“Don’t take a cold drink on an empty stomach on a hot day. It gives you a bad belly and with a bad belly you can’t heal.”
Here is sound advice from a 93 year old medicine man. I read this in a book once and it got me thinking about modern day medical training. As a physician, going through 12 years of schooling, I don’t recollect even once being taught how to care for myself. In fact, the opposite was true. The subtle and often times, not-so-subtle message was to put ourselves last, at the bottom of the heap. War stories abound of physicians coming in sick, pushing their IV fluid poles around while rounding on patients, or the countless hours worked with no sleep and no bathroom breaks or even worse, one surgical residency stating with great pride that their residents had a 100% divorce rate by the end of their training.
There is a twisted sick pride underlying these stories. No wonder the rates of substance abuse, burnout and suicide among the medical profession is so high. Most physicians are of above average IQ, have comfortable incomes and have very good job prospects and security, more so than almost any other profession. And yet, there is an underlying sense of despondency in the profession as a whole. The reasons “on the outside” are multiple no doubt, such as decreasing autonomy, increased regulatory burdens including electronic health records, decreasing reimbursement and so on, but what about the “inside”? What about the person inside that white coat?
When one is sick, the expectation from the patient is that he will be well cared for. In order to do so, the physician needs to be at their optimum best, mentally, physically and emotionally. We have the same human needs as anyone else. It behooves us to therefore to “take care of ourselves first” in order to care for others. After all, you would think twice about boarding a plane if you knew the pilot had not slept for 36 hours straight or is so sick with the flu that he cannot concentrate!!
Not only should medical training incorporate self care practices but the culture of allowing abuse under the guise of “dedication to the profession and to the patients” must change too. We have to model the behavior we advise our patients to follow. In the last few years, there is much focus on the issue of physician burnout.
Medical schools and residency training programs now have started to include a wellness component. Unfortunately, many trainees are unable to take advantage of these programs as they are expected to continue with their full workload and somehow make time to attend these sessions when offered. The culture around the “The Lone Ranger” syndrome has not changed much either. It is not uncommon for trainees to keep to themselves the anguish they feel on a day to day basis. Caring for sick patients is not only physically exhausting but takes an emotional toll as well. I still remember my first patient who died, even after all these years. There was no one to discuss my grief with. Over time, one just learns to “suck it up” and move on to the next task to avoid another disaster.
When grief does not have time to be metabolized and absorbed and worked through, it builds up and changes a person in subtle ways. It is imperative to have an outlet, a way to debrief. I have seen the effects of this dysfunctional culture in myself and in numerous other very well meaning and caring colleagues. For me, the answer lay in walking away from it all. I wish it had not been that way. For many other physicians, burdened with debt, expectations from family and society and mostly, the paralysis that comes with an identity crisis, keeps them tied to their jobs. Some, unfortunately feel so trapped and unable to seek help, they end their own lives.
As awareness spreads and we have new generations of physicians, whose philosophy around work-life balance is uncompromisingly and unabashedly different, there is a shift in the air. It is going to take a long time to change old paradigms, but it is slowly happening. As a group of caring individuals, we have to keep speaking up. We have to be willing to be vulnerable and share our stories, so we don’t feel like the “freak”. It is not a sign of weakness to ask for help when we are drowning. It is not a sign of weakness when we show our emotions or ask for a sympathetic ear. And it is not a stigma to get counseling if we think it would help. We have to break down barriers that have been erected by past generations.