I was talking to a colleague recently about the lack of proactive wellness initiatives in our residency training program. [We do a very good job of reacting when residents come to us seeking help]. Instead of meeting general agreement or disagreement about my view on the topic, I was shocked to find this person felt that wellness initiatives were soft and unnecessary. This really got my gears churning.
As you can obviously tell by reading this website, I care very deeply about wellness in the medical community. It is an important and too infrequently discussed topic. I will readily admit that some of my posts on wellness do not generate nearly as much traffic as my financially related posts. Regardless, I will continue to post on wellness, because I think it’s important. On this Wellness Wednesday, we will discuss three reasons why very few people care about wellness and why I think people who find it worthless are wrong.
Reason #1: Generational Differences
I am not quite sure where I fit in the whole generation discussion. My place is somewhere in between a Generation X’er (GX’s) and the Millennial generation. One article called the people in the years in which I was born Xennials. I like this because I feel that I can relate to both the generation before (GXs) and after me (Millennials).
Those in Generation X often complain about the entitlement that most Millennial’s have. They bemoan the participation trophies the millennials demands, yet spend little time asking which generation was the one that provided the participation trophies in the first place (hint: It wasn’t the millennials). The distinct differences between these two generations places wellness conversations in a very awkward position.
GX’s often describe their walk up hill both ways in snow when no one cared what they thought, felt, or did so long as it didn’t impact patient care. [“See one, do one, teach one.” That’s safe, right?]. Because of their perception of how difficult training was in their time, they feel it unnecessary to discuss how “challenging” or “difficult” training is today, because they see it as being vastly easier in comparison to their own experience. Why do they need to make sure residents today are dealing well with the challenges? After all, their restrospectiscope shows that they had it much harder than the current generation.
There are many reasons that this line of thinking is flawed. Let’s touch on a few of them:
- The retrospectiscope is not a valid instrument. We are all extremely biased when we look back on our experiences. We tend to remember things differently than they actually occurred. I’ll spare you the bordeom of discussing all of the different memory biases that exist. Suffice it to say that just because someone remembers their experience one way doesn’t mean it is accurate.
- Regardless of whether GX’s memories are accurate, it doesn’t change the question of whether we should help our trainees experience exceptional training at the same time that we help them deal with life issues. The difficulties found in residency training are not unique to training. As we have discussed at length before, rates of depression and suicide are not unique to only residents (though suicide is the number 2 overall cause of deaths during residency). If we do not teach our trainees how to deal with managing life and residency difficulties now, they will not have the requisite skills to help them deal with this in their future practice in medicine.
- The wrong question is being implied: “How do we help residents deal with a challenging residency.” More often than not, its not the residency that is causing burnout or depression. It is usually a combination of what we see in residency that are never discussed/processed in a formal way (pediatric deaths, traumatic events, untoward side effects from treatment, bad family discussions around death, etc) and other life events (marital stress, problems with kids, financial stress, etc). The question of wellness has little to do with making residency “Easier” and much more to do with helping residents experience, discuss, and process difficult experiences.
Reason Number 2: Show me the Money
We have looked into the financial aspect of attacking wellness before. So, I’ll keep this short. Simply put, administrators love metrics. If you can’t show them numbers that will change their bottom line, very rarely do they care. This becomes difficult as wellness, until recently, has been difficult to measure and quantify. More difficult still is is figuring out a way to measure the impact of changes on wellness and whether they produce an adequate return on investments.
The post linked above goes into a lot of the detail needed to have this conversation. I’ll let what I said their speak for itself. I will add one thing:
There is one aspect of wellness that is free of charge to training programs: Wise Teachers. If those supervising young trainees would take the time to debrief following a potentially traumatic experience, this could prove really helpful teaching the trainee how to process difficult situations. Simply asking, “That’s tough. Are you handling that okay?” is enough to have a good conversation. It takes little time, costs nothing, and really helps.
Reason Number 3: The Stigma
Unfortunately, there is a stigma involving mental health, burnout, and depression. The stigma exists in providers taking care of patients with mental health struggles. And the problem also exists in the medical community. It is common to think less of those that are struggling with these issues and to view them as a “lesser” person. They simply must not be “tough enough.” As humans, we (unfortunately) rarely want to help people we think less of or look down on. So, starting a wellness initiative to help others we think just need to “fix things” is unlikely.
The fact that the brain is viewed this way is baffling to me. If you have severe kidney disease because you were born with polycistic kidney disease, we feel bad for you. If you were born with cystic fibrosis and have trouble breathing, we feel bad for you. But if you were born with a predilection towards mental illness, there is just something wrong with you. I find this double standard absurd as we now know that many of these diseases are related to altered levels of neurotransmitters in your brain or even structural changes (think about chronic traumatic encephalopathy often discussed in the NFL).
Mental health problems can be treated just like the patient with coronary artery disease or high cholesterol. One of the first ways we can help this is by not being part of the stigma and being part of the community that cares and is on board with putting resources into helping our colleagues. This is where wellness initiatives come to the rescue.
Do you think wellness initiatives are a waste of time and money? Have you been helped by a wellness program? Is this something that we, as a medical community, should invest in?