Studying medicine with a health condition
Medical students talk about their experiences of studying while dealing with mental and physical health conditions
Hannah Venables had just finished vomiting, and her face was still wet with tears after a suicide attempt, when she was told: “pull yourself together.” The words were spoken by a junior doctor. Venables, then a second year medical student, was in the emergency department having swallowed 20 paracetamol pills while in her parked car in a country lay-by.
“That morning, I decided I didn’t really want to be around anymore. It was quite a snap decision [to take the pills that day], although I had been thinking about it for a while,” says the now final year student from the University of Liverpool. “But straight after taking the pills, I regretted it and called my mum.”
Venables had had depression since experiencing a family tragedy at the age of 14. The illness had led to disordered eating, self harm, unpredictable behaviour, and a suicide attempt.
The junior doctor later apologised, but the comment stuck with Venables, who now writes a blog called Pull yourself together as an outlet to help her and others cope with depression. Venables wrote about her experience for the first time in her blog on World Mental Health Day in 2016—the day she was told by her general practitioner that she could stop taking antidepressants.
Her experience of being told to pull herself together in the emergency department was formative and made her realise the sort of doctor she wanted to be. “I want to be the doctor that gets to know their patient before jumping to conclusions . . . that knows how to talk to a patient with a mental health condition, and who is empathetic and helpful,” she writes.
One in four people in the United Kingdom will experience a mental health problem each year. A survey by Student BMJ last year found that 30% of respondents (343 out of 1122) had experienced or received treatment for a mental health condition while at medical school. According to figures obtained from the General Medical Council, 8.3% of medical students in 2015 reported that they had a disability of some sort—whether mental or physical was not specified—(3343 out of a total 40 084 students studying medicine), according to data submitted by medical schools.
Two years ago, while a student at St George’s University of London medical school, Hannah Barham-Brown was diagnosed with Ehlers-Danlos syndrome (EDS). She has type III, which affects connective tissue and includes joint hypermobility. Now a foundation year 1 doctor, she has chronic pain in her knees and uses a wheelchair and a walking stick to make her way around the hospital wards. “I thought it was normal to dislocate your knees when you run, but it turns out it’s not,” she says of her diagnosis.
Barham-Brown has grown up around disability because her mother is in a wheelchair, with a different condition. She has not been particularly affected psychologically by her condition, but coping with the pain is a big challenge. “Pain can be really distracting. When you’re trying to study for finals you don’t want to be focusing on what your body is doing as well,” she says. Like Venables, Barham-Brown had good support from her university. “In my exams, I could get up every 15 minutes or so and have a walk around so my joints didn’t seize up,” she says.
Notifying your medical school
Barham-Brown told her university straightaway about having Ehlers-Danlos syndrome. The Medical Schools Council (MSC) says applicants to medical school and existing students should declare a history of any serious physical or mental disorders, so that universities can provide the appropriate occupational support.
But Clare Owen, policy adviser at the MSC, says: “The guidance provided by the MSC and GMC to medical schools makes it clear that in most cases, health conditions and disabilities do not affect a medical student’s fitness to practise, as long as the student demonstrates appropriate insight, seeks appropriate medical advice, and complies with treatment.”
The GMC says that in exceptional circumstances, students may be removed from their course after consultation if their condition means they are unable to meet the necessary outcomes of undergraduate medical education. “This is a very rare situation and the views of occupational health physicians and other specialists will be crucial in supporting medical schools to make this decision,” a GMC spokesman says.
One of the priorities this year for the BMA medical students committee is helping students to disclose mental health conditions to their schools. Twishaa Sheth, the committee’s welfare lead, says that there is a perception that medical students are “infallible,” yet their lives make them incredibly vulnerable to mental ill health. Medical students are susceptible because of the pressures of funding a long, expensive course with placements away, dealing with the daily emotional burden of sickness and death, as well as certain personality traits like perfectionism, she says.
“It is important to note that we are humans first, medical students second. Being a medical student does not exclude us from having mental illness. And with good support, having a mental health condition is not a barrier to becoming a good doctor.” She says that students with physical disabilities can also be concerned about the adjustments they may need to make, and be “fearful of seeming anything less than superhuman.” “In every case, it is better to talk about it earlier rather than later—and the support systems are available if we ask for help,” Sheth says.
Stigma around health conditions still exists, but some students report feeling better for being open and, in some cases, being public about it by blogging about their experiences.
Barham-Brown writes a blog called Wonky Medicine, while Imperial College London second year student Usama Ali documents his journey with depression, with mild psychotic symptoms, on his Depressed Medical Student blog.
“Initially, I was very reluctant to tell anyone, but then I found that keeping it to myself made me feel worse. It helped just to speak to other people. I started blogging about my experiences because I wanted some good to come out of it by helping other people,” Ali says.
His medical school, particularly his personal tutor, has been supportive, but he says there is still an uncertainty among peers about what to do. “Often people would avoid [the subject], and me, and I’d end up feeling isolated. More education is needed,” Ali says.
Using the experience of ill health to understand patients
Ali says he really understands the need for communication skills sessions in medical school now that he has been on the receiving end as a patient. He recalls a visit he made to a patient with multiple sclerosis, which became a formative experience in his training.
Ali had seen this patient many times before his depression, but he says he then saw her only as “a set of interesting symptoms,” rather than as an individual.
He did not pick up on the conversational cues the patient was giving about the impact of her husband’s death and living alone with her condition. “I feel that we often miss these ‘obvious’ cues when we are so engrossed in the details of a patient’s illness, or are trying to act professionally and stick to a set guideline. This time I did explore [the situation] with my patient and was sure to be as empathetic as I could be,” he says.
Barham-Brown says her wheelchair can be a conversational aid for patients wanting to express a concern. She recalls rolling into a lift in her lightweight wheelchair alongside a female orthopaedic patient being pushed in a heavier wheelchair by a hospital porter.
“She said to me ‘I’d love a wheelchair like yours,’ and I said ‘speak to your GP,’ and explained how important it is to get a lightweight one. Later, a nurse said that the patient had told her that no one had ever spoken to her about that before, and she hadn’t known how to get the information.”
Venables’s personal experience has also influenced her professional interactions. On a GP placement, she noticed how a patient’s itchy body rash might have been exacerbated by stress. The patient was not sleeping or eating, had a low mood, and was feeling anxious. Venables asked the GP to consider referring the patient for counselling. “This patient’s symptoms would not have simply resolved with a cream, as there was an underlying cause of stress. So I felt that being able to treat this patient holistically benefited her a lot more,” she says. Venables says it was through her own experience and symptoms—and the closed body language and speech of the patient—that she noticed this. She responded in the empathetic manner she wishes the junior doctor in the emergency department had used when she was a patient.
Box 1: The experience of studying and practising medicine with a health condition
- Bansal H. When the worlds of medical student and medical patient collide. BMJ blogs 2016; 20 October. http://blogs.bmj.com/bmj/2016/10/20/hitesh-bansal-when-the-worlds-of-medical-student-and-medical-patient-collide/
- Sayburn A. Why medical students’ mental health is a taboo. Student BMJ 2015;23:h722
- Anonymous. I’m a doctor, and I have a mental illness, Student BMJ, 2015;23:h2819
Box 2: Resources for medical students living with mental and physical health conditions
- General Medical Council and Medical Schools Council. Supporting medical students with mental health conditions. 2015. www.gmc-uk.org/Supporting_students_with_mental_health_conditions_0816.pdf_53047904.pdf
- BMA counselling service—this helpline is staffed by professional telephone counsellors, 24 hours a day, seven days a week. They are bound by strict codes of confidentiality and ethical practice. If you would rather speak to a doctor adviser, you can specify that when you call. Telephone: 08459 200 169 (01455 254 189 landline)
- Nightline—this is a confidential, non-judgmental service that will listen to any problem, whether it be exam worries, problems with friends and family, or just the need to have a chat. Find your local Nightline service at www.nightline.ac.uk/want-to-talk/find-your-nightline/
Twishaa Sheth, BMA medical students committee deputy chair and welfare lead, for her help with compiling this feature.
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
- Venables H. Pull yourself together. 2016. http://pull-yourself-together.blogspot.co.uk/ .
- Venables H. World Mental Health Day: my overdose. Pull yourself together 2016; 10 October. http://pull-yourself-together.blogspot.co.uk/2016/10/world-mental-health-day-my-overdose.html .
- Billingsley M. More than 80% of medical students with mental health issues feel under-supported, says Student BMJ survey. Student BMJ 2015;23:h4521.
- Mind. Mental health facts and statistics. 2016. www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/ .
- General Medical Council. Achieving good medical practice: guidance for medical students. 2016. http://www.gmc-uk.org/Achieving_good_medical_practice_0816.pdf_66086678.pdf .
- Barham-Brown H. Wonky Medicine. 2016. https://hannahbarhambrown.wordpress.com/ .
- Usama A. The Depressed Medical Student. 2016. http://thedepressedmedstudent.com/ .