Caring for the Carers

Understanding The Best Medicine

By Dr. Ana María López, Dr. Carrie L Fisher, and Dr. Carrie A Horwitch


In this session, we discuss the current state of wellbeing in oncology care globally and the stressors that oncology providers and healthcare professionals face. We propose a framework to understand the connection between inclusion and wellbeing where inclusion leads to wellbeing which leads to quality patient care.


System based changes have been shown to have the greatest impact on clinician wellbeing, including initiatives that create flexible scheduling, reduce administrative burden, and increase time spent with direct patient care. Fostering a supportive atmosphere for healthcare professionals with mentorship programs, employee assistance programs, or other support programs help create an inclusive culture which leads to wellbeing.


We particularly bring attention to oncology fellow wellbeing, as there is a significant gap in the literature on fellows’ unique wellness needs compared to other career stages including medical students, residents, and faculty. Given smaller fellowship cohort sizes, they are more prone to feelings of isolation as well as difficulties with flexibility in their scheduling. Compared to the resident population, they are on average older and may have increased family responsibilities necessitating more flexible scheduling. They also may be prone to feelings of regret for continuing training which often comes with increased work hours and decreased compensation, when compared to their colleagues from residency practicing in internal medicine as faculty.


We propose ways for programs and institutions to improve wellness for the whole healthcare team, including trainees and team members that may be transitioning career stages. Initiatives implemented should focus on building physical, mental, and professional wellness. We will also practice learning a new, innovative technique that can help clinician well-being and also help patients. Literature has shown that laughter has positive outcomes on health including improving immune modulator function, reducing renin levels in patients with diabetes, improving pain, improving arterial compliance, reducing stress and anxiety, and IT’S EXERCISE, IT’S FREE and IT’S FUN. 


Author Bios 

Dr. Lopez serves as Professor, Medical Oncology and Integrative Medicine & Nutritional Sciences at the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, PA. She is board-certified in medical oncology and integrative medicine and has authored more than 100 peer-reviewed journal articles and multiple book chapters. Dr. Lopez has dedicated her career to addressing health inequities through health services research and community partnership. She is President Emeritus and Master of the American College of Physicians, a Fellow of the Royal College of Physicians in London, and a lifetime member of the American Medical Women’s Association.  


Dr. Carrie L Fisher is a current hospice and palliative medicine PGY4 at VCU. She serves as the first housestaff member on AAIM’s ASP fellowship committee where she has advocated for fellow wellness and initiatives fellowship programs can implement to improve wellness. She completed residency training in internal medicine at VCU in 2023. 


Dr. Carrie A Horwitch is an outpatient internal medicine physician with over 30 years of experience in general internal medicine, residency education and care of those living with HIV. She is also a certified laughter leader since 2007. She has survived three cancers and continues to thrive using laughter as one of her well-being techniques and teaching this skill to clinicians. She is the author of Death of My Uterus and Other Humorous Events. 


We have no conflicts of interest to disclose. 


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