Resiliency training in medicine is a farce


I knew that residency would be indentured servitude for (in my case) three years.

I knew it. I prepared for the fear, the shaming, and the isolation as best I could.

And I have for the past 11 months done OK. I am not the smartest or fastest. But I am told that I am passionate about my patients and have an “adequate fund of knowledge.”

Woohoo. Adequacy!

I have had dark moments. And it’s funny because the thing that prompts my dark moment, the impetus for my darkness is always the same issue: when my residency program tries to prove that they are caring about resident well-being.

I get it. Most attendings came into med ed hoping to change it. Instead, they perpetuate the cycle, repeating the same old, same old broken methodologies. It’s not their fault. They joined a system hoping to change the system. It’s Satre’s L’Engrenage. It’s Nietzsche saying “He who fights too long against dragons becomes a dragon himself.”

Side note: My husband asserts that I am more of a post-modernist than an existentialist. But would an postmodernist cite Satre and Nietzsche in the same post? (When asked that question, he asserts that they would. He is wrong.)

Anyway, I digress, I am OK with my residency program being indentured servitude until my attending assert that it is not, in fact, indentured servitude and that they actually care about resident well-being.

Today in fact, we had a mandatory lecture about building your “infrastructure of happiness” which was a diatribe that among other things included a 40-something-year-old man talk about his vacations (with pictures), high moments in his life (with pictures), and several strangely elaborate sea creature analogies (you guessed it, with pictures).

The “infrastructure of happiness” includes things like eating well, exercising, remembering why you went into med school, staying in touch with your roots and family, etc., etc. And, he touted, if you do that, you will avoid the blank slide.

Yep, he had a black blank slide to represent depression. Very clever. He did tell us that he did, in fact, mean to leave it blank. It was supposed to be just black.

This particular speaker’s cheesiness aside, the thing that I could not get over was the irony. This man was taking an hour and a half of our limited time in a mandatory lecture to tell us to be more intentional with our time.

Furthermore, I believe that the idea of resiliency training in medicine is a farce. To say that I as a student/resident needs more resiliency in order to succeed is to say that the program, the system of the 80-hour work week and 28-hour shift, is not the problem. It is me.

And that is frankly insulting.

Look, my dear attendings, I knew coming into this career that I was going to spend residency working long hours and catering to your every whim. I get it. I was prepared.

I was not prepared for you throwing my exhaustion, my crushed soul, my struggle back in my face. Get more resilient, eat more vegetables, run more.

I run every day. I run every day because I can cry and heal while running. And I can’t do that in the hospital.

I get it. You didn’t come into med ed to perpetuate the problem. You came into it to fix it. That is what we, doctors, do! We fix people! But you couldn’t fix it. It is too big to fix. So, you justify. You justify the broken system to justify your paycheck. You justify the struggle as better than yours (which it probably is). You justify your resident dissatisfaction with a lack of resilience.

Stop telling me to be more resilient. I know you don’t understand my millennial resilience. You think I am still clutching my junior high participation trophy while eating an avocado while tweeting on my Facebook crying because I am too weak to work 80 hours a week (and you had to work 120 hours, so you really have no sympathy).

You do not understand me. And that’s OK. Stop trying to and just be my boss. My boss that makes me cater to his/her every whim and expects me to make life-and-death decisions for patients 80 hours a week. Be my mean, unrelenting boss. That is who you are. And that is OK! Medicine is not the only career with strict bosses (citation: that one Meryl Streep and Anne Hathaway movie and the West Wing and all high school teachers, etc.). Be the strict boss. Embrace your identity.

And don’t worry. I fully expect to be the mean boss to the next generation (that is, if the baby boomers every retire, am I right?). I fully expect them to fleek angry posts about me on the next Snapchat on the newest iDevice.

Or whatever it is these young people are into these days. I don’t even know.

The author is an anonymous family medicine resident.

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