Becoming a health professional is a challenging and complex process. Trainees frequently experience stressors that exceed their previous life experience and coping skills. These demands are proportionate to the responsibility and complexity of caring for patients in all their variability and vulnerability. These demands of professional training are enormous, and trainees often neglect their own physical, emotional, relational, and spiritual health; however, a central component of professionalism is awareness of one’s own limits, and mindfulness about the wise allocation of one’s energy in providing quality patient care (see Chapters 6 and 7). Neglect of this awareness may sow the seeds of burnout and lead to poor quality care and medical error (see Chapter 37). Close attention to maintaining well-being, however, can enhance satisfaction with medicine as a career and optimize the clinician–patient relationship. Given that trainees are vulnerable to pressures to postpone their own well-being until training is completed, it is paramount to include promotion of self-care in the formation of health professionals.
CASE ILLUSTRATION 1
Jill Rayburn had not slept in 30 hours. She had been studying for her pathophysiology examination for a week, and still she felt ill prepared. As a second-year medical student she was beginning to wonder whether she was cut out for medicine, in spite of the fact that she was in the upper 20% of her class. Many of her classmates seemed to be on top of the material to be mastered for this examination. Some of them had even gone for a hike yesterday afternoon. Last night she declined an invitation to play indoor soccer. It was mid-January and cold outside, and she was tired of being stuck in the library. She was beginning to resent the professor who invited her to coauthor a paper, even though at the time she felt flattered that he had singled her out for this honor. Now she did not feel up to the task, and she wished she had started preparing for this examination earlier rather than working on the paper. She looked back to her days of high school and college, when she was consistently at the top of her class, and remembered many carefree days. She wondered what had happened to that teenager with the sense of humor and the time to hang out with friends. Now as she looked ahead to the remainder of the winter, all she saw were more deadlines and isolated days in the library without respite. She wondered if she would ever have fun again.
A common trait of physicians is compulsivity. Although many attributes of compulsivity—thoroughness, accuracy, second guessing, monitoring changes—are beneficial to patient care and success in medical training, this trait may also erode the personal health, satisfaction, and well-being of the physician. Early in her training, Jill is manifesting many of the associated characteristics of compulsivity that if unchecked by reflection can lead to cynicism and burnout by the ...