By Luke Murray
In my last few posts I’ve argued that all you have to do to be a “good” third year medical student is be “engaged.” In order to make this insight more actionable, I described the biggest source of disengagement for me (not accepting my circumstances and calibrating my expectations) and what I wish I had done about it. In the third article, I talked about distractions as a source of disengagement, and what I did to minimize my own. In this final post, I’ll talk about the last category of reasons for which I found myself mentally unplugged during rounds: physical discomfort.
There’s no denying that being “engaged” is mentally and physically taxing. And the more physical discomforts you have to ignore in order to keep your head in the game, the more exhausting it is – and the less likely you’ll be able to keep it up. This experience is called ego depletion, which is “the concept that self-control or willpower draw upon a limited pool of mental resources that can be used up. When the energy for mental activity is low, self-control is typically impaired, which would be considered a state of ego depletion.” The following were my biggest “ego depleters” and what I did (or should have done) about them.
Low blood sugar depletes your willpower and your ability to think. In a famous study, judges are more likely to grant parole when they are not hungry. I now always have something to eat in my pocket.
This is a no-brainer, but I really screwed it up in medical school. I tried to improve my sleep hygiene (wind down at night, no screens, no eating, etc), but I was still exhausted during rounds. It wasn’t until my assistant residency director stepped in after seeing me fall asleep in noon conference a few times that I finally saw a sleep physician who told me: get caffeine, however you can. I don’t know why I’d had this mental block about it for so long, but I thought if I just made the right ‘lifestyle changes’ I could fix my problem. I’ll never forget her response: “You have a sleep problem. It’s called residency. Caffeine is cheap, safe, and effective. Use it.” I’ve had two caffeine pills so far today and I haven’t slept more than eight hours total in the last three days. Not ideal, but problem (temporarily) solved.
I’ve got hyperlordosis…which means I’ve got a BMI of 22, but I stand with my back arched like I’m eight months pregnant. When you do that for a few hours a day your back will hurt. A lot. The way to fix this is to strengthen core muscles, but it takes daily stretching and exercise to permanently change your posture, and I didn’t think I had the time. So my back hurt worse and worse, and I became less able to focus throughout the day. My back still hurts to this day, even as I write this. I’m now going to physical therapy, even though I have less time now than I had then. I wish I had prioritized this in medical school.
So pay attention to anything that makes you physically uncomfortable during the day, and take systematic steps to eliminate it. Otherwise you’ll spend the limited resource of your willpower fighting these various forms of pain instead of soaking up the ambient knowledge emanating from the group of residents and attendings around you.