The Myth of the Young, Healthy Physician-in-Training

Surgical residents are in an often unrecognized position—encouraging and reminding patients to see their primary doctor for regular preventative health tests and cancer screening. Rotations on various surgical services provide an opportunity to discuss injury prevention and substance abuse issues (trauma), smoking cessation (vascular), obesity (bariatrics), and various cancer screenings, especially breast and colorectal cancers. Indeed, every rotation brings a new challenge of mastering the proper cessation and screening guidelines for a particular surgical patient population.

Despite having an important role in preventative health for surgical patients, surgical residents are among the most at-risk young health professionals for neglecting preventative health care needs, at times delaying or even ignoring their own age-appropriate vaccinations and family history-directed cancer screenings. In a systematic analysis of resident well-being, residents were found to have lower self-rated mental health scores and well-being that the similarly aged population norm (Raj 2016). Residents were also found to have worse work life balance and less frequent exercise compared to faculty. When schedules become busy, regular exercise routines are often the first activity to get cut from an overwhelming schedule. Overnight calls, bloated daytime rounding, and operating room schedules make vending machines and fast food easy and convenient, yet unhealthy and self-sabotaging options. Even simple tasks like twice yearly dental check-ups and cleaning may get pushed off or even skipped over altogether.

Potentially even more damaging than poor behavioral health habits are the poor mental health habits that are often cultivated during residency training. Trainees are often told that the 80-hour work week rule makes life much better than it was in years past, yet sleep deprivation and busy call schedules are still the norm. When a resident is feeling overwhelmed, underappreciated, or some combination of the two, there is minimal space for a “pop-off” valve. Downtime that allows for a resident to secure a moment to themselves to rest are few and far between. Even more elusive are periods of time where the resident can reflect on a difficult complication, patient death, or even more rare, engage in mindfulness activities that have been shown to aid in overall mental health well-being. As demonstrated in the FIRST trial, residents in the flexible policy arm of the study were more likely to perceive negative effects of restrictive duty hours on activities away from the hospital, including rest, health, extracurricular activities, and time with friends and family.

Dr. Weinstein, a trauma surgeon, recently shared his personal struggle with severe depression in an article encouraging other physicians to stop ignoring their own self-care needs. While not all surgical trainees, students, or faculty will suffer in that way, when talking to most attending physicians, many will reflect on various struggles they had when they were in training. Balancing the psychological demands of training with the difficulty of maintaining a healthy lifestyle can be hard to achieve. Despite this, fostering healthy behaviors during training will increase the likelihood that young trainees will continue these habits as they advance in their careers.

During my first two clinical years of residency, I spent of a lot of time learning about perioperative management of patients and very little time attending to my own physical and mental health needs. It wasn’t until my lab years that I began running regularly (including finishing not one, but two half marathons) and cooking healthy meals. I started using the free iPhone app Stop, Breath & Think for meditation several times per week, which helps to calm my busy mind at the end of a long day.  As surgeons increasingly focus on preventative health for our patients, we must not forget to focus on our own health needs. As physicians, we should take the time to cultivate positive coping mechanisms and healthy habits surrounding nutrition, sleep, and other self-care needs earlier in our careers. We should ask ourselves every day, what I am doing to further my own health and wellness today? The better we take care of ourselves, the better we can serve our patients.

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Allison Martin is a general surgery resident at the University of Virginia. After completing her undergraduate education at the University of Louisville, she pursued an MD at Vanderbilt School of Medicine and spent an additional year obtaining an MPH at the Harvard School of Public Health. During residency, she completed a two-year research fellowship in surgical oncology, including a year-long Fogarty fellowship in Rwanda. Her future plans include a career in surgical oncology and global surgery. She currently serves as the AWS Facebook Subcommittee Chair. You can find her on Twitter @globalsurgallie. ​

 

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