25 Nov Stress and Time Management
Physician demoralization is both well-documented and unfortunately prevalent in emergency medicine physicians and residents. Burnout can be attributed to a vicious cycle of poor overall health, or well-being. Classically, wellness and well-being can be broken down into various dimensions: social support, spiritual wellness, mental health, physical health, occupational fulfillment, and financial independence. Some sources may additionally cite emotional health, intellectual wellness, and environmental wellness. Instead of considering these dimensions as individual components, a modified representation is shown below. This diagram shows wellness supported by the aforementioned “pillars of health.” Overall well-being is reliant on all these dimensions working in conjunction, with overlapping qualities and attributes. These interrelated pillars cohesively create the foundation for a person’s health.
During medical residency, overall health may not like ideal. Instead, it may more closely resemble an unbalanced individual, tipping over to one side, and about to collapse or topple over. For example, the financial burdens of living in an expensive city with an inappropriately matched salary can cause mental stress. A lack of time outside of the hospital can prevent residents from maintaining their physical health or engaging in typical activities that contribute to their spiritual wellness. Combining these factors, residents often times cite decreased satisfaction with their occupation, causing strains on their social connections. Considering this new model helps residents better understand how to address deficiencies within this model.
Strategic management often uses a SWOT (strengths, weaknesses, opportunities, and threats) analysis to understand how to approach business competition or project planning. Analyzing wellness with the same model enables residents to better approach overall well-being. Every individual will enter their residency with varying strengths and weakness within their own pillars. Relying on strong pillars will help overcome weaknesses within others. Residency training offers plenty of opportunities and threats, as medical students often move to new cities, states, or even countries. Planning to take advantage of these opportunities can help shield from the anticipated, known threats to well-being. Some may use the opportunity of starting residency to address known weaknesses, creating an improved overall wellness.
Take a few minutes to sit down and analyze your pillars of wellness. Consider which ones are strongest and weakest. Will you have friends and family nearby? Understand how residency can provide the opportunities to grow and improve. Are you moving to a new place? Plan for the threats that inherent to this portion of medical training. How will you re-allocate reduced free time to maintain well-being? Review your pillars quarterly, semi-annually, annually, or however often you are able.
Jason Wang, DO
Member, New York ACEP Emergency Medicine Resident Committee
Resident, The Brooklyn Hospital Center