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.
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.
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.
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.
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.
Jab! Cross! Left body hook! Right front kick! Left side kick! Right roundhouse kick! Beads of sweat drip down my face as I finish Round Six. I am exhausted. The sense of accomplishment is palpable. Not only have I made it through one hour of high intensity exercise after a long day of work in the office, but I have learned a few valuable life lessons along the way.
How are you DOing? Or, should I say, “How are you EATING?” During our medical training we spend hours learning about cardiac disease, pulmonary disease, blood disorders, diabetes and surgical emergencies, but relatively little about nutrition. Nutrition, unless properly balanced, has a negative impact on all organ systems!
On my first day in the hospital as a new intern, I had the healthy amount of fear that most new DOs have. I anticipated that long hours and dedication to taking every opportunity to learn would leave very little time to spend with family, friends or for self-care. I thought I would be putting my personal life on pause during the next three years in order to focus on becoming the best clinician I could become. Starting a new hobby or interest didn’t even cross my mind. As a single person entering the rigorous life of residency, I also thought dating would be off the table for the foreseeable future.
The pre-clinical years of medical education leave students unfulfilled. It's a relentless obstacle course full of memorization, stress, and student loans; ignoring our higher calling to treat and connect with patients. The things that light us up and made us want to become physicians in the first place are traded for limited patient interaction, multiple choice exams, and spending hours sitting, reading and repeating until we all have upper-cross syndrome. We learn scores of physiology, pathology and clinical pearls, unsure of clinical correlations due to a lack of experience. In the meantime the things we love about medicine are put on pause and we are told to wait for it, all while the student loan interest accrues. It’s easy to see how students have become bogged down and frustrated before their careers even begin.
We all know that doctor who worked constantly, took little time for himself or herself, always seemed to be doing “okay”, until you hear he or she had suffered a serious health concern, or worse yet, sudden death. Occurrences like this lead one to ask, “Could that have been prevented?”
Depression is defined as persistent feelings of sadness and loss of interest in work or activities. In the medical profession, these feelings can be present in medical students, residents and practicing physicians. In a study recently conducted by the Council of Osteopathic Student Government Presidents (COSGP) and the Student Osteopathic Medical Association (SOMA), nearly 40 percent of medical student respondents admitted to feelings of depression and thoughts of suicide.
