LIN Session – Resident Wellness

LIN Session - Resident Wellness

Michelle Lin MD and Chris Doty MD

Take Home Points

▪       Emergency medicine physicians are at higher risk of burnout and suicide.

▪       We devote limited time to this topic in training and at conferences.

▪       We need to normalize the conversation about the stress of our jobs.

●      Chris Doty sent an email to emergency medicine residency leadership across the country after a tragedy at the University of Kentucky.

o   “Dear colleagues. The unbearable has happened at the University of Kentucky. Last Friday we discovered that one of our residents was tragically taken from us. It appears that the resident took their own life in response to acute grief over a moribund family member. As you might imagine, the residency, faculty, department, institution in general and I have been devastated by this loss. I will not be sharing details about his death except that this was completely unexpected by myself and his resident peers. There was not an obvious history of depression or warning signs of impending doom. He was struggling with some significant family stressors but appeared to be processing those with support from the program. This is a catastrophic loss for our program and his family and friends. While I am immensely embarrassed that I lost a resident on my watch and guilty that I didn’t see this coming, this needs to be said. Honestly, I have struggled with whether I should write this email at all. I make this information public in order to shine a bright light on a problem that often lurks in the dark. Suicide, and specifically suicide in our trainees, is a significant risk and we are at higher risk than the general public.

o   “In order to face this issue, we must acknowledge its existence and speak its name. We must learn about it and talk about it. I am absolutely devastated that one of my residents felt so alone and afraid that he chose to end his own life. I am even more devastated to learn just how common this is. It is one or two physicians a day in the United States alone. This is a remarkable number to me. I send this email to turn our attention to ourselves and our trainees. This resident was already on my radar screen. I was already looking out for this. I knew he was struggling and undergoing stress but I thought he was managing it. I missed it. I say this just to increase your awareness of your own residents that are struggling. This resident had many people who cared about him and he was universally liked. Several residents made efforts to support him during this stressful time. None of us saw this coming. I encourage all of you to renew your efforts on resident wellness and carefully assess your residents who appear to be struggling or appear to be depressed.”

o   “I will clearly be renewing my efforts to focus on resident wellness for my trainees and EM residents across the country. Perhaps that will be the legacy left by the tragic loss of this caring, promising, handsome, smart, successful young man.”

●      Why don’t we talk about this? It is contrary to the culture of medicine.

●      We are at higher risk. Emergency medicine physicians are at higher risk of burnout. We see this across all acute care specialties involving sick patients. We are on the front line to all the bad stuff that happens. It takes a toll.

●      Mark Linzer MD identified 7 risk factors for burnout and they apply to emergency medicine. 1. You have a high tolerance to stress. 2. Your practice is exceptionally chaotic. 3. You don’t agree with your boss’ values or leadership. 4. You’re the emotional buffer. 5. Your job constantly interferes with family events. 6. You lack control over your work schedule and free time. 7. You don’t take care of yourself”.

o      Vassar, Lynda. How to beat burnout: 7 signs physician should know. AMA Wire. Mar 4 2015. LINK

●      How do you define wellness? It is like spokes on a wheel; occupational, financial, spiritual, social, intellectual and physical wellness. We devote minimal time to this during training or national conferences. We need to turn more attention to these issues so we don’t burn out.

●      We need to normalize the conversation about the stress of our jobs. We don’t talk about this with other doctors. It breaks the cardinal rule of medicine; don’t be weak. It is hard to go to your partner or director and tell them that you are feeling down about your practice and feel like a bad doctor.

●      We all have these feelings. We don’t talk about our own depression or second victim issues. We don’t talk about anxiety or worries about patients. We don’t talk about medical mistakes or getting sued. We don’t talk about family issues. We don’t talk about our physical exhaustion or parenting difficulties. We don’t talk about illness in our family. We don’t talk about financial issues.

●      What are some of the obstacles to wellness? The culture of medicine is that you can’t be weak. Mental illness and anxiety aren’t viewed as ok. Teaching wellness competes for time with all of the other issues we need to teach. We need to commit to teaching and learning about this.

●      We need to be willing to talk about this. We need role models to stand up and say, “I was really depressed in residency.” “When I went through that lawsuit, I felt like a bad doctor for a while.” “I’ve struggled with anxiety my whole career.”  Then it becomes normal.

●      If you can see that this happens to all of us, it becomes normal. We need to acknowledge that this is a hard job. Commiserate, not correct.  As Robert Wah MD said, the most important patient we have to take care of is the one in the mirror.