Lee A. Resnick, MD, FAAFP
Nothing like a frigid winter day to inspire a discussion on emotional well-being; the final reserves of endorphins and serotonin that I stored away for the winter are almost depleted, flu season is
upon us, wait-times are long, and everyone is cranky.
Times like these remind me of the importance of refueling the emotional tank.
This is not just a matter of feeling good, though that’s important, too. But physical and emotional fatigue are major contributors to burnout, medical mistakes, and lost productivity. As acute care practitioners, we are especially vulnerable to the ravages of job-related stress. Many of us are also loathe to admit we’re susceptible to its effects, however.
Ask yourself the following questions:
- Do you have a shorter temper than you used to?
- Do you feel the need to self-medicate after a shift?
- Do you have chronic pain or depression?
- Do feel energized in the morning?
- Are you still excited about medicine?
- Are you argumentative with patients?
- Do you have healthy hobbies?
- Do you get regular exercise?
- Do you carry a lot of physical tension in your body?
- Do you feel like you don’t know your spouse or children well enough?
If these signs of emotional fatigue and burnout apply to you, take action. So what can we do to improve?
Admit that you have a problem, even though acknowledging stress is affecting you can be the hardest thing to do.
Take a break! This is the most obvious thing to do, but it can be the hardest to validate. Start by giving yourself permission to take a break. If you can’t be away from your practice for long stretches, take at least one long weekend per month, with no phone calls, no patients, and no Blackberry. Choose calming activities, get outdoors as much as possible, and sleep as much as you can, day and night. Urgent care work is a cortisol binge, and we all know that cortisol binges are followed by cortisol crashes.
Reserve 30 minutes of “me” time daily. Physicians spend most of their time caring for others—on the order of 30-40 “others” per day, in fact. Add to that a spouse and kids who need your care, daily financial management, and home maintenance, and you’ll be lucky to have any time left for you. Your time is limited, but if you have no “me” time you will not have anything available to give to others.
Exercise! Sounds like mundane advice, but 30-40 minutes of exercise is the fastest way to boost endorphins, reduce ten- sion, and temper chronic pain.
Breathe! Diaphragmatic breathing exercises are the method of stress reduction most supported by the literature. Try it once and you’ll be convinced. It’s simple to learn.
Keep humor in your life! Laughter has more scientifically proven health benefits than almost anything other than exercise. Seek out humor in your daily interactions with your staff, your family, your patients, the cashier at the grocery store…. In a grumpy world, nothing has a bigger impact than making someone laugh!
Choose your battles. For some reason, stressed out doctors like to argue with people. Remember that anger is a notoriously bad motivator. Keep your eye on the prize; if your goal is to motivate change, find ways to recruit people. “Sell” them on your ideas, and you will have much less to stress out about.
Stress is a physiologic process governed by neurohormonal regulation; it has no shortcuts and accepts no excuses. Over time, the body becomes resistant to cortisol, requiring ever-greater amounts of stress hormone to fight everyday battles. Couple this with the cortisol crash associated with withdrawal and you have the physiologic recipe for burnout. Managing your stress more effectively will help you moderate the peaks and valleys of cortisol, which in turn will help mitigate withdrawal symptoms and promote a long and happy career in urgent care medicine.
