Isobel Walker considers how we can dispel the notion that those with a mental illness aren’t “cut out” for the medical profession
My medical school experience has definitely not been “typical”—I’ve spent most of it under some level of psychiatric care. Being a patient as a medical student affects every aspect of my university life. When I’m attending a clinic as a patient, I’ll anxiously try to work out whether any medical students will be observing the session, and I’ve found myself calling the receptionist to hide all evidence of me being there so students can’t accidentally stumble upon my notes. In the past, I have been so distressed that I would take anyone (even someone who may recognise me) listening to me at that moment in time, only for worry and embarrassment to creep in afterwards.
When friends are applying for their next placement locations, I already know mine; it has been planned for months because I need to be within easy access of my consultant, or psychotherapy session, or whatever treatment it is for what my mental health next decides to throw at me.
I’ve been diagnosed with some form of mental health condition since I was 11, and have tried both pharmacological and psychological interventions. Naturally, my ability to cope with medical school was questioned before I had even started my first year. I still clearly remember an occupational health appointment where I felt like a list of diagnoses—a “liability.” I resolved then that I would always fight to prove that I was “good enough.” However, this led me to succumb to the self-stigmatisation that so many people in my situation are subject to—unfortunately, it causes many medical students, who would be incredible doctors, to decide that they aren’t cut out for the profession.
The obstacles to seeking support that medical students with serious mental illnesses face only add to the stigma. Some are true obstacles: for example, the geographic instability of clinical placements and, more recently, the restrictions placed upon students by the covid-19 pandemic. Others, however, are perceived obstacles. The nature of medicine’s admissions process, and its aim to positively select candidates who demonstrate traits such as “resilience,” produces cohorts full of students who appear mentally robust and strong—making a confession of not coping even harder. This emphasis continues beyond medical school into life as a qualified doctor, where a preconceived professional culture of invincibility is rife. “We’re supposed to treat the sick, not be sick ourselves” is a common ideation among students when considering their role.
It’s frequently assumed that medical students will be “fit and healthy” when, all too often, this isn’t the case. I once had a clinician remark to me how they couldn’t imagine how awful it would be to need medication to not feel “miserable,” assuming I would share this view. I implore clinicians, medical educators, and fellow students to consider their words before they make statements like this, which may add to stigma. Medical students are certainly not exempt from invisible illnesses and hidden disabilities. If anything, with over two fifths of doctors reporting that covid-19 has worsened their mental health, these issues are likely to affect an even greater number of doctors and students during and beyond the pandemic.
One further contributor to stigmatisation is students’ fear that confidentiality will not be upheld, and that seeking care for their mental health will harm their career progression or prevent graduation due to fitness to practise processes. It’s a misconception that disclosure of any mental health problem, no matter how small, will automatically result in fitness to practise proceedings. The GMC clearly states that this is only in “exceptional” cases where it is “impossible” for a student to meet required outcomes. The GMC also requires medical schools “to show the support, interventions, and reasonable adjustments” it has made for a struggling student before a fitness to practise process can even be started.
Early preventative measures by medical schools are advised and outlined in the same guidance, ranging from reassurance that some degree of stress and anxiety is normal, to peer schemes and confidential support. The normalisation of preventative action, advocacy of students’ welfare and wellbeing, and promotion of looking out for one another and seeking help are positive steps towards reducing stigmatisation.
However, mental illnesses can range from mild to severe, just as physical health conditions can. The GMC specifically admits that people with severe mental health conditions like mine are more likely to be discriminated against. I desperately just wanted to be seen for me, and the abilities that got me into medical school. Although it was by no means an easy thing to open up about, I found that the way to do this and access the support I so needed to achieve what I was capable of was to be brave, open, and honest as to how I was feeling—three key qualities of a doctor. This support is individualised: for me, it’s knowing doctors’ offices where I can hide away if need be or people I can drop a quick email to.
I’ve now achieved more than I ever imagined was possible: I was recognised for services to welfare, have graduated with my BMedSci, and was awarded for an outstanding personal and professional development record in terms of difficulties overcome. I’m also beginning to seriously aspire to my future for the very first time: I absolutely loved my paediatrics placement.
Realistically, it is likely that I’ll slip downhill again. I’ll probably need to read my own advice back to myself, but that’s why it’s there: to remind people that you don’t need to “disappear” from the medical world just because you have a mental illness.
Isobel Walker is a fourth year medical student at the University of Nottingham and is also a member of the Sharp Scratch panel. Outside of medicine, she can either be found in a boat (of any sort!) or creating pieces of artwork.
Competing interests: none declared.