Wellness: an interesting oxymoron in medicine. As physicians, we focus our daily energy on promoting wellness in our patients’ lives; discussing appropriate diets, weighing risks versus benefits of medications to lower mortality, and outlining treatment plans that lead to the healthiest state of being for any given person. The cornerstone of medicine is wellness, but the emphasis is on the patient, not ourselves. We lecture about eating whole foods, yet barely manage a five-minute lunch that tends to rarely be a healthy choice. We parrot statistics of the benefits of exercise on cardiovascular health, yet can’t squeeze a run in after work once the 14 hour day finally comes to a close. We study the damaging effects of chronic stress on well being, yet continue the fast paced, overly stimulating job where lives are literally in our hands for 80 hours per week.
The sleep deprivation, stress, unhealthy behaviors, and lack of quality time for self and family snowballs into an unsustainable lifestyle that we deny can lead to mental and emotional disasters down the road. Currently in medicine, there is a huge push to abolish the stigma of mental health. Psychiatric illnesses are just as important to treat as physical illnesses, and physicians have strived towards more community awareness of the consequences if neglected.
It is not about being superwoman. We aren’t invincible and eventually we will all hit some form of burn out if we haven’t already. With burn out, a physician begins to lack empathy, showing less compassion where before it would have been apparent. A physician begins to denigrate his/her own accomplishments and trudging into work can seem impossible. Depression sets in, and with the barrier of stigmatizing mental health, help can seem unreachable. The shaming of mental health by society isolates the many of us who may suffer at one point in life or another, and that isolation only further spirals depression into oblivion.
The hypocritical nature of our profession is quite ridiculous. We chide others for not valuing the severity of untreated or unrecognized mental illness; yet ignore the high prevalence of it in our own profession. We have all seen the shocking stories in the news about interns and residents who have attempted suicide. At my residency orientation just the other day, the chief medical residents discussed the emerging presence of wellness as a critical component of graduate medical training. The new focus is essential, but when the question of allowing for up to three mental health days off per year emerged, many interns balked. The thought of having to sacrifice a lighter outpatient clinic workday for possibly a stressful inpatient ward service day so someone can regroup emotionally seemed ridiculous to them. We don’t question a resident when he/she can’t work due to gastroenteritis, yet when someone is suffering mentally and emotionally just as some of our patients unfortunately do, we just have to buck up and get over it. Yes, when a physician has gastroenteritis they can spread it to patients or other health care workers and potentially cause more physical ailments. But when a person is burnt out, depressed, and so far past their breaking point, they can do even more damage. The lack of empathy destroys rapport with patients, their sleep deprivation and emotional fatigue can lead to medical errors that could be ten times more grave than some vomiting, it could lead to death. Yet we ignore it, because we are superheroes right?
What is wrong with this picture? I found another intern’s response to our wellness discussion quite amusing. He said the solution to burn out and being overworked is not scheduling a ten-minute meditation session once a week to our schedule, or expecting hot yoga once a week to solve our problems. The solution is to work fewer hours. And he is right. Adding something else to our never-ending list of to-dos will not mitigate the situation. It’s like treating a side effect of a medication with another medication. We need to treat the source of the problem, not the symptoms.
And we can’t do it alone. Only overarching medical reform can. Unless they increase the number of residency spots per year to train more physicians, we will continue to have to work insane hours because who else would cover the hospital? There is a significant physician shortage, yet nothing is being done about it. Many people think that increasing the number of medical schools will solve the problem, but they don’t realize that there is nowhere for those graduates to train afterwards. The number of medical students has outnumbered the number of residency openings for years, and the gap becomes wider annually. There is nothing worse than studying your life away for four years in college and then another four years in medical school, only to be told that you can’t actually practice medicine because there is nowhere for you to train. Oh, and you have $250,000 worth of tuition debt with no feasible way to repay it.
This farcical system is in definite need of change, but like everything else in life, money is the driver. Unless more funding appears out of thin air, the matter will carry on unremitting and unabated. I don’t have a clue about how to solve this problem. That is what is so frustrating about it. It seems interminable and somewhat hopeless. Maybe that is just my cynical nature that residency has brewed up in me over the last eleven months. Either way, the fact that wellness what even brought up at our orientation is amazing in and of itself. Someone has realized the importance of taking care of self before tending to others. I hope that this concept permeates the medical community enough to instill permanent change. It all has to start somewhere, and one discussion can pioneer a movement.