by Emily Chin, DO
On the same day as I’m drafting this blog, I came across a post from one of my former medical school classmates that announced that one of her co-residents died by suicide at her residency program. Tight knots began to form internally rapidly, yet I can’t even begin to fathom what the co-resident’s family (which included his wife and young child) is going through. The knotted feelings felt all too raw and fresh as I reflect back to one of my continuity clinic patients, who happened to be a resident in his transitional year, who booked a last-minute appointment with me to review his depression and anxiety when he heard about Dr. Jing Mai’s, another resident from California, death by suicide last year. It was an emotionally draining appointment as I allowed his emotions of helplessness flood the inner walls of the patient room as he was coming off a 28 hour shift from the Medical ICU as the following day after his short call was the only time he could get in to be seen; ultimately, despite allowing him to vent, reaffirming his valid emotions over and over again, and also echoing back similar feelings, the best fix I could do was increase his SSRI dose, remind him what the warning signs were, and reiterate the importance of regular therapy (although even as a resident myself, I felt like a fraud as I also blame time commitment issues as to why I don’t go to therapy as regularly as I’d like), all with the attempts to damper his normal and justified human emotions even further, which didn’t feel quite right.
The feelings of hopelessness and helplessness in the broken system of residency is one of the leading causes to burnout in young, newly minted physicians, who have the newfound energy and idealism to heal patients and help others. The burnout of healthcare workers came to light to many people not in medicine during the COVID-19 pandemic, but it surely existed prior. With this knowledge in mind, I’ve always consciously knew I needed to take care of my physical, mental, and emotional wellbeing as I embark on the journey of residency. It was then very serendipitous when I found out about the University-wide Wellness Elective to take during my second year: a two-week elective held annually around November to December for residents and fellows across all specialties who are interested in learning more about resiliency, interdisciplinary collaboration, healing, and self-care. The outline includes didactics that is interactive and experiential learning aimed at fostering meaningful connection with patients and colleagues, exploring wellness literature, and decreasing burnout.
On the very first day of the course, we discussed the eye-opening and terrifying statistics of physician suicide and burnout. From 2017, there were 41.7% of physicians who screened positive for depression (Shanafelt et.al., 2018). To narrow the scope down to specifically the University of Utah as a whole, the 2022 Resident survey reveals that 52% of all residents are burned out, with approximately 35% having depression. We discussed openly as a group about these numbers, and for those within the system, it is obvious what contributes to these stats: underappreciation, unhealthy work hours and shifts, sense of isolation, guilt and shame, lack of support from those around us, and more. It’s a very multifactorial picture, and studies interestingly enough, point to how the culture of residency is a likely contributor to more depression and burnout. For example, despite other workers in other fields with lengthy shift hours, it appears that they do not put off taking care of their own health as often as physicians would and that other workers have less self-condemnation. But with that being said, it still appears that the longer the hours of work there is, a higher percentage of physicians/workers have self-undervaluation (i.e. taking time out for self-care and more self-condemnation).
Overall, chronic burnout can lead to depression and thoughts of suicide as the only way out. Obviously, this is very wrong, so what can we do to change this?
As discussed during our wellness elective course, the mindset and “trends” in wellness NEED to change. One notion is that currently, wellbeing is seen as something YOU, as the individual, need to take care of, such as making time for yourself to sleep enough, exercise enough, or taking the responsibility to find a therapist. This needs to be shifted to wellbeing being more integrated as something WE take care of (i.e. support for more personal time off from those who control protected time like admin, support from attendings picking up scut work that do not contribute to learning and allowing going home on-time, etc.). Additionally, we need to stray away from a zero-sum approach (mindset of my wellness will suffer at the costs of others increased wellness) to raising all boats. This speaks to making mental health support more PROactive than what it is typically currently: reactive.
Everyone in medicine has the ability to be sympathetic, but it is empathy that takes it a step further and ask, how can we help? What changes could we implement? As much as we’d like to “put the patient first” always and heal as physicians, we must first look within ourselves and to our colleagues as reminders that healers need healing too.
Emily Chin is a native Texan of 23 years from Allen, a suburb outside of Dallas, where she completed her undergraduate and MBA/MHA at the University of Texas at Dallas. She then moved to Alabama where she attended the Edward Via College of Osteopathic Medicine – Auburn and found her passion for health policy and advocacy work during medical school where she served on the Student Osteopathic Medical Association’s national team. Her medical interests include primary care transformation issues, lifestyle and preventive medicine, women’s health, and global health. Outside of medicine, Emily enjoys both outdoorsy and indoorsy activities, such as hiking, playing volleyball, hot yoga, flying drones, traveling/Couchsurfing, drinking wine from boxes, and brewing kombucha. She chose the University of Utah for its strong emphasis on wellness and awesome teaching and advocacy opportunities as a top-tier academic and community blend program.