“Physician heal thyself” has changed to a plea “Physician don’t kill thyself”. Every year it is estimated that 300-400 physicians commit suicide. To put this in perspective, my graduating medical school class is approximately 200. So every year up to twice the number of my classmates who are entering the workforce, exit the workforce in an untimely manner at their own hand. This has been rightfully recognized as a problem; the response? Something called “Wellness initiatives”.
Wellness is one of the buzzwords that medical schools, residency programs, and academic hospital systems are all touting. Visiting large academic centers around the country “wellness initiative” were defined with some variation of visits from therapy dogs, ice cream, wine and painting, or cookies. Akin to rearranging the deck chairs on the Titanic, these measures are laughable. Just as worrying about what to serve at dinner is a moot point as the ship slips beneath the waters, so junk food and running around with a four legged fur ball is a moot point as the crew drowns in 80 hour work weeks often watching the people they take care of slowly deteriorate and die.
A small handful of programs are taking meaningful measures including scheduling preventative health appointments and faculty members who could be reached 24/7 to provide support. There are no easy answers to this problem, and no easy solution. Certainly medicine may attract people who are already at increased risk of taking their own life. Or the decade or more of training may play a role. Or the bad outcomes, difficult decisions, and limited time outside of the hospital to attend to ones own affairs may play a role.
The hours in the hospital are entirely necessary for good training. You must see a lot of cases and work a lot of hours to be a good physician. One of the problems with the hours and the stresses is that you are not given freedom to self regulate. Running long distances you can feel yourself start to overexert, a feeling of panic and uncertainty creep in. At that time you can slow down until you regain control so that you are better off in the long run. In medical training you hop on the treadmill and the system increases the speed. Will Smith is quoted as saying about his work ethic “I’m not afraid to die on a treadmill”. Most physicians would probably agree. Unfortunately on the treadmill of the medical system, many have and many more will.
80 hour work weeks are fine. Often they are enjoyable because you are doing interesting things with interesting people. However when you are working 80 hours a week, as soon as anything becomes off kilter there is little room to correct before large consequences are realized; the margins are already so thin. Often it is not just the number of hours in a day or week, but the number of weeks and months in a row. One time I accidentally referred to having a weekend completely off as “vacation” because that was how it felt.
As our current system works, it is a fragile system. The hope is to maintain without any catastrophic mistakes and outcomes. The status quo is intermittently interrupted with major losses, and we return to the status quo waiting for the next catastrophe. Moving toward the antifragile, as Taleb puts it, should be the goal. Where struggles, perturbations, make both the person and the system stronger. Where the goal is an upward trajectory from the difficulties and shattering events instead of simply plodding away where we were before. Wellness initiatives and discussions of physician suicide must be replaced with focusing on strong social connections, honest reflections and the opportunity to rebuild and regroup, and the time to live, sleep, eat, and exercise in a healthy manner.
The goal is true wellness and longevity for both the patients and the providers.