“Mandatory Wellness” – Seems Like an Oxymoron

“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.

https://www.nydailynews.com/features/sns-tns-bc-edu-med-schls-student-therapies-20191122-story.html

https://thehill.com/opinion/healthcare/471847-doctors-are-dying-by-suicide-every-day-and-we-are-not-talking-about-it

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Kailee Marin

Aloha! My name is Kailee Marin, I'm a DO student in California. I was 15 years old when I decided to go to medical school. I spent three years in Hawaii getting my bachelors, then I came straight to CA to pursue my dream. These three years have been a rollercoaster - the best and worst of my life. I've spent med school listening to, and participating in the complaining of my classmates. I've come to realized that it's all the same. It comes down to the common barriers that current and future doctors face - and it starts in medical school. Moral injury being disguised as burnout so that institutions can pretend they care... But moral injury can't be fixed by wellness Wednesdays, or fitness Fridays. I have realized, to heal moral injury, you have to treat the underlying cause. And there are so. many. causes. So I guess I have a lot to talk about! As an aspiring psychiatrist, I feel compelled to advocate for mental health. This includes the mental health of my colleagues, my future patients, and myself. 

  9 comments for ““Mandatory Wellness” – Seems Like an Oxymoron

  1. PW
    December 2, 2019 at 9:57 am

    An attorney once said the best way to avoid malpractice lawsuits is to not see patients. I would say the best way to avoid burnout in medicine is to not be a physician.

  2. December 1, 2019 at 10:46 am

    As a conventionally trained family physician who resigned her employed position in 2016 to open up a private practice, I know all to well about completing year-end mandatory requirements: Employee Wellness, Learning Objectives, etc etc. They’re horrible. They’re disempowering and reductionist.

    While I understand the oxymoronic frustration behind “Mandatory Wellness”, I feel that we need to start somewhere. We’re all trying on ideas to handle this burnout epidemic. But we need to try it on to see if it fits before reflexively condemning a suggestion.

    This is what frustrates me: brilliant physicians stuck in the horrific machine of modern medicine. No one would deny the fact that burnout is not an individual “problem” but rather a symptom of systemic decay. But no matter the root cause(s), physicians would still benefit from keeping an open mind on wellness suggestions.

    A little meditation goes a long way to reduce cortisol. Awareness to circadian sleep patterns can increase mental cognition (by quadrupling BNDF hormone).

    Let’s not react like toddlers, crossing our arms and turning our backs. This burnout epidemic will take decades to unravel a solution(s), and until then, please take care of yourselves.

    And if it takes a *mandatory* suggestion to do so, I’m glad you’re trying.

    • arthur gindn
      December 1, 2019 at 8:45 pm

      I would still recommend that you have $1m in your retirement fund and a house. We spent most of our cash on the house and had little left over. Financial advice is readily available from AIS in Gt Barrinton MA 01230

    • Pat
      December 2, 2019 at 6:35 am

      I think one can be pro-wellness and anti-“mandatory.” Accepting that others constantly tell us what to do is what has largely ruined this profession.

  3. Steve O'
    November 30, 2019 at 4:12 pm

    Nonsense! Each medical school saves lives every year by mailing out rejection letters.

    • Pat
      December 2, 2019 at 6:14 am

      Briilant 😂

  4. Art Gindin
    November 30, 2019 at 2:05 pm

    does any of the “hokus-pokus” work?

  5. Art Gindin
    November 30, 2019 at 1:58 pm

    one of my classmates committed suicide her junior year using the instruments she had used as a nurse-anesthetist. no one had any idea she was depressed.

  6. Pat
    November 30, 2019 at 11:05 am

    Kailee, sorry to say it but this is all a trap. Med students and physicians should seek needed mental health support anonymously, cash-only, and never admit to having received help unless you know there is already a record and you’ll be found out. In other words, lie.

    Your article aptly describes the reality of a very unhealthy, dishonest profession. “Mandatory wellness” is a splendid doubletalk example. Those that still have alternatives should avoid medicine, or at least have a bailout plan before you start.

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