We would be remiss to not acknowledge the unique challenges we as emergency providers have faced over the last few months. Prevention of burnout and active wellness management is more important now than ever. This month on our “How I stay Healthy” series, we’re featuring Dr. Christian Rose, clinical informatics fellow at Stanford University and staff physician at Kaiser Permanente. He shares some guiding principles when facing difficult clinical decisions, his belief in the power of connection, and his favorite noise machine!

Words of Wisdom

“Always do the right thing.” (Do the Right Thing, Spike Lee)

There are so many times when it can feel easier to take a short cut. Can this wait for the next shift? Isn’t this a problem for someone’s primary physician? Does this patient really need the surgical consultation?

I think of this line every time I am about to have a difficult encounter, or am faced with the complexities of a medical system that seems stacked against “doing the right thing.” Facing the inertia of the medical establishment is tiring and can feel Sisyphean, but it feels worse to go home and reflect upon the decisions I made because of inertia. Should I have called that patient’s family to corroborate the story? Why did I just CT scan instead of performing serial exams?

As emergency physicians, we are continuously involved in complex situations. There are so many different ways to approach clinical problems, social issues, interpersonal relationships, and our own needs. Take a minute to identify “the right thing.” It’s as simple as that.

A Day in the Life

I cannot wake up unless I absolutely have to. My body always wants to sleep. Because of this, I try to avoid early morning shifts. It’s not that I am not a morning person! If I wake up and go directly to work, I seem to leave all of my energy there and have little left afterward for home or friends.

I like to exercise as soon as possible after waking up since my energy levels are the highest. Generally, I will have had coffee and some light breakfast which I know can sustain me for a few hours on a bike or run.

Christian Rose

Image 1: A typical breakfast, “breakfast wine” included.

During exercise, I try to allow myself the space to think more abstractly and let my brain determine the direction of my thoughts. If some creative energy strikes or imagery pops into my head, I try to write it down immediately on my iPhone. Later, I might sit with the thought in a more expansive format with a pen and write out an outline of my thoughts or an idea map. My exercise time is my catharsis.

Image 2: Unformed but promising ideas.

I generally like to exercise before a shift. My critical thinking is at its best when I have already shaken off that well of anxious energy. Without that outlet, I have so much running through my mind that I can’t focus on any one thing. After exercise, I am much more chill and ready to listen. The anxious energy is gone and I can instead focus and be present.

I enjoy the role of the nocturnist and have found several benefits of “nocturnisting:”

  • Emergency physicians have a hard time (at least I do) responding to emails on shift. I try to avoid working when there would be disruptions or a constant deluge of emails.
  • Nocturnists tend to get paid more.
  • Nocturnists get to help your colleagues get home and to sleep – which kind of makes you their hero.
  • I love the night shift crew. Without offending the day-shifters, there’s a different camaraderie for the people keeping the city alive when everyone else goes to sleep.
  • I’ve even come up with a rotation of “night shift” playlists:

When I get off work, it’s time for either sleep or exercise but I have no steadfast rules. I tend to either exercise right away with friends if they are doing something that morning, or go immediately to bed.

Christian Rose

Image 3: A celebratory team “jump” after a group track workout.

I don’t use blackout shades because the odd arrangement of window sizes hasn’t allowed me to recruit some from Ikea yet. Instead, I use the cupped, bra-type of eye mask and a Dohm noise machine.

Christian Rose

Image 4: Bra-style mask eye mask here.

I also use my Garmin Fenix to keep track of my running or riding and to get a “10,000 foot view” of my sleep patterns. Knowing whether I just slept 3 hours instead of 7 helps me ensure I get enough rest and avoid being overly tired for the next shift. Knowing I actually did get enough sleep can sometimes provide me with some reassurance that I’m only feeling tired because I’m awake at a different time, not because I actually missed out on needed sleep.

Wellness Hacks

I prioritize 3 daily values:

  • Being present on shift
  • Working on niche interests
  • Exercising or getting outside

As long as I have done these three things, I feel like a million bucks. My mind is less anxious, and I feel better equipped to tackle all the other things still on my To-Do list.

In terms of addressing that list, I use the pomodoro method (named after a small tomato timer). It works great and can help people, especially emergency physicians, block out the parts of the day when they are not in the ER or to make use of the non-clinical days more efficiently.

Image 5: For those of us who don’t have a tomato timer accessible, this bear focus timer app works well, too.

My biggest hack is making time for family and friends. There are so many books about the pursuit of wellness, but they always seem to end with the same conclusion: surround yourself with people you love. I try to do this as much as possible. Although it does sometimes require being intentional, I find that it’s worth the extra effort because everything else seems to stem from here.

At home, I am super close with my siblings and they make me feel GREAT about the sacrifices I’ve made as a practicing physician – so I don’t feel bad about lost sleep or missed vacations. My wife and I were together for over a decade before we got married last fall. I love her family and lived with her mother during residency after her parents became empty-nesters. She and I would cook together and watch movies which helped me maintain a sense of balance.

Christian Rose

Image 6: My closest family and friends.

I also like my colleagues and really enjoy being around them. I am fortunate to be included in a diverse group of intimate friends who share in all that life has to offer. Who knows if they see me the same way, but I am enamored by them. They reflect back to me how I present myself to the world, and we share in the ups and downs of life and our profession.

I honestly believe this is the biggest wellness hack of all time: Surround yourself with people who take interest in you, care to make dinner together, push you to be better, and lift you up when you fall… sometimes literally. I haven’t yet seen any evidence that there is anything stronger to support wellness than a strong social group, so this is the one I work hardest at. That’s the hack. It’s like some strange alchemy – you put in energy here and true gold comes out.

On that note, I also avoid social media as much as possible.

More Wellness

Any and all feedback is welcome as we continue this series! We would be happy to hear from you, especially if you have specific wellness resources to share, would like to be featured, or are interested in hearing from any particular EM rockstars. And if you missed them, check out our other “How I Stay Healthy” posts.

Christian Rose, MD

Christian Rose, MD

Clinical Informatics Fellow
Stanford University;
Emergency Physician, Kaiser Permanente