Thoughts: On Being the Best.

This is an article written for my friends who are also residents.  However, I suspect it applies to many of my other friends who are nurses, paramedics, EMTs, firefighters, police officers, staff physicians, respiratory therapists… well, pretty much all of my friends.  Even those who aren’t in healthcare!  Ones worth these days seems to be measured by productivity, which makes all of our lives stressful.  I hope some of the tips in this piece can help you stay calm and carry on.

“When the lines-to-limb ratio is >1, the patient is sick”- Blair Bigham, 2015

Last year, a resident died by suicide. It wasn’t the first time a resident died this way. Another resident commented “well, clearly there was something going on”. This phrase was intended to excuse the death, to make it an anomaly, and to say “it happened to them – but it can’t happen to us.” It was, I think, a form of self-talk, a way of saying “don’t worry, that was them – I’m ok.” Any resident worth his or her salary knows that ignoring our own fallibility and blowing off alternate diagnoses is a good way to end up in trouble.   This got me thinking about my own psychological wellbeing and the techniques I use to protect it.

Psychological wellbeing is something we preach. We’ve studied the DSM, interviewed PTSD patients, written exams where C) was “vicarious trauma” and we’ve talked with real people with real problems. And yet, despite the current shifting of tectonic plates (even the Armed Forces and their stoic ways of being are evolving to recognize that “suck it up” is not often a valid response to personal suffering), healthcare workers often view themselves as psychologically invincible.

As the world has changed, so too has the experience of “growing up”. Information is easier to access than ever before, and with that, distance has died. Constant media presence means we live vicariously through radio, TV, Facebook and our smartphones. Scary things that rarely happen berate our senses, and before you know it, it’s not safe to walk to school alone or play in the park after dusk. Parents take freedoms away, and without those freedoms, experiences are never had.   If parents benevolently navigate our worlds for us, we have limited capacity to learn and develop, and this in turn leaves us vulnerable to psychological trauma. Without the freedom to play, we lose out on developing strategies to cope when things don’t go our way.

This may explain why young adults today have rising rates of mental health illness. As health care providers we residents think of ourselves rather highly, and why shouldn’t we? Most of us have been in university for a decade, we’ve dropped hundreds of thousands of dollars into tuition and textbooks, and most of our friends already have houses and kids and dishwashers while we wallow alone in our studio apartment with a sink full of dirty plates. We’ve sacrificed, and we know how to be tough. However, we are human and although great, some even brilliant, resilient, caring and extraordinarily hard-working, we have breaking points. In fact it’s often our brilliant, resilient, caring and extraordinarily focused nature that keeps us from reaching out.

Suicide rates amongst medical students, residents and staff physicians are inordinately high. Depression, substance abuse and marital disharmony are also prevalent amongst our ranks. Despite these evidenced truths, our own mental health is the elephant in the room. We are Type A personalities, we succeed at all costs, and we are stronger – stronger than everyone else.

The signs and solutions to this are well known to you. Today, give yourself permission to apply these principles to yourself. Learn to recognize the red flags, and have a management strategy at the ready should you need it.

This is hard: most of us are Type A personalities and view struggling as a weakness. But everyone needs to talk about their experiences as a resident, because being a resident is stressful. A lot of us frown on “touchy-feely crap” and suck up both small and large stressors. This is akin to having chest pain on a run, ignoring it, having chest pain at rest, ignoring it, getting sweaty and pale while having chest pain one morning, ignoring it, and then… yep. “I’m clear, you’re clear, we’re all clear!” There is no strength or intelligence in waiting to fall apart and develop PTSD, compassion fatigue, depression, or worse.

We are all nice people. When we stop being nice, something is going wrong. It starts a process that leads to hypo and hyperarrousal during crisis situations and results in underperformance. Compassion fatigue makes us susceptible to vicarious trauma, PTSD and ultimately suicidal ideation. Some of the signs of compassion fatigue include negativity, diminished tolerance for frustration and ambiguity,,intrusive thoughts of difficult patient situations, dread of working, anger, depression, absenteeism, or organic illness. Separating work and personal lives becomes difficult, and home life becomes impacted.

Time does not heal all wounds – its what you do with that time that aids healing. Cumulative stresses build up over time, and any one event can be the straw that breaks the camel’s back. Don’t stop using what already works for you – I’m a roller blader – but perhaps a few of these tips can be added to your toolbox. In other words, “if it ain’t broke, don’t fix it… but if you’re stuck in a hole, stop digging” (Steve Miller, 2004).

Now, some of these suggestions have a pretty high “cheese factor” but take a gander.  Many thanks to friend Tom Walker, a traumatologist and social worker, who is an expert (and advocate) in this area.

Change your Physiology in Two Minutes: Inhale through your nose; exhale through your lips as if they were wrapped around a straw: Inhale (4 counts) + hold (4 counts) + exhale (6 counts) + hold (2 counts). Repeat.

Shift your thoughts: If you shift your attention to a different thought, the chemicals connected to any emotion naturally subside in ninety seconds. Sometimes negative self-talk can take over. Call a friend and try to laugh or talk about something fun or interesting, or search for cat videos on YouTube

Take in the Good : Consciously experience a good feeling by absorbing it into your body and letting it expand for twenty to thirty seconds. One way of doing this is to use your senses to remember a really good time.

Practice Gratitude : Seek things to be grateful for; take a moment to reflect on and embrace the feeling of gratitude for something or someone in your life. The research shows that if you have gratitude it is much more likely that you will have happiness.

Exercise humour! Humour is essential in all health care environments.

Journaling: not for everyone, I admit, but put pen to paper, and you just might run out of ink. You can save the piece of paper or burn it, I don’t really care, but the exercise can be eye-opening.

Call it as you see it: If you think a colleague is struggling, call them out on it in a sensitive way. A phrase like “you’ve been snappy recently, what’s up?” can give someone permission to talk about the stress they are feeling and how it is negatively manifesting.

Your mental health is extraordinarily important; refresh your memory of the services available to you through your employer (such as employee assistance plans, extended health benefits and wellness services), University (such as resident affairs offices and social supports), and associations. Residency should be an enjoyable and healthy part of your life and lead you to prosper in your profession, your relationships and your own sense of wellbeing.

So, to all my fellow Type A’s – be the BEST at self-care. Or nothing else will matter.


4 thoughts on “Thoughts: On Being the Best.

  1. Blair, great tips for getting your feet back on the ground. I wonder why, though, some people have ultimately been more susceptible to PTSD or the decision to check out? I learned we’re all addicts, but to what? And we used to teach Scazzero’s line about not being able to be more spiritually mature than you were emotionally healthy. I wonder if psychological health is underlain by emotional health?


  2. Excellent article. Extremely well written with practical techniques. Should be sent to Readers Digest for wider distribution. Great job Dr. Bingham.


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