#349 Doctors, it’s OK to take a break – adequate rest is essential for safe and competent practice
“Self-care is not a selfish act. People who are selfless to the point of self-sacrifice end up burning out.” - Adam Grant, organisational psychologist.
In her recently published biography ‘Emotional Female’, Dr Yumiko Kadota describes herself as a workaholic who put ‘knife before life’ in the hope it would lead to her dream career in plastic surgery. Her self-sacrifice was exploited and ultimately, she became physically and mentally unwell, burnt out, and had to walk away from her career aspirations.
The Royal Australasian College of Surgeons (RACS), in conjunction with several other medical colleges, recently released a Wellbeing Charter for Doctors. The fundamental principles in the Charter include:
- Maintaining wellbeing leads to the performance of high quality and effective health care delivery and optimises patient care
- Doctors who maintain and maximise their health and wellbeing are able to manage the physical and emotional demands of medicine
- Wellbeing is essential to achieving the competencies required for good medical practice
- Wellbeing is beneficial to the individual and to the medical community in which doctors work
- Jurisdictions, hospitals and medical colleges must support the wellbeing of doctors and provide an environment that is safe, accessible and inclusive for all.
The Charter places shared responsibility for wellbeing in the hands of doctors, colleagues, managers, leaders, hospitals, and jurisdictions. Doctors are expected to practise self-care and continually evaluate what works best to thrive.
Basic needs include sleep, exercise, nutrition, hydration, rest, boundaries, and engaging in enriching activities that bring joy and purpose, such as learning, giving, hobbies, spiritual practice, mindfulness, and social connection.
The Charter indicates that, while the systems including hospital management and other jurisdictions have a responsibility to support the wellbeing of doctors, each doctor has a responsibility to practice self-care to meet their basic needs, such as getting adequate sleep, taking regular breaks and leave, and setting boundaries for themselves.
Unfortunately, there has been a culture in medicine which discourages calling in sick; admitting that you are tired or needing a rest break is seen as a sign of weakness and is strongly discouraged. Additionally, doctors-in-training are under pressure to gain experience by working long hours, and there is a fear of missing out on an interesting case or an opportunity to participate in a procedure. Senior doctors may also promote the idea of long hours based on their own training experiences, forgetting that the pace of medicine has increased significantly over the years, with shorter lengths of hospital stay, many more diagnostic tests and much more documentation.
The effects of fatigue on performance include:
- Cognitive slowing
- More variable performance
- Neglect of nonessential activities
- Decrease in learning
- Decay in problem-solving
- Impaired memory
- Decline in motivation
We know that being tired adversely impacts performance and decision making. Doctors who are sleep deprived do have motor vehicle accidents driving home after long shifts without adequate rest breaks. A doctor’s life is put at risk and patient care is compromised when a doctor has not had adequate rest. This has been known and discussed for many years but change in culture and systems has been slow. There are provisions for adequate rest breaks included in the hospital Enterprise Bargaining Agreements.
The added pressure on healthcare systems and all healthcare professionals during COVID-19 is tiring and exhausting our healthcare workforce. As this pandemic will be with us for quite a long time, it is essential that all healthcare workers, including doctors, pace themselves and make adequate rest a priority.
What is rest
Rest is a skill. Like any skill, it takes training and effort to improve. Think in terms of deliberate rest.
Rest should be active, not passive. The most effective and restorative action that counterbalances long and stressful work hours comes from active leisure. Reconnect to childhood pleasures, explore hobbies and creative outlets and build connections outside your workplace. Cooking, gardening, music, dance, art, learning for its own sake, reading for pleasure, journaling and writing blogs, travel, sport (especially team sport which brings connections) and spiritual and religious practices can all be restful activities. There are times for passive activities, such as binge watching a Netflix series, but this alone is not regular, adequate rest.
Part of rest is scheduling enough sleep. Chronic sleep deprivation affects mood and job satisfaction, as well as intellectual performance. An adequate sleep schedule does not just occur on its own without planning.
Rest should be scheduled
Rest should not be an afterthought. It is not just a passive void to be filled in when there’s nothing else to do. We may need to learn how to prioritise, set limits, say no, and plan our ‘work’ hours.
No one will tell you the amount of rest that you need for optimal living. You need to plan, schedule, and make rest a priority. A rest day is a day where you take a break from your regular work routine and are an important part of any lifestyle. They give the body and mind a chance to repair and recover and help to prevent long-term injury.
Rest fosters creativity and makes you more productive. The best ideas come while relaxing. Adequate rest on a regular basis will counter burnout.
AMA Victoria Coordinator of Doctor Wellbeing
- Emotional Female, Yumiko Kadota, Penguin Random House, 2021
- RACS, Wellbeing Charter for Doctors
- Blog, Kevin MD - Practicing physicians need rest
- Blog, BMJ - Breaks at breaking point - doctors need to take time out in a pandemic
- Steven K. Howard (2005) Sleep Deprivation and Physician Performance: Why Should I Care?, Baylor University Medical Center Proceedings, 18:2, 108-112
Article image: Björn Söderqvist