As medical school graduation nears and I prepare for my first year of residency, I find myself doing the math. If rounds are at 7 AM, then I have to pre-round (gather vitals, labs, review how my patients fared overnight) by 6 AM, this means I have to leave my house by 5:30 AM and wake up by...
How many hours are left for sleeping and eating, and where will workouts, let alone showers, fit into the picture? Have I mentioned yet that I don't have a dog, kids, or demanding houseplants? I know that by many standards, my responsibilities are minuscule. So why won't these numbers add up?
Most doctors don't look like the actors in (insert favorite medical TV drama). The inaccuracies in these shows are wide-ranging, but supposing all of these physicians have enough time for self-care and regular exercise (and have the bodies to show for it) is certainly among them.
Most physicians, particularly residents, look a little tired, even bedraggled: beepers and stethoscopes hanging from them like needy children; papers with the latest patient vitals rolled up and stuffed in their back pockets. The first year of residency (also known as intern year) is a well-established period of increased stress and burnout, depressive symptoms, and decreased sleep for newly minted doctors.
Not that our behavior was something to be emulated before starting intern year. Rates of alcohol misuse and or dependence were reported to be higher among medical students than their nonmedical peers in one study several years ago.
"Do as I say, not as I do."
Why can't it be, "Do as I do?" Let's start with physical activity. Achieving the recommended amount of weekly exercise may make us more confident patient educators. It might also make us more likely to educate patients in the first place.
Nutrition is another area in which clinicians may fall short. Improving our diets would not only help us lead by example but may even make us more effective providers.
It's not uncommon for residents to go 8 hours without a bathroom break or sip of water. I remember working with a resident on a busy 12-hour shift who wryly noted: "Residents are basically walking cases of acute kidney failure [from inadequate hydration]."
A study I consulted on physician nutrition proposed a simple intervention that is hardly novel: consuming nutrients and fluids at regular intervals throughout the workday. One must wonder that it has come to this, that the profession requires an intervention to reestablish a basic need. The study's interventions included "providing healthy nutrition choices" and "enforcing nutrition breaks."
Cognition was measured through tests that quantified cognitive function, noting improvement on both simple and more complex tasks.
I don't need to tell you this, but physician wellness isn't getting any better. According to Medscape's Physician Lifestyle & Happiness Report 2022, 6 in 10 physicians now say that they are currently very/somewhat happy, down from 8 in 10 prior to the global pandemic. If there was ever a time to emphasize and prioritize physician wellness, it's now.
We also have good reason to believe that interventions could be helpful. Similar to the nutritional study discussed earlier, researchers at the Mayo Clinic conducted a 12-week incentivized exercise program many years back for residents. At the end of the 12 weeks, exercise participants reported increased self-assessed quality of life and reduced symptoms of burnout.
Throughout medical school, I've had weeks that felt like daylight savings time — every day. Days in which I'm perpetually suspicious of the clock on the workroom wall, its hands fuzzy without my glasses and open to optimistic interpretation.
A 2020 survey of residents agrees: Insufficient time is the greatest barrier to exercise and wellness activities. Interestingly, the hours residents worked did not significantly affect whether a resident exercised. Although lack of time is an oft-cited barrier to working out, the ratio of exercisers to nonexercisers was not influenced by the number of hours worked. These findings suggest that one's commitment to wellness is just as important as the time available in a day.
I don't yet know what barriers to wellness I will face during residency and beyond. But I want to set an example by taking care of myself, and I believe prioritizing it is a good initial step. My patients deserve it, and I do too.
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Cite this: Liana Meffert. Working in Healthcare and Struggling to Be Healthy: Why Medical Providers Should Lead by Example - Medscape - Mar 18, 2022.
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