This article originally appeared on The Wealthy Physician Blog.
Medical training can be a transformative and enlightening process but carries with it a high cost. Most people are aware of the immense time commitment required to become a well trained physician. Long nights studying for tests, weekends rounding on hospital wards and countless holidays spent away from family come as no surprise to most. But it is the emotional and spiritual transformation that can often be the most challenging as so many are unprepared and lack appropriate coping mechanisms.
While most young medical students understand the compassion and care needed to do this job well they often fail to realize the danger that spending so much of one’s energy helping support others through life’s greatest challenges can put you in, depleting you emotionally, spiritually and even physically over the years of rigorous training. Rates of depression among trainees remain unacceptably high and the alarming rate of physician suicide in America should give us all reason to pause and think about what we are doing with medical training in this country — or rather not doing.
Accruing general medical knowledge and understanding basic physiology drives the first few years of medical training as a strong fund of knowledge is absolutely necessary to do this job well. Then students enter clinical training and the focus moves towards building clinical skills such as physical exam and interview strategies while learning to apply scientific principles to clinical practice. Not until residency do trainees face the reality of modern day medicine, a world marred with psychosocial challenges and often too few resources. Residents must help their patients navigate through mammoth obstacles such as extreme poverty, unsafe and sometimes violent family dynamics, end-of-life care decisions, untreated mental illness, fear, uncertainty and really the entire spectrum of human emotions. Some may have had similar experiences in their own lives but most experience much of this for the first time in training. Unfortunately, many trainees are often ill-equipped to deal with these issues and with so much stigma surrounding mental health rarely seek assistance until things get desperate, if at all.
Of course doctors want to do the best they can for patients. They want to provide compassionate care while giving each patient plenty of attention and an individualized treatment approach. They want to help people live longer and better lives so they spend years sacrificing their time and energy to gain the skills necessary to do so. And while honorable this sacrifice can cost trainees their physical and emotional wellness often as a result of unhealthy coping mechanisms.
Many physicians build emotional walls separating themselves from their patients in order to get through the day. Rather than deal with the complicated emotions triggered by caring for sick patients they ignore them and focus on the work. Over time growing physical and emotional fatigue lead to a reliance on routine and patterned treatment rather than focused individualized care plans. Substance abuse, infidelity and self neglect haunt the field. And while residency programs and health care organizations attempt to provide support for providers I believe its the lack of upstream training and preparation to deal with these complex psychosocial issues that leave so many vulnerable to this burn out phenomenon.
As more and more attention is being brought to the issues of resident wellness and physician suicide in the media and medical community we will hopefully see an increase in resources and opportunities to prepare trainees for the psychosocial challenges they will inevitably face. More emphasis must be placed on improving dietary habits and exercise practices, perhaps allotting time for physical activity and team building during the different levels of training. Counseling and therapy services should be expanded and all trainees should be encouraged to share their emotional experiences with each other to help process their emotions. In the end accountability for ones well being remains on the individual but we must build a culture of health and wellness that encourages communication, sharing and support for one another. Finally, as a healthcare community we should strive to be role models of health and wellness for our patients and for society as a whole.
This article was written by Dr. Gary Shlifer, DO. Gary is currently finishing up his last year of residency in Internal Medicine. He is passionate about sharing his experiences from medical training and giving a voice to young physicians.
Gary has appeared as a guest on the Docs of Tomorrow podcast in the past. Check out any one of his talks with Mike and Matt, Co-Founders of Docs of Tomorrow, by downloading them from iTunes or simply clicking on the links below.