Uphill both ways … in my dad’s pyjamas!

In Education & Quality Improvement by Nadim Lalani6 Comments

Imagine being at a conference where 1 in 3 attendees are depressed and 1 in 5 wish they were somewhere else …  fun conference?

I was reflecting on my residency when I wished that an attending would have stuck up for me just once when I was getting abused – three particular nurses, two residents and one physician stand out. I made a promise never to let that happen in front of me. A couple of years ago, I kept that promise when I intervened when a nurse thought fit to dress-down a resident publicly in the ER.

What? I’m being soft? Sure some people require a verbal reality check when they are out of line, but there seems to be a culture of “resident aware” and “resident needs to suck it up” that frankly is uncalled for and its time it went away.

These young doctors are the backbone of the entire system. They come in all sizes and increasingly they are not putting their lives on hold for medicine – which means added stress from juggling young families and a career that expects so much. They should be valued and nurtured – like Olympic athletes.

It’s a long road

I know what you’re thinking … You’re thinking that “in my day we knew how to work hard” “we just sucked it up” “I never called in sick” “I never whined or needed a personal day“. Okay – give yourself a pat on the back for being macho. When you were flying around the hospital all sleep-deprived. How productive were you? How many errors did you make? How compassionate were you? Do you not think medicine is more complex nowadays? Do you not think that you’ve become a teeny bit cynical?

Medicine becomes more complex on a daily basis. Patients demand safe, conscientious and evidence-based care. You think that residents can provide this when they’re stressed out, depressed running around the hospital wishing that they were someplace else? Seriously??

From this 2006 Alberta Study When 1 in 5 residents wish that they were doing something else – that’s NOT right. We all came into this profession to make a difference. Somewhere along the line we become depersonalised and jaded. Guess what? This reflects in your work [2002 US Study]. So when we’re being unfeasibly tough on them – patient care suffers.

That’s right … poor resident wellness = poor patient care

Perhaps we need to stop thinking of resident wellness as being “soft on residents” and start recognising that it’s actually a health issue. We all need to be part of the solution. Here are ways to Combat Residency Stress.

Start by having a Program for Wellness – this should be Institution-specific and NOT program specific. It should come with a Sh-load of resources. Confidentiality is paramount.

Get with the program – You’re not being soft on them. You’re nurturing a future star in your specialty – SUPPORT THEM. (You want them to be mediocre then maintain the status quo).

Learn how to diagnose stress and burnout – Should be easy … you were a resident [and human being] once. If a resident is under-performing, burnout is probably higher on the Ddx than incompetence – ask some questions!

Have an annual retreat– Retreats are a good way to blow off steam, rejuvenate and reflect.

Have an ombudsman-person– they need a shoulder that is at arms length from the program.

Check in with them regularly – Focus on their mental well-being, financial well being and family life. Set goals.

Play together – Creating a sense of community is vital to stave off the isolation that many residents feel [read how we do this at U of S].

Nadim is an emergency physician at the South Health Campus in Calgary, Alberta. He is passionate about online learning and recently made a transition into human performance coaching. He is currently working on introducing the coaching model into medical education.