Chair, AMSA Medical Education Team
The University of Miami Miller School of Medicine
I was recently talking to friend, who is an intern. She told me she didn't remember the last time she'd had a bite to eat. She'd been up for 16 hours. We talked about an article written by a classmate, also an intern, about the stress of his days. A fellow resident commented on it, something to the effect of "don't be weak, you haven't seen anything yet.”
To some extent, this is the normalization/desensitization process that all residents must go through, in order to make it through the tough years of training, to be able to handle a full schedule with emergencies popping up at a moment's notice. This is understandable, it's what we go to med school for; it's what we train for.
What is not understandable is how this aspect of the culture of medicine permeates to the very health and sanity of the physicians it trains. There is no honor in losing a grip on your own mental and physical well-being in the process of caring for your patients (which, as a resident, is less of that and more dealing with bureaucracy, paperwork, and miscommunication). The medical community, to some degree, has recognized this issue by way of one of its symptoms: patient deaths and countless medical errors, and had tried to deal with it in part with work hour regulations. This is surely a positive step; however criticized it may be as the regulations go from theory to practice. However, the onus is still on the community at large to self-police, and to shift perspective.
It begins with little things - a resident asking an intern if they have had something to eat (and vice versa), for instance, or finding more efficient ways to prioritize time with patients (more fulfilling than paperwork), and better care for the patient, which leads to higher satisfaction for the doctor. Honestly, it all comes down to the simplest concept - looking out for one another, as colleagues, as doctor to patient, as a community. There comes a point where the doctor is too sick, too tired, too burned out, too anxious - to be an effective clinician and decision- maker.
The analogy of doctors and pilots is sometimes overused, but the image works well. Would I want a pilot, having not slept for more than 16 hours straight, and not eaten for 8 of those hours, to fly the plane I'm on? The answer, without a second thought, is no. There is a very high likelihood, though, that your surgeon might be in this state. This should be a sobering thought. Providing good medical care need not come with the physical and emotional toll that is the status quo.
I'll end with this: I was at a conference recently where an Australian physician gave a talk on work-life balance. I enjoyed his talk and went up to him afterward to say how hearing about balance is so necessary in our community, especially for young physicians as they go through training. I mentioned the work hour restrictions and generally explained the way hospital medicine is in the U.S. He looked at me incredulously. He works three days a week, taking care of his entire community in a small town in Australia. Work-life balance and preventive medicine is valued. "Come train with us!" he encouraged me. I'm more than a little tempted. Obviously, there are more than just work-life balance differences that make this lifestyle possible. The model, though, exists.
We have come far from the age of my grandfather's day as a doctor, where being a member of the "housestaff" literally meant you lived in the hospital. We have so far yet to go. As a community, let's strive for our health as well as the health of our patients. We are only as good of a doctor to our patients as we are to ourselves.