Thanks for writing that, my heart breaks too. My girlfriend is a second year resident in Germany, which is different in many details but, for doctors if not for patients, surprisingly similar. I'm watching her passion, ethics, social life, and physical and mental health slowly crumble. I know she's probably thinking the same thing that I am: practicing her hard earned craft will cost her her happiness, and by extension that of those who love her. There is no light at the end of the tunnel, other than leaving. I know she knows it but so far I haven't had the heart to say it to her.
I'm really sorry to hear that. I've seen so many people crumble in residency and fellowship. I'm unfamiliar with the details of how Germany structures its medical training; for her, does residency imply she's already selected a specialty?
What I'd recommend is that she get in touch with a healthcare professional. So, so many docs I know are afraid of getting help for the (fucking inevitable) depression because they're afraid of the stigma, despite it being so common in our field. I was one of them. Keeping a good, discrete psychiatrist in your corner can be incredibly valuable for getting through that time in one's life.
In Germany - once you finish medical school (6 years) you can practice medicine and be paid for it but you're not yet specialized. Specialization is achieved via a 5-year hospital residency. During that time you're considered an "Assistenzarzt" (assistant doctor), which is hilarious. She was handed her own station 2 months into her residency - a station with a capacity of 15 patients that's very often at 20, with extra beds crammed into what used to be 3 person rooms. That residency rewards you with a lower middle class salary for days that consist of 8 hours of frantic clinical work and 4 hours of clerical work. There's a serious overall doctor shortage, especially of senior doctors, so on-the-job training and guidance is very thin. Never enough time and always too much responsibility is the name of the game.
My girlfriend has a therapist who supports her and isn't afraid of any stigma. That part is easier here because the system is so desperate for doctors that no one has reason to fear for their job. But, I just don't understand what any therapist can do to help anyone survive 60-80 hour underpaid weeks with occasional night duty, in a context where serious medical mistakes are simply inevitable. She knows she's doing her best and she knows she's being set up to fail, but in her mind, understandably, none of that negates that in the end, it was her that made that mistake.
Where did you land? Did you find a sustainable way to practice?
I'm so sorry to hear that. I know that scenario too well, and I know the pain is unbearable. You learn to keep an impersonal distance with 90% of your patients, just put on a good show, but once in a while you connect, and you see it all over again with fresh eyes and it's so painful.
My interest is in chronic pain management, by way of psychiatry. I have very strong feelings about the way chronic pain is handled, or mishandled. The american approach to pain is incredibly ... uncomfortable with pain. There's an underlying guilt and discomfort that makes physicians very, very uncomfortable, in a way I think very few are willing to honestly admit or engage with. They turn their brains off when it comes to pain, the better to salve their hearts. When the drug companies pushed hard to market "pain as a vital sign," it gave physicians permission to just throw painkillers at patients to shut them up. Now the addiction crisis gives physicians license to just not throw painkillers at anyone. Either way, it's mindless, and patients suffer for it. Heck, even when physicians are thinking about it, the question is always about addiction, malingering, etc. This isn't helped by the fact that addiction and malingering are common, and addicts and malingerers also get sick and also have pain that requires training.
I don't have a good answer for that one. It's just another survival thing. We aren't robots; we can only do so much to retain our sanity in the face of pain. But I am more bothered by pain treated poorly than I am by the mere existence of pain itself. It helps that I'm chronically ill myself, have been in shoes few patients have ever been in, and can meet them heart-to-heart on the topic.
Psychiatry residency in the states is pretty merciful compared to others, either because psychiatrists better appreciate psychological distress in general, or because we're the ones our colleagues come to for help and we're loathe to inflict the same suffering on our trainees. It comes with a decent hit to your bottom line - you give up a fair chunk of income in exchange for retaining your sanity - but I am happy to be able to see my loved ones and remain a human being. I used to think I'd want to do critical care, but seeing how critcare fellowships ate alive people far more resilient than I am... thank goodness I didn't do that.
