As pre-meds, we're always busy: jobs, studying, volunteering, research, shadowing, and much more. When there is always something that needs to get done, it is easy to develop the habit of classifying tasks into two categories: important and can do later. Of course, studying for your Chemistry exam and working on your personal statement are filed as important but this also makes it easy to file things such as self-care as can do later. This creates problems later on when the stress levels are high around finals and you haven't developed the habits of taking care of yourself. You are more likely to neglect the needs of your body and mind as well as possibly increase your levels of stress and anxiety.

If one does not learn the skills to nurture themselves before medical school, this high stress state of anxiety can also arise in medical school and could possibly lead to depression. According to the American Foundation for Suicide Prevention, medical students have 15 to 30 percent higher depression rates than the overall U.S. population. This can also carry into training as a physician. According to a five year cohort study and an anonymous survey, about 10 to 12 percent of physicians will develop a substance use disorder in their careers. This rate is consistent with or exceeds the rate of the general population. However, a 2009 study reported that medical students began their training with similar or better mental health than controls of a similar age. Thus indicating that the environment and process of medical training contributes to the increase in distress experienced by doctors and doctors in training.

So what is causing this stress in medical students and residents? The job itself. Some risk factors for mental illness during medical training include smaller support systems as a result of relocation and feelings of isolation from copious amounts of studying. Other factors also include lack of enough time for proper sleep, healthy eating, and routine exercise which together can culminate into deteriorating health and mental aptitude. In addition to facing these challenges, students and physicians face negative barriers in seeking help. A consensus statement published in the Journal of the American Medical Association stated that some of these barriers include discrimination in medical licensing, hospital privileges, and professional advancement. It becomes difficult for people to reach out and seek help for their depression when the threat of their success as a physician is at stake. In the same article, it notes, "The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide." Even though institutions are aware of the research that shows how medical culture can deplete some physicians and medical students through burnout, still not enough is being done.

So how are some ways that a pre-med can start practicing self-care to instill good habits for their future? Start by acknowledging that you are a person. As a person, you are a multidimensional being who needs to acknowledge all aspects of your being in order to find balance in your health and wellness. To use the six dimensions of wellness model created by Dr. Bill Hettler, a person is physical, social, occupational, spiritual, intellectual, and emotional. Take time each week to address each of these categories for yourself.

Physical

Partake in outdoor physical activities that you might enjoy such as hiking, kayaking, biking, swimming, playing basketball, or running - and take dogs along to add to the good vibes and dopamine flow. Don't forget that in order to take care of your mind, you also need to take care of your body.

Social

Take a friend with you when doing activities you love. This could include going golfing, going camping, taking a fitness class, going to brunch, or having a movie night. Humans are social beings so while it can be easy to retreat to a cave you have built and have almost established squatting rights with in the library, make sure to create meaningful and pleasurable interactions with other humans.

Occupational

This is the dimension of your wellness that you probably spend too much time on. This dimension recognizes the achievement one can receive through working. While working towards your goals is important, one should recognize that it is more beneficial to work in an environment that is more aligned with your own values than to be unhappy in a high stress workplace.

Spiritual

Try meditating to spend time centering your mind. Practicing mindfulness meditation could possibly be helpful. If you are religious or spiritual, spend some time in prayer or practicing some values of your faith that make you appreciate the beauty of your life. Reflect a little on your actions and reactions in your day. This can help you be more conscious of the effects of your actions and help you to be more intentional in them.

Intellectual

You already exercise your intellectual curiosity throughout the day when studying for classes. As you expand your knowledge in science, try to also do so in other subjects pertinent to society such as sociology, culture, public policy, and social justice. Stretching your mind in more than one way can help you become a more well rounded individual.

Emotional

I think this dimension particularly gets kicked to the curb. It can be seen that sometimes in the culture of medicine, to display emotions is to be weak. In some instances, it is not appropriate to put your emotions first; however, at some point, you need to properly address them in order to maintain a healthy emotional balance. One should be conscious of the emotions of others and themselves. Do not brush off emotions but be aware of them because doing so can help you connect more with others and help you express your feelings in a healthy manner.

In general, you should give yourself credit. With so many requirements to do well in as a pre-med, it can be difficult to not put yourself down but you must remember to maintain perspective. Make time for yourself to relax, don't isolate yourself when you are feeling down, and rely on your peers who are going through the same thing for understanding. Some day to day activities that you can do to maintain wellness can include setting an alarm for five minutes to stand up and stretch when you're studying. Do something everyday that affirms your sense of who you are as a person. Go on school sponsored medical school trips to help maintain drive. Shadow physicians to let you actually see what all your hard work is for. Doing these things is important but a key trick is to treat self-care activities just like you would with your work by specifically allotting time in your schedule to take care of your health and wellness. Doing this can make you feel less guilty about not working if you can see the value in your health.

When you start to feel like you're "wasting time" by going hiking instead of studying, don't forget about the many benefits that practicing self-care has. Taking care of yourself can improve your interaction and impact you have on others, decrease stress and burnout, increase your ability to empathize, and energize and sustain you. Practicing these habits can help you develop good habits for one day becoming a better doctor.

Though implementing these self-care practices can help you develop good habits to avoid intense burnout, it would be naive to think that this is the solution. Indeed, it's going to take more than deep breathing exercises to improve the mental health of doctors in training. I think that in order to help alleviate these issues, we need to change the culture of medicine. Instead of discouraging and penalizing medical students for seeking help for their depression or anxiety, we should encourage them to seek help. Students should be encouraged to have open dialogue on each of their struggles for solidarity to reduce their feelings of isolation and build a sense of community. We need to eliminate the stigma of mental health issues by incorporating education on it in curricula, organizing student clubs such as peer to peer counseling for peer support, and most of all, we need to recognize that physicians in training and physicians are humans just like the rest of the population. We cannot keep treating humans like robots and not expect for some aspect of their life to feel out of balance. I think it is toxic to create an environment where to be human is to be weak because doing so would be trying to go against our very own nature.

Above all, I think medical schools, residency programs, other medical institutions, and communities of healthcare providers need to implement programs that would encourage people to seek help, treatment, and social support on all levels. Anecdotally, implementing these programs would help people like an anonymous medical student who wrote about their struggles with depression and burnout on KevinMD.com,

But I am officially a statistic: one of 50 percent experiencing burnout; one of 15 percent with depression; not one of 10 percent contemplating suicide … yet. I don’t know what to do, where to go. I feel alone, yet I know half of my classmates are experiencing similar burnout...I don’t know how to explain myself, let alone ask for help; so I avoid conversation and rely on impersonal texting to communicate.

Implementing programs on multiple levels of medical training along with removing the stigma of mental illness and fostering environments that encourage students to seek help can help improve the health of the very people who provide us healthcare.