Dear MS1s,
“Golden Rule #1: Your priority is ALWAYS your own personal safety. Look around—assess for risks. Always WALK. Keep an eye open for changing conditions.”
These phrases flashed across the screen in Law Auditorium, bright text standing out against the background of a plain PowerPoint slide. Our entire class was sitting in the “Out-of-Hospital Emergency” lecture, a component of our first-semester Introduction to Clinical Medicine course that taught us how to respond to everyday emergencies outside of a clinical setting. The emergency medicine physician who stood at the front of the room emphasized, “You are of no use to anyone if you yourself become a patient or victim.”
In the midst of scribbling annotations on my iPad, I paused and suddenly lifted my pencil as a peculiar realization washed over me. While the physician’s words intended to apply to medical emergencies—injuries on the soccer field, broken bones in car crashes, heart attacks in the grocery store—I couldn’t help but see their connection to my own navigation of a critical learning curve in becoming a physician: caring for myself.
The first year of medical school was challenging not because of any single dimension alone, but because of their integration. Ironically, everything I had anticipated before starting at PSOM transpired. A health policy course in the business school, a social needs screening program at the children’s hospital, and research projects related to health economics and behavioral science filled up my fall. I dove headfirst into student groups and met with mentors with whom I had only dreamed of crossing paths at Penn. I went on runs on the Schuylkill River Trail, explored new restaurants with friends, and enjoyed frequent coffee chats in Rittenhouse Square.
I was energized by the projects I was pursuing and the people I was meeting, but this influx of opportunity made it too easy to enter a state of “volume overload.” Overwhelmed with excitement, it was tempting to say “yes” at the expense of sleep, healthy meals, or my favorite Schuylkill runs. As I started to notice how much I increasingly looked forward to my head hitting the pillow at the end of the day, I realized that I was trying to squeeze in too much. The balance between “range” (passing on a fellow PSOM student’s recommendation for David Epstein’s book) and my own well-being seemed to be teetering too close to tipping in the wrong direction.
Our Out-of-Hospital Emergency lecture snapped me back into reality. “You are of no use to anyone if you yourself become a patient or victim,” the physician repeated. A phrase I had jotted down during orientation back in August from Dean Albright returned to mind. “While pursuing the path of clinical training, do not lose what makes you you.”
Medicine is a demanding field not only because of its emotional dimension, but also because if we love what we do and view medicine as a true calling, it can become too easy to let it fill up every moment of our time. This is the concept of “Parkinson’s Law”: the notion that a task lengthens to fill the time allotted for its completion. If we allow our profession to fill every moment of our lives, it not only can—it will.
At the end of the day, while we are all passionate about our interests outside of clinical medicine, we also want to become the best physicians we can for our future patients, because they deserve doctors who are equipped to promote their health with clarity, competence, and compassion. This begins with taking care of ourselves. Think of Maslow’s hierarchy of needs—we cannot reach higher levels and care for patients without first attending to our own physiological health and safety. Self-compassion is fundamental to the delivery of excellent clinical care. You cannot pour from an empty cup—it’s simply impossible. Without a strong foundation of caring for ourselves, we cannot care for others.
After our out-of-hospital emergency lecture, I decided to practice my own form of “scene safety” through a re-institution of morning journaling (even if just for 10 minutes), twice-weekly Schuylkill runs, and a priority on sleep. Even though these changes may sound small, they made all of the difference in my ability to be present with patients in clinic, engage with my learning team in small group, and experience joy in my daily life.
MS1s—see if you can identify three concrete practices that you will prioritize to keep your cup of self-care full during the first year of medical school (or at the very least, not sloshing all over the place as my cup felt). Practicing these habits now will make it easier to maintain them going forward, because the demands on our time will only become more significant as we progress through training and into our careers. The following steps certainly aren’t “cure-alls,” and they are much easier said than done. However, even small changes can drastically improve our well-being, ultimately making us better students, clinicians, family members, friends, and human beings.
- Assess your current level of “scene safety.” Keep a log for a week—spend 5-10 minutes jotting down your thoughts and feelings at the end of each day. What activities or actions do you notice bring you energy and replenish you? When do you find yourself feeling depleted? These notes will be important for shaping your next action steps.
- Take care of your physiological needs— set time aside for sleep, meal prep, and exercise. These are the most fundamental determinants of being able to function at your highest level for your patients, their families, and your own loved ones. Prioritize these first before getting other things in order; according to Golden Rule #1, “Your priority is ALWAYS your own personal safety.”
- Attend to your mental and emotional needs. If you’re an introvert, block off a non-negotiable chunk of time on your calendar for reading, journaling, or enjoying a cup of tea and absorbing nature. Even if it’s just 30 minutes, this time will help to recharge you. If you’re an extrovert, schedule meals with friends, evenings with family, or a phone call with a close confidant. Time for these activities is productive, but it must be actively protected, or the rest of our work will fill to expand it—remember Parkinson’s Law.
- Cultivate authentic relationships. Process emotional experiences with colleagues and be intentional about time with loved ones. Humans are social beings, and we need each other to function at our best. Share struggles and best practices and lean on one another for support. Initiating self-disclosure can prompt colleagues to open up, strengthening your relationships in the process.
- Practice self-compassion. Above all, if you aren’t able to realize these goals, or if they seem too lofty or unfeasible, do not beat yourself up. Be kind to yourself and realistic in your bandwidth to make these changes. If anything, start small. Pick one tiny concrete change that you can make, starting from the bottom up. As you begin to “refill your cup” drop by drop, you will notice that you have more to give to your patients. Keep your cup full—remember, you cannot pour from an empty one.
Sincerely,
Aidan
Aidan Crowley is an MS2 at the Perelman School of Medicine.
