Studying medicine and quality of life
Tiago Villanueva and Irina Haivas
explore what medical students and junior
doctors think about the quality of life in their chosen careers
Medicine
plays an important part in ensuring the wellbeing of people, but
quality of life matters too for medical professionals. Although we
mainly target our actions towards a better quality of life of our
patients, we should not neglect the importance of taking a look in
our own little world.
Medical students face demanding tasks
throughout medical school, and our first years as junior doctors
include tight schedules, severe time constraints, and often
considerable limitations to our lives. We cannot overlook the
impact and long term consequences of such a routine, which can be
serious and disabling or even counterproductive.
Do we eat and sleep properly? Can we cope with
stress? Do we give ourselves enough time to be creative, to expand
our other talents and interests, thereby living to our full
potential? Is our social life balanced, and are we spending enough
quality time with loved ones?
Also, the country we live in has a certain
standard of development, certain values, cultural norms, and
lifestyle. How does that shape our quality of life?
Does a student in the United States, where the
gross domestic product per capita (purchasing power parity) in 2005
was $41-800 (£23-800; €34-300),1
necessarily have a better quality of life than one
living in Angola with a medium income a year of $2500?
2
A subjective concept
To give a general definition of “quality
of life” that applies to all medical students and junior
doctors is difficult if not impossible, except perhaps for more
sleep.
What quality of life means to each of us is an
individual matter, reflecting our own views and goals. “My
favourite quote about this is: ‘The quality of life is
determined by its activities,' (Aristotle). To my mind it is
completely true: quality of life means activities,” says
Bishoy Morris, who studied medicine in Asyut, Egypt.
For Sadat Edroos, a foundation year one house
officer in John Radcliff Hospital, Oxford, the perspective is
different: “I associate the term quality of life with
independence, to live in the way one wishes; autonomy, in that a
person is able to achieve what they desire without restraints; and
social and familial support.”
Others see things more clearly cut. Bruno
Rushforth, currently a trainee general practitioner in Leeds, says,
“Having a good quality of life means having health, love, and
fulfilment.”
What it means for medics
The factors that medical students consider to
be essential to good quality of life almost always include the
support of family and friends; physical and mental wellbeing;
financial independence; and time to engage in hobbies and interests
not related to medicine. Beyond this, opinions differ. Not everyone
considers enjoyment of medicine a priority, but Sadat does:
“Being in hospitals and seeing patients is the most
fulfilling way in which I could possibly spend the day.”
On the other hand, Bishoy Morris describes an
alternative outlook: “To a medical student, quality of life
is determined by the quality of medical education, fairness and
objectivity of exams, equal opportunities to all students to choose
the specialty they wish to pursue, adequate psychological
counselling and educational guidance, and a loving
partner.”
Before and after
Medical school has changed our lives and
altered our previous levels of quality of life. But does medicine
actually leave a place for quality in our lives? ”Admission
to medical school does not improve quality of life substantially,
in fact it usually decreases it (more work, less fun, financial
hardships),” claims Bishoy, “but it increases what I
call ‘life exposure.'”
Panos Alexopoulos, a junior doctor working at
the department of psychiatry of the Universitaet Rostock, Germany,
says that his medical school days tended to decrease his quality of
life. “Nevertheless, I managed to set my priorities soon,
before this tendency had become overwhelming. Medicine is only an
aspect of my life,” he emphasises, “and not my whole
life.”
If, as Nadeeja Koralage, final year medical
student at the Royal Free and University College London, points
out, you value “the independence of university and the
opportunity to do something you enjoy,” then studying
medicine has probably added to your quality of life. “Talking
to other people keeps us sane, so it's nice that
communication is a big part of medicine,” Nadeeja adds.
“Just because we do medicine, it does not mean that other
professions do not work as hard”, she argues.
Between positive and negative effects of
medical school on his quality of life, Sadat Edroos found a
balance. “Did it decrease my quality of life? Financially,
yes. I had no money. Socially, yes. I had no time to do the things
I used to love doing. But in terms of taking the opportunities I
had been given and making something of them, I was happy to be at
medical school,” he says. “When I think of the
alternatives and what I would be doing now if I hadn't got
in, it makes all the moans about having no money, eating cheap food
and living in horrible parts of the West Midlands seem a little
less important.”
Human development
The Nordic countries usually top the rankings
of the Human Development Index,3
and they are known for providing the highest
levels of quality of life to its citizens. Last year, Norway was
considered the most developed country. Does this make Norwegian
students the envy of the rest of the world?
Melponiemi Kounturi, who is from Greece but
studies in Birmingham, points out a burden of development:
“Most of the times, technology poses more demands on
individuals, making our life more difficult.”
Nevertheless, Sammy Radstone, a Foundation
Year 2 doctor in Birmingham, acknowledges the benefits of wealth
and prosperity, albeit with reservations: “If you have the
money, you can try and make things better for everyone and improve
health, education, and the environment. But at the same time, it
does not always correlate. The United States is a rich country, but
there is no way I would want to live there due to traffic, guns,
crime, health disparities, and so on.”
Thinking of factors contributing to better
quality of life in countries other then their own, Marion Simpson,
a medical senior house officer in the Western Infirmary, Glasgow,
names “the long lunches and high quality coffee” in
Italy, while Sammy points to “the more laid back and less
hurried life style, less pollution, and the friendlier
people” in New Zealand.
Bruno values the “social cohesiveness
and sense of community” to be found in Sweden. “This is
reflected in their social care system, which is generous to those
in need and those who are ill or who have young children,” he
explains.
PHOTOS.COM
Enemies of quality of life
Bruno describes what he calls an attitudinal
problem hampering Britain from achieving a better quality of life:
“We are still driven by the myth that, as Margaret Thatcher
said, ‘there is no such thing as society.' We
erroneously believe that to achieve happiness and a good quality of
life, we need to be self serving, individualistic, and ambitious
workaholics.” But the problem may well be multifactorial:
“I would point out the economy, the narrow minded
politicians, and the inner weaknesses of the education
system,” says Panos.
You could also argue, as some students do,
that it has to do with the inequalities in access to education,
healthcare and job opportunities, with the rich taking precedence
over the poor. But Melponiemi Kounturi has another opinion on
social issues, “I think it has to do with shortage of doctors
and to the rising complaints culture. More doctors are sued
nowadays than before, so medical school wants to make sure that
students are well prepared for the outside world.”
Loose ends
A lot of doctors in the world are overworked
or overstressed. Marion thinks that her government is not doing
enough to ensure the quality of life of doctors. “There
should be more opportunities for doctors to train flexibly and to
take time off when required. And more formal support from senior
colleagues,” she says.
Marcel Aries, a registrar in neurology at the
University Medical Centre Groningen, in the Netherlands, has a
different opinion: “I don't think quality of life is
especially connected to the job of a doctor. In my country doctors
have to work hard but they get paid well and have enough spare
time. I don't think the government should do things to ensure
the quality of life of doctors.”
With the introduction of the European Working
Time Directive,4
healthcare professionals expect that things will
get better. “There needs to be, however, a cultural change
within the medical profession away from cynicism and towards
practising medicine with passion and enthusiasm,” Tim
Rittman, a house officer in Lincoln, claims. “I think if more
doctors enjoyed their work, they would be happier.”
We thank the advisers who replied to our
questionnaire: Bishoy Morris, Bruno Rushforth, Marion Simpson,
Melponiemi Kounturi, Marcel Aries, Panos Alexoupolos, Nadeeja
Koralage, Sadat Edroos, Sammy Radstone, and Tim Rittman.
Irina Haivas , final
year medical student, University of
Iasi,Romania
Email: ihaivas@yahoo.com
Tiago Villanueva , junior doctor, Lisbon
Hospital Centre, Lisbon, Portugal
studentBMJ 2006;14:133 - 176 April ISSN 0966-6494
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