Become a Better Physician: Take a Vacation

Jul 25, 2014


By Faith Hayden, Senior Writer

When was the last time you took time for yourself? If it’s been longer than eight weeks, you may be showing signs of exhaustion, edginess, and compassion burnout. Worse, your decision-making skills may be impaired. Known as decision fatigue, this phenomenon occurs when a person is required to make too many decisions in a short time without breaks; in other words, a typical day in the life of a physician.

“If we’re asked to make too many decisions, we become worse at it; we can’t do it anymore,” explained Ramani Durvasula, PhD, a neuropsychology researcher at California State University, Los Angeles, and author of You Are WHY You Eat: Change Your Food Attitude, Change Your Life. “The only way to address it is to stop making decisions, which is really what vacation is. You’re able to check out, and the only decision you have to make is, ‘Am I having a Mai Tai or a margarita?’”

In the U.S., taking a vacation—especially an extended one—has become less of a priority. According to a 2013 study by the U.S. Travel Association, Americans left an average of 3.2 earned days off in the pot in 2013, totaling 429 million unused days among U.S. workers.1

“We’ve all bought into a personal superhuman myth for ourselves,” Dr. Durvasula said. “We believe that we can keep pushing through day after day, that we can do it all, and that five hours of sleep is enough. This isn’t good for our minds and bodies.”

Thanks to the Internet and seemingly endless reach of Wi-Fi, “taking a vacation” has come to mean working under a palm tree instead of at your desk.

“I was able to get wireless access at the base of Mount Everest. That’s how much wireless access there is on this planet,” Dr. Durvasula said. “We’re not taking that break even while away. You may not be wearing a white coat, but you’re still just as connected. It defeats the purpose of giving the mind and body a break so you can come back and be a better practitioner.”

If you’re overwhelmed by the thought of leaving the office for a week or two, you’re not alone. According to Dr. Durvasula, many medical professionals in their early career believe an extended holiday will reflect poorly on them because they haven’t built up their reputation, so she advocates for the long weekend.

“Even one day off can make a difference,” she said. “Instead of making a weekend about doing laundry, use it to live more fully. A change of scene and a change of routine go a long way in shaking the dust off our mind so we have a fresh perspective in the office Monday morning.”

If a Friday off isn’t in your future, taking a mini-break during the day for activities such as exercise or mediation can also help reset the mind. “Oncologists face tremendous stress—there is so much they take on emotionally,” said Dr. Randy Kamen, a psychologist and former professor at Boston University’s School of Medicine and author of Behind the Therapy Door: Simple Strategies to Transform Your Life. “The best way to disconnect from work in today’s workplace is to take short frequent breaks. A five- to 20-minute relaxation break helps train the brain to better control emotions and pain, lowers stress levels, improves sleep, and helps one feel more present. Even mini-breaks as short as one to two minutes can initiate a relaxation effect. A simple abdominal breathing or relaxation exercise can accomplish this, as can meditation.”

According to Dr. Kamen, many individuals report feeling more rested after a meditation session than a night of sleep. Although she doesn’t recommend meditation as a replacement for sleep, it can be an energy and creativity booster during the course of a demanding and potentially depleting day.

For longer vacations, there are steps you can take to ease anxiety about taking time off. Dr. Durvasula recommends the “pre-vacation,” which means taking the first two days of your scheduled break and putting all matters to bed so you can more effectively enjoy the rest of your holiday.

“Instead of having seven anemic days off during which you work for half of them, have five days where you are really off,” she said. “Tell your stakeholders that you will spend the first two days taking care of issues, last-minute details, or answering crisis calls, but that you’re unplugging for those last five. You’ve got your calls covered. You’ve got people who can receive your clinical inquires. If you’re involved in editorial work or on a journal, you’ve got your email auto-replies set up. You’ve cleared your vacation with everyone so no one is blindsided.”

She also recommends triaging your patients and seeing those with the most critical cases right before you leave. You can also use that appointment to inform the patient of your holiday and introduce him or her to the attending physician in your absence.

“Some doctors feel protective of their patients and act as though they must be available to their patients at all times,” Dr. Kamen said. “It is important to develop a team approach as medical providers. This gives the patient ongoing, comprehensive care and the physician time to take breaks. Patients and doctors seem to generally fare better with a team approach, especially when communication between medical providers remains strong.”

Finally, while on vacation Dr. Durvasula recommends setting aside one hour per day to check emails and even take calls, if it will give you peace of mind. Although it may seem counterintuitive, knowing that you have a set time each day to address any issues will actually help you relax and turn your mind off work during the rest of your break.

“It allows me to enjoy the day because I know there are no fires (or they have been put out), and I can go about my business,” Dr. Durvasula said. “My staff knows that if they email me the night before, they’ll receive a response the next day. Different people have different boundaries, so you have to know yourself. But I don’t think anyone can hand out of the prescription of requiring someone to shut their phone down for five days. It is wonderful if you can do it. But to force it can cause a lot of anxiety in most physicians and have a paradoxical effect.”

Regardless of how much vacation time you can take in a year, what’s really important is carving out consistent time for yourself and your passions.

“It’s not necessary to travel far to get a break,” Dr. Kamen said. “It is a matter of taking the time for oneself and finding those places of beauty and tranquility where you are and choosing to take it in. Find something you love to do and build it into your life. Prioritize whatever it is that takes you into that zone of relaxation.”

1. U.S. Travel Association. The Day Off Accessed June 1, 2014.

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