this, my patients seem to like me. But making a sick person smile isn’t enough. Smiles help, but they don’t heal. Medicine heals, and despite my greatest efforts I’m just not good at it. So what’s left? 

I honestly don’t even think my particular med-ed environment has been abusive, really. For all its logistical shortcomings, it’s actually been quite nurturing. I think that’s what concerns me the most—what I’m experiencing now is probably nowhere near as difficult as it will be during residency (if I get in). In residency, I imagine it’s not cute or okay for you to get pimp questions wrong, and people are running around overworked and sleep-deprived, unable to take sick/maternity leave, etc. In some programs, based on testimony on your site, it sounds like if you’re still alive by the end of training, it means you’ve won—for the moment. If I’m this run-down now, what’s it going to look like when that begins? 

What you do for other doctors, health professionals, and students is really great. Feel free to share if you like. Not sure what good it’ll do, but it’s there if you want to use it for anything.

~Ben 

DearDoctorWible-Impostor-Syndrome

Hey Ben,

I totally relate to the loss of joy you are feeling as most of us start med school with the same fervor and excitement. Then reality hits. Half of us soon fall to the bottom half of the class. With all the studying, we’ve got no time to develop deep friendships. Instead, we develop trauma bonds with one another through all the bizarre things we experience together.

My first year of med school was the worst year of my life. Since I’m not a great test taker, I studied far more than most and found myself feeling very isolated too. Lack of any free time made it nearly impossible to develop close relationship as did the competitive environment that seemed to pit us against one another unnecessarily. I felt maybe I was just the sensitive idealistic oddball; however, I now know that many students felt the same way.

My medical education seemed totally inhumane and barbaric. I was most distressed by the dog labs. I was on the verge of quitting med school over these labs. Thankfully I was granted an exemption based on my vegan lifestyle. Killing dogs and torturing sheep and other animals as part of the curriculum is absurd. How does that help us maintain compassion and empathy for others? Amid my complete devastation, I somehow managed to pass my tests. No idea how I survived. Seriously. I actually did sign the papers to quit. My tuition and apartment was paid for and I had nowhere to go so I sat on the bench outside the medical library. My anatomy partner (who later died by suicide) sat down next to me and convinced me to stay. His advice: “just keep taking tests and see what happens.” I did. And I graduated.

Like most students, I felt this deep calling to pursue medicine—my soul’s purpose—so it took me by surprise that medical training itself would cause me to lose touch with the very part of me that was so devoted to this career. Like you I developed depression. I spent most of my first year crying. In fact, I cried so much that when I woke up one morning my eyes were actually sealed shut. I literally had to feel my way to the bathroom and couldn’t leave my apartment to go to class. I’ve never cried so much in my life. I felt like my soul was being slaughtered.

Ben, your travel schedule is insane and would have put me over the edge for sure. On top of all the other stressors, now nomadic students are drifting state to state, hospital to hospital, EMR to EMR. My friend lived out of her car and took showers at campgrounds to save money during her third-year rotations. Very disorienting. You are having the normal reaction anyone would have to this crazy schedule. Who could thrive in such circumstances? At least at my med school, I did all four years in one location (and didn’t even own a car)! Just walked to school in the pre-EMR days. I consider myself fortunate that way. Hey, one good thing is that in many residencies you won’t need to travel as much as med school. And just so you know, for me residency was way less stressful than med school. I actually loved residency! Always interview current residents to see if they like their program. Life can get better!

You’re essentially suffering from Impostor Syndrome. Do you realize everyone feels the same way you do (to varying degrees)? Doctors all struggle with self-doubt and low self-confidence at times. Totally normal. Many of us wonder if we really belong in medicine. We feel somehow we don’t deserve to be physicians because we’re not smart enough. Don’t worry. You are amazing to have made it as far as you have! Seriously. Most people in the world don’t have the stamina, patience, or brain power to survive one year of med school. You’re a winner. The admissions committee wouldn’t have let you in if they didn’t believe in you. 

My best advice is that you remember why you’re doing all of this. Dig out your personal statement. Remember your dream. What images or thoughts led to your “starry-eyed excitement” on day one? What kinds of patients did you want to serve? Focus on your dream. It’s the antidote to your despair. 

I actually read your letter to an intern tonight and he was nodding along because he could relate to everything you wrote—almost as if your letter was his own. I’m thinking all med students will relate to at least a portion of your letter. Let’s see. I’ll publish it.

I’m here for you Ben. So glad you wrote me! ~ Pamela

P.S. Let me know if you want to talk. I’m still old-fashioned that way. Hate texting. I love the human voice and real conversations. You know how to reach me. Oh, and you should come to our medical student retreat for free! It’s at the most amazing hot springs in 150 acres up in the mountains of Oregon. Love to meet you in the flesh.

So many medical students suffer like Ben. Impostor syndrome happens frequently in high-achieving individuals who lack the ability to internalize their accomplishments and develop a persistent fear of being exposed as a “fraud.” Remember: Nobody knows what they’re doing when they start medical school. 

Pamela Wible, M.D., is author of Physician Suicide Letters—Answered. She is devoted to saving her colleagues from despair.

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66 comments on “I hate myself. I don’t deserve to be a doctor.
  1. Christina Grucella says:

    Join us at the retreat Ben!
    Take time for yourself and meet other physicians you can share with. We are out here waiting fir you❤

    • Pamela Wible MD says:

      YES!!!! We’d all love to give you a BIG HUG!!!

      • Ben says:

        Thank you for your words of advice and encouragement, Dr. Wible. I would like to meet you in person someday!

        Although I have other interests outside of healthcare, I can’t imagine making a career in anything else. This has been my dream–while I have had periods of self-hatred, I have never hated medicine itself. I’ve spent my life wanting to minimize people’s suffering and helping them make the best of the life they have. I know this is where I’m supposed to be–it’s just that some days the scales of self-doubt and frustration are harder to peel off than they are on other days.

        An update on my situation: I’ve found solid ground for the next couple months. I’m finally in the same geographic region as a lot of my classmates (for the time being) and I have easier communication access to academic advisors and counselors to help me on my way. While my anxiety and depression still persists, it is diminished somewhat by this precious newfound stability. Hopefully it’ll allow me to get my head above water for a while.

        • Pamela Wible MD says:

          Awesome Ben! I hope you see that you have a fan club now 🙂 WE are all cheering you on my friend!

  2. Tara Zandvliwt says:

    Ben, you are not an imposter. The really good physicians know their limits, but we never doubt our patients. When we hit the intellectual or emotional wall, we ask for help.A good doctor knows they can never know everything. It is impossible. An arrogant doctor makes assumptions and always thinks he is right. A good doctor always knows they can be wrong
    That is the difference. Humility. And that quality benefits the patient always. Because you are always seeking the more. For their benefit.

    But it takes a toll, so accept you are a good doctor. And forgive yourself for not knowing all The answers. And nourish your soul with the things that give you Joy. So you are revived and can continue to help your patients. The mere fact that you question, makes you perfect for the job

  3. I felt the same as Ben, and later in my career learned two things he has yet to discover.

    1. I never became the ultra smart and super educated doctor I wanted to be. We all feel inadequate against the monstrous things that attack human beings. Yes some things were simple to deal with after memorizing the right drugs and procedures, but much of sickness is an evil monster devouring my patients slowly, piece by piece. I learned I can do a little, and Pam can do a little, and the surgeon can do a little and all together we can sometimes do enough to get the patient healthy. I learned eventually to be able to pretend I was a doctor, saying and doing enough of the right things to get by.

    2. And the most important of all is the lesson that Ben has already learned but does not understand yet. He said “making a sick person smile isn’t enough”, and unknown to him he is the most wrong he can ever be. WHEN I can make a sick person smile, I have learned that I have accomplished the greatest part of medicine there is. I now know it is the most accomplished thing I can do and does more for their healing than any medicine or procedure I can do. And I have learned it heals me to! Bringing even the smallest joy to another human is the greatest thing a doctor can do, and we get to do it often in a good career. I had to learn this years after my own severe depression which hit after my first patient died, and continued for 20 years. As a medical student in my third year, a 16 year old youngster told me he was going to die during a procedure the next day, and with a smile we sat and talked for the next several hours. I reassured him but mostly we just talked about how wondrous this gift of life was. He did die the next day, cascading me into a dark scary place that lasted the next15 years. It took a long time and a recovery from my severe depression over his death and others to realize he had actually thanked me for taking the time to make him smile and enjoy his last day on earth. To this day as I recall this I feel overwhelmed that I had a part in making this young mans passing easier. No one except a doctor who cared could have done that for him, and 30 years later I cry at how proud I become whenever a patient overwhelms me like this. I hope Ben can shortcut my learning and know that allowing a patient the room to smile, or laugh or cry with him will be the crowning of his career in medicine.

    Our calling is a rare one, we get to be present as a strong part of peoples lives, from birth to death, and yet 33 years after medical school I am still pretending to be a doctor. In reality, I have graduated from being a doctor to being a human being, a far better and far more powerful calling. And for that I have years and years of smiling patients to thank.

    • Pamela Wible MD says:

      You made me cry. Good tears.

    • Thanks for your humility; and for sharing such a deep and truth-ful message. We go through many stages in our lives and the feeling of inadequacy is one of them. Then, you continue your journey and one day , as you say, you graduate “from being a doctor to being a human being”.
      Beautiful and meaningful post,
      Dr.Aviles

  4. Greg says:

    Ben I was there. I was ready to give up. It initially took my physician to treat me but also to believe in me. I felt like such a mess. How could I be a physician. Well it was a pivotal moment when he looked at me and said Greg “I think you can do it”. Took me on rounds with him. I did need to take a slower pace in the beginning (very supportive medical school). I also exercised, meditated, surrounded myself with good positive people. I did some significant healing, learned new life skills and got some confidence back. Yes I found difficulties down the road but learned skills now to not only survive but thrive. I graduated near top of my class (not important). I was always a more sensitive and caring doctor for my experience. Patients really valued it and it helped with their treatment. The pain you are now having is preparing you to heal yourself and others. Don’t give up. Seek all the help you need. I would much rather see a doctor like you than someone who breezed thoughtlessly through their training. Yes I still have imposter syndrome despite being a very successful physician. I loved my career and am so glad I had the support and drive to keep on going. Don’t decide your path with your ego, decide with your heart. Best wishes to you. Remember “everybody hurts”- REM

  5. Debra Fant says:

    So you’re not omniscient yet? Welcome to the human family of fallible people who ‘practice’ as they learn, grow, expand. Well, that’s what is supposed to be happening but I would postulate that when people are on survival level (remember Maslow’s hierarchy?) don’t learn very readily, and when the culture is not supporting caring for oneself, you have little to give either. Recipe for feeling bad about yourself and what you’re doing. I speak as a nurse whose first spouse went the distance of med school, internship and bailed to practice as GP as he wouldn’t have lived through the whole process. Had his gun out more than once.I empathize with your distress and hear you – a very well written expression from deep inside yourself it seems, Ben. As a patient, I prefer working with those who are able to be vulnerable, to not know everything, but who have curiosity, humanity, can laugh at our human foibles, and connect with me, hear me, get who I am.
    My learning journey as “healer” has been finding how to connect deeper within to the intuitive, spirit connection where I can develop skills to trust what direction I am receiving, to ask questions and give the client choices that feel right to them. To honor there is a higher power on which I can depend, receive what I need to be nourished and to have something to give that ‘other’ who is in need.
    Seems like you are asking good questions and I hear you and care that you find your way to wellness within yourself. Google Michael Kearney from Ireland/Bay area of CA…..some good teachings about healer/heal-ee, inner journey, mentor. Blessings be yours young one.

  6. Carolyn Eaton, MD says:

    Dr. Wible has already mentioned the “Imposter Syndrome” – we all have that. The other issue, besides the clinical depression that you have already identified, is that you worry so much about becoming this idealized person, you are forgetting who YOU are. That is who you need to be – you. YOU are sensitive, caring, compassionate; therefore you start to carry the burdens of your patients and somehow feel inadequate to the task. Believe me, none of us can carry our own burden and that of so many others, so you learn to share the load. You don’t need to have every answer – we have so much technology, that when a patient asks a question – you can stop and look up the answer – if there is one. Sometimes there aren’t any answers. Today I had to be the one to tell a patient that the stroke she had a month ago that knocked out her ocular nerve was not going to heal and she would not be getting her sight back. She took it OK – she just needed to know.
    One of the changes we are making in our clinic is at the start of every meeting – we start with a “win” – it does not need to be a big win; we in medicine are so scared of failure we forget to high five the successes.

    • Pamela Wible MD says:

      Right on Carolyn. I tell docs this all the time. When you have enough time to sit with patients (especially off the assembly-line model) then you can look stuff up—together. Patient love that you care enough to look stuff up and talk to them. You don’t have to be a walking encyclopedia.

  7. Ben you are a child of God and if you had grown up with love you wouldn’t be feeling this way. The ugly duckling saw his beauty when on a STILL POND and when you quiet your mind you will see the truth of your beauty too. You want to care for people and not treat their diagnosis and can help others to do the same. Look up the poem RAGS on the internet and spread the word
    REad some of my books they will help you Love, Medicine & Miracles, The Art of Healing
    and learn from Carl Jung’s and Karl Menninger’s books too.

  8. Ben, I’m a psychiatrist, celebrating 40 years as an MD next month. I am in the business of giving people their lives back. Ben, it sounds like you are depressed. Please visit a psychiatrist and get your life back. Sure you might end up in the hands of a PHP. So what? PHP supervision is TIME LIMITED. You are an amazing, blessed human being. I want for you that you feel that again. Please seek help. Susan

    • Pamela Wible MD says:

      Oh please call me before entering a PHP. Come to the retreat first. Many docs have been healed without PHP intervention (some PHPs could make thins worse by placing you on a AA program even though you are not abusing substances). Come be with your kindred spirit colleagues who love you! xo

      • Denise S MD says:

        Oh PHP heavens no! PHP is for physicians who don’t have the insight or means to get help. IMHO.

        Ben, I keep all of the little notes and pictures and drawings my (adult) patients have given me over the last 30 years. When I lose my confidence and want to quit, I sometimes remember to look at these notes and remember the good things patients have said to me. We are in hazardous jobs and we deserve enormous respect for the risks and sacrifices we take and make. Some patients and staff really get it and let us know how much they respect us. Listen to them when you cannot tell yourself that truth. JMHO. Hugs. With respect and appreciation. Denise

  9. Bele says:

    The place where I get therapy has started making us fill out PHQ-9s. I happily fill mine out and score it for (severe range 20s) my therapist who promptly ignores it. She doesn’t need a PHQ-9 because she looks at me (not a computer) during our sessions. She knows when I’m sick with PTSD and she knows what I need to hear to keep me on the path to recovery. She knows when I feel happy confident and strong. She places my symptoms and behaviors within developmental and spirtitual contexts as well as medical. She advocates for me and tells me I’m owed every second of the 60 minutes I’m allowed with her. The PHQ-9 is a waste of paper when good clinicians can very easily see signs of depression and suicidality if they are given time to actually examine their patients!

    • Pamela Wible MD says:

      I’ve actually never done a PHQ-9s. Agree. Waste. Talk to the human being in front of you and listen closely. That’s real medicine.

      • Doctor Sal Cow says:

        Amen, sister! The PHQ-9 ends up being just ‘one more box to check.’ Ugh. There is no shortcut to caring.

  10. Dr. CR says:

    Dear Ben,
    If you have not done this already, please seek medical and psychological/psychiatric evaluations and care. You do not deserve to be suffering like this. The pressures of medical school and post-graduate training are immense, and facing them when you are depressed is overwhelming. I have a strong feeling that you are going to be one of the best kinds of doctors because you have “been there”. I am hoping that this painful period will be behind you soon so that you can shine, and even more, KNOW that you shine. I wish you the very best.

  11. DO student says:

    As a 3rd year myself, I suffered too. I cracked under pressure and shirked some responsibility but was able to coast thru 3rd year (11 weeks left!!!) I got the help i needed, some ppl get it, some don’t , but it feels like your re-evaluating your life EVERYDAY, its exhausting.

    I also sometimes get disrespect for being a DO so it hurts more.

    Get help, talk to a friend, family, see a therapist, psychiatrist or whatever you need. go out, and its ok if you didn’t finish Uworld for the week. it will get done. it doesn’t help to worry- I didn’t think I was abused either (Surgery rotation was the best anyone could ask for 7- 4! but I had a hard time getting thru and cried a lot for no reason) something wasn’t right …

    Sh*t happens. people die . its inherent in the field but we are expected to get over it, some ppl are good at it , others are not. other ppl just feel more than others, its something not accepted widely in medicine but just keep pushing, bc ppl will appreciate that about u as a doctor

  12. Doctor Sal Cow says:

    Ben, Please know that it is normal to have doubts. Frankly, I’d be more worried about someone who didn’t question this career and this life. You will be a more compassionate physician who recognizes suffering in others. Sometimes, I think medical school is hardest because you see so much suffering (not just patients, your fellow and future colleagues as well) but feel helpless in the face of it. Even listening to a patient can be incredibly therapeutic though, and often medical students have the time to do this. As for worries about knowledge….. Often, attending physicians are so wrapped up in their private worries and thoughts that they may seem distant or cold or impatient, but more than likely it has NOTHING to do with you. Definitely reach out for help when you need it; it’s ok!

  13. Karen Drodge MD CCFP says:

    Dear Ben,
    I feel the pain you are suffering with every word written in your letter. I have been where you are, have felt stupid and doubted myself completely, as have many other doctors/doctors in training. I agree with everything the other posters have said to you, in terms of suffering from imposter syndrome, to their encouraging words to you.
    I am most worried about the fact that you said you hate yourself, and are isolating yourself. That is a terrifying place to be, and can continue to spiral downwards.
    Please seek help from people that you trust, if you haven’t already done so, whether that is your own family doctor, a therapist, or a physician mentor.
    I know that in Canada, there are mental health services available for students, residents and physicians; there must be in the U.S. as well. If you have suicidal thoughts, please seek help now.
    You deserve the same empathy and kindness as anyone. When you get through this, you will realize that a good doctor is the one who cares for the patients’ wellbeing, who does their best to find answers if they don’t know them, or refers to a colleague who can help the patient; not the arrogant one who thinks they know everything and sees patients as numbers. You already have the empathy and willingness to learn within you, you just have to start believing it. It will get better.

  14. Richard A Loftus says:

    Ben, if it’s any consolation: I’ve been doing this 20 years, and *I* sometimes feel like I’m faking it. I agree with the other posters, idealists in particular can never REALLY feel like we’re at the level we want to be. I won every award every year that my residency and med school could give out–and yet I have to remind myself of that on many days because I feel like such a dumbass at least once per week. That’s just being human.
    The secret, I think, is to make sure you’re taking care of yourself–diet, exercise, stress relief, etc. so you can keep a perspective on things. And remember that “The perfect is the enemy of the good.”
    By the way: I’m headed to the SGIM meeting in just over a week, and while signing up, I laughed out loud that almost a third of the workshops had to do with dealing with burnout or building resilience. The ship of state for internal medicine is creaking and leaking at the seams. I’ve felt it myself and have made some changes recently to make sure I can (sustainably) feed my soul–which is all the more important as the practice of medicine becomes increasingly corporatized (which is a bad thing for children and other human beings, as the saying goes.)
    I agree with Dr. Wible, you should go to the retreat. The time will be worth it. You’re not alone–in fact, you are in good company with how you’re feeling. You’re simply brave enough to admit it.
    Also: Read “Kitchen Table Wisdom” by Rachel Remen, and check out her organization, RISHI (http://www.rishiprograms.org/contact/). I started a local chapter of “Finding Meaning in Medicine” to serve as a burn out prevention aid for local docs and nurses. Rachel teaches her students to repeat, every day, “I am enough.” So Ben: You are enough. For reals. Go to the retreat. You’ll be glad you did.

  15. Roshan Mahabir says:

    Do not worry about not feeling like you deserve it or you hate yourself.
    Remember you not a ‘doctor’ you are a ‘human’ you have feelings and a personality too.
    Sadly the system is set up that it tries to choke and beat that out of you.
    The fact that you still ‘feel’ and are not cold and calculated means you are still a good person.
    More people at this point are just trying to finish each rotation and move on to exam and residency….
    I remember the same feeling when I moved from hospital to hospital, country to country… No history, no pass and a questionable future.
    If you run into problems and want to talk call me or Pamela.
    646-617-0678, I am not a counselor but I know how you feel

  16. Dr.H says:

    Dear Ben,

    I have received an email, then red your letter.

    My heart goes out to you. Why? I had been there. I trained in another country, for 6 years total of medical school. I had very serious doubts that i am right for medicine in the preclinical years, as i wanted to treat patients not become a library mouse that had no time to have a life.

    The times changed when I entered clinical rotations, i saw patients that appreciated me, but the self doubt increased, as i was in love with becoming a surgeon, which was actually my childhood dream, but not where my best talents were.

    Patients were what sustained my determination to finish the medical school. I seem to have been always an odd fit for the mainstream medicine. I strongly believed in my dreams, and although doubted i will make it in medicine, that i will survive the drilling of countless exams, senseless interactions that mostly did not provide guidance, but seem to had been a perpetual bootcamp, i refused to give up my soul.

    It felt like i betrayed myself many times: physically as I did not sleep properly, did not take enough time to move properly, emotionally isolated, not having time to socialize enough, to pursue my outside interests, lost the feeling of joy that i had at the thought of being a doctor, started doubting i was as smart as my colleagues, as i seemed to need to study longer and harder to pass the same exams, to remember the same data, to apply them to real cases. I seem to have a slower speed in which everything happened for me. I will reluctantly go to my tests, thinking i will not pass and eventually seeing i was not my best evaluator, clearly underestimating what i knew.

    What was the hard part was to look at older doctors and see what they had become, how they had been trotted to such degree they were numb to us, to the pain of patients or to their own selves. I have been through many phases since then. Residency can be rough, depending where you are and what you chose. I trained here in the States, but the residency was not what i thought will be. It was more reality that came in, that medicine had degraded even more, attending at the interest of other parties than actually the poor patients and even less or non existent to the quality of life of residents and doctors.

    What did I do/What can you do?

    I realized that surviving medical school and residency IS a great accomplishment. Unfortunately, true. It is more than you can possibly imagine or care for now. The conditions under which we exist in Medical school will never be a thriving environment for normal human beings. Isolation, lack of sleep and proper food and time to rest, not even talk about play, all kinds of other considerations like finances and actual conditions under which we learn, makes this more like a survival matter.

    I realized later, when i became a psychiatrist and actually ended up treating doctors, residents and medical students that we are all faking it pretty well, lying to ourselves until we can’t do it anymore, that all is good, that is something wrong with us not with medical school or the culture we are so accustomed to.

    Doctors, both my patients, my friends, myself included have one of the poorest quality of life, if you conform with the current unreasonable demands of this field. It is not reasonable nor realistic that people will put up with this lifelong without getting burned out, depressed, anxious, starting using any distractions and sometimes poor coping to make the day. We are afraid to admit to ourselves and others that we are feeling the way we feel, we think we are alone, not worth it a life like the one we try to teach our patients to have, not even sure what we are doing in that position, when we do talk, we feel ashamed and alone, although many go through exactly the same things, we seem to have hard time reaching for help, accepting the help, seeing ourselves in a loving way,in a gentle and empathic light. In some medical schools depression can be as high as 30 %. I won’t go into details, but what you are going through it is real and painful and far more common than you think.

    Pam advised you well, in your personal statement there is the reason why you went into this in the first place. I have learned only after i left residency and years into the practice that I need to do something to improve the quality of my life if I am to do this long term. I realized I don’t have to take the path that everyone is taking, I realized that are many paths in medicine that we don’t know of or are afraid to take, that we are not well prepared for taking good care of ourselves as we are taking of others.

    Take it from a seasoned psychiatrist, actually what you have in your heart and that smile, does wonders in the process of healing. The allopathic medicine and doctrine in medical schools have us believe that is one way to heal. While you learn this way, the western way of approaching life, medical way, it is by far the newest and not the most effective way of healing long term conditions like mental illness, chronic conditions, cancer and other impairing conditions. Progress is made and science has some answers, explore them and remember that data can be found in sites, books and is rapidly changing, what you learn in medical school is a way of organizing and thinking about it. Sometimes even that becomes quickly outdated, as progress and new perspective occur. After residency and medical school, i realized that what i was upset so much over not being able to remember so then was not vital to my practice.

    What is vital to my practice? That i have started taking care of myself and learnt this the hard way, by taking jobs with high demand that did not leave much to my personal life. That i had learnt to listen to my heart and my dream rather then tons of other people that said that what i wanted, what i thought will work for me, what i thought it can make a difference did not exist in current practice or will be hard to find. I will tell you that is not true.

    Probably when you will listen to Dr Wible will see that “ideal clinics do exist” that doctors do recover from the often nightmarish life we have in medical schools some in residency and beyond, is real that you can meet and make your dream come true.

    Today, I have a life because i decided i will not work more than 3-4 days a week, i have become better at saying no, no longer getting intimidated or discouraged, i stayed true to my values and my earliest dreams by carving into reality what was fit me and in this way i can make a difference in the lives of my patients. I will never fit the medical model so well, it is in my nature to encourage creativity in myself and others and derive great joy from that, it is a powerful healing path, too. I made a pact with myself that i will not let the reality of medicine today get the best out of me, that i will constantly explore what i need to live a happier, healthier, more fulfilled life. Few years ago i was at the breaking point when i thought, does this even exist for doctors. But it does, there is a lot of hope! We deserve to be a doctor and we deserve to have a life outside of that, too. There is a way to do both.

  17. lucinda mundorf, MD says:

    Ben,
    Please find someone who can support you, you are important and your patients do appreciate you. As physicians, we need to have equally thorough, care from a qualified and engaged professional. As Dr. Wible encouraged call if you need to talk.
    Most importantly, reject the idea that you are unworthy, you as a human being are invaluable!!!!!

  18. Ann Socolofsky MD says:

    I agree with the people who suggest your seek psychological or psychiatric care. It is a way to take care of yourself and get help getting through a difficult time in your life. But I would suggest you check out Dr. Wible’s information first.

    It is possible for getting help to backfire if not done carefully. When I was a resident, I went through some struggles when the program went through changes that made my life much worse than what I signed up for. I worked with a psychologist outside the medical system where I worked and that went well for me.

    However, another resident also was having problems and she saw someone in the same hospital system. The residency director demanded that the program have access to all her records and was able to receive those records. My psychologist outside the system was able to ignore those demands and keep my information confidential.

    Do not let this keep you from getting help. Just be cautious in what you do and look for the right kind of supportive people.

    • Pamela Wible MD says:

      I think everyone needs a therapist. Definitely everyone in medicine should have one on retainer – on call for YOU! You can not make it through this career alone.

  19. RemyWoods says:

    I agree with Pamela–please, please don’t go to a PHP program. They have gotten out of control and they hold your hard earned medical license in their hand. After paying an attorney a large sum of money they will likely send you to a 3 month treatment program which can cost upwards of $100K. It happened to my sister who worked as a pain management specialist in Arizona. She ended up walking away from her career, rather than spend that money for treatment of ?? she doesn’t even know.

    Please seek help if you haven’t done so yet. You’re suffering and it breaks my heart. I know there is little time to see someone– but you have to make it a priority. I think the shame and profound self doubt you feel is the depression. Seek a therapist and a psychiatrist. Change your name if you have to, and pay cash. That’s what many docs I know do.

    Medical school sucked the blood right out of me as well. I was also dissociated, anxious, depressed and had severe insomnia. I didn’t seek help for years and suffered needlessly. I wish there had been an online community like this when I was in school.
    There will always be egomaniacal doctors who will try to intimidate you. I always felt like a failure around them until I realized most of them were just there for the prestige being a doctor. It sounds like you’re a real doctor. If you can make a patient smile then you have succeeded. You would be the kind of doctor I would want to see.

    I worked at an HMO (an assembly line job as Pamela has called it) in my city for 18 years. All the docs I worked with seemed to have their shit together but me. I wanted to spend more time with patients but there was always pressure from the “suits” to see as many patients as possible and send them out the door with as many diagnostic codes as possible. I was the only female and was in a constant battle with HR for spending too much time with patients. (despite that, I won many awards for being the “most compassionate doctor”).

    About a year ago I came into work and was told one of my colleagues had died from alcoholism the age of 38. I was shocked–I had no idea he was suffering. If anyone knew, they didn’t talk about it. A few months later a doc was removed from our clinic for having an addiction to pain meds. He had been writing prescriptions for patients and picking them up for himself for over a year. I never saw him again. These docs never sought help and their lives and careers were ruined.
    Stay in touch with Pamela and join the community of doctors who want to spend time with patients. Be your own boss so no one is looking over your shoulder. You can be a cash pay only doctor and write your notes on paper if you’d like.

    We are all on the sidelines wishing you better health. Hang in there.

  20. Remy Woods says:

    I agree with Pamela–please, please don’t go to a PHP program. They have gotten out of control and they hold your hard earned medical license in their hand. After paying an attorney a large sum of money they will likely send you to a 3 month treatment program which can cost upwards of $100K. It happened to my sister who worked as a pain management specialist in Arizona. She ended up walking away from her career, rather than spend that money for treatment of ?? she doesn’t even know.

    Please seek help if you haven’t done so yet. You’re suffering and it breaks my heart. I know there is little time to see someone– but you have to make it a priority. I think the shame and profound self doubt you feel is the depression. Seek a therapist and a psychiatrist. Change your name if you have to, and pay cash. That’s what many docs I know do.

    Medical school sucked the blood right out of me as well. I was also dissociated, anxious, depressed and had severe insomnia. I didn’t seek help for years and suffered needlessly. I wish there had been an online community like this when I was in school.
    There will always be egomaniacal doctors who will try to intimidate you. I always felt like a failure around them until I realized most of them were just there for the prestige being a doctor. It sounds like you’re a real doctor. If you can make a patient smile then you have succeeded. You would be the kind of doctor I would want to see.

    I worked at an HMO (an assembly line job as Pamela has called it) in my city for 18 years. All the docs I worked with seemed to have their shit together but me. I wanted to spend more time with patients but there was always pressure from the “suits” to see as many patients as possible and send them out the door with as many diagnostic codes as possible. I was the only female and was in a constant battle with HR for spending too much time with patients. (despite that, I won many awards for being the “most compassionate doctor”).

    About a year ago I came into work and was told one of my colleagues had died from alcoholism the age of 38. I was shocked–I had no idea he was suffering. If anyone knew, they didn’t talk about it. A few months later a doc was removed from our clinic for having an addiction to pain meds. He had been writing prescriptions for patients and picking them up for himself for over a year. I never saw him again. These docs never sought help and their lives and careers were ruined.
    Stay in touch with Pamela and join the community of doctors who want to spend time with patients. Be your own boss so no one is looking over your shoulder. You can be a cash pay only doctor and write your notes on paper if you’d like.

    We are all on the sidelines wishing you better health. Hang in there.

  21. Yasamin Brown says:

    Hey Ben,

    I come from a family of doctors & nurses and we are ENTHUSED to have you as part of the profession!!!

  22. Pamela Wible MD says:

    Ben,

    We have all felt that way. It takes time and patience. Go easy on yourself. You do deserve to be a doctor.

    The patients themselves will save you. Listen to their stories, get to know them. Our society deserves and needs physicians like you who have humility. A humble caring physician who worries about their patients will always succeed and provide excellent medical care. Let your patients into your soul; let them get to know you and in turn you will find joy and happiness in being a physician.

    Paul McClintock MD (FP), retired after 30 yrs and missing my extended family

  23. Lenny says:

    Dear Ben,
    You’re not alone. I felt the same way during my clinical rotations as well and also during my intern year. Medical school takes over every aspect of your life and there’s so much to learn it makes you feel like you’ll never be good enough. But that’s not true at all. The truth is we all feel this way. We all feel inadequate and like we don’t know enough. While we don’t always have all the answers our patients are happy that we are there doing our best for them. Just because we were raised to be perfectionists and now we realize there is no such thing as perfect, don’t let it destroy you. Accept that we all have flaws. Take things one day at a time and the amount of material to know will slowly seem less insurmountable.

    Despite how busy your schedule is (I remember how brutal my clinical years were too, working up to 90 hours/week on surgery and still expected to study) it’s VITAL that you take 1 hour per day to do something for yourself that you enjoy. This means NOT studying for that hour. It doesn’t matter what that is, this is YOUR time. You need an escape from the hell you’re going through. I also recommend trying to start getting your own health back on track too. Eating healthier and losing some of the weight you said you’ve put on will also help with your mindset. Doing these things should help with some of the negative thoughts that you’re having. I know the gym is my only saving grace and reason that I’m getting through residency now.

    One last trick that might help is to start each day by saying thank you/showing gratitude for 3 things in your life. Even if it’s as simple as having a roof over your head, clothes to wear and food to eat. Not everyone has these things. It’s near impossible to feel bad and gratitude simultaneously. I hope this helps and feel free to reach out anytime. You’re not alone.

  24. Liz says:

    *Virtual hug* I had a lot of similar experiences when I was in medical school. What got me through was that despite the lack of any rational supporting evidence for it, I could choose to have hope (I got this from the TV show Farscape, ymmv), and the idea that surviving would allow me to help bridge to a better world for all of us. Don’t know if either of these sentiments speak to you or not.

    2 articles I found in my google search that I think may also help you.

    17 Genius Tips For Dealing With Impostor Syndrome
    https://www.buzzfeed.com/annaborges/everyone-is-faking-it?utm_term=.byEXk7Ox5#.vpv98V1Le

    Feeling Like an Impostor Is Not a Syndrome
    It’s a totally normal part of experiencing success.
    http://www.slate.com/articles/business/the_ladder/2016/04/is_impostor_syndrome_real_and_does_it_affect_women_more_than_men.html

  25. Leslie says:

    Ben-
    The comments everyone has posted cover so much of what I have experienced also- I hope you are reading and re-reading them and that their words are helpful to you.
    I started medical school ( a DO program) at 48 years old and a single mom. I was very fit (ultra-long distance runner), optimistic and ready to dive into learning what I needed to eventually help people with their health needs. The fitness, optimism and altruistic dream went downhill fast and I could only focus on taking care of my children and getting through each semester, each rotation. I had been in the education field prior to med school and was really taken aback on the atmosphere, pedagogy and archaic system of medical “education.” I found that if I talked with classmates about difficulties I was having, many other students opened up and expressed having the same issues. Knowing I wasn’t alone helped somewhat. Clinical rotations were rough with having to move about and be away from family and friends. I did try to set up rotations that were near family, friends and in areas in the country I wanted to see. All those things helped make it a better experience. However, by the middle of fourth year when it was time to apply for residency I really had doubts about continuing due to many of the similar reasons people have discussed in the other comments; and without the support of my close friends and family, may not have finished. I did put off applying to residency and just focused on graduating. That was a scary decision at first, but turned out to be a good decision for me, as I had time off to “recover,” clear my head and work on getting “myself back.” I ended up applying for residency the following year and have now finished my internship year! I am in a psychiatry residency program that is cognizant of trying to prevent burn-out and excessive stress rather than trying to “fix” us to withstand the program. I am finally starting to balance my life, becoming more active and looking ahead with a more positive view. Part of my more positive attitude has come from reading Pamela’s blogs and books, talking to her and joining the tele seminar. Reaching out was the first part in healing. You have reached out to Pamela, and I guess by default, all of us. I hope this is the first step in things becoming better for you too. The system is flawed- NOT you!

  26. Jocelyn says:

    Everyone is different. Some people have miserable training periods and then feel better once their situation changes. It’s very possible that although med school is hard on you, residency and/or real work will free you from your current depression and make you glad you stuck it out.

    Feeling like an imposter isn’t unusual for anyone taking on a new challenge – whether you’re a newly promoted restaurant manager or a soldier on her first tour or a naive medical student suddenly learning that, gosh, it’s not as fun and glamorous and easy as it looks on the TV shows.

    For most med students, years go by and the white coat starts to fit like any work uniform fits: it’s not exactly “the real you” but you get used to putting it on and playing the role of doctor. The right words roll off your tongue and the (usually) right decisions come to your mind. You get a sense of mastery just from having some things a thousand times – and from being out of training with no one looking over your shoulder and second-guessing you anymore.

    Is that a guaranteed happy outcome? No. Some people just flat-out don’t like medicine and never will. Or they have such a hard time with the basic elements (learning the book stuff, smiling at strangers, working long hours) that things just won’t work out for them.

    I suggest you take a hard look at your own situation and try to figure out what category you fall into. Most of the problems you cite sound situational: you’re too busy to have friends, you’ve gained weight, etc – which means that if you are motivated to stick it out, there is hope up ahead when your situation will certainly change.

    On the other hand, if you think a doctor’s life just isn’t for you and never will be. there is no shame in leaving and doing any of the thousand other things you could be doing instead.

    Most of the world are non-doctors. And almost none of them walk around miserable because they aren’t doctors. It’s hard to see the clear truth when you are inside the mirrored walls of the cage, but you are a free person who can do any damn thing you want – including walking away.

    You sound like you’re having a pretty normal unhappy experience. I would guess that ten percent of every Med school class in the country feels just like you. I know I did. And I turned out okay. So do almost all of the others – whether they stay in medicine or not.

    Keep remembering that you’re normal.

    • Pamela Wible MD says:

      Keen observation: Most of the world are non-doctors. And almost none of them walk around miserable because they aren’t doctors.

  27. Third Year Medical Student says:

    Ben, in the most loving, compassionate, and empathetic way possible, I encourage you to seek psychiatric care for yourself. You have identified what is likely a depressive episode yourself on the PHQ-9. I, too, had similar thoughts/feelings my first year of medical school in the midst of a depressive episode. I felt unworthy, guilty, and as though my shortcomings were obvious to all around me (which you also identified). In reality, I ended up earning an award for clinical experience my first year… That is to say, sometimes our own perception is different than our reality. I was CONVINCED that attendings, residents, and fellow medical students could ascertain there was something “wrong with me.” In reality, only my best friend in medical school actually knew. When in the midst of a depressive episode, the thoughts that we tell ourselves (and genuinely believe) are not real or based in reality even though they may feel that way. Cognitive behavioral therapy truly helped me to reframe my thoughts and base them in reality. That, and learning to be gentler with myself, and celebrate my successes, no matter how small 🙂

    I am now completing my third year (sounds like you are too), and am extremely happy. Of course, there are days that are different, or even particular rotations that are difficult. BUT my coping skills to navigate those days/rotations, and to continue loving myself throughout it all, are what allow me to consistently find joy in it all. Speaking as someone who HAS BEEN THERE, I would not trade my first year of medical school for the world, as it has made me into the almost physician I am today. My empathy, understanding, compassion, and reliability to my patients would not be what they are without my experience. My experience, despite the pain and devastation, is being used for good daily in my ability to care for patients. Trust me, I know that right now it doesn’t feel as though any of what you’re experiencing can possibly be used for good, but also trust me when I say that it will be used for good in your case too 🙂

  28. David Murphy says:

    Ben-
    My heart goes out to you as I am quite sure many who read your post feel for you as well.
    I can tell you after 26 years in practice as an ophthalmologist I still deal with Impostor Syndrome. Am I a good enough surgeon? (as I compare myself in my my mind against nationally renowned eye surgeons demanding of myself the same results for my patients) and am I a good enough entrepreneur/businessman?(to keep my practice solvent and growing in uncertain and changing medical climate.)
    I remember telling my faculty adviser in my second year of medical school that I was afraid I was about to flunk out. Fortunately, he directed me to the dean of student affairs, who pointed out ‘why would we flunk out a B+ student?’ (as I compared myself to the mass of material we were being taught and the few students who retained it all.).
    Don’t compare yourself to others but love who you are. You’re compassionate and introspective. That will make you a great physician who cares about and relates well to his patients.
    Find the counseling and support staff that, I hope and expect, are in place at your school. Medical school is immensely stressful and you need the support and guidance of others.
    It’s ok not to know answers to questions, on rounds, from patients, from doctors, etc. Just don’t make up answers but rather acknowledge you don’t know (and you CANNOT KNOW EVERYTHING), and seek out answers where you can, and where you can’t (or don’t have the interest or expertise), make sure you get patients to those who do. Use your compassion for people to motivate your learning and professional development. Use your own trials, fears, sadness, disappointments to be sources for your empathy for others and you’ll have enough and then some.
    It’s a lifetime process.

  29. Miriam says:

    Ben, I know it’s hard I get it. But trust your guts trust your wings. You have already impacted many lives and will continue to impact more. You are enough, you are more than enough and we need you. I know you will find your way and once you do, you’ll realize that this was needed in order to make you a greater person/doc. But don’t feel bad, their is a reason why you are on this path. Although it seems kinda heavy right now, one day you’ll look back and realize why it happened. You’ll be ok. You have more potential than you think. Be kind to yourself. Love yourself, you are a beautiful human being and you can do anything.

  30. Landi Lowell says:

    Ben, I am hoping to reach you–your heart. I notice you are an exceptional writer, and you illustrate in words what you are living and feeling. That’s a gift.
    It’s hard to trust a stranger’s assessment, I imagine, but I feel like I have something to offer here.
    First of all, holy hell–traveling from state to state??? I guess I’ve been out of school too long and I have no idea what that’s all about, but seriously man, that sounds horrible. I didn’t realize my social isolation and incessant fear of failure during clinicals wasn’t so bad compared to your nomadic life.
    Please don’t give up. We need you here. I’m a human being (and it turns out–an amazing doctor.) My patients do love me and thank me a lot for helping them. And I love those little gifts from them. I’d like to turn your phrase on it’s ear, btw. Medicine helps. Smiles DO heal. Patients want to know someone gives a crap about them. And that someone is you. And me too.
    I used to worry I wasn’t good enough. I am med/peds–and two separate residency program directors and attendings from all specialties told me I wasn’t smart enough and I didn’t have what it took blah blah blah. Well–fuck them. I was smart enough. I did pass my boards, in both specialties (though I was told I “never” would.) In fact, I passed both I.M. and peds now twice! I’ve been around that long. And now I’m the doc that colleagues ask for advice and send their own families to. I’m it. (It still feels surprising sometimes, and other times I feel like a regular bad ass! ha)
    Ben, you feel. And that’s why this all sucks. I resented medicine for a long time for stealing my soul. I lost myself, I think that might be a part of a lot of people’s stories. But dammit, I was called to do this job, and so were you.
    You don’t get to know how many lives you affect. But sometimes you get a glimpse. I’ve been sitting at my desk, feeling overwhelmed and like I couldn’t go into the next patient room. But I did somehow, and that patient had a gift to give me. Often a smile. Sometimes some really timely advice. Sometimes a story about what they learned from me and how it made them better.
    You have gifts to give your patients in terms of love and talent. Your patients have gifts for you too. Accept them. Tuck them away to fill your energy tank.
    Please do NOT give up. There are many good days ahead. Some of those days suck ass, ha, yes. But some days, I wouldn’t have wanted to miss. There is beauty and love. And you were meant to witness it all.
    Ben, peace to your gentle soul. I’ll tell you what my best friend reminds me all the time (from Gaslight Anthem’s song, National Anthem) “Take it easy baby, it ain’t over yet.”
    I’d love to be a mentor for you if you need one (proctor, preceptor, whatever.) It might help for you to witness my crazy haphazard version of “the good doctor” — I don’t fit easily into the standard box either.
    Keep coming along Ben. You’re going to fit in just fine right here with the rest of the HUMAN doctors. I’m sure of it.
    Landi Lowell MD
    Gillette, WY
    landi.lowell@cchwyo.org

  31. Regina Bahten, D.O. says:

    Dear Ben,
    Lots of good advice here, so I hope you’re seeing that none of us knows enough to fix all disease and despair, but after a while, we learn that we know enough to help our patients get part of their lives on track, or to help them deal with their mortality. You never know which offhand comment that you make can really spark an insight and a change in a patient. Sometimes my patients will tell me great things, then say that it’s something I told them! I am better now at not looking quite so surprised–it’s good that they can find the gems in my ramblings.

    Here’s a thought: Did you know that as an attending, I am graded on whether or not I seek consultation (aka help) appropriately? Even my bureaucracy knows that no one doc can know everything.

  32. Virginia L. Waryas says:

    Ben, hello.
    Imagine this. Just imagine, for a moment, mentally framing your letter ‘as if’ it was one you were reading which had been penned by someone else.
    Now, imagine this individual’s background in a profession other than medicine. Do you find you agree it realistically could be the case? And that this person could be at any point along their occupation path? Yes? I hope you will be comforted by the universality application to a majority of the human population. You are not alone in your experience, believe me, truly reflected by a multitude of others in close to your circumstances in their medical training as well as permeating the general population in borderless radius.

    You are strongly suspect to be amongst the first who would have made notations along the course of reading their letter in figurative gold font. Preserving to show up every day, clear goal declaration, observation of attendees conduct of abruptness/lack of mentoring extended (injurious to you but acknowledged as ‘their’ choice of behavior and anything but intentionally provoked by you making your best effort; if only they could do the same — they are missing an opportunity to feel higher level of satisfaction at the close of the day perpetuating well beyond yours as they have forgotten to apply ‘First do no harm.’ to another member of the same profession in addition to patients while you are ‘not’ missing the opportunity each person requesting care presents to you); realization of not knowing what medical school consisted of reflects something wonderful about you – your candor – no one entering rank of any profession or education it necessitates possesses a true sense of what it entails until they are having the experience, I feel sure you will concede, and this observation of your own is of immense importance. It reflects the ability you possess to acknowledge a wish to continue learning and the ‘uniform’ a symbol to patients you will share your knowledge/experience completely to attempt to improve their lives. Self awareness someone has that even if becoming an expert in something does not concede they know everything there is to be known in any area is something we value enormously. The uniform is an outward sign of this or it is an insulator of self conceit. You can chose to consider your ‘uniform’ in this framing and even share how you think of it to those you care for. Who could not feel they had someone walking beside them, earnestly attempting to help them, if this was stated to them as a preface to asking them to let you know anything they thought of which might prove helpful to assist you making them feel better. It would serve as a reminding support to you of sincerity of your effort while building a bridge of connection without which they may dismiss what they could tell you as inconsequential, perceiving themselves as ‘unimportant’, taking someone’s time ‘unnecessarily’ which can equate on a scale right alongside of ‘fraud’ feelings. Identifying your humanness acknowledges theirs and your returned trust they will aid you in any way they can. That is something invaluable you ‘are’ and can continue to present every individual. My hope is you will come to view this as admirable in yourself. I am feeling certain you would have that perspective of others presenting themselves to you in this fashion if circumstances were reversed.

    It is human nature to wish to attend to all things at once or leave as little without attention as possible – a garden, painting exterior of a house. When time is made to pause and consider everything will never be all done? We walk away from all that clamor of voices within our head to invest fully in the moment in which we find ourselves.

    This is not a bad place to be but the opposite. If we can guide ourselves toward living fully on a moment by moment basis, we will feel more peace as we go about our work sharing as fully as we can and providing things outside of that moment our attention as soon as opportunity arrives to provide them our focus.

    Do not be offended by the illustrative example of necessity to postpone scraping the side of the house to receive paint due to rainy weather or being needed at work or needed by family time or exasperated by a sprained wrist or ankle imposing weeding or shoveling a hole to receive a landscaping bush you’ve been thinking about adding. Instead, there is opportunity to reassure yourself the house will dry out, eventually, to receive the paint and maybe a holiday weekend enlistment of additional hands to help while taking some time of ease with reading indulgence while the garden makes its own decisions provides the additional benefit of being surprised what it will do left to rest itself in a natural state plus provide some additional designing time in your mind.

    You have achieved much and are continuing to do so. Numerous assignments, while draining from adjustment perspective, are gifts others have not had come to them with a greater variety of people to interact with as well as presenting problems. These will prove advantageous to your residency application and your residency years, both. Do think of me in terms of an admirer of all you are accomplishing.
    Best,
    Virginia

  33. Kate says:

    Dear Ben,
    I read this and felt compelled to tell you, you are enough!
    Med school was 100% the darkest years of my life. I thought about killing myself not infrequently, especially in the first few years. A wonderful psychiatrist in our student counseling center literally saved my life. If you have anything like that available (it sounds like maybe not as you are forced to be a nomad these days) please take advantage of it. I also was helped by seeing, over time, that probably half of my class was seeing someone in student counseling and just not talking about it.
    Please take care of yourself. There is light at the end of the tunnel. Now that I am out of training I have been able to make choices like others have mentioned … to work part-time, to know that I provide good care though (perhaps because) I may not always meet productivity targets, and to enjoy time in my garden, with my family, with my horses. This brilliant psychiatrist also told me that residency would be easier because I would be with my people and it is true. It was hard, no doubt, but they were more my tribe in family medicine and that made it easier.
    With love.

  34. NewDoc says:

    Dear Ben,
    We hear you and we are here for you. I thank you for drawing attention to the absurd and unnecessary travel requirements at some schools for rotations. I also lived in a different city every month for my last 2 years of medical school rotations. In addition the school did not assist with finding housing. And I went to an American medical school. Something needs to be done about this. How can medical students focus on learning and exams when they are sleeping on people’s couches or in their cars? We paid too much money for our education. We should be able to focus on studying and resources as opposed to finding a place to live every month. There were many months I felt downright unsafe in my living situations. A lot of times students are discouraged from “complaining, being negative,” or drawing attention to this at schools. We are the ones paying 6 figures for a medical education, we are the consumers, they should at least find us safe and affordable housing!

  35. Nishanthie Dolage says:

    Dear Ben,
    Your self doubt is quite normal , even after 23 years in the filed of Mental health I still have doubt about my skills , these are random thoughts that pop in to my mind , however what happens is we take these random thoughts very seriously when it is thoughts that are generated through electric impulses ( ATP etc ) . We get more than 80,000 + thoughts popping in to our mind ( Some one actually have done this research I of course feel it may be more than ½ million thoughts a day , most of the time we are busy and not aware of these thoughts). I get all kind of thoughts, some are amusing, some are silly, some are self doubts, some are compassionate and kind thoughts, some are creative thoughts , some are self critical thoughts etc . I did an experiment in my team about 5 years ago and found what weird thoughts people get in their mind and still working.

    The problem in life is we take them seriously when they are just random popping up thoughts ( there is some research out there that indicate that we notice our negative thoughts in 1/8th of a second and positive thoughts in takes about 15 second to register. After years of meditation and observing my mind I have come to realise that I am not going to take them seriously, if mind gives me a useful suggestion for a meaningful life then I will take it up. I do not fight with such self critical thoughts ( if you do they become more powerful , e.g try to forget a pink elephant , you realise you cannot, pink elephant becomes bigger and more clear the more you struggle to supress it ) , So develop compassion for your mind , which over 2 million of evolution is trying to protect us . NO 1 Priority of the mind is to keep us save , so it is doing its job of scrutinising, comparing so that we do not get kick out of the social group if we did get kicked out during the cave man time then we would have got eaten by the tigers . So mind is creating all these thoughts to keep you safe , protect you, and possibly entertain you at times ( cave man time no TV or internet ) , in the modern society we do not have tigers roaming around but our mind is still doing it job which it is use to for 2 million years. So we are from a gene that over scrutinised and survived the ones who did not got eaten by the tigers . So please be kind to your self and your mind.
    I would suggest the following books
    Happiness trap by Russ Harris, there is a APP also available
    Confidence gap by Russ Harris, His online courses are very good I have done up to the advance level of training in ACT ( Acceptance and commitment therapy )
    I also suggest Mindful self compassion by Chris Germer his book The mindful path to self compassion very good book .
    Self Compassion by Kristine Neff .

    Both of them have got a 8 week MSC course it is fantastic . I have done and up to teacher training and I have seen this shifts people’s perspective ., so suggest that when you have the time to go for this course .
    Above have got plenty of youtube clips for you to watch.

    I have design a Hope toolbox and manual for patients , today I presented this to the Clinical psychologist group hope to put this under creative common licence for non commercial purpose for people in distress so that they do not end up harming themselves . If I can do this for one person , I feel I have done a meaningful contribution to the world.
    Finally always remember human life is very precious and it is very rare and to be a doctor you have done lot of merit in the last birth ( this is the Buddhist view, though GMC tells we cannot speak about religion , I am sharing this information with you as you are not one of my patients and I am sharing this information with best interest at heart ( Buddha compared a human life to a turtle coming out and seeing a full moon day ( this is a very rare event, so human life is very precious and a doctors life is extremely rare and precious) . So please be kind to yourself , In the west people find it very hard to be kind to oneself , it might be due to so many reasons , however, as a person who went to a Buddhist school this is the first skill we are taught in school at 5 years . Be kind to yourself and then you radiate kindness to others . You are a person who have shown kindness to others , what you need to develop now is to be kind to yourself and your mind .
    As Buddha indicated just because anyone tells you “this is good, do not believe it” , Experience for yourself . If you feel you are benefiting then do it .You as a person is more powerful than anyone else.

    The above resources I have mentioned will teach you how to do it ,experience for yourself, and just because I say so do not believe it . If you feel it changes your life view then please continue these skills . I have done from childhood and seen the benefit and now I am 52 years. These skills are secular and not religious. There are lot of scientific papers on this subject .
    With best wishes for a bright and meaningful future , Nishanthie

  36. Rachel Gressel says:

    I am a nurse reading this wrenching letter and my gut says this student has a serious issue with depression and is teetering on the edge. Having suffered a severe depressive episode years ago I am concerned that he may be having suicidal ideation with or without a plan and needs to be talking with someone regularly. Yes, it will all probably get better and the depression may be situational. But that is the case in many suicides. You see no way out and you feel very alone. I do hope you have spoken with him. There are other wonderful careers besides MD. Family, financial, and personal pressure need to be put in perspective.

  37. Bob Rozner says:

    Ben,

    I graduated medical school in 1987, it still sucked back then! What you need to realize is that in undergrad you were probably the upper 10% of your class. EVERYONE in med school was/is. So you are being graded on a scale that is extremely skewed. I always thought that med school classes should not be graded but every student should be privately tutored for incorrect answers on the tests. That’s right, make it a real learning experience rather than posting the class ranking in the hall for all to see then leaving you on your own to wonder why suddenly you’re in the lower 10% of the class. Great confidence builder, Huh? As far as pimp questions and attendings are concerned, there is always going to be some asshole who thinks that belittling another person is an effective way of teaching. It is NOT and NEVER will be acceptable in my book! I vividly remember fantasizing on horrible things I would do to such people. I know it’s twisted but at the time it got me thru. (Probably the first time I ever admitted this in writing) I now pity those who had to put down someone else to feel better about themselves, for there is really no other reason for it.

    Self doubt: For most physicians it is constantly looming in the background. Even now after 27 years in private practice! I have learned to befriend it (albeit at an arms length distance). There will be times when you feel dumb as a box of rocks and times when you feel that you really have a handle on medicine. Let it be a motivator for you. Over time it’s presence will be less frequent and it’s voice less loud. BTW:Every doctor I’ve ever met(so far) has been a human being. They all have self doubt, some of their ego’s won’t allow then to admit it though.

    Speaking of being a human being: What patients want the most is a physician they can relate to. Someone who will listen, hold their hand, laugh with them and sometimes even cry with them. Someone who is able to give them an honest and balanced opinion of what is going on with them in a language that they can understand. Never be afraid of not knowing all the answers and even admitting that to your patients. They will respect an honest “I don’t know” more than two paragraphs of unintelligible(to them) medicalese,especially if you follow it up with a “But I will find out for you”. By making that patient smile, you did much more for them than you realize. You connected with them on a human basis, which is all too uncommon in modern medicine.

    Going to medical school is a funny thing. Too many times students see only the clinical side of medicine while doing their clerkship and SubI’s. Unfortunately most of these are hospital based inpatient oriented. That type of practice is not for everybody. When I did my clerkship in Family Medicine 50% of it was outpatient in an office. This was a real eye-opener for me and was my decision maker for going into Fam Med. My college room mate got thru 4 years of medical school and an internship before he decided he hated medicine. After starting several other non-medical businesses, he is the founding partner in a large wellness clinic in San Diego(Centricity Wellness). My point is: you will find your niche. Whether it’s in mainstream medicine or not is entirely up to you.

    Not every residency out there is designed to suck the life out of you. Don’t get me wrong, it won’t be easy but there are many that are easier on you both physically and psychologically.

    From your letter, you seem like a genuinely nice guy, who gives it his all and who has a lot of heart. Don’t let the BS of medical school and residency wear you down. You will be amazed that when you find that area of study that you love, the skies will suddenly seem like they cleared up and you will find peace.I’ll leave you with one last thought: When I complained to my father( who was a combat veteran and went to College on the GI bill) about how hard medical school was his reply was: “Of course it is. If it was easy every AH would be doing it”. At the time is was not exactly the response I was expecting! Over the years I realized what he was really saying was that just getting in med school is an accomplishment and they don’t let you in if they think you are going to fail.

    Dr. Bob

  38. Frank says:

    Hey brother. I know its hard, I was there too. But, at some point you need to get out of your own head to step out of the way to pave forward. Life is full of “zasetsu,” especially in a field like ours. Some food for thought from wise ones who have gone before us: “It’s not what happens to you, but how you react to it that matters.” Epictetus. My current favorite: “Eventually all things fall into place. Until then, laugh at the confusion, live for the moments and know everything happens for a reason.” Albert Schweitzer, MD.

    Hang in there. Speak to people, good you reached out to Pamela. Enjoy the journey, as best as you can really and love thyself.

    Dr. Frank

  39. Michael Grier, MD, PharmD says:

    You forgot the most obvious help that Ben needs and that’s to see a counselor.
    The purpose of a medical education is not to give otherwise likeable folks who are miserable with themselves a chance to be physicians. It is to train people who are smart enough and talented enough to heal people in one of the most complex and intellectually challenging fields available.
    I’m not being callous or insensitive; I really hope Ben gets his head into the game and makes a great physician, however…
    the way he’s going now, he’s not learning what he needs to know and he’s not developing the skills and self-confidence to successfully transition from student to resident and beyond because he’s too busy pitying himself. If he goes into every new patient’s room spending all his time beating himself up because he doesn’t deserve to be a doctor, it’s just a matter of time before he kills someone by omission or commission.
    What you should tell him when he calls to talk to you is to get with his advisor or someone in his school’s administration to hook him up with a counselor so they can work together to figure out whether he can turn himself into a talented, skilled clinician or whether he needs to find another career.

    • Ben says:

      Already done, Dr. Grier. They’ve been helpful.

      I have been working on changing my perspective into something that’s healthier. It has been challenging, yes. But I’ve never been so busy “pitying myself,” as you say, that I’ve endangered anyone’s life, and I don’t plan on doing so, either. Thanks for your concern.

  40. carol says:

    Hi Ben,
    You will not know the full effect of your kindness to people, how much it means to them. It makes such a big difference to people, sometimes they will say it, sometimes they don’t, but it is the feelings you leave in them that matters the most in the end. Intelligence in a doctor does not factor into how they will see you in their eyes.
    I have had to be a patient (for baby care) and went to many doctors and nurse practitioners. The ones who “talked over” me instead of “talked to” me, I left his practice immediately. The one doctor who I felt most connected to was the one who actually spoke to me about my concerns and fears, my feelings about my condition. I felt comforted even though it had nothing to do with the general care and “facts” of the condition.
    Your kindness to people goes more than just skin deep. They remember you even after many years how you were to them.

    I still remember the teachers in medical school that I honored the most, not the ones that were verbally abusive. The best teachers and people bring out love in other people, the worst teachers make people feel small. In medical school, i have experienced both sides. It was the teachers that made me feel worthy that pulled me through medical school (and residency), not the abusive teachers. That one teacher said only one line that pulled me through. He asked me a very simple question, a no brainer. I at that time had a lot of anxiety about being pimped. It was a simple response, but he said simply. “See……you can do it.” Up until his presence, I had cried a lot because i didn’t think i could do it. I had had a lot of “mentors” saying how much more training i still needed to become a doctor even if i completed medical school and residency. Can you imagine the confidence of a third-year medical student on her second month of clinical rotations being said that?

    Please don’t let other people’s remarks ruin your self-confidence. 🙂

  41. Michael Grier, MD, PharmD says:

    What you should have told Ben to do is to see a counselor.
    The purpose of medical school is not to give otherwise likeable folks who hate what they are doing because of self-doubt a chance to become physicians. It is to take the brightest, most talented and capable among us and teach them how to heal in one of the most challenging fields around.
    If Ben is so wrapped up in his own self-doubt, he’s not learning what he needs to move on to residency and beyond. If he goes into every new patient’s room obsessed with his idea that he doesn’t deserve to be there, it’s only a matter of time before he kills someone by omission or commission.
    I’m not being cruel or callous; I really hope Ben gets his head in the game and becomes a great physician.
    When he calls to talk to you, tell him to get with his advisor or someone in the administration to get him in with a counselor so they can work together to figure out whether he can become a talented, self-confident physician or whether he needs to find a new career before it’s too late.

  42. After so many great comments, let me add a thought. Every day, remind yourself that you are choosing how you live this day. At first, really take the time to ponder and truly give yourself permission to think about the life you really want to have, what you would choose if all options were available, and consider your profession, (and other things like play), and really be honest with yourself. Then, if you choose to stay in medical school, it will feel different. Every day is a choice, and I know there are consequences, and they factor in, but often they are given too much and sometimes too little weight. This is your life, choose, please choose your path, and remind yourself when it’s difficult that this is a challenge you are choosing.
    Here’s something else that I find helpful. Stressors tag team, they dog-pile. I found that when I feel overwhelmed, I stop and ask what stressor am I facing and I ignore all the others. I learned that the smallest stressor feels as big as the largest when allowed to combine. This also helps me in relationships. If I am upset with someone or about something, I separate out the event/feeling I am experiencing with that person and all the other feelings/thoughts that want to jump on board. So, she forgot our dinner plans is simply that, not (she forgot our dinner plans, combined with the less conscious but still present stressors – boards are coming up, how will I match, that attending asked me 3 questions today and I froze, …..)
    I hope you give yourself permission to live the best life for you and that you can then have something to give to others.
    Your life is the greatest adventure, and it has chapters, some are sad, hard, challenging, happy, tearful, etc. Most of the time, you have more control of the story than you probably think. Sometimes, you have almost no control, learn the difference. Do you worry about the sun rising in the morning or that you can’t control the weather? But you can get out of bed, take a shower, smile when you enter the room….
    Be well.

  43. Pamela Wible MD says:

    Hi Pamela, Something you can pass on to Ben. I tried to post it to your website but my internet is running really slow.

    Hi Ben,

    I feel the same. It’s been a real struggle for me and many times I wanted to quit and walk away from medicine for good. But for the past 2 months I’ve been feeling a lot better. I’m not saying the struggle is over for me but perhaps you might find these ideas helpful.

    1. Pamel’s website & “The Real Doctor Will See You Shortly by Dr. Matt McCarthy” (I LISTENed to it on the Audible app.)
    I’ve moved so much and I’ve lost a lot of friends along the way.
    I tried to talk about my struggles with other medical students and other residents but I feel like we’re all putting on a brave face in the hospital. I never get the honest ugly truth from them.
    I felt isolated and very much alone with no one to talk to.
    My family (none of which are in medicine) wasn’t enough.
    I needed someone to hear me, to understand what I was going through, to relate to my pain.

    So I read the blogs on Pamela’s website and that helps.
    And I read all her books, which really helped!!
    And I read this book, “The Real Doctor Will See You Shortly by Dr. Matt McCarthy” and I can’t even tell you how much I related to the resident in it.
    I don’t know but something about his book really struck home with me.

    2. EMDR
    2 months ago I was really struggling, hating medicine and I had just moved to another town with a new hospital and at the time I was about 99% sure that I was going to pull out of the MATCH. I realized I needed to talk to someone again. So I found a new therapist that did EMDR. I’d never heard of it before and I was actually looking for a therapist that did CBT but when I met with her she recommend EMDR.
    She believed I had PTSD from my experiences in the hospital. I spent 4 weeks doing EMDR almost every other day. Yes, it cost but I I really think it helped me.
    Find a therapist that does EMDR or at least a therapist who works with PTSD patients or has treated doctors/medical students/nurses etc in the past.

    3. PTSD –
    READ the BOOK “The Body Keeps the Score by Bessel van der Kolk”
    If you don’t have time to read it or you’re too tired, LISTEN to it on Audible app (iPhone)
    Within the first chapter I found myself saying, this is me, this is how I feel. By the second chapter I wanted a book of my own to highlight so I bought it off amazon.
    It really helps you understand that medical students have PTSD (our understanding of PTSD is outlined by DSM V criteria, but the author argues that PTSD applies to many people who have been traumatized not just by war or rape.)

    Hope this helps!
    -anonymous

    P.S. I matched into a Residency, one of my top choices. And for the first time in awhile I feel okay about it.

  44. Pamela Wible MD says:

    “Ben, if you are pursuing your lifelong dream of becoming a physician, then you DESERVE to be a physician! Passion for this field is more important than any costume you wear. Don’t let anyone take away your passion”

    Helen

  45. Hi Ben,

    Remember that your patients just want you to love and care about them! You will learn the medicine part along the way. You already have the humanity. Remember, it’s you and the patient against the disease. Be honest with your patients. Sit with them, hold their hands, tell them you care about them and you will do your best to help. Ask for help yourself. We are all human. Speak positively to yourself – encourage yourself like you would encourage a child to succeed. You wouldn’t tell a child, “You can’t do this; I don’t know why they let you in this school to begin with!” Never! Be kind to yourself. Be kind to your patients. If you find you’re having trouble caring for yourself, take a break, breathe, realize life is beautiful and there are people in this world that need you here 🙂 Hang in there, one step at a time! We care about you Ben!!

  46. Cheryl says:

    Hi Ben,

    I’m a patient and a very sick one. I’ll say one thing. I’m pleased that you have the ability to see that it takes more than making patients smile. So many doctors think themselves “so smart,” and I can tell you I was dead after about 20+ years in their care. A Chinese physician saved me from my bad position, which was near-death. I think perhaps it would benefit you to try some alternative medicine, gain focus, and care for yourself. You might not think yourself worthy, but just the fact that you asked that question makes me wonder if you aren’t more worthy. I had Lyme disease and co-infections and even Mayo Clinic missed it. Countless doctors gave waste-basket diagnoses, and they outright told me they didn’t care or that it was my fault. I’ll take a nice doc that sees his or her flaws to that!

    Hang in there!

  47. Grammy says:

    Dear Ben,

    Go to the retreat!! You’ll have the time of your life!! Laugh! Joke cry(from laughing I bet!) Don’t think about it just you go do it!

    From a caring anonymous patient who loves doctors who love to help people!! DONT you dare back out and leave the meanies for us out here!! We need you docs that have feelings & emotions and have experienced this downer but don’t stay there because you’re suppose to come out so you can relate to your patients and help them come out. A REAL DOC is blessed by not knowing it all because if he/she did know it all they would never listen to their patient! My grandmother told me once,” don’t you ever let anyone or anything ever break your spirit!”. She’s gone now but I can still hear her saying that to me. So, I’m passing it on to you. Dope slap yourself and pack up for an awesome retreat, ok! Ya! B+ and learn to hit the “delete” button when negativity enters in any form just DELETE all negative thoughts upon entering your mind. Shake up a little Joel Osteen if you have to! He’s awesome! He also mastered hitting that delete button in his own life. To each their own. Try it you might like it PACK UP FOR RETREAT TIME! PUT YOUR FAVORITE rock & roll tunes on while you’re packing!! FREE TOO! Woo-hoo!! YOU ROCK! <3 XO

  48. E.A. says:

    Dear Ben,
    I am foreign medical graduate doctor trained in Greece… please be patient you are already in your clinical years believe me things are going to become better from now.
    You are not depressed you are exhausted… tired…a lot of medical students pay this price, neglecting sleep,nutrition,exercise,rest even time spend with freands and family all this as sacrifice for effort to achieve excellence…all for love of medicine for that starry-eyed excitement…this too will come back once you will join the real battlefield of medicine… I used the world battlefield in purpose because your white coat is not just a uniform you wear in certain way it is more military outfit which sauldiers put on when they are ready for battle… once you will become a doctor your are called to fight for life and health of your patients having death and disease to overcome…this is going to be your job
    Believe all the tears all nights of study all this sacrifice all this exhausting will one day change a life of someone for better even more will give life back to someone…
    making this world healthier happier place to be… every good sauldier knows that it is your heart that brings the victory intelligence alone is not sufficient…
    We take good care about our homes keeping them clean taking care… but are we taking care about our inner “home” our inner mental space our heart? Does not matter the name of trial you are going through,medical school,residency,hospital
    it is as important as to be skilled and be knowledgeable to be prepared in your heart too…you have a choice what you allow to fill your heart… keep it pure and clean… it is every day work like having a garden, if you want to have a garden you pull out every day every weed and take care and plant good plants every day… put good fences too to protect…take out every
    spirit of fear, doubt,anxiety( by the way if you dig your anxiety you will find some sort of fear hidden there too), despair… and plant on their place spirit of love, patience, humility (know and accept your limitations) the most rewarding and difficult journeys you will ever take is journey inside yourself in your inside gardens and one of the most tough battles you will ever give is with yourself…take day by day as good sauldier you are called to be without fear,with love,do your best with all your heart every day…what you are learning now can and will be literally life changing for someone one day… take out every fear and anxiety (usually they disappear once you have courage to look them in the face)
    and enjoy your amazing ride in medicine you are still student you do not have full responsibility, you are free to make questions,learn, grow…medical training is one of the most tough ones you are going though all this not only to learn medicine but grow personally learn by overcoming your own limitations and fears… how to win,how to fight, how to lose sometimes too, how to love, how to fly… Your white coat is more than uniform it is every battle you will win, every life you will safe,every smile of gratitude you will receive from your patients… you are already third year do not quit…take care about yourself with love and compassion ( not only your patients but you need them too) your sleep hours ,your food ,add some good vitamins, protein, spend some time to take
    a walk just relaxing just breathing just enjoying the beauty of the nature… recharge yourself, do not be afraid move forward calm and brave…day by day…
    I apologize for my English it is not even my second language…

  49. Kindness Wins says:

    I don’t think you’re an imposter or a fraud at all. However, based on my own experience, I do wonder if you’ll be happy as a doctor. I know it’s hard to walk away during medical school due to loans (and maybe ego), but I think it’s better to walk away sooner than later.

    Honestly, I sort of wish I had done that and I still consider it. I’ve learned some amazing things and love helping to care for patients, but the administrative aspects of medicine have become so burdensome that doctors who actually want to provide meaningful care struggle with the cognitive dissonance that stems from trying help people in our current productivity-driven factory-assembly-line-type system.

    I know this is not the answer others have given. They have adjusted over many years, and I’m sure you can, too. What I’m not sure is whether that’s the right choice for YOU. Only you can figure that out with the help of trusted people in your life. I wish you the best and hope you will know that whatever you decide, you have the capacity to move forward and thrive.

    • Pamela Wible MD says:

      Definitely agree that if medicine is not your passion (and if you chose the profession for the wrong reason) then please do something else with your life. There are so many other ways to be a healer in the world and medicine can take a toll on your own health (as you have already experienced). Curious what other careers you were interested in . . .

  50. Ramiro Gonzalez says:

    Thanks for your very deep Info sharing.In my personal opinion this kind of consequences to be a Physician is World wide,in my personal & Profesional experience talking about two specific countries USA & Mexico.
    The Burn out Syndrome is affecting a Thousands​ of Colleagues around of our Crazy Blue Marble, also like USA, Canada and other countries are struggling with deficit of enrolled students in their Medicine Schools.
    So I’m so Sad reading this very deep & emotional article, affecting to all my Colleagues around our Crazy Blue Marble.
    Thanks in advance.

  51. First Year Intern says:

    Hey Ben,
    Reading you, I had a gut punch moment wondering if I had written this during med school or especially this past intern year. I still double take every time someone calls me “doctor”. I’m terrified of being an “upper level” in 2 months. I am right there with you in not having energy at the end of the day to work out or call someone on the chance I’ll have to deal with one more person saying they have a problem I can’t fix. I still have days I pray that my lymph node swelling is a cancer precursor rather than from a cold, as awful as that is. I’ve contemplated best drug combinations to overdose on so they couldn’t save me. I’ve called myself awful things when I don’t think of a diagnosis or forget to put in an order or other screw up. And yes, some days I wake up wanting to just crawl back in bed and lay until I get a massive PE and die.
    I came into med school with a prior history of cutting (cut free for years until 4th year med school one lapse) and no previous suicide attempts until second month intern year trying to hit my radial artery with a razor blade. Obviously not successful and didn’t need a hospital, but now carry a scar to remind me to reach out before it gets to that point. So, the good kind of scar if such a thing exists.
    I can’t speak to how to be the physician we feel our patients deserve because I have no idea either. But I can say my patients do seem to appreciate a doctor who can crack a joke and be compassionate for their situation. And it’s hard to do that when we are so wrapped up and dragged under by black tendrils of depression, anxiety, fatigue, and everything else. Getting into therapy, learning CBT techniques I can do in a 5 minute break, and medication addition/adjustment helped considerably with that for me. I never thought I had anxiety until I used my CBT techniques and realized I was so paranoid of hurting or killing a patient I was cognitively paralyzed, especially when attendings would ask questions.
    Trying to do all the things involved with training while fighting off unaddressed depression/anxiety/other medical problems is trying to fight a war on two fronts.
    Sounds like you’re doing the smart thing already reaching out from the comments below. Just hoping one more story saying someone else has had these questions and struggles helps you. Or maybe it’s my confession to the internet because it’s too scary to admit to my residency classmates. Either way, I wish you well from a bit further down the trail, I hope my story helps you.

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