To the graduating medical school class of 2017: Welcome to the profession.
Many of you will be moving, planning long vacations, and preparing for your life as a medical resident. Right now, you're probably furiously reviewing handbooks on being a medical intern as you sit on a beach.
(Or, like me, promising yourself you will — right after you finish "The Fault in Our Stars.")
Forgive me, but I have something to add to your to-do list: It’s time to find a therapist.
There are untold joys in medicine. Every day, at least one patient thanks me for looking into her eyes and reassuring her. Patients tell me things large and small that they have never told another soul, the "holy secrets" that confirm our shared humanity and our infinite diversity.
I cannot describe to you the feeling of saving a life, other than to say it is pure joy, love and peace, and a sense of meaning that many people will never experience. You, as a dedicated member of our profession, will undoubtedly have this feeling during your career. You will know what it means to be the person that someone who is sick and frightened trusts because you have earned that trust.
You will know what it means to walk a family through the death of their loved one, to bring peace to a harrowing and painful experience, which you will transform with your care into a time of loving goodbyes and healing.
But those joys will come at a cost to you.
You may have been compared unfavorably to those doctors who came before you — those giants who lived in the hospital during residency and tell us they treasured every moment of their 120-hour weeks. But they are wrong. You will be asked to do much more than they ever were.
The number of patient admissions to hospitals have outpaced the number of residency slots by a factor of more than 3 to 1. The time that patients are spending in the hospital is ever shorter. Instead of getting to know your patients, you will be spending two hours on paperwork for every hour of patient care because hospitals will not pay the money necessary to simplify your work and offload your tasks onto support staff.
So you will be spending less time with more patients — patients who are sicker and require more attention, but are getting less. You will daily perform what 20 years ago would have been considered a miracle.
The system will be asking too much of you and it has no incentive to stop.
Many of you will have friends who experience depression, substance abuse, or other illnesses in medical school and residency. Like me, you may tell yourself that your story will not be theirs.
Even as you slowly lose touch with friends and loved ones, stop eating regularly, stop exercising, stop leaving the house altogether on your days off, you will tell yourself that you are not sick. Your colleagues will probably echo that sentiment themselves — telling you that these feelings are a "normal" part of training.
You will keep coming to work. And until you don’t finish your tasks on time, or fail to show up, no one will notice that your life has fallen apart.
Roughly half of you will experience depression in your first year alone.
The people who are supposed to help you may not. And few of them will be proactive enough to suggest that you should expect to experience some level of mental illness and should plan accordingly.
You need to find a therapist so you can process the challenges you will face, so you will have someone to call if you do become sick.
You must be better than those who came before you. And you must understand your own humanity and capacity for suffering in a way that your advisers still may not.
You are your most important patient because we need you to be healthy. We need you to take care of America’s sick. We need you to fight for them. We need you to demand that our dysfunctional and broken system does better.
And you cannot do that if it breaks you first.
Dr. Elisabeth Poorman is a recent graduate of Cambridge Health Alliance and a primary care physician in Everett. She tweets at @DrPoorman.