By far, one of the most memorable sessions I attended at the 2017 ASCO Annual Meeting was one on physician wellness. Judging from the packed room and the diversity in the audience and on the panel, both in terms of age and job description, wellness is top of mind for many oncologists—and much needed, to combat the rising epidemic of physician burnout.
By now, most of us have heard—and perhaps are personally familiar with—the hallmarks of physician burnout: depersonalization, including cynical or negative attitudes toward patients; emotional exhaustion; a feeling of decreased personal achievement; and a lack of empathy for patients. I might add a lack of empathy toward colleagues and coworkers as well.
Addressing physician burnout and optimizing physician wellness is a big part of becoming and producing physicians who are resilient enough to face the challenges of the rapidly evolving science of medicine and our very technology-driven world. Wellness improves our ability to ensure patient safety and deliver high-quality care.
I write from a trainee’s perspective, certainly not as an authority on the subject but as someone on the journey with you, gathering pieces of wisdom along the way, hoping to learn and to share. I believe that we can all become physician wellness champions, and in taking care of ourselves we can also serve each other.
1. Prioritize wellness in your education.
To champion wellness, you have to know what it is: the multidimensional aspects that, in combination, lead to optimal levels of health and emotional and social functioning. Make learning about physician wellness a priority.
You can self-design a whole curriculum on wellness and burnout for free using online tools and resources. There are surveys to see if you are at risk for burnout, short videos that help you learn how to meditate and self-reflect, and strategies to increase resilience and empathy—two qualities we absolutely need in order to be successful physicians.
I am committing to spending 5 to 10 minutes each week logging off Facebook, going on YouTube, watching a short video on physician wellness, and learning something new. I chose videos because that method of learning works well for me; if I go fishing for information on physician wellness on Facebook, I end up liking photos and loving posts—not how I intended to spend my time.
Find a method that works for you. Social media, including Facebook and Twitter, can be a good source of information about physician wellness (especially if you are not prone to distraction as I am!). If you like to read studies and papers outside your specialty, the American Medical Association (AMA) STEPS Forward program has good information about physician well-being. ASCO offers physician wellness information as well.
Five to 10 minutes each week is about 30 to 40 minutes each month—enough to learn something that might help you, and help you help others.
(If you’re interested, my YouTube video this week was “Happy Brain: How to Overcome Our Neural Predispositions to Suffering,” a TEDxUNI talk by Amit Sood, MD. It was certainly worth the time—very enlightening, and highly recommended.)
2. Prioritize wellness on your calendar.
I learnt this strategy recently and it changed the way I think about how I plan my week. (Note how I said “think about”? That is because I am not there yet, but I am working on it. Baby steps!) As you plan your day, your week, your clinic, your research, your paperwork, your Journal Club, your writing time, it is just as important to schedule time for sleep, time for fun, and personal downtime.
We all have things we hope to get around to but don’t schedule, and often we see those things float away on the wings of wasted time. So schedule time to spend with your family and non-medical friends. Schedule time to learn a new skill (and schedule your 5 to 10 minutes each week for learning about wellness). Schedule time to go somewhere.
I know it sounds silly to schedule “Sleep: 1 to 4 PM” on your day off, but humor me and try it just once!
3. Prioritize wellness in your relationships.
“Secure your own oxygen mask first before assisting others.” You’ve probably heard this in the pre-flight instructions on a plane, but it applies to wellness too. You have to take care of yourself in order to take care of others—sometimes that means allowing others to take care of you.
I learnt this the hard way as a parent. In many ways, being a physician feels like being a parent because you’re a care provider. You are always supposed to chin-up, figure everything out, and keep moving. It’s hard to do that if we are not recharged and ready. One of the most important ways to do this is to prioritize relationships with the people who sustain and energize us.
My younger sister is a busy fourth-year OB/GYN resident in a very rigorous program, but manages to inspire me, listen, and offer support, advice, and encouragement. I am fortunate to have her not just as a sister, but as a professional colleague. I also have three wonderful colleagues who listen to me when I need to vent, when I need sound advice, and when I need help seeing a situation from a different perspective.
We all need relationships in our lives that revive, recharge, and refresh us in order to thrive. Figure out who the energizers are in your life—a colleague, a friend in a totally different profession, a spouse or partner—and prioritize them (schedule it!). Maximize your time with people who see your wellness as a priority and minimize your time with people who don’t. And remember, it’s not the number of relationships that counts, but the quality of the connection.
4. Prioritize wellness on your team.
I love my colleagues, but the very qualities that make us such wonderful, dedicated, resilient physicians also make us highly driven, highly opinionated, and highly caffeinated. We spend long hours together, and sometimes it gets challenging to get along for a significant amount of time. As colleagues in a very stressful environment, camaraderie is crucial for our well-being.
What if we treated our coworkers as nicely as we treat our patients, and held them in the same high esteem? I cringe inwardly when a faculty member berates another faculty member in front of trainees. We have all met physicians who are kind to their patients but mean or indifferent to their colleagues, as if empathy is a skill for specific occasions and not a character trait we should strive to develop. And that is one way we burn out: when we segregate our empathy, we create tension within ourselves and in our workplaces.
The ways we can offer camaraderie are so simple, and we can start practicing them immediately. A smile. A greeting. Giving meaningful and respectful feedback. Mentoring. Being a safe and confidential ear when a colleague needs to talk about their struggles. Speaking kindly and professionally to and about your colleagues regardless of the setting. Role-modeling those skills for junior trainees.
If you know you are going to be in clinic with someone who grates on your nerves, do something relaxing the day before (schedule it!). Be proactive about replenishing your own emotional reserves so that you have the energy to serve the people around you.
5. Become a local champion for physician wellness.
By now, you are prepared: you’ve educated yourself about wellness, you’ve made your own wellness a priority in your schedule and in your relationships, and you’ve developed empathy for and camaraderie with your colleagues. You are now well positioned to have an impact on structural issues that lead to burnout. Like medical errors, physician burnout is not just a personal issue, it is a systems issue.
Training programs need trainees who are thinking about how we can improve the systems we train and work in. The Accreditation Council for American Graduate Medical Education’s Back to Bedside initiative offers grants to trainees with innovative ideas for developing local programs to improve physician wellness and patient safety, with an emphasis on collaboration. Your institution may already have a wellness-related project you can tap into that will give you the experience to develop and implement your own ideas. The AMA STEPS Forward program reminds us that no change is too small when it comes to addressing burnout and improving the wellness and resiliency of residents and fellows. If you don’t have robust local support for a wellness improvement project, start with something small and informal, then scale up to bigger programs over time.
We are the faculty members and program directors of tomorrow and we are the victims of the physician burnout epidemic. It really is up to us to make sense of how to maintain the necessary rigor to get through medical training but also how to live and let live while doing it.
I close with a quote from former AMA president Robert Wah, MD, that I’ve come to love, which I hope you and I will remember to remember:
“The most important patient we have to take care of is the one in the mirror.”