An alarming new report by Elsevier Health found that one in every four medical students in the U.S. has thought about quitting their studies. This is on top of the one in three physicians planning to reduce their work hours in the next 12 months and the one in five who plan to leave medicine altogether.
The Scope of the Problem
The Elsevier report includes more bad news. Over half of U.S. medical students plan to pursue healthcare careers that do not involve direct patient care. Globally, 60% of these students in healthcare are worried about their own mental health. This should concern not only those of us who teach or mentor medical students and residents; it should also concern anyone who wants to have a doctor in the next 10 years. The healthcare system is in crisis. According to Christine Sinsky, the American Medical Association vice president of professional satisfaction, “If even one-third to one-half of nurses and physicians carry out their expressed intentions to cut back or leave, we won’t have enough staff to meet the needs of patients.”
Other concerns cited by the more than 2,000 global healthcare students surveyed for the Elsevier study include financial pressures, work-life balance, the current pervasive culture of medical misinformation, as well as the shortages and burnout already being reported in our field. As a pediatrician, I am gravely concerned by these new statistics. As the writer-in-residence at a family medicine residency program leading narrative medicine workshops for residents, I think I have a solution.
What Is Narrative Medicine?
A narrative approach to the stressors affecting young doctors’ fears about their futures is within the capabilities of every medical school and residency in the country. Narrative medicine programs have been shown to build empathy, foster meaningful engagement, shape perspective, and offer a shared space where deep moral values are shaped and cultivated. All of this will sustain the physician when facing the moral ambiguities inherent in our work. Narrative medicine provides a regular forum where clinicians can share mutual struggles and find common solutions.
In my workshops with family medicine residents, sessions begin with a close reading of a piece of literature or a focused group discussion on a visual work of art. Close attention to detail of paintings increases powers of observation, an essential skill to bring back to the exam room. The reading of poetry and short stories develops the skills of empathy, deep listening, and mindfulness that will sustain physicians in challenging clinical encounters.
Next, we “write in the shadow of the art” as narrative medicine’s founder, Rita Charon, PhD, at Columbia University likes to say. I create writing prompts that are based on the literature we’ve just read and specifically designed to address issues the residents might be going through. For example, when one well-known patient of the residents died unexpectedly, we read Lucille Clifton’s poem, “The Death of Fred Clifton,” and then wrote in response to prompts designed to give residents a place to express their anger, helplessness, and grief. In July, when fourth year students are becoming attendings and medical students interns, we used Sionann Mastromonico’s poem, “Autumn,” as a jumping off point to write about the subject of transitions.
In the last exercise of the session, we share our written work with each other. Being vulnerable together, and sharing our most intimate thoughts and feelings in this safe space we have collectively created, fosters engagement and strengthens our relationships as colleagues. Together we are building a supportive community that will gird us against the stressors of the discipline.
Addressing the Larger Issues
To be sure, the complete solution to burnout requires buy-in from hospital management, health center administrators, and the upper echelons of our professional organizations. In fact, the CDC just rolled out a new initiative to support hospitals as they address physician burnout. Attention must be paid to structural issues such as patient panel size, adequate support staffing and time off, as well as appropriate autonomy in medical decision-making.
But personal attributes such as resilience, wisdom, creativity, and joy can all be enhanced by a narrative approach. The role of the humanities in medical education and its positive contribution to the medical workplace should not be underestimated. It just might be our way out of these astronomical levels of physician burnout and into a new way of finding meaning in our work and locating the joy in our jobs again.
Carolyn Roy-Bornstein, MD, is a retired pediatrician and the writer-in-residence at the Lawrence Family Medicine Residency program. Her new book, Writing Through Burnout: How to Thrive While Working in Healthcare, is forthcoming.
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