Wednesday, March 31, 2021

Is Self-Censorship in Med School, Residency Applications Driving Burnout Among Physicians?

“From its earliest stages, a medical career unfolds within a culture of censorship of our vulnerabilities, a culture that contributes to burnout and depression.” So writes Michelle H. Silver, M.D., an internal medicine resident at the Hospital of the University of Pennsylvania, in an article in the New England Journal of Medicine describing the ways in which aspiring physicians are instructed early to censor their personal narratives in competing for medical school admission and residency slots.

In Silver’s case, this included censoring the story of her history of an eating disorder. “Like many of my pre-med colleagues, I agonized over what to write in my personal statement. … None of my ideas felt sufficiently personal—until I wrote the truth: I wanted to be a healer because of my past suffering from mental illness. The years I had spent coming to understand and recovering from my eating disorder had empowered me to apply those skills to my future patients. This experience, I believed, would make me an empathetic doctor, capable of taking a holistic approach to patients’ wellness.”

Silver quoted the disapproving advice of a physician who reviewed the statement: “While someone who knows you well can appreciate your openness. I don’t think it is a good idea to share this with an admissions committee. They won’t think you’re fit to enter into the medical field.”

“The irony was glaring: mental illness is even more prevalent among medical professionals and trainees than in the general population,” Silver wrote. “But it is so stigmatized that despite its disproportionate prevalence in the field I was about to enter, I had to pretend I’d never faced it.”

She found the same censoring voice when, in an application for residency, she described a challenging encounter with a critically ill patient and his family. Her mentor “explained that by describing an experience in which I had cried during routine medical practice, I was setting myself up to look unfit for the role—that I appeared ‘too emotional’ to handle the day-to-day work of a resident,” Silver wrote.

Silver argues that the censoring of personal stories is not only detrimental to individual doctors and to the field of medicine, but is also fueling the epidemic of burnout in American medicine.

“I hope that explicit criticism of the outdated tradition of devaluing life experiences deemed unpalatable by an admissions committee will inspire a cultural shift toward transparency,” she wrote. “In such a culture, our personal statements might in fact become personal—and could, collectively, become a celebration of diverse lived experiences, an opportunity for a more comprehensive appreciation of each person who aspires to become an empathetic and effective physician.”

For related information, see the Psychiatric News article “Symposium to Address Self-Disclosure of Mental Illness, Burnout Symptoms.”

(Image: iStock/PeopleImages)

APA Seeks Input on How Psychiatrists Can Address Racial Inequities

The APA Presidential Task Force to Address Structural Racism Throughout Psychiatry is fielding a new short survey. Help the task force inform its important work by responding to the survey by Wednesday, April 14. Learn more about the task force and view the results of its previous three surveys on the task force webpage.


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