“Heal your mind, heal your body, heal the world.” – Unknown
In January, I charged us all with a few resolves for 2024 and intentional focus on communication and feedback, mentoring and role modeling, and wellbeing. March, which marks the beginning of spring, Match Day and March Madness, feels like a fitting time to focus my newsletter and your attention on renewal and wellbeing.
Wellbeing is a hot topic in healthcare and science these days. Burnout among the health professions and scientists is staggeringly high. Mental health disorders including anxiety, depression, and suicide rates are higher in many of these professions than in the general population and have been for some time. There have been a variety of interventions to attempt to address this including duty hours reform, wellbeing curricula and programs, mindfulness, stress-management, yoga, peer support networks, and expansions of mental health access to name but a few. Systematic reviews demonstrate limited or inconsistent impact with most positive results occurring in individuals who opt in to specific programming of interest to them.
More recently, there has been a move to redefine wellbeing. I believe this has been partially driven by a recognition that what we are doing does not seem to be working. However, this may also be driven by a realization that such interventions usually target only one part of a much more complicated construct. To this end, the Substance Abuse and Mental Health Services Administration envisions wellbeing not as the absence of disease, illness, and stress, but as the presence of a positive purpose in life, satisfying work and play, joyful relationships, a healthy body and living environment, and happiness. They go further to define eight areas of wellness as follows:
I was introduced to this framework by Dr. Quinn Tyminski, a leader in our Program in Occupational Therapy, when I asked her to help build a program evaluation plan for our wellbeing strategic initiative in MD Program Student Affairs. This program launched this year, led by Tammy Sonn, Associate Dean Student Affairs, Colleen Wallace, Assistant Dean Student Affairs, and the very capable Medical Student Affairs team, after significant work by Drs. Kelly Mock and Lisa Moscoso. Our hope is that a systematic plan that addresses each of these domains through curricular and co-curricular activities will work to improve the wellbeing of our MD students. Of course, we have a thorough plan to evaluate its effectiveness, thanks to Quinn. If successful, my hope is to launch this program for all students and trainees on the campus.
While waiting, we have invested deeply in supporting the mental health of our students and trainees. Student Health Services provides exceptional psychiatric and psychological services to all our students and contracts with external providers to ensure availability of a diverse population of providers with various skills, specializations and backgrounds. To facilitate navigating this network, we launched a pilot program with Caralyst Health last month – a platform to help students find a therapist that meets their unique needs. Similarly, we have invested in support for mental health for our residents and fellows through GME Wellness Counseling. Dr. Jenny Duncan and team have also put together wellbeing resources and offers wellness consults to programs as well as educational sessions for programs. Next month, they will host the second In Our Words: Finding Meaning Session in collaboration with Becker library.
While we have made significant strides and investments to try to address wellbeing, it remains unclear what impact we will have. Conversations on the topic of wellbeing can easily become derailed – focusing only on things like more time off, reducing what many consider necessary or productive stress, and increasing requests for institutions to take on more responsibility for the personal lives and choices of a subset of their constituents. Some faculty raise important concerns about the weaponization of wellness to excuse a lack of accountability to the professions of medicine and society, making it okay to not show up on time or at all for critical learning or work requirements. Others worry for the future of the health professions when putting our own needs and desires before those who we are supposed to serve. Specifically, they ponder how it will affect the trust and privilege we are granted by the public – perhaps how it has already impacted those things. Read this (link requires WashU network or VPN access) thoughtful article in the NEJM for more on that.
My perspective lies somewhere in the middle. When we are truly unwell (mentally or physically), we must remove ourselves from the work environment, or we will cause harm – something that fundamentally violates the values of our profession. We must also individually, as professions, as an institution and as the healthcare industry prevent becoming unwell. This involves personal accountability to learning how we individually stay well (physically, mentally, socially, emotionally, spiritually) and recognizing when we are tipping over and need to change what we are doing or get help. It also means that we must identify what gives us meaning in our work and cling to it (occupational wellness). However, it also involves the institution building community at work and school, improving the learning and work environment, and addressing moral distress and system dysfunction where possible. More broadly, it involves us and the organizations we belong to advocating for local and national resources to improve the healthcare and research enterprise. This is a complex problem. It requires looking at ourselves, our profession, our microenvironment and our macro environment. I am hopeful that together, and with a more holistic approach to wellbeing, we will be able to address this very important problem.