Although biblical scholars may have different insights on the original meaning and context(www.gotquestions.org) of the proverb "Physician, heal thyself" (Luke 4:23, KJV), its contemporary interpretation essentially boils down to a single point: If you want to provide the best care possible to your patients, you have to take care of yourself first -- physically, mentally and emotionally.
Family physicians and other health care professionals seeking evidence of the importance of self-care need look no further than research presented in an article in press in the Journal of the American College of Surgeons. The study,(www.journalacs.org) "Lack of Routine Health Care Among Resident Physicians in New England," found that although family medicine residents often take better care of themselves than their peers in other specialties, there's no doubt that all residents could benefit from a greater focus on personal well-being.
Methods and Findings
The study reported on the results of a survey of 299 residents in academic, independent and community-based training programs throughout New England. Eleven specialties were represented, including 11% of residents who identified themselves as specializing in family medicine.
All residents completed a survey that collected demographic information, such as age, level of training and relationship status, and posed questions about residents' mental, psychiatric and reproductive health. The survey also included a screening question for depression that was initially developed as part of the Primary Care Evaluation of Mental Disorders instrument.(jamanetwork.com)
- Research presented in an article in press in the Journal of the American College of Surgeons found that a considerable percentage of residents do not have a routine place for health care.
- Residents who did not have a routine place for care were less likely to utilize routine preventive health services and screenings.
- A relatively high number of residents did, however, report seeing a mental health professional, which appeared to offer some protection against burnout.
The average age of residents who completed the survey was 30.5, and almost 61% of participants were female. Most participants (60.5%) were in their first or second year of training, and 51 residents were married to, engaged to or in a relationship with another resident.
Thirty-five percent of all residents reported that they did not have a routine place for care. This finding was notable because according to the 2018 National Health Interview Survey,(www.cdc.gov) only about 22% of U.S. adults ages 25 to 44 reported having no usual place to go for medical care.
Compared with residents who had an RPFC, those without an RPFC were less likely to have undergone a skin examination or routine screenings for cholesterol, blood glucose or blood pressure in the past year.
Notably, although only 42% of residents reported having seen a primary care clinician in the past year, more than 75% said they had seen a mental health care professional. The latter action may have offered some protection against burnout, as residents who reported that they did not see a mental health professional were significantly more likely to report symptoms of depression and burnout compared with those who did.
In a separate multivariate analysis, the researchers found that family medicine residents were more likely than residents in any other specialty to have an RPFC, and they were significantly more likely than residents in anesthesiology, internal medicine, OB/Gyn, pediatrics, radiology and surgery to have one.
Noting that maintaining residents' health "is vital to the larger mission of physician well-being and mitigating the escalating problem of burnout and depression," the researchers called for implementing programs that would improve trainees' health-related behaviors and remove obstacles to care, such as the patient-centered medical home. Doing so, they contended, would not only show a commitment to the health and well-being of residents, but also establish habits that could reduce the incidence of burnout in the future, leading to fewer medical errors and better patient care.
Resident Member Q&A
Kelly Thibert, D.O., M.P.H., the resident member of the AAFP Board of Directors and a second-year resident at the Family Medicine Residency at OhioHealth Grant Medical Center in Columbus, reviewed the study and offered her insight on the topic in response to a series of questions from AAFP News.
Q: Was there anything in the survey results that surprised you?
A: Honestly, I wasn't surprised by any of the findings. What was interesting, however, is that a higher percentage of residents sought care for mental health than for routine care. I think this speaks volumes to what the needs are for residents and that there are significant changes that must be made in not only the medical system but also the graduate medical education system.
Q: As a resident, what do the survey results mean to you when it comes to your well-being and your training?
A: The survey results show that the medical education process is still not doing all that it can or should be doing for resident physicians in terms of well-being.
I feel very fortunate to be at the program I have trained at these past 2 1/2 years because I feel I can discuss things openly with my faculty members and that they genuinely care about my well-being. My program has worked wellness half-days into the curriculum on particular rotations, which enables us to make appointments for our health during business hours. We have also had the opportunity to incorporate wellness Fridays into our lunch hour once a month, where we are encouraged, but not required, to show up for a different activity to help us reconnect to ourselves and our passions for family medicine.
There are many unique things that programs are integrating across the country, and with each step we get closer to wellness. But, despite the things our programs do to ensure our safety and happiness, overall there needs to be a change in medical culture to alleviate the threat/reality of burnout, not just for residents but for attending physicians, as well.
Q: What should residency directors take from these findings?
A: Listen to your residents -- but go a step further and ask your residents (about their wellness needs). The study clearly shows there is a lack of residents being able to care for themselves and that when they are, they are opting for mental health care. There is a high likelihood that your residents are experiencing this at your institution and you may not be privy to it. Often, residents won't offer up their needs for wellness due to fear of being perceived as weak (a medical culture issue) or fear of retaliation.
Please do what you can to show your residents that you genuinely care about their well-being, take the time with them, have an open door and invite difficult conversations with the goal of improving well-being not just for one resident who may be struggling, but for everyone. These changes, even if perceived to be small, are what make all the difference in continuing to change the culture of medicine for the better.
Q: What self-care tips or suggestions can you share from your personal experiences?
A: It's important to leave work at work. It is also important to use your vacation days! There will always be something that needs to get done. Your in-basket will always have something new waiting for you. People will always send emails. Patients will always have more they want to discuss. But make your time away from the office or hospital your time -- whatever that means for you.
Q: What has worked for you in preventing or managing burnout?
A: Staying involved with things you're passionate about. Whatever hobby has brought you so much joy in the past, keep doing that. One thing I like to do is participate in organized medicine and health policy. With that, I have become more involved in the AAFP. Some might see this as extra work, but being involved in this organization is something that fills my cup and reminds me in challenging times why the challenges are worth it. Participating in conferences and in-person meetings gives me the energy I need to continue to advocate for changes for my patients and my peers on a multitude of levels.
Something I have tried to do in the past was get back into running half marathons. While working out is something that helps with my stress, trying to plan my training schedule -- on top of my residency schedule -- was something that ultimately created more stress in my life. So, even if you love something, just be mindful of the time that you actually have and of how you'll truly feel after that 24-hour shift.
Q: Anything more you'd like to add?
A: Wellness in residency is tough, but that doesn't mean we shouldn't make efforts to change the culture of medical education or medicine in general. Just because things have been done certain ways historically doesn't mean that these are the most effective or successful ways of continuing to do things. Medicine is very different than it was even 10 years ago, and we need to be open to adapting and changing along with the field itself.
If we resist acknowledging the needs of learners and the significant moral injury that is present in this new era of medicine, then we're missing opportunities to improve quality of life for those who have dedicated their lives to this profession and who may have difficulties "remembering their why" a lot sooner than those who came before them.
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