Residency as a series of mini-interventions against physician suicide and depression

They say you never forget your first crush. Or your first date. Or your first kiss.

And you don’t.

Just as we have landmarks events that shape us in the adolescence of our personal lives, physicians also have landmark events that shape them in the adolescence of medical training: residency.

No longer a child of medical school, needing constant supervision and clinical babysitting by elders, resident physicians start with a refreshingly nascent view of medicine still unmarred by the responsibility death and disease. Quickly, as the leash is lengthened with each year of residency, that view becomes increasingly more burdened.

They experience their first real patient. Their first medical code. Their first death.

They conduct their first barbaric procedures like filleting open chests of innocent teenage bystanders who were victims of gang shootings. They release a confetti of blood into air of the trauma bay, only to reluctantly call time of death moments later.

They question all that is right and wrong with the world, if there is even a right and wrong in the world at all.

They tell the first patient they personally relate to that they have terminal illness. They see themselves in that patient and share the same aspirations of early career greatness. They shatter those dreams with two words: “metastatic cancer.” They see themselves in that patient, and start to become obsessed with their own small aches and pains as potentially insidious signs of something more malignant. They face mortality in a way they’ve never had to before and become convinced that life is unfair and there is neither good nor evil.

They experience grief as a full body experience for the first time when they pronounce an infant’s short innocent life and face the parents with the news. They never forget that scream and fear it with their entire beings when they become parents themselves.

Like adolescence, residency is a time of formative firsts. We never forget them just as we never forget our firsts in our personal lives.  But at every step of the way, we do need to decide how they will shape us as not only physicians but as humans.

As a resident, you have the unique opportunity to map out in real time the steps to burned out cynicism or to a broader sense of the greater good and a resolve to defend it ever more.

As a young attending, you have the unique opportunity to recognize and intervene at each of these landmark events in a young resident’s life — to show solidarity, to encourage introspection, and to breed resiliency.

As a seasoned physician, you have the unique opportunity to share the color of time on these firsts — to show wisdom and provide advice on your own struggle in the peaks and valleys of defining life’s meaning in a field where death and life are fluid.

We as the house of medicine are increasingly infatuated with the buzzwords of “wellness,” “burnout,” and “resiliency.” We are constantly assaulted by a barrage of new statistics about how unhappy physicians are. Popular media seems almost voyeuristically captivated about each new young physician — full of life, hope and promise — who was self-slain by the dark underpinnings of medicine and medical training.

We know we are high-risk group and depression is endemic in our field — yet, we’ve yet to figure out how to stage an intervention.

These firsts of residency are inherently traumatic and worse, delivered rapid-fire with little reprieve over the few short years of training. If we have hope of addressing our collective mental health at all, we need to stop the focus on resuscitative efforts when someone has already come to a cry for help.

Instead, we should recognize each of these firsts for the impact they have on the development of a physician, and help guide their impact every step of the way — into self-improvement, respect for life and dignity, and humility in the face of overwhelming circumstances.

Amy Ho is an emergency physician.  She can be reached at her self-titled site, Amy Faith Ho.  

Image credit: Shutterstock.com

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