By Katie Fortenberry, PhD
A resident suffering from depression drinks too much and sleeps through a hospital shift the next morning. Another resident walks out of a patient room in the midst of a panic attack.
As family medicine educators, how do we best handle these health concerns in our residents?
The pendulum in medical training can swing in two directions. At one end, residents are indoctrinated into a macho mentality, where the need for self-care is a sign of stigmatized weakness that must be hidden. At the other end, where rejection of this mentality and fear of the physician suicide epidemic intersect, faculty may diagnose or treat their own residents in hopes of preventing bad outcomes.
Unfortunately, pain and suffering, both in residency and in life, are inevitable. We know that medical residents experience rates of depression at twice the population average; given high caseloads, sleep deprivation, and constantly changing schedules, this shouldn’t be a surprise. Even among residents (and medical educators) who do not experience diagnosable depression or anxiety, difficulties in life are unavoidable. We will all face heartbreak, and we will all lose someone we love. We may experience life-changing car crashes, or be diagnosed with cancer. Life challenges are a certainty.
As medical educators, it should not be our job to diagnose, treat, or (as much as we would like to) prevent mental health concerns in our students and residents. However, it is our job to teach professionalism. And a critical component of professionalism is to accurately assess one’s own ability to meet work and personal responsibilities in the face of these life challenges.
A pragmatic approach may be the best way to teach professionalism in the face of life challenges. A panic attack during a clinical shift is, in many ways, no different than an unexpected bout of diarrhea – unpleasant and time consuming, with a strong potential to throw off the rest of one’s day. A matter-of-fact approach from an attending physician could involve reminding the resident of effective grounding techniques, then helping the resident evaluate their options. Should they find a replacement? Take 10 minutes to gather themselves and continue focusing on the patients? No overreacting on the part of the attending physician is needed, as the panic attack is just another professionalism hurdle to navigate.
We can coach residents that, when considering the challenges of maintaining professionalism in the context of severe life stress, they should always keep their goals and values in mind. Patient care must be a top goal. Sometimes optimal patient care will involve treating the patient despite the resident’s own challenges; sometimes it will involve recognizing that the resident can’t do it. Self-care, and care of loved ones, must also be a top (and often competing) goal. There should be no shame in taking the time that we need to care for ourselves and our families.
As medical educators, let’s try to view helping residents cope with mental health and life challenges as a critical teaching opportunity. We can help residents learn how to self-evaluate and determine how to best maintain self and patient care in the face of significant challenges. How terrible it is that residents must deal with these concerns at such an already difficult time of life, but how fortunate that they can do it in a supportive environment with caring educators walking them through the next steps.
Talking about how to cope with life challenges early in residency won’t prevent the challenges from coming, and may not even prevent depression or burnout. But we can help residents to embrace a proactive stance, where mental health concerns are embraced as just another of life challenges. And this may be one of the most important parts of professionalism that we can teach.
Katie Fortenberry, PhD is an Assistant Professor (Clinical) in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.