When Eneida Roldan, MD, was a second-year med school student, she began experiencing headaches. While they weren’t severe necessarily, she became deeply focused on them. Why? She was in the middle of studying brain disease processes. Drawing a line between her headaches and her lessons, Roldan convinced herself she was suffering from a brain tumor.

She wasn’t. Roldan’s primary care physician reviewed her symptoms, ordered a sinus x-ray, and determined her headaches stemmed from sinus inflammation, stress, and allergies. The tumor wasn’t real. But the anxiety was.

“The symptoms aligned with diseases,” Roldan recalled. “A headache meant a brain tumor. Abdominal bloating aligned with abdominal masses. All could be related to being a med student under stress, not sleeping and eating a poor diet. But I thought I had a true pathology or disease.”

Today, as the executive dean for the College of Health Professions and Medical Sciences at Barry University, Roldan frequently sees her second-year self in many students. Like her, they suffer from what is known as “med school syndrome.”

What’s the Disease of the Week?

The experience of connecting real physical symptoms like Roldan’s headaches with their current training is a psychological condition that many medical trainees experience. Some studies suggest the occurrence may run as high as 70%. Usually, the symptoms aren’t serious. But how students react to them can be intense.

“In most cases, med school syndrome presents early on in training,” said Roldan. “Students are learning about disease processes and their signs and symptoms, but they don’t yet have the clinical experience and evidence-based education to put it all into context.”

During a unit on the liver, for instance, a student may experience abdominal aches and start self-diagnosing cirrhosis. Even though they have no other symptoms, their minds spin, their anxiety ticks up, and they’re certain they’re headed toward a serious illness.

Medical school syndrome is so common that well-known psychologist Bernard J. Baars noted it in his 1997 book In the Theater of Consciousness: The Workspace of the Mind. Baars wrote that “suggestible states are very commonplace. Medical students who study frightening diseases for the first time routinely develop vivid delusions of having the ‘disease of the week,’ — whatever they are currently studying.” Baars and others go so far as to consider medical school syndrome as a temporary type of hypochondria.

In most cases, med school syndrome is imagined and (looking back) somewhat humorous. But what if a student might have a genuine illness? “If a student comes to us, we have to be careful because the symptoms could be real,” Roldan said. “That’s where we apply an evidence-based approach and run through all their symptoms.”

Either way, for doctors who work with med students, sympathy and understanding for this experience could be the best prescription.

Is This Stress or Amyotrophic Lateral Sclerosis (ALS)?

Med school syndrome has been around as long as there have been medical schools, according to James Cox, MD, an assistant professor and director of clinical skills development and physician communication at the Burnett School of Medicine at Texas Christian University, Fort Worth, Texas. “It’s very, very common,” he said. “The students are experiencing a bigger workload, and the stakes are getting higher.”

These stress levels exacerbate the symptoms a student might feel while learning about disease. As a gastrointestinal (GI) doctor, Cox estimates that about 25% of his students message him with worries about bloating, diarrhea, or constipation. “It’s rare that anything is wrong, and I talk them through their symptoms, the warning signs, and help them get through it,” he explained. “In most cases, with some education, they feel better.”

How deeply a student may experience med school syndrome depends on their baseline character, said Roldan. “Medical school is anxiety provoking in and of itself,” she said. “If you’re an anxious person already, that may exacerbate the issue.” For those rare students for whom med school syndrome becomes a bit too constant or overwhelming, seeking mental health services can be useful.

Will Flanary, MD, an Oregon-based ophthalmologist with a wildly popular and humorous YouTube channel about medicine — he’s Dr Glaucomflecken — has even dedicated an episode to med school syndrome. “I drew on my own experience for that one,” he said. “You’re studying something intensely and learning about its signs and symptoms, then bam! You have this disease.”

During his time in med school, Flanary often convinced himself he was suffering from one disease or another, only to drill down and learn it just wasn’t true. “I was sure I had ALS,” he recalled. “But that wasn’t grounded in reality. I was 25, and there was no reason for me to be entertaining that idea. But the symptoms allowed me to divorce that from demographics.” 

While Flanary’s bouts with med school syndrome were never too severe, he recommends that students bring it up to superiors if it begins to have a negative impact on their lives and training. “What are your coping strategies?” he suggests asking. “How can you get yourself out of that line of thinking? Maybe this is something professors can help with in school.”

In many cases, students are loathe to admit to professors or senior doctors that they’re experiencing concerns, nervous about appearing vulnerable. But sometimes, it’s necessary, and the reception they get from their superiors is important.

It’s All in Your Head…Except When It’s Not

On rare occasions, a student’s self-diagnosis is on target. This was the case for Justin Choy, currently a fourth-year student at the Burnett School and one of Cox’s students. As a first-year student, Choy experienced all the common stresses of medical school. “You place so much pressure on yourself, and sometimes, that can bleed over into physical symptoms, and you begin to scrutinize everything,” he said.

Off and on for months, Choy experienced stomach pain, bloating, and constipation. As he approached his first board exam, Choy’s symptoms grew steadily worse. “It all came to a head when we studied the gastrointestinal system,” he said. “We had a clinical skills session where we learned how to examine patients.”

Taking those skills home with him, Choy palpated his own abdomen and concluded that something was amiss. “When you have a hammer, everything is a nail,” Choy said. “I thought something was very wrong.”

Choy was worried enough that he consulted with Cox. “I trusted Dr. Cox and wouldn’t have turned to him if he wasn’t approachable and kind,” said Choy. “He was very detailed and we had a long conversation about my symptoms.”

After asking if Choy had night sweats, whether his symptoms had persisted over a long, slow build, and more, Cox concluded that Choy was likely experiencing med school syndrome. Reassuring Choy, Cox sent him on his way with a referral for a GI doctor on the offhand chance there was anything truly wrong.

Time passed and Choy felt like he was improving, so much so that didn’t bother with Cox’s referral. “Two months later, it came back, this time with night sweats and vomiting,” said Choy. “But at that point, I thought it could be in my head.”

It wasn’t. This time, when Choy palpated his abdomen, his rebound tenderness told him something really could be wrong. After struggling to even get out of bed, “I still went on my clinical rotations because I thought good students didn’t take time off,” he said. “My preceptor looked at me and told me to go home.”

On his way out, Choy passed the emergency department and decided to ask for a CT scan. It revealed his appendix had burst, infection had set in, and scarring had begun. After surgery and a week’s hospitalization, Choy resumed his rotations, much wiser, and much more sympathetic to the patient experience.

“I thought it was really important to remember the details of how different aspects of treatment felt,” he said. “What IV [ intravenous] flushing feels like, for instance, and how much time you spend with the nursing staff. I learned it takes a village and how important it is to understand the patient experience through their lens.”

‘I (Really) Know How You Feel’

The silver lining — even if it arrives through temporary hypochondria — is that students can become more sympathetic as clinicians. “Maybe you will have a patient someday who is a big worrier,” Roldan suggested. “You can understand how they feel, and that makes you a better doctor.”

Many patients today are very good at looking up their minor symptoms and reading too much into them without expert context. Maybe this rings a bell? Remembering your own med school syndrome is a good way to understand where they are coming from.

And remember to have some sympathy for the med students you encounter. When Roldan sees students experiencing med school syndrome — after she has ruled out any real issues — she always leads with the tried-and-true axiom: “Common things are common, and rare things are rare.”

“I like to remind students that if they feel a symptom, it’s rare that a first sign equals a real problem,” she said. “I like to provide that pause, help them look back at their symptoms, and think things through.”

When the students eventually get through school and come out the other side, the goal is to emerge not just wiser, but more empathetic. “In the moment, med school syndrome is not a fun emotional experience,” Roldan admitted. “But hopefully later you can laugh about it, and also, better understand how your patients feel.”