Note: The following speech was presented to medical students and residents at the recent American Medical Women’s Association conference.
As reports of physician burnout fill our medical journals and inboxes, concern among medical students and residents has skyrocketed.
An Internal Medicine residency program director, for instance, once shared that applicants routinely inquire how the program addresses this problem. Their worries are not unfounded, as research documents that up to half of residents become depressed and 75 percent feel burned out.
As an assistant clinical professor of medicine at the University of California, San Diego, I have witnessed both depression and burnout among students and am encouraged by the many ways in which our school attempts to support students through the rigors of medical training. From earlier contact with patients to formation of smaller communities within the school to provide support and connection, medical schools are responding to this alarming trend.
Knowing that 300–400 physicians take their lives each year can make us wonder how to enhance our own mental health. For women, this situation is especially frightening: Women physicians’ risk of suicide is 450 percent greater than other women professionals.
Women in medicine are subjected to continuing harassment and prejudice, reducing the personal satisfaction that sustains us. While women are entering our profession in record-breaking numbers, we still fulfill the majority of childcare and home building responsibilities. Ruth Bader Ginsberg’s story illustrates the way in which society places these expectations on women. After receiving several phone calls from her child’s school, she suggested the school alternate calling her and her husband. “This child has two parents,” she remarked. The school stopped calling as often, since interrupting a man at work felt less acceptable.
As women’s nonmedical friends move on to achieve other life milestones — finding a partner, having children — we often feel left behind. Many women physicians feel they need to choose between career and family. If we do start a family, pregnancy — with its effects on our bodies and interruption in the continuity of our work — invites some to label us as less committed or dependable. The result is often limited opportunities for leadership roles or promotion and reduction in our earning potential, eroding our confidence and satisfaction.
While each person has both masculine and feminine qualities, our society tends to believe that men must be all masculine and women must be all feminine. Men who show their more sensitive sides are often labeled weak. Women who display strong masculine qualities such as assertiveness and aggression are shunned and given unflattering labels. The system of medicine in which we practice was set up to reflect a primarily masculine orientation. This leaves women, or anyone who has strong feminine qualities, feeling cut off from their innate orientation to life and disconnected from themselves. Accepting and reconnecting with who we are as individuals is the most powerful tool for us to promote our own wellbeing, no matter what comes our way.
One powerful tool for reconnecting with ourselves is mindfulness. Mindfulness allows us to become aware of the thoughts that often unconsciously control our reactions to the experiences of our lives. Our thoughts are like the operating system of our computer: running in the background. If we are in a state of fear, we interpret new experiences through the lens of fear, even if they are not actually threatening. Our reactions will then be either more aggressive or less powerful than they might otherwise be. Only if we’re aware of the thoughts filling our mind can we shift our attention to something more appropriate to the circumstance. By repeatedly bringing ourselves back to our breath or a mantra during meditation practice, we gain practice shifting our attention. If we have a difficult interaction at work, we often bring our anger or frustration into our next encounter. Mindfulness helps us learn to let go of those thoughts so we enter our next experience (entering a patient’s room, interacting with a staff member) with a more open mind.
Practices to enhance resilience also promote wellbeing. Repeatedly connecting with the meaningful purpose in our life is perhaps the most overlooked strategy. One simple method, offered by the Remen Institute for the Study of Health and Illness, offers three simple questions to connect to the meaning of our life. What surprised me today? What touched me today? What inspired me today? By regularly seeking the answers to these questions, we naturally connect with the deep meaning, joy and fulfillment that exist in our daily lives.
Medical training imposes strict demands, limiting our choices in life. By finding opportunities to make even small choices in our life, we affirm that we have agency, further building our resilience. And since resilience is the ability to easily bounce back or withstand difficult circumstances in life, it’s essential to see that we can learn and grow from difficult events. Acknowledging what we learned from each challenge about ourselves or how life works, or what qualities of ourselves we recognized that we didn’t see before, allows us to see each experience in our life as part of our overall human development. Intentionally finding opportunities to experience positive emotion and laughter each day is another easy tool to build greater wellbeing.
Finally, we are trained to always ask ourselves, “How could I have done this better?” While this reflects our professional desire to learn and grow, it continually highlights our shortcomings. It is just as important for us to recognize what we already do well. Ending each day by asking, “What did I do well today?” helps us recognize our strengths and understand that we are already capable in many ways, giving us confidence that we can continue to improve.
We accept many responsibilities when we enter the profession of medicine. One of these must be a commitment to sustaining our own wellbeing, as we cannot help others if we are suffering. Spending a few minutes each day to promote our wellbeing may be a crucial investment, allowing us to provide the best care to our patients.
Dr. Helane Fronek is an assistant clinical professor of medicine at UC-San Diego School of Medicine. She is a certified physician development coach at DoctorsCoachingDoctors.com. She can be reached at HelaneFronekMD@gmail.com.