Every year I struggle with what to tell our 300 incoming residents and fellows about physician health, impairment, and fitness for duty. This is an essential part of graduate medical education orientation that ensures all trainees receive ‘the basics’ about what to expect during this most important facet of their professional journey.
As I gaze out upon the sea of faces, I recall a mix of excitement and fear when I myself was being oriented to my ‘rotating internship’ in June of 1966 in the old auditorium of Los Angeles County General Hospital-USC Medical Center. But how do I convey the hard facts of what we know about residency stress and morbidity without terrifying or traumatizing these young doctors?
A significant proportion of today’s residents report burnout (1). Many describe symptoms of clinical depression, including suicidal ideation, particularly during internship (2). Some misuse or overuse alcohol, and a small but not insignificant number use prescription drugs, including self-administering (3). An unknown number develop symptoms of various types of anxiety disorders. And many are diagnosed in DSM-5 with adjustment disorders and various V codes—or don’t neatly fit into our nosology at all.
But the good news is that the physician health literature is increasingly punctuated with reports of how resilient today’s doctors are (4). In essence, this includes having: the ability to face their fears and actively cope; optimism and positive emotions; cognitive reappraisal, positive reframing, and acceptance; social competence and social support; a purpose in life, a moral compass, meaning, and spirituality (5). The new buzz word of “resilience” is equivalent to what we mental health professionals have conceptualized as one of the protective factors in our time-honored biopsychosocial case formulations.
What I ultimately decided to do was to: 1) highlight and describe resilience; 2) explain how stressful being a resident can be, particularly PGY1 and PGY2; 3) emphasize its variability and time limitedness; 4) briefly describe burnout, depression, etc.; 5) normalize our humanness and vulnerabilities; 6) describe and debunk the stigma of seeking help; 7) list the local and regional treatment options; and 8) stress the notion of being our brothers’ and sisters’ keepers (with the use of an evocative case vignette from my practice that illustrated both the notion of fitness for duty and how much residents reaching out to each other can save a life).
How’d I do? I don’t have the formal feedback yet from the GME office but most of the residents and fellows seemed to be paying attention.
1. Dyrbye, Liselotte N, West, Colin P, Satele, Daniel et al. MD Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population. Acad Medicine. 2014.89(3): 443-451.
2. Sen S, Kranzler HR, Krystal JH et al. A prospective cohort study investigating factors associated with depression during medical internship. Arch Gen Psychiatry. 2010. 67(6): 557-565.
3. Guille C, Sen S. Prescription drug use and self-prescription among training physicians. Arch Int Medicine. 2012. 172(4) 371-372.
4. Epstein RM, Krasner MS. Physician resilience: what it means, why it matters and how to promote it. Acad Medicine. 2013. 88(3); 301-303.
5. Feder A, Nestler EJ, Charney DS. Psychobiology and molecular genetics of resilience. Nature Reviews Neuroscience 2009.10(6); 446-457.
Dr. Myers is Professor of Clinical Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, NY. He is the author of seven books the most recent of which are “Touched by Suicide: Hope and Healing After Loss” (with Carla Fine) and “The Physician as Patient: A Clinical Handbook for Mental Health Professionals” (with Glen Gabbard, MD). He is a specialist in physician health and has written extensively on that subject. Currently, Dr Myers serves on the Advisory Board to the Committee for Physician Health of the Medical Society of the State of New York. He is a recent past president (and emeritus board member) of the New York City Chapter of the American Foundation for Suicide Prevention.
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.