Ilana Birnbaum is a medical student in the Class of 2020 at the University of Toronto.
This work represents some of my reflections during my 6 week Surgery rotation as a third year medical student. While I enjoyed this rotation and learned a great deal about surgery, and clinical care more broadly, I largely felt anonymous. I felt hidden away behind my surgical mask, cap, gown, and gloves.
Even when I was not physically wearing this personal protective gear, I felt as though there was a distance of sorts between myself and the patient. This lack of identity seemed reciprocal. As I felt anonymous to my patients, they too had an element of anonymity in my eyes. My consults in the emergency department were focused, follow-up appointments in clinics were concise, and rounding on inpatients in the mornings was reduced to a few yes or no questions. The majority of my time spent with a given patient was when the patient was under anesthetic.
Sarah Tulk is a family physician in Hamilton, Ontario
Despite earnestly advocating for physician mental health, my own story has remained cloaked in secrecy. As a medical student, I felt far too junior to risk such a revelation. I watched as stigma, perpetuated by the hidden curriculum, kept my peers from seeking mental health care. Still, I kept my head tucked safely in the sand, and swore to break my silence in residency. However, as a resident the fear of jeopardizing job prospects maintained my mutism. I vowed to speak up when I was staff. Unfortunately, early in my staff career my advocacy efforts were smothered by fierce judgment and harsh consequences. I wholeheartedly renewed my vows with the ostrich approach and reconciled to start talking about mental health when I was protected by more seniority. I hated the secrecy and hypocrisy, but at least I was safe. Then I heard of another resident suicide. Then a medical student. Another resident. A staff physician. ...continue reading →
For Canadian resident doctors, July 1st is more than a national holiday; it represents the day when newly-minted doctors become responsible for decisions in patient care. While this is an exciting day, it can also be fraught with anxiety and stress. Over the course of residency, acute work-related stressors, including traumas and patient deaths, can negatively impact residents’ wellbeing. Additionally, residents endure chronic stressors such as large debts, extended work hours, and isolation from family. These factors predispose residents to burnout. The prevalence of burnout among resident doctors is up to a staggering 75%. Resiliency interventions have been shown to work, and the time to begin implementing them nationwide is now. ...continue reading →
Rising awareness of the toll that physician burnout is taking on our profession and our healthcare services has inspired numerous organizational physician wellness initiatives and resilience courses aimed at individual physicians. Yet, as experts discuss the relative merits of the system-level approach vs. the individual-wellness-training approach to addressing burnout, one key element seems to be all-but ignored: the healing power of the relationship between physicians and the patients they serve.
Dr. Tom Hutchinson, in his book, Whole Person Care: Transforming Healthcare (Springer International Publishing AG, 2017), suggests that we have lost touch with “the interior processes of healing and growth in the individual patient and the practitioner that give meaning to illness and to healthcare,” ...continue reading →
Hissan Butt is a medical student at Queen’s University in Kingston, Ontario
I recently learned that two Canadian medical students died in the past three weeks. Little is known about the circumstances surrounding these deaths.
However, this has not stopped worried Canadian medical students from speculating about the causes of death. The speculation arises not because of a desire to gossip. Rather, I think, it stems partly from a lack of information and partly because of fear. At the time of writing, most believe that the students died by suicide. One university has acknowledged the death of one of the students, although the cause is not identified.
The silence is justified - we are told through unofficial sources – by a request from the families to respect their right to privacy. We are also told that talk might spark copying. Indeed, any decent person should want to respect the wishes of the bereaved families, to help them grieve and lighten their burden in this difficult time. There is no need for naming, but there is a need to talk. ...continue reading →
Often when we talk about improving health care, we turn to the Triple Aim. Developed in 2007 by the Institute for Healthcare Improvement (IHI) in the United States, the Triple Aim captures three objectives for a better quality health system: Improving a patient’s experience of care, improving population health and doing this at a reasonable cost. It has become a way of thinking embraced by many health care systems around the world.
The Triple Aim takes a big-picture, system-wide approach that can be applied to any part of the health care system, as well as across all levels of an organization. The ultimate endgame is a sustainable health care system that patients trust and that contributes to healthier populations.
Magbule Doko is a family physician in Windsor, Ontario, and an adjunct professor at The University of Western Ontario
School. Career. Children. Partner. Parents. Siblings. Being a Doctor. Getting Older. Turning 30. Teaching the next generation of doctors. Next step in my career. In-laws. Body. Health. Meditation. Having another baby. Trying to make the world a better place. Trying to understand who I am. Vacation time. Couple time. Debt. Income. Work. People living. People dying. Crying. New life. ...continue reading →
Amy Gajaria is a third year resident in the Department of Psychiatry at the University of Toronto
Last week was the first snowfall of the season in Toronto. Usually, the first sight of fluffy white flakes collecting on city streets would have me dreaming of strapping on my cross-country skis. This, year, however, the first snow left me huddled inside, frightened of slipping on ice.
Towards the end of September I badly damaged my ankle when attending a charity event. In a few moments I went from an active 30-something to someone unable to stand independently. After the paramedics got me to the nearest hospital, the first thing that popped out of my mouth was not “pain medication STAT” (that was the second thing), but instead “I’m a doctor. I hate being a patient.”
I later told myself that this was because I wanted to speed up communication and avoid unnecessary explanations. ...continue reading →
Dr. Sabine Ziegler is a general practitioner with an interest in palliative care, practising in Ettlingen, Germany
For readers from Canada, a "mother land" of physician health, my reflections on physician health in Germany may surprise; the structures in Germany are not nearly as well developed as in the USA, Canada or Great Britain.
Doctors in Germany can prescribe and self medicate without any consultation or assessment by a colleague- which means drug misuse, including benzodiazepines, is possible. Long working hours, high professional responsibility and little recreational time lead to a large percentage of doctors feeling physically and psychologically affected. On top of that is the constant confrontation with suffering, fear and death. Doctors also often crumple under the high demands they create for themselves. It doesn't fit with a doctor’s self-perception to seek help for their own problems. Yet when a sick healer tries to cure himself most of the time it doesn't work. Every year around 150 German physicians end their lives. ...continue reading →
Professor Dame Carol Black is Principal of Newnham College Cambridge, Expert Adviser on Health and Work to the Department of Health, England, Chair of the Nuffield Trust, and Chair of the Governance Board of the Centre for Workforce Intelligence. She was a keynote speaker at the recent International Conference on Physician Health
Whatever the nature of their work, whatever skills they bring to bear, however strong their calling and dedication, employees come under the influences of their workplace and of those who employ them. It is as true for doctors as it is for the drivers of tube trains, the builders of Olympic stadia or civil servants in Whitehall. The evidence, gathered painstakingly over many years, in such different arenas of work, is consistent and strong. It leaves no doubt about the characteristics that we look for in identifying good work and a good workplace.
The effects of workplace influences are felt and measured to varying degrees in ways that are clear. First is the personal health and wellbeing of employees – their physical health and their mental health, the former often measurable declared, the latter often masked and hidden.
Second is the performance of the group, the team, and ultimately the institution for which they work. In health care such performance is measured in terms of the quality of patient experience, the safety of care and health outcome.
These measures correlate with features common to organisations which have achieved success in promoting staff physical and mental health and well-being. ...continue reading →