Medical residents need to be accountable for their own well-being

I am three months into my medical residency, and I am getting fat.  Not the noticeable change-in-pant-size fat, not yet.  But I am most certain that what was once muscle is now just “padding,” and I can no longer solely attribute the words “muffin top” to the anatomy of the snacks that I scrounge to stay alive during the long hours in the hospital.

I am three months into my medical residency, and I am stressed.  Not the bug-eyed, frazzled-haired stress, not yet.  But I am most certain that what once were exciting thoughts surrounding my life as a physician have now been acutely replaced with persistent fears of making mistakes on the job that I cannot afford to make.

In short, I cannot say that I am in a state of good health.  And if you or anyone you know is in the midst of medical training, I am confident that you will agree with me that I am not alone.

So whose fault is this?

It’s hard to say.  I’d like to attribute my declining sense of well-being to the intrinsic stress of caring for the sick, the lack of time for more than just sporadic trips to the gym, and the plethora of unhealthy food options served daily to the hospital’s house staff during meetings and lectures.  However, I know that the job of a resident physician itself is only partially to blame.  Add the work-hard, play-hard culture surrounding medical residency and my personal lack of motivation for self-care beyond basic survival needs and we may be on to something.

Regardless of the source of our health issues and the obvious problems that we residents have with this almost expected physical and mental deconditioning, we should be aware that by not actively addressing our own well-being, we are perpetuating a crude “do as I say, not as I do” dialogue with our patients that we know that deep down in our fatty livers may not be the best approach to patient care.

Which brings up the Resident’s Hypocrisy. In an environment where it is so easy to slip away from acting personally accountable for our own well-being, it is our duty as physicians to educate, motivate, and ensure that our patients become personally accountable for their own well-being.

This is bad.  I wouldn’t go as far to say that we are infringing on medical ethics and morals by choosing to spend our limited free afternoons watching Breaking Bad on the couch instead of hitting the gym (guilty as charged), but I do think that care is optimized in settings where physicians practice what they preach.  After all, no one wants to see his or her doctor plow through a pile of fried onion rings in the hospital cafeteria before an office visit focused on weight management (very guilty as charged).

Despite the difficulties of staying hale and hearty during the busiest few years of a physician’s career, medical residents not only have a personal responsibility for their well-being but also an obligation to their patients to engage in the healthy behaviors that they recommend.

Brian J. Secemsky is an internal medicine resident who blogs at The Huffington Post.  He can be reached on Twitter @BrianSecemskyMD.

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  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for posting this Dr. Secemsky. You have nailed 1/2 of 1/3 of the full equation. Ultimately, we are each personally responsible for the quality of our own health. As physicians we are rightfully held to a higher standard because our health can serve as an example to the patients we counsel – in an ideal scenario.

    You have it 1/2 right because the organizations where we work can choose to play a role here as well. They can care about and support the health of their providers and staff. With burnout rates averaging 1 in 3 doctors on any given office day over the last 20 years, worldwide, regardless of specialty this is a massive issue that remains mostly invisible. Your health as the provider is the single biggest influence on the quality of care you offer and your quality of life.
    Make time for exercise
    Do your best to eat healthy
    Help your organization create a culture of caring about the docs and staff

    You are only talking about 1/3 of the full equation because physical health is only one of the three main ways we are drained at work. The other two are our Emotional Health and our Spiritual Health. Each of these “bank accounts” can be over drawn and each is ideally recharged with activities outside of work that nurture our meaningful relationships and feed our sense of purpose.

    And you have made one massive assumption you will realize is false sometime in the next 5 years. Your residency years are simply not the most challenging you will experience. I encourage you and all residents everywhere to establish the habits of taking care of yourself physically, emotionally and spiritually now … so that you don’t join the burnout statistics that hit their peak about 10 years into private practice. You have no idea what is coming that will feel like a continuous series of last straws … and none of them have anything to do with your clinical skill set.

    My two cents,

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • aek2013

    The crockpot and freezer are your friends. Throw into the crockpot an assortment of proteins, vegetables, olive oil, water or broth and favorite seasonings as early in the day you have away from the hospital. At the end of said day (or night as it may be), ladle single/double serve portions into freezable/microwaveable containers and freeze. Bring them to work with you along with a half dozen pieces of fresh fruit. They’ll thaw/stay cool in the staff/on-call fridge, and you can grab and go. Nuts and hardboiled eggs can also be great for this. Good luck! I feel for you.

  • http://www.practicebalance.com/ PracticeBalance

    I saw your original article on HuffPost; I’m so glad you’re addressing this in broad arenas. I was in your same position a few years ago, and after ignoring my own wellbeing due to “go-go-go” I ended up being a patient! I survived, now I blog about it, and I’m here to say that taking care of yourself is tantamount to being the best physician you can be. Hang in there and just say no to the doughnut tray!

    • Brian Secemsky, MD

      Thanks PracticeBalance. PS, tantamount is one of the better words out there. Appreciate the support!

  • buzzkillersmith

    Have you considered another specialty? Internal medicine is no way to live, Brian.

  • bill10526

    One has to realize that the brain is a computing machine that needs sugar during periods of concentration. Some people with high metabolism can take in sufficient sugar or its precursors without putting on weight. Many of us can not.

    Try to relax. I found taking a half hour walk at lunch time helpful. I call it focus to infinity, and It helps the eyes too. I think one reason diet and exercise fail almost all the time is that concentrating on weight loss programs uses sugar in the brain.

    When God wants you to be heavy, He usually prevails. It is sad when others are cursed, and depressing when it happens to you.

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