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The practice of medicine goes beyond treating bodily wounds or electrolyte imbalances, but also involves understanding and holistically helping patients. To ensure that the healthcare system functions well, physicians work tirelessly around the clock to provide care, support, and hope.
Our focus is on delivering the best possible care to our patients, often putting aside our own needs and wants to complete the never-ending daily scroll of to-dos and pending items. We make numerous sacrifices as physicians and to become physicians, but many new challenges have surfaced with the pandemic. More than ever before, there are additional complexities involved in providing care and creating and promoting a culture of wellness in medicine.
As a medical student, I witnessed how the effects of the COVID-19 pandemic wreaked havoc on the ability to provide patient care and self-care. Regarding patient care, I saw how quick the interactions with patients had to be and the devastating effects of limited physical contact and connection. As an MS4, I particularly remember a COVID patient on dialysis who could not keep track of her physicians who were not very recognizable in head-to-toe personal protective equipment. She also had difficulty following her treatment plan due to the forced isolation she experienced.
As physicians, we needed to think quickly on our feet and adapt in real-time to changes in protocol, public health conditions, and the availability of resources while still caring for our patients. There was little to no time for rest or rejuvenation. As a result, many physicians became ill or felt the effects of burnout or isolation during the pandemic. A further limitation of a stretched health care workforce created additional pressure on an already boiling crockpot. The end result of these competing tensions and the desire to deliver optimal care during the pandemic were experienced by many physicians, team members, and patients.
The more I spoke with medical students and residents, the more I realized we desperately needed to figure out how to continue providing holistic care to our patients while safeguarding ourselves from the deleterious effects of the COVID-19 pandemic. This is how I came to create a series of interviewing physician leaders and mentors nationwide about their best wellness practices and career advice.
This project became a platform for physicians from various specialties and backgrounds to share their personal experiences and challenges in maintaining wellness and how they navigate the inevitable ebbs and flows. There was not a natural place to tap into this type of information. During busy rotations, there isn't time for much else except patient care, and it can often feel taboo to ask questions such as "How do I have a well-balanced life in and out of medicine?" or "How do I manage my stress level both inside and outside the ICU?"
In addition to the concern of being judged or criticized harshly, there is also the fear that you are somehow inadequate or that this may reflect on an evaluation that determines your future prospects. Unfortunately, most students suppress these questions and concerns and then try to figure them out after they have literally stepped into a hole and are having difficulty climbing back out.
In addition to collecting pearls of accumulated wisdom, this interview series also served to generate awareness on how we can support tomorrow's physicians while working and training in trenches, especially through a global pandemic. The most prevalent themes discussed by physicians during their interviews included burnout in medicine, perfectionism, the importance of community and belonging, managing stress, and how to create a personalized wellness toolkit.
Several physicians shared how perfectionism had been a struggle throughout their careers. As medical professionals, we all share the desire to be the best, do our best, and never make a mistake. We are also hardest on ourselves and would not say what we often say to ourselves to our friends and colleagues. To an extent, this is what makes us successful – by being what I like to call "micro-perfectors" of our actions, words, and even thoughts.
Perfectionism has helped us, and in many ways, we rely on it daily to prescribe the correct medications and make the right decisions in our care of patients. Alana Iglewicz, MD, a psychiatrist, pointed out in her interview that we all need to learn how to have better control of the volume knob of perfectionism–how and when to turn it down when perfectionism gets in the way of life and how and when to turn it up when it facilitates more optimal patient care (i.e., not missing your patient's lab results).
Kerri Palamara McGrath, MD, shared a quote, "Do the next right thing, take a step, step again, it's all that I can do," from the movie "Frozen 2" to illustrate the point that we need to be more self-compassionate and avoid being our own worst critics. Eric Dahms, MD, provided a visual example of perfectionism in his interview comparing it to a painting with a blemish in the middle.
Most people would gravitate to the blemish when asked to describe the painting rather than admire the beauty of colors and artistry of the painting. Moreover, perfectionists would dwell on the blemish and find it difficult to see anything beyond it! If we catch ourselves falling into that trap, it's beneficial to take a step back and realize that no one can be perfect all the time, that we are all human, and that mistakes are some of the best opportunities to learn and grow.
Jorge García, MD, relayed that when his patients come to him feeling as if they fell short or didn't follow his recommendations perfectly, he reminds them that no one is perfect and hopes they will remember that he is not perfect. Perfection, after all, is not a requirement for a successful physician-patient partnership.
Another powerful analogy was given by Cynthia "Daisy" Smith, MD, who compared the medical education system to a forest ecosystem. Historically, forests were believed to be a place of competition for light and resources, with the tallest trees being the most successful. Suzanne Simard, an ecologist, looked further below the ground to discover that the trees are connected through roots and fungi in a system called the rhizosphere. The trees were not competing but sharing nutrients, water, and even used this system to send out distress signals. The term "complex adaptive systems" was coined to describe how the trees worked together to promote overall health.
Smith shared that the medical education system has the capacity to become a complex adaptive system if the focus is less on individuals, perfectionism, and competition but on the overall health of everyone involved. As toxic as perfectionism can be in medical education, there is hope. Jess Mandel, MD, advocated for a team-oriented perspective to foster a more inclusive and welcoming environment for the benefit of everyone, including patients.
The ability to practice medicine is a beautiful gift that we use to serve others and to help them navigate some of the most arduous and formidable moments of their lives. To be our best as healers and guides, we need to prioritize our own health and wellness and look out for our colleagues. It's impossible to serve from an empty vessel, and no one should try. As Tammy Lin, MD, shared, "The routine practice of self-care is a high yield activity. Creating even a little time and space to do so can lead to increased energy, health, creativity, fulfillment, and better relationships. All things that allow us to realize our potential as physicians and people."
The pandemic has forever changed how we practice medicine, but it also provides us with the opportunity to become a well-functioning complex adaptive system. This will not be an easy task, and we will face many challenges along the way, but it's also a chance to come back stronger and more united than ever. As Iglewicz stated, "Don't let adversity define you. Rather, let it be an opportunity to refine you."
The dream is to foster never-ending waves of wellness in medicine that transport positive energy over vast distances. This energy is needed to grow, innovate, and succeed as a profession and deliver the very best care for our patients. Delivering on this promise depends on fiercely protecting the wellness of today and tomorrow's physicians, who have battled so selflessly on the front lines. It will require the commitment of leaders and organizations and sustained investment in precious human capital. Creating and promoting a culture of wellness in medicine will pay for itself many times over, especially during the next public health crisis. Doing so now ensures that our workforce will be prepared and willing to serve instead of fighting more battles than necessary.
As a newly-minted physician, I will take care of our patients to the best of my ability as I have pledged to do and care for you one day if you need me to. My colleagues and I ask that we be cared for along the way, including recognizing and accepting that it is a shared and sacred duty to care for ourselves and each other.
Alex Maloof, MD, is a physician.
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