Getting to the root of historical wellness issues in the health-practitioner community

Chief wellness officer Melanie Lewis, Faculty of Medicine & Dentistry.

Chief wellness officer Melanie Lewis knows too well the individual stories of exhaustion and burnout that can accompany the journey through a career in the health professions. In her previous role as associate dean with the Office of Advocacy and Wellbeing, Lewis and her team met daily with learners who were struggling to stay afloat. It was at times an overwhelming job, she recalls, “trying to find solutions on an individual level to crises in well-being and engagement.” 

In that frontline role, much of the focus of the team was on helping learners build the kinds of healthy personal habits—diet, exercise, balance, practising mindfulness—so important to well-being. “These are lifestyle factors we as individuals have some control over,” Lewis says, “but it’s kind of the low-hanging fruit to tell a member of our community who’s in distress, ‘you just need to do more yoga.’ When you look at the research in terms of the issues that typically lead to burnout and erode well-being, most of the worst problems are systemic.” 

These days, as chief wellness officer and lead for the Health Promoting Work and Learning Environment initiative, Lewis’s focus is on those systemic foundations. Her role—the first of its kind in a Canadian medicine faculty—was launched last October by dean Brenda Hemmelgarn in response to one of several key recommendations for leadership in well-being, issued by the Association of Faculties of Medicine in Canada (AFMC) in the spring.  

There has never been a better time to embark on this path, says Lewis. For one thing, the pandemic has brought health-care professionals’ well-being into the spotlight like never before. “And,” she adds, “the research just keeps growing that shows depression, burnout and suicidality among physicians in particular is not getting better. So we need to do something different to move forward and bend the curve.” 

Doing something different will take time. It involves an in-depth analysis of existing systems, policies and procedures, with the ultimate goal of creating a more health-promoting working and learning environment for all members of our community.

No time like the present

One of Lewis’s most immediate goals is to determine which clerkship sites provincewide might need support in creating healthier learning environments. Beginning this term, “hot-spot surveys” will be sent to all undergraduate students at the end of their clerkships. These short questionnaires inquire about four key possible areas of concern—bullying, harassment, intimidation and barriers to inclusivity—that the students may have experienced or noticed. “The students are well-placed to be the sentinels,” says Lewis.

Formal feedback from those ‘sentinels’ will enable a proactive approach to problem-solving, “rather than waiting until the small flames become a four-alarm blaze,” she adds. Responding to that feedback, Lewis’s team will act as facilitators and collaborators, helping site leaders co-create the solutions that will support their own healthier working and learning environments.

Long-term goals

Lewis plans to eventually examine all policies and procedures in the faculty, in terms of both content and tone, “to make them as supportive as possible rather than punitive,” she says. This is a significant culture shift that will encompass everything from faculty promotion processes to learner/practitioner work-life balance.

In terms of promotion, there is much room for improvement in fairness and transparency in the process, says Lewis. In her own experience, “As a woman, trying to make promotion in the first six years of work, I was trying to build confidence, I had three children, I was sleep deprived—and I was supposed to have time and energy to devote to research in order to get tenure.” Medical school starts with a good balance of gender representation, but those numbers shift over time, says Lewis. “We need to put structures in place that support women and other underrepresented groups in advancing leadership roles.” 

And, when it comes to work-life balance for residents pulling long shifts, accommodations have not readily been made that might take into account the needs of someone on medication or with a fatigue-related condition such as a mental health condition, migraine, epilepsy or MS. “We don’t want our learners to have to go off their medications just so they can work all night,” says Lewis. “You can learn in different ways and we can restructure things so more work gets done on evenings or weekends, or whatever works for them. It’s just doing things differently and recognizing that’s OK.” We have come a long way over the past decade in recognizing appropriate accommodations, but we still have work to do. 

Overcoming barriers

“Medicine is a very traditional culture,” says Lewis. “We are not good at admitting our vulnerability and we’re not good at mentoring it. If established physicians boast about working 26-hour shifts through a divorce and other personal problems, there is no space for learners to be vulnerable and say they’re struggling.” And with high rates of suicide among medical students, residents and physicians, Lewis knows that the hard work ahead to shift those attitudes is crucial to the future of both the profession and public health. “When we’re not at our best, we don’t give the best patient care,” she stresses. 

While tradition is one roadblock, the very burnout Lewis is working to turn around also gets in the way of progress. She has already faced cynicism from exhausted colleagues who question, “This all looks good on paper, but is this role really going to have the power to change anything?” Lewis knows that she and her allies will have to produce tangible evidence of improvement in the coming months and years to win over those skeptics. But with the support of the administration—and of health-promoting colleagues like Rob Pauly, Helly Goez, Penny Smyth, Jonathan Choy and Cheryl Goldstein, all of whom are on her steering committee—she’s more than up to challenging the status quo and making bold changes. “I’m happy to make people uncomfortable if it’s for the greater good,” she says with a chuckle.

Reasons for hope

The culture shift needed to support Lewis’s work has already begun, she says. These days, people in the health professions are quicker to acknowledge their own humanity and be more open and honest about needing support. And when they do, there seem to be more and more peers and colleagues ready and willing to help. “There are so many incredible individuals who want to make things better,” says Lewis, both within the faculty and around the province in organizations such as Alberta Health Services, a valuable partner in her work. “There’s so much will to change things, and so many good ideas. We just have to harness that.”