Dr. Rob Orman is an emergency physician from Bend, Oregon. When he’s not in the ED, he can be found creating and working on podcasts for the EM:RAP series, for which he is the Executive Editor. From using mindfulness techniques to stay active, Dr. Orman ensures he is mentally in check at the start of each day. Here’s how he stays healthy in EM!
- Name: Rob Orman
- Location: Bend, Oregon
- Current job(s): Executive Editor EM:RAP; Attending emergency physician at St. Charles Hospital, Bend, OR
- One word that describes how you stay healthy: Consistency
- Primary behavior/activity for destressing: After a shift, Netflix. Before a shift, meditation.
What are the top 3 ways you keep healthy?
- Diet. I have the same breakfast most days. Oatmeal with walnuts, raisins, flax, brown sugar, and milk. Whether or not it’s healthy, I love it. Before a shift, I eat 2 eggs before the oatmeal to increase the protein load and delay onset of hunger.
- Fitness. Cycling is my main activity, both mountain and road biking. It used to be triathlon but the time investment made it prohibitive. I try to get in at least one core workout per week, sometimes more. It might be on my own, or it might be as part of a group fitness class at the local health club.
- Mind. Each morning I try to meditate for at least 10 minutes. The technique is usually vipassana (mindfulness) meditation. Missing a day, I can feel the scattered and distracted brain taking over and the calm focused brain put in the corner.
What’s your ideal workout?
Mountain biking with friends
Do you track your fitness? How?
Strava – this logs miles, intensity, etc.
How do you prepare for a night shift? How do you recover from one?
Preparation: Sleep late if possible. It’s not always possible. Get some sort of exercise, but not a huge blowout workout that will tap my energy for later in the evening. An hour before I want to sleep, stop all cognitively intense activity (working on a podcast, reading articles, etc). 45 minutes before desired sleep time, take 10 mg Ambien. This usually gives about 3 hours of sleep. On the way to the shift, listen to a medical podcast to start the EM mind.
Recovery: On the way home, listen to Men in Blazers or WTF podcast. No thought required, just fun. On arrival home, watch Netflix or read a book to transition the mind back to a slowed state. If the family is home, chat with them. Eat breakfast and then go to bed with ear plugs and a face mask. Sleep is about 2-3 hours. That evening, take 3 mg of melatonin to reset the sleep clock.
How do you avoid getting “hangry” (angry due to hunger) on shift?
I bring several bars (Bounce bar is my new favorite) and eat one every few hours. Toward the end of the shift, I’ll eat a bigger meal if I’ve brought one. There is serious energy depletion at that time and it needs a major refuel. If there is any hangriness brewing, I’ll take a moment to get a bar or even some diluted apple juice to raise the blood sugar. That’s temporary and needs to be followed soon by something with more substance.
How do you ensure you are mentally in check?
At the beginning of the shift, it’s easier than at the end when there’s physical and decision fatigue. When things get busy and I start to feel like I’m spinning my wheels, that triggers a cognitive reframing of closing loops rather than picking up new tasks/patients. I make a checklist of everything that’s outstanding on every patient and work through completing those tasks. In a resus, continuous communication with the team helps keep my thoughts clear. If it’s all in my head, such as if there’s a complex decision to make, I’ll say the decision as well as my thought process out loud so the rest of the team can hear it, understands why we’re doing what, and can give input. The giving input part (from other team members) improves care significantly.
The biggest thing that’s helped with staying mentally in check, though, has been meditation. It significantly diminishes the stressful stimulus (having too many tasks) leading to the stressful response (feeling overwhelmed and out of control).
What are the biggest challenges you face in maintaining a longstanding career in EM?
I’ve burnt out several times in my career. It stemmed from working in a place that was not the right fit. Super busy and super high pressure. Changing jobs to a rural ED made a huge difference. Ironically, it was just as busy as the previous place but a totally different groove. Everyone knew each other well (CEO, nurses, housekeeping, kitchen staff, docs, everyone) and it made a collegial atmosphere. That totally changed my mindset about medicine.
I’m now working at a busy city ED again, but having had the 4 year rural experience reset the negativity to positivity.
How do you address these challenges?
Doing only clinical medicine was not fulfilling, I started a medical podcast about 7 years ago. That was the biggest pivot of my career. What felt like drudgery was now interesting. Every case was a learning opportunity. I think the main aspect of this was having the outlook of a student again rather that an expert – Keeping a beginner’s mind is much more pleasant and enriching.
Best advice you have received for maintaining health?
Good excuses do not make good products. That was something my karate instructor had on the wall of our studio back when I was a teenager.
Who would you love for us to track down to answer these questions?