During residency, do you ever stop to think why you wanted to become a doctor? What were your reasons? I wish I could remember mine. I could have pursued so many other careers. I used to be a director of a non-profit organization, helping individuals from low socioeconomic backgrounds attain technical skills. I do not recall being at my current level of mental, emotional and physical dysfunctionality while working that job.
There is so much pain … medical school did not teach or prepare me to deal with this level of distress.
So, I become a machine … keep working despite pain, suffering and illness. I just have to keep working.
No one stops to ask how you are doing; at least not in a genuine way. Only in passing, because it does not matter how you are truly doing, it only matters that you get the work done.
A few attendings told me during evaluations, “Tee, you should manage your tone and body language better while frustrated because it can be disruptive to team dynamics.” You know what else is disruptive to team dynamics? When one member of the team has been called the n-word more than once by patients, with no time to process it. She is only able to internalize the contempt and fall into a depression. Every time her morning alarm buzzes, she sobs at the thought of entering the hospital. But never mind that, just keep working.
What about when your patient’s chief complaint is suicidal ideation (SI), and it is 8:00 p.m., and she has been sitting in the lobby for hours with SI while you were busy filling out forms and teaching a medical student. By the way, you are working with a medical student when you are still a learner yourself. You are no longer an infant, but should a toddler really be tasked with something so important as teaching a medical student? You’ve been working all day and given so much with nothing more to give. What do you do now? You do even more because you took an oath to help others; so, you dig deep and give some more and become a hollow vessel.
Then the next morning comes and now you are unable to move — physically unable to move, to speak — and you do not go to work because you cannot go to work. However, you begin receiving excessive messages about documentation from the previous day. You keep working. You work when you cannot. No debriefs. No check-ins on your own mental status. No wellness. Just get the work done.
One time, I accidentally poked myself with a needle while drawing blood from an immunocompromised patient. No one even asked me how I was coping while waiting for my lab results. I just kept working.
Endless paperwork.
Fatigued. I passed that months ago. I do not know what I am now.
I need to be reminded of who I am. I still cannot remember why I chose medicine.
My personal relationships have also been injured. I try to avoid thinking about the extent of injury.
With all this distress, it seems odd to get feedback about my attitude in the workplace when there is nothing in place to foster a better, more positive work environment. Nor is there space to discuss all the challenges that residents face on a near-daily basis. Perhaps faculty forgot what it was like to be an intern … a resident? I do not believe that is so. In reality, I think no one has time to pause to reflect on how unjust our health care system is. I do not believe the faculty do not care; in fact, I believe they are more like me — taking the time to care is terrifying because you may just find yourself as I found myself this morning — completely incapable and empty. Allowing yourself time to reflect only leads to additional burnout.
Studies have shown that approximately one in every three physicians experiences burnout, which can lead to poor patient care, more medical errors, substance abuse and suicide. Physicians have higher suicide rates than the general population for both men and women. However, medical school and residency give minimal attention on how to manage stress and prevent burnout. Primary burnout symptoms are exhaustion, depersonalization, and lack of efficacy. Examples of these symptoms are found above.
So, what can I do now?
Well, I finally termed my feelings as burnout.
For a long time, I thought I was just a bad resident … doctor … person.
My classmates are a good source of fuel. I cannot survive through a day of residency without them.
However, there has to be something more that can be done, which is why I am writing you.
What are you doing to prevent burnout?
Image credit: “envelopes” by Dean Hochman is licensed under CC BY 2.0.
Resident Physician Contributing Writer
Montefiore Medical Center
Tequilla Manning is a second-year resident in the Department of Family and Social Medicine at Montefiore Medical Center, which is located in the Bronx. In addition to her residency training, she is pursuing a Master of Public Health through George Washington University. Her interests are in maternal and newborn care and healthcare disparities in underrepresented minorities. She has extensive international travel history and experience working with underserved populations. Her research interests are in women’s health, sex work, and LGBTQ.