Scheduled Downtime

Beyond Epic.

Scheduled downtime - a phase more often associated with Epic notifications than rest for many physicians.

Internally, the older guard might cheer a little at the thought of paper charts, recalling the good ol’ days. Residents and students collectively groan, recognizing the margin of time once available for fitting in some sleep or food on the night shift has vanished.

Today, however, I’d like to focus on a different, more important, type of downtime:

scheduled downtime.

Rest.

"For in six days the Lord made the heavens and the earth, the sea, and all that is in them, and rested on the seventh day. Therefore the Lord blessed the Sabbath day and made it holy." -Exodus 20:11

Dr. Saundra Dalton-Smith, MD outlines 7 different types of rest humans need in her book Sacred Rest.

1. Physical rest

2. Mental rest

3. Sensory rest

4. Emotional rest

5. Social rest

6. Creative rest

7. Spiritual rest

Notice these are types of rest humans need.

As physicians, we can sometimes end up playing God (whether by conscious choice, unconscious habit, or administrative edict) by denying our human need for rest.

Many of us know rest is important. We may, in fact, even recommend it for our patients. But learning how to live it out - physician heal thyself - can be a challenge. Especially during the transition from residency, where work hours (while better than in years past), remain unsafe and promote lack of rest.

Of course, we’re in good company. When considering physical rest alone, about 56% of adults in the U.S. get adequate sleep (at least 7 hours) according to a recent analysis of National Health and Nutrition Examination Survey data.

.

.

Learning to Rest

On a more positive note, we also have an incredible capacity to learn as humans. We can learn to rest well.

I’m a little over 2 years out of residency, and I’ve had some time to practice what it means to rest. I’ll share what’s worked for me. And what hasn’t worked. And I’d love to hear what works for you, especially if you’re a physician who has been in practice for a while. I’m still finding ways to rest well, so these aren’t all the answers.

1. Understanding the different kinds of rest.

As an introvert, I learned throughout the years that I needed social rest. I could plan a full weekend with friends, but I would do my best to plan more solo time to recharge the following weekend. However, while I had some scheduled alone time to recharge, I would tend to use it working on projects. So while I was enjoying social rest and progress on projects, I would sometimes still finish the day feeling unrested. Once I discovered the distinction between different types of rest, this opened up my perspective to consider where I was excelling and where I was lacking. Sometimes it does make sense to work on a project that fills my cup on a day off. Other times, its best to hit pause on the projects.

If you know you’re lacking in rest, but not sure what areas could use some TLC, check out this quiz by Dr. Saundra Dalton-Smith on types of rest.

2. Scheduled downtime

I was fortunate during medical school to have some great mentors. One mentor in particular (shoutout to Dr. J!), set a great example of rest by scheduling his Wednesday mornings off from patient care. He used that time in various ways for personal care, doctor’s appointments, administrative time, etc.. When it came time for me to open my own practice, I borrowed from his example and set aside Wednesdays for administrative time and personal care as needed. Knowing that I have that downtime in the middle of the week helps take pressure off of the other days, making it easier to rest at the end of other days because I know I’ll have time on a Wednesday to address these other tasks.

Scheduling vacations, conferences, and other big events ahead of time is also important for promoting rest - another pearl from Dr.J when I first opened my practice. I was planning to schedule vacations as I went along, but he encouraged me to go ahead and block out vacations a year in advance [of course, since it’s my own practice, I will sometimes change these dates. I also only book out 3 months in advance, so it’s easy to adjust as needed. The important part is that the vacation is on the calendar in the first place].

While it might sound ideal or more relaxed to just weave rest into the schedule, I find scheduling rest - like vacation and administrative time - is its own form of mental rest. I know a vacation is coming up, that the schedule is taken care of, and I don’t need to keep thinking about it.

Similarly, I also block off one day per week from work to rest. I find I’m more effective on the other 6 days when I know I’ll get a break on the 7th. This comes from the idea that if God needed to rest on the 7th day, we’re unlikely to be above needing a day of rest, too. Some authors alternatively interpret this 7th day He took off to actually be for God to enjoy what He had spent the other 6 days creating (since God probably wasn’t tired like a human would be). Working for 6 days and resting on the 7th creates a sustainable rhythm of rest and work.

3. Restful Boundaries

The term boundaries can sometimes have a bit of a harsh, intense connotation. It’s a line in the sand. Once crossed, there can be consequences. Entire books have been written on this topic, so I’ll suffice it to say that boundaries can also be viewed as requests that promote rest. In the world of direct primary care for example, many of us note that we are not available 24/7, but rather “it’s like having a doctor in the family”. If there’s an urgent need after-hours (pretty rare, but happens a handful of times per year), my patients are welcome to call me, and I’ll do my best to answer in a timely manner as best as I can. I let all new patients know this boundary when they join the practice. And because I’ve clearly communicated it, I can rest after-hours knowing if there’s something urgent, my patients will call me.

Putting process measures into place to support these boundaries is also key. In the first few months of my practice, I found myself sometimes checking messages in the evenings or weekends. I eventually realized when I was becoming annoyed with working after-hours, that I was violating the boundaries I had set in place for just this reason.

To help me enforce my own restful boundaries, I discovered I needed to turn off all office notifications and only allow phone calls to come through when I’m out of the office. Patients receive an auto-reply for any after-hours messages that reminds them to call if there’s anything urgent, so I know that they will be reminded of the boundary/workflow as well. This allows me to rest without checking my phone frequently when the office is closed.

4. Rest is not the only way to recharge

Just the other day I had a conversation with a patient who mentioned “My energy is a battery, and it’s empty.” While it’s important to recognize when our energy is low or empty, the battery analogy can breakdown when people assume only rest can recharge it.

A story to support this:

It’s been a long day of work. Your battery feels empty. You drag yourself through the door to your home. And you’re greeted with several of your closest friends who have thrown you a surprise party, showering you with love, treasured company, and your favorite foods.

Is your battery still empty?

No, it’s likely been filled to the brim (or at least recharged to some degree). It’s important to recognize that joy and meaningful activities can fill our cup. Rest is not the only way. This somewhat overlaps with the concept of different types of rest, but I think is a worthwhile distinction to mention. Recharging is not a 1:1 ratio of work to rest. Sometimes joy can bring it to 100% in a few seconds.

Likewise, an entire day of physical rest can also leave people still feeling tired. I consciously schedule time with friends or things that bring me joy throughout the week (and especially on the 7th day) as a way to keep my battery charged.

4. An outside perspective

Sometimes we know when we are lacking in rest or energy. And other times, we have it pointed out to us by a spouse or a friend. It’s important to maintain trusted relationships with people who are willing to kindly remind us in areas where we are missing out in life.

During residency, I found just being outside the medical community was often enough to provide me with renewed perspective on rest. When I was in medical school, I would study intensely for 50 minutes and take a break for 10 minutes, often repeating this for hours on end. My roommate at the time worked a 9-5 office job. She would watch me come and go from my 10-minute breaks every hour. This earned me the nickname of “the machine”.

While this intense work ethic served me for a season in medical training, I also learned during that season that I needed to rest just as intentionally as I worked. I took every 7th day off from studying. This was pretty counterculture to medical school where every hour of studying counts. However, as hard as we may try, at the end of the day we are human, - not machine - and we need rest.

Maintain relationships that encourage regular, sustainable rest.

“As iron sharpens iron, so one person sharpens another.” - Proverbs 27:17

.

.

There are many types and ways to rest.

What has worked well for you?