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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.
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.
Rishab Gupta is a third year resident in psychiatry at SUNY Downstate Medical Center in Brooklyn. He is also enrolled in a PhD in Neural and Behavioral Sciences at Downstate. He graduated from All India Institute of Medical Sciences (AIIMS), New Delhi in 2008. Being extremely interested in understanding human behavior since his medical school days, he joined Psychiatry residency at AIIMS in 2009. After finishing his training, he continued to work in the Department of Psychiatry at AIIMS as a trained psychiatrist. He is very passionate about academics and loves teaching and pursuing clinical research. He has presented his work at multiple national and international platforms and published numerous papers in different domains of psychiatry. Because of his unquenched thirst for learning he joined SUNY Downstate Medical Center as a Psychiatry resident in 2016. After graduating, he plans to pursue fellowship in Neuropsychiatry because of his active interest in disorders lying at the interface of Neurology and Psychiatry. He aims to be an academician and pursue research into the neurobiology of frontotemporal dementia, and psychotic disorder. When he is not in the clinic or learning psychiatry, he enjoys reading trivia, making jokes, doing social networking, trekking, listening to Punjabi music, and bingeing on various TV shows and movies.
Nwayieze Ndukwe
Dr.Nwayieze C. Ndukwe, MD, MPH, is a psychiatrist based in New York and New Jersey who enjoys exploring the interesection of mental health and popular culture. Dr.Ndukwe serves a associate professor at Mount Sinai Hospital systems in New York City and Mountainside Hospital in Montclair. Dr.Ndukwe was trained at Mount Sinai Beth Israel, and is board certified in Psychiatry by the ABPN. Dr.Ndukwe also holds a Master's in Degree in Public Health from Rutgers University.
Candace Good
Dr. Good specializes in college mental health as a staff psychiatrist at Penn State Counseling and Psychological Services. She is also the founder of Sig: Wellness, LLC, an integrative psychiatry practice in State College, PA. Her office includes a mind-body studio to encourage yoga, meditation, and other healing arts for stress management. The space serves as an incubator for other female wellness practitioners to grow their presence in the community. Dr. Good welcomes freelance writing and editing projects relevant to her specialty and blogs at https://howtoshrinkashrink.com.
Dr. Good is board-certified in both general and child & adolescent psychiatry. She maintains a clinical faculty appointment with the Penn State College of Medicine, where she also completed her medical degree and residency training. Over the past 15 years, her clinical work has included care of families in both rural and underserved communities as well as academic settings. Administrative roles have included medical director at the Western Psychiatric Institute and Clinic Center for Children and Families, vice president of Sunpointe Health, and both unit director of behavioral health services and department chair of psychiatry at the Mount Nittany Medical Center. In 2017, she was elected to the Board of Trustees of the Pennsylvania Medical Society (PAMED) and was recognized as a Distinguished Fellow of the American Academy of Child & Adolescent Psychiatry (AACAP).
Dr. Good enjoys knitting and spending time with her family, especially her daughter and rescue hounds, Abbott and Flip.
Dr. Chepke attended NYU School of Medicine and completed psychiatry residency at Duke University, where he also completed undergraduate studies. He is Board Certified by the American Board of Psychiatry and Neurology and is a Fellow of the American Psychiatric Association. He currently has a private practice in Huntersville, NC, serves as medical director for a level 3 residential adolescent treatment facility, and is an Adjunct Clinical Professor of Psychiatry for the University of North Carolina-Chapel Hill Medical School at the Charlotte Campus.
Dr. Chepke has particular interests in treatment-resistant/severe persistent mental illness, as well as patients with both psychiatric and neurological disorders. He is a member of the CURESZ Foundation Clozapine Experts Panel and Tardive Dyskinesia Experts Panel, as well as a member of the International Parkinson and Movement Disorder Society. He also emphasizes engaging his patients in psychotherapy and strongly encouraging integrative approaches including physical health and wellness through exercise and dietary modification and supplementation. Dr. Chepke’s research interests are in neuropsychiatry and drug metabolism/interactions and is currently a principal investigator for several clinical trials.
Nishi Bhopal, MD is Board Certified in Psychiatry, Sleep Medicine, and Integrative Holistic Medicine. She grew up in Vancouver and completed her undergraduate studies at the University of British Columbia. Her interest in medicine and love of travel took her halfway across the globe where she graduated with a degree in medicine from the National University of Ireland, University College Cork School of Medicine. She went on to complete her Psychiatric residency training at Henry Ford Hospital/Wayne State University and then a fellowship in Sleep Medicine at Beth Israel Deaconess Medical Center/Harvard Medical School. She now calls the Bay Area home and practices outpatient psychiatry in San Francisco. Dr. Bhopal is passionate about helping her patients find health and wellbeing through a combination of modern medical science and the wisdom of traditional eastern practices.
Dr. Nissa Perez completed her undergraduate work in psychobiology at UCLA and then obtained her medical degree from University of Southern California. She completed residency at UCLA San Fernando Valley Psychiatry Training Program and is a Board Certified Psychiatrist. She worked for one year as an attending in her residency program and has been in private practice for the last four and a half years, now in San Jose, CA. She incorporates psychopharmacology and psychotherapy into her practice and draws from multiple therapeutic modalities, primarily psychodynamic and mindfulness, but also incorporates cognitive behavioral therapy.
Dr. Perez is also an avid meditator and yogi. She meditates daily, regularly practices yoga and has attended multiple silent meditation retreats. She blogs at AMindfulMD.com.
Dr. Leslie Walker obtained her MD and MS (Neuroscience) degrees from the University of Michigan. She finished residency at Johns Hopkins Hospital in 2000 and has been in solo practice since then, first in Baltimore and then in Cleveland. She has particular interests in treating women as well as physicians, and for five years served part-time as the psychiatrist for the Women's Trauma Treatment Program at the Cleveland VA Hospital. She enjoys teaching residents and medical students at Case Western Reserve University School of Medicine, and she speaks nationally to physicians on psychiatric topics, work/family balance, resilience, and self-care. She is married to an academic neurologist and has one child in college and one in graduate school, making her officially an empty nester! Next goals: starting a blog and publishing a book.
Erik Messamore, MD, PhD is an expert in the fields of psychopharmacology, complex mood disorders, psychosis and schizophrenia.
He earned a PhD in neuropharmacology from Southern Illinois University and completed a Postdoctoral Fellowship at the Karolinska Institute in Stockholm, Sweden. He received his Medical Degree from the University of Illinois and completed a residency in Psychiatry at Oregon Health & Science University in Portland.
His current research is focused on characterizing the blood flow response to niacin among people with schizophrenia. This research may ultimately improve our ability to detect schizophrenia at its very early stages and to categorize psychiatric illness along physiological lines.
He currently serves as an Associate Professor of Psychiatry at the Northeast Ohio Medical University (NEOMED) in Rootstown, Ohio. He is also the Medical Director of NEOMED’s Best Practices in Schizophrenia Treatment (BeST) Center.
He is a seasoned clinician and accomplished scientist, with a passion for improving the lives of those affected by mental illness.