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Question #1: Develop and/or discuss your own self-care plan for preventing and managing acute and daily stress.
I find that I am less stressed throughout the day when I wake up early and give myself plenty of time to take care of my dog, eat breakfast and pack up for the day! At work or in the clinic one way I can manage stress is taking advantage of all break times that present themselves, even if I feel like I do not need them at that time! You never know when your next break will come. Also, during these times I make sure to eat a healthy snack like veggies or fruit so that I do not get hangry. During these break times I try not to go on social media, but rather give myself just one time at the end of the day to scroll for a while and catch up on the news and friends that day. When I am feeling acute stress sometimes it makes me feel better to discuss my frustrations with a co-worker or my partner, but sometimes I just need a minute alone. Part of my plan is to listen to myself and take which of those options I need. One tool I like to use is the Headspace app on my phone, I bought a year of this app and for some reason spending money on an app makes me use it more. There are nice short breath exercises or meditations that I turn to when I have trouble falling asleep or need a break in the middle of the day!
Question #2: List at least three reasons for health professional burnout or compassion fatigue. For each reason, please provide a tool for prevention and management.
It is difficult to stay resilient as a healthcare worker because we never have the same day twice. We don’t know if we are going to have a relaxing day of simple cases or stressful and complex patients. One way to combat this is to try to maintain routine in areas of your life that you can control, for example having a set morning routine. My favorite morning routine is going on a walk with my dog right away, feeding her breakfast after and making coffee and breakfast, then packing up and getting ready for the day. Another reason for burnout is physical exhaustion. One way to combat this is to have a set bedtime and wake up, if you are on a consistent shift schedule. If you are not, my favorite way to combat exhaustion is to take a caffeine nap. I do this by drinking a cup of coffee, then take a nap on a couch, nothing too comfortable. Once the caffeine hits in 20 minutes you wake up refreshed. One final way to combat compassion fatigue resulting from the emotional toll that caring for people in a time of illness and stress is to seek out regular counseling. If you start with a baseline mental health practice by talking to a mental health professional, in a time of personal or relationship crisis, you will have a set baseline to work back to with a counselor to help.For the most part, I sleep pretty heavily and get about 6-7 hours of sleep each week. One thing that does wake me up in the middle of the night is my dog, Leighla. She takes up about 7/8ths of my queen size bed; however, I don’t think I possess the willpower or strength to kick her out of bed at night. One factor that I can control is that when I enjoy a glass of red wine at night, I reliably wake up at 2am thirsty and unable to fall back asleep. To improve this causing a lack of sleep, I will stick to a glass of wine only on the weekend evenings or on special occasions when I have friends over at night. If I do have a glass of wine I will try to drink it earlier in the evening and drink plenty of water as well before bed. Instead, I will start drinking some peppermint tea and a little chocolate, to ease my craving for a treat beverage before bed time. I will also start using my alarm clock and leave my phone on its charger in the living room to prevent me for scrolling too long before bed and only go into my bedroom when I am ready to sleep. Finally, I will only take naps before 3pm. I love to nap, but sometimes I nap too late and end up going to bed later as a result.
Instead of keeping a million post-it notes for myself and little to do lists on random scraps of paper with names of people to contact or email…etc, I have started using my google calendar and email as the one place where I keep track of everything. If there is a “to do” that I don’t have to get done right away, I will make a calendar reminder on the weekends to get that done, if I don’t feel like I don’t need “to do” that – I push it back one more week. This has been pretty life changing. With all events and reminders in one place, I feel more confident setting boundaries because I have a physical event to remind me what I have time for.
I want to continue to use this one resource because I can log in to it anywhere, on my phone, laptop or school computer.Jessica, I love that you can do those workouts at home with little/ no equipment. My favorite part about your fitness plan is going for walks and playing with your kids! I think we forget how much we are doing when we are chasing them around! Sounds like a great week.
My health plan to try for next week:
Cardiorespiratory Fitness – run 2 miles before lifting 5x weekly
Strength – 3 leg days, 2 arm days – 1 push, 1 pull
Muscular Endurance – Teach yoga flow 2x weekly
Flexibility – Teach yoga flow 2x weekly
Body Composition – Try to eat healthy throughout the week – eat lots of veggies, a little bit less bread and carbs while making sure to get enough protein from beans, eggs and soy
Power – Play intramural softball on Friday eveningsMy not important change was feeding my dog breakfast before we went for our morning walks instead of after. This was kind of nice because while she was eating, I would start making my coffee. By the time we got back from our walk I got to my coffee right away! This reward was enough to make this change permanent.
My important change this week was that I got back to the gym and started working out again! A few weeks ago I hurt my back and I had been using that as an excuse not to go, but this week I went three times and just took it easy! On Monday I almost didn’t go but made it, and felt great afterwards. On Wednesday I actually wanted to go and brought a friend along for motivation and we had a great workout. On Friday I went after teaching a morning yoga class and I started looking forward to it again! I hope that this change sticks. My goal is to go 3 times per week. One thing I don’t like is how easily something can fall out of your routine and how difficult it is to pick a habit back up after you have dropped it!Three things that surprised me after analyzing my nutrition diary over the week is that I eat pretty healthy! For the most part, I tend to have a few different kinds of vegetables with each meal and try to keep my sugar and salt intake low. The days that I ended up eating less healthy meals are the days that I did not pack my own lunch or do not schedule time to eat. On these days I tend to eat out at Jimmy Johns or grab whatever sugary snacks are laying around the office. The next thing that I can recall about my week is that I do feel very guilty when I have a treat like ice cream or a glass of red wine at the end of the day. I definitely even debated whether or not I should even write those treats down, so that was a pretty big red flag that I have a lot of shame surrounding my unhealthy meal choices even though they bring me a lot of happiness and they are enjoyed in moderation! Next, was how often I eat. I tend to eat three big meals a day and have snacks in between those meals even if it is just something light like some watermelon or seaweed snacks. I think that I eat the healthiest on the days where I don’t let myself get too hungry and binge out on whatever unhealthy food is around. I also tend not to keep unhealthy food in my house, which is easy to control because I live alone. If I keep unhealthy foods in my pantry, I will eat them. So I just try not even to test my self control because when it comes to food… it is pretty non-existent. I would like to continue to work on trying new, healthy recipes and keeping them prepped and ready to eat at the beginning of the week. I would like to try to stop being ashamed when I do enjoy a treat like chocolate or ice cream. If I were to cut back on any foods I would like it to be carbs, maybe switching my regular pasta with whole wheat pasta or whole grains like farro or lentils. I feel my healthiest when I do not eat meat, so I would like to continue with my vegetarian diet!
Question #1: I have to admit, I suffered from quite a bit of culture shock after moving to a small town in Missouri from Madison, Wisconsin. I went from a college city where I felt safe running anywhere, walked my dog at night without worry and enjoyed innumerable restaurants and grocery stores full of healthy, vegetarian options. Now, I live in a place where the local Walmart has the best produce options and where the only restaurants are fast food, with the exception of one Mexican restaurant, and I do not feel safe walking around any time of the day. This not only affected my lifestyle and health, but also affected the type of patients I saw in the clinic. Simple and easy physical activity is discouraged in Kirksville given the layout of the city. Lack of healthy diet options creates a dependency on cheap, processed foods. Over the last three years, my classmates and I assimilated to Kirksville from all different areas of the US, we found ourselves acting differently to align with this small town’s culture. I am excited to see how moving to new city in May will once again affect my physical activity and diet as I adjust to a new town. This highlights the importance of the physical community you live in and its effect on health.
Question #1: An example of precontemplation includes someone who continues to smoke cigarettes regularly, enjoying their daily intake and not considering quitting. Contemplation is when this person recognizes that smoking is unhealthy and acknowledges the negative health impacts and high costs of continuing this unhealthy habit. At this stage they may not be ready to quit. Preparation is when the smoker may be ready to take action and maybe starts to cut back from 1ppd to ½ ppd. Action is when this person may seek out help in the form of a primary care provider appointment or reading books on quitting. At this point they have stopped smoking daily and are actively taking steps to quit. Maintenance is when this person continues not to smoke and works hard not to relapse to previous steps. Termination is difficult to get to, but at this stage this person no longer craves cigarettes and is confident that they will not smoke again.
Question #2: There are many support strategies that can contribute to the success of the transtheoretical change model steps of precontemplation, contemplation, preparation, action and maintenance. Creating awareness, for example, can push someone forward from precontemplation to contemplation because they are made aware of the problem or maybe even recognize the positive outcomes of making a change. Things like education and social encouragement can also help propel change by making the painful process of changing more enjoyable and rewarding.
Edwin, I think that improving your sleep habits is a great goal and one that I often struggle with as well. Your steps of turning off screens and coming up with a consistent bed time and routine sound like great ways of getting there. Good luck!
Question #1: The SCIENCE acronym Stands for Stepladders, Community, Important, Easy, Neurohacks, Captivating and Engrained. The book’s author has created this phrasing to help recall ways in which we can change our behaviors. So far I have enjoyed the idea of the stepladder step, with the differentiation between little steps, goals and larger dreams. By using these steps the author hopes to guide the reader through the tough business of making a change that will actually continue on past that initial burst of energy we all get with a new change.
Question #2: I would like to work on setting healthy boundaries for myself. I tend to be a “yes man” and that often leads me to overbook myself and cause me to miss appointments, dates with friends or important chores. My steps to this is going to be to take advantage of my google calendar, to block off chunks of time when I am busy or need to set aside time for myself to get life chores done. I also want to work on telling people no more often, especially when I see that I have that time blocked off on my calendar. My goal is to not miss out on any important tasks or events this month because I have overbooked myself. My dream is to be a person with healthy personal boundaries (this of course is impossible to do professionally, as a medical student if I said I couldn’t write a patient’s note to my resident… well, that would be a different story!)Q1: I do think that there is an expectation for healthcare professionals to be healthier than their patients and lead a healthy life by example. I remember the first time I got a “… really? You are going to be a doctor…?” A few thanksgivings ago as I unbuttoned my jeans and heaved a sigh. Similarly, my best friend from medical school is overweight. She called me daily on her bariatric surgery rotation to discuss how she struggled talking to patients who were often smaller than her, there for weight loss surgeries. I think this article from 2015 highlighted that there is still chronic disease present in the field of healthcare but I really do think that there has been a lot more data since then finding that alcohol use is higher in this field compared to the general population and more data on weight, hypertension and type II diabetes has been brought to light. Especially over the recent pandemic years I believe that we are starting to see a movement proving that we need to care for ourselves so that we can care for our patients.
Q2: I think that we all dread the patient who has consulted “Dr. Google” before coming in for a visit. I think that knowledge is power when used correctly and in the right context. For example, I am terrible at pharmacology. I can explain the physiological benefits of taking an ACE inhibitor until my face is blue, but if you asked me to give a dosage without my phone’s app… I may not be able to do it at this stage of my training. In this way, I think that technology is a GREAT supplement to knowledge but it should be the source of knowledge of healthcare. We need a foundational understanding of basic sciences and strong interpersonal skills. We need to know what to look up first so as not to land in the dreaded “WebMD”.
Q3: Self-care tools that I use to handle stress and promote my health include daily walks with my dog, we try to go for two to three long walks a day! It keeps us both outside for some fresh air and lots of exercise even on days when I cannot make it to the gym. I also like to run and lift weights at my school/ hospital’s gym where I also teach yoga some mornings. I love to cook and am used to living on a grad school budget, so I switched to being a vegetarian a few years ago. I love meal prepping and coming up with filling, healthy meals for myself. This year as I teach, I have had a lot more time than I ever had in medical school to really find these healthy habits that work for me so that when I start working in the hospital again, I will have a strong self-care routine! One thing that the article highlighted is that unexamined emotions can lead to compassion fatigue and burnout, especially in the busy resident years. I would like to incorporate a mindfulness exercise like meditation into my routine!My name is Emma Rehnelt and I am in between my second and third years of medical school in Kirksville, MO at A.T. Still University. This year, I am a part of a fellowship program at ATSU working as a teaching assistant in gross anatomy, histology and embryology. In July I will be moving to Temple, TX to begin my clinical rotations. Before medical school, I attended the University of Wisconsin and worked in the emergency department in Madison, WI. Also after college I spent time abroad in Entebbe, Uganda studying midwifery practices. This is where I found the motivation to pursue my MIH. For now, I believe I would like to practice as an OB/GYN and focus on women’s health. I am taking this course with the hopes of building a strong foundation of self care before leaving medical school, so that in residency I can continue to try my best for a balanced and healthy life for myself, my classmates and family. It was so fun and inspiring to read your introductions, I am looking forward to hearing more about your experiences in healthcare and abroad!
Question #1: Why can’t the US just import or export Healthcare Systems? Explain two limitations of direct comparisons.
One limitation of direct comparisons is the difference in data collection. As the article describes, different countries may identify the same conditions differently or collect data in different ways. Another fallback is the fact that different countries have different health considerations. For example, while the U.S. is concerned with cardiovascular health another country may be focused on more communicable diseases like TB and malaria. These problems in direct comparison shed light on why we cannot exchange healthcare systems. Each system is set up for its specific population, therefore we cannot exchange systems without exchanging the population itself.
Question #1: Describe the three most important characteristics to you in selecting your own care provider and if ‘Prescription for the Future’ has impacted these and why.
I do agree with POF that being able to see your physician the same day and being more patient-centric rather than physician centric is important for primary care and other long term care providers like OBGYNs. Often a family member will call me after they call, and their doctor’s next appointment isn’t for 3 months. By that time the problem has gotten so bad they need to seek out emergency care, will go to urgent care in the local WalMart or “just deal” with it. Less important for specialists and more for pediatricians, primary care providers and OBGYNs is a good relationship with their patients. I think it is a red flag if a physician is overbooked and doesn’t have a long term history with their patients. For me it is important for my doctor to know me both at baseline and in illness. Third, something I had not considered was the importance of performance assessments. Patients often forget that they have the right to choose doctors when they feel that their health isn’t being properly managed. This data would be valuable and I will make sure to check out NCQA before my next appointment.