Breaking Point

The first two years of medical school are intense. I put my social life on hold and studied constantly, yet I never could catch up with assignments. Add national board exams to the work load, and you have the recipe for a meltdown.

Dear Medical Student:

Virtually all physicians have felt as though they reached their breaking point at least once, if not several times, during medical school. This is especially true in the first two years, when students are tasked with learning new material at a frenetic pace. Just when you think they can’t pile it higher, they do.

I vividly recall the time I felt I had reached my breaking point. It was near the end of my second year, with clinical rotations just around the corner. But before reaching that destination, I had to get past pharmacology.

Of all the material that needed to be mastered during the first two years of medical school, I found pharmacology the most daunting. The amount of information, including the need to translate frequently and fluently between generic and brand name drugs, was staggering.

About two weeks prior to my final exam, precisely when I believed I was caught up with all the assigned reading (the basic science years are essentially a game of catch up, aren’t they?), our class was hit by an onslaught of oncology-based pharmacology. There were oh so many drugs to memorize, including where they worked in the life cycle of a cell. I felt as if I was going to blow a gasket. Mind you, this came around the time we were also supposed to be studying for Step 1 of the USMLE.

I didn’t think I could handle it. I left my study cubicle in the library, walked down the street to the medical research building, and popped in to see one of our admired pharmacology professors. Sensing my panic, she invited me into her office, and we chatted for well over an hour. The professor was a good listener and she was sympathetic to the onslaught of oncology reading. Just being able to vent about the travails of medical school put me at ease, albeit temporarily.

My anxiety raged heading into the final exam, so I decided to visit my family doctor. Perhaps seeing a well-rounded doctor might help calm me down, I thought. His assessment was “situational anxiety.”

“Take this tranquilizer,” he said, handing me a sample package of Triavil. He proclaimed it was a “new” medication.

“Triavil?” I said, while exploring the package insert for its ingredients. “It says it’s a combination of amitriptyline and perphenazine.” I was familiar with those compounds and, believe me, they were not like a typical diazepam (Valium). In no way, I told myself, is Triavil similar to the benzodiazepine class of medication commonly used to treat anxiety disorders. “It’s an antidepressant and antipsychotic combined in one pill,” I continued. “This will knock me out!”

The physician insisted it was a tranquilizer to help me “get by.” Though I disagreed, I thanked him and left the office. I discarded the medication once I got home.

It occurred to me that, as a second-year medical student, I already knew more about the pharmacology of this drug than my family doctor, whose knowledge appeared to be on par with the drug representative who dropped off the sample medication.

I was comforted by the fact that I possessed a fairly good understanding of pharmacology, at least enough to overrule my family physician and enter the final exam with confidence. In retrospect, I should have given myself more credit for the knowledge I already possessed.

Now, I know what you are probably thinking. Comparing myself to a doctor whose knowledge of therapeutics was gleaned primarily from a drug “detail” is bound to instill feelings of superiority in even the lowliest of medical students. He must not be a very good doctor if he does not keep up with the medical literature to stay abreast of the latest advancements in practice and relies on marketing information instead.

I would not argue this point with you. But consider this: There were other times in my third and fourth years when I thought I didn’t measure up. I was inclined to compare myself to my classmates — a better benchmark than my family doctor — but it was useless. Invariably, I discovered, I had areas of strength where they had weaknesses, and vice versa. We all are prone to feeling like imposters. Don’t let perceived inadequacies define who you are.

Long before medical school, most of us achieved some degree of superstar status in our education. We were well tested on the educational battlefield and survived a very competitive pyramid system. Although we often doubt ourselves and our abilities, we should realize that past behavior is the best predictor of future behavior, and given our track record of exceptional performance, there is no reason to believe we won’t succeed in present and future times.

The most influential physician in my life, my analyst, said it best during medical school orientation: “You all belong here.” The sooner we realize that, the sooner we can avoid untold worry and grief, not to mention burnout and depression, which beset many doctors today.

If your mood becomes persistently depressed, however, it’s a red flag that you need help. Don’t hesitate to utilize resources available at your school or elsewhere — support groups, yoga, meditation, mindfulness exercises, psychotherapy, and the like — to prevent or treat a major depressive episode.

The main message here is to never believe you are not good enough. Fortunately, a simple reality check got me back on track. None of us are imposters, and we must stop thinking that way.

If there is a denouement to this story, it is this: At graduation, I received an award for the highest academic achievement in pharmacology. I sometimes wonder whether I truly surpassed all my classmates in the final exam, or whether the heart-to-heart talk with my pharmacology professor endeared me to her and was the reason I received the honor. After all, she was the course director.

Excerpted from Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine by Arthur Lazarus, MD, MBA, CPE.