Physicians Anonymous

physician self-care

Physician self-care for stress and burnout

Doctors are notoriously bad at self-care. From early on we are in self-sacrifice mode, and the pressures of medicine really give us an opportunity for physician self-care. Yet we are burning out in record numbers. While we fully acknowledge that the biggest cause of physician burnout is systemic – and largely out of an individual physician’s control, we also believe that there are things we can do to help ourselves.

  • We cannot pour from an empty cup.
  • Put your oxygen mask on before helping others.
  • Check your safety before starting the ABCs of CPR.

It’s all there but few of us have time or awareness to action this wisdom in our daily lives.

A broken system is not an excuse to not care for ourselves.

In this article we explore science-based small and inexpensive physician self-care practices that may, we hope, help relieve stress and ultimately tackle physician burnout.

We also argue that physicians should consider a critical shift in thinking — one that prioritizes caring for oneself as an effective means of caring for others.

What is physician self-care?

Physician self-care has been defined as “a multidimensional, multifaceted process of purposeful engagement in strategies that promote healthy functioning and enhance well-being.” 

Essentially, the term describes a conscious act a person takes to promote their own physical, mental, and emotional health.

Not easy for physicians. We like to think we are super beings and not subject to the same laws of physics, biology, and psychology as our patients. Fortunately, our smoking rates are now way lower than the public average, but there was a time when doctors smoked and drank like everyone else, before we started acknowledging the evidence. Then physicians became leaders in public health, often (but not always) leading by example.

Perhaps it is time for us to do the same when it comes to looking after ourselves? After all, we cannot give away what we have not got. We cannot pour from an empty vessel.

1. Airway-breathing-circulation

Nope, this is not CPR, but arguably as important over a longer time period than 4 minutes. 

We all know that a deep breath helps us relax. No surprise then that decades of research have demonstrated that by taking slow deep breaths, we calm the body and mind by activating the parasympathetic nervous system; when this happens, stress markers, heart rate, and blood pressure all decrease.

That’s why taking deep breaths throughout the day can help keep us calmer and more balanced. Breathing may also form part of meditative practice, yoga, or relaxation, all of which may contribute towards positive physician self-care.

Breathing may also form part of meditative practice, yoga, or relaxation.

Below is an easy and accessible breathing practice that newcomers to physician self-care may find useful.

Easy breathing practice for beginners

  • Sit in a comfortable position with the spine straight and head inclined slightly forward. Gently close your eyes and take a few deep breaths. Then let the breath come naturally without trying to influence it. Ideally, it will be quiet and slow, but depth and rhythm may vary.
  • To begin the exercise, count “one” to yourself as you exhale
  • The next time you exhale, count “two,” and so on up to “five”
  • Then begin a new cycle, counting “one” on the next exhalation
  • Never count higher than “five” and count only when you exhale. You will know your attention has wandered when you find yourself up to “eight,” “12,” even “19.” Try to do this for 5 minutes and work up to 10.

Try this once a day for 30 days and see what happens to your stress levels.

2. Nutrition

So many physician colleagues and coaches that I’ve known think they’re superwoman/man.— able to work all day without the need to eat, sleep, or exercise. Denying physical needs is like a badge of honor in medicine, but it also contributes to an empty tank and negatively affects our ability to care for others.

Are we following the lifestyle advice that we give our patients?

Denying physical needs is like a badge of honor in medicine, but it also contributes to an empty tank and negatively affects our ability to care for others. Are we following the lifestyle advice that we give our patients?

Evidence-based strategies that promote our physical health include healthy eating, sleeping, and exercise habits, yet we often neglect these basic means of refueling ourselves.

How many of these can you honestly say you do?

  • Do I eat five or more fruits or vegetables daily?
  • Do I limit saturated fats and foods and beverages with added sugar?
  • Do I drink alcohol in moderation, if at all?
  • Do I get 30 minutes of cardiovascular exercise most days and muscle-strengthening at least twice a week?
  • Do I get the recommended seven or more hours of sleep each night?

If so, bravo! If not, could you change just one thing to improve looking after yourself?

3. Movement for physician self-care

The evidence is overwhelming that exercise is associated with a longer health span, delaying the onset of some 40 chronic conditions and diseases.

Exercise improves mental health, physical health, longevity, cognition, mood, motivation. It’s good for just about everything.

Even short bursts of high or low-intensity exercise seem to improve health markers. For example, randomized control study found that overweight or obese women that were usually sedentary improved their cardiorespiratory fitness by walking for only 10 to 15 minutes a day when compared to a control group.

Another study among sedentary men also found the short interval group, who biked for 10 minutes with one minute of high intensity, increased their oxygen uptake the same as a group who exercised at a moderate rate for 50 minutes.

Even the busiest physician could make 10 minutes in their day for exercise, whether it’s right when they get up, before taking a shower, during their lunch break (and if you don’t get a lunch break, take a lunch break!).

Our bodies and minds benefit in a variety of ways when we help others. Some research has focused on the “helper’s high.” Studies show that volunteering, donating money, or even just thinking about donating money can release feel-good brain chemicals and activate the part of the brain stimulated by the pleasures of food and sex. Studies of volunteers show that do-gooders had lower levels of the stress hormone cortisol on days they did volunteer work.

In fact, research by Stephanie Brown suggests that those providing help may get more benefits than those receiving it. In this study, mortality was significantly reduced for individuals who reported providing instrumental support to friends, relatives, and neighbors, and individuals who reported providing emotional support to their spouse.

4. Immerse yourself in nature

People feel better after getting in nature, yet we underestimate the healing power of these experiences. 

Fortunately, most physicians have a level of physical ability that makes this possible, unlike many of our patients with mobility issues and social circumstances that make this really hard to do. 

The next level is the Berkley practice of “awe walks” for those who can do them.

Additionally, AllTrails, an app to find a hike wherever you are to practice walking meditation

5. Forgiveness

Forgiveness doesn’t mean denying we were wronged; it means we let go of our anger and other unhealthy cognitive processes.

Forgiveness requires some hard work, but the benefits are profound: Those who have learned to forgive live longer. This occurs from less stress, depression, and better sleep and relationships.

Practicing active forgiveness – whether to the offending person’s face or just in your heart and mind – is like a weight off my shoulders.

6. Physician, be kind to thyself

Physicians are often our own worst critics, and when work feels overwhelming, we can direct an unhealthy amount of blame upon ourselves. Self-compassion helps us heal ourselves rather than hurt ourselves.

Self-care by talking to ourselves in a kinder voice is the key to this practice.

For the more curious, you might consider practising a loving-kindness meditation; research suggests it can help us feel more love for ourselves and others.

7. Mindfulness for physician self-care

Mindfulness, in its most simple form, is self-awareness. It is the practice of looking, observing, reflecting, and listening so that you see the present — yourself and the world around you — more clearly and without judgment.

For physicians, the benefits of mindfulness extend beyond personal stress reduction, improved health conditions, and increased job satisfaction; mindfulness can also improve the patient experience.

If you’re new to mindfulness, you might start with a simple self-assessment. The Mindful Attention Awareness Scale (MAAS) is a validated tool that measures our ability to focus attention and awareness in daily life.

There are many ways to begin a mindfulness practice. I recommend starting with as little as 10 minutes a day of mindful meditation, mindful walking, or focused breathing (see 1, above), or the following resources:

  • Mindfulness video by Jon Kabat-Zinn
  • Headspace, a guided meditation and mindfulness app (free limited session options)
  • InsightTimer, a free app for guided meditations, music tracks, talks, and courses
The evidence base? 2020 nonrandomized pilot study of 34 physicians who had reported having anxiety suggested that the use of an app-based mindfulness program may reduce anxiety associated with burnout by as much as 48% within the first month.

Conclusion: physician self-care

We doctors are excellent at caring for others. Yet,  we are not great at caring for ourselves. 

Changing ourselves can be the most challenging yet most rewarding work we will ever do. We will need to walk the walk every day, learn from those around us, and learn from our own successes and struggles. Prioritizing our own well-being has the power to change not only us but also the culture of medicine.

This article has explored a number of evidence-based options for self-care for physicians. Things that we advise our patients to do.

We sincerely hope that you try one or two of these and find benefits. If so, we’d love to hear from you!

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