Balance

Image Credit: Pixabay

Author: Thomas Hull, MSIV
Medical Student
Loyola University Chicago SSOM
AAEM/RSA Social Media Committee

This post was peer reviewed.
Click to learn more.

The eyes do not see what the mind does not know,” a common saying many of us have come to hear in medicine. A simple and powerful aphorism illustrating the fundamental connection between awareness and intelligence; it urges us to keep reading and expanding our education. The connection between study and clinical success may seem obvious, and even elementary, but one cannot dismiss it as reductive. A deeper proverb is speaking here about the connection between mind-body, or more specifically, consciousness and well-being. We all know the feeling after a long day, with energy running low and emotional barriers wearing thin, of being “brain-dead.” The medical community has been forced to deal with this in recent decades, most prominently and publicly with residency duty restrictions. Now this November with conclusions by the Accreditation Council on General Medical Education (ACGME) task force that 24-hour call (with 4 additional hours allowed for transition) for first-year residents does not affect patient care,[1] it’s even more relevant. Their recommendation has found support in the idea that increasing number of handoffs and transitions of care could result in an actual rise in medical errors. A 24-hour shift may also be desirable to some, as one long shift with a day off after may seem better than to two rigorous 16-hour shifts abutted. Though the ACGME has requested public discourse on this topic before making its official 2017-2018 recommendations on December 19th, it’s likely these changes will take affect and highlights the importance of maintaining healthy balance heading into residency. After all, these hours are already the standard for PGY2 and beyond, thus it’s only a matter of time.

So, what does that mean? What is healthy balance? We often hear about companies employing the newest trends in business culture and workplace satisfaction, with many trying to imitate the magic Google has conjured in its post-modern office model.[2] As stated in their culture manifesto, “Our offices and cafes are designed to encourage interactions between Googlers within and across teams, and to spark conversation about work as well as play.” Their massive success, and the fetishizing of their philosophy in the business world, speaks to the truth they have found: people work better when they are happy. Hospitals and medical schools may try to construct similar cultures, but given the enormity/conformity of those operations in general, such seemingly whimsical and unconventional progress occurs at glacial pace (and essentially goes against the old-school philosophy). Ultimately, this retention of play and fostering positivity in each of our lives is up to us. If it’s important to you, and you can find the time, here are some basic steps one could take:

• Exercise - Countless studies have shown the positive effects of physical activity on cognition, memory, attitude, and sleep cycle. It’s now becoming first-line prescription for depression and is a key recommendation in Harvard’s “Understanding Depression” guidelines.[3]
• Lift Weights - This may seem redundant given the above; however, “exercise” in most studies refers to aerobic activity (running/swimming etc.) and there are specific reports within the National Center for Biotechnology Information (NCBI) review which show resistance training is particularly effective. Additionally, I recommend reading the essay “Iron and the Soul” by Henry Rollins. Because, as Rollins states, the iron never lies to you.[4]
• Interact Socially – This has many incarnations and can be qualified by both in-person activity as well as online; the main point is that isolation can worsen negativity. A controversial but anecdotal study found isolated rats consistently self-medicated with heroin in comparison to their counterparts in a group setting. It comes with a caveat (especially online) - not everyone is nice.
• Protect your Hobbies – from my experience talking to multiple residents, especially those in demanding programs, one of the biggest laments is the loss of personal time. We all experienced the sacrifice during medical school to some degree, but residency and life milestones that usually accompany it (marriage/children etc.) can kill your passions. Whether it be writing/music/photography/fishing/shooting/art/cooking/movies whatever, try your best to keep some aspect of your life your own.
• Play a Sport – I had initially grouped this under exercise in my mind, but now as I’m making this list I realize that playing a sport would pretty much encompass all the above. Go out and join a league and get after it, “the credit belongs to the man who is actually in the arena...” – Teddy Roosevelt.
•  Eat Healthy – This may seem obvious to medical personnel, but I still struggle given that taro froyo is my heaven on earth; try your best.

In summary: the mind, body, and senses are all intricately connected. As emergency physicians in particular, and as people helping people in general, we must constantly strive to balance our subjective experience with the objective and critical presentation of others, and vice versa. Stay healthy and stay positive.

“The ability to control your thoughts, treat it with respect, it is what separates us from the beasts and connects us to the divine” – Marcus Aurelius

References

1. Jaspen, B. “Why its Ok for Medical Residents for Work 28 hours Straight.” Forbes, Pharma and Healthcare online. November 5, 2016.
2. Gillett, R. “5 reasons Google is the best place to work in America and no other company can touch it.” Business Insider, online. April 28, 2016.
3. Blumenthal, JA., Patrick J. Smith, and Benson M. Hoffman. “Is Exercise a Viable Treatment for Depression?” ACSM’s health & fitness journal 16.4 (2012): 14–21. PMC. Web. 2 Dec. 2016.
4. Rollins, Henry, “Iron and the Soul.” Details Magazine, 1994. Available at: http://www.oldtimestrongman.com/strength-articles/iron-henry-rollins. Accessed December 1, 2016.