Wellness During Medical Training

Here's a question that commonly pops up in my email: "How do you stay well during medical school and residency?" This is usually prompted by a scenario such as, "I'm finding it hard to balance it all, I feel so overwhelmed, I'm not taking care of myself, the pressures to get good grades/perform well are just too much, I'm losing empathy, etc. etc." These messages are so devastating to read, because they're a collection of testaments to just how difficult it is to become a healthcare provider.  

By no means do I think it should be easy. Part of these feelings are a natural part of growth when becoming a professional, especially in a field that requires life-or-death decisions and skills. We should be challenged, pushed to our limits, and instilled with an intense commitment to the career.  But more often than not the expectations are limitless, and coupling highly competitive environments with a group of type A personalities results in a scary eruption of mental health disturbances and maladaptive behaviors. 

We're trained early on that giving up necessary sleep in order to cram for tests is not just ok, it's encouraged.  Important family events are missed for the sake of deadlines.  As we move along through training, many of us stop doing the hobbies that we truly love. At the beginning of this academic year, our clinic group went around the room to introduce ourselves.  " Hi my name is ____. I'm a 2nd year resident; I really used to love doing ___ but haven't gotten around to doing it much." Hobbies from dancing, to playing instruments, to leisure reading are ignored for the sake of our careers (but hopefully not forever.) I so badly wanted to give everyone the day off to go do what makes them feel themselves. Sacrifices should and will inevitably be made-- no one is forcing us to work in this field! It's truly an honor to have a career we love, but it doesn't mean we have to completely lose ourselves in the process. 

 Resident Lifestyle & Happiness Report, Medscape. 

Resident Lifestyle & Happiness Report, Medscape. 

In the middle of intern year (at my personal all-time low in terms of burnout, career confusion, and inferiority complex) it took me months to realize that I actually wasn't the only one feeling that way.  If we all kind of felt like this, well then why aren't we talking about it?? (Listen to Jamie Katuna, a current medical student and physician advocate, speak about her similar epiphany HERE.) I brought up an idea with a chief resident that maybe this is something I'd want to research and actually create some sort of quality improvement project aiming to improve our general wellness. The graph you see here is what really struck me. 9% of surveyed residents in the United States in 2016 had considered suicide? How completely unacceptable. I never wanted anyone to feel that way, or certainly not feel they had no one to turn to.

 I got an immediate and immense amount of support for this, especially because another chief resident for the upcoming academic year also had this idea in mind-- that we had a great program already, but we could make it better in terms of awareness and empowerment to participate in self-care. Truly, I never cared to get my co-residents to eat more vegetables and exercise more. All that seemed meaningless if our mental health was still suffering (yes it's true that working out and eating nutritiously can improve our minds, but.. you get what I mean right?).  In the process of our initiative, we've certainly made small changes that impact our wellness overall (including changing the food quality we get at noon conference) but the true goal was to ensure everyone felt supported. That no one felt alone. That everyone believed they were good enough to be here.

After all I've learned over the past 1.5 years of starting and improving this resident wellness initiative/curriculum, I've got a few tips to help those feeling lost and unable to feel ok while they accomplish their career goals. I also want to clarify that I do understand that much of the shift in improving resident wellness specifically will be a change in the infrastructure in our training. No normal human who moves forward in a career requiring limitless empathy can leave residency unharmed by the job demands. Until then though, we can practice self-care exactly as we need, including advocacy for medical education cultural change.  By no means am I an expert, and many days I'm worried I could be doing more or doing different things to ensure all my co-residents feel their best. But the truth is, much of it is an internal decision to take the necessary steps for yourself.  No one will care for you the way YOU can.  Decide today that you and your health are important enough.

#1: Decide on your non-negotiables. 

I had a classmate in medical school who decided that every Saturday and Sunday morning from the time she and her husband woke up until 11am, they would spend their undivided time together. They would go for a long walk both mornings then show up at Panera (while the rest of us were ferociously studying) and sit peacefully together enjoying a cup of un-rushed coffee. She NEVER missed a weekend morning with him no matter how overwhelming the schedule ahead.  This was such a sacred time for her, and I promise you her future career didn't suffer because of it.  I noticed that some of the most successful healthcare professionals have made these decisions; whether it's to travel through hellish weather to never miss a Thanksgiving dinner, to always attending their kid's soccer game, or simply talking to their mom on the phone daily, we all have things that make us feel normal and well.  They obviously have to be within reason (ya surely can't fly to Hawaii every weekend, sorry about it) but you don't have to give up everything.

#2: Fix the scary things you've been ignoring.


Part of our anxiety is the things we'll let build up, that we've ignored for the sake of moving along in the career.  The AMA (American Medical Association) published the pillars of residency wellness as the following: mindset/behavioral adaptability, nutrition, fitness, preventive health, finances, and emotional health. Think about each of those.  Maybe you've done a great job at caring about exercising and becoming adaptable, but you haven't gotten the pap smear you've been ignoring for 3 years.  [Side note; a recent study found that resident physicians are more likely to die from malignancy than age-matched peers. Kind of scary, but also a testament that maybe we're the last to see the doctor despite, you know, being surrounded by them.] Perhaps you have incredibly strong social support and feel great, but your lingering student loans that you still haven't consolidated (like, how do you even do that?) is this nagging stress in the back of your mind.  Maybe you can identify one stressor that's within your control, and do something about it? It's amazing what it can do.

#3: Complain constructively.

There are two extremes of complaining: doing it so often that it holds no merit and can negatively affect those around you, and never doing it to the point that it bottles up inside you and you eventually can't even process it anymore.  We should all aim for a middle ground.  Knowing who and when to complain to is important! More often than not, it's best to do this with co-workers/co-residents/co-students. Unloading all your suffering on your family and loved ones outside of your career may be detrimental with your relationships with them.  When you can, complain with a plan to find a solution.  Maybe there isn't one, maybe your day just hella sucked. But if a certain situation is habitually bothersome to others and yourself, maybe it needs to be addressed.  You are not helpless and not everything has to remain status quo. 

#4: Optimize your time off

This is an important one. Any hours outside the hospital (and if you're still a student, any hours that you have pre-determined to NOT be studying) should be used optimally for YOU.  For some people this means a daily workout and preparing healthy food. For others it means undivided attention to their children.  Perhaps you love the satisfaction of getting research published, and you spend a good portion of time writing manuscripts. Or just maybe its laying on the couch watching netflix without any intention to interact with another human being.  Whatever you choose to do, do it GUILT. FREE.  The minute you let your decision by spoiled by thoughts of, "wow I should really be reading instead of enjoying myself," or vice versa "man I can't believe I'm working on submitting this publication instead of watching that movie" puts you in a state of limbo, and you end up either not enjoying or not accomplishing what you set out to do. 

#5: Never doubt the power of supportive relationships

We all need just one person to whom we can confess, complain, and feel supported by.  Social butterflies maybe need a village of people to feel like themselves and that's ok too.  Whether you're an introvert that likes talking to their best friend every day on the phone, or the perpetual bar-hopping extrovert, understand the investment you'll make in your relationships with others.  We can be the fittest, healthiest eating, well-rested, most financially stable, completely up to date on preventive health visits, most adaptable person in the world, but if we feel alone, all the rest is for nothing.  Understand that if you do feel alone, look around.  There are so many people just waiting to reach out and be the support you need, but sometimes you need to step out of your comfort zone and simply ask.  Likewise, if you've noticed that someone in your workplace or school may seem isolated, never underestimate the power of reaching out. You could just be the light that pulls them through a very difficult time. 

So, this probably not what you intended to read. Maybe you were looking for tips on how to eat healthy or exercise regularly in the midst of a chaotic and stressful schedule.  Sure, those things are definitely important. But even more than that I urge you to ask yourself, "how am I REALLY doing?" And if the answer is a very confident "excellent" than you can worry about the small stuff.  If the answer is not so reassuring, now is the time to address those nagging concerns. You deserve it. You are worth it! And if you plan to provide excellent care to your patients, then your participation in self-care is downright REQUIRED.

All my love,

Shanny DO