It’s no secret that, on top of our demanding role as physicians, we as Black physicians face a multitude of challenges related to the experience of being Black in Canada.
This can range from constant stress from microaggressions and being looked over, to overt institutional or personal barriers to self-determination by way of insidious and overt racism.
With the continued developments of the COVID-19 pandemic and chapter of racial reckoning in the Black Lives Matter movement since Spring of 2020, more than ever before, Black physicians in Canada are under the pressures of their intersectionality. All the while, we continue to provide stellar care to our Canadian community. Given this, the BPC Wellness Committee advocates that now, more than ever, is the time to prioritize our own wellness.
A prominent cultural relic in medical education is that the less vulnerable we are, the better and “stronger” physician we can be. However, the stark opposite could not be more true: vulnerability dissolves the dichotomy between healer and patient and allows yourself to treat yourself with the same standard of compassion as your patients. This in turn permits you to take better care of yourself, and ultimately sustainably care better for your patients.
The Canadian Black Physicians Wellness Project is an ongoing effort to understand what we face as a community of physicians and to sustainably support us for generations to come. See below for ongoing initiatives and resources that can support us now, and make sure to sign up to the BPC newsletter to keep an eye out for upcoming BPC wellness events. Don’t see what you would expect or know of an initiative that could benefit all but is not reflected here? We would love to hear your voice to contribute to this evolving project and community!
- Dr Sydnee Burgess, MD, CCFP, MPH (Cand.), Wellness Committee Chair.
Dr Burgess keeping up
with self-care practice
The Canadian Medical Association Wellness Hub: the Canadian Medical Association recognizes there is need for a culture shift and we are at the beginning of a new age of how we think of wellness. Topics ranging from depression, burnout to managing families and workplace interpersonal conflict. They also feature a section on Physician Wellness during the Covid-19 pandemic.
Dr Nnorom, president of the Black Physicians Association of Ontario, discusses on this podcast with guests around navigating professional life as a racialized person
There are high yield topics discussed that do target Black Wellness in this podcast by ICU/Palliative Care Physician Dr Kyeremanteng. Also, hearing what our peers are pioneering in Canada to improve our system can in itself be a source of wellness!
A US based podcast and facebook group by Omolara Thomas Uwemedimo that focuses on wellness for Black Physician Mothers. It also captures eloquently the theme of practicing resiliency as Black Physicians and there are important takeaways for any parent and Black Physicians.
Psychotherapist Dr Joy Harden Bradford’s “Therapy for Black Girls” podcast has an interesting episode #146 on the particular challenges of being a Black physician.
Leading expert on this topic and author of Daring Greatly’s Brene Brown gives an introduction on the topic of Vulnerability and its contributions to living whole-heartedly.
We believe in putting the physician’s health first. Just like putting an oxygen mask on yourself first in case of emergency on a plane, the only way you can truly help others is if you take care of yourself first. In addition, we support the idea that you, as a physician, should aim to prioritize your needs first because of how much you already give to others: you deserve it!
Here are elements of a presentation on Medical Education and Burnout [permission was asked to Dr Darshan Mehta for this information based off his presentation in October 21st 2020 at the Herbert-Benson Mind-Body Medicine Summit]: Medical Students of racialized groups face higher rates of Burnout and Depression and lower quality of life overall during medical training[ 1]. It has been shown that when students experience intense continued stressors and pervasive perceived mistreatment, compounded with lifestyle and psychosocial sacrifices that would have otherwise supported them, there is a tendency to have significant elevations of depression and anxiety and a shift to a more cynical and hedonistic orientation. This ultimately is correlated to more aberrant and non-compassionate behavior as staff physicians. Ultimately what is protective against this is the concept of resiliency, or a person’s ability to adapt successfully to acute stress, trauma or more chronic forms of adversity. Resilient individuals are tested by adversity [3, 4].One proposed protective factors that promote resiliency are: Spirituality, Moral compass, facing fear, Optimism, Social support, Role models, Physical exercise and Mental exercise, or the concept of mindful awareness practice : “To become more aware of one’s own mental processes, listen more attentively, become flexible, and recognize bias and judgements, and thereby act with principles and compassion”. Cultivating these factors requires practice, mentoring and guidance, flexibility and acceptance, and meaning and purpose . One can envision their energy level as a tank of reserve, with forces that act as fountains to fill it or drain it. There is the tank of the day, or longer term like a year. While we cannot control everything, as the saying goes, wisdom comes from knowing what can be strategize around. For example, say you have a meeting with a person who absolutely drains your energy scheduled that day. Think to sandwich the encounter with a phone call to a friend before and a 5-minute walk or break afterwards, for example. Taking inventory regularly (every season, for example) of what feeds your mind, body, heart and soul and strategizing around them could be a key feature of building resiliency. This means that you have to deliberately and intentionally factor your well being into your schedule. Remember, there is no perfect wellness. It is an ever-continued practice to get nearer to a balance .
A eer reviewed article by Dr Mpalirwa reviews Black medical trainee experiences in Ontario:
Resiliency does not fall on trainees to accomplish alone: the responsibility to harbour resiliency is shared with educational institutions and society at large. While the American Medical Association recognizes this, there is still work to be done in the US and Canada alike .
1. DyrbyeLN, Thomas MR, EackerA, et al. Race, Ethnicity, and Medical Student Well-being in the United States.Arch Intern Med.2007;167(19):2103–2109
2. Wolf TM. Stress, coping and health: enhancing well-being during medical school.Med Educ. 1994;28(1):8-57
3. Feder, A., Nestler, E. & Charney, D. Psychobiology and molecular genetics of resilience.Nat Rev Neurosci10,446–457 (2009)
4. McEwen, Bruce S. “Mood disorders and allostatic load.”Biological psychiatryvol. 54,3 (2003): 200-7.)
5. Southwick and Charney. Resilience: The Science of Mastering Life's Greatest Challenges. 2018
6. Epstein RM. Mindful Practice. JAMA. 1999; 282: 833-839
7. Dunn, L.B., Iglewicz, A. & Moutier, C. A Conceptual Model of Medical Student Well-Being: Promoting Resilience and Preventing Burnout.AcadPsychiatry32,44–53 (2008)
8. Dyrbye, 2019. Downloaded From: https://edhub.ama-assn.org/ on 10/12/2020
Medical training can be the biggest challenge we face in our lives up until that point, with a minimum of 4 years of constant academic pressure and competition, long call hours during residency, and sometimes maladaptive educational environments in places where staff themselves are not prioritizing their own wellness. Black medical and residency trainees also face the subjectivity of evaluations, microaggressions and institutional racism that are present from day 1 of medical school. Imposter syndrome and burnout are common shared experiences during this time.
When you consider medicine as a profession, it’s important to be acutely aware of the bottom line: there are still currently many cultural caveats to the medical training and medical professional culture that can render someone unwell. Having a solid foundation in your own self-care practices and understanding your own wellness journey is paramount to a successful, sustainable journey through medical training as well as as a practicing physician.
The journey of being well starts long before entering medicine. Certainly, there is under-representation in medicine, and the Black Community would benefit from Black physician representation in the Medical Community, but from a wellness perspective, it is important to examine with the utmost integrity to yourself about whether medicine is right for you and the reasons why. Integrity is looking at this honestly, which will allow this to be anchoring during the challenges of Medical School and a healthy career in Medicine.
The basics of being well is about taking care of every aspect of self with its different dimensions.
Here are some suggestions:
o Sleep, exercise and nutritious food
o A practice like mindful movement or 5 minutes a day of meditation
o Being aware of your mental diet: what do you expose yourself at every hour of the day? How do you feel after an hour of social media or the news. Paying attention to what you are exposed to will help strategize more healthy overall exposure.
o Journaling. No one will go into your journal and gaslight your perspective. It is a healthy practice to affirm for yourself what you are experiencing
o Bringing awareness to your experience allows you to then make conscious decisions and strategize your life around your needs
o We all have different “sociostats”, or the level of introversion/extroversion and amount of socialization we need. There is nothing wrong with honoring your needs
o Reach out to people who fuel you or bring something positive to your life
o Setting boundaries with people. Saying no sometimes is saying yes to yourself
o Being part of something bigger than yourself is said to be a component of human fulfillment. What is your greater purpose with your time on Earth?
The decision to become a physician is a very personal one. Reasons can include wanting to help people in a direct way for a living, wanting to have job security, wanting to challenge oneself and become the best that we can be, or perceptions of prestige and success by society. Our expectations around what might be gained through a career in medicine must be examined carefully, as each of these aforementioned tenets can be a reality, but are also not guaranteed, depending on where your career takes you.
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