Reducing the impact of distress during medical training and clinical practice:

A recent paper in Medical Teacher reviewed the common professional stressors, noted additional ones, and proposed ways to reduce their impact. The authors state that a narrative review of literature suggests adding two professional stressors to those already described. Firstly there is the incongruity between students’ expectations and the realities of medical training and practice. Secondly, there is inconsistency between some aspects of medical education (e.g., its biomedical orientation) and clinical practice (e.g., a high proportion of patients with psychosocial problems).1

Reading this, I was powerfully reminded of my own undergraduate medical training and early professional experience as a doctor. I had entered medical school naively imagining that doctors were universally compassionate, caring individuals motivated by the desire to help sick and suffering people. The reality proved to be rather different – many (thankfully not all) of my teachers were arrogant, rude, ambitious, career motivated people with little regard for the human beings they were treating. This was profoundly disillusioning and caused me significant distress. Then when I entered General Practice after postgraduate vocational training, I found that although I was fairly well prepared for the wide variety of medical problems I had to recognise and treat, I was poorly prepared for dealing with the psychosocial distress that many of my patients were experiencing.

Medical education has improved a great deal since my experience of it thirty-five years ago, but the fact that this article is written recently reminds us that these issues are still a significant problem in how medicine is taught. The authors of the paper suggest, ‘The impact of these stressors may be reduced by two modifications in undergraduate medical programs. Firstly, by identifying training–practice discrepancies, with a view to correcting them. Secondly, by informing medical students, both upon admission and throughout the curriculum, about the types and frequency of professional distress, with a view to creating realistic expectations, teaching students how to deal with stressors, and encouraging them to seek counselling when needed.’2

‘Identifying training-practice discrepancies with a view to correcting them’ is easier said than done. It must surely begin with student selection, identifying students who are compassionate as well as intellectually able in the natural sciences. Then the training itself must include attention to self-care, to the psychosocial aspects of illness, to the recognition of the innate dignity and worth of every human being, as well as to the ever increasing scientific and technical aspects of modern medical practice. Most importantly, medical teachers must be good role models of caring , compassionate physicians, whatever their speciality, treating their patients and students with the respect and concern they deserve. Medicine is a ‘caring profession’ and only by demonstrating care in how it is taught can this

crucial and central aspect of its ethos be maintained. The need to always consider the patient’s background and circumstances and not just the narrow biomedical presentation is also crucial, and is a marker of good practice.

Do you treat your patients and students with respect and care? Do you routinely consider and teach about the psychosocial (and where relevant, spiritual) aspects of your patients’ problems? PRIME’s aim is to encourage us all to do so, in every consultation and teaching session that we conduct.

Dr Huw Morgan

PRIME Senior Tutor

References:

1.Benbassat et al (2011), Sources of distress during medical training and clinical practice: Suggestions for reducing their impact. Medical Teacher Vol. 33, No. 6 , Pages 486-490.

2. Ibid 1