Resident Corner: A Day In the Life


As a third-year psychiatry resident in at SUNY Downstate, a university hospital in East Flatbush, Brooklyn, most of my training time is spent working at Kings County Hospital (KCH), a large community hospital across the street from Downstate, serving one of the poorest neighborhoods in this rapidly gentrifying borough of New York City. I am confident that all of you must have either read or heard of “physician burnout.” Maslach and Jackson define it as “a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can occur among individuals who work with people in some capacity.” In health care settings, resident clinicians are known to be its most frequently affected victims and literature suggests highest prevalence in the surgical specialties. Although psychiatry is considered by many an “easy and relaxed” specialty, psychiatric trainees and other mental health staff are not immune to burnout. The assumption that mental health professionals can utilize their skills to handle and ‘cope’ with their problems is as wrong as thinking that oncologists have a lower risk of cancer.

I would like to familiarize you with a typical day in my life. My entire residency class has been working in the outpatient clinic since the beginning of the third year. We reach KCH by 8AM, spending 30-60 minutes commuting one way. We see around seven to 10 patients on any given day, some of them for weekly psychotherapy which requires a 45-minute visit. Our patients – mostly immigrants (sometimes undocumented) and citizens from low-socioeconomic status – present with a wide array of psychological, interpersonal, and socio-occupational problems. We all share the emotional “baggage” that our patients bring as in any human dyad transference, and countertransference is unavoidable. It is a challenge to maintain professional composure with our patients expressing suicidal thoughts and plans, mourning the death of loved ones, describing their traumatic events in grisly details, swearing at us, becoming increasingly animated and crossing boundaries in making threats and sexually provocative gestures. Apart from addressing their clinical issues, we perform the role of social workers and assist them in obtaining social security benefits such as housing, food stamps, employment and health aide services. In addition, rigorous documentation outreach phone calls to no-shows, liaison with insurance staff for pre-authorizations, pharmacies and patients’ families (to quell their anxieties), as well as mental and physical fatigue from excessive computer use can all make life quite difficult in the clinic. Apart from being tired, we often feel sad, angry, helpless, anxious, emotionally numb, disillusioned and incompetent. Some of us even experience nightmares involving our patients. There are numerous days when we feel completely drained and just want to go to bed after work. Based on an informal discussion with my colleagues, I estimate that 40% of us would meet the criteria for burnout.

All of us have our own ways of dealing with stress. We are a very diverse group of helping and caring residents who are always willing to support each other and lend an ear. I personally believe in the power of an popular Sanskrit verse from Bhagvada Gita that states: “karmaṇy-evādhikāras te mā phaleṣhu kadāchana mā karma-phala-hetur bhūr mā te saṅgo ’stvakarmaṇi,” which translates to “You have a right to perform your prescribed duties, but you are not entitled to the fruits of your actions. Never consider yourself to be the cause of the results of your activities, nor be attached to inaction.” Whenever I think about it, it provides equanimity and helps me to maintain a healthy distance from my patients’ stressors. I also unwind by listening to music and watching movies and TV shows. My classmates cope by going for personal psychotherapy, talking to friends and family, playing board games, watching funny videos on YouTube, cooking, exercising and taking vacations. They find these outlets rejuvenating and it gives them an impetus to continue their everyday work.

I would like to finish by confessing that not all our patient interactions bring negative emotions. Many of them fascinate us with their stories, inspire us with their resilience and reward us with their improvement. Despite the occupational hazards of psychiatry, there has never been a day in my brief career when I regretted embarking on this exciting journey that traverses the interface of medicine, psychology, neurosciences, sociology, anthropology, and philosophy. I feel extremely gratified and fortunate for being a lifelong student and practitioner of this subject.