How to sit through a lecture on a condition you have

This is a lecture I wish I'd received at the start of medical school. It's one of those lessons I've had to learn by been thrown into the deep end and experiencing some of the most uncomfortable moments imaginable.

I hope this article means you wont be the student who leaves the lecture theatre crying, but even more, I hope it means you won't be the student who make a harsh generalisation about a condition that statistically someone in your classroom has.

1. Selectively disclose your condition

This needs to be judged for each situation. With full respect to the girl in my first year lecture who announced to the theatre of 300 people that she had endometriosis, I personally believe in disclosure to a small group setting is important but disclosure to large groups isn't always required.

I wish that being in the medical field meant there was no judgement, but I'm realistic. When you tell someone you have a condition, they will judge you on some level. I sincerely hope the majority of medical students will not change their opinion of me because I have depression, but inevitably some people seem to think having a mental illness means they need to walk on eggshells. Mental illness obviously is a 'high risk' disclosure, but all the same, your fear disclosing your Crohn's Disease or Rheumatoid arthritis is legitimate. You get a bizarre wash of sympathy and a 'chronic illness' label that you never asked for and don't know what to do with.

You need to weigh the risk of a negative reactions against the risk that someone makes an insensitive comment about your illness and really upsets you. I once witnessed a horrible comment about people with borderline personality disorder in a tutorial, knowing the girl next to me had that very diagnosis.

After much trial and error, my comment in (small) tutorials is this:
'Before we start I just wanted to say that I have depression. I'm not saying this to make you uncomfortable but I've seen people make generalisations about conditions not realising people present had them and I wouldn't want anyone to feel uncomfortable from a situation like that.'

2. Do your research

It might seem strange to read the textbook chapter on a condition you've had your whole life, but I promise you that you don't want to discover anything new in front of your classmates.

It's going to be a difficult class already, don't give yourself the extra pressure of having to apply new information to your life/ wondering if you'll be eligible for new treatments.

3. Focus on someone else with the condition

Remember this isn't a lecture or tutorial about you, even though that's what it might feel like. You're in this situation to learn how to one day manage a patient with this condition. Try to picture your future patient and apply everything you're learning to that imaginary patient.
You will compromise your knowledge for the exams if you use yourself as the patient you imagine with that chronic condition - you don't have every single symptom or complication and you can't look at yourself objectively. Invent your imaginary patient before the class and and at difficult times relate the topic back to them.

4. Don't resent the patients

On my clinical placements, I would sometimes get frustrated seeing inpatients who I perceived to be less unwell than me. It was particularly hard on days when I felt at my worst.
You aren't benefiting yourself or the patient if you have this attitude- be happy that this person has received help before getting to the severity you did and if you really do feel worse than the inpatients, maybe that's a huge alarm bell to get more help for yourself!

5. Don't take things personally

My third year class was shown a series of photos of perianal fistulae during a lecture on inflammatory bowel disease. As with many graphic photos, these slides were accompanied by groans and gasps of horror. We've all done it - the involuntary and almost expected reaction to graphic surgical photos.

Now imagine being the medical student with Crohn's disease in that lecture theatre hearing his friends shout 'that's disgusting'. How do you get through that?

It's not about you. Their comments are not about you. They would die if they knew you were sitting there taking this personally. They wouldn't react like this in front of a patient and they would never react like this towards you - it isn't personal and if it becomes an ongoing issue, this is one of the times to use point 1 and selectively disclose.

6. Be altruistic

At the end of the day, it's still difficult to sit through a lecture about a condition you have. You'll feel stereotyped and judged and there is no amount of reassurance I can give that will make you feel differently.

Before getting upset that your peers don't understand what it's like though, consider using this as an opportunity to put a face and a success story (you're in medicine after all!) to the disease. I spent many years upset that no one spoke about depression before realising that I needed to admit to having it if I wanted it to be something that was spoken about. I hope that there is at least one doctor from my med school who has a greater understanding of depression having listened to one of my speeches.

Remember that having a chronic illness in medicine can be your burden or your edge - it's your personal insight into the life of a patient. It can make you a more brilliant doctor if you embrace it.

Popular posts from this blog

About to become a real doctor?

Delivering heartache

Do Not Resuscitate