“Sleep’s for the weak.” Arguably authored by William Halstead, himself, this has become an adage turned mantra for chronically-tired resident physicians. Mind you, Dr. Halstead trained like a machine because he and Coca Cola shared the same secret ingredient: cocaine. When your plasma contains more benzoylecgonine and ecgonine methyl ester (cocaine’s major metabolites), a substance-induced increase in goal-directed activity (i.e., doctoring) seems irrationally reasonable. Coincidentally, Halstead set the precedent pervasive unrealistic work expectations for residents, requiring his successors to be on call 362 of the 365 days per calendar year. Granted, the culture’s modestly improved. Even so, it is still found to be lacking.

As a resident physician, risk for burnout is exceedingly high at 74% and significantly correlated with depression (graded by workload demands) (Fang et al., 2022). It is alarming when the baseline depression prevalence for residents is 20% in a cohort that prefers and prioritizes the needs of others, too often leaving the healer unhealed and at risk for fragmentation (Kalmoe, Chapman, Gold, & Giedinghagen, 2019).

Wellness is an investment, but we’re worth it. By developing a residency-led wellness initiative, our load’s still heavy, but feels noticeably lighter, and we’re cultivating our residency culture, affecting what we can.

The Memorable Pain and Invisible Healing - Avoiding Negative Bias as an Essential Coping Skill

One of the worst aspects of being a human is that your brain makes bad experience worse. The human brain is wired with the tendency to memorize bad experiences for a longer period than the good ones. The phenomenon is called “negative bias,” per Dr. Barbara Fredrickson, a professor of psychology at the University of North Carolina (Fredrickson, 2001). This tendency is adaptive, with the purpose of avoiding harm in the future; however, it can also lead to rumination and depression. Recalling and savoring positive experiences benefit one both physically and mentally. Evidence shows that consciously memorizing positive experience is related to increased happiness, improved relationships, lower stress level, and reduced anxiety.

Fredrickson asserts that positive emotions serve an important evolutionary function that helps an individual adapt to a new challenge or an opportunity. This leads to their growth—increased openness, curiosity, and engagement with the world around them. Experiencing positive emotions modulates the brain to be more receptive to new information. This theory is called “broaden-and-build theory” in positive psychology. In a study conducted by Fredrickson and Branigan, participants were asked to complete a series of physical tasks after recollecting a happy experience that they recently encountered. The results revealed that participants who recalled happy experiences were able to perform the tasks with greater strength and endurance compared to those who did not. The study also disclosed that the type of positive emotion that a participant experience affects their creativity in different ways. For example, participants who had recalled an experience of love showed more originality and flexibility in their thinking, while those who had experienced gratitude showed more persistence and determination. The more positives we experience, the better social connections and physical health we build, and the better-equipped we are to tackle the challenges that come along the way. At the core, staying open-minded and cultivating positive emotions can pave the way for a more creative, affirmative, diverse and inclusive environment.

Handing over the Helping: We Thrive Together with the Wellness Committee

In September 2022, with the support from leadership, the Wellness Committee was created by and for the psychiatry residents. The purpose of the committee was to improve the overall wellbeing of the residents and support those who are in need. “We aim to invent a legacy that makes our program a better home,” said the psychiatry chief resident, Laura Huff. Since the launch, the Psychiatry Wellness Committee has provided support to the residents in many ways, including frequent social events such as a bowling night, a day of sunshine at Jeter Farm, and a musical evening at Fork in the Alley. Another initiative was the creation of Kudos box which allows people to acknowledge residents for their hard work. Not to mention the monthly restocked residents’ lounge with snacks and coffee.  

Little by little, the fluttering wings of this wellness butterfly altered the climate at an individual level. The increased influx of anonymous acts of kindness and support are recognized and cherished secretly. One could argue, the essence of wellbeing in healthcare can be found in these random acts of kindness and compassion between colleagues. This includes offering a warm cup of hazelnut cappuccino to a friend and colleague, providing a care package to a resident who is working the night shift, inviting a colleague who is living away from family for dinner, or taking a walk in the woods with a buddy resident and their two-year-old child. These simple gestures profoundly impact nurturing a sense of community and support within the medical profession.

By promoting the wellbeing of doctors, we acknowledge and celebrate the accomplishments of our colleagues and foster a sense of love and gratitude. This serves as a gentle reminder of the creativity, perseverance, and determination that are inherent in our profession, even though they are sometimes overlooked. In the end, the little things matter in life, and they play a valuable role in shaping an individual and preparing them for the challenges ahead. 

 

References:

Fang, Y., Lodi, S., Hughes, T. M., Frank, E., Sen, S., & Bohnert, A. S. B. (2022). Work Hours and Depression in U.S. First-Year Physicians. N Engl J Med, 387(16), 1522-1524. doi:10.1056/NEJMc2210365

Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American psychologist, 56(3), 218.

Kalmoe, M. C., Chapman, M. B., Gold, J. A., & Giedinghagen, A. M. (2019). Physician Suicide: A Call to Action. Mo Med, 116(3), 211-216.