Dear Dr Bernstein

I read your student friend’s message with great interest and an immediate resonance to my experience. I am not sure this is helpful, but I wanted to explain my experience, in case it might help give some perspective.

As an initial disclaimer, I am always aware that people are different, and that this is what makes advising someone an often redundant pursuit. I was acutely aware of this when in his/her situation. However, as your friend says, the perspective can help! The useful perspective is shared experience that helps them see themselves and their current situation more clearly, or at least in way that helps them move forward. The catch is that someone “in the system” cannot give certain perspective, whereas someone outside cannot understand it.

Anyway, I am a med school dropout, but now work in a usually enjoyable, and certainly far less intense (for me) job developing new book ideas for medical publishing. I also studied Biology at a top UK university, and am very interested in science and health in general. These things are still core to my motivation.

The key sentence for me in your friends very rational and well written message is “I felt as if I could not handle what I was going through and didn't want to put myself through such physical and emotional stress as it was manifesting itself in ways that were very uncharacteristic to who I am. ” I struggled with this for 2.5 years and tried everything in my power to override this anxiety – exercise, counseling, moonlighting as drummer, intense hiking in exotic locations in (increasingly brief!) vacations, getting involved in global health projects, an interesting community health project in Ecuador, trying to find a “mentor” I could see myself in, for example. None of it helped – I could not escape a constant grating feeling that I was trying to drag myself down a road that wasn’t for me. I only left when it was no longer a “decision” but simply what I had to do. I’ve never felt such sweet release in all my life.

Which isn’t to say I am not disappointed in myself sometimes (I wouldn’t term it ‘regret’). I still don’t entirely understand why I found it such a struggle. I’m a fairly gentle but confident person, hugely fascinated with people, really interested in clinical skills, science, and community/national health service. I was constantly aware of the unbelievable privileges and opportunities that a career in medicine can bring. But, when I am really honest with myself, I think my personality means that I find it overwhelming – not necessarily emotionally - but in trying to process all the things you experience as a med student/doctor. I have more of an artistic temperament (if not skill!), and require time to properly reflect on new experience, or else I am left on-edge. Also, if I am honest, I think the pure biomedical model is redundant, and I could not fit with the reality of the culture of medicine (rushed, linear thinking, bureaucracy, short-termism, treating symptoms over causes, body-mechanics, Cartesian reductionism [as an aside – even Descartes would prescribe his royal patients rest and exercise and discuss (perhaps partly from having little to offer!) ‘disease of the spirit’], etc.).

A third thing I often consider is that medicine alters the way you interact with people and bodies. These are core aspects of our identity. I found, perhaps compounded by a generally increased level of anxiety, that I started to feel more detatched from people, as if a sensitivity towards people I valued was being lost. I am not a sentimental, prudish or squeamish type, but it is very important to me to feel I am “connecting” to people. I don’t think this is an absolute thing, for or amongst individuals: it changes over (life)time. It is more a problem of learning to adapt, and I felt that I didn’t want to.

I suspect by the way your student writes that he(?) is quite a deep thinker that struggles with the reactive, immediate need of medical culture and its focus on a purely physical world-view. The anxiety doesn’t sound like it comes from fear of failure or inadequacy, but more from the high-demands of something they don’t want to commit to. I am only guessing. The culture and requirements of the job can be flexible after the (long) period of training, but you need a clear goal that sees you through this. There is not much time to search for this if it isn’t forthcoming, but needs must.

I now have quite a few young doctors as friends. I do feel that we inhabit different bubbles of reality – if not planets – and I know nearly all struggle, even now. But suffering with meaning is OK. It’s when you don’t believe in or are not aware of the goals that it drains the spirit. Sometimes the goal that sees you through is simply discipline, determination or a competitive identity. There is nothing wrong with that, for the most part, but I am wary of comparing myself to others in this way. Or I am just not as ambitious as I thought. I still have struggles, of course, and in something as demanding as medicine, at least your struggles are usually right in front of you, and you can often act to alleviate them.

I am personally against any medication that is not necessary. Psychoactive drugs can sometimes jolt a person out of a psychological rut, but they are overused as a crutch that blurs ones sense of identity and surely cannot then influence clear-mined decisions based on self-determination.

I hope some of this is useful. I am certainly not advising them to quit. I still think it is one of the noblest professions with huge opportunities and a passport to places few others can safely go. But I found my time at medical school erosive and it always felt that I had an instinctive aversion to ‘joining the community’ I was trying to. It seemed at the time that it would really help to find a good mentor, and I always considered that medicine should be learnt as an apprenticeship, so that all elements of its practice can be passed on.

Please wish them well from me, and I would be interested to discuss more if they thought it helpful.

Kind regards

Paul