Resident Column
Richard Malis, M.D.
University of Iowa

     I received an interesting e-mail recently. The author said I could share itif I kept his/her name anonymous. We discussed that this letter was writtentongue-in-cheek, but it could have been someone's serious plea for help:

     "I'm wondering if my experience is similar towhat you have heard from other med-psych residents. When I started residency I thought I was a well-adjusted person; but before long, I noticed I was changing. At first I didn't know what it was, but after a few months on psychiatry I recognized I was becoming a borderline. The identity disturbance came about first. During orientation I didn't know where I was supposed to go, or whom I was suppose to hang out with. Others looked at me as "different". My first month I helped out at several codes, and each time it seemed like I was on autopilot. It now seems like a dream. I can only guess that it was a form of dissociation of reality. Next came the impulsive behavior. These aren't too severe, but they definitely are reckless. My drinking is maybe a little more than "recreational" when I get the chance. And then there are the in­tense personal relationships. Several people who I had considered mentors I soon deval­ued when I found out more about them.While I'm a borderline, it's amazing just how dis­turbed some of these doctors are. Efforts to avoid abandonment started my second year. Other residents whom I had bonded with were preparing to move on. I don't know if my conversations with them were exactly frantic, but I did try to persuade them to stay at my institution for fellowships. I also have noted reactivity in my mood as residency has worn on. Before my weekly clinic and on the evening of call nights I feel anxious and dysphoric. Sometimes it seems like I might feel better banging my head against the wall. So, I'm writing to ask if this is a normal reaction to combined training?"

     My response is that this e-mail could have come from just about anyone I've met in a combined residency program. I think we would all benefit if more work were done to identify and address the unique stresses that combined residents face.

Return to Table of Contents