92. Strategies for Shift Endurance

It’s a tough time to practice medicine right now, which makes paying attention to self care even more important. In this episode we break down three specific strategies for: improving mental and physical performance, sustaining shift endurance, and building a scaffolding for joy at work.

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Mentioned in this episode: The Awake and Aware Physician conference sponsored by Wild Health. Jan 13-15 Sedona Arizona. Use the code CONSCIOUSPHYSICIAN for 15% off (that’s 15% off the whole package – lodging, meals, the course)

We Discuss:

A perennial nocturnist shares his approach to career longevity;

Parasympathetic nurturing: being deliberate during time away from work to fully embrace recovery (meditation, diet, exercise, enough time off between shift blocks)
When he goes back to the emergency department, he sees that as ‘game day’. He’s rested, recovered, caffeinated, not hungover, and ready to rock and roll.

An unexpected thread in the origin story of medical training in the US;

William Halstead, a surgeon and founder of Johns Hopkins, was a pioneer in surgical sterility and medical education. He was also a dedicated cocaine researcher (on himself).
From history daily

“He used his own body to experiment with the effects of cocaine. He injected himself with the drug, ingested it, and even rubbed it in his eyes. The stimulating effects that the drug had on him gave Halstead almost endless energy, allowing him to work long hours, perform many surgeries, and train students. There was no need for food and sleep. There was only progress and cocaine.

Halstead was not only a prodigious user but also cocaine’s best promoter, encouraging his students to try it so that they, too, could keep up with the high standards and demands that Halstead set. He expected his residents to be on-call 362 days a year and handle a workload that was difficult to maintain without artificial stimulants.”

When you wonder why we train like we do, this is one of the ingredients that set things in motion.

Three strategies to focus on self care and improve endurance during shifts;

Nutrition
Tension and Relaxation
Intention

Fuel like an Ironman triathlete;

Plan out your nutrition before your shift and pack food the day before with enough to refuel and hydrate every two hours to three hours, refuel and hydrate (don’t rely on what’s in the hospital or clinic).
Protect the time you refuel just like you’d protect time to do a procedure
Challenge: Experiment with your next three shifts, pick a time interval for fueling, set a reminder to do it, pack your goodies, and take a few minutes every couple of hours to fill your tank.
- Pay attention to how it went, what got in the way of doing it, what were the circumstances when it went well?

Saying that it is just not possible to eat or drink during a shift is a self-imposed belief bordering on delusion.

Does the patient always come first?;

We are tireless advocates for our patients, but the adage ‘the patient always comes first’ can plant the seeds for neglected self care.
You come first. Take care of yourself so you can take care of your patients. If you are depleted, you’ll provide suboptimal care and have a suboptimal experience.

Using the dynamic between tension and relaxation to conserve energy;

When you need focus, focus. Upregulate and bring all your skills to bear.
When you are in the interstitial time between patient care moments, procedures, etc, relax. Use that time for point of care parasympathetic nurturing.
Challenge: Tension check in and release
- Set something to remind you to check in with what’s going on your body. It might be a post-it note that says ‘tension’ or ‘relax’ or some part of your body that tenses up or something to help trigger that check-in.
- When you are at your workstation documenting (or doing whatever kind of recording you need to do), take a brief inventory of your state of tension or relaxation.
- Are you tense? Are you relaxed? If you feel tension, where do you feel it?
- Take a breath and let it release. Use a breathing technique where the out breath is longer than the in breath such as 4-7-8 or in for 4 through the nose and out for 6 through pursed lips.
- Release the tension

Using intention as a tool for self care;

Before walking through the door of your work arena, set a clear intention for what you are bringing to bear.
It can be an intention for the week that you carry through each day, a new one for each day, or a combination of the two. It can be the same intention day after day or a new one each day. It doesn’t matter.
How is this even remotely related to self-care? This gets to the core of self care, especially now when it can feel like you’re being buffeted by the winds where there’s so much crap going on.
Setting an intention expands your sphere of control, your sense of agency.
When there is no agency, it’s a lot harder to experience joy . When there is agency, that is a scaffolding for joy to be built upon.
Challenge: For 1 week, set a work intention. If it’s a big one for the whole week, remind yourself of it each day. If it’s a new one each day, take a pause and fully feel it before starting work.
- Examples (what you choose may not even be on this list, it needs to be meaningful to you to have the necessary voltage):
  - I’m going to be attentive to my periods of tension and relaxation
  - I’m going to bring curiosity to each encounter
  - I’m going to be deliberate about refueling
  - I’m going to be open to accepting gratitude for my patients, my clients, my coworkers.
  - I’m going to learn something new today.