Editor's Note
Working on Wellness
The doctor was clearly not getting the job done. Always meticulous, his notes were still exhaustive—when he got them done. But the charts piled up for weeks. Warnings from the billing office received well-intentioned reassurances from him. His partners first encouraged him, then chided him, then gave him deadlines. His normal late afternoons now stretched into later nights as he tried to get his work finished. He was irretrievably behind when he found out his hemoglobin was 5 gm.
Medicine is tough work. It takes mental and physical stamina to survive medical school and training. In most settings, practice requires mental agility and physical endurance to track and manage the deluge of data that is the coinage of medical practice. Illness undermines doctors’ performance. Try listening to a patient’s history while suffering the diffuse myalgias of influenza. Try tackling a stack of phone messages with the cloud of depression distracting your every thought. Try dictating office notes from last week with a hemoglobin of 5. Physicians need to be on top of their game to do the job.
As physicians, we learn about DNA structure and cranial nerves in medical school and diagnosis, treatment, and procedures in residency; and we emerge from two decades of schooling as superbly trained professionals, our heads crammed with knowledge and wisdom about keeping people well. Yet somehow, many of us haven’t finished grade school when it comes to keeping ourselves well. In fact, some of our training was anti-wellness, with 48-hour workdays as the acceptable standard and generations of physicians indoctrinated with the macho ethic of “I’m the only one who can do it, so I have to be there.” The message: Ignore your sleep deficit and battle your foggy mind, all for the “good” of the patient.
When docs surfaced from training and entered practice, they carried their dysfunctional habits with them, driving body and mind in the name of dedication to patient and practice. Nobody had taught them to pay attention to their own bodies for signs of illness. Nobody had mentioned what burnout was or felt like. They listened to their patients but not to themselves.
Thankfully, that is changing. Realizing that fatigue is dangerous to patient and physician alike, the Accreditation Council for Graduate Medical Education placed caps on resident work hours a few years ago. Learning to mind their minds and their bodies, medical students are now pursuing approaches to their own wellness with the avidity they once marshaled for the MCATs. Listening to their bodies and hearing a chorus of groans, practicing physicians have restructured their lives in order to decompress. And hoping to yank physician burnout and depression out of the closet, the MMA and other physician organizations are highlighting it as one of the perils of practicing medicine. Playing hurt may work in the NFL, but it is inappropriate in the clinic or operating room.
When I was selecting an internal medicine residency, I visited a highly touted program notorious for the hours demanded of its residents. At the time I visited, the call rotation was five out of seven nights. When I asked one of the residents what he thought of the schedule, with a bit of a swagger, but through clenched teeth, he said, “We love it.” Hopefully, the day of such macho self- flagellation and the day of pressing on with work despite a hemoglobin of 5 is past.
Charles R. Meyer, M.D., editor in chief, can be reached at cmeyer1@fairview.org.