In the process of learning how to save lives, some residents feel they’re at risk of jeopardizing their own, or their mental wellness at the very least, says family medicine physician Frances Southwick, DO.
Dr. Southwick’s 2015 book, “Prognosis Poor: One Doctor’s Personal Account of the Beauty and the Perils of Modern Medical Training,” details her firsthand account of her residency from 2009 to 2013.
Sharing to help others
Dr. Southwick describes her training experience as traumatic and writes about an unrelenting workload, low wages, little to no sleep and trainees facing unrealistic expectations of perfection. During intern year, Dr. Southwick suffered a major depressive episode.
“I treated it with medication, which did not help, and therapy, which was not enough because I was not really permitted time to go,” she says.
Writing the book helped Dr. Southwick to evaluate her emotions and chart her journey.
Last year, the book was adapted into a 90-minute stage play by Building Company Theater in Camillus, New York, which is planning a 2019 tour of medical schools, residency programs and universities. An excerpt of the play, which also covers relevant moments in Dr. Southwick’s upbringing, is available here.
Dr. Southwick hopes the book and play will help other struggling residents who often feel isolated and don’t know where to turn for help.
In a 2018 Medscape report, 10 percent of residents surveyed reported feeling depressed most of the time, and 33 percent said they were depressed sometimes. Ten percent had thought about suicide.
Support for ‘Prognosis Poor’
Dr. Southwick says she’s received responses of gratitude from residents who’ve read her book and do not feel like they can speak for themselves. “Some swear me to secrecy or reach out for support when they don’t know where else to go,” Dr. Southwick says. “It’s rewarding and also sad.”
Some who have reached out to Dr. Southwick to share their praise have suggested that the book become required reading for medical students.
Several health care professionals gave “Prognosis Poor” five-star reviews on Amazon and provided their own take on the current state of residency training.
“I loved reading this book as it brought back memories of training that should be revisited if we are to improve medical education and the care of patients—and physicians,” wrote Pamela Wible, MD, who runs a blog, a suicide prevention hotline and a retreat for physicians, residents and medical students struggling with depression.
The book “shows tremendous personal insight and thought on the experience of going through medical school,” wrote Tyler Cymet, DO, chief of clinical education at American Association of Colleges of Osteopathic Medicine (AACOM). “It also provides thoughts on the areas of medical education that need to be done better.”
A personal story
In both the book and the play, the stories are personal and designed to inspire awareness and change.
“We don’t come out individually and say, ‘I have suicidal thoughts, or I have a drug and alcohol abuse issue or intimate partner violence issue.’ Whatever peoples’ weaknesses are, those are the things that tend to pop out,” Dr. Southwick says. “Personalizing the issue is the next step.”
Today, Dr. Southwick is a family medicine physician in Northern California, where she focuses her practice on osteopathic manipulative medicine, trauma and addiction. After finishing residency, she resolved to take steps to improve the system for future trainees.
“Residency shouldn’t be life-threatening or personality-threatening,” Dr. Southwick says. “Most people say they’re not the same person after residency. They’re dehumanized.”
In the book, Dr. Southwick suggests a maximum 60-hour work week for all residents and an opt-out option instead of an opt-in option for mental health services.
“Trainees need quarterly meetings with mental health professionals,” she says.
The current approved resident work-hour limit is 80 hours per week. However, the Accreditation Council for Graduate Medical Education (ACGME) recently embarked upon an aggressive path to address resident burnout and mental health, including the launch of a comprehensive tools and resources page for residents and faculty members.
Dr. Southwick is in a better place now. She says that her experiences during residency helped guide her search for a full-time role that fit her personal needs and professional goals.
“Professionally, I could not be happier. I work four days (40 hours) a week plus minimal time on call. My team at work is supportive,” Dr. Southwick says.
For life after residency, finding balance is key, Dr. Southwick says.
“Work after residency depends on what we sign up for. It can easily be overwhelming if we don’t know what we are looking for,” she says.
Dr. Southwick suggests evaluating your priorities and the perspective of the significant people in your life.
“Fortunately, my wife helped me remember what ‘normal’ is, so I didn’t jump straight back into the frying pan,” she says.