How to combat burnout.

Perhaps with a few months of practicing medicine in this “pandemic-era” under your belt, you are feeling like you are taking on water and sinking fast, aka BURNOUT? Or, perhaps you’ve been managing to keep your head above water, but feel the current workload and stressors are unsustainable, and that you could use something to help stay afloat? Or, perhaps you are thriving and just want to add a tool in your resiliency toolbox? Wherever you are along the “Surviving –> Thriving Spectrum“, I’m here to help, by meeting you where you are RIGHT NOW. Here are three pragmatic tips, to lighten the workload and stress levels for you, as well as for your future self:

  1. CREATE AN EHR SHORTCUT. TIME IS YOUR MOST VALUABLE RESOURCE. It is estimated that clinicians spend 2 hours of documentation time per 1 hour of patient care1. In addition to that frustration, clerical tasks and EHR use are frequently cited as top causes of the burnout pandemic2. We all need to decrease our EHR burden, and improving proficiency (optimized usage) and efficiency (time spent) are ways to save time both within and outside of working hours. Set a goal for today of creating at least one EHR “shortcut”, “speed button”, “dot phrase”, “macro”, “smart phrase”, or whatever your EHR refers to it as: The investment will likely only take a few seconds out of your day, but the time saved will be exponential. Think of it this way: Creating the EHR shortcut will likely take you less than 60 seconds, but let’s use 60 seconds anyways. Invest 60 seconds into creating your shortcut, preferably on one of your most frequently used orders, reply messages, E+M or CPT codes, or physical exam templates, and you will likely save about 5 seconds each time you use it (along with the invaluable mental bandwidth and decision fatigue savings). If you use that shortcut 10 times per day, you have now saved 50 seconds per day, the equivalent of 4-5 minutes per week, or 4 hours per year, just with a single EHR shortcut!  


    An example is creating a “QuickAction” item in Epic for the “FYI” telephone encounters you may get each day, with the shortcut adding in your rapid response (“Noted, thanks” is mine), while also signing it off and closing the message…all with just 1 click. If you are unsure how to do this, contact your IT department, locate a Super User/Speciality Champion or someone who geeks out on this stuff like myself. This tip alone just saved you 4 hours within the next year, so now you can start planning on how to reallocate this time towards something else to move yourself away from survival mode and towards thriving.
  2. CREATE A MANTRA. I’ll start by giving you the mantra that I use: “What kind of day have I decided to have?” This is the question to myself, from me, that I post on a sticky-note on my computer screen. Implied within this question is that I have control over my thoughts and feelings, regardless of what my day may bring. It serves as a reminder to focus on what I can control, not the variables outside of my influence, and this approach is rooted in Stoicism. I’ll also argue that there is a comfort to this sense of control, especially during these uncertain times, and that may appease many of us who have Type A personality traits. When our workdays become particularly challenging, and threaten to overwhelm us, a mantra can serve to comfort us and ground the negative thought patterns that may be spiraling, and even compounding. Simply thinking or speaking your mantra will stop the mental/emotional rollercoaster you are on, one that, as it turns out, you are actually the operator of, and then give you an opportunity to hop off and change course. From there, choose wisely.  
    So, “What kind of day have I decided to have”? I choose to have a joyful and fulfilling day where I welcome the challenges that may come my way; a day that reconnects me with the reasons I enjoy my career as a PA.
  3. TAKE A COLD SHOWER. Wait…what??!! The purpose of this exercise is to overcome something that gives you hesitation. Former FLOTUS Eleanor Roosevelt said “You gain strength, courage and confidence by every experience in which you really stop to look fear in the face.”  Although I wouldn’t classify the hesitation one might have with cold water immersion (CWI) as a “fight-or-flight” level of fear, it still elicits a natural response to consider other options, making CWI a perfect and convenient way to shock you into improved willpower, decreased stress, decreased inflammation and many other physical and mental benefits3. Your primitive brain is risk-averse, and CWI is one method to bypass some innate fear, as you get to choose the comfortable (warm and cozy) or less comfortable (CWI) path for the day ahead. 
    I’ve found this useful as a desensitization strategy, which seems to reign in whatever nervous energy that I may be harboring (TIP: most notably on days with presentations or any “performance” activity on the schedule). I usually end my morning shower with 30-60 seconds of cold water immersion, mostly focused on my face, neck, head and shoulders, while focusing on deep, rhythmic breaths (the natural instinct is to breath-hold or take a giant gasping breath). Consider trying to progressively lower the water temperature over time, as opposed to just going to the extreme from day one. I challenge you to try it today, and don’t be surprised if you come out feeling exhilarated, and that you find the rest of your day’s stressors might seem a little more trivial and easily overcome. 

1 https://www.mayoclinicproceedings.org/article/S0025-6196(19)30836-5/abstract
2  https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#5
3 https://www.tonyrobbins.com/health-vitality/the-power-of-cold-water/

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) There are no conflicts of interest to report. 3) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 4) I am not recommending you do anything foolish or extreme with cold water immersion, and I do not take responsibility for anyone who decides to do anything beyond my basic recommendations.