On airline flights, there’s a familiar safety instruction prior to takeoff: “If conditions arise causing the oxygen masks to deploy, you must put on your mask before assisting others.” I believe this same paradigm applies to medicine, as physician burnout escalates due to a complex variety of healthcare system issues.
The stress and pressure to see more patients in less time, perform more procedures, provide quality care, continuing medical education, and somehow enjoy our own lives can lead physicians to forget about their own health. This is prominent in what we all know to be the most important foundation of health, lifestyle as medicine.
Last year, my brother and I wrote a piece for MedpageToday about professional society guidelines for medical conditions affected by lifestyle. We pointed out that every expert-led analysis of the evidence shows that optimizing different aspects of lifestyle (dietary habits, exercise and physical activity habits, sleep patterns, and stress management) is the primary information we need to convey to patients. However, we ourselves often feel overwhelmed with the time constraints and lack of support, so we may have trouble emphasizing these lifestyle prescriptions to patients, let alone ourselves. I put a lot of effort into giving lifestyle advice in almost all of my appointments, even when it is unrelated to the reason the patient is seeing me. Even a brief mention or showing support for the patients’ healthy lifestyle efforts can have benefits.
In efforts to battle burnout, physicians must care for their own health and practice what they preach. This may seem daunting or even impossible, but it is essential not only for optimal survival, but in order to provide the best care for our patients. On top of that, there is evidence that physicians who practice good lifestyle habits do better with patients on those measures. So how do we do this?
As I’ve gone through medical training, married, and had two young children, I also have found ways of putting more on my plate in order to reach more people and contribute to causes that I think are important. I think of it as “reaching higher,” as Coach Dantonio of the MSU Spartans referred to it. However, I have a background that has prepared me to take on more and still preserve my health. As a Spartan wrestler prior to medical school, I found it easy and mandatory to focus on fitness and diet, since it was essential for optimal performance.
When I went to medical school, things changed and I had to adapt my healthy habits. I made them a priority and continued to focus on the quality of my diet, avoiding eating out too much, and I made sure I got to the gym on days I was not overwhelmed by classes or long hospital shifts. I also surrounded myself with others who shared and acknowledged the importance of supporting our own health through that journey. As a small group, we synchronized our gym time and got in about 3 to 5 workouts a week. Weekend mornings were usually guaranteed unless we were rounding at the hospital. During the week, any day that ended 4pm or earlier, we made it. As time has gone on, I have adopted a much shorter, but perhaps more intense, voluminous exercise routine that started in medical school for the sake of time management: hard but short aerobic warmups on the treadmill or elliptical followed by moderate to heavy weight lifting utilizing short rest periods. My weight lifting has always been simple. I use basic pushing movements (bench press, shoulder press), pulling movements (seated rows, pull-ups), and leg exercises (squats, deadlifts, leg-press, extensions/curls, calf raises). I use enough weight to make 6 to 12 reps difficult and keep rest periods short, sometimes using “strip” sets where I take weight off as I continue repetitions.
During residency, gym hours became more difficult to schedule but I always made sure to take advantage of any sudden time availability. If I tell my patients to find a way to exercise, then I must too. Earlier in residency, since I had to be at work so early, my exercise schedule was similar to medical school—afternoons when I could leave by 4pm, plus weekends. I usually managed 4 days per week. But by the end of residency, perhaps as I wore down, it was difficult to motivate myself for afternoon workouts. I am a bit of an early bird and coffee became my pre-workout supplement of choice as I switched to morning workouts, which I continue to do—with more full-body circuit training to get what I need while keeping workout time short, sometimes less than 30 minutes. Go hard, then go to work!
I married a nurse who shares these values and together we support our own health in order to promote it for our patients. The next hurdle was the most cited by patients, children. I had my son as a new staff internist and then my daughter near the end of my endocrinology fellowship. Certainly having kids adds extraordinary difficulty to an exercise regime. However, if I don’t take care of myself, what kind of role model am I for my kids? My wife and I continue to adjust our schedules along with the kids’ to get to the gym a few times a week, and we endorse the physical activity and sports of the kids. We take turns going to the gym early in the morning during the week while the kids are sleeping. After work and school, we make outdoor activity and play a priority as a family. On weekends, we will take turns going to the gym or we will include a family activity that is more strenuous, like long bicycle rides.
We also know how important diet is for the kids so we continue to cook our own meals just as we always have—exactly what I prescribe to patients. Some argue it is faster to eat out, but I disagree. Keeping it simple in the kitchen doesn’t require increased time and renders healthier meals with lower empty caloric loads than restaurant food. Over the years, we have put some recipe ideas on our DocsWhoLift website (here is a favorite: http://docswholift.com/leaner-lasagna/), but mostly we stick to simple concepts:
-We load up on veggies, salad material, and beans/legumes.
-Then a variety of lean protein sources from fish, poultry, lean beef, eggs, and dairy.
-Plenty of whole fruits.
-Fats are derived from whole foods such as nuts, olives, and avocados
We don’t buy much in the way of bread, pasta, rice, or other baked goods but do utilize some of the high-fiber, low-carb flat breads and P28 protein bread. We also don’t buy many sweets or salty processed snack items as the hyperpalability of those are hard to avoid at home.
We keep cooking simple but experiment with different seasonings and use added oils sparingly. My wife will prepare her lunches for the week on Sunday, emphasizing mostly sautéed vegetables with some lean meat like chicken or fish. For breakfast during the work week, I generally have coffee prior to exercise then have oatmeal with berries and simple whey protein + milk for breakfast. I have been fortunate to have healthy options for lunch at work and am able to load up on vegetables with lean meats while we snack on nuts, fruit, and sometimes protein shakes or bars. Dinner is generally prepared as a group and the simple concepts include salad with low-cal dressing, grilled or baked fish, poultry or lean beef, and a variety of vegetables.
Sleep is the unsung hero of lifestyle medicine and the lack thereof is the root cause of many ailments referred to my endocrinology clinic. Adequate sleep is not always possible when kids are little and doctors are on call or nurses/doctors are changing shifts, but we have to continue working on making the best of our opportunities to make up sleep and/or enhance the quality of our regular sleep. I have always tried to keep to some sort of regimented schedule, just as I advise patients. We don’t stay up late on weekends, relatively speaking, and I am fairly consistent with my usual 9pm bedtime in order to shoot for 8 hours of sleep. I sometimes use melatonin to assist with circadian consistency, and other habits include basic sleep hygiene (no caffeine after noon, lighted rooms, or, ambient noise; avoid screen time before bed; etc.).
We all must individualize our approaches to making healthy lifestyle habits a priority but hopefully my story can encourage your efforts. As physicians, nurses, and other healthcare providers, we must practice what we preach in order to serve as role models for patients and enjoy the health (including mental) benefits ourselves in this era of burnout. So take a step back, look at your situation, and put the oxygen mask on yourself before assisting others.