The Depressed Doctor and How Not to Become One!

It’s been almost a year since I received my MBBS final results, passing them first class. The internship has been up and down and I’ve gained some experience on handling the patients and emergencies that arise. It’s time to reflect and share what I feel the medical professionals, especially new doctors should know about the practice of medicine.

Medical college is about learning new stuff, expanding our knowledge, share the same with friends and help the juniors along. I’ve done all these and guess most of us have done the same while competing for better grades and trying to excel in each subject we study. But that’s all to medical college. Medical practice is a whole different scenario. Your book knowledge can take you only so far and many a times, those who’ve done brilliantly in academics will find it difficult to come to terms with this changed scenario.

I did my 3 months of rural posting first, at the Government District hospital in Karwar. It was a mistake. Fresh out of MBBS, without the restricting environment of college, I wasted the three months, not learning much at the bedside (of course we handled a few cases, but nothing very focused and rigorous), the clinicians treated us as friends and we enjoyed our stay in that funny little town.  Then, came the work part, upon my return to the District hospital in Belgaum, I was posted to the casualty. This was the first time, I realized what I’ve studies for. I learnt what it meant to be a doctor here, some of it through pleasant experiences and some through not so pleasant experiences.The days spent in the burns ward will remain forever etched in my memories!

I moved on to surgery and then medicine, before working in Pediatrics. This was one department I was looking forward to. I wanted to specialize in this subject and was excited and depressed at the same time. I woke up at 4.00 am, came to work to saw 10-14 kids and then returned home very late at night despite not having continuous shifts, and was unable to sleep. I was so anxious. You see, I wanted to be able to help everyone of those kids. I still had to learn a few lessons.

A few days in to the posting,  I was so depressed, I couldn’t present the case properly and especially when the specialist asked simple questions like what is the diagnosis for a particular child, I couldn’t recall.  The problem was that I had been a comparatively better student and wanted perfection in everything I did. I did all my work with clockwork precision and hence the specialists wouldn’t tick me off on my smaller errors. But this only made me angry with myself for not rising to their expectations and set off a whole cycle of self-loathing and depression.

As I learn later,  this all or nothing way of working I was prone to is the most stupid way to work in the Medical world. I did not realize it during that time, and the anger would be followed by depression and anxiety followed by insomnia and the consequent memory problems. I felt that my dreams of becoming a pediatrician were falling off, ironically during the pediatrics posting and this made me feel worse. I wanted to seek help, but was embarrassed to do so. I managed to find someone to speak to about this problem but became more defensive after he suggested many things radically different from what I wished to do. I became very defensive. Avoided visiting the wards, avoided my few friends and basically stayed away from society. The internet was like a dream land at that time and I spent many hours whiling away my time without a goal. It was immature but the only way I thought I could survive at that time.

Luckily for me, I was able to get out of these troubles through meditation and mediation by a few friends. I also realized that we can’t do all the work all the time and need to learn to relax a bit. The truth is that as new doctors we want to make everything perfect. We overestimate our abilities (like me – I wanted to have all my patient’s data at my fingertips). We are human beings, we tend to make small mistakes, as long as it does not cost a patient’s life, it should be fine. We cannot expect our colleagues to behave just like us, they are human too. And it is natural that as interns we will be put in line by our superiors. That is one of the ways we remember our mistakes. Do not take it personally.

So here are 16 tips on not becoming a depressed doctor –

1. Do not listen to what other people say about certain people/workplace – go discover it yourself.
2. Make friends with patient and wards staff. Chatting with patient can cut your stress and at the same time, patients will love you too.
3. Try as best you can to memorize the  case, it’s ok if you forget 1 or 2 small things.
4. Respect others – respect the patient, respect the nurse, your superiors and the specialist (no matter how smart you are, they still have more experience than you).
5. None of your superiors have an ulterior/personal motive against you – they usually scold you for the sake of the patient.
6. Keep on studying – not just to increase your knowledge, but for the sake of patient.
7. Help each other – help and practice the procedures as much as you can, so that you can become an expert in that particular department.
8. Be dynamic and proactive during rounds – present case properly, don’t just stand there like a dumb idiot.
9. All or nothing is shitty motto for a doctor, but its good for Adidas.
10. When you’re working, remember that you’re paid to work, whatever little stipend you get.
11. If you’re stressed, anxious or depressed, seek help (through your specialist).
12. If you don’t know, just say you don’t know, even to your patient.
13. Enjoy working, change “working” to “helping patient”.
14. If you’re very anxious, take a deep breath through your nose for 4 seconds, hold it for 4 seconds, and exhale through your mouth for 4 seconds.
15. Enjoy your time off, don’t just sleep throughout the day, cultivate a hobby.
16. A Depressed doctor is not a good doctor.

I completed my Bachelors degree in Medicine and Surgery (MBBS) in the year 2002-2003. During the period, I used to regularly maintain a daily diary, the contents of which I cherish to this day. This is an excerpt from my diary, somewhere during my internship at Jawahar Lal Nehru Medical College (JNMC), Belgaum. It was an especially tough period for me when I was addicted to the new and wonderful phenomenon that was sweeping the country – The Internet and my poison was the Internet Chess Club. I used to spend days at the internet cafe and landed in a very heavy debt which took almost a year and a half to repay. Thanks to the support of my good friends and the girl who would be my wife, I was able to get back on my feet.