How Residents Cope With Stress: Bingeing, Drinking, Sports, and Friends

Pamela L. Wible, MD

Disclosures

September 20, 2017

In This Article

Residency Years Are Ripe for Burnout

Residency is tough. Internship is the worst. "I know how terrifying it is to come to the end of medical school and know that you will have to be an intern," a physician friend disclosed. "The fear is overwhelming at such awesome responsibility." She told me that her classmates would "buy lottery tickets hoping that if they won, they could wipe out their medical school debt and not have to be an intern."

Medical students are the best and brightest, valedictorians, leaders among their peers. Why do such competent, resilient, high-functioning people suddenly get so terrified?

It's called being a new doctor.

Life-and-death decisions. Sleep deprivation. Social isolation. Perfectionists in an imperfect system, residents are just trying to survive without maiming or killing anyone. Yet there's no time to be thorough. Take too long with patients and risk being written up as inefficient, flagged for work-hour violations, and then sent to a psychiatrist for "evaluation."

Our physiologic needs are placed on hold for years while we care for others. We may not have access to regular meals, adequate rest, emotional support, bathroom breaks, or even time to take a breath between patients. Even the most well-adjusted may become unhinged.

So what do we call a doctor who caves to exogenous mental and emotional strain resulting from such demanding circumstances? We diagnosis them with "burnout."

What Does Burnout Look Like?

"Burnout" is a complete mental and physical collapse from overwork. Psychiatrists define it as a job-related dysphoria in an individual without major psychopathy. Which means—your job sucks. You're normal. The term "burnout" blames the physician as the problem while deflecting attention from the system that makes it nearly impossible to care for oneself—or patients.

Although physically demanding, medical education is largely a supratentorial experience—a multiyear marathon for brainiacs. Why do some residents thrive while others crash and burn?

Medscape's Resident Lifestyle and Happiness Report 2017 showed results from more than 1500 residents regarding what they do to relieve stress and burnout. Here are their answers:

  • 31% engage in some form of exercise;

  • 23% turn to movies, TV, video games, and digital entertainment;

  • 21% socialize with friends or family;

  • 9% play with their dogs, cats, or other pets;

  • 5% engage in hobbies;

  • 4% play sports;

  • 4% sleep;

  • 4% eat or drink;

  • 4% enjoy music or arts;

  • 2% turn to spirituality;

  • 1% do nothing;

  • 1% travel, and

  • 1% turn to sex.

I was asked to analyze these findings. Reviewing the qualitative data, I was impressed with the predominance of healthy responses—Zumba, meditation, Bible study, even relaxing with a pet parrot.

Yet not everyone has such great coping strategies, so I asked a few hundred physicians for the real story: How did they survive residency? I was immediately impressed by the extreme creativity in scheduling activities around busy clinic schedules.

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