Lessons from Seven Years of Struggles and Successes

Delivering the Chief Talk

I was asked to write this blog after presenting my chief talk “It’s okay to not be okay” earlier this summer. Every spring, chief residents prepare for graduation and one of the most anticipated and anxiety inducing moments of that time is the delivering your chief talk. All graduating resident are asked to give a talk to the department, but the content of that talk is mostly at our discretion. Some share their research, others share clinical triumphs, others talking about their lives outside of the world of medicine. When it came time to compose my talk, I knew deep down what I wanted to talk about, but I admittedly was hesitant to address an auditorium of my colleagues and leaders and be forthright and honest about the struggles I experienced during residency training. I wasn’t an expert, hadn’t spent hours upon hours in the lab studying the topic, but I had lived it and experienced it. The more I reflected and considered other less personal topics, I knew that this was the talk I had to share. Not because I am an expert on burn out, not because I am all knowing about the struggles of mental health, not because I want to preach about being more whole and well. But rather the exact opposite, I have fallen, faltered, and struggled—and I want everyone in medicine (and outside of it for that matter) to know that it is okay.

To provide a sense of order and direction to this talk that felt very personal and complex, I collected my thoughts in the form of 10 lessons I learned in residency:

1. Failure does not define you
2. It’s okay to not be okay
3. True diversity doesn’t end with race and gender
4. When you make yourself a priority you give others permission to do the same
5. It’s still just a job
6. Look out for others
7. Let the humanity of our job make you a better human not less of one
8. Self-sacrifice is not a virtue
9. Kindness is not weakness
10. Be grateful

It's Okay to Not Be Okay

Now I could share each and every one of those lessons, and if you’re interested the link is here. But I think all of the lessons are guided by one important principle: we are all human. That’s what makes medicine so special of all the scientific fields, we get to care for our fellow humans. Humans who are unique, engaging, emotional, breakable, challenging. We are unremitting in the study and treatment of the maladies of our imperfect co-humans, yet we are not willing to acknowledge the same in ourselves. We suggest that we be on all the time, we never take sick days, work hours and hours on end. And when we start to feel the gnawing of the inexorable job start to take us in our grasp we blame ourselves for not being strong enough. And that is simply crazy.

We are humans first, surgeons (insert any job here) second. We have these incredibly awesome jobs (see lesson 10) but cannot be expected to be our job. It’s okay to bask in a day off, to feel exhausted, to cry, to fail.  But that’s really hard when everyone around you seems to be totally on. ALL. THE. TIME. Even harder when the system, which we are very much entrenched in, chains us to computers more than bedsides, asks us to give more and more care in less and less time, and creates an environment where we feel if we are not working all the time we are letting down our patients¹. Large scale change is required from a systematic standpoint, but I think we can do a lot of things as individuals to make our training and overall burnout epidemic in medicine better. One easy place to start is being honest with each other and looking out for each other.  All of the most challenging journeys in my life, and I assume most people’s lives, have been made better by the support and empathy of those around me. The most challenging I’ve experienced—residency included—required professional aid from a therapist.

Reaching Out

We all need help sometimes. But if we hide our struggles away, pretend to be superhuman, we continue to perpetuate and environment in which our health and seeking out support is secondary. A career in medicine is emotionally taxing, our every day is our patients’ and their families’ worst day of their lives. Being compassionate and empathetic takes effort, energy that is not available if you are running on empty—if we do not take care of ourselves we are not at our best to take care of our patients. Interestingly though most of us have developed a keen ability to detect a patient in need of rescue, we are often quite poor at recognizing the need for aid in ourselves .

We have to abandon the belief that if you put yourself as a human first you are less of a doctor. Nothing could be further from the truth. Admittedly this is quite the challenge, most of us in the field of medicine have gotten where we are because of a lot of personal sacrifice. And I am not saying that we should all abandon our patients and go take bubble baths, but self-sacrifice without moderation will inevitably leave you broken. One in three residents in training has signs and symptoms of depression, doctors die by suicide at a rate higher than the national public, with women at even higher risk^{2, 3}. Take time for yourself, check in frequently with your friends. Recognize that the practice of medicine is a marathon, not a sprint. And please be honest and compassionate for each other. Struggle is so much easier when you feel that you’re not the only one.   

You are not the only one.

References

1. Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.
2. Goldman ML, Shah RN, Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA Psychiatry. 2015;72(5): 411-412.
3. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161(12): 2295-2302.