Staying Healthy While On Call

Every once in a while, we must be reminded of what health is exactly. As you probably know by now, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO definition). As a resident, your job is to make people healthy. Unfortunately, because of many contributing factors, residency can be a very unhealthy part of a physician’s life. We must be careful not to let it get out of hand.

Eating

Let’s face it. Hospital food tends to be on the tasteless end of the taste spectrum. If it’s tasty, it probably spent some time in the deep fryer and we all know how healthy that is. I personally have never been the guy bringing lunches from home when on call. However, I will make a conscious decision about the quality of the food that’s offered by the cafeteria. That’s easier said than done. For one thing, we tend to associate food with reward: “I’m on call and I’ll work hard tonight, therefore I deserve french fries”. That’s a bad habit we should try to eliminate. However, that’s easier said than done. As you will quickly learn, food tastes SO much better at 3AM. Chips? Chocolate bars? They are tasty to begin with, but in the middle of the night, they could replace sleeping.

After a few years of hard work, what that can lead to is a nice little belly. You don’t want to have to calculate a Framingham score on yourself do you?

I recommend bringing easy-to-carry food with you in your “on call bag”, such as

• almonds / trail mix
• apple
• banana
• baby carrots

There’s a lot more good choices to include and you should create your own solution. Just knowing about the problem is a good first step.

Move!

Many people think that since they’re running all over the hospital, that must be good enough to qualify as the minimum recommended daily activity. It is common knowledge that what is considered the “recommended daily activity” changes every other week, but we rarely do that. If you doubt my last statement, just get a pedometer or one of the wearables (Fitbit, Nike FuelBand, Polar Loop, Apple Watch…) and see for yourself.

During residency, I started running more regularly. I’m not a big runner - maybe 30 min. 2-3 times a week, but it’s better than nothing! I like running because you can easily bring your equipment with you and you can do it almost anywhere. Running is not for everyone, I know, but I strongly encourage you to find a sport that will help keep your heart and mind in great shape.

Sleep

“Sleep when you can” is one of the rules of residency. If you can nap, nap. Even during the day, if you can spare half an hour, try to go to your call room for a power nap. No one will beg you to go to bed in the middle of the night, but the rule still applies.

The day after being on call, I always try to get a few hours of sleep, but I will set my alarm for a few hours later so I have time for dinner and then exercise a little before going back to bed to get ready for the next day. With the new duty hour rules, this may change, but the gestalt remains the same.

Social

Having a social life during residency can be a foreign concept for many, but it’s important! When a group of residents organise an evening out, join them, even if you’d rather stay home and watch TV. Besides clearing your mind, you will get to know your colleagues differently. This special rapport will carry over to the hospital and will make your job easier as well. It is a win-win situation.

Mind

Unfortunately, the “social well-being” part of the WHO health definition is often overlooked. Residency is notorious for sleep deprivation and difficult working conditions. High expectations we set for ourselves are another source of worries. That can lead to important mental health issues.

About six month into my first year of residency, I had had enough. I just finished two blocks of general internal medicine and was now on gen surg with 1 in 4 calls. On top of that, it was Christmas and the medical students were away. I was covering for all three gen surg teams and doing floor and emerge consults. (I had good help from my seniors though, I must say. I’ll always remember the night Dave Robertson brought me a Starbucks coffee. I almost cried with joy). Anyway, I realized I was becoming mentally tired. I just couldn’t give anymore. Fortunately, I had a few days off over New Year to recharge the batteries, but they were really low and it took me a while before I felt “normal”. I often wondered if I was clinically depressed at that time, but I don’t think so. However, that episode made me realize how dangerous work can be for our mental health.

I personally find sports to be of a great help for my mental well-being. Others find that practicing mindfulness is best for them. Mindfulness has gained momentum over the last few years, especially in medical schools. Many offer free classes and I recommend attending them. A good tip is to practice mindfulness when your pager beeps.

If you ask an older attending what makes a good resident, they will likely tell you “someone who knows when to ask for help”. I believe that applies to everything in residency, including yourself. Even if you’re feeling fine right now, I recommend at least knowing what resources are available in your centre.

Online depression screening test

Suicide

Suicide is the number one killer of young physicians. Here’s a very good list of the whys: with a corresponding TEDx talk. I’ve been indirectly affected by resident suicide and obviously this leaves a mark. This is a touching article on the suicide of a family medicine resident (French; use Google Translate). This is another, more recent one. If you’re thinking about suicide, please get some help. A mentor, program director, suicide helpline… There is help.

Good JAMA article on the topic.

There’s been some debate about the root cause of this tendency of suicide. Some believe it’s due to the unrealistic expectations (patient care, calls…) combined with a physician’s tendency to be a perfectionist and not accepting the fact that we just can’t do it all. They say the solution is to re-think the residency training to allow more time to study and to do extracurricular activities. I disagree; this is not only most likely to remain unchanged (in my mind), but it would only delay the problem until a later date. Everything does not magically get better when you’re an attending — it often gets worse. We’re always going to be evaluated (yearly “productivity” reviews) and we’re probably always going to be taking exams (maintenance of certification).

Obviously the problem is very complex and there’s never going to be “one” solution. One part of the answer probably lies in stress-coping techniques, ideally starting at an early age so that we’re not trying to learn stress management skills in med school. This will never solve all the mental health problems that plague us, but it would be a good start.