Avoiding Medical Fatigue

This was a tough week at med school. As a class, we had several sessions to learn about trauma-informed care: screening patients for traumatic events, and learning how to ask about these experiences to better provide a safe healing environment for them.

We were told in advance that this might bring up painful memories or difficult emotions. Although we had known to be prepared for this, I sensed that my class, including myself, seemed tired and drained after a long day of discussing important but hard topics.

As I understand it, this is an experience that is virtually universal in the medical field. Those in health professions, including medical students at almost every point in the training, are exposed to many difficult experiences that challenge us in unprecedented ways. Being a witness to suffering and illness can lead to fatigue—even losing the sense of compassion and empathy that caused us to choose this profession in the first place.

I know that I’ve often found some of the aspects of medical work to be emotionally difficult, especially feeling affected by patient stories. Outside of medicine, a lot of what I see on the news can get to me as well. I have my own ways of taking care of myself to make sure I stay well and avoid fatigue—one of which sometimes is just eating a big bowl of ice cream. But I decided to reach out to someone who has advised me about wellness, Dr. Potter, to see what insights she could offer beyond ice cream.

Dr. Jennifer Potter is an internist at Beth Israel Deaconess Medical Center, and in addition is an expert on wellness and a mentor for medical students. I asked for her advice about maintaining a “toolbox” of wellness—strategies to keep yourself well and avoid fatigue despite working in potentially stressful environments.

Be Well, Stay Well, Get Help

Dr. Potter acknowledged how difficult it can be stay well while working and learning in a medical setting. She said, “In medical school, there are constantly challenges in terms of the volume of information that you are being asked to take in, and finding yourself in new experiences all the time—that can be hard and can trigger deep sadness from the past. That is something that happens over and over in medical training.”

I completely agreed when Dr. Potter described the role of being a med student (or a pre-med) as “performing”—trying to be “on” all the time, showing that you have what it takes to become a physician. Feeling like you constantly have to function at your best becomes draining over time. It can be especially hard when you witness something that makes you uncomfortable, but feel like you don’t have the ability or time to process the emotional impact.

Dr. Potter’s advice is to “be well, stay well, and get help,” and to develop a toolbox to maintain all different aspects of wellness. She described elements of wellness including nutrition, physical activity, sleeping and getting rest, connecting and sharing with others, relaxing, and staying in touch with your spirituality. When you’re able to find what works for you, you continue practices to attend to those various aspects.

If you’re not able to find right away what works for you, seeking advice or help can be the way to go. “Know where to go when you need help, so that you don’t experience any barriers, or worries that it may be perceived in a stigmatized way,” said Dr. Potter.

What to Put in the Toolbox

Developing a “toolbox” is essentially developing skills for resiliency—the ability to deal with different kinds of situations that might come up in the future. Two of the tools that Dr. Potter shared with me were mindfulness and gratitude.

Mindfulness means attending to the moment: taking a breath to pause and assess how you feel, physically and emotionally. It’s easy to work for a long stretch of time, or spend the whole day in clinic, and suddenly stop and realize that you haven’t eaten or you’re not feeling well. Mindfulness counters that tendency to go through the motions without pausing to check in with ourselves.

At times, I’ve felt worried about what my clinical year next year might be like, when I’m taking part more actively in the care of a number of patients. What if I’m not prepared for some of these experiences?

Dr. Potter offered a piece of advice for dealing with those difficult experiences in the clinic, when something comes up that doesn’t feel quite right. She said, “Take that little U-turn that says: ‘Something just hurt me, and I’m going to come back to it later’…Never try to push aside the reaction that you’re having.” Even if you can’t address the feeling in the moment, revisit it later when you have the time and capacity to think about it. Don’t invalidate your feelings, but instead know that your reactions are normal and completely fine to have.

To practice mindfulness during the day, Dr. Potter has a technique that she uses: “mindfulness minis.” She ties mindfulness to simple moments such as washing her hands or entering a patient room. She takes a deep breath and tries to relax and achieve a moment of mindfulness.

In addition to mindfulness, another tool is gratitude. “Keep an outlook of optimism, and an easy way to do that is to try and think about, what are the good things that happened during the day?” said Dr. Potter. She described how in the winter during the snow, most of us are walking to work bundled up and grumpy. But a little child in a parka might be laughing and playing in the snow, delighting in the joy of something simple. Dr. Potter believes that we can learn from that.

Practicing Self-Care

Self-care might seem like something silly or extraneous, but to me it is essential to long-term success in a demanding profession. It’s about being “smart” in a different way from just succeeding in the classroom. Later on, I will write about self-care, what that means, and when and how to care for yourself.

When it seems like a billion things are going on and demanding your attention and emotional capacity, it’s okay to pause and center yourself. As Dr. Potter said, “Know how to stay steady when the boat is rocking.”