National Academy of Medicine

100 Days of Rain: A Reflection on the Limits of Physician Resilience

By Miguel Paniagua
January 30, 2017 | Commentary

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By January 1999, it rained, they say, for over 100 days in a row; Seattle has a reputation for precipitation, which I have to believe could lead to higher rates of seasonal affective disorder and the need for strong coffee. It was during this month that I can say I may have reached my low point. I was a young, insecure, and nervous intern in the Harborview Medical Center intensive care unit that month—one in which our attending physician later admitted was the busiest of his long career. Myself and my senior resident, Phil, came to expect the admission of more than 10 critically ill patients every fourth night.

The idea of caps on resident duty hours has been studied and discussed since the early 1970s, and even in 1999 the 80-hour workweek was implemented, if not necessarily followed. But caps were not a term we used on-call—they were what our surgical colleagues wore in the OR (operating room), and what I wore on the rare off day I could attend a Mariners game.

Despite a deep-seated feeling that I was an imposter in such a well-regarded training program, I was always a relatively happy-go-lucky guy, who tended to be a shoulder to cry on rather than the one who might suffer from burnout. When two of my peers committed suicide in medical school, or when residency colleagues simply left the field, it seemed at the time more like the “cost of war” than a symptom of a bigger problem. But I was fortunate to feel reasonably well adjusted to the rigors that commenced at the beginning of my residency. I felt that 6 months in, I was hitting my stride. And then I hit a brick wall. Looking past recommended admission limits and duty hours was almost a sign of unspoken stoicism among our peers. I remember seeing a fellow resident during his on-call day on rounds being pushed around in a wheelchair, refusing to go home, with a 103° fever and rigors. Read more >>

This Perspective is written by members of the Global Forum on Innovation in Health Professional Education. To view more papers written by members of this forum, please click here.

100 Days of Rain Graphic

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Disclaimer: The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.