Hi everyone,
I trained in the dystopian days of anti-wellness. In the late 1980s, an 80-hour work week was considered short and a 28-hour call considered easy. We had no days off during the summer because new interns required “all hands on deck.” Post-call days ended in the evening, after our work was done, just as the hallucinations were setting in. On the worst post-call days, we’d have clinic, after which we’d return to the floor to finish notes. Our seniors said we had it easy, since we were the first interns to have call every fourth night instead of every third, although it was still every third in the unit.
I loved my co-residents and attendings. Our Program Director, Don Martin, was encouraging and paternal. But compared to now, the learning climate was often miserable. We feared public humiliation, afraid our ignorance would be exposed at Morning Report or that bad outcomes would sink our reputation. Criticism was rarely “constructive.”
Many of us took a warped pride in our struggles. The fatigue, months without days off, and missed holidays were considered the price due to enter the profession. I was lucky to have a patient, loving partner who also happened to be a talented cook. Otherwise, I would have subsisted on three years of cheesesteak and pizza.
My residency experience was typical for that era. It wasn’t entirely miserable, and I have many fond memories: I learned a lot, made great friends, and developed resilience and self-reliance. But there were too many dark days. Cynicism was rampant, and many of us said terrible things about patients. Those admitted for chest pain were labeled “CAD for Cath.” Patients with chronic complaints were called “gomers” (“get out of my emergency room”). Vulnerable, elderly men were “pop drops.” New admissions were “hits.” We complained that crashing patients were “hurting us” and dying patients were “circling the drain.” One night, my senior told me a patient I was supposed to admit had died in the ER. Instead of sympathy, I felt relief, since the news meant I could return to bed.
Medicine has become much more patient-centered since I was a resident. We teach communication skills and encourage residents to see their patients’ humanity. Learning climates are more collegial, collaborative, and supportive. Many of these changes reflect the hard work of educators, but I wonder if we’ve given enough credit to better resident wellness. Good patient care and learning can only happen under humane working conditions, and when we support residents’ physical and mental health. To thrive and function as physicians, we have to care for ourselves and each other.
Our work to promote wellness is far from finished. Over the next few weeks, I plan to chronicle the work we’ve done, and what’s left to be done, to promote wellness in our residency and profession. I hope that thirty years from now, you will look back on your training and say you had three of the best years of your lives. Let’s discuss how to make that happen.
Enjoy your Sunday, everyone. I’m heading out into the sunshine.
Mark
PS- Here’s my intern class. Top prize goes to the first of you to spot the other current Yale faculty member in my class.