1 a (1): the practice of forming ideals or living under their influence
In Family Medicine, we were asked to reflect on whether we have seen burn-out with 3rd year or idealism……here is my reflection:
It’s funny. In many of our clerkships, we are encouraged to reflect on our medical experiences thus far as a means of coping with exciting/disastrous/tragic/rewarding facets of medicine. While most of naturally cope using exercise, extracurricular activities, and leisure time as means of decompressing, we are always forced to reflect in one particular way – by writing. While many of our assignments illicit an eye-roll and a gasp of sorrow, this is a topic that I am glad to write about.
When I first received my white coat during medical school orientation, I was surprised at how mundane it seemed. It was plain – no patches, no embroidery, and no embellishments. The fabric seemed rough, like a burlap sac, and the pockets were too small. It almost seemed funny to me that this article of clothing was a cause for celebration. Did my parents really need to take time off from work to see me put on this $10 coat.
The day of the White Coat Ceremony came around and I was still a little skeptical. I must say, I was a little excited about the reception food and desserts but the concept behind the ceremony still seemed a little silly. It’s hard to believe that this would be one of the more memorable aspects of my medical career. For me, the defining moment of the event was the recitation of the Hippocratic Oath. Somehow that Oath transformed the plain jacket I was wearing into a symbol – an icon representing the responsibility and privilege of patient care. It made me optimistic about myself and the journey I was embarking upon. It also made me optimistic about my fellow classmates making the same commitment. I carried that optimism through the first half of medical school.
Despite the stress and anxiety of Step One’s, I looked forward to my first day on Internal Medicine. The first month of the clerkship was great. I was learning an incredible amount of information and really connecting with my patients. While not all of my cases had happy endings, I was trying my best to ensure a high quality of patient care. Many of the people I worked with enjoyed my enthusiasm, but it was difficult and stressful to balance studying, friends and family. Initially, I found the simple act of providing care enough to get me out of bed every morning.
Sadly, that sentiment faded and the enthusiasm and idealism I started 3rd year with diminished. While many moments were incredible, they are overshadowed by the moments in which I realized that I was not actually a patient’s provider. The moments where I called a consult on a patient to somehow became the last person to hear their recommendations. The instances where my evaluations reflected my ability to search for journal articles rather than reflecting my attention to patient care. The moments where I pretending to be excited about another hernia repair, chest pain admission, Pap smear, and/or pediatric asthma case. The moments that seem to add up and leave me constantly fatigued.
Like Toxic Intern Syndrome, I do believe there is a Toxic Third-Year Syndrome. It started first with a quiet rebellion against spending extra time in a clinical setting. It continued with a disdain for SCUT work and call-schedules. With the stress of the impending shelf exams, Step 2 and the MATCH, patient care starts to slowly fall by the wayside. Soon one begins to wonder whether it’s worth staying an extra half-hour to check on patients or whether it’s better to give up, head home, and study. Eventually, one begins to do the bare minimum because overachieving is rarely rewarded.
The sentiment that predominated during my 3rd year stemmed from a discord having a genuine interest in providing medical attention to patients and realizing that I was simply a student. Although I have experienced “burn-out,” it is not a result of my attitude toward patient care. Rather, it’s a manifestation of overwhelming desire to be Dr. Savla, not Student Dr. Savla.