A Call for Change: Fixing A Broken Medical Training System | Jake Goodman | TEDxUGA

[Music] thank you imagine you are sitting in a busy Airport to finish your Auntie Anne's pretzel avoid booms over the intercom now boarding flight 292 to Honolulu Hawaii you reach for your carry-on bag as the pilot and the co-pilot walk past you towards the gate agent you're struck by their appearance bloodshot eyes weary stride wrinkled uniform they look exhausted you're close enough to hear their conversation the co-pilot turns to the pilot and Whispers I've been working for 18 hours straight what about you 22 the pilot replies I am wiped out can't wait to get to Hawaii to grab some shut eye before tomorrow morning's flight do you think they have some Red Bull on board okay and seeing fortunately you will never be in this situation you see there are rules and regulations that exist that prevent pilots from working 24 hours straight in fact similar regulations exist for nearly every profession responsible for human lives but now imagine a scenario where you or a loved one are sitting in an emergency room maybe there's been a car accident or maybe someone's experiencing severe sharp chest pain you are scared and desperate but thankful that you're in a place where you can receive life-saving care in walks the resident doctor you see those same sunken eyes and disheveled appearance a look of exhaustion I mean this is the person you're relying on to make critical decisions to save you or your loved one there is no way that this person can be working for 24 hours straight right wrong in nearly every academic Hospital in this country it is not only legal for resident doctors to work 24-hour shifts and 80 hours a week it's accepted and at times even considered a right of passage my name is Jake Goodman and I'm a resident doctor you see I wanted to be a doctor since I was five years old the other kids they wanted to be Spider-Man or Cowboy or dig up some dinosaurs but not me for me it was always Jake Goodman MD I went to school for 22 years I earned three degrees two of them right here at the University of Georgia go dogs [Applause] and I dedicated tens of thousands of hours towards this dream and now as a doctor I help people rebuild their lives and improve their health and well-being I love being a doctor however I cannot say that I love medical training you see I have seen countless enthusiastic future doctors future healers enter medical training only to be broken down physically mentally and emotionally every few weeks I see a post on social media discussing how another Resident Doctor ended their lives by Suicide due to a culture that worked them to the Bone and silence them when they tried to seek help many future doctors believe that entering medicine will make them healers but the great irony is that medical training generates far more mental health sufferers than Healers but what if we could change our medical education system revamp it modernize it humanize it not only could we improve the health and well-being of resident doctors but most importantly we could dramatically improve patient care let's rewind for a moment out of 144 660 resident doctors in this country what makes me qualified to speak to you today about this important issue to answer that question let me take you back to January 26 2020 a chilly winter day in Athens Georgia on this day I launched a social media account called destination med school my goal was simple I wanted to document my journey in medicine in hopes of inspiring others but also shine a light upon the problems that exist in medical training when I first started my OG followers consisted of my parents a few friends and my girlfriend at the time now my wife as the months progressed the account grew and my mission expanded I posted about the rates of depression and suicide ideation in medical students I posted about the inequality that exists regarding the prohibited cost of medical education and in time I posted about a resident Doctor Who experienced depression while in training he shared his story to let others know that they're not alone and that taking medication or going to therapy for your mental health is a sign of a strength not a weakness that doctor was me today I've grown a community of over 2 million followers and supporters on social media and my videos have been viewed over a half billion times but this talk is not about me I am not here today to share my personal experience in medical training rather I'm here for the thousands of pre-meds medical students and resident doctors who have opened up to me over the years and shared their personal experience in medical training see I've heard their stories and I've come to the conclusion that there are three major problems that exist in medical training number one resident doctors are simply overworked and not given enough time to sleep or recover and as a result we have more medical errors and sub-optimal patient care number two medical training is a hierarchy that can perpetuate a culture of mistreatment emotional abuse and a fear of retaliation and number three trainees are afraid and at times dissuaded from seeking help for their mental health which causes more untreated mental illness let's take a closer look at these problems one by one first resident doctors are not given enough time to sleep or recover and as a result they suffer and patient care suffers 24 hour shifts 80 hour work weeks how did we even get here 's a brief history lesson see much of modern residency training is rooted in a program started by Dr William Stewart Halstead he was the chairman of the department of surgery for Johns Hopkins University in 1897 Dr Halstead introduced the concept of a formal residency trading program see back then resident doctors got their name because they lived in the hospital they were literally the hospital's residents they were working 24 7 365. Dr Halstead he had this reputation for being able to stay awake for seemingly days on end without fatigue and if he didn't need sleep his residence didn't either after his death it was uncovered that a cocaine addiction fueled his ability to work impossibly long shifts but by the time this became public knowledge his teachings had spread throughout the country up until the 1980s there were little to no regulation on Resident work hours however everything changed following the case of an 18 year old girl named Libby Zion see Libby presented to a New York hospital with fever and flu-like symptoms but hours later she passed away it's suspected that her death was caused in large part due to a critical medical error made by an overworked resident doctor working 18 hours straight later that year the Libby Zion law was put into place which created the first work hour restrictions for resident doctors 80 hours a week well it's been nearly four decades since then and residency training has largely maintained this status quo 80 hour work week today it is still legal and accepted for resident doctors to work up to 28 hours in a shift all Doc no all humans need sleep to adequately function and perform at our best I mean researchers have studied the effects of sleep deprivation for decades research shows that acute sleep deprivation causes physiological impairment in our bodies similar to being under the influence of alcohol no seriously being awake for 24 hours straight is equivalent to having a blood alcohol content of 0.1 which is above the legal limit to drive if it's not safe for resident doctors working 24 hours straight to operate a vehicle why would it be safe for us to operate on or treat a human being sleep loss has been shown to decrease concentration problem solving ability and memory recall and all of this leads to more medical errors a study at a Johns Hopkins found that up to 250 000 people die every year in this country from medical errors which would make medical errors one of the leading causes of death some people say 24-hour shifts are a rite of passage or a badge of honor but do you want to know the truth they are a recipe for disaster let's move to problem number two medical training is a hierarchy that can perpetuate a culture of mistreatment emotional abuse and a fear of retaliation I mean medical training is the ultimate hierarchy maybe you've seen this hierarchy play out on shows like Gray's Anatomy for example where the surgical interns they wake up at 4am they Sprint to the hospital they spend all day trying to outwork each other to get the best surgical cases all while being yelled at by their chief resident they get home at midnight and then somehow they repeat the cycle for years see the hierarchy of medicine it looks a little something like this you have your attending physician at the top they're the boss then you have your fellow your chief resident your senior resident your Junior resident your intern AKA your first year resident and down here at the bottom you have your medical student see Team culture in the hospital starts from the top it trickles down the tone is set by the attendance by the time attendings become attendings many have endured eight plus years of excessive work hours mistreatment from superiors and emotional abuse from those assigned to help them grow as young Physicians as the saying goes the abuse can become the abusers now let me be abundantly clear there are many attending physicians that walk with respect Grace and dignity for all their colleagues regardless of training level but survey any medical student or resident doctor and nearly every single one will have a story about a time that they were berated humiliated or belittled by an attending physician in medical training there's so much pressure and so little margin for error one mistake one slip up one negative evaluation from a superior and it can feel like your career is over I had a friend who told me that when she was in medical school she was working with a surgeon in the operating room who was making unwelcome advances towards her saying inappropriate things touching her in inappropriate ways I asked her why she never reported him she told me he's the head of the department he's writing my letter of recommendation for residency what choice did I have so what do you get when you take years of sleep deprivation and you sprinkle in a toxic culture of emotional abuse well that brings us to problem number three trainees are afraid and at times dissuaded from seeking help for their Mental Health Med students and residents we witness severe trauma I mean we see victims of car accidents we watch cancer destroy people no older than us and at times we tell family members that their loved one won't be returning home with them tonight there's no medical school lecture on how to grieve it's on to the next patient Med students in Residence experience rates of mental illness that far surpass the general population according to a study published in the Journal of the American Medical Association the annual prevalence of depression for Med students and residents is one in four one in four what's even more shocking is that one in nine trainees experience suicide ideation or thoughts of ending their lives one in nine I mean these are young dedicated people who came into this profession to become Healers and now they are contemplating ceasing their very existence leaving their careers their dreams their loved ones leaving everything behind why do only 16 percent of trainees with depression seek help one of the major barriers that prevents doctors in training from seeking help is the fear that they will be unable to receive their medical license in states that require doctors to disclose if they sought treatment for a mental illness let's touch on this point for a moment so after four years of college four years of medical school and three to seven years of residency training doctors are required to fill out a form to apply for their license to practice medicine this is a requirement in every state at first glance The Forum is pretty straightforward you're going to see questions like where'd you go to medical school and what was your residency training in but then in Most states you'll see a question that stands out from the rest it may be some variation of a question like this have you sought treatment for a mental illness what so if you were diagnosed with ADHD and started on medication is this something you have to report what if you sought treatment for depression after the loss of a loved one in residency would you have to report that due to the fear of checking that box and somehow jeopardizing their medical license most doctors in training never seek help at all they suffer in silence sometimes for years and some lose their lives the State Medical boards say that this question is there to protect the public but isn't the best way to protect the public to allow Physicians to seek mental health treatment when they are in need so here's the truth going to medical school and training to become a doctor has become an occupational hazard training that reliably sends one in every four members of its Workforce into a clinical depression is unethical and unsafe not only for resident doctors but for patients too so how do we fix a broken training model how can we create healers again let's start at the national level to improve access to care and lighten the load that resident doctors are currently burdened with we need more resident doctors and earlier this year Congress approved additional residency positions we are moving in the right direction but we need way more it's projected that the US will be short 124 000 Physicians by 2034. doctors in training also deserve access to mental health services without any fear a professional repercussions in March of 2022 President Biden signed the Dr Luna Breen health care provider protection act into law this is legislation designed to protect the mental health of medical professionals this law was named after and dedicated to Dr Lorna Breen an emergency medicine physician physician working on the front lines of the coronavirus pandemic who ended her life in part due to fear that she would lose her medical license after accepting mental health treatment we cannot wait for change to occur at the national level we need to act at the local level now as we speak resident doctors are unionizing due to unsafe working conditions compromising their health as well as the safety and care of their patients joining a union provides residents a voice it also gives residents the opportunity to fight for more Humane medical education no hazing no harassment no fear of retaliation perhaps the most important change comes at the individual level from all of us to the Future doctors and the future healers listening tonight let me speak directly to you for a moment you are the future of our profession take notes on those doctors you want to be like the ones that encourage and support those they've been granted the honor of mentoring equally as important take notes on those doctors you do not want to be like one day you will be in a position to create the type of learning environment that you wish that you had and you don't have to wait to be at the top of the hierarchy to make a difference I know many of you have no plan to pursuing a career in health care but one day you or somebody you love will be a patient and you may find that care is being provided by a resident doctor I hope this talk has given you an appreciation of the struggle that they face and if I can ask one thing of you it would be this take a moment to look a resident doctor in the eyes acknowledge their sacrifice and thank them One Voice alone is not enough to change medical training together we can shine a light on these problems in our medical training system and illuminate the path towards a brighter and healthier future for students for doctors and for patients for all of us thank you [Applause]

Channel: TEDx Talks

Views: 27,790

Keywords: Education, English, Medical research, Medicine, TEDxTalks, [TEDxEID:51602]

Id: 2lNk4Svcazw

Length: 18min 46sec (1126 seconds)

Published: Mon May 22 2023