What I wish they had taught me in PA school

As I look back on my 16- year career as a surgical Physician Assistant, there are things that I wish would have been included in the PA educational curriculum.  These things are more intangible, however are just as important as anatomy, physiology, pharmacology, critical thinking skills, surgical dexterity, and the multitude of other skills needed to practice medicine.  I feel strongly that our schools gave us the tools with which to build our professional career, but failed to properly prepare the foundation for us to build upon.  

After using my tools to build my career–gathering experience, knowledge, and clinical pearls– the cracks in my foundation, that had started as early as graduation, started to affect me.   I began feeling like I was having to spend extra time and energy to hold up everything and keep it all in working order.  It was futile.  I felt trapped by the career which I had built.  I didn’t know what to do.  And then the day came where I succumbed to the weight of it all.  

I was severely burned out.

Here is where I found myself four years ago.  My relationships were crumbling.  I didn’t have any friends.  I was having health troubles that doctors couldn’t explain.  I hated going to work and was starting to slip and forget things at work.  I was cynical, exhausted, and wondering, ‘What the hell happened?”

Fast forward to now and I can see very clearly what happened.  Even though my intellectual brain was eager for all of the information and a career in medicine, there was another part of me that needed to be nurtured.  I needed a better understanding of the interconnection between my mind and body.

I wish my university would have included a course called,  “A Foundation for Wellness– How to Have a Long and Healthy Career in Medicine”.  

This course syllabus would look like this:

Brain Non-Evolution: 

Our brains are wired to see the negative in order to keep us alive.  You are wired to see threats, such as a lion coming to attack you. In modern medicine our threats are different, but equally ferocious: insurance companies not approving the treatment for our patients, argumentative patients, unattainable metrics, patient satisfaction surveys, along with difficult interpersonal relationships, and even fighting traffic on our way to work.  Medicine reinforces and actually rewards this wiring in our brain so that we can predict and avoid the things which may hurt our patients.  What I never knew was that this wiring eventually becomes our default based on our frequent usage. Therefore we start to only see the negative in our relationships, in our work, and in the community–all really without any conscious choice on our part.  

Thinking: 

Your thoughts alone can trigger your fight, flight, or freeze response, flooding your body with stress hormones all day, every day.  Thoughts centering around our worry, anger, and anxiety will release stress hormones just as if we are being chased by a lion.  Research has found that exposure to these stress hormones on a chronic basis correlates with damage to the cardiovascular system, a weakened immune system, metabolic syndromes, and sleep disturbances. 

Mental Health for practitioners: 

You will experience trauma.  It may lead to depression, anxiety, or PTSD.  Symptoms may include sleep disturbance, anhedonia (the inability to feel pleasure), increased irritability, and increased anger. It is not only okay to get help, it will not get better without help.  YOU CAN NOT IGNORE IT. GET HELP.

Healthy Boundaries: 

You need to set your boundaries early in your career.  If you answer emails after work, people are going to send you emails after work and expect a response.  If you never take vacation time and then ask for 2 weeks off, people will give you a hard time because you have trained them to depend on you being there.

The Gut Microbiome: 

This is your second brain.  The food you eat has a direct effect on your mood via the nervous system in which the gut talks directly with your brain.  Think twice about eating those sugar treats if you would like to feel happy. 

Self-compassion: 

We need to put an end to self-criticism. Research shows that people who have more self-compassion are more successful.  Flatulating yourself with sharp criticism does NOT make you a better practitioner.   

Guilt and Shame: 

Shame=you are bad.  Guilt=you did something bad.  This is very different and how you interpret your mistakes will shape your actions.  Shame needs to be spoken to in order to take its power away and not be hidden in silence.  Check in with a trusted individual often to voice what is inside.  This can be a close family member or friend, a colleague, or a licensed therapist.  Speak about it so that you do not have to carry it with you. 

Positive Psychology:

There are ten positive emotions that have been studied.  These emotions can help you rewire your brain from the negative default mode to a more positive default mode.  Just a few seconds a day (that is right– seconds) of joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe, and love can make a drastic difference in the chemistry of your brain.  

Scheduling downtime and playtime: 

Take every single hour of PTO you have. EVERY. SINGLE. HOUR.  Your body needs to reset, recharge, and relax. Research shows that play is just as important to the adult brain as it is for children.  It helps us see creative solutions and is not a “waste” of time.  

Sleep: 

This is the everyday reset for your brain.  If it doesn’t have an opportunity to reset, research shows that literally every cell in your body suffers. The result is an increased risk of cancer, cardiovascular events, and automobile accidents.  It is recommended to get 7-8 hours a night. This may not be possible all the time, especially while working night shifts, but prioritize sleep when you can.

Know your Core Values (and make decisions based on those values):  

If you value time with family, do not take a job that has you working 60-80 hours a week along with being on call.  If you are single and want to pay off student loans and retire early, working 60-80 hours at a high-paying job fits with your values.    If your values do not align with your work, you WILL get burned out.  

Mindfulness Meditation: 

Mindfulness strengthens pathways in your brain to help with attention control, emotional regulation, and self-awareness.   This practice can also help calm your body and mind.  

If “A Foundation For Wellness” had been even taught to me in PA school, I believe I could have avoided my crash course in burnout. I hope you consider adopting some of these practices to help you for years to come. I also hope that you pass this along to one of your colleagues.  I started my podcast, “Burnout: What I Have Learned So Far,” to help those who are struggling with burnout. 

My greatest wish is to help break the burnout cycle in medicine and shift the culture from one in which we simply survive to one in which we actually thrive.