![\"photo](\"https:\/\/www.europesays.com\/uk\/wp-content\/uploads\/2025\/08\/ht-250820-archana-shrestha-120x156.jpg\")
Archana Shrestha, MD, MS<\/p>\nDuring her residency in emergency medicine, Archana Shrestha, MD, MS, would fall asleep at stoplights on the drive home after night shifts.<\/p>\n
Archana Shrestha, MD, MS<\/p>\n
\u201cIt happened a few times,\u201d she recalled. \u201cIt was scary; I didn\u2019t feel safe driving.\u201d To power through night shifts, Shrestha snuck in 2-hour naps beforehand.<\/p>\n
And maybe you\u2019ve heard something like this from a senior physician: \u201cIf you see a chair, sit in it. If you see a bed, sleep in it. If you see food, eat it. That\u2019s how you survive residency.\u201d<\/p>\n
Elsa Alaswad, MD, now a fourth-year neurology resident at the George Washington University School of Medicine, Washington, DC, learned that \u201crule\u201d from her cardiologist father. She trained herself to sleep when she had the chance. \u201cIt was untenable,\u201d she said. \u201cI wanted to quit so many times.\u201d<\/p>\n
![\"photo](\"https:\/\/www.europesays.com\/uk\/wp-content\/uploads\/2025\/08\/ht-250820-elsa-alaswad-120x156.jpg\")
Elsa Alaswad, MD<\/p>\n
Segmenting sleep was just one of several habits that Shrestha, Alaswad, and many physicians have internalized for decades. From stress eating to repressing emotions, Shrestha said she learned these behaviors by emulating senior residents, attendings, and peers. Transmitted implicitly, these values and habits are part of medicine\u2019s so-called \u201chidden curriculum.\u201d<\/p>\n
\u201cIt\u2019s ironic. You basically learn: Do no harm to the patient, but it\u2019s okay if you do harm to yourself,\u201d Shrestha said.<\/p>\n
![\"photo](\"https:\/\/www.europesays.com\/uk\/wp-content\/uploads\/2025\/08\/ht-250820-tania-m-jenkins-120x156.jpg\")
Tania M. Jenkins, PhD<\/p>\n
\u201cThere\u2019s an understanding within medicine as old as the Hippocratic Oath that the patient comes first, and you come second,\u201d explained Tania M. Jenkins, PhD, associate professor of sociology at the University of North Carolina-Chapel Hill and author of Broken Promises: Why So Many Physicians are Sick and Tired.<\/p>\n
Jenkins has interviewed hundreds of physicians about their work and heard the same refrain: \u201cThat translates to your own needs \u2014 drinking water, eating breakfast, getting enough sleep, or fresh air \u2014 being secondary to the patients\u2019 needs.\u201d<\/p>\n
The result is that young physicians ingrain unhealthy routines and, often, never give them up, even years into their careers. That is, unless they make a conscious shift in mindset. The first step is recognizing the unhealthy habits and behaviors frequently learned during medical training.<\/p>\n
The second step \u2014 well\u2026are you willing to do anything about it?<\/p>\n
Part 1: The Physical Toll<\/strong><\/p>\n Ultimately, medical training comes down to one word: endurance. That means learning to ignore your bodily needs, said Stefanie Simmons, MD, FACEP, chief medical officer at the Dr Lorna Breen Heroes\u2019 Foundation<\/a>.<\/p>\n Shrestha agreed, \u201cYou need to tough it out; it doesn\u2019t matter what is happening to your body. Whatever it takes is what is required.\u201d<\/p>\n Hydrating and urinating.\u00a0<\/strong>\u201cWhen a patient codes, you\u2019re not going to say, \u2018I\u2019m sorry, your intubation will have to wait 2 minutes while I pee,\u2019\u201d said Simmons, who once worked as an emergency medicine physician.<\/p>\n An unhealthy logic takes over: If I don\u2019t drink anything, I won\u2019t have to go. Unfortunately, as physicians know, urinating fewer than four times and consuming fewer than eight cups of water daily are risk factors for urinary tract infections, according to research<\/a>. Plus, dehydration can impair cognitive performance<\/a>, especially executive function and motor coordination.<\/p>\n Starvation or junk food.\u00a0<\/strong>During her second year of residency, Alaswad would work from 6 AM to 6 PM. Many nights, she\u2019d skip dinner and fall asleep, then leave for work the next morning without time to eat breakfast. \u201cI trained myself not to need consistent meals,\u201d she said. \u201cI would be starving a lot of the time, and when I\u2019d eat again, I\u2019d be ravenous. I would lose a lot of weight and then regain it.\u201d<\/p>\n During Shrestha\u2019s medical training, \u201cthere were always cupcakes for someone\u2019s birthday and doctors\u2019 lounges stocked with pastries and donuts,\u201d she said. Finding nourishing fare during night shifts, when the hospital cafeteria is closed, was even more difficult. \u201cStudents sometimes grab food at 2 AM from the vending machines or raid the nurse\u2019s stations for ginger ale and soda crackers,\u201d said Jenkins. \u201cThat\u2019s what\u2019s available.\u201d<\/p>\n As any primary care doctor will tell you, a lack of nutrient-rich food can impair the immune system and lead to headaches, dizziness, irritability, and even fainting.<\/p>\n Working through illness.\u00a0<\/strong>\u201cDuring my first 2.5 years of residency, I would get sick almost every 3-4 weeks,\u201d recalled Alaswad. \u201cNight shifts were brutal for my health.\u201d But she never took a day off. She didn\u2019t feel she could.<\/p>\n \u201cGetting sick doesn\u2019t mean getting to be home recovering. It means getting to work while sick,\u201d she said. \u201cBecause otherwise you\u2019re seen as the weak link who lets down their peers. It\u2019s hard to prioritize yourself when calling out sick means someone else must carry your load. There is simply no wiggle room.\u201d<\/p>\n Can You Fix It?<\/strong><\/p>\n The obvious fix is a series of tricks designed to make healthy choices easier or automatic: an apple or a bag of nuts in a coat pocket, exercise snacks, carry a water bottle, duck in a bathroom anytime a 2-minute window opens. You\u2019ve heard them all before: This is a healthy lifestyle via opportunism.<\/p>\n But in the end, even if you remedy the physical toll \u2014 and some do \u2014 what are you fixing?<\/p>\n Understand not just what you learned, but how you learned it. Gutting it out, pushing through, demanding more from your body, and then pulling it all off\u2026that\u2019s an accomplishment. A lot of physicians value that accomplishment.<\/p>\n Working to eliminate this entire aspect of physician training requires a mindset shift, said Shrestha. And often that requires help. She spoke from personal experience. A few years ago, Shrestha began exercising and seeing a nutritionist to address her own weight gain. After improving her health, she became a certified wellness coach to help other doctors do the same. She founded the Mama Docs School<\/a> and is also the chief wellness officer at Physician Wellness Solutions<\/a>.<\/p>\n You are a physician, she said. What\u2019s really driving your self-neglect? Are you willing to seek the help you need?<\/p>\n Part 2: The Psychological Toll<\/strong><\/p>\n Medical trainees absorb psychological habits as well, which are often rooted in the culture of physicians as stoic and self-sacrificing, said Jenkins. These can be even more damaging than bad physical habits because they can in themselves take a physical toll.<\/p>\n Isolation.\u00a0<\/strong>Isolation can contribute to depression, according to research<\/a>. But many trainees don\u2019t have time or energy to socialize. A common result is impaired personal relationships. \u201cIt\u2019s a cycle of social isolation,\u201d said Alaswad. \u201cYou\u2019re isolated because of your work hours. And you\u2019re too tired to see friends on the weekends \u2014 instead, you just want to sleep.\u201d<\/p>\n Many medical students even avoid study groups, said Christen C. Hairston, PhD<\/a>, associate dean, Center for Holistic Student Success, Emory University School of Medicine<\/a>, Atlanta. The reason: They don\u2019t want peers to witness them not always knowing the answers. So, they cram alone. Now that medical schools don\u2019t always require students to attend classes, this isolation has become more acceptable, she added. \u201cBeing alone on a laptop is part of the culture now. It\u2019s a lot easier to appear connected even if you\u2019re really suffering.\u201d<\/p>\n Repressing emotions.\u00a0<\/strong>Shrestha recalled feeling surprised when a med student once started crying after a patient\u2019s death. Then she took a step back. \u201cI realized this med student was having a very normal human reaction to death. What was surprising was my surprise. I realized how much I had numbed myself. I\u2019d gotten good at stuffing down emotions as a self-defense mechanism.\u201d<\/p>\n Repressing emotions can feel necessary in medicine, especially during residency, said Simmons. But many doctors continue to hide even severe emotional distress. On licensing forms, applicants must disclose their personal experience with mental health struggles. If they admit such history, there\u2019s been a \u201cprofound lack of transparency\u201d around the consequences, she added.<\/p>\n The result is medical trainees who are suffering but feel they cannot get help. If they do seek treatment for mental health issues, they sometimes pay out of pocket for sessions or see providers in different health systems, as Jenkins has observed during her research.<\/p>\n Not to mention, getting help can be logistically challenging. \u201cResidents are constantly being evaluated,\u201d said Hairston. \u201cEveryone is watching you all the time, and you want to show up in the best possible way. You don\u2019t want to lose time in clinicals to go to a mental health appointment. Students get a half day for wellness sometimes, but that\u2019s for everything they must do, including laundry,\u201d she added.<\/p>\n![\"photo](\"https:\/\/www.europesays.com\/uk\/wp-content\/uploads\/2025\/08\/ht-250820-christen-c-hairston-120x156.jpg\")
Christen C. Hairston, PhD<\/p>\n![\"photo](\"https:\/\/www.europesays.com\/uk\/wp-content\/uploads\/2025\/08\/ht-250820-stefanie-simmons-120x156.jpg\")
Stefanie Simmons, MD, FACEP<\/p>\n