Megan L. Fix, MD


May 24, 2007


How can medical students prepare for the stress of residency and avoid burnout and depression?

Response From the Expert


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.

Physician impairment is defined by the American Medical Association as a physician who is 'unable to practice medicine with reasonable skill and safety to patients because of physical or mental illness...or excessive use or abuse of drugs including alcohol.'

Although all of these syndromes are possible in residency, fortunately they are treatable with the right professional guidance. By enhancing your wellness along the journey, hopefully you can avoid these conditions in yourself and also look out for others who may be struggling.

How Can I Enhance my Wellness?

To maintain your sense of balance, you must make time for what is important to you. Make a list of priorities (family, work, research, friends, exercise, cooking, hobbies, etc) and order them. Decide for yourself what is the most important thing outside work that you need to maintain balance, and then give that to yourself! Studies show that physicians who maintain wellness categorize their wellness practices in 5 general areas:

  • Relationships: this category includes relationships with friends, family, colleagues, and community;

  • Religion/spirituality: this includes involvement in organized religion as well as meditation or prayer;

  • Self-care: make time to take care of you! This category includes hobbies, exercise, good nutrition, avoidance of drugs and alcohol, personal counseling and treatment of depression. Don't forget to have fun!

  • Work: we need to find ways to make our work more meaningful and satisfactory for ourselves. Ideas include suggesting shift schedules that are more circadian friendly, adopting a night float system, debriefing difficult cases with others at work, and planning wellness events with other residents; and

  • Approaches to life: it's important to be generally positive about the journey you are on, maintaining balance, and focusing on your successes.

    Each of us is different, but here are some quick ideas for enhancing your personal wellness:

  • Develop a personal philosophy and prioritize your goals;

  • Maintain healthy relationships and set aside time with those people to talk about your feelings;

  • Take care of yourself by eating right, exercising, sleeping when you can, and doing the things that make you YOU!

  • Find something about each day that brings you joy, including joy at work, such as a positive patient interaction or learning pearl;

  • Block off times in your schedule for important things such as family time, exercise, or social events, and make sure you prioritize them;

  • Appreciate your accomplishments and growth during this time;

  • Learn to say "no" to commitments that are not important to you (although they may be important to someone else), so that you can say "yes" to those that are important to you; and

  • Learn where your resources are and don't hesitate to use them.

Finally, I can't overemphasize the importance of talking! Every one of us needs confidantes with whom we can be honest about our feelings. Whether with a colleague, spouse, friend outside of medicine, clergy member, or a counselor, it is important to talk. Take advantage of the resources that are available at your school or hospital. I hope that all of you can look back on residency as I do, as a journey that has been challenging, rewarding, and full of contributions to my own personal wellness.


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