I recently read a medical school commencement, delivered by a physician, that was both inspiring and sadly reminiscent of what physicians should aspire to throughout their careers.
This physician relayed how patients throughout her training and career had provided her with moments of clarity, helping her identify the “why” she chose a career in medicine. She went so far as to describe how a group of patients saved her from choosing suicide to escape what she labeled “being a physician in a big-box clinic.”
The unfortunate part of her commencement speech is that the positive experiences with her patients and colleagues, as she described, are rare in present-day medical practices within corporate health care.
Even sadder, the pre-med, medical school, and resident training leading to practicing as an attending, are rife with contradictory messages. One only needs to look at the statistics from recent surveys done at medical schools and residency programs to see the isolation tactics routinely taught and condoned.
Examples include teaching physicians to distance themselves from patients emotionally, perhaps taught in the spirit of protecting them from becoming too emotionally invested in their patients. Also, condoned is competitive colleague interactions in the hopes of creating an invigorating learning environment. Both of these teaching techniques, can, unfortunately, backfire, increasing the future overall isolation physicians start to experience more commonly in their practices.
If we are intent on improving the overall emotional and mental health of physicians, we must look for ways to alleviate and even prevent this type of isolation from creeping into our careers. We must first begin to change the culture that prevails in pre-med and medical schools from one of intense competition to one of fostering teamwork, learning within a community of like-minded students interested in the sciences.
Medical school should continue to encourage teamwork to solve problems as well as supporting each other during difficult clinical situations with both patients and families.
Furthermore, the emotional and mental health of the provider-in-training should be the top priority of medical schools, teaching students calming techniques to de-stress, positive coping mechanisms, as well as time management and juggling work-life balances that foster healthy families. The emphasis should not be in getting the best grades to acquire entry to top residency programs. Instead, the emphasis should be on becoming a compassionate as well as a competent physician.
Unfortunately, once these students enter into residencies, so much of the negative behaviors currently allowed to propagate, become ingrained personality traits.
By this time, if appropriate survival strategies that benefit both physician and patient were not taught, these residents continue to undermine their colleagues, treat their patients as disease processes rather than complete human beings and ignore their own emotional and mental health issues, using bad behaviors to survive each day.
“Physician, heal thyself” is no longer an option as their lives spiral out of control, with some choosing their only perceived option of suicide to completely eliminate the pain they face daily.
Residents that, despite their negative behaviors, survive to become attendings, continue their legacy of bullying, arrogance, and entitlement into their work lives.
Perhaps this seems all very overblown and not the norm, but I challenge you to look around.
Be honest in your assessment of where you work. What is the environment like? Are your colleagues cooperative, friendly, and willing to help? Or do you feel isolated, afraid to say or act the wrong way and be reported to HR?
Are you able to talk to a colleague about a bad outcome? Or do you go home and indulge in too much food, alcohol, or drugs to forget the pain you are feeling?
Is your family suffering because you cannot cope with their problems, being unable to deal with your own? Do you feel you have to put on a happy face even though it is disingenuous?
Perhaps you are a good physician, but feel unappreciated by patients or as an employed physician. How do you deal with this? Do you brush these feelings aside because RVU’s are more important? What happens if day after day you continue to feel this way? Is there someone who can help, who will listen and understand?
What if your colleagues are jealous of the work you are doing and undermine your progress in front of other colleagues and patients? How do you cope with this type of work environment? What happens if, despite your best intentions and work ethic, you are terminated? Are there any resources?
These are all very difficult questions to answer but deserve resolution if we are to create healthy work environments for physicians. So much of these scenarios might be avoided in the future by creating supportive learning environments early on, as I have described above. However, these problems are occurring in real-time and will not be solved by going back in time.
We need to have empathy for physicians presently going through these issues and, more importantly, programs readily available to help heal a very broken system and the physicians working in them who are just as broken.
Common catchphrases in our conversations as physicians to mitigate or eradicate toxic work environments and decrease physician suicides include the “culture of caring” and “joy of medicine.”
Let’s not just pay homage to the words, but instead rise up to the challenge to make a difference. Reach out to your colleagues, ask them how they are doing and how you can help.
Be present, be kind, and be grateful for the ability we have as physicians to heal ourselves as well as others. And finally, as we look to the younger generation being trained, let’s support them in a positive manner during rounds. Let’s demonstrate a better way to practice our chosen profession, with kind words and actions for ourselves and others. Remember, “if not for myself, who will be for me? If I am not for others, what am I? And if not now, when?”
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