“Always Events”: A Mental Health Checklist for Resident Physicians

Physicians are guided by the maxim, “First do no harm,” but many would benefit in extending that directive to “First do no harm to yourself.” Dr. Christine Moutier, Chief Medical Officer at the American Foundation for Suicide Prevention, provides a “Mental Health Checklist” in order to support resident physician well being without sacrificing patient care.

As physicians, we’re probably all familiar with the concept of Never Events: largely preventable incidents such as operating on the wrong limb or leaving a scalpel inside a surgical patient. The Never Events List helpfully formalizes certain procedures to keep accidents from happening, protect patient safety, and optimize clinical care.

We also know through research that there is an established link between resident physicians experiencing symptoms of burnout or depression, and making medical errors. Optimizing one’s mental health, therefore, and maintaining a certain level of well-being, is just as much a physician’s responsibility in terms of patient safety as marking off the correct body part before operating on it.

Hear what Dr. Moutier has to say about medical student mental health:

It’s hard enough, as residents, just to soldier on through the high pressure and long hours of a typical work week. We can’t reasonably expect ourselves, during ridiculously busy periods and at the height of exhaustion, to think about lofty “luxuries” of self-care. But, in order to keep functioning well and safely, we must maintain an adequate level of mental wellness. It therefore makes sense to have a Never Event-style “Mental Health Weekly Checklist.”

In the spirit of positivity, let’s think of this as The Always List.


… get enough sleep. Everyone has a baseline number of hours they need to keep cognition intact and frustration tolerance at a reasonable level. (For most, it tends to be six to seven hours.) Know your minimum healthy amount, and make sure you get it.

… make sure to get enough exercise. Physical activity – aside from running down a hospital hallway to your next patient – is indispensable to your mental health, as well as your physical health. Find a form of exercise that works, usually something you enjoy and can fit into your life on a regular basis.

… make time for loved ones. Connecting with friends, family, and other coworkers whose company you enjoy may seem obvious; but when you’re working long hours, it can fall by the wayside. Make sure to schedule time with the people who keep you sane. On the flip side, consider those people who are toxic to your mental health and establish boundaries or limit time spent with them.

… maintain a positive attitude. Being a doctor can do a psychological number on you: you’re held up in a position of authority, but that can ironically make you more sensitive to perceived slights. Think of it as a marathon. Do your best to let things roll.

… stay connected with a mentor. Another doctor who’s a bit further down the road on her professional journey can be more than just a clinical supervisor or reference for job opportunities. A mentor can advise you on the nitty-gritty aspects of work-life balance and your professional/personal goals.

… pursue outside interests. It may not feel like you have time for Juggling Club this week, but think of yourself as a smartphone with limited battery life, and certain extracurricular activities as a charger. You may need to figure out which activities serve as the best power charger for you: this looks different for each person. (If you don’t have any outside interests, consider this article a prescription.)

… find a way to process conflict. No matter how even-keeled you are, there are going to be moments as a doctor (and as a human) that you have to contend with troubling events. Whether it’s on the job or at home, come up with a clear-cut system that helps you deal with conflict, anxiety, and the messy, hard things in life. If you have trouble coming up with a tried-and-true method, meeting with a therapist to arrive at one is a good idea. Talking tough situations through with a trusted peer, mentor, or therapist is a powerful protector of well-being.  For others, journaling and other self-reflective activities can be effective.

…avoid an over-use of alcohol or drugs. Reliance on alcohol or any sort of drug is only a temporary Band-Aid™. Be honest with yourself: if you need to artificially alter your consciousness regularly, know that there’s sure to be an unpleasant wake-up call at some point that would best be avoided. Changing habits with drinking or using are often the first signs heralding significant slippage in mental health. (And also can clearly threaten professional licensure and safe practice.)

… keep an eye on nutrition. It’s so easy to grab a cheeseburger or other not-so-healthy food on the run. Whip up a giant salad over the weekend, or make a conscious effort to have some decent food options at the ready, so it’s just as easy to eat right when you don’t have time to think beyond junk food.

… maintain a sense of humor. It’s easy to “go dark” when you’re surrounded by illness, frustrations in the healthcare system, disgruntled people, and in some cases, cultures within the training environment that are less than respectful and compassionate. Figure out ways to maintain perspective, resilience, and optimism. Download some comedy albums for your commute; keep some episodes of “Unbreakable Kimmy Schmidt” at the top of your Netflix queue; and don’t fail to hone in those little moments throughout your day where something seems even just a little funny. Humor is all about perspective…which is a really effective and “higher level” mechanism to boost well-being.

Keeping your own weekly Mental Health “Always Checklist” handy, and using it as a guide for when your work life threatens to overwhelm your natural resilience, isn’t just for your own good. Proactively taking steps to ensure that you operate in a state of balance and mental stability is what’s best for your patients, and ultimately vital to your success as a physician.

Dr. Christine Moutier knows the impact of suicide firsthand. After losing colleagues to suicide, she dedicated herself to fighting this leading cause of death. As a leader in the field of suicide prevention, Dr. Moutier joined AFSP in 2013, and has revitalized AFSP’s Education team, re-launched its Loss & Healing department, and expanded AFSP’s support to include those with lived experience of suicide.

If you are in crisis, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255)

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