News: Trying to Find Regularity in an Irregular ED World : Emergency Medicine News

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Trying to Find Regularity in an Irregular ED World

Harrison, Raquel MD

Emergency Medicine News 43(8):p 24, August 2021. | DOI: 10.1097/01.EEM.0000771076.51226.02
    lifestyle medicine, self-care, wellness

    Emergency physicians welcome the flexibility and variety of the job. I choose never to work on my birthday or the birthdays of my husband or children. The variety of patient complaints keeps things interesting. It keeps us learning daily, challenging us to be better physicians. We are envied by many in medicine, and EM is a highly sought-after specialty. But then why does all this flexibility lead to so much burnout?

    All the flexibility and variety may keep us engaged clinically, but it affects our lives and the regular rhythm that a healthy lifestyle requires. Just like the rhythm of the rising and setting of the sun, we require a rhythm. Those rhythms are set by our circadian clocks in the suprachiasmatic nuclei regulated primarily by melatonin and cortisol. Humans usually default to that diurnal rhythm, rising and setting with the sun. But in EM, we have had to toss this out the window. We work around the clock because we have to.

    Taking Inventory

    Our hospital lives as emergency physicians are irregular. We come in at irregular hours, care for irregular complaints, and deal with irregular situations. How do you begin to impose regularity when your work life is so irregular? Lifestyle medicine principles offer a place to start.

    This list can help you determine what your day off looks like as well as the rhythm of those days. On your days off, do you:

    • Sleep in and take naps, trying to snag any sleep you can?
    • Eat when hungry or later than usual? Are you snacking all day?
    • Feel too tired to exercise and make excuses?
    • Stay up late watching TV or surfing social media?
    • Drink more alcohol than usual?
    • Eat out at restaurants and indulge in unhealthy choices?
    • Avoid seeing others because you are too busy or too tired?

    Take a moment to think about these questions and the way you treat yourself.

    Your days in the hospital are going to be varied. You would keep a regular, healthy eating schedule while you work and try to get out on time in an ideal world, but we are lucky if that happens 50 percent of the time. It can take a single sick patient (or sometimes 20) to make sure that we forget to eat during our shift or to keep us over time.

    Self-Care for EPs

    If our control over our irregular ED world is limited, then we need to consider controlling our off days even more. How do you care for yourself on those days? Starting to impose some routine on days off can offer normalcy and improvement in self-care and health. Multiple smartphone apps have advanced calendar features. The Owaves app in particular is structured and geared with circadian and lifestyle medicine principles in mind, allowing you to set up and think through an ideal daily structure. ( Even something as simple as a shorthand list can help you structure your day.

    Your ideal “regular” day off is personal. No one can tell you how to fill it, but consider making it something that nourishes your body and soul. A few principles from our earlier questions should be considered as you structure your ideal day off:

    • Wake up at the same time each day.
    • Try to eat on a regular schedule. Breakfast should always occur within the first hour of your ideal wake-up time to entrain cortisol spikes and improve wakefulness from sleep. (J Behav Med. 2006;29[3]:223.)
    • What time of day do you feel the most motivated to exercise? Maintaining a regular time (some data suggest the morning is most beneficial) may help with the regulation of melatonin. (J Physiol. 2019;597[8]:2253;
    • How can you structure the day so that you increase the opportunities for healthy eating (i.e., a predominantly whole-food, plant-based diet)?
    • If you drink alcohol, set a limit to your consumption. Your last alcoholic drink should be three hours before your set bedtime. (J Behav Med. 2006;29[3]:223.)
    • Go to sleep at the same time each day. You should include time to wind down away from electronic devices because blue light can affect sleep onset via melatonin suppression. (J Clin Endocrinol Metab. 2005;90[3]:1311;
    • Set aside unstructured time to spend with family and friends or to meet new people.

    Really challenge yourself to think about how you treat yourself on your off days. Are you “treating” yourself with indulgences and unhealthy habits because you finally have a day off, or are you taking care of your health and creating a mental and physical foundation that is often challenged by the nature of our work? Begin to create structure on your days off, and the regularity will spill into your workdays.

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    Dr. Harrisonis board-certified in emergency medicine and lifestyle medicine, and practices emergency medicine at Bridgeport Hospital-Yale New Haven Health. Learn more about the intersection of emergency medicine and lifestyle medicine by visiting her website Find more information on the American College of Lifestyle Medicine at Follow her on Twitter@acute2root.

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