Hypochondriasis: The Medical Student’s Affliction

stressed student revisingLou Gehrig. Appendicitis. Boerhaave syndrome. Hemorrhagic fever. Fibromyalgia. Parkinson’s. Cancer.

The list of diseases and health conditions is seemingly endless. Each one constitutes its own list of syndromes, risk factors, death rates, and other statistics. Collectively, they make up a significant portion of the second-year medical student’s (M2’s) curriculum.

First-year medical students (M1’s) attend lectures for mostly basic core science classes, such as Biology, Physiology, Human Development, and Medical Genetics. M2’s learn about all the things that can go wrong in the systems they learned the year prior.

“Medical students are bombarded with new definitions, new terms, syndromes, diseases,” said Jeremy Lai, a Washington in St. Louis alumni and third-year medical student at Northwestern University Feinberg School of Medicine. It isn’t until the third year that students finally gain clinical experience and are exposed to the actual manifestation of diseases or illnesses in patients. Second year medical students are thus immersed in a stage where they have “too much knowledge and lack of experience in applying that knowledge,” according to Re-I Chin, a first-year student at St. Louis University School of Medicine.

Put two and two together, and what you end up with is Hypochondriasis in medical students. Or at least, there is an increased risk of it during your first few years of medical school. According to the National Library of Medicine, hypochondriasis is the “preoccupation that physical symptoms are signs of a serious illness, even when there is no medical evidence to support the presence of an illness.”

It is commonly heard that at one point in their medical education, many students have mistakenly self-diagnosed themselves with one condition learned in their first few years of medical school. In a New York Time’s article, “When Med Students Get Medical Students’ Disease,” around a startling 70 percent of students have gone to student health services complaining of symptoms. Of course, the small percentage of students who do not consult student health services must be taken into consideration as well.

Hypochondriasis presents itself as a curriculum-sensitive phenomenon: medical students have a greater tendency to misdiagnose themselves during their preclinical years in medical school. “They don’t see the patients who have it, or the doctors who deal with it,” said Steven Sun, a fourth-year at University of Michigan Medical School. “One of my residents once told me M1’s and M2’s know just enough to be dangerous – to themselves and to other patients. If you don’t truly understand the disease processes, you could have misconceptions about the disease.”

Lai concurs. “It becomes easy to associate our own experiences with what we’re learning.”

Another possible cause of increased risk for preclinical medical students to become hypochondriacs is the unfamiliar lifestyle they must lead during the school year. Medical school and its demanding curriculum is an “immersive experience, during which your perspective is narrowed and limited,” according to Lai. As a result, with much of a medical student’s mind suddenly preoccupied by lectures upon lectures of diseases, they easily fixate on certain diseases.

“We live, breathe, and talk medicine,” said Sun. What does that translate into? Students will more readily match their own current symptoms with those presented for certain diseases in lecture, as their lives and medicine become more and more indistinguishable.

Not only does medical school cause an increase tendency to correlate life events to information learned in class, but it also commonly induces many of the constitutional symptoms that medical students readily use to misdiagnose themselves. Suffering from fatigue, weight loss, and difficulties falling asleep? Are you also a medical student? If so, there is a likelier chance of being diagnosed as a stressed medical student than being diagnosed with cancer. “Medical school is not a great time to be health conscious between work hours. It means you don’t eat right or exercise or sleep enough,” said Pham.

So what’s the solution? Keep perspective. Pham said of his own experience, “When I was shadowing as an M1, my preceptor told me a lot of people have ADHD/bipolar disorder and don’t know it. They typically look like classmates who don’t get a lot of sleep and can’t remain very focused, and I thought, Well, that looks like me. What if I have ADHD and that’s why I can’t focus? Ultimately, you have to understand what’s within the range of normal, and what would be clinically abnormal.” Not only does keeping perspective mean distinguishing between normal and abnormal, but it is also rationally determining the causes behind the abnormal. A headache could be a sign of cancer, but it can also be a sign of insufficient sleep.

While it cannot be concluded that all and only preclinical medical student develop hypochondriasis and absolutely no practicing doctors can have fears of having certain medical conditions, there is a decreased occurrence of hypochondriasis amongst practicing doctors. Students do learn better. “As we go further in our training, it becomes less of an issue. You become used to seeing disease and illnesses, and you learn to separate yourself more from that,” said Lai.

Sun elaborated on that idea, saying, “They have more experience, so they understand the full disease process. You’ve gone through more of your training, so if you think you have something, you’re closer to being correct. There was once a neurosurgeon who woke up in the middle of the night, and realized he was having a stroke. He drove himself to the ER, and after they scanned him, lo and behold, he was having a stroke.”

Of course, there are also anecdotes floating around about students who have correctly diagnosed themselves after learning about the symptoms. Isn’t it better to be safe than sorry?

Chin responded, “It pays off to be vigilant. But I wonder if the benefits ultimately outweigh the costs of worrying.” Costs not only include mental and emotional ones, but also physical as well, as an excess of radiation, biopsy, and other tests may cause more overall harm than good.

The best option, Chin advised, is to “bring it up to the health care provider in your medical school, whether or not your worries are warranted. If they agree with your suspicions, then they can run further diagnostic tests to support a possible diagnosis.”

While there is a general consensus that hypochondriasis is by definition unnecessarily debilitating for a student, there is some level of understanding and compassion around the issue amongst classmates. “If you need help, it’s okay to ask for it. Turning to friends, family, and professional help should not be looked down upon. Each person’s reaction may be different – we’re not in an era where if you can’t handle it, you’re not cut out for it,” said one anonymous interviewee.

So Lou Gehrig? Boerhaave syndrome? Hemorrhagic fever? For medical students, the fear of having these illnesses may be more common than actually having them.


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