#everybody give it up for friends who don’t disclose feeling sick until 2 hours in to having dinner together

[saltinesinsoup]

bwuhhuuh sick

[sidenotelife]

3 things I learned from 7 years of counseling

One of the major perks to the med school I’ve been at for the past seven years is that they offer free counseling and psychiatry visits for students. I essentially started going to counseling to deal with issues related to depression and anxiety which include but are not limited to: understanding my emotions, anger management, coping with stress, recognizing when I’m stressed, social skills, effective communication. Sidenote - fun fact, 66% of state medical licensing boards require you to disclose if you’ve ever had a mental health diagnosis regardless of whether you are receiving current treatment and if it affects your ability to be a physician. If you are interested, see article here that shows that physicians in states where you have to disclose your mental health history are less likely to seek psychiatric treatment. There’s actually a bunch of online conversation about this topic, but I had never even considered it until I graduated med school. Anyways, over the past seven years I’ve had good and bad counselors, but I’ve managed to learn some useful stuff regarding self-care during these years. Sidenote - I should preface this by saying that many counselors spoke to me about the importance of exercise, taking time to myself, etc. but I feel these ideas are well established and basically common sense, so I’ll address three things that I had never really thought about before going to counseling. 

1. The emotion wheel.

A big problem I had/have... Sidenote - throughout this post I’ll talk about problems that I’ve worked on during counseling and I’ll refer to them either as “had” or “have”, but really these are all problems I still have, hopefully just to a lesser degree than I did seven years ago. Anyways, one problem I had is that I felt angry a lot and whenever Katie would ask me what was going on I would explain it as being tired but in reality I was having trouble putting my finger on the exact emotion I was having. I would just bunch up a lot of emotions under the umbrella of “tired.” So I had one therapist that introduced me to this emotion wheel where you choose your initial emotion which starts in the center, which is a simple one that literally includes the emotion “bad.” Then you branch out from there and progressively specify your emotion. 

For example, a common scenario when I would use the wheel is when I was doing the laundry wrong and Katie would comment on it and I would get upset, but when I broke down the “angry” feeling it branched to humiliation to disrespect. I was feeling disrespected about my laundry-doing skills, and understanding this was the precise emotion I was feeling helped me to troubleshoot it by working on my humility and helping myself see that I wasn’t the king of laundry, this was in fact Katie’s domain because she deals with house stuff all the time and I needed to humble myself to follow her laundry guidance. This feeling angry really had more to do with a resistance to being humble than simple being angry There are other examples of this, but the point is that the emotion wheel has been really useful for me because it helps me to interpret my own emotions at a more specific level, and thus allows me to better figure out how not to get angry. I saved a screenshot of this emotion wheel on my phone and look at it frequently. 

2. Nobody pays as much attention to me as I do. 

Another topic I worked on a lot during counseling is dealing with social anxiety and becoming real paranoid that everyone was judging me for all the awkward things I was doing. Part of this was probably true because I do lots of awkward things but I had several counselors coach me into understanding that the reality, for better or for worse, was that people were not paying that much attention to me. They, like me, were probably obsessing over their own actions and too preoccupied with themselves to pay attention to me. This has really helped me brush off social anxiety and not get so caught up in what I am or am not doing and become more comfortable just being myself. This kind of transitions nicely into my last thing: 

3. Stopping to think through my circumstances as if I were observing someone else. 

Whenever I found myself in a frustrating situation at school, like say I got critiqued for making a mistake in the operating room, I would go down a rabbit hole of worrying and thinking about irrational things which would rapidly deteriorate into meaningless anxiety. A thing that helped me escape these sorts of stress sinkholes was the idea of looking at my problems as if one of my friends were telling me about their problems, and then imagining what sort of advice I would give them. This was really useful because what I would tell someone else to do was usually a lot more rational and well-grounded than what I would do myself. For instance, if my friend was stressed about making a mistake in the operating room and being criticized by an attending I would not tell that person to reconsider medicine as a career, I would not tell that person to avoid that attending for the rest of their life, and I would not tell that person to replay the mistake over and over. Instead I would probably tell that person that it’s extremely normal to make mistakes as a medical student in the operating room, and it’s not really a natural setting for learning, and that they should go back and work with that attending unless they were told otherwise because they probably don’t even remember that you made a mistake nor do they remember your name. I sense that this general principle of minimizing self-bias is really important to introspection and self-improvement. 

So overall I’ve had a good experience with counseling these past seven years, but I wanted to end on this slightly paradoxical caveat. I want to take a second to talk about access to mental health care. If I had to consider paying for counseling, especially if I had to consider paying like $100/hr for it, I’m not sure I would have done it. I hate to say this because I would love to be a stronger advocate for counseling, but it’s just logistically complicated. And it’s not just the price. Over the past seven years I had like ten counselors and I felt really good about one or two? of them. I imagine this is the ratio for just about anyone who goes to counseling because it really does come down to personal fit, and it’s really not like finding a good orthopedic surgeon, it’s a lot more like finding a good spouse. So using some back of the envelope calculations, the cost of all the visits just to find a good counselor, not to mention it takes several visits to establish an initial rapport with a counselor, you could easily rack up $1,000+ to simply FIND a good counselor, and then you have to start paying $100 an hour to do the actual work of counseling. And we haven’t even gotten to the time it would take out of residency. In all the rotations I’ve never seen a resident leave early to make a personal medical appointment. In fact, I’ve rarely even seen a resident call in sick. I’ve much more frequently seen residents come in hacking up a lung. Considering that you would probably have to meet with a counselor semi-regularly to establish some initial rapport, it rapidly becomes impractical from the financial and scheduling perspectives to go see a counselor. Like I said, I hate to say this because I really believe counseling is useful and would be beneficial for basically everybody, but the way mental health services are valued by insurance companies and the greater healthcare community, I have serious questions about the practicalities of counseling. I guess I’ll end by reiterating that I overall recommend going to counseling and I really feel if the connection with a good counselor is there the benefits are quiet impactful, but I can also see the reality and I’m honestly not sure if I will continue going to counseling after medical school. 

see you on the other side,

from ken