A few months ago, I got this invitation from the director of graduate medical education:
We have 115 residents and no meaningful wellness program to speak of. My goal is to create not only a resident but also a faculty wellness program. To help jumpstart the endeavor, I would love to showcase your work and efforts. I would like to invite you to speak on physician depression and wellness to our residents and faculty.
I love speaking on physician depression and suicide. Wellness . . . well, not so much. Yet last week I helped jumpstart their endeavor (see fun video). I just refused to call it a “wellness program.” Why? Wellness is the wrong word.
Wellness is defined as the state of being in good health, especially as an actively pursued goal. Here’s the problem: actively pursued sounds like work. Wellness is too controlled, measured, and almost forced upon us. Who’s really excited to join a “wellness committee” this week? Or start a “wellness program” at work? Any volunteers? If you’re not that eager, here’s why: the word wellness is boring, overused, and totally uninspiring. Tack on another uninspiring word like committee or program after wellness and you’ve just killed the last drop of enthusiasm in the room. Weirdly, just saying “wellness program” makes us feel less well.
Yet in medicine we strive for wellness. We work hard to help patients be well. So we order lots of labs and tests and check lots of boxes on the electronic medical record to prove how well everyone is. We measure body mass index and blood pressure. We take Pap smears and search every orifice in the human body with scopes and bright lights. And at the end of your Pap and physical we write in the medical record “well woman exam.” How inspiring is that? Patients don’t seem inspired. Kind of a blah experience overall. But, hey, they’re well! Yep, we’re certifying people as mentally and physically well, yet they’re not real excited to be alive. How does that make any sense?
Weirdly, while we’re helping everyone else achieve “wellness,” physicians and med students have high rates of anxiety, depression, and suicide. So medical organizations are racing to create “wellness programs” as the big new innovative solution. Well that kinda seems like forward momentum. But can a wellness committee really save our doctors? Misery in medicine is at an all-time high. I get phone calls, Facebook messages, emails every day from miserable doctors like this one:
Today I realized that if I become a dog walker and charge $25/hour and walk 5 dogs per day I would make my equivalent salary with a lot less hassles. I’m seriously considering this as a career move. I could be the most over-qualified dog walker out there with a bachelors, masters, doctorate and specialty certification! Sometimes I also dream about becoming a Yogi and Herbalist, maybe a part-time Barista? Maybe that would be more helpful to society than the assembly-line medicine I currently participate in and I would likely be happier and healthier. What do you think?
Here’s what I think. This doctor is well. She’s got normal vital signs. She exercises and eats well. In fact, she’s as well as all the other doctors who tell me they’re dreaming of quitting medicine so they can start organic farms, get certified as yoga instructors, or move to cabins in the woods to write their novels about surviving the trauma of medical training. This is what well-adjusted rational doctors want to do these days. Wellness is not the antidote for misery. Happiness is.
Happiness is a state of well-being and contentment as in joy, delight, even bliss. I’ve never heard of a happiness committee. Maybe because happiness is so untamed. You can’t easily plan for laughter with a committee. Happiness is great and we certainly need more of it, but I’m aiming for something even better—exuberance. Exuberance is the quality of being full of energy, excitement, and cheerfulness. It’s uninhibited and spontaneous exhilaration that’s infectious. Exuberance is happiness on steroids. Physician exuberance is my specialty. Every year, I help hundreds of doctors overcome depression, anxiety, even suicidal thoughts, to become exuberant in medicine.
Oh, when I asked these 115 residents how many felt well, eight people raised their hands. When asked how many felt happy, I got about ten people. What about exuberant? One. Kinda. So I asked how many were sometimes exuberant? Three.
For those who are unfamiliar with the exuberant physician, I’ll share two case studies to demonstrate how to move from blah to exuberance (without a wellness committee stamp of approval).
Case study #1: Dr. Jennifer Zomnir, a family doc in Texas, thought she was living the good life at her 600-doc big-box clinic. Until her husband signed her up for our Live Your Dream Physician Retreat. She didn’t even realize she wasn’t living her dream (she looked about as happy as all the other docs in her clinic). So she arrives at our 150-acre hot springs retreat, has an epiphany that she deserves to live HER dream, quits her assembly-line job and launches her own ideal clinic. Now she works when she wants to, attends all her kids’ events (even takes her children on house calls). She sees all patients over 90 for free! Her patients are over-the-moon thrilled. She’s thrilled. In fact, she’s so ecstatic about her life that she asked me once if she should see a psychiatrist. Why? She’s thought she was manic. Nope. She’s just not used to experiencing exuberance. I recognize her exuberance because I feel the same way in my clinic. Joy and spontaneous exhilaration is our normal state. We should all jump out of bed each day like an excited three-year-old—full of awe and inspiration. That’s normal. Instead, physicians have normalized their unhappy lives so when they’re exceedingly cheerful they think need psychiatric care. Isn’t that weird?
Case study #2: Family doc in New York opens ideal clinic and is so overjoyed that she worries she’ll get arrested. Read her Facebook post:
So here’s the weird reason why “wellness programs” won’t work: they’re uninspiring and they mislead us from our real objective: happiness—even exuberance. So how do we get more exuberant doctors and less doctors-turned-dog-walkers? Not by starting a wellness committee. Let’s model what works. Showcase exuberant medical students and residents (there are a few in every program). Bring in exuberant doctors to teach in our medical schools and residences. They’ve already got it figured out.
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Pamela Wible, M.D., is a family physician and author of Physician Suicide Letters—Answered. View her TEDMED talk Why doctors kill themselves. Ready to live your dream in medicine? Join our upcoming retreat. For retreat scholarships, contact Dr. Wible.
I think wellness is found within balance of life and fun. As a student, type A personality I understand what it is like to ‘achieve wellness’ without happiness. It was my first year of medical school and I basically gave up everything that made me happy and spent all my time sitting to studying. Second year has been different because I schedule time to get my fun in daily to ensure happiness and thus a sense of purpose.
Individuals must put their own basic needs for health & happiness first. Employers can create a healthy culture (and should be obligated to conform to basic human rights & labor laws). A wellness committee can’t force people who work 28-hour shifts to be well or happy.
I would love to follow the model for an ideal medical clinic but I am concerned about obtaining a health insurance policy for myself, given the current administration’s goal of changing the ACA. I have pre-existing conditions and am unsure if I will be able to get affordable coverage.
Any suggestions?
I want to thank you for all you’ve done to cast a very bright light, in such an articulate and profound way, on the very real stress we as PCP’s experience. I care about patients and know I would be able to provide better care to my patients if I had more time, less Press-Ganey pressure, fewer labs, emails, messages, PAR’s and computer work every day. I never have time to eat, drink water, use the restroom, etc.. because my lunch break is entirely consumed with the above tasks.
I’ve read the comments from docs that call PCP’s who complain about the workload as “babies”. I’m not a “baby”. I am a genuinely caring human being that wants nothing more than to truly care for patients without “production bonuses”, positive Press Ganey scores, etc..
Some folks get insurance from spouse or high-deductible plans. In general you have to realize this is YOUR life and if you work in a sick environment you actually place your health at risk and will limit your lifespan. So it turns into a quality of life & quantity of life conversation. Have you heard of Karōshi (過労死)— ‘excessive work death.’ Look it up.
quick question, quick answer, long implementation.
We have disagreed on this point previously. In our profession,
we have to function, clearly and quickly, as one teacher said,
make haste slowly.
There is no room for emotion. Rule number one in time of a code blue-
take your own pulse first. from The House Of God. Sam Shem pseudonym.
That means-stop think breathe act, a self-check of sorts.
The problem is leaving work without our emotions our sensations our ability
to feel, to be a sentient being.
And when we are not at work but at home? What do we do to release those
many stressors? When I was on the Admissions Committee here, that was a
major question. Most do something physical, few read or bake or other gentle
activity. Something to burn away the stress aggravation draining sucking
cascading shit of the system.
When not at work what is available to do to make to explore to experience.
A hospital clinic office is more or less the same anywhere you go, so what
can you do to breath deeply to enjoy life on the outside? That is where you
live. After all, in life you have two questions only to ask and to answer. to wit,
what to do with your life and with whom do you share it. Anything and everything
else comes at the (partial) expense of one or the other or both.
At some point in the education process, hopefully we realize there is only one
stupid question, the unasked question.
So, stop the inevitable downhill flow of shit in the medical/surgical educational
system, and open up again the varied aspects and experiences of life-museum
walkabout explore read live love laugh music theatre. people, stimulating high
level conversation, current events from various perspectives-historic philosophic
religious it may change.
if you can enjoy what you are doing then it less work and (maybe) more play.
Ultimately I subscribe to the zen poet quote:
A zen poet said, “A person who is a master in the art of living
makes little distinction between their work and their play, their
labor and their leisure, their mind and their body, their education
and their recreation, their love and their religion.They hardly
know which is which and simply pursue their vision of excellence
and grace, whatever they do, leaving others to decide whether
they are working or playing. To them they are always doing both.”
I love this perspective Pamela. We can be quite well, yet living a life with little joy. It’s that feeling that something just isn’t quite right but we can’t figure out exactly what the problem is. I wonder how many of us simply forget what true joy feels like after a brutal residency. We replace happiness with just being OK and think for some reason they are equivalent. They are not. Thanks for this, one of my favorite things you have written.
We should all be jumping out of bed like enthusiastic 3-year-olds ready for our next adventure. If were not then something is seriously wrong with how you have arranged your life.
The last time I did that was a Renal Medicine rotation. Inspiring attendings and residents with plenty of intellectual stimulation. No managers with absurd and meaningless productivity numbers. No additional 3 hours for documentation at the end of a day’s work. So inspiring that I did two consults and presented them at 8PM the night before I graduated from medical school.
That was in 1982.
No secret why wellness programs won’t work.
The cause of physician burnout is clearly mismanagement:
The idea that a wellness class is going to cure or ameliorate burnout basically doubles down on management’s theory that every aspect of a physician’s life needs to be managed by somebody who doesn’t know a thing about medicine or physicians. They manage physicians like production workers rather than knowledge workers. Production workers with an onerous documentation burden that is.
That’s how we got here in the first place. Thirty years of mismanagement in fact by the government and managed care companies.
Before that we were doing quite well without the managers.
Some priceless comments from docs via email:
The wellness movement is a sham, a pathetic facade. Can you believe I have to spend ANOTHER 2.5 hours next week sitting in a chair learning about “wellness.” How bout letting me leave early to go to the gym or nap. 80-100 hours a week – I’m EXHAUSTED. I hereby create a new hashtag, Pamela. It’s called #F$~%k wellness. 🙂 love u and all you do! ❤
I’ll be eagerly watching what you do! As an intern, I was horrified by the shadenfreude of the weekly “wellness corner” emails sent out by wonderful and well meaning therapists. I think my program at University of Washington really tries hard, but is still hampered by a masochistic culture of overwork. Now that I’m a 2nd year resident, I’ve found that my wellness is much better at 55 hours rather than 80–and I can’t wait until I build my own ideal clinic and develop a true life of wellness. In my mind, residency (and medicine in general) is the problem. I’m so grateful to keep hearing you speak out and work to make things better. Thanks for giving me a cause to cheer for!
The CONcept of “wellness” is bullshit. Its Obfuscate-speak to undermine HEALTH. It avoids the distinction between health and disease. It’s politically incorrect to use the word “health” as it is politically incorrect to say “disease”. The same attempt is made with substituting “accountability ” for “responsibility “. Accountability is blaming some one for something and you don’t have to be “responsible” for your actions –just held accountable. Bullshit. IMHO. (Well, maybe not so H.)
The two concepts that must be compared are happy vs unhappy. Not wellness vs happy. I’m not sure when the smarmy approach to re-defining words in our language occurred, but it’s probably New Age Vague. If one can avoid a definition of a word then y’ don’t have to worry about what y’ say. Because the intimidation will work : “if you know what I mean, no definition is necessary; if you don’t, none is possible.”
As a mental health practitioner, I may get a great deal of professional flack for saying this, but remaining silent never changed anything. The wellness programs that I see emerging from this are not wellness programs. Let’s call them what they are: a nice title with some would-be concessions that, at best, band-aid a gaping wound in the system. This is an attempt to distract from a root issue and say that ‘something’ was done. A real focus on wellness means exposing and fixing a culture that systematically is killing those who dedicate to healing others. If medical institutions (and behavioral health services) were truly caring for their own practitioners, there would be no need for wellness programs in the first place.
EXACTLY Jerimy! Love, Love, Love what you wrote . . .
This post reminded me of a quote I love- “The opposite of play isn’t work. The opposite of play is depression.” (I believe I heard it in one of Brene Brown’s talks). If we don’t play enough (which I lump creativity into the play category), we’ll be depressed. I don’t think medicine looks too fondly on play…
My $0.02
Mary Ellen
Kudos to you Dr. Wible for shaking up the medical profession! An invitation to create a “wellness” program is a WEE step in the right direction. (I hope you hire an acupuncturist or two to be part of your program.) But we all know your profession needs a GLOBAL shift…NO ONE would choose to be chronically sleep deprived (isn’t this a form of torture?) while performing a job where literally, lives are in their hands. Doctors (of ALL people!) should know this – of course they know this. Traditions need to be kicked to the curb ASAP, so doctors can function with a clear head, and choose happiness.
Just a truth teller by nature. Amazing how we can solve most of our problems just by telling the truth. Secrets and lies help nobody. Let’s use the proper words. A good start.
As a Psychiatrist in solo private practice, I have watched the largest hospital system in our city
develop “wellness” programs for practically everyone – yet, people who are anxious, depressed,
demoralized, fearful, hypodopaminergic (thanks to all the SSRIs increasing the amount of
everyone’s friend serotonin which in turn shuts down the release of dopamine – and then of
course the individual is convinced that they have ADHD and need Adderall – “ADD for all” –
amazing how they name these drugs!), lost, and usually addicted are flocking to my practice
in a steady stream even though I accept no insurance reimbursement – cash or card at time
of service. And many have been through wellness programs without any improvement. Until
we get real and stop thinking wellness is a combo of honor, wealth, pleasure, and turning the
age clock backwards, nothing will change. I wish you luck – (email I just received)
Wellness programs are a PART of preventing med student and physician suicide.
But if a doc is carrying GENES that predispose him or her to DEPRESSION, ANXIETY or BIPOLAR, wellness programs won’t be “enough”.
Medication may be needed to restore wellbeing.
Wellness programs MUST teach docs how to get help. Wellness programs MUST teach, at length, in lecture and later, in small group discussions, that dealing with a PHP (physician health program) is a TIME LIMITED BURDEN.
Time-limited supervision by a PHP is superior to suicide!!!!
Time-limited supervision by a PHP is superior to suicide!!!!
Time-limited supervision by a PHP is superior to suicide!!!!
Truth is, the PHP’s ONLY concern is the doc’s “fitness for duty”.
Medication restores not only fitness for duty but a wonderful sense of wellbeing.
I’ve been a psychiatrist for 40 years, and my job is GIVING PEOPLE THEIR LIVES BACK.
TAKE YOUR LIFE BACK. Get help if you are suffering. And deal with the PHP on a time-limited basis if you have to.
They are not going to pull your license. They are going to make sure that you are fit for duty. They are going to make sure that you comply with treatment. That’s all they care about.
Pamela,
Thank you for the email, as you know I have been following your work closely. I have listened to your latest podcast on physician “wellness” and would like to offer my input.
I could not agree more with you about why you would not want to call it a Wellness Program.
As an individual who would like to pursue a career in medicine, I can share an interesting viewpoint.
My story goes like this, I know that I am not “well”, I also know that I am not “happy”. I have a number of physical ailments as well as a number of mental health ailments. My mental health declined rapidly as I entered into the field. After only a year in the field I went from being a happy go lucky, outgoing individual to being someone who sees a therapist weekly for depression, am on two anti-depressants, a sleep aid, two anxiety medications, and at times having no hope for the future. I began in the field working as a residential counselor. I soon realized that upper management only cared about the bottom line, how much money can we make. This was working for a non-profit. To me that was just a label they put on themselves while they were being non-transparent about their finances and the company executives and board were making huge salaries, using company vehicles, company cell phones, getting free health insurance, dental benefits, retirement accounts, 401K’s, and many other “fringe benefits”. The company leadership pretended to care about the employees all the while they really could care less. They would cut your pay, ask you to work more hours, take on 2-5 job responsibilities because of 3-4 vacant positions in your program and never say thank you. I got attacked by a client and how did they respond, they plotted a plan to fire me the day I return to work. The plan got to me by fellow employees because the upper management was so happy to brag about their plan to fire a hardworking employee who did so much for them. I was awarded a State Senate Citation and a State House of Representatives Citation but from them all I got was threatening phone calls after I got injured. This is the problem, the problem is that the companies care only about the bottom line……..
Perhaps we shall call it the “Physician Happiness and Wellbeing Program” or the “Caring for Physicians Happiness and Wellbeing Program”
Maybe you could come up with a better name…..
This covers all aspects of what we want for our physicians. The word Wellbeing is defined below….
well-be·ing
ˈˌwel ˈˌbēiNG/
noun
the state of being comfortable, healthy, or happy.
We want our physicians to both feel happy and well at the same time, isn’t this correct?
I look forward to seeing more posts on this topic.
I think it’s because wellness committees make “wellness” a duty, and suck all the fun out of it. I throw their stuff in the same wastebasket as the Fitbit our post-horrible-bicycle accident CEO gave all out silverbacks for Christmas, the mandates that our staff wellness program hands out (I opted out and it costs me 40$/month), and the woman at my church who says “We MUST be joyful!” in the grimmest possible tone about once per week. Never been nagged to be joyful before. I am not an MD, but am amazed at how many I know are so earnest and so grim and unhappy. when I can’t afford to retire from my day job, they will be dead, the poor things with the clenched jaws and sad eyes.
As a Psychiatrist in solo private practice, I have watched the largest hospital system in our city
develop “wellness” programs for practically everyone – yet, people who are anxious, depressed,
demoralized, fearful, hypodopaminergic (thanks to all the SSRIs increasing the amount of
everyone’s friend serotonin which in turn shuts down the release of dopamine – and then of
course the individual is convinced that they have ADHD and need Adderall – “ADD for all” –
amazing how they name these drugs!), lost, and usually addicted are flocking to my practice
in a steady stream even though I accept no insurance reimbursement – cash or card at time
of service. And many have been through wellness programs without any improvement. Until
we get real and stop thinking wellness is a combo of honor, wealth, pleasure, and turning the
age clock backwards, nothing will change. I wish you luck –
Geoffrey M. Gabriel, MD, FAPA
Greenville, SC
Physician wellness programs have been around since I was a resident. I am now within a few years of retirement. The prevalence of burn-out has gone up exponentially despite their efforts. Physicians now have responsibility without autonomy, and that classically aligns with high job stress.
Want less burn-out? Make the job suck less.
LOVE this thread! Why do humans do anything? The ultimate goal/state of being we all hunger for, even live for and are willing to die for, is to be happier. We seem to think that external conditions are key; the right job, right mate, right salary, right president will unlock the doors to our happiness.
In truth, happiness is an inside job. I love Mark Twain’s comment (at least I think it was Mark’s, or perhaps AL deserves the credit), “A man’s about as happy as he makes up his mind to be.” It seems that if one waits for things to be “right” before one will allow one’s own happiness, one will never be happy.
All of us every day, doctor, patient, caregiver, carereceiver (knew spellcheck wouldn’t like that one,get to choose happiness each and every day. A question worth pondering, “What can I do, think, or say in this moment that increases happiness? My happiness or another’s?” What if we all decided to become a happiness vector?
I’m certainly a fan of exuberance for doctors and non-doctors but I think first we might start with happiness. In case you’re not familiar, Harvard completed a 75-year long study to research the key(s) to lifelong happiness and what they found was a consensus that CONNECTION was the key to happiness. The reference is a book, Triumphs of Experience: The Men of the Harvard Grant Study. Call it what you will but IMHO the key reason why “wellness programs” do not work is because none address the root cause which drives most of human behavior which, once again, is CONNECTION. And connection has also been shown to be a primary driver of mental health and emotional well-being; two spokes of the wellness wheel that are grossly ignored. Not only are mental/emotional health ignored in wellness programs they are also virtually ignored in a doctor checkup as described in this post. Until we start to address the true root cause of behavior, including depression, stress and anxiety, little progress will ever be made. The real key is true connection and when 25% of Americans do not feel like they have anyone they can “go to” at any given time it’s no wonder people are struggling.
Being “well”, in contrast to being ‘healthy’, which involves some luck (genetics, environment, random chance) along with active participation in healthy living. The latter is mostly out of our control while a healthy lifestyle requires conscious decision and affirmative action.
I would much rather be healthy and well because “happiness” IMHO, comes from within rather than from one’s environment. Being healthy depends on many factors out of our control while being happy is primarily a result of our attitudes, expectations and our responses to our circumstances.