Burnout Isn't Going Away. These 3 'Microskills' Can Ease It.


                                  By Resa E. Lewiss, MD, & Adaira Landry, MD, MEd

We are emergency medicine physicians familiar with burnout. We're not alone. In fact, 62% of nurses are burned out. The irony is that the people who take an oath to care for sick people are themselves working in a system that fails to protect their health. We have learned the individual limitations of changing a complex work culture. As a result, we adapted by realizing our individual agency. While the system and culture of any workplace is figuring itself out, individuals can learn fundamental concrete steps -- we call them "microskills" -- for self-care.

Baked into the culture of many workplaces is a denial of biological functions: eating, getting adequate sleep, and calling in sick when sick. The hesitancy of many physicians to meet these needs is not just a matter of being a team player. The lack of self-care goes deeper. Often present in the culture of medicine is internalized shame: we can never be hungry, need sleep, or be sick.

In order to move the needle on self-care in the workplace and help other employees realize their agency, here are a few small actions you can take right now that will have a big impact on your workday. (While these may seem obvious, it's abundantly clear that most physicians are not meeting these needs. We're here to remind you it's time for change.)

Eat Regular, Nourishing Foods

During our 4 years of emergency medicine residency, we hardly ever ate a full meal on shift. When we did eat, it was not particularly healthy and we scarfed it down in minutes. This was just the culture.

There is a growing body of evidence that eating whole foods with a plant predominance helps prevent, treat, and even reverse chronic medical conditions, such as diabetes, cardiometabolic disease, cancer, and obesity. Additionally, eating healthy foods, and avoiding processed and sugary foods at work, helps with steady energy and focus, and results in fewer fluctuations in that energy.

This is an easy change to make today: make it your objective to eat a nutritious meal at work. Prepare or pack healthy foods likely not found in a vending machine, and bring them with you on your next shift. Find a nearby cafe or food delivery service that focuses on nutrient-rich food, not fast food.

But it doesn't have to be all on you: bring the challenge of eating on shift to supervisors, colleagues, and hospital administrators to help foster institutional wellness and culture change.

Take Care of Your Sleep Hygiene

In our field, unhealthy sleep habits are historically applauded. People boast about how long they can stay up to take care of patients, attend meetings, or write papers and grants. This is definitely not healthy for doctors, nor is it patient-centered care. Sleep deprivation has real health risks, such as stress, depression, and obesity and other chronic diseases. Good sleep is especially important for people working long days or overnights. In medicine, we know colleagues who have fallen asleep at the wheel while driving home, or while stopped at a red light or stop sign. In extreme situations, motor vehicle accidents are some of the worst consequences of working long hours.

Even with a busy schedule, we believe you can take steps to improve your sleep hygiene now. Going to bed and getting up at the same time every day is unfortunately unrealistic for doctors in training. However, creating sleep hygiene habits can result in deep, healthy rest.

Minimize light in the room via blackout curtains or eye covers, since darkness stimulates melatonin and circadian rhythm regulation. Keep the room temperature cool but not shivering cold. Avoid eating right before going to sleep, as it is associated with acid reflux and suboptimal digestion. Lastly, minimize alcohol, especially near bedtime; the science shows that alcohol disrupts the sleep cycle and contributes to insomnia.

Call Out When Sick

In the hospital, it is not uncommon to see colleagues with migraine headaches, morning sickness, or food poisoning slip into an empty patient care room on shift to briefly rest in darkness. We've even seen physicians walking around with an IV in their arm, seeking symptom relief while still seeing patients. Yes, the situation is as shocking as it sounds. And working while sick happens in other spaces too, such as healthcare administrative offices, on Zoom, and at conferences. Without question, the system needs an overhaul.

But corporate America does, too. Broadly speaking, the American workforce culture has normalized avoiding calling out sick, when sick. Change can occur by recognizing when others are sick and suggesting they take time off to rest and recover. Or simply model good behavior (especially attendings and other later-career health professionals): take time off so that you may return healthy, and so earlier-career colleagues know they should do the same.

"I am feeling unable to work. I'd like to use a sick day," is all it takes to demonstrate self-care and model survival skills.

To be clear, physicians are not solely responsible for their self-care. Healthcare systems must play a role. They too can institute initiatives and policies to ensure healthcare team members have access to healthy meals on-shift, are scheduled with adequate time to sleep between shifts, and can take time off when they're actually sick. While deep and lasting cultural change at the institutional level may be slow, microskills for self-care can help assuage the speed of change and more readily help all of us feel better at work.

Resa E. Lewiss, MD, is a professor of Emergency Medicine at the University of Alabama at Birmingham. Adaira Landry, MD, MEd, is an assistant professor of Emergency Medicine at the Harvard Medical School and Brigham and Women's Hospital. Lewiss and Landry are co-authors of the book MicroSkills: Small Actions, Big Impact.


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