Is it ok to take a mental health day off from residency?

[WiseOne]

What is your take on this?

Thanks.

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[agranulocytosis]

A what?

 

[WiseOne]

A what?

Using a sick day when you're not physically sick, but are using it because you're burned out, stressed, or having something affecting you/bothering you on a non-physical level

 

[NotAProgDirector]

It really depends upon the culture of your residency program. Either they support this, or they don't. All of our residents have personal days (on top of vacation days) that can be used for things like this -- you need to arrange coverage for any work that needs to be done, and you can't cancel patients in clinic. But if your program doesn't support it and you do it anyway, and it's discovered, you could be in serious trouble for abusing the sick call system.

 

[WiseOne]

It really depends upon the culture of your residency program. Either they support this, or they don't. All of our residents have personal days (on top of vacation days) that can be used for things like this -- you need to arrange coverage for any work that needs to be done, and you can't cancel patients in clinic. But if your program doesn't support it and you do it anyway, and it's discovered, you could be in serious trouble for abusing the sick call system.

Thanks. I'm on an elective right now so won't need anyone to cover me. At my program it's more frowned upon it seems when you are on a service that requires coverage like you mentioned.

 

[Mass Effect]

If you need a mental health day, I always advise to take it. If you don't have personal days, you should be allowed to use a sick day. Mental wellness is extremely important in training and does affect your work, just as a physical illness would.

 

[NITRAS]

If you need a mental health day, I always advise to take it. If you don't have personal days, you should be allowed to use a sick day. Mental wellness is extremely important in training and does affect your work, just as a physical illness would.

Some others might call it being self entitled snowflakes.

Yeah that’s probably what my old PD would call it.

 

[Mass Effect]

Some others might call it being self entitled snowflakes.

Yeah that’s probably what my old PD would call it.

Your old PD doesn't know what he's talking about.

 

[GoSpursGo]

Some others might call it being self entitled snowflakes.

Yeah that’s probably what my old PD would call it.

I have literally never seen someone use the word "snowflake" in a productive manner in a conversation. I even partially agree with your underlying point.

OP, each program is different, and importantly while you're on elective you need to actually show up a certain number of days to get credit and ultimately graduate. That said, if you're truly struggling mentally and it will impact your health or the care you deliver to patients, then I would encourage you to talk with your chiefs and let them know what you're going through.

Deciding on your own that you "need" a mental health day and NOT clearing it with anyone runs the risk of being found out, and generally is unprofessional. Only you can decide if you can't honestly discuss this with your program and need the day that badly.

 

[Dave1980]

If you call out you should tell them you are sick. Mental health days are not looked upon favorably.

 

[Piebaldi]

It really depends upon the culture of your residency program. Either they support this, or they don't. All of our residents have personal days (on top of vacation days) that can be used for things like this -- you need to arrange coverage for any work that needs to be done, and you can't cancel patients in clinic. But if your program doesn't support it and you do it anyway, and it's discovered, you could be in serious trouble for abusing the sick call system.

Not all programs have personal days which is a shame. Ours didn't.

 

[Piebaldi]

Thanks. I'm on an elective right now so won't need anyone to cover me. At my program it's more frowned upon it seems when you are on a service that requires coverage like you mentioned.

For me, I think it's important. Now if you are burned out and just need a day or so to just collect I think it's acceptable, particularly in an elective, or a situation where coverage is not needed. I think a lot of places do have personal days (our program didn't) and in those cases you can just take a day without having to explain anything.

 

[NuttyEngDude]

The culture of my program does not look favorably on it, but I am a proponent of it.

 

[Piebaldi]

The culture of my program does not look favorably on it, but I am a proponent of it.

Well then that's a tough choice to make. Not sure what to tell you. If you are having serious mental health issues though you need to address them. This is both for your own well being and for the well being of your patients.

 

[NuttyEngDude]

Well then that's a tough choice to make. Not sure what to tell you. If you are having serious mental health issues though you need to address them. This is both for your own well being and for the well being of your patients.

I'm just stating the culture of my program and my views on it. I was not disclosing the state of my mental status, but thank you. I think anyone who needs such a day should take it and consider it a sick day.

 

[Dr.LeoSpaceman]

I'd start at determining whether it means your work is going to get dumped on someone else. If so, then I think it's a bushleague move regardless of program policy.

Taking time for personal issues like doctors appointments or "real life" problems (closing on a house, etc.) is a different story. But it this situations, I also think it's appropriate to arrange them to impact co-residents as little as possible and wouldn't be talking about taking a whole day for something that might take 3 hours.

 

[Mass Effect]

I have literally never seen someone use the word "snowflake" in a productive manner in a conversation. I even partially agree with your underlying point.

OP, each program is different, and importantly while you're on elective you need to actually show up a certain number of days to get credit and ultimately graduate. That said, if you're truly struggling mentally and it will impact your health or the care you deliver to patients, then I would encourage you to talk with your chiefs and let them know what you're going through.

Deciding on your own that you "need" a mental health day and NOT clearing it with anyone runs the risk of being found out, and generally is unprofessional. Only you can decide if you can't honestly discuss this with your program and need the day that badly.

Hold on. The OP needs a mental health day and people make it sound like he's being gamey or duplicitous. If he had the flu, he'd call in sick, he wouldn't wait for someone to clear it so he can avoid an unprofessionalism charge. Mental wellness is every bit as important as physical wellness. This is the medical field. The sooner we realize that things like anxiety are every bit as debilitating as the flu, the clearer our collective conscience will be when we tell our patients it's okay to seek help for mental health issues.

 

[310prolene]

I don’t have an opinion one way or another about taking a “mental health day,” and I would agree that mental health is as important as physical health. However, I’m not sure that one single day will cure burnout. I think the natural course of an illness like the flu is different from that of burnout or stress. While a day or two off from work may provide opportunity to rebound from a physical ailment, I’m not so sure it would offer the same benefit to a burned out individual. He or she will come right back to the same job / environment. You may want look more closely on what is causing you this level of stress. Is there something you can change that may provide long term improvement?

 

[Raryn]

If you call out you should tell them you are sick. Mental health days are not looked upon favorably.

This.

If I were to call out for a mental health day, I'd claim I had some temporary but reasonably debilitating illness that should last 24 hours. Food poisoning works. Migraine + vomiting might be sufficient. But then I'd also be very careful not to be seen in public that day as well.

My program didn't require proof unless it was multiple days in a row.

 

[Piebaldi]

I'd start at determining whether it means your work is going to get dumped on someone else. If so, then I think it's a bushleague move regardless of program policy.

Taking time for personal issues like doctors appointments or "real life" problems (closing on a house, etc.) is a different story. But it this situations, I also think it's appropriate to arrange them to impact co-residents as little as possible and wouldn't be talking about taking a whole day for something that might take 3 hours.

It depends. And doctor's appts should be allowed time

Hold on. The OP needs a mental health day and people make it sound like he's being gamey or duplicitous. If he had the flu, he'd call in sick, he wouldn't wait for someone to clear it so he can avoid an unprofessionalism charge. Mental wellness is every bit as important as physical wellness. This is the medical field. The sooner we realize that things like anxiety are every bit as debilitating as the flu, the clearer our collective conscience will be when we tell our patients it's okay to seek help for mental health issues.

Agreed. And sometimes far more debilitating!

 

[Piebaldi]

This.

If I were to call out for a mental health day, I'd claim I had some temporary but reasonably debilitating illness that should last 24 hours. Food poisoning works. Migraine + vomiting might be sufficient. But then I'd also be very careful not to be seen in public that day as well.

My program didn't require proof unless it was multiple days in a row.

Same in ours. Some residents took advantage of this and would repetitively take off sick days in a row. I think after 3 days it was required to have a note.

 

[dpmd]

Hold on. The OP needs a mental health day and people make it sound like he's being gamey or duplicitous. If he had the flu, he'd call in sick, he wouldn't wait for someone to clear it so he can avoid an unprofessionalism charge. Mental wellness is every bit as important as physical wellness. This is the medical field. The sooner we realize that things like anxiety are every bit as debilitating as the flu, the clearer our collective conscience will be when we tell our patients it's okay to seek help for mental health issues.

I think you would find plenty of folks who wouldn't call in sick for the flu either due to how it would be perceived. Coming in and having your senior send you home because you look terrible is the more frequent way people dealt with it in my specialty. Not saying that is how it ought to be, but I wouldn't advise any surgery residents to call in saying they are taking a mental health day. I would guess that applies to some other specialties or programs too.

 

[GoSpursGo]

Hold on. The OP needs a mental health day and people make it sound like he's being gamey or duplicitous. If he had the flu, he'd call in sick, he wouldn't wait for someone to clear it so he can avoid an unprofessionalism charge. Mental wellness is every bit as important as physical wellness. This is the medical field. The sooner we realize that things like anxiety are every bit as debilitating as the flu, the clearer our collective conscience will be when we tell our patients it's okay to seek help for mental health issues.

I agree with you, but we're being realistic here that not every program is so understanding or considers it a valid use of a sick day.

 

[Mass Effect]

I think you would find plenty of folks who wouldn't call in sick for the flu either due to how it would be perceived. Coming in and having your senior send you home because you look terrible is the more frequent way people dealt with it in my specialty. Not saying that is how it ought to be, but I wouldn't advise any surgery residents to call in saying they are taking a mental health day. I would guess that applies to some other specialties or programs too.

But that's the problem with the culture of medicine and it takes people standing up and saying "hey, we're all human and we all get sick and we don't need to be taking care of sick people when we're sick" for the culture to change. That also means that we be decent human beings and we don't fake illness to skip out on work. Of course, that also means that we don't bitch and moan when our colleagues are legitimately sick and can't make it to work and we have to cover for them, knowing that when we're legitimately sick, our colleagues will cover for us. It takes decades to change the culture, but the last thing we should do is advocate for the same culture that was known to be unnecessarily harsh.

I agree with you, but we're being realistic here that not every program is so understanding or considers it a valid use of a sick day

But again, it's about changing the culture (and stigma of mental illness). If a PD lodges a professionalism charge against a resident for taking a sick day for debilitating anxiety, that's a fight the PD will almost certainly lose. We just live by the golden rule in medicine: "they can always hurt you more." And to what cost? We continue to push people through the system, telling them they have to do the very things trainees did 50 years ago when it's just not realistic.

 

[emergentmd]

I have worked since I was 15 yrs old. I have never missed a day at work in my life. I would never call in sick for residency. That is just how it was 20 yrs ago. I can't remember anytime when someone called in sick. When you call in sick, someone is doing the work for you and I just don't feel that this is right unless something really bad happened.

 

[enalli]

Hold on. The OP needs a mental health day and people make it sound like he's being gamey or duplicitous. If he had the flu, he'd call in sick, he wouldn't wait for someone to clear it so he can avoid an unprofessionalism charge. Mental wellness is every bit as important as physical wellness. This is the medical field. The sooner we realize that things like anxiety are every bit as debilitating as the flu, the clearer our collective conscience will be when we tell our patients it's okay to seek help for mental health issues.

I'm all for anything that helps prevent burn-out in medicine, which would include more personal days and vacations for times like these, but equating a "mental health day" to a sick day is ridiculous. If we're trying to make comparisons to organic issues, I would compare "I need a mental health day" to "I feel really tired", "I haven't been getting enough sleep", "I think I'm starting to get the flu", or "I have some indigestion"--all are real issues that affect one's life negatively, but I would not consider them as rising to the level of a sick day.

But again, it's about changing the culture (and stigma of mental illness). If a PD lodges a professionalism charge against a resident for taking a sick day for debilitating anxiety, that's a fight the PD will almost certainly lose.

Debilitating anxiety, panic attacks, suicidal ideation, etc. all sound like sensible reasons to take a sick day (or many); being "burned out, stressed, or having something affecting you/bothering you on a non-physical level" (as described by OP on his second post) do not. Those sound like reasons to take a personal day or a vacation.

 

[Dr.LeoSpaceman]

Let's stipulate that burnout is a problem in medicine.

That being stipulated it's also the case that "taking a mental health day" isn't a way to combat the issue of burnout. Burnout doesn't go away or improve because you got an extra day off. It's a symptom of systemic issues with a person and their work environment. A "mental health day" isn't going to address these issues in any meaningful way, and framing this discussion in terms of preventing burnout is therefore a red herring. It's a way to score cheap points on people who don't agree with the idea by retorting "You mean you don't think burnout is a problem?"

If there are people who have mental health issues for which they are actively receiving care, then yes it's reasonable they may have "sick days" related to their mental health. But someone without said condition saying "Man I'm stressed and need a mental health day" is trivializing the needs of the former group, while also dumping on their co-residents. Not a great combo.

 

[hallowmann]

In situations where you don't need coverage (i.e. a co-resident won't be called in to do your work), won't be seen out in public (please don't do this, people are almost always caught outside), and need a day to recharge, which may help prevent burnout, not necessarily "cure it" if its already full blown, then I see no problem calling in sick. I would also do just that, call in sick with something that will likely be resolved in a day.

My general rule is that if another resident has to do my work or get called in, then I don't take a sick day. I just don't, whether I'm sick or not. I power through unless I literally can't stand (happened once and was sent home by senior/staff). I've also never used up my 5 sick days/yr.

Thanks. I'm on an elective right now so won't need anyone to cover me. At my program it's more frowned upon it seems when you are on a service that requires coverage like you mentioned.

Sounds like you'd be fine taking a sick day, just don't be caught outside.

 

[Dave1980]

The problem with mental health days IMO is that you are either:

1) Really tired and need a day to sleep in and relax...taking a day for this is not appropriate.

or

2) Mentally unwell with real and problematic anxiety/depression...in which case one day off won't even come close to solving your problem.

 

[AMEHigh]

Of course if you’re having a mental health crisis or true debilitating "burn out" then one day off isn’t going to cure that.

But for me (who doesn’t have a mental health illness), sometimes 1 day to veg, clean/organize, get a doctor or dentist appt in that I haven’t been able to squeeze in, and reset is really helpful.

So yes I took a couple during residency by calling in sick (on days where it had no impact on other residents or attendings) and I have no regrets, and encourage other residents to do the same.

 

[Saddleshoes]

I am of the opinion that personal days, however used, are limited and are golden. I don't want to waste a personal day on "mental health"!

 

[Perrotfish]

Hold on. The OP needs a mental health day and people make it sound like he's being gamey or duplicitous. If he had the flu, he'd call in sick, he wouldn't wait for someone to clear it so he can avoid an unprofessionalism charge. Mental wellness is every bit as important as physical wellness. This is the medical field. The sooner we realize that things like anxiety are every bit as debilitating as the flu, the clearer our collective conscience will be when we tell our patients it's okay to seek help for mental health issues.

No one would have a problem with OP seeking help for mental health issues. If OP needed protected time to receive care from psychiatry, psychology, or a substance abuse program I think pretty much every program director would support that. If there is some kind of acute traumatic event (death in the family, etc) I think most program directors would be OK with a resident taking a day or two off. If, as part of a treatment plan overseen by a psychologist, OP needed to reduce work hours or eliminate nights for several months I think many (though not all) programs could even work with that.

However if 'taking a mental health day' means sitting on the couch and watching Netflix because you're burned out that's probably going to be perceived as just skipping work. And to be honest, if you do that chances are its not going to be just once. I wouldn't recommend it.

I am of the opinion that personal days, however used, are limited and are golden. I don't want to waste a personal day on "mental health"!

Many residencies don't have a set number of personal days. In my residency we had vacation days, and if we called in sick it would be on top of our vacation days and not made up in any way. Of course this meant the program took calling in sick more seriously than a program where the day is charged against your vacation.

 

[Dral]

It theory I agree with doing so with a caveat: The only time people use them is when they truly need it and are honest about it and truly work on thinking/meditating/exercising or whatever helps someone best deal with things.

On the other hand, I could take a mental health day and just play video games all day or goof off. I think the potential for abuse of the time off is why people may look down on it.

If it's a pre-determined number of personal days that everyone gets it, then sure...use it how you want it.

 

[FrustratedFamDoc]

Don't overcomplicate things. Take a rare sick day and stay home like everyone else does. Definitely don't do it on a call night, don't go on a bender, and be ready to start the next day at 100%. If you want to fall on your sword in the name of progress and tell your PD that you're taking a mental health day, be prepared to end up on the dreaded radar. It's not a good place to be, but we will enjoy reading your rant on SDN on how you have been unfairly targeted by admin.

 

[NotAProgDirector]

As a PD, I can tell you that this is a very complicated and contentious topic. What constitutes a reasonable request for a "sick" day is highly personal. As already mentioned, a "Mental Health Day" means different things to different people. To some, it's "I'm so tired I can't really function any more", and to others it's "The weather is going to be great, my sibling is in town, and I want to go golfing".

I have had residents call in sick because their child was ill and there was no plan when they couldn't go to school. Also had residents call in sick because school was closed due to weather. Once, the resident called in to cover had kids of the same age, but had made plans so that if this happened their kids had somewhere to go -- they were rather angry.

Personal days (which also count as sick days) tend to solve most of these problems. Everyone gets them. If you don't use them, you get to graduate early and have more time to move.

No matter what you do as a program, someone finds a way to abuse the system. The choice then becomes whether you want to make the rules strict enough to prevent the abuse (but also makes it hard for good folks to use), or live with the occasional abuse so that others can still use their personal days reasonably.

 

[dpmd]

As a PD, I can tell you that this is a very complicated and contentious topic. What constitutes a reasonable request for a "sick" day is highly personal. As already mentioned, a "Mental Health Day" means different things to different people. To some, it's "I'm so tired I can't really function any more", and to others it's "The weather is going to be great, my sibling is in town, and I want to go golfing".

I have had residents call in sick because their child was ill and there was no plan when they couldn't go to school. Also had residents call in sick because school was closed due to weather. Once, the resident called in to cover had kids of the same age, but had made plans so that if this happened their kids had somewhere to go -- they were rather angry.

Personal days (which also count as sick days) tend to solve most of these problems. Everyone gets them. If you don't use them, you get to graduate early and have more time to move.

No matter what you do as a program, someone finds a way to abuse the system. The choice then becomes whether you want to make the rules strict enough to prevent the abuse (but also makes it hard for good folks to use), or live with the occasional abuse so that others can still use their personal days reasonably.

Days off you can use at the end or get paid seems like it would help curb abuse at least compared to places that are use it or lose it.

 

[VA Hopeful Dr]

Days off you can use at the end or get paid seems like it would help curb abuse at least compared to places that are use it or lose it.

My wife's program had the latter, the extra grand or so with the final paycheck was nice.

My program did neither (in fact you couldn't take any time off the last 2 weeks in June) which, while irritating, since I'm FM really wasn't something any other doctor would have any sympathy for had we complained about it.

 

[hallowmann]

Personal days (which also count as sick days) tend to solve most of these problems. Everyone gets them. If you don't use them, you get to graduate early and have more time to move.

Yeah, we get 5 "personal days/sick days". If we don't use them, we lose them. No finishing residency early, no extra money. I do not consider taking a mental health day that doesn't affect coverage a problem, because almost no one ends up using all 5 days, but some certainly abuse it. If someone is truly sick and needs coverage, the person taking over gets owed a call day from that resident. Simple as that. That said, I wouldn't mind a little extra money for never using all 5 days/yr.

 

[GoSpursGo]

But again, it's about changing the culture (and stigma of mental illness). If a PD lodges a professionalism charge against a resident for taking a sick day for debilitating anxiety, that's a fight the PD will almost certainly lose. We just live by the golden rule in medicine: "they can always hurt you more." And to what cost? We continue to push people through the system, telling them they have to do the very things trainees did 50 years ago when it's just not realistic.

We actually DON'T continue to push people through the system. That's where the ACGME duty hour cap came from, that's where the maximum number of hours you can work in a row came from, etc. This happened because people who went through the system saw how bad it was, became PDs or chief residents, and decided to change the system.

That is where change needs to come from--PDs and chief residents. Maybe it doesn't move as quickly as we would like, but unilaterally deciding that you're going to take a mental health day is incredibly risky and probably not in the OP's best interests.

 

[GoSpursGo]

I have had residents call in sick because their child was ill and there was no plan when they couldn't go to school. Also had residents call in sick because school was closed due to weather. Once, the resident called in to cover had kids of the same age, but had made plans so that if this happened their kids had somewhere to go -- they were rather angry.

So I hear this, but at the same time not every situation is equal. Some people have family where they are doing residency, others are stuck on an island.

I know some programs have resources to help parents get short-notice childcare, but I haven't heard how successful/unsuccessful those have been.

 

[dpmd]

My wife's program had the latter, the extra grand or so with the final paycheck was nice.

My program did neither (in fact you couldn't take any time off the last 2 weeks in June) which, while irritating, since I'm FM really wasn't something any other doctor would have any sympathy for had we complained about it.

So ours capped the amount of time you could get paid for (can't remember if we had sick days on top of vacation that would accrue for the payout or not) however apparently the admin staff in our department never told hr about any time off so I ended up getting the full payout. This is on top of the fact that as chiefs we basically got June off (secret hush hush style so we were supposed to be available in case acgme showed up to check but most people who needed to move did so whenever they wanted). Even better was that i stayed on as attending and took July off (intending to use my accrued vacation hours) but ended up getting paid my attending salary that month and getting my vacation payout a few weeks later. Was awesome.

 

[Dr.LeoSpaceman]

So I hear this, but at the same time not every situation is equal. Some people have family where they are doing residency, others are stuck on an island.

The problem is that these situations are foreseeable. There will be days the daycare is closed and unexpected sick days. To not have a contingency in place (whether spouse, extended family, backup daycare, "sick kids" daycare, or nanny) is irresponsible. If it happens once, that's understandable. But if it becomes a habit, it's a problem.

 

[GoSpursGo]

The problem is that these situations are foreseeable. There will be days the daycare is closed and unexpected sick days. To not have a contingency in place (whether spouse, extended family, backup daycare, "sick kids" daycare, or nanny) is irresponsible. If it happens once, that's understandable. But if it becomes a habit, it's a problem.

Your spouse probably has an important job too. If you matched on the other side of the country from your family, you probably don't have extended family. I'm not sure how you think a nanny works, but it's not feasible to just have a nanny on retainer for random days.

Backup daycare and "sick kids" daycare generally is available based on whether your employer, in this case your residency program's hospital, has that available; if it doesn't exist it doesn't exist. But this discussion highlights how important these kinds of resources are. Or getting back to the OP's original point, personal days.

 

[Dr.LeoSpaceman]

Your spouse probably has an important job to. If you matched on the other side of the country from your family, you probably don't have extended family. I'm not sure how you think a nanny works, but it's not feasible to just have a nanny on retainer for random days.

Backup daycare and "sick kids" daycare generally is available based on whether your employer, in this case your residency program's hospital, has that available; if it doesn't exist it doesn't exist. But this discussion highlights how important these kinds of resources are. Or getting back to the OP's original point, personal days.

I have a kid. I'm familiar with how all of these things work, and they're all options my wife and I investigated before we had a kid. My spouse has a family-friendly job (which she specifically looked for) that is pretty flexible about these things. There's a "sick kids room" in our mid-sized city not affiliated with my hospital system. On-call nannies exist, and though while not ideal, can be used if all else fails. We have other friends in town that have kids with one stay at home parent whom (by prior arrangement) are our "last resort". And because we had a plan, we've made it through without me having to impose on any of my co-residents. Having this plan in place also has helped my own stress level.

Should programs strive to make things available to residents in these situations? Of course. But sitting around waiting for a program to solve your problem for you isn't the right answer either. Which is part of what annoys me about these discussions about burnout. We can agree that burnout is a problem, but avoiding it requires the individual to be proactive in developing strategies to help avoid it. These efforts should be facilitated and promoted by the program, but expecting it to happen without any individual effort is fairly entitled.

 

[GoSpursGo]

I have a kid. I'm familiar with how all of these things work, and they're all options my wife and I investigated before we had a kid. My spouse has a family-friendly job (which she specifically looked for) that is pretty flexible about these things. There's a "sick kids room" in our mid-sized city not affiliated with my hospital system. On-call nannies exist, and though while not ideal, can be used if all else fails. We have other friends in town that have kids with one stay at home parent whom (by prior arrangement) are our "last resort". And because we had a plan, we've made it through without me having to impose on any of my co-residents.

I think we're getting fairly far from the OP's original question. I'm glad that you have a spouse who can take care of a sick kid, and other resources that are not necessarily widely available or affordable.

In any event, again, there are a number of reasons why it makes sense to allot some number of personal days to residents/fellows.

 

[Mass Effect]

We actually DON'T continue to push people through the system. That's where the ACGME duty hour cap came from, that's where the maximum number of hours you can work in a row came from, etc. This happened because people who went through the system saw how bad it was, became PDs or chief residents, and decided to change the system

That isn't how it happened at all. The only reason duty hours was even explored was due to bad press after an 18-year-old girl named Libby Zion died and her journalist father blamed a tired and unsupervised intern for the death. That's how it started and it was against the objection of many of the old guard who argued that with duty hour restrictions, we'd have providers who are unqualified to become attendings. Changes were made despite these people, not because of them, and the world didn't end.

That is where change needs to come from--PDs and chief residents. Maybe it doesn't move as quickly as we would like, but unilaterally deciding that you're going to take a mental health day is incredibly risky and probably not in the OP's best interests.

We'll have to agree to disagree. For me, I make unilateral decisions all the time when they concern my health and being a resident wouldn't deprive me of my autonomy and my ability to recognize that *I* need a sick day. Yes, it's a calling, yes, it's a privilege. But at the end of the day, it's a job and if I need a sick day, I need a sick day.

 

[rokshana]

That isn't how it happened at all. The only reason duty hours was even explored was due to bad press after an 18-year-old girl named Libby Zion died and her journalist father blamed a tired and unsupervised intern for the death. That's how it started and it was against the objection of many of the old guard who argued that with duty hour restrictions, we'd have providers who are unqualified to become attendings. Changes were made despite these people, not because of them, and the world didn't end.



We'll have to agree to disagree. For me, I make unilateral decisions all the time when they concern my health and being a resident wouldn't deprive me of my autonomy and my ability to recognize that *I* need a sick day. Yes, it's a calling, yes, it's a privilege. But at the end of the day, it's a job and if I need a sick day, I need a sick day.

Lawyer father and it influenced initially NY to form the bell commission and duty hour limits were only for NYS programs...the ACGME didn’t adopt duty hour changes until 14-15 years later...there were plenty of discussion amongst the LCME,ACGME,IOM, etc about changes and input was not just from this case...which later was found that the pt had cocaine in her system and no one disclosed that she was taking an antidepressant that was CI with the meperidine she was given ...its thought she developed serotonin syndrome.
This article gives a nice timeline and what was involved introducing duty hour limits

https://www.nejm.org/doi/full/10.1056/NEJMsr1210160

This one is quite recent, though looking at patient safety perpective

https://www.nejm.org/doi/full/10.1056/NEJMoa1810642

 

[Merely]

wow, if physicians are making some of the comments above it is no wonder why suicide is an epidemic in this country..

 

[Mass Effect]

Lawyer father and it influenced initially NY to form the bell commission and duty hour limits were only for NYS programs...the ACGME didn’t adopt duty hour changes until 14-15 years later...there were plenty of discussion amongst the LCME,ACGME,IOM, etc about changes and input was not just from this case...which later was found that the pt had cocaine in her system and no one disclosed that she was taking an antidepressant that was CI with the meperidine she was given ...its thought she developed serotonin syndrome.
This article gives a nice timeline and what was involved introducing duty hour limits

https://www.nejm.org/doi/full/10.1056/NEJMsr1210160

This one is quite recent, though looking at patient safety perpective

https://www.nejm.org/doi/full/10.1056/NEJMoa1810642

Yes, I know the history. I said no one even explored it until this happened, which is true. It was only after the bad press that anyone even suggested such a change. It took ACGME so long because of all the in-fighting with people opposing the suggestion.

As for Sidney Zion, he started out as an attorney, but was an investigative journalist at the time of his daughter's death, writing for the New York Times from time to time. He pushed the bad press that followed Libby's death through his connections in the media and that's what ultimately led to changes in NY.

@Merely nothing said here has been out of line by any of the parties. Your comment confuses me.

ETA: @rokshana NYS duty hours weren't changed until the late 90s and the ACGME followed suit only a few years later. Also, pretty sure they did know about the phenalzine. They just didn't know about the interaction.

 

[enalli]

But sitting around waiting for a program to solve your problem for you isn't the right answer either. Which is part of what annoys me about these discussions about burnout. We can agree that burnout is a problem, but avoiding it requires the individual to be proactive in developing strategies to help avoid it. These efforts should be facilitated and promoted by the program, but expecting it to happen without any individual effort is fairly entitled.

What exactly do you think causes burn out if you claim it can be prevented by a single resident being "proactive in developing strategies to help avoid it"? I'd love to hear your proactively developed strategies to help avoid dealing with hostile patients, malignant attendings, 30+ hour shifts, etc.