I don’t want to go back. Starting at 6 a.m., the intern entered the hospital with coffee from the bodega down the street, anxious about the patients that were admitted to the ward the previous evening.
I deserve it. At 8 a.m., he had already rounded on his nine patients, one of which was an angry male with dementia who spewed expletives at any healthcare provider that dared cross his path. He had no energy to challenge the abuse.
Guess I don’t belong. By noon, he was chewed out by the surgical service because of an inappropriate consult he was told to call in by his upper-level resident.
I am terrible at this job. By 6 p.m., he began writing his nine notes, including two lengthy admission notes that only few would read.
I should probably sleep in the hospital. By 8 p.m., he walked aimlessly around the hospital, looking for the night float intern who was to recuse him of his daily duties until the following morning. He left the hospital exhausted knowing that tomorrow would bring the same agenda.
I guess I have to go back.
Defined by psychologist Freudenberger as a “state of mental and physical exhaustion caused by one’s professional life”, burnout is often used to describe how medical trainees and faculty alike can feel after spending a significant amount of time in a stressful professional environment. Since the term was coined in the 1980s, burnout has been studied extensively within the medical community. In terms of etiology, burnout appears to be derived from multiple systemic factors including environmental (excessive patient load, long working hours, extensive documentation), personal (having children while in training, lacking social or familial support), and psychological (lack of feeling in control, loss of autonomy).
Manifestations of burnout appear to follow three phases, beginning with emotional exhaustion, proceeding to feelings of depersonalization and an increased sense of cynicism, and finally developing an inability to experience personal accomplishment. The consequences of burnout are also well researched. Physicians who demonstrate symptoms of burnout are at an increased risk of developing substance use disorder, depression, and suicidal ideation. Furthermore, patients also suffer from having physicians who suffer from burnout as medical errors increase and patient satisfaction decreases.
However, this is not breaking news, particularly to medical providers themselves. As a psychiatrist in training, it was heartbreaking to observe these types of symptoms develop in my colleagues. Every day, I was trained to provide tools to help patients self-reflect in a safe environment while exploring solutions to their psychological stressors only to find myself running into my peers who suffered from emotional exhaustion and learned helplessness.
I was also a victim of these stressors during intern year and was referred to therapy by a mentor as a way to navigate through these struggles. Ironically, even as a psychiatry resident, the idea of disclosing deep feelings to someone in an office on a weekly basis was terrifying. However, over time, thoughts of inadequacy, worthlessness, and perpetuating self-doubt slowly decreased as my therapist supported and challenged me to look deeper into why I feel the way I feel. I believe this entire process occurred due to working in a medical specialty that openly encouraged and provided mental health assistance to their trainees.
So the questions arose: How, as a psychiatry resident, could I help engage other medical specialties in accessing mental health resources? Who would be the target audience for this initiative? And more importantly, how would this audience buy into the idea of conversing with a trained professional about their challenges inside and outside of residency?
With the collaboration of both internal medicine residents and psychiatry residents, Crossroads was born. The project was designed behind to model group therapy, which involves a mental health provider meeting a group of clients on a regular basis. There are many variations of group therapy, which have been shown to be significantly effective in treating disorders such as depression and substance abuse. Furthermore, the use of self-development groups led by psychiatrists for medical professionals has been shown to be effective in reducing depressive symptoms.
Crossroads provided a protected hour of self-reflection and discussion between PGY-1 internal medicine residents twice a month throughout the NYU health system. Guided by psychiatrists, discussions relating to burnout, depression, and suicide were just a few of the talking points that interns explored. Confidentiality and food were provided to fortify the idea that our colleagues’ thoughts were protected and that this hour could be a sense of reprieve from the ebb and flow of a chaotic workday.
Contingency planning was also established so that if trainees presented with thoughts of suicidal ideation or another psychiatric emergency, our psychiatrists could get them urgent help in a safe and confidential manner. While still in its youth, Crossroads has shown promising results. Attendance has risen, and trainees who are need have been referred to mental health providers for extra assistance.
There is still much work to be done. Burnout is a system’s issue, and we do require systemic change to make a significant impact. However, what if we began teaching our trainees that their mental health is a priority? That while the patient is essential, the provider’s well being is also an integral part of their therapeutic relationship. If we give our trainees the time and space to heal, they might create the culture that we always wanted.
Ashvin Sood is a psychiatry resident.
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