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What is Medical Student Syndrome

by Dr.Sal MD on author

hypochondriac medical student

Medical Student Syndrome, also known as Nosophobia, or 'medical student disease', or 'intern's syndrome', or 'first/second year syndrome' among others, is a phenomenon we used to talk about in med school whereby some of us started to think we had every ailment we read about. I personally think 'medical student syndrome' is not restricted to young doctors in training but pandemic to the general population itself for I often see patients that think they have some spooky malady after an internet search of their symptoms. But it's so much more amped up in student doctors because that's all they google and digest all day - maladies and pathology.

What Causes Medical Student Syndrome?

The mental magic of reading yourself sick is not that hard. It is an exploit of two potential flaws in our thought processes.

The first, we can actually physically point to - a hardware cluster of cells in your brain called the reticular activating system (RAS), responsible for awareness and attention. When you buy a new red car and suddenly notice all the other red cars on the road, or cut your finger but don't feel the pain until you look at it, that is your RAS making you aware of information that was there all the time but you previously ignored. In like vein, when a stressed medical student reads about stomach disease and begins to focus on the recurring gnawing burn in their tummy as they read, it can be easy to misconstrue these hunger pangs for stomach cancer, and forget the more likely explanation: skipped meals. OMG.

The second driver for illness illusion is a software glitch in our hierarchical assignment of new information. Our poor medical student with an imagined stomach ulcer or worse, now reads about myocardial infarctions - heart attack by another name. S/he reads that the symptoms are: shortness of breath, rapid pulse, dizziness, e.t.c. The next morning at the top of a flight of stairs to their classroom, they feel a bit short of breath, palpitations, and slightly dizzy. As their anxiety builds up over the ensuing hours they feel more flutters and inexplicable sensations in their chest, air hunger, and discomfort. They now panic convinced that the Grim Reaper has their name on his naughty list and they must present to the Emergency Department with haste before their career is cut prematurely short. Of course anxiety can also cause all of these non-specific symptoms and the kicker is that the more you worry, the more symptoms you get, which leads to more worry, which leads to more expression, feeding even more anxiety, ad nauseum. And there are a myriad of other conditions that share the same calling cards. Asthma. Fatigue. A common cold. Exercise. What is missing from the immature diagnostic mind of a medical student is a weighting system. We learn in isolation that condition X consists of that, that, and that symptoms, but it takes the benefit of experience to realize that that, that, and that are also shared symptoms of X, Y, and Z conditions and that of the possible symptoms not all are created equal - some features carry far more gravity in making a diagnosis than others. A fact that can only be appreciated after sharpening ones diagnostic skills over time in medical practice.

Add to the above cerebral vulnerabilities, stress, long hours, missed meals, high volume memorization and you have a recipe for mental meltdown aka 'Medical Student Syndrome'.

How is Medical Student Syndrome Treated?

Most cases require no treatment. We simply outgrow the shock of flirting with new illnesses like you might overcome fear of public speaking or driving for the first time, or your first dance. A minority of the more pervasive type need psychological counseling and occasionally SSRI medications but likely these cases unmasked an underlying general anxiety proclivity that existed prior to, but made worse by, medical school exposure.

What is the Cost of Medical Student Syndrome on Sufferers?

For the majority of Medical Student Syndrome sufferers, it is a benign and self-limiting illness. A rite of passage of sorts and something to put aside like childish things when you graduate.

I think there is a bigger long term sequela to 'Medical Student Syndrome' which I like to term the 'Laissez-faire physician syndrome'. Remember when I said that most of us grow out of our fear of being afflicted by every affliction? Well by the time doctors get a decade or more out of medical school, they often become calloused in their fear of illness. Instead of fear of infirmity they evolve into a complacent bullet proof feeling through familiarity. They stop washing their hands. They stop fearing every blood spatter and needle stick they sustain. They stop bothering to get regular check-ups. And I've been guilty like most doctors of this.

It can be dangerous to assume medical students are feigning illness. One of my colleagues was told by a consultant that she was neurotic for having blackouts and dizzy spells with a normal cardiac workup. Turns out she had multiple sclerosis. During my medical school training I also witnessed one colleague come down with tetanus, another grew a myosarcoma (butt muscle cancer), another collapsed during training with a pericardial effusion, and one very close to me grew a prolactinoma (brain tumor) - each of these happenings was so rare that you would be more likely to be struck by lightning than get stuck with one of these illnesses, yet these events did happen. Sometimes the wolf does come to those crying wolf.

 


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