The Steeper Obstacles Faced by Women in Medicine

by Dhruv Khullar

Happy medical residents are all alike. Every unhappy resident would take a long time to count.

A new study in JAMA Internal Medicine suggests yes.* Dr. Constance Guille and colleagues analyzed the mental health of more than 3,100 newly minted doctors at 44 hospitals across the country. Before starting residency, men and women had similar levels of depressive symptoms. After six months on the job, both genders experienced a sharp rise in depression scores — but the effect was much more pronounced for women. A major reason: work-family conflict, which accounted for more than a third of the disparity.

The structure of medical training has changed little since the 1960s, when almost all residents were men with few household duties. 

This article is worth reading by all trainees, prospective physicians, and practicing doctors.

Someday, this may be the reality

 *  Work-Family Conflict and the Sex Difference in Depression Among Training Physicians. Constance Guille, etl a.  JAMA Intern Med. 2017;177(12):1766-1772. doi:10.1001/jamainternmed.2017.5138  

Conclusions and Relevance:  This study demonstrates that depressive symptoms increase substantially during the internship year for men and women, but that this increase is greater for women. The study also identifies work-family conflict as an important potentially modifiable factor that is associated with elevated depressive symptoms in training physicians. Systemic modifications to alleviate conflict between work and family life may improve physician mental health and reduce the disproportionate depression disease burden for female physicians. Given that depression among physicians is associated with poor patient care and career attrition, efforts to alleviate depression among physicians has the potential to reduce the negative consequences associated with this disease.

I thought I wasn’t thin enough to be anorexic

BMJ 2017;359:j5378

Caitlin S, 17, and her mother, Sally, talk about what helped, and what didn’t help, when Caitlin developed anorexia

Comment by Brian Maurer, PA-C

This piece highlights the issue of the distorted body image that patients with anorexia nervosa manifest.  Although this adolescent dropped her weight by 10 Kg, she didn't recognize that she had developed AN because (1) her BMI remained at an acceptable level, and (2) her perception of a desirable body habitus was reinforced by social media.

It is interesting to note that this adolescent started to buy into the fact that she was sick after her doctors and caretakers educated her about her eating disorder and supported the diagnosis with facts.  Many patients suffering from AN forcibly push back against the diagnosis, as they continue to perceive their distorted body habitus as normal and desirable.

This case also raises the issue of how a patient with a body image disorder might relate better to a clinician/counselor/caretaker of the same sex, particularly when the patient is an adolescent female.

Widespread use of social media among young people has resulted in an uptick of anxiety, depression, cyberbullying, and suicide in this age group.  Clinicians who care for adolescents need to be aware of these influences as they evaluate and care for patients who suffer from eating disorders, mental illness, suicidal ideation and abuse.

BTW, the latest eating disorder to hit the DSM-V is ARFID, avoidant/restrictive food intake disorder. While similar to AN, patients with ARFID lack the distorted body image component.  We follow a handful of kids who meet the criteria for ARFID in the practice.