I believe physician wellness is essential to an effective doctor-patient relationship and an optimal healing environment. Thus, I approached my intern year with a sense of curiosity about what wellness would look like during a time that is well-known to be a particularly rigorous portion of residency. Having heard sentiments of “doom and gloom” from physicians who had walked the path before me, I was ready to experience the reality for myself. While intern year is an undeniably difficult time during which wellness can easily fall to the wayside, resilience means living a physically, mentally, and emotionally healthy life and having the reserve to recover from stressors that arise. Now, nearly finished with that infamous year, I write to you with the goal of sharing a framework to safeguard personal wellbeing, promote resilience, and combat burnout.

Identifying your “raison d’être”

Delineate why you chose to become a physician and keep that in mind as you navigate intern year. Most likely, you had some altruistic reason, from which you will need to derive strength. It can be discouraging to do demanding work for long hours and meager pay; however, you came seeking a different kind of value found in helping others. Medicine is a glimpse into humanity that most will never have, it is an honor, and it is deeply fulfilling.

High-intensity interval training (HIIT) in residency

HIIT, a form of exercise aimed at rapidly increasing strength and endurance, is an apt metaphor for residency. A 30-minute HIIT session with brief periods of intense exertion is more challenging and uncomfortable than a 30-minute walk. Even after a tough interval, you have to keep moving in order to get stronger. The same is true in residency. After each interval ends, despite the exhaustion, you have to move on to whatever rotation you have next. It is an enormous task to get up to speed in medical knowledge and experience, and high-intensity training is an efficient way to do it. View each interval as an opportunity for growth and to become a better doctor.

The cognitive behavioral therapy (CBT) approach to intern year

CBT, a technique that uses behaviors and thoughts to influence emotions, can be applied to intern year to improve emotional wellbeing. CBT recommends continuing activities that bring you joy and promote physical and mental health. Examples include exercise, cooking, nourishing relationships, hobbies, and meditation. Necessary aspects of life that promote health and happiness as well as better patient care, these should be non-negotiable priorities in the eyes of the individual and the residency program rather than the first things to fall to the wayside.

Another key protective action is camaraderie: joining with colleagues to overcome challenges. Co-residents understand the specific struggles you face and can empathize, at times commiserate, and ultimately encourage and inspire. Helping one another and working for the common good of the team promotes a sense of community and concern for the whole rather than self, a shift that provides strength in the face of great challenges.

Negative thoughts can be common during intern year, particularly in the throes of exhaustion. Imposter syndrome is an example of one cohort of negative thoughts. CBT asserts that you are not your thoughts, but rather the awareness of them, and you, therefore, have the agency to choose which thoughts to keep. In order to do this, ask yourself two questions: 1) is the thought true, and 2) is the thought useful? If the answer to either is no, then nonjudgmentally set the thought aside.

Humanity in medicine

We are part of a universal family of human beings. Patients and medical professionals alike, we have lives outside the hospital, hopes and dreams, fears, and unique skills and personalities. If we remember that we are all similar, we are more mindful of treating each other with care and kindness. We remember to start the day with a warm “hello,” to ask how each other’s day off was, to meet mistakes with understanding as opposed to frustration, and to have a little more patience. Though our work is as serious as life and death, we have to find a way to enjoy the present moment.

COVID-19 as a threat to wellness

COVID-19 poses a threat to health, causing fear of personal or family illness or death; a threat to social comforts, such as gatherings, meals, camaraderie, and celebrations; as well as a threat to the normal routines of life. A strong foundation of wellness, with mechanisms in place to handle added stress, is more important than ever to prevent burnout. Recall that in the physician’s oath, you “solemnly pledged yourself to consecrate your life to the service of humanity.” Those words are heavy, and they were spoken solemnly—they were serious, deeply sincere, and perhaps bittersweet as this is a life-altering and overwhelming promise. The wording evokes a sacred and religious quality to this promise, emphasizing a deeper meaning: this is bigger than a nine-to-five job. Despite how frightening it may be, you belong on the front lines. Have faith that this is a transient interval that will pass and view it as an opportunity for growth. Cultivate activities and thoughts that will allow you to endure, setting aside disheartening and foreboding thoughts. Rely on your team, and treat yourself and others with kindness and understanding.

Conclusion

You are embarking on your life’s mission to serve others through medicine. At the same time, you are about to be tested: the medical world is extremely challenging by virtue of the high stakes we face. However, the challenges can be gracefully overcome with commitment to wellness, with determination, and with teamwork. Commit to your own wellness as an essential responsibility of being a health care provider. When times get tough, reason that we could have never expected practicing medicine to be easy; remember the promise you made by taking an oath and honor it; help one another, and do not back down. Find satisfaction in the triumphs and the struggles, and enjoy life as a physician.

Elizabeth Sage Epstein is a physician.

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