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"Cognitive dissonance" is a term I learned from a medical ethics course during my sophomore year of college. A Google search defines it as "the mental discomfort felt from holding two conflicting beliefs; or when your beliefs are inconsistent with your actions." During my psychiatry clerkship, I battled with this internal conflict more than on any other rotation, likely due to the nature of the field and presentation of its most ill patients. From the first day of medical school, we are taught to "first, do no harm," yet a few days after beginning this clerkship, I found myself eliciting tears from an 11-year-old girl as I systematically asked her to recount (probably for the eighth time since she arrived) the distressing events that led to her coming to the hospital.

When I stepped onto the adult inpatient unit, to my surprise, the patients were roaming freely about the milieu. We all probably have our preformed assumptions of what an inpatient psychiatric unit would look like, mostly based off of what we've seen on Netflix, and I immediately felt guilty about mine. Yes, the image of a long dark hallway lined with locked cell doors came to mind, with the assumption that our patients would be confined to their rooms, in restraints, or somehow displaying the stereotypical behavior that is portrayed by the media. As staff and patients circled around for the morning's community meeting, we were asked to introduce ourselves and say one thing we were looking forward to. Each staff member shared their pearls of excitement—the holiday season, spending time with family, becoming a physician—while many of the patients either mentioned having nothing to look forward to or only awaited their day of discharge.

An hour later, it was time for treatment team for formal assessment of each patient. On any given day, treatment team can consist of seven or so unfamiliar members of the care team. Fourteen penetrating eyes surrounding one patient with the expectation that they share their deepest traumas to a room full of strangers: strangers sipping Starbucks in their $100 scrubs, scribbling down direct quotes, and scrolling critically through the medical record. The imbalance of power is difficult to ignore, yet I know everyone in the room is well-intended. I found myself at the head of the table, directly opposite of each patient. As nonessential personnel, it often feels as if I am more of a spectator, just there for the "show" of distorted reality that is experienced by many of our patients—and again the guilt returned.

As each patient came in and out, I couldn't help but question why I was the one with the privilege of being seated on this side of the table—the "doctor" side. Why was I so fortunate to be the medical student with an expectantly bright future ahead—and countless things to look forward to—while the 27-year-old woman at the opposite end of the table has been subjected to a lifetime of abuse and a seemingly unsurmountable battle with mental illness. Why am I the one who gets to return home to a loving family, but the individual in front of me is informed that she cannot return to her shelter due to the incident that led to her hospitalization, leaving her and her three young daughters homeless.

I often take comfort in the fact that I cannot relate to this experience; but am I one mistake, one overwhelming stressor, one trauma, one prescription stimulant, one accident, or even one failure away from taking a new place at the opposite end of the table? How similar are we, as medical students, with our rigorous academic demands and ever-expanding pressure to achieve, to the previously healthy young woman now presenting with depression and SI due to a stressful educational load and other life responsibilities that have just become too much to bear.

Actually, the evidence says we are more than likely than the average population to experience those very things. It seems that the medical profession has become numb to the concept of depression and suicide, or maybe avoidant is the better term, pretending to be oblivious to the fact that because of this life path, we are at an increased risk for these feelings that should not be mentioned. We hide behind dark humor and dismiss the silent impact that lack of sleep, isolation, baseline cortisol elevation, and exposure to death/dying/trauma may be taking on us.

Now, I did not write about this topic to be a complete downer to those who will read it; I also did not intend to make an assignment meant to illustrate a meaningful patient experience about medical student mental health, although it is a salient topic of discussion. As much as we, as future physicians, hate to admit it, we are not invincible. Therefore, we should be the last to place judgment on the circumstances of another human, especially when acknowledging the unearned advantages that many of us may have benefitted from throughout our lives. Compassion, my friends, has always been the name of the game. As you click the SmartPhrases for your "unkempt" or "malodorous" patient, remember that this is another person you are referring to, not just a fascinating pathology or real-life depiction of a UWorld question stem. While we may not be able to understand exactly what our patients are going through, we can certainly treat them in the same manner we would want our loved ones to be treated if ever in a similar situation.

We won't solve homelessness, poor access to mental health resources, or any other public health crisis during our time in medical school; but I challenge you to consider the things we can do to help our patients while we have the privilege of being on their care team. What resources can we assist in finding? What can we do to help meet even the most basic needs of our patients? How can we leave them more empowered than when we first met them? These questions stand regardless of your chosen field, and every specialist can benefit their patients by providing optimal mental health care.

Life is not fair—simply put—which is kind of the answer to my own existential questions from earlier; but we have been given an exceptional opportunity to make a positive impact on the lives of others. With the same tenacity used to argue for a point back on a quiz, use your voice to help meet the needs of your patients who may have been silenced. That voice will carry influence and soon be backed by years of training and expertise. Advocate holistically for your patients and provide them with the exceptional medical care they each deserve, but don't forget to take care of yourself, and each other, along the way.

ACP offers well-being resources tailored to the unique challenges of medical students.

Back to the July 2024 issue of ACP IMpact