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After the Match

The State of Resident Wellness

Cook, Thomas, MD

doi: 10.1097/01.EEM.0000559981.52102.57
After the Match

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Wellness is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.—The World Health Organization

Physician, heal thyself.—Luke, 4:23

Wellness has become a buzzword in nearly every professional organization over the past several decades. It is especially a priority for young adults who fear that the bulk of their lives will be spent toiling away at work without experiencing their fair share of happiness in meaningful professional and personal endeavors.

But what are the implications for the emergency medicine resident? How should he maintain a level of wellness to support his professional and personal goals? And who is responsible for this? The program? The hospital? The resident?

If you look at the residents' pictures on our website, they look like students from any other program. No one would think they are unhealthy. Many are former college athletes or military personnel, and all have led physically active lives. Of course, they are all intelligent, and understand what it takes to be mentally and physically healthy, but I wondered if they actually practice what they preach to their patients.

Unfortunately, I did not know how to measure wellness. How can I measure their level of happiness? Should the program have social events and team-building exercises? Is wellness quantifiable? I began searching for a tool to figure out where our residency program was in wellness issues. I did what nearly everyone does in this situation: a survey.

The goal was to establish a baseline for our program's wellness. All 39 residents responded anonymously to the survey, which asked about basic lifestyle issues such as sleep, diet, exercise, personal finance, and health care. I thought most of them would make healthy choices in these areas. The results, however, were not what I expected.

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Poor Sleep and Diet

Twenty percent said they did not get enough sleep. Ninety-two percent slept more than six hours after a day or evening shift, but one-third slept fewer than six hours after a night shift. This is actually pretty good compared with a report by the Centers for Disease Control and Prevention on sleep patterns in the general U.S. population: One-third of Americans reported that they get fewer than seven hours of sleep each day. (May 2, 2017; http://bit.ly/2USsIYj.) Lack of sleep reported by the residents after night shifts is unavoidable. Good sleep is critical for good health (not to mention good decision-making), and it is an area that needs to be regularly monitored.

One-third of our residents were not happy with their diet, but the most surprising finding was that 90 percent felt that they consumed less healthy food when they dined in the hospital cafeteria. Most of them, however, said they eat most of their meals there while on duty. Few, if any, brought their own food to avoid this. The driving force is their free food allowance in the cafeteria. Nearly 40 percent rarely exercised, and more than half were unhappy with their level of fitness. The challenge going forward is to develop ideas to encourage residents to be proactive about fitness.

One of the greatest stressors over an EM career is managing personal income. I knew absolutely nothing about this at their age, and I made many mistakes that cost me lots of money. The great income that comes with practicing emergency medicine can be a tremendous source of anxiety. Our program has been teaching personal finance for the past 20 years. We integrated a personal finance curriculum into our regular conference schedule, and give our residents time off from clinical duty to meet with financial planners and learn the basics of working with industry professionals.

Even so, it appears we are not doing a good job. Eighty percent of our residents do not have a power of attorney, 85 percent do not have a will, 87 percent do not have a living will, and 68 percent do not have a financial advisor. It's stunning that people who routinely care for patients with life-altering problems are not prepared if something bad should happen to them.

Things weren't much better in residents' personal health care: Three-quarters responded that they did not have a primary care physician, and an even greater percentage had not seen one in the past year. They did slightly better with their teeth—more than 70 percent had a dentist, but less than two-thirds had seen one in the past year.

What should we make of all this? It was a small sample size, but I would bet that our program is like most others. Wellness is not an easy concept that comes naturally. You have to invest time, thought, and money. Wellness is about commitment, and although any program can make adjustments to foster a resident's ability to be well, it is ultimately up to the residents. The challenge is to make them aware of the pitfalls of taking these issues for granted and demonstrate to them the long-term benefits of staying well for their careers and lives.

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Dr. Cookis the program director of the emergency medicine residency at Palmetto Health Richland in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter @3rdRockUS, and read his past columns athttp://bit.ly/EMN-Match.

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