A mentor once told me, “Friendship comes at a cost.” He meant that to maintain relationships, we must be willing to give of ourselves. Meaningful relationship takes work, and cannot rely on convenience. The value of mutual self-sacrifice can empower both individuals, but it requires effort. As a medical student, I often feel that school is antagonist to these principles in my relationships.
Medical school is consuming at times. There is constant pressure surrounding the next test, day of rounds, or research project. It is easy to fall into a track solely focused on oneself. It is in the moments when friends and classmates around me are feeling down that I feel the pressure to stay in the self-focused track most. Pushing things off for a night of studying or work is almost always the wrong decision when it comes to relationships, but the pressure to do it is there. Being inconvenienced is difficult in the moment, but the inconveniences themselves are the key to demonstrating that our friendships are meaningful. Going to visit friends when they are having a hard time or bringing them small gifts unprompted take minimal effort, and fight against feelings of isolation.
Given the widely discussed mental health issues facing medical students, partaking in sacrificial friendships with those around us has the potential to improve the situation. Research shows that 1 in 4 medical students report depressive symptoms. These statistics reflect the rising prevalence of depression in society, compounded with the stress and pressure associated with medical training. The mental health crisis among medical students has thankfully led institutions to search for answers, but the issue is far from resolved. The answer certainly lies in a multifaceted approach involving systems and cultures, but in the meantime, we must look out for our struggling colleagues and classmates.
The recent suicides of Anthony Bourdain and Kate Spade highlight that even people who “have it all” and are “put together,” are often hiding deeper internal issues. On the outside, they appear happy and successful, but internally this is clearly not the case. The same can be said about medical students. The admissions process selects for highly successful individuals, which creates a culture expecting success. This forces mental health issues beneath the surface to keep up appearances. Unless we truly ask and get to know those around us, the culture of medical school will hide the real issues at hand. As structural changes and policies are being implemented, we must rely on our relationships to care for those around us. To do this well will require commitment to and sacrifice for our colleagues and classmates.
The road to becoming a physician is already full of sacrifices. We give up time with our families, friends, and other things we enjoy to study and treat our patients. We endure all these things in the name of patient care. Being willing to endure these things to also assist our colleagues will enable them to continue to care for their patients as well. Giving up time to spend time with those struggling, while being cognizant of our own limits, has the potential to improve the culture of medical school and help those dealing with mental health challenges.
We must be willing to engage people in hard, honest conversations at inconvenient times. It is easy to accept the “I’m doing fine” at face value when you know that is not the case. These raw moments, when we acknowledge that we do not have it all together, help shift the negative aspects of a high performing culture. We must continually acknowledge that it is okay to not be okay. Sacrificing for those around us will never supersede appropriate counseling, medication, or system improvement, but is certainly part of the equation to reduce the mental health issues that are currently so prevalent in medicine.
In the immediate, medical students today must support our classmates who are struggling, recognizing the sacrifices required to effectively do that. We each must ask if we are willing or capable to endure inconveniences for the well-being of those around us? Will we accept superficial answers, when we know there are hidden, deeper problems?
The timing of opportunities to help our friends and classmates will almost never be ideal, but it will always be important. The answer to these questions will determine our immediate ability to combat the mental health crisis facing medical students. No single individual can completely fix this problem, but most of us are capable of reaching out to those who need it most.
Cameron Todd is a fourth-year medical student at Tulane University School of Medicine. He is a 2018–19 Doximity Author.