This is Day to Day. I'm Madeleine Brand. Medical students endure a lot of stress.

(Soundbite of TV show "Scrubs")

Mr. JOHN C. MCGINLEY: (as Dr. Perry Cox) Each and every one of you is going to kill a patient. At some point during your residency you will screw up, they will die, and it will be burned into your conscience forever.

BRAND: OK, maybe in real life the pressure isn't as plainly stated as it is here by Dr. Cox. He is the sarcastic attending physician on that show "Scrubs." But there is plenty of real fear to go around for med students, and a new study on stress has uncovered some disturbing findings. Dr. Sydney Spiesel reviews medical literature for us and the online magazine Slate. He's also a professor at Yale Medical School.

So what are the big findings in this study?

Dr. SYDNEY SPIESEL (Pediatrician, Clinical Faculty, Yale University School of Medicine): They looked at about 2,000 medical students across seven quite different medical schools. And they found that half the students, fully half the students, had a sense of being burned out. That is, they were emotionally exhausted, they were depersonalized, they had a sense of a loss of themselves, somehow. What is much worse is that in any one year, one in 10 had active suicidal thoughts. And when you take the whole medical school experience, about a quarter of them, at some time during medical school training, had suicidal thoughts.

BRAND: Very startling. What can be behind that?

Dr. SPIESEL: There's obviously a huge amount of pressure in medical school. One needs to absorb just an insane amount of knowledge. Huge, huge amounts, actually more than it's possible to absorb. So, there's always the sense that you might have to know something important at a critical moment, which you've forgotten, or you somehow were not paying attention, and somebody's life is going to be damaged by this thing that you can't remember, or don't know.

I think also the teaching in medical school is often, how to put it delicately, less that nurturing. At least theoretically, the intention is to motivate learning, but the consequences are often very destructive. They reinforce a sense of incompetence and worthlessness in these already worried students. You know, it's sort of understood that they're doing a lot of work under great stress that is really designed to save the hospital the money of hiring somebody more appropriate to do the work.

BRAND: Is there a direct link between high stress and increased suicidal ideation, or at least increased depression?

Dr. SPIESEL: Yeah. The study to some degree addressed this. The study really was a collection of seven different studies all put together. But yes, there really is clearly a connection between these stressors and the consequence of suicidal ideation and depression.

BRAND: We always hear about medical students and doctors, you know, they have access to prescription drugs and sometimes they abuse these prescription drugs. Is there a link there?

Dr. SPIESEL: There's been a little bit of look at that. But, you know, the real stress, when you think about it, is the problem of exposure to human suffering and death, which usually these young people have not encountered before in their lives. Statistically, by the time they're medical students, they're beginning to find family members who are sick and who are having medical problems, and that makes them feel like they really want to do something and they can't. There are some times, I won't say often, but at least some times, kind of ethical conflicts that medical students feel. They're sometimes put in the position of witnessing patients being treated badly, or unethically, but find themselves kind of powerless to help them.

BRAND: Do these feelings go away after medical school and the students become doctors? Do they encounter less stress? Do they feel less inadequate and less depressed?

Dr. SPIESEL: I actually don't think so. I think these stresses are always there. And I think the problem is that as a society, we're not very good on figuring out how to help people.

BRAND: Dr. Sydney Spiesel is a practicing pediatrician, and professor at Yale Medical School. You can read his Medical Examiner column at Thanks again, Syd.

Dr. SPIESEL: Thank you.

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