Mastering Well Being for Residents Physicians and Patients Takes Time

During this time of "value" focus, we have apparently replaced the temporary focus upon reflective practice. Recent patient care experiences confirm the value of reflection as there are so many dimensions of learning available, especially compared to the few via biomedical focus. Well being is about restorative time. Across residency training and primary care practice, there is an assault on this time and the value of such efforts. A major theme for practice or for patients or for those in training is the value of rest and reflection time.

The most important learning requires rest and reflection - and these require time. Well-being is compromised when rest, reflection, and sleep are compromised.

Too often it is easier to just work toward the end of the day. It is easier to speak too soon, listen too little, or jump to treatment as seen in too much medication. It is harder to insure best communication or to go the extra mile to impact the care experience of a child or a new parent or a suffering patient in need of support.

The research in primary care confirms movement away from support and more disruption of team members as well as increases in burnout and other consequences.

The research finally appreciates the complexity of primary care - finally. Given the three times greater contribution of family medicine toward care of the elderly, one would have expected this realization long ago. Higher concentrations of complexity in places and populations with  lesser resources add to the complexity and this is multiplied for family medicine physicians.

Family medicine needs to make a stand for better support for primary care and also for better support for residents.When this is something that we face and understand, we need to stand up and be counted.

The sad direction of Graduate Medical Education indicates a return to higher probability of sleep disruption. Even worse the focus has become reducing hand offs rather than improving team work and communication.

• Better team care, communication, empathy, and service orientation requires more support in the form of more team members and more colleagues to share the load. We should not tolerate designs for more to do with less support and more hours a day required with less sleep remaining and disrupted sleep patterns.

Primary care must have a better financial design. Graduate medical education has a better financial design and we should hold it accountable for better learning and better support of residents. Since we never stop learning, we should not tolerate distractions from this focus for residents and for our learning from interactions with our patients, team members, and communities.

Compassion, empathy, life-long learning, and the patience to deal with differences in languages, expectations, regulations, documentation, and health literacy require more support and adequate restorative sleep for the team members that work closest with patients. We require reflective time for what we do with patients, with our own families, and with ourselves.

The designs for residency and for primary care practice move residents and primary care physicians the wrong directions.

It is time to stop the distractions and focus on what is best for our well being as this is clearly what is best for the well being of our patients.