This week we are going to be switching things up! In May of 2015, as a part of a bi-annual combined conference with residents and faculty from Saint Louis University and Washington University in St. Louis, they focused on how they stay healthy in Emergency Medicine! St. Louis is a large urban city with its own fair share of stress and wellness. Prior to the conference, a survey containing all the following questions was sent to all of the emergency medicine residents and faculty. 75% of all those polled responded to the survey. Within this post, they share their tips for how to make wellness a part of your everyday routine. Thanks to Dr. Craig Krausz for spearheading this project and putting the post together. Check out how out these two programs stay healthy in EM!

  • saint louis university and Washington universityName: Saint Louis University and Washington University Emergency Medicine Physicians
  • Location: St. Louis, Missouri
  • Current job(s):
    • 36 Emergency Medicine Residents (PGY 1-4)
    • 21 Emergency Medicine Academic Faculty
    • 8 Emergency Medicine Clinical Faculty
    • 1 Fellow
  • One word that describes how you stay healthy: Physical-exercise
  • Primary behavior/activity for destressing: Time with Family

What are the top 3 ways you keep healthy?

  1. Exercise. Everyone that we polled placed exercise in the top 3 ways to stay healthy. It was recognized that finding time for exercise is a constant challenge.
  2. Sleep. Sleep was recognized as one of the most important and sometimes elusive parts of staying healthy in emergency medicine. During our conference, we had the opportunity to hear from a board certified sleep physician who talked about sleep importance and how sleep affects our health.
  3. Diet

What’s your ideal workout?

More than 27% of those participating stated that they have running as a mainstay of their ideal work out. However, it was noted that this was not the only ideal workout. Many participated in activities including weightlifting, cycling, climbing, hiking, playing various sports, and yoga. Some of the more interesting workouts included “Walking from the couch to the fridge” and working a “Trauma shift”.

Do you track your fitness? How?

58% of those who responded stated that they do track their fitness. Fitbits and an in-phone app seemed to be the most common. However, some used less costly methods such as tracking it in their head, watching how their clothes fit, and as one person stated, ‘How good I look naked’.

How do you prepare for a night shift? How do you recover from one?

Prepare: Many in our group had different ways to prepare for their nightshifts. It was not at all a consensus. The most common way to prepare was to stay up late the day before the night shift, and then get in a nap during the day of the night shift. This nap usually occurred from 1-3 hours prior to the start of the shift. Some words of wisdom included:

  • “I keep my activity and stress minimal prior to the shift”
  • “Try to get some sleep beforehand (but that’s virtually impossible)”
  • “Gym and protein shake before shift”

Recovery: When recovering from the night shift, most had slightly different approaches, depending on the schedule following the night shift. Was it an isolated night or a string of nights? Responses varied from sleeping 3-5 hours post shift, to getting as much sleep as they can post shift, to using exercise to help to acclimate. Comments included:

  •  “No recovery”
  • “Switching back to days is awful”
  • “I pretty much know I’m going to chug coffee all day, maybe be mentally slower that day, and that I’ll sleep well the following night ready to go for the next day”
  • “Recovery the day after is to do almost nothing except hang out with the family”
  • “… a few beers and as much sleep as possible.”

How do you avoid getting “hangry” (angry due to hunger) on shift?

Most of those surveyed bring something to eat while on shift. This can be anything from a full lunch to general snacks, fruit and healthy snacks, protein bars and junk food. About 10% of those surveyed will power through the shift without food. The two statements given do acknowledge the difficulty in this very question:

  • “I don’t do this well- although I don’t get angry until I notice a drop in efficiency when I get hungry”
  • “When things get busy, I can’t avoid being hangry.”

How do you ensure you are mentally in check?

To keep mentally in check there were 4 main strategies:

  1. Self-reflection and focus.
    • Techniques included making to-do lists and checking off responsibilities, using cognitive check points, deep breathing techniques, and reflection. A constant theme was the the need to always remind ourselves that we must treat every patient like we would want someone to treat our family.
  2. Having a community that you can use as outlets, to help you maintain balance.
    • Many communicate with their friends, colleagues, spouses, and family.
  3. Staying physically fit and rested.
  4. Have distractions outside of medicine.
    • Enjoying the outdoors, traveling, family activities, and blocking out the issues you are worried about.

What are the biggest challenges you face in maintaining a longstanding career in EM? How do you address these challenges?

We all deal with night shifts, shift work, administrative pressures, and health issues including burnout. The ideal answer to address these challenges was different for everyone. There were some common threads which included taking time for yourself, ensuring your priorities are in line with your personal and professional life, and staying positive and balanced. Remember what Mel Herbert says,” What you do really does matter.”

Best advice you have received for maintaining health?

We had several pieces of advice for maintaining health:

Some focused on reflection:

  • “One should periodically re-evaluate happiness, do the best that you can without doing everything.”

Others focused on work:

  • “Remember that you have permission not to work 70 hrs/wk.”
  • “People sometimes think that if you’re not miserable, you’re not doing it right.”
  • “It’s okay to work less.”
  • “Nobody died thinking that they needed to spend more time at work.”
  • “Career is a marathon, not a sprint.”
  • “Seek advice from your peers and those that have come before you.”

And some focused on family.

  • “Put your families first. Make sure when you’re with your family you stop emails, turn phones off, etc. To sum it up: Be present wherever you are — be present at work, be present at home.”

Who would you love for us to track down to answer these questions?

Mel Herbert
Michelle Lin
Douglas Char

Zafrina Poonja, MD

Zafrina Poonja, MD

Editor, How I Stay Healthy in EM series
Emergency Medicine Resident
University of Alberta
Zafrina Poonja, MD

@zafrinapoonja

Emergency Medicine Resident. Assistant Editor @ALiEMteam. Lover of travel, soccer, and boat shoes.