Head, Shoulders, Knees and Toes, Knees and Toes...

I have to admit, when I was young, I did not like to color. We all had to do it in elementary school. Coloring was a skill that taught us how to follow instructions, express creativity and stay in the lines. As a child, I followed instructions well, was more creative with words rather than drawing, and honestly, I had trouble staying in the lines, (though, my difficulty staying in the lines helped discover a vision problem).

Have you ever found yourself faced with a task so daunting and seemingly insurmountable that you procrastinate to the point where the task keeps mounting? Maybe it's a garage that needs cleaned out, a checkbook that needs reconciled, a mountain of incomplete medical records waiting for your finishing touch, a stack of CME articles that need to be read, a case review that needs written for submission for publication, a shelf exam requiring dedicated study? Me too.

Usually to restore wellness, one seeks activities that are peaceful and tranquil. Such activities might include yoga, meditation, exercise, or reading.

Have you ever wondered how you accumulate so much stuff and why you keep certain things? Recently, I have had the distinct privilege and responsibility to sort through the belongings of people who are close to me that have died. In the past five years, I have peered into the intimate life details of my mother, father and most impacting, my husband of 26 years.

How are you doing?  This is usually the first question I ask my patients when I see them in the office.  I suspect like many of you, the typical answers I get now (terrified, I don’t know, bad) are different than what I would have gotten six months ago (good, ok, not bad).  What hasn’t changed is the thing that patients most need from us – information.

As physicians, we tend to offer solutions and process thinking to our patients to solve their problems and stumbling blocks. Yet, as a group, physicians are facing burnout at unprecedented rates and are having trouble solving our collective problem. Single physician centered solutions, like practicing mindfulness, can be helpful but doesn’t not impact the overall systems of practice.

Postdoctoral training is rigorous and time-consuming. The emotional and physical implications of residency and fellowship call for trainees to take what little time they do have to participate in enjoyable activities that keep them going. As co-residents at Albert Einstein Medical Center in Philadelphia, we found the popular indoor cycling class, SoulCycle, to be our go-to wellness activity. Since our intern year, we have been arranging meet-ups at the music-blaring, sweat-dripping, lights-flashing dark room that is SoulCycle. Now, carrying on into our separate fellowships, we still find time to enjoy a 45-minute jam and cycle “sesh.”

I’m fortunate to sit on our residency leadership committee at Lehigh Valley Health Network and attend conferences where we discuss a wide range of physician leadership topics. A common topic is physician burnout and what healthcare leaders can do to mitigate it. At a recent meeting, we discussed an article from the Mayo Clinic Proceedings titled “Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout.” The authors, Tait D. Shanafelt, MD and John H. Noseworthy, MD, cite evidence suggesting that physicians who spend just 20% of their professional activities focused on the work they find most meaningful are at a dramatically lower risk for burnout. There was also a ceiling effect to this benefit at 20%, meaning that physicians who spend 50% of their time in the area most meaningful to them had no further decrease in burnout rate.

Throughout my 20-something year career in outpatient medicine, I’ve had the opportunity to enjoy a wonderful connection with many patients behind the closed doors of my offices.  There, patients can freely smile, cry, and share concerns without a fear of judgement.  This emotional sharing allows for a powerful connection between patient and physician.  Sometimes I know more about their inner thoughts and fears than their family does.  I’ve laughed with my patients as well as shed many a tear in solidarity with them.  Both encounters are equally powerful to me as well as to me patients.  Don’t be afraid to express your humanity in the moment.

“Art is the queen of all sciences communicating knowledge to all the generations of the world.” If this statement hadn’t already been so eloquently articulated by Leonardo Da Vinci, it would have been my own. These words perfectly illustrate my view of the relationship between art and science, and how this relationship has fueled my unique path towards a career in medicine.

Attend a Funeral

It doesn’t matter if you are new to medicine or more experienced, we will all be faced with a situation where a patient we are caring for dies.  Regaining your strength when this occurs is a challenge.  Depending on the situation there may be sadness, inadequacy, fear and loss of self-confidence.  Allowing yourself to feel these emotions and move on is critical.

I seldom park in the designated “Physician Parking” spaces. Mostly, because during this time of very active construction at the hospital where I work (or as I refer to it, the “employee wellness program” encouraging all of us to get that 10,000 plus steps in a day) I have found a strategically placed, out of the way “spot” that no one else appears to have claimed. It is not designated for patients, it is not a handicapped spot, I have to travel a couple of side streets to get to it, but it works for me.

Scream...

As residents, working 12 hours a day, we often wonder, “How do we do it all?”. It feels easy to be overwhelmed at the idea of achieving wellness. While we strive to have the perfect professional and personal life balance, it sometimes feels impossible to read, exercise, do household chores, and fulfill the role of a loving partner/parent/child/friend when we return back home. 

When I was first approached by a good friend to write this article for “how are you DOing”, I laughed.  But I wasn’t asked to write a “How are you DOing” I was asked to write “Who DO you walk?”

I knew residency wouldn’t be easy for someone as beholden to REM cycles as I am, though I naively believed I could make it through four years of training unaffected by their relative absence.  It turns out that was wishful thinking.  Although I took an oath to do no harm to my patients, learning how to practice medicine came at the cost of my own health and well-being.

Have you ever found yourself so overwhelmed you literally didn’t know where to start sorting through your “to-do” list? Been there, done that.

Learning How to Unwind

When we were young, my brother and I spent much of our summers at my grandma and grandpa’s farm in Boswell, Indiana. Running around with our cousins in the country and being doted on by grandparents was typically much more appealing than being cooped up in the suburbs and getting assigned the perfunctory summer chores from our mom.

The Power of Nutrition

Resident wellness is an important part of today's medical training. We at the Washington Hospital Family Medicine Residency have had the good fortune of having support from our administration in maintaining wellness of the residents in our program. With the help of the POMA Mental Health Task Force and the POMA foundation, we were granted funding to support our idea to create an event combining resident wellness with nutrition integrated with medicine, notably, culinary medicine, inspired by the Goldring Center for Culinary Medicine at Tulane University.