This essay won Medical Student Category first place in our second annual essay contest “Healthy and Happy doctors provide better care: define barriers and solutions to physician wellness.”
Do you remember the scene in the movie Mean Girls where everyone in the mall begins acting as if they were wild animals, fighting at a water hole? With limited resources, judgment among each other, and the idea of success in mind, people in our real world can act in similar ways. While this analogy is a bit dramatic, I think that it addresses a core issue that we all have a desire to survive and succeed, but that our society and educational structure has rewarded mainly individual success in the process of achieving these goals. Our natural world, and especially our healthcare system, does not achieve success through individual efforts though. Many studies have shown that people who have strong support systems and teamwork skills are happier, and other studies show that happier and healthier doctors provide better patient care. The question is not if we should focus on physician wellness, but how do we improve it? I think that one core way we can improve physician wellness is by designing and rewarding ways to not encourage independence, but interdependence.
It is difficult to formally study physician wellness because measures are based on perceptions, timing, and uncontrolled variables. As a scientist, I understand these limitations. But as a medical student, I have witnessed and experienced some stages of training required to become a physician and believe that these stages significantly affect how physicians eventually develop, practice, and interact with each other and patients. While our stages of training can act as a barrier to becoming happy and healthy physicians, I think that they have more potential to help foster the development of skills that allow physicians to more likely be happier and healthier. Thus, one part of the equation is to understand how we can improve the wellness of trainees before they even become physicians.
Training to become a physician officially begins with pre-medical education, during which we are told that our courses are designed to extract those not smart or strong enough for medical school. At my very competitive undergraduate institution, we students retreated to the library corners for hours of solidary studying, created study guides that were tucked away in public places, and heard rumors of those who cheated on assignments and exams. Looking back, the worst part is that those behaviors were seemingly accepted as what must be done to succeed, defined at that time as high grades and acceptance to medical school. However, these behaviors are not rewarded in the practice of medicine.
When I began my studies at the University of Kentucky College of Medicine, it was so exciting to make new friends and share in the joy of learning about medicine. I was given a leadership opportunity to help improve our academic curriculum by working with course directors, older students, and my peers. I soon realized that each person I spoke with had something to contribute: an idea, interest, or background. This drove me to help create and foster a shared College of Medicine website that allows students in all years to post shared academic resources, advice, and suggestions for improvement. I imagined that different students would contribute throughout the year, as some students had strong biochemistry backgrounds while others were more passionate about genetics or neuroscience. Unfortunately, sharing such strengths and resources were not rewarded in the beginning and the academic structure of grades based solely on individual exam scores posed such limitations. The culture began to change though once we began small group discussions and working on projects and team-based learning sessions together. In these settings, we were able to recognize and celebrate our individual strengths to achieve a shared goal.
Team-based learning has become a buzz topic in medical education over the past year, and it deserves the publicity. Not only do students seem to remember material better under team-based learning conditions, but they also seem to enjoy it more. Such teamwork skills are crucial for clinical patient care and are essential to develop as part of a solution towards improving physician wellness. Today, patient teams consist of not only of physicians, but also specialized nurses, pharmacists, physical therapists, nutrition advisors, social workers, and more. Each member of the team has a necessary role, but if any member acts independently, then communication and patient care can become compromised. Teams succeed when they work in an interdisciplinary manner, appreciating each member’s role and working together towards a shared goal. Team-based skills are also necessary in order to achieve patient-centered care.
Interdependence and teamwork can only work when individuals are able to take care of themselves. This is where it becomes important to also focus on how physicians and trainees can develop healthy habits. An obvious place to start in terms of barriers to a healthy lifestyle is a lack of personal time due to long and odd hours at the hospital. The long working hours are at their peak during residency, a time when physicians are really developing behavioral traits that will carry with them as attendings and they will teach to medical students. Long working hours are a necessary part of residency, but creating solutions to reduce stress inside and outside of the hospital for all physicians will create better patient care. To start with, it is important to recognize that most residents do not have spouses to help take care of household needs perhaps as much as in the past. Personal lives and responsibilities can become very hectic, and spill over into the work environment in the form of poor sleep, stress, and disorganization.
If we remember Maslow’s hierarchy of needs, then we know that at the very core of happiness is the need for nutrition and sleep. In fact, it is known that nutrition has effects on energy and that a lack of sleep decreases the effectiveness of the immune system. Despite these known facts, nutrition and sleep seem to be sacrificed during medical training. There are many solutions to help address these issues, but the most important is the culture that endorses that success and strength in medicine includes such sacrifices. While training methods discussed before are a bottom-up solution, these solutions act in a top-down manner. Physicians themselves must set an example that nutrition cannot be scarified and they should advocate for healthy food in work environments and even provide breakfast and lunches for trainees. Additionally, programs can hire people who can help with personal needs, such as grocery shopping, laundry, and childcare in hospitals. Many residency programs have begun to develop such solutions with positive results for physicians and patient care.
It is important to recognize the barriers to developing happier and healthier physicians and create realistic and simple solutions because a healthy lifestyle and work-life balance has been shown to create physicians that make fewer mistakes and want to be more involved in their patient’s long-term well being. This is best achieved through a perspective of interdependent learning, training, and work environments.
About the Author
Tara is from Frankfort, KY and went to Vanderbilt University for her undergraduate studies in Molecular Biology and Political Science. She now attends the University of Kentucky College of Medicine, where she is currently on an NIH-funded research year to pursue her interests in improving cardiovascular health care through research and advocacy. Jeff is from Toronto, Canada and went to McMaster University for Biomedical Engineering. He now works for Brainlab as a clinical specialist in intraoperative navigation during neurosurgical procedures, and he is currently applying to medical school to pursue his interest in patient care.