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When Self Should Come First

By Caroline Trent-Gurbuz

Becoming a doctor — and a mother — had always been part of Kathleen Ogle’s life plan. As it turned out, her path to both goals included detours and roundabouts, divorce, financial struggle, and a devastating miscarriage, but she emerged. Furthermore, she emerged with a George Washington University (GW) School of Medicine and Health Sciences (SMHS) degree in hand, a laudable career in emergency medicine, and a healthy son, Kole.
“One of my more recent epiphanies,” says Ogle, MD ’08, assistant professor of emergency medicine at SMHS, “is that by having my medical education and training, I now have the resources to find little ways to take care of myself, and ultimately, that makes me a better mother. It makes me a better teacher. It makes me a better doctor.”

Illustration of female doctor with stethoscope

For a profession steeped in compassion, medicine tends to draw practitioners more inclined to devote their entire store of kindness to their patients, leaving little for themselves. SMHS, with support from faculty, students, and alumni, plans to change that.

A Balancing Act

In May 2008, Katherine Chretien, MD, associate dean for student affairs and professor of medicine at SMHS, was a new mother when she found herself gearing up for an additional “labor of love,” as she says: an online group blog, Mothers in Medicine, that could serve as a resource and community for physician mothers. In the years since, those blog posts — which now number in the thousands — have morphed into Chretien’s first book, “Mothers in Medicine,” a collection of essays written by clinician moms tackling every aspect of life, including work-life balance, infertility, divorce, childrearing, and support systems.

“I felt like [the blog] was such a treasure trove of advice, like there was gold in there, sprinkled throughout,” Chretien says. “The goal is to help women in medicine and to provide it all in one place.”

Terry Kind, MD, MPH, assistant dean of clinical education and professor of pediatrics at SMHS, whose chapter in the book focuses on answering common questions — “I’m a mother, should I go into medicine?” or its counterpart, “Can I go into medicine if I want to be a mother?” — found her answers in commonsense wisdom that both Ogle and Chretien echo: choose a specialty that inspires passion; ask and accept help from family, friends, and colleagues; and practice self-care.

“Physicians have a demanding, stressful job by nature. If the original ideals of why someone such as myself would go into [medicine] get squelched along the way, then it’s just stress and not the balance in the job itself of serving others,” she says.

Finding an outlet, whether it’s exercise, as Kind prefers, or taking a few minutes to sit down and have lunch, is crucial for not only mitigating stress, but also ensuring a healthy emotional balance.

“Having an emotional reserve and self-care is essential to doing your job well and still being invested without getting burned out,” Chretien says. “The importance of self-care and wellness, in all of medical education and medicine, is becoming more and more important and recognized as critical.”

Taking the First Steps

By nature, clinicians are prone to holding themselves to an impossibly high standard, one that the professional culture appears to uphold.

“We can tell our students as much as we want that it’s important for them to take care of themselves, but if they then go out on rotations, go out on the wards, and see people running themselves ragged and not stopping to have a bite to eat and getting home way after their kids are in bed on a regular basis, that sends a pretty clear message to them about what is expected and what is acceptable,” explains Kaylan Baban, MD, MPH, assistant professor of medicine at SMHS. Ideally, she adds, changing the culture among the faculty and alumni to one that emphasizes self-care as an important part of professionalism would spread virally and “benefit our students because they’ll see that role modeling.”

Effecting that kind of change — and ensuring that self-care happens on a daily basis, not just when it feels needed — can help slowly turn the cultural tide to one of more sympathetic norms. And it starts at GW.
Currently, there are numerous wellness programs that Baban, along with Ray Lucas, MD, senior associate dean for faculty affairs and health affairs and associate professor of emergency medicine at SMHS, is working to consolidate under one umbrella. Internal residents, for example, have participated in retreats and a lecture series on mind-body tools, and Baban, Chretien, and Cynthia Powell, MA ’07, clinical instructor of psychiatry and behavioral sciences at SMHS, are beginning to incorporate mindfulness, including personalized wellness and resilience action plans, into the curriculum for medical students. Chretien co-chairs the school’s Wellness Committee, which also has a student chair and is composed of dedicated students, staff, and faculty. Among their initiatives has been “Pumpkins and Pals,” when students brought in their dogs for an informal pet therapy session, and Chretien and other faculty have babysat students’ children so the budding clinicians could enjoy a night out, free of responsibility.

Wellness has also spread to the health sciences, with Howard Straker, PA-C, MPH, assistant professor of physician assistant (PA) studies at SMHS and a longtime practitioner of mindful meditation, folding mindfulness into the PA curriculum. His initiative is still in its early stage, but close to half of PA students have volunteered to participate in the five-session seminar.

“This generation of students understand the importance of health and exercise … but they haven’t necessarily added on the mental part to it,” Straker says. “Taking care of [yourself] is really important, and it has to be practiced because our natural inclination is to want to do something for other people.”

The MD Class of 1985 has also delved into wellness with the creation of its Wellness Fund, designed to support practicing and budding physicians. The idea sprang from the classmates’ 30th reunion, when a core group of friends realized that physician health was integral to caring for others.

“The class … has raised money, which has been used by the alumni foundation to fund some wellness projects, but we’re hoping to do more,” says Gail Rousseau, MD ’85, adding that the fund has also brought a wellness expert to GW. The steering committee also plans to launch a pilot program of medical and non-medical talks whose topics will include fly-fishing, medical missions in Africa, painting, and cross-country motorcycle riding.

“There is a real need for physicians to be healthy in order to have the personal resources to be able to help others,” says Rousseau. “We go into medicine because of altruism and wanting to give our all to help others, but it’s come at a cost. … We all have an interest in having physicians be healthy, happy, and productive, for the good of the individual and the patient and the good of society.”