Time off, Days off, and Vacations

As my vacation is winding down I’m struck again by how restorative time away from work can be, and how much we all need these breaks.

The word vacation has the same roots as vacate (from Latin vacātiō – freedom, from vacāre – to be empty).  Vacations – whether daily, weekly or annual are effective only if you really walk away from work.    It’s particularly hard to disconnect from email, the internet and texting … but “needing” to stay connected electronically may keep you from connecting with your surroundings and your loved ones. If the idea of emails piling up adds to your stress, compromise by scanning, deleting (and not answering) your emails when you are on vacation.

There’s a tendency to think that vacations have to be a planned trip away for at least a week… but here’s another perspective from WebMD.com:  “While it is ideal to have a full week or two off from work, it may not always be feasible, and there’s still the rest of the year to deal with. Weekend getaways are also good for rejuvenation. So is an hour to yourself during lunchtime or a few hours on weeknights.”

Some ideas….

Plan a half-hour or hour (on days you can) to disconnect and “vacate” from your work in whatever way makes you happy.

Try to really have a full day off every week (call schedule permitting). There’s a reason most religions in the world build in a day away from work – it’s part of the rhythm of rest we need as human beings.

Plan a long weekend away (or even a day) by yourself or with loved ones every couple of months.  Make it time free of electronics – go hiking, sit on a beach, stay at a great bed and breakfast, eat great food.

If you have vacation days you are storing up – start using them!  And, when you take those days off work, don’t use them to “catch up” on chores or other tasks…take the time you need to recharge your batteries.

Why we need vacations from treecitytimes.com

The Science Behind Vacations: Why we Need a Break from lbtimes.com

Why Summer Vacations (and goofing around on the Internet) Make You More Productive from TheAtlantic.com

How to Spend Your Day Off

I know I should study for the Absite this weekend, but I haven’t had a real day off in over a month”.

Here’s the scenario.  It’s Friday evening.  You’ll be back at work on Sunday.  You’re sleep deprived because you are a resident.   You haven’t spent any quality time with your significant other, friends or family because you haven’t had any real time off.  Next week has plenty of call and it would really help if you planned out good food for the week and cooked something.  And, by the way, you have the inservice exam coming up, so you really should study.

There is no one answer how to balance these things. Everyone will be a little different in what is most important to them, and different weeks will be different, too.  But, there are some basic concepts to think about that might help you plan how to spend your time off.

  • Sleep is actually a high priority even though it feels like you are giving up social time.  Whether it’s visiting friends, studying or just goofing off, you won’t get the benefit of your time off if you are completely exhausted.  If you are sleep deprived, try going to sleep really early (8 or so) the night before your day off and see if it doesn’t make a big difference.
  • Good food is important.  Be efficient, but be conscious about what and when you eat. Use a little of your down time to think about your week, plan what you are going to eat, and go shopping.  Find a good recipe for something easy to make and make a big batch for the week.  Or at least buy good quality frozen food that serves the same purpose.
  • Get some exercise, but be realistic.  A serious workout can use up a big hunk of a day off.  For some, that’s great – the hours will be more than worth it.  For others, don’t beat yourself up.  It’s far better to figure out how to do 30 minutes 3 or 4 times a week than to be a “weekend warrior” for 4 hours on your day off.
  • Don’t plan for huge blocks of study time on your day off.  You’ll wear out your neural pathways and you just won’t remember what you are trying to learn.  Like exercise, a little every day is much, much more effective than a big block on the weekend.  Plan now for the big test months from now… pace yourself!  (If you’ve just started studying for the Absite later this month – go for it.   But, as soon as the exam is over, map out a way to study for next year so you don’t do the same thing again.)
  • Absolutely use a significant part of your day off to socialize with your family or friends.  It’s very isolating to live in the hospital and these hours are critically important.
  • Once you think about what’s important to you, and make a decision about your day – enjoy it!  The worst way to spend a day off is to spend the time worrying that you should be doing something else.  There’s a reason that almost every religion in the world has the concept of “Sabbath” .  Human beings need real down time once a week to refuel.  It’s not “wasted” time, it’s essential time.

“Failure”

Dear Dr. Brandt,

I enjoy your blog very much. As a second year medical student, I know that my peers and I all struggle with what we view as ‘failure’ at some point or another. I imagine this problem doesn’t stop (…ever), especially since medicine seems to attract people who hold themselves to extremely high, if not impossible, standards. If you’re looking for topics, I wonder if you might have some insight to offer on how to deal with the downfalls along the way.

Dear colleague,

It is part of our profession that we will never stop trying to be perfect and – just as true – that we will always fall short. As a student, it tends to be about the tests you are taking and the feeling that you will never study enough.  As a resident, it’s the feeling that you don’t know enough to make the decisions you are being asked to make. As a practicing physician, you will at times stay awake at night worrying about your decisions, even when you know you did the best you could.  All of this sounds like a huge downside to the profession we’ve chosen, but it’s actually a blessing.  One of the core personality traits of physicians is that they care.  In a way, all of the stress about not doing well enough happens only because you have empathy and compassion for your patients.

Although it’s hard to believe at the beginning, with time you will realize that the feeling of having “failed” is actually a gift.  You’ll discover that “mistakes” and, more importantly, “near misses” become your most valuable teachers.  What’s important is that you grasp the opportunity to learn from falling short, rather than beating yourself up.  “Failing” at a task (or test) is different than being a “failure.”  When you have moments you feel you could have done better, use it as motivation to study a little more, go back to the textbook, look up one more article, or review all the facts again.   William Osler, in his famous book to medical students (Osler’s Aequanimitas) talked about keeping a journal of mistakes:   “Begin early to make a threefold category – clear cases, doubtful cases, mistakes.  And learn to play the game fair, no self-deception, no shrinking from the truth… It is only by getting your cases grouped in this way that you can make any real progress in your post-collegiate education; only in this way can you gain wisdom with experience. “

So, to answer your question about how to deal with the downfalls along the way –  Start by revisiting your motivation. Remember why you started down this path in the first place.  If you are trying your best to do the right thing, and are humble about the fact that you are human (and will therefore fall short) you can end every day with satisfaction and a sense of accomplishment. That being said, make sure that you work with focus – that when you study or work it is with dedication to the patients and families who are trusting you with some of the most precious decisions of their life.  When you fall short, use it as motivation to learn.  But, in this process, make sure you are taking care of yourself by taking time for good nutrition, exercise, social interactions and spiritual growth.   The worst thing you can do when you feel inadequate is to just work more and more.  This leads inevitably to compassion fatigue, which makes you less effective (and will make you suffer).   Compassion fatigue is a common diagnosis for care-givers; it happens to every medical student, resident or physician at some point in time.  Just like any other diagnosis, the next step is treatment.  In a nutshell, the treatment is self-care.   Here are few sites that can help you with tips to prevent and treat compassion fatigue:

Top 12 Self-Care tips

Preventing Compassion Fatigue

Burnout and medical errors among American surgeons. Shanafelt et.al. Ann Surg. 2010 Jun;251(6):995-1000

Ann Surg. 2010 Jun;251(6):995-1000.

Burnout and medical errors among American surgeons.

Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J, Freischlag J.

Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA. shanafelt.tait@mayo.edu

Abstract

OBJECTIVE: To evaluate the relationship between burnout and perceived major medical errors among American surgeons. BACKGROUND: Despite efforts to improve patient safety, medical errors by physicians remain a common cause of morbidity and mortality. METHODS: Members of the American College of Surgeons were sent an anonymous, cross-sectional survey in June 2008. The survey included self-assessment of major medical errors, a validated depression screening tool, and standardized assessments of burnout and quality of life (QOL). RESULTS: Of 7905 participating surgeons, 700 (8.9%) reported concern they had made a major medical error in the last 3 months. Over 70% of surgeons attributed the error to individual rather than system level factors. Reporting an error during the last 3 months had a large, statistically significant adverse relationship with mental QOL, all 3 domains of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and symptoms of depression. Each one point increase in depersonalization (scale range, 0-33) was associated with an 11% increase in the likelihood of reporting an error while each one point increase in emotional exhaustion (scale range, 0-54) was associated with a 5% increase. Burnout and depression remained independent predictors of reporting a recent major medical error on multivariate analysis that controlled for other personal and professional factors. The frequency of overnight call, practice setting, method of compensation, and number of hours worked were not associated with errors on multivariate analysis. CONCLUSIONS: Major medical errors reported by surgeons are strongly related to a surgeon’s degree of burnout and their mental QOL. Studies are needed to determine how to reduce surgeon distress and how to support surgeons when medical errors occur.

PMID: 19934755 [PubMed – indexed for MEDLINE]

Book Recomendation: Iron Doc by Mamta Gautam, MD

I became aware of this book last week through one of the anesthesia residents at work (whose chairman made this book required reading for all residents in his department).  Dr. Gautam is a psychiatrist who has specialized in caring for physicians and is an expert in physician wellness.  She uses training for an Ironman triathalon as an analogy.  Physicians have to “train” for different roles (personal and professional) if we want to prevent burnout.  She proposes a training program that helps keep balance in the complicated life of a doctor. The book primarily addresses physicians already in practice, but the information is very applicable to trainees, as well.

Here’s her website if you are interested:  http://www.drgautam.com/gautam/books.htm