“It is neither wealth nor splendor, but tranquility and occupation, which gives happiness.”
– Thomas Jefferson
If you are a practicing physician, you need rest.
Why do I say this? Because you have gone through an enculturation process which focuses on hyperactivity and super high-level achievement. In training programs and in practice, admitting that you are tired or needing a rest break is a sign of weakness and is discouraged, to say the least.
This may be especially true for older doctors who trained in a prior era, but it is still true for most of us. Calling in sick or going home early was a sign of inexcusable weakness when I trained. That has been deeply ingrained into my being.
I recently read an entire book about rest. If the importance of rest is not clear to you or if you find yourself struggling to obtain rest in your life I recommend reading that book. It is evidence-based and very well written. For those who are unable to read the book, I will summarize here some of its points.
Work and rest are two sides of the same coin. Like day and night, you cannot have one without the other. Like the peak and trough of a wave, they have no meaning in isolation, but only relative to each other.
Likewise, we tend to be obsessed with either work or rest as though it is an all-or-none binary position. Work may consume every waking hour of our life. It then takes over every aspect and drives us to burn out.
At that point, we dream of retirement. Our dream and vision of retirement may be a complete and total cessation of work so that our days are filled with rest or leisure only. Either extreme is not conducive to optimal living.
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. Rest does not just appear on its own in sufficient quantities. No one will give you the amount of rest that you need for optimal living. You need to take the bull by the horns and plan rest and schedule rest and make rest a priority.
Rest will make you more productive. The reason to rest should not be solely based on increased productivity. Nevertheless, there is significant research and anecdotal experience that shows those who can take enough rest are more productive in their work hours. This was seen on a large scale when mandatory overtime was required in manufacturing firms. Productivity per work hour suffered markedly because the employees became exhausted and disengaged.
Rest fosters creativity. To become world-class. To become a genius. To create a new infrastructure or paradigm requires a well-rested active body and mind.
One survey showed that the most productive world-class performers are more likely to consider themselves lazy than to consider themselves ambitious. Part of the reason is that they schedule non-work activities. This is not only a distraction from the work. It allows a different mode of thinking. Instead of focused thinking, it induces diffuse thinking — which better lends itself to creativity.
It is not a coincidence that a discoverer of DNA, James Watson, enjoyed an active life of leisure, dating, and skiing. Some of his best ideas came while relaxing on the slopes or while browsing in a bookstore.
Steven jobs had his most successful meetings and ideas while going on long walks. There is a strong link between the creativity level of theoretical physicists and their consistent predilection to hiking and mountain climbing. In what ways could you use more creativity in your life?
Rest as a skill
Part of rest is scheduling adequate sleep. Americans live in a hyperactive, sleep-deprived world. It seems to be something to brag about. How few hours of sleep can you get by on? An increasing body of literature is demonstrating harm to psychological well-being as well as physical well-being due to sleep deprivation.
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. It takes effort to carve out this important time.
Rest should be active, not passive. The most effective restorative rest that counterbalances long and stressful work hours comes from active leisure. Passive activities such as mindless TV viewing can allow a brief break after a busy day, but it does not have the restorative capacity to truly counteract work in the way active leisure does.
How could we better reconnect to our childhood pleasures? Did you used to like running? Or tennis? Or playing kickball? Or climbing a wall? Incorporating some of those activities in a normal adult life can lead to a healthier psychological and physical disposition.
Rest is a skill. Like any skill, it takes training and effort to improve. Have you heard of deliberate practice? Think in terms of deliberate rest. Most of us have not been trained in improving the skill of rest or understanding its true importance with regards to creating a whole and meaningful life.
Fighting burnout with rest
We may need to learn how to prioritize, set limits, say no, and plan our “office work” hours. I have had to learn the skills of letting go and disconnecting.
I achieved some milestones:
- I took a 2 1/2 week summer vacation.
- I took a few Wednesdays off in one month.
- I had a practice partner cover my in basket in my EMR while I was away.
- I turned on the autoresponder on my email noting I was out of the office.
These were difficult habits to break or establish. At first, I felt like I was dumping on my partners and abandoning my patients. As time goes on, I am much more comfortable with being disconnected and enjoying the non-work aspects of my existence. I highly recommend incorporating more time with each patient, shorter work hours, and true time off to disconnect from everything work-related. It is restorative.
None of this is new
Rest is not a new concept. Although we may think that our obsession with busyness and our interaction with technology is a new phenomenon, it is not. The ancient Greeks and Romans argued that you cannot have a good life without good work and without good rest.
Technological innovation is also not new. The revolution in travel, manufacturing, mobility, railroads, telephone communication, etc. was at least as disruptive as our current instant messaging and social media technology.
Physician burnout is not new. There is a growing body of literature and research in physician burnout. One very early neurosurgeon, Wilder Penfield, warned medical students that unless they cultivated other interests -other than their specialty- an “insidious disease” would enter them and imprison them in lonely solitude.
He felt that the subspecialty focus would make them isolated and not connected to other important things in life.
Penfield’s mentor, William Osler, warned that without care, “good men are ruined by success in practice.” He also warned that the “ever-increasing demands” can leave even the most curious person “worn out, yet not able to rest.”
Have you ever heard a more apt description of physician burnout? I have not. Osler also felt it was essential to develop “some intellectual pastime which may serve to keep you in touch with the world of art, of science, or of letters.”
The challenge we face when learning to rest better is not to avoid work, but to discover how to create a better fit between our work and our rest.
“Physician on FIRE” is an anesthesiologist and can be reached at his self-titled site, Physician On FIRE.
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