“Mandatory Wellness” – seems like an oxymoron. Though she finds it helpful, the polite medical student quoted in this article explains, “It’s just not convenient sometimes when we’re so busy, like the week before an exam”.
As a medical student who has also had to attend mandatory wellness lectures, I can relate to feeling this “inconvenience”. In hindsight an hour lecture sounds like it might be a little inconvenient, but those 60 minutes of focus split between the speaker and the never-ending virtual stack of flashcards builds significant frustration, tension, and anxiety for students who distractedly gloss over concepts they aren’t actually digesting and won’t really be able to recall. All the while someone is rambling on about the importance of sleep and nutrition. Imagining the studying they could be doing, students often leave a wellness lecture more stressed, not less.
Although I would like to take “Yoganatomy” (a yoga class that reinforces what is being taught in anatomy), this article, and many others that touch on similar topics take a diplomatic focus to give programs a pat on the back for their wellness initiatives, while neglecting to discuss the response from students. My experience aligns with the feedback from the above student, which is that when you put the word “mandatory” in front of “wellness” it doesn’t do much to keep you well.
I have a greater appreciation for this article, which provides a more authentic picture of what is really happening to physicians, and it’s not something that mandatory lectures are going to fix. The title says it all, bold and blaten, “Doctors are dying by suicide every day and we are not talking about it”. It goes on to discuss why suicide rates amoung physicians are the highest of any profession, acknowledging the systemic issues as the root of the problem.
In short, it’s the costs (physical, emotional, intellectual, financial, social) of medical school in combination with the reality of practicing medicine in the current setting (“a profession that offers far less autonomy than most expect; care is micromanaged at every level-and more modest financial rewards than a generation ago. The prestige, access, and wealth that once accompanied the a medical career are substantially diminished”). Significant depressive symptoms and suicidal thoughts occur in students as they delay gratification for years, then all too often find themselves in careers far from what they expected.
Putting wellness programs in their place, the authors provide a starting point to address some of the wide-spread, systemic issues that contribute to the malignant culture of medicine.
“Institutions need to provide top-down changes in culture, structure, and strategy to effectively address this epidemic. The growth in wellness programs represents a small step in the right direction. However, these programs focus disproportionately on individual self-care outside of work and school rather than cultural changes to help providers feel safe, supported, and connected in the workplace.”
Making physical and mental health care more accessible and acceptable is key. It’s hard enough to find a provider, even the polite medical student will admit “Sometimes there are waits to see [the school’s mental health providers]”. Time becomes an issue, taking time off induces anxiety already, because when will there be time to make up that work you’re missing while you’re getting help? And what are you supposed to tell your school/supervisor/attending? The stigma around mental health is ironically high in healthcare professions, and it doesn’t help that state licensure boards frame the “mere fact of having received mental health services as a potential disqualifying factor”. This is not okay.
Doctors are dying by suicide every day and we need to start talking about it.