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New surgeons take time out for mental health

rope webI spent a recent morning watching about 30 Stanford surgical residents take time off from their operating rooms to participate in a series of team-building games out on the alumni lawn on campus. These are busy, dedicated professionals who are passionate about their work, so getting them to take time off is hard. "I can tell you a surgical resident would rather be in the operating room than anywhere else on earth," Ralph Greco, MD, a professor of surgery, told me as he sat on a nearby bench watching the residents play games.

In a story I wrote about the games, I describe how the Balance in Life program, which sponsored the day’s event, was founded following the suicide of a former surgical resident, Greg Feldman, MD. Greco, who helped build the program, was committed to doing whatever he could to prevent any future tragedies like Feldman’s, as I explain in the piece:

"The residency program was just rocked to its knees," he said, remembering back to the death in 2010 of the much-loved mentor and role model for  many of the surgical residents and medical students at the time. Feldman died after completing his surgical residency at Stanford and just four months into his vascular surgery fellowship at another medical center. "It was a very frightening time," Greco said. "Residents were questioning whether they’d made the right choices."

Today, the Balance in Life program includes, among other thing, a mentorship program between junior and senior residents, group therapy time with a psychologist and a well-stocked refrigerator with free healthy snacks. Residents themselves, like Arghavan Salles, MD, who participated in the ropes course, plan and coordinate activities:

"Some people think this is kind of hokie," said Salles, who was one of a group of residents who helped found the program along with Greco following Feldman’s death. "Surgery is a super critical field," Salles said. She paused to instruct a blind-folded colleague: "Step left! Step left!" "You face constant judgment in everything you do and say," she added. "Everyone is working at the fringes of their abilities. They’re stressed."

While writing this story, my co-workers suggested I read a September editorial in the New York Times that brought the issue into sharp focus. Spurred by the suicides two weeks prior of two second-year medical residents who jumped to their deaths in separate incidents in New York City, Pranay Sinha, MD, a medical resident at Yale-New Haven Hospital wrote about the unique stresses of new physicians:

As medical students, while we felt compelled to work hard and excel, our shortfalls were met with reassurances: 'It will all come in time.' But as soon as that MD is appended to our names in May, our self-expectations skyrocket, as if the conferral of the degree were an enchantment of infallibility. The internal pressure to excel is tremendous. After all, we are real doctors now.

Pranay's message was similar to the one promoted by Stanford residents during the games: The key to battling new physician stress is realizing that you are not alone, that your colleagues are there to support you. "It sounds touchy feely to say that we care," Salles told me. "But at the end of the day, if we want to have better patient care, we need to take care of each other too."

Previously: Using mindfulness interventions to help reduce physician burnout and A closer look at depression and distress among medical students
Photo by Norbert von der Groeben

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