Coping With Stress During Residency
Megan L. Fix, MD
Chief Resident, Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, Massachusetts; Chief Resident, Brigham and Women’s Hospital/Massachusetts General Hospital, Boston, Massachusetts
This is a very good question and one that can be easily overlooked. Residency is a time of stress and challenge, but it does not have to be a time of suffering. During residency there are many things we should be doing: reading more, doing more procedures, staying up during on-call nights. What about the things that our bodies and souls need just for us?
I realized that I was unwell in residency when I woke up and couldn’t remember the last time I had gone running. It was something I enjoyed immensely in medical school. Everyone has things that are special to us, and when I stopped doing that for me, I was unbalanced. Now, after helpful conversations with colleagues, friends, and a counselor, I feel much more balanced and well in my life.
In residency we have less time to do the things that make us unique, but to maintain our sense of personal wellness, we must take care of ourselves with the same respect that we give our patients. In this article, I will explore why wellness is important, some potential side effects of ‘unwellness,’ ways to enhance your wellness, and most of all, encourage you to talk about your experiences as you go along.
What Is ‘Wellness’?
Wellness is defined as a state of psychological and physical well-being. I like to think of it as a state of balance in one’s life. Residency inherently has stressors that threaten this balance, such as abnormal sleep patterns, high stress, and a heavy workload.
The quest for wellness is to bring your life back to a balance to enhance your general happiness, work, relationships, friendships, hobbies, spirituality, and other interests. Being well is not just avoiding depression and burnout, but involves a greater overall enjoyment of our lives, which can help make us better doctors, better partners, and better friends to others and to ourselves.
What Can Happen if I’m Not Well? How Can I Tell?
Although there is no way to escape the stressors of residency, we can try to avoid more serious effects such as burnout, depression, and impairment.
Burnout is a syndrome of decreased enjoyment and effectiveness at work. There are 3 components: emotional exhaustion, depersonalization, and a sense of low personal accomplishment. Symptoms of burnout include loss of interest at work, feelings of fear, avoidance, isolation, anger, loathing for work, exhaustion, inability to concentrate, anxiety, insomnia, irritability, increased use of alcohol or drugs, body pain, nausea, divorce, broken relationships, and disillusionment.
Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. Although we all learn ‘SIGECAPS’ in medical school ( Table ), depression is a real concern for medical students and residents. If you notice that you are having trouble getting out of bed, avoiding things you used to enjoy, or anything else that is concerning, make sure you talk to someone.