Following suit after an AAS blog post from another former Vanderbilt General Surgery Residency graduate,1 I decided to base this post on what we call a “Tarpism.” Tarpisms are phrases stated (and often repeated) by former Vanderbilt General Surgery program director and poignant advice giver, Dr. John Tarpley. This one, in particular, has been on repeat in my head since my intern year: “Get in the habit of having good habits.”
In his address to the 1997 Vanderbilt School of Medicine graduating class, Dr. Tarpley stated: “A balanced life is necessary for the health care professional. Physicians are intellectual, physical, psychological, spiritual beings with nutritional needs, exercise needs, and sleep needs.” While it sounds like common sense, we surgeons often forget this simple fact. The path to become a surgeon is long. After studying our way through undergraduate training and medical school, we embark on 5 to 7 years of rigorous training. We find ourselves missing events – starting with happy hour with an old friend who is in town, then maybe an anniversary, or a child’s birthday. For many, this stressful career begins during young adulthood, when many of our colleagues are starting families. We promise ourselves that this is temporary and that there is a light at the end of the tunnel, making happiness a distant luxury.
But what is happiness? While it may have a different meaning for different people, happiness was defined generally by Aristotle as “human flourishing.” In his book, “The Happiness Advantage,” author Shawn Achor describes happiness as “an indispensable ingredient of our success.”2 His research demonstrates that positivity fuels productivity. Thus, the concept of working hard now to have happiness later in life actually limits one’s ability to succeed.
The benefits of happiness are boundless. Happy individuals have higher levels of productivity, higher levels of pay, are healthier (requiring fewer sick days), and have lower rates of burnout. In the past decade, the phenomenon of burnout has been explored within surgical specialties, and data suggest that burnout is highly prevalent amongst practicing surgeons, particularly those who are young and female.3,4 Based on studies involving trainees, burnout symptoms are a significant problem at the residency level as well. A high prevalence of mistreatment (such as sexual harassment, abuse, or discrimination) in training contributes to the issue.5
So how do we invoke the “happiness advantage” to reduce the rates of burnout in the field of surgery? In a study assessing the diagnostic ability of experienced physicians, those primed to feel happy prior to the exercise performed better than those given either no prompt or neutral statements to read.6 Importantly, the happy doctors exhibited less anchoring, or inflexibility in thinking. What is most notable in this study is that the doctors were primed with just a small package of candy. Thus, even a tiny morsel of happiness can go a long way. To create happier surgeons, we need to find a way to inspire and support their intellectual, physical, psychological, and spiritual well-being from the beginning. Interventions targeting stress-management, goal-oriented workloads, work-life integration, and others that may be part of the Wellness Toolkit proposed by the SECOND trial7 are a start. Coaching programs have shown promise and may be particularly effective in providing support for female surgeons in training who experience burnout related to moral injury, imposter syndrome, or the social pressure to “do it all.”8,9 A specific focus on improving the level of work satisfaction – to provide even the smallest amount of happiness – can go a long way.
Dr. Tarpley was spot-on with his target audience when he spoke the above-mentioned words: a graduating medical school class. This mentality needs to start early, and there is perhaps no place more in-need of adopting a positive mindset than the field of surgery, where stereotypes paint a picture of harsh, arrogant, or inflexible workaholics. As surgeons, I think we can all benefit by being reminded of his advice. It all starts with having good habits, which first and foremost means taking care of one’s intellectual, physical, psychological, and spiritual self. Only then can we be entrusted to take care of others.
- Snyder RA. Catching Flies. Association for Academic Surgery Blog. October 2021. https://www.aasurg.org/blog/catching-flies/. Accessed May 6, 2022. .
- Achor, Shawn. The Happiness Advantage: The Seven Principles of Positive Psychology That Fuel Success and Performance at Work, 2010. Print.
- Dimou FM, Eckelbarger D, Riall TS. Surgeon Burnout: A Systematic Review. Journal of the American College of Surgeons. 2016;222(6):1230-1239.
- Shanafelt TD, Balch CM, Bechamps GJ, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463-471.
- Hu YY, Ellis RJ, Hewitt DB, et al. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med. 2019;381(18):1741-1752.
- Estrada CA, Isen AM, Young MJ. Positive Affect Facilitates Integration of Information and Decreases Anchoring in Reasoning among Physicians. Organizational Behavior and Human Decision Processes. 1997;72(1):117-135.
- The SECOND Trial. Available: http://www.thesecondtrial.org/. Accessed May 12, 2022.
- Fainstad T, Mann A, Suresh K, et al. Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians: A Randomized Clinical Trial. JAMA Network Open. 2022;5(5):e2210752-e2210752.
- Sandberg S, Scovell N. Lean in: Women, Work, and the Will to Lead. New York: Alfred A. Knopf; 2019.