Hangry in the Hospital

Admit it- we’ve all been there.

You’ve got all of 5 minutes to get lunch before the next thing on your schedule and your pager goes off about something that needs your attention urgently.

You haven’t peed in 10 hours and a staff member who needs something for a patient starts to follow you into the bathroom (even though the patient need is not truly something urgent).

You’ve been taking care of everyone but you for the last 29 hours, a patient decompensates, and you’ve got to handle it because no one else is available.

You get paged at 2 am for berry blast tums because the patient doesn’t like the usual flavor (yes, this actually happened, though not to me).

The truth is that our healthcare system isn’t well designed for us to partake in self care.  While I know it most intimately from the ICU physician/ surgeon side, I see it exacting similar tolls on nursing staff, aides, PTs and OTs, pharmacists…really anyone who is involved in the nitty gritty of patient care. We get hungry (or hangry), we get tired, we get pulled in at least 6000 directions, all because we’re trying to do our best to take care of the patients and their families.

On Tuesday my team and I attended the March installment of Schwartz Rounds at the University of Utah, and the title of the session was the same as the title of this blog post.  We got to hear from people who work in the healthcare environment in very different roles and get their perspective on how challenging our jobs as caregivers make it to take care of ourselves, and there was a great discussion about the role that culture plays in that.  If I ask the staff to try to let me catch a 20 minute catnap while it’s slow, am I perceived as weak? If I call my supervisor to let them know I’m currently overwhelmed with patient demands, does that make me an incompetent resident? Putting those potential opportunities for shame into context was, quite honestly, eye opening.  Our culture in healthcare mandates that as care providers we all run fast, leap high, and do all of the right things for everyone with a smile on our faces at all times.  Reality mandates this simply can’t happen because we’re all human.

We all have basic things that we can try to do to help ourselves just a bit.  I have a cache of healthy snacks at all times and I have two water bottles in the hospital (one in my office, one on the ICU).  One of my “treat” tricks is that I have a stash of teas that I can brew up for me, which is an inherently stress-reducing activity, and that I am willing to share with team members as a boost. I’ve been doing this more recently and I’m starting to wonder if good loose-leaf tea simply has magical calming properties, even when it’s got caffeine.

One of the things that struck me the most during the Schwartz Rounds discussion was the role that leaders and teammates can play in creating a culture where we’re allowed to be human, where we somehow manage to get something nutritious to eat, where we can actually function at our best because we’re taking care of ourselves in the little ways that can add up when we’re stressed and tired and hungry.  I realized as I was listening to a few horror stories that we are so fortunate in our unit to have a culture where we try very hard to take care of one another, be that by grabbing a coffee for someone’s morning fix, running to get someone lunch who is swamped, or simply having that willingness to step up and lend a hand when it’s crazy so that no one person has to shoulder too great of a burden.

Here’s my challenge for each of us this coming week: Think about the things that you wish someone would do for you when you’re hangry in the hospital. Then offer to do one (or more) of those things for someone on your team. You never know when you’ll need the same favor, and I can assure you they’ll be grateful for the kindness.




All the cool kids are doing it?

First, a brief apology for my unplanned “break” the last couple of weeks.  Travel +  a wicked cold (which was at least thoughtful enough to not settle in until AFTER my half marathon last weekend) + life = no blogging.  Fortunately I have a backlog of topics so we’ll be good to go for a bit.

Last week Medscape released their annual report on Physician Burnout.  For those who don’t want to flip through the whole thing, the report indicates that burnout among physicians is at epidemic proportions. In one sentence, physicians are miserable.

Or are we?

I have many friends who are in medicine, most of us in academic medicine but not all. There are times when our work nearly brings us to our knees; I had one of those call weeks two weeks ago that was both physically and emotionally draining.  We share our tales of woe around EMRs and well-intended but poorly executed federal rules that actually impair the care of the patient (Meaningful Use, I’m looking at you). We talk about meeting requirements for MOC and how we’re a little intimidated by taking our recertification exam when we haven’t taken a night of general surgery call in several years.

And yet…I don’t think that most of us can imagine doing anything else because at the end of the day we love what we get to do and we love the people we do it with and for. While there are times when any of us would definitely acknowledge being burnt out, I’m also seeing many of us exhibiting wisdom about knowing when we must have time and space to put on our own oxygen masks first. That’s why I had a crazy-hard week of call nights with tons of administrative stuff to manage during the days…then promptly got on a plane to Louisiana and spent the weekend with friends eating great food and running.

Lest you think I am a paragon of self-care and burnout prevention, I’ll tell you I’m not.  I’ve been tremendously burnt out at a few points in my career (twice during residency, once early in my attendinghood), and I hope that I’ve learned from my mistakes. I’ve learned that I don’t like who I turn into when I’m in that place (I become mean- and if you know me personally you know I don’t care for mean people AT ALL).  I’ve also come to realize the simple joy in an early morning or late evening dog walk with Olivia; some days our adventures in the neighborhood provide the most effective therapy possible. I realize that time outdoors with a dog won’t help everyone in the same way it helps me, but I provide it as an example of a simple and high-yield intervention.


I have a few plausible theories behind the current epidemic of physician burnout, and I’m not sure which is correct- or if all are:

  • Physician burnout really has increased (question, related but unrelated:  What about burnout rates in other high-stress, long-hour fields?)
  • The stigma around physician burnout has gone away, so people are owning it (but the true incidence isn’t any different)
  • Surveys are being worded in a way that if someone had a bad day last week they may be described as having burnout, when it’s really just a bad day
  • We’re saying we’re burned out because we think we’re supposed to be burned out.  We’re busy!  We’re working hard! We’re supposed to be exhausted and maybe something is wrong if we’re not.

I suspect the truth lies somewhere in the spaces between these ideas; what I do know is that regardless of the actual incidence of burnout in medicine that a focus on wellness is both merited and deserved.  The pace that our world runs at simply isn’t sustainable and the demands placed upon us by our patients, our teams, and the healthcare system are huge- much less the demands of our “normal person” lives. We both need and deserve time and space to do those things that heal and restore us if we’re to sustain our roles as effective healers, team members, friends and family, and humans.  The challenge, of course, is prioritizing that time.  The reality is that if you don’t prioritize if for yourself, no one else will do that for you.

What’s your wellness today?  What do you need to sustain you? Sitting still with a cup of coffee? Yoga? A snowball fight? I challenge you to pick something, then revel in that- even briefly.

The bare necessities



Okay, maybe that’s not exactly where I was going, but the levity is a perfect opener for tonight’s blog.

We’re in the process of starting a wellness program for our residents, and last Wednesday I met with several of our residents one-on-one to help them establish wellness goals for themselves.  I’m not sure that I’m entirely qualified to do this, other than I do know what has failed dismally for me in this realm, and I’ve previously confessed to having experienced full-fledged burnout at least twice during residency and once as faculty.  I suppose since I think I am getting it right more days than not, that makes me reasonably well qualified.  And since my biggest vices are designer shoes/ clothes and half marathons, an argument could be made that I have mostly functional coping mechanisms.  Confession:  This has not happened without a LOT of work and a LOT of introspection.

About 3 1/2 years ago, I was introduced to the work of Jennifer Louden and was particularly drawn to her concept of  “minimum requirements for self care.”  Her concept inspired me to make a list that I divided into multiple categories- daily, weekly, monthly, and yearly.  The great part is that the list isn’t full of complicated things, at least not until you get to the monthly or yearly portions of it, and those lists are much shorter.  For example, the daily list:

  • Walk with Olivia Ann
  • Movement- workout, yoga, running, wiggling, whatever
  • Reflection- meditation, writing, prayer
  • 5+ fruits and veggies
  • 6+hours of sleep (this being the least-controllable when on call)
  • Time to just “be” with Olivia, Tucker, and Belle!

If you look at that list, it’s all pretty simple.  There’s nothing terribly time-consuming on it (the sleep doesn’t count on that basis), and they are simple, measurable things I was able to identify that help me stay at my best.  Even the weekly list isn’t onerous:

  • Dedicated time outdoors
  • 1:1 time with a friend
  • Reading fiction
  • Learning something, teaching something
  • Making music
  • Finishing something, starting something

Again, nothing that requires huge amounts of time, and all things that I know help keep my work choices and life choices at their best.

What I’ve been most proud of in the context of these lists is how little they have shifted over the last three years (meal planning has come off of the weekly list, bless you creators of Blue Apron), and how grounding it is to go find my list when things are completely hectic.  At core I’m not a list person-  much more of a visualizer- but in these lists there is some inherent comfort and that gentle reminder to have a salad or to just shut things down and go to bed because it’s what will help me the most.

And, of course, there are all of the things not on the list.  I’m the first person to admit a love for social media, but FB, Twitter, and Instagram aren’t on the list for the true basics of self-care.  Neither is Inbox Zero.  And by virtue of their absence I’m reminded what my priorities would be when it’s incredibly easy to forget them.

What are your bare necessities- your minimum requirements for self care?  And how can you put them to work for you? There’s your challenge as we move into Fall…I would love to know how it goes.