Graduates of the class of 2006, we salute you!

Recently it was that time of the year for my medical school's graduation ceremony. Three hours and forty-five minutes of speeches and handing out diplomas, wearing warm academic regalia in an auditorium that could have used more air conditioning-I think you all have been there and know the drill. Deans, vice deans, assistant deans, and department chairmen are accorded the honor of sitting up on the stage, so we get a close-up view of the proceedings.

"The United States loses the equivalent of seven medical-school graduating classes each year to drug addiction, alcoholism, and suicide."

David Hilfiker,
Author of Healing the Wounds; A Physician Looks at His Work
(New York: Pantheon, 1985, p. 13)

Recently it was that time of the year for my medical school's graduation ceremony. Three hours and forty-five minutes of speeches and handing out diplomas, wearing warm academic regalia in an auditorium that could have used more air conditioning-I think you all have been there and know the drill. Deans, vice deans, assistant deans, and department chairmen are accorded the honor of sitting up on the stage, so we get a close-up view of the proceedings.

"You graduates will soon be out in the world helping others in your roles as successful, independent physicians, unless you decide to go into academics and have to move back in with your parents."

This got a lot of laughs from graduating students and their families in the audience, and evoked a lot of groans from my academician colleagues on the stage.

This annual graduation rite was called to mind recently when I learned the disappointing statistic within the quote above. While medical schools try to meet society's demand for physicians by putting out a bumper crop of the best and brightest each year, at the same time we are losing annually the equivalent of seven graduating classes worth of doctors in the United States to drugs, alcohol, and suicide.

Personally, I know of four ophthalmologists whose careers and lives were ruined, or nearly ruined, by alcoholism. It is discouraging to me that we lose so many physicians each year, and I wonder why that would be. Is it the nature of the medical student/physician beast-hard-driving, extremely self-demanding, having difficulty settling for "pretty good" results? Is it the window that medical training provides into the often sad lives of our fellow human beings?

My memories include a young woman who poured liquid drain cleaner on the eyes and face of her sleeping boyfriend who had been paying attention to other women. She wanted him not to be able to look at other women and to be so disfigured that no other women would find him physically attractive, and she accomplished her goal.

Of course, training in an academic medical center with a referral population of high-acuity ill patients meant seeing people die.

Ophthalmologists tend to be lucky. Our field is extremely rewarding because we can benefit so many people, and we (almost) never see anyone die under our care. But having a patient go blind, or a child die of retinoblastoma, can be difficult.

What I wonder is whether medical school and residency training programs could do more to help our trainees effectively deal with feelings and emotions that may arise in the course of their work. We do a great job conveying scientific biomedical knowledge, and I think a very good job emphasizing the importance of empathy toward patients, but do we adequately address the natural human reactions of our trainees when bad things happen? Do we, should we (or can we?) teach the importance of social relationships outside of medicine, of the benefits that might accrue from regular exercise or hobbies such as music, or confront the emotions and "non-scientific" feelings that manifest themselves in the course of becoming a doctor?

Can we help this at-risk group of people learn strategies that will address needs that are currently being or in the future likely to be served by alcohol, drugs, or suicide?