In the past few days a lot of my classmates have been passing around a New York Times article titled “Medicine’s Search for Meaning,” a piece detailing the high burnout rates of doctors-in-training and the inadequacies of medical education to address physician wellness. What I found to be of the most saddening paragraphs in the article goes as follows:
Nearly half of medical students become burned out during their training. Medical education has been characterized as an abusive and neglectful family system. It places unrealistic expectations on students, keeps them sleep-deprived, overstressed, and in a state of fear of making mistakes, and sends the message that doubts or grief should be kept to oneself. While the training formally espouses the ethics of empathy, compassion and altruism, doctors and researchers say that the socialization process — the “hidden curriculum” — teaches something very different: stay detached, objective, even a little cynical. Five out of six doctors say that medicine is in decline and close to 60 percent would not recommend it as a career for their children (pdf).
I can only speak from my experience attending medical school at Stanford, which has been an overall incredibly supportive environment. We have Educators for Care, designated faculty members who mentor us throughout 4 years or more and meet with us regularly to discuss wellness. We have a Physician Wellness Committee that promote well being through exercise, lecture series on wellness, and a peer counseling program. All of these resources are great, and I appreciate Stanford making wellness a priority. But personally, it is hard to take time out of clinics to attend events or put extra effort into incorporating wellness into my life. I think at a very basic level, a cultural change needs to take place in our medical schools.
I’ll start with a story. It was my first day working in the neonatal intensive care unit (NICU) on my first rotation of my third year, and minutes after I arrived, I was brought to one of the beds where a baby was being taken off life support. She was born the night before with malformed lungs and a variety of birth defects incompatible with life. The NICU team had tried various things throughout the night, keeping the baby on a ventilator to buy a little more time while various services came by to assess possible interventions. By the time I came to the scene, the team had discussed with the parents that there was no way to save their newborn girl, and that it was time to remove care. “This is a rare thing to see,” one of the residents told me. “You should come watch.”
I stood in the back corner of the room helpless and nervous as multiple physicians and nurses gathered around the tiny baby. The parents sat in the room, the father’s arm wrapped around the mom’s shoulder. I watched as the baby was extubated, and after a few agonizing moments, the newborn was pronounced dead. Both the parents broke into heartwrenching sobs as they watched their baby die in front of them. I didn’t know what to do. I wanted to comfort these strangers, but I didn’t know what was appropriate for my role. I clumsily offered up a box of tissues to them, and felt relieved when they took it. I hid in the back of the room after that, tears streaming down my face, feeling overwhelmed with sadness for this couple and their baby. The nurses wrapped the newborn in blankets and gave her to the parents to take to the grieving room, where they sat with her for the next 15 hours. And I? I went straight to orientation, where I was given a tour of the rooms, an overview of my responsibilities, and which patients to pick up. No one mentioned the death, and I felt embarrassed to have been emotional when the rest of my team just picked up and moved on.
That same scenario played out multiple times in the next few years. Breaking the news of metastatic pancreatic cancer to a patient who thought he was just a “little under the weather.” Telling a family that their loved one did not survive the surgery. I understand that doctors face death constantly, and after time, they learn to accept it as just a part of their job. Becoming too emotional or involved can hinder doctors from doing their work efficiently. But what I don’t understand is why I felt ashamed to express grief in the hospital. It seemed to me that feeling too much was a sign of weakness, and no one wants a weak doctor. I thought I was alone because no one talked about these experiences openly.
That is where Dr. Rachel Remen’s course, the “Healer’s Art”, comes into play. Dr. Remen is a physician at UCSF where she started a course in 1992 focusing on the humanistic aspects of doctoring, tackling topics such as healing, loss, grief, and mystery. She believes that physicians must learn to heal others by learning to heal themselves first, and she helps doctors achieve this through small group sharing in a safe and confidential environment. When I was at NBC, I sat in on an editing session for the following segment we did on her very interesting work, which you can view here:
Before going through clinical years myself, I didn’t understand the importance of such a class. Many of my classmates thought it was a waste of time, calling it that “touchy feely stuff.” But honestly? The more I experience in medicine, the more I realize that every physician could benefit from having some time for reflection once in a while. It doesn’t necessarily have to be in a structured group or class format. But the things we experience in medicine are sometimes so bizarre and beyond the scope of normal human experience that afterwards we have to pause a moment to take it in, react to it, give ourselves permission to feel. It’s a myth that the best physicians are the stoic ones who put a wall between themselves and their patients. I strongly believe that by acknowledging the human aspect of our medical experiences, we become better doctors who can relate to our patients and burn out less from the profession.