B is for Body

B = Body Physical Wellness

B of BASICS is the domain dedicated to wellness of the body. This is physical wellness. It has four main sub-categories. 

1. Exercise 
2. Diet & Nutrition
3. Sleep & Fatigue
4. Preventative care

Each of these sub-categories of B is for Body is important for physical wellness. Below we will explore each area in more depth.

Exercise

You’re a doctor. I don’t need to tell you how important exercise is…but I will anyways.

Benefits include better sleep, improved sense of energy, reduction in physical and emotional tension, fewer feelings of depression and anxiety, lowered risk of many physical illnesses, including cardiovascular disease, and much, much more

As doctors, we know this. So why don’t we all exercise regularly?

• Not enough time—patients and family come first.
• Not enough energy — the long work day leaves little reserve for much else, let alone exercise.
• Not enough motivation—the inertia of a sedentary existence just can’t be overcome.
• Not enough expertise— we aren’t already the best at running, rowing, dancing, or whatever.

There are ways to overcome these barriers to an active lifestyle.  With strategic planning, exercise can be built in to everyday routines.

BASICS Ideas for Exercise

• Idea 1: Travel Differently

  You can integrate exercise into your work day.

  Exercise while going to work:

  • walk to work 
  • jog to work
  • biking to work
  

  Exercise while at work: 

  • Using the stairs at the hospital
  • If there is a gym, pool or workout room where you work, use it during any down time in your day

• Idea 2: Make it fun

  Have fun! Join a doctors’ basketball or softball team.

  Some find joining a gym or fitness facility, and using the services of a professional trainer, motivating.

  

• Idea 3: Kill two birds with one stone

  Hold occasional journal club meetings in association with a physical activity, such as yoga or swimming.

  Build dedicated physical activity, such as group walking, into professional meetings.

  

• Idea 4: Keep it small

  The trick is to start small. Commit to a few minutes two or three times a week.

  Eventually try work up to an exercise routine of 15 or 20 minutes duration.

  

  Don’t listen to the four horsemen of the burnout apocalypse. In this situation, these traits are your enemy. 

  Give yourself permission to be slow and inept at first. Understand that there might be a little discomfort, very soon offset by the many, immediate benefits.

  Then, gradually build on those initial gains. Before you know it, you’ll be the beneficiary of an active lifestyle you won’t want to part with.

• Shader Strong Spot

  Shader Strong Spot: Dr. Jonathon Shader, Ophthalmology (Kaweah Delta TY Resident 2018-2019),  has a great tool for finding time to exercise while working a hectic schedule. He finds a secret spot in the hospital to do quick exercise routines. These secret spots are a place to get strong, thus the name, “Shader Strong Spot”. 

  Dr. Shader uses these “Strong Spots” as places to do push ups. They can be used to do other exercises, like sit-up or burpies. 

  Good “Strong Spots” include un-used conference rooms, meeting rooms, and break rooms. 

Sleep

Sleep loss is associated with increased irritability, anger, depression, sensitivity to criticism, decline in cognitive performance, including the ability to solve problems and learn new skills, daytime drowsiness (nodding off), and more.

Losing sleep impairs psycho motor function. In fact, it has been shown that four hours of sleep loss results in the kind of impairment usually associated with a breath alcohol level above the legal limit for driving in most jurisdictions. In short, being sleep deprived hurts — us, and potentially those we serve.

BASICS Ideas for Sleep

• Idea 1: Listen to your body

  Listen to your body’s rhythms. There are times when falling asleep is easier because it’s natural to do so.

  

  Plan bed-time and naps to coincide with your bodies natural sleep rhythm.

  To the best of your ability, don’t let anything else interfere with this schedule. 

• Idea 2: 3S Sleep Schedule

  Sleep schedule: Develop a bedtime routine pattern of behaviors, even post-call, that facilitates the onset of sleep.

  1. Soften Stimuli: “Close shop” sufficiently early in the evenings to give your mind a chance to wind down.

  
  • Avoid work-related e-mails, calls, journal reading, paperwork and so on for a few hours before sleep. 
  • Avoid heavy exercise right before sleep.
  • Avoid caffeine right before sleep
  • Avoid excessive fluid ingestion or a heavy meal right before sleep

  2. Signal Sleep: Engage in  activities right before going to bed that signals sleep is coming.

  • Make sure the activities are relaxing!
  • You know what works for you: listening to or playing music, taking walks, reading a novel or other non-work related material (However, reading Rosen’s always put me to sleep).

  3. Set Support: Arrange your sleeping quarters to support your sleep. 

  • Light level: Dark for most (many use a face mask)
  • Noise level: quiet for most
  • Temperature optimization. 
  • A light snack can help prevent overnight hunger. 

• Idea 3: Things to Avoid

  
  • Generally, avoid sedative drugs for sleep, unless for short periods and as prescribed. This includes over the-counter preparations. Never prescribe sedative hypnotics for yourself.
  • Avoid alcohol

• Idea 4: Bounce Back

  •  If at all possible, grab a quick nap (about 45 minutes) during the day prior to an overnight shift or call.
  
  •  Be sure to get extra sleep on days off. This is the way to achieve sleep homeostasis, that is to repay the “sleep debt.”

Diet

Healthy eating decreases allostatic burden and increases resilience and our ability to cope with stress.  

BASICS Ideas for Diet

• Tool 1: Timing

  • Eat breakfast—even if you round at 0700! It’s an important meal. 
  
  • There is no sense in starting the day without quality fuel in the tank, relying instead upon the “supercharged” effect of caffeine, fat and sugar in your morning “double double.” 
  • Avoid heavy eating before sleep. 

• Tool 2: Choices

  • Consider yogurt, high-fiber cereals, fruit, cottage cheese, or eggs.
  • Avoid the muffins. If it’s white and fluffy or greasy, avoid it.
  
  • Choose the salad bar at the hospital cafeteria more often.
  • Choose the burgers and fries less often.
  • In general, all the authorities agree: variety is good, fad diets are not so good.
  • The jury is still out on routine use of multi-vitamins, which should not be seen as a good alternative to regular, healthy
  • In reality, even the “non-good” foods are OK every once in awhile. 
  • Maintain  hydration with water and juices rather than coffee or sugared beverages. About two to three liters per day is required, depending on gender, body size and activity.

• Tool 3: Portions

  • Eat smaller portions more often— every three to four hours during the day. Keeping blood sugar and insulin levels steady is preferable to the peak and trough effect of occasional eating of large meals.
  • It’s probably a good idea to have a healthy snack mid-morning (especially if breakfast is very early), late afternoon or in the evening before bed.
  • Consider fruit, vegetable sticks, cheese, whole grain bread, crackers or cereal.
  • It’s easy to throw an apple and an individually wrapped piece of cheese into your bag in the morning and take it with you to the office or hospital. Be especially certain to do this if expecting a long, stressful day with the possibility of having to work through lunch or supper. 

• Tool 4: Call & Overnight

  • If on-call and sleep is not so likely, be sure to have an overnight snack. Bring something with you to the hospital in order to avoid the vending machine with the tempting junk food when the cafeteria is closed. 

Preventative care

BASICS Ideas for Preventative Care

• Idea 1

  A fundamental of self-care is that we have a personal physician and use him or her as others would.

  

  Don’t let being a doctor get in the way of this basic need.

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• Credits & Disclaimer

  All images and pictures were created by Michael Stanley D.O. Please do not reproduce these without written permission from Michael Stanley.   Credit for BASICS and the content listed on this page was taken directly from the BASICS articles written by Dr. Kaufmann, CCFP, FCFP. These articles were published in the Ontario Medical Review.