Family Medicine Vital Signs

By Rachel Caspar, MD

My first responsibility as a physician is to take care of myself. I cannot care for my patients until my own needs are met.  After experiencing depression as a medical student, I now recognize burnout as a life and death issue. I use a number of practices to prevent recurrence by making my own mental and physical health a priority.

Confront mental health stigma and seek help early.

Medical training is rigorous and brings maladaptive coping mechanisms and cognitive distortions to the surface. This can contribute to problems like substance use disorder, depression, and anxiety. As a medical student, I did not seek help for depression as early as I could have because of my fear of the implications of my condition and fear of the mental health system itself.  This perception in concurrence with my symptoms led me to delay care until I was in crisis. Having learned this lesson the hard way, I have been best served by establishing care with a therapist before a crisis occurs because it takes time to find someone who is a good fit. I have used cognitive behavioral therapy in addition to an antidepressant because I have found it provides practical tools for both initial treatment of my depression and to address cognitive distortions that lead to depression.

Practice mindfulness self-compassion and learn to let go of perfection.

Self-compassion means treating myself as I would a friend in a similar situation. Mindfulness is an important part of this technique because self-talk occurs automatically, sometimes just below our awareness. If it is habitually negative, it will color everything we do and experience. In practicing mindfulness, I have learned to practice for a few minutes at a time, because my schedule usually prohibits a more formal practice regimen. I have been working on practicing while waiting in line, walking up stairs, or walking to the cafeteria at work.  Another essential part of self-compassion for me is letting go of the myth of a perfectly well balanced life, especially as a resident. This idea of a perfect life can be discouraging because it is not achievable. I try to remember that wellness is a process.

Stay connected with my support system.

It took me a long time to learn how to ask for emotional support from others. I make a point to stay in touch with people through the good times, because I know I will then feel more comfortable asking for support in difficult times. Another big support system is co-residents. I find if I am in a difficult spot it is helpful to check in with one of my peers for reassurance what I am experiencing is normal. I find that makes a difficult situation easier to accept.

Strive to practice what I recommend to patients in regards to lifestyle.

These are the basics like eating well, exercising 30 minutes a day five times a week, and getting 7 hours of sleep a night. I accept the fact that for me it is easier to eat healthy and sleep than to exercise, and that’s okay. Once again, I look at it as a process, and I can feel satisfied as long as I am making positive progress overall.

Stay connected to what gives my life meaning.

I remind myself that advocating for my own well being is what will enable me to carry out my mission to promote the health of my patients and underserved populations. Whether your purpose is to practice a particular kind of medicine, provide for and spend time with your family, or anything else, staying connected to any meaningful purpose is helpful.

Rachel Caspar, MD is a second year Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.