Keeping healthy and maintaining your wellbeing

Today our guest blog comes from Laura Howard and Susie Hewitt who look at how you can keep healthy and ensure your long term wellbeing.

Celebrate RCEM 50 by looking after yourself and your team! Take this opportunity to make a commitment to your wellbeing; try out and embed evidence-based strategies, promote and maintain wellbeing and take a preventative, supportive approach for when times are tough. We owe it to ourselves, and our patients, to feel good and function well. Wellbeing is not a new or trendy concept for doctors as an inscription from 22 AD shows:

 “These are the duties of a ­physician: first….to heal his mind and to give assistance to himself before giving it to anyone (else).” Epitaph of an Athenian doctor, AD 2.

What’s in your wellbeing toolbox (and what’s the evidence base)?
No “one size fits all”; find out what works for you.  There are lots of simple tools you can pick up and use every day that have been shown to improve wellbeing. There is compelling evidence that the way you think and the things you do have the biggest impact on how you perform and feel.

The Government’s Foresight Programme, together with the New Economics Foundation, has proposed five simple and worthwhile evidence-based ways to invest in your personal and team health and wellbeing.(1)

1. Connect – Take time to invest in meaningful relationships with family, friends, colleagues and communities.  Strong, meaningful relationships will encourage and support you.

Feeling valued by other people is a fundamental human need, both at work and in your personal life. Creating a community at work is something we do well in EM; working in an Emergency Department is true team work. That feeling of community gives a sense of familiarity and increased self-worth. If you’re a team leader, make sure you spend time encouraging and supporting your team.

Connect with your family and friends. There is a link between the total number of close relatives and friends (primary group size) and the risk of developing common mental health problems. A primary group size of three or less is a predictive factor for problems in the future.(2)

Get together over coffee and cake or a beverage or two (all in moderation!) to create and maintain meaningful relationships. Pick up the phone and put a date in your diary. Get outside and connect with nature.

2. Be Active – Play sport, walk, run, dance, garden, cycle, swim and many more. Find the thing you enjoy that gets you active.

Participating in physical activity lowers rates of anxiety and depression, as well as preventing cognitive decline.(3,4) In terms of mental wellbeing, the exact recipe (type, duration and frequency of physical activity) needed for positive effects is not clear. It is known that engaging in physical activity reduces negative thoughts whilst giving a sense of empowerment and self-mastery.(5) As little as ten minutes exercise, 3-5 times per week, is known to improve mood and reduce symptoms of depression. Create a running or cycling club, organise walks together or set a step challenge. On an individual level, go for a walk before you settle down with your favourite box set. As well as getting active, think about what you eat and drink and impact of nutrition on stamina, concentration and decision making during a shift. Get off the sugar roller coaster of caffeine and biscuits.

3. Give – Be grateful, be kind, do something nice for a friend or a stranger.

Kindness and gratitude have many positive effects on wellbeing; they have a basis in neuroscience which shows the neural response to social co-operation is rewarding. (6) Kindness and gratitude increase serotonin and oxytocin production which will leave you energised and give you pleasure.(7)

Create a culture of thankfulness, perform random acts of kindness and make gratitude lists.  Put up a calendar of random acts of kindness for yourself or your department and follow it. Create an applause board in your staff room or integrate gratitude lists e.g. “three good things” into your routine handover structure. Make someone’s day today.

4. Keep learning – Learn a new skill, find a hobby or take on a new challenge.

One of the most enjoyable things about a medical career is that we never stop learning from every day, from every patient and from every colleague. Continual learning increases optimism, efficiency and satisfaction. (8)

Make a list of the things you always dreamed of doing. How can you learn the skills you need? Are there classes you can take? Can you protect some time to pick up that hobby you love?

5. Take notice – Pay attention and be in the moment, notice how you are feeling.

Practising mindfulness is not for everyone, it’s just another tool; find the tools that work for you. Giving yourself the time to be aware of sensations, thoughts and feelings has been shown to increase a sense of wellbeing. (9)

Even as adults we need to know how to self soothe, to calm or reduce anxiety. What smell, sight, taste, sound or feeling soothes you?

Allow yourself to experience emotion; sadness, anger and frustration are all perfectly valid emotions and we will feel these from time to time working in emergency medicine. It’s normal. Self-awareness will allow you to acknowledge and move through these feelings. Create a culture of safety within your department, where feeling and emotions can be expressed.

Celebrate RCEM 50 by making a pledge to put something in your wellbeing toolbox as an individual or team!

References

1. Foresight Mental Capital and Wellbeing Project. Final Project Report-Executive summary: The Government Office for Science, London 2008.
2. Brugha T, Weich S, Singleton N, et al. Primary group size, social support, gender and future mental health status in a prospective study of people living in private households throughout Great Britain. Psychological Medicine 2005; 35(50): 705-714.
3. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta- analytic study. Psychological Science 2003 Mar;14(2):125–30.
4. Studenski S. From Bedside to Bench: Does Mental and Physical Activity Promote Cognitive Vitality in Late Life? Science of Aging Knowledge Environment. 2006 Jun 28;2006(10):p21- p21.
5. Dishman RK, Berthoud H-R, Booth FW, Cotman CW, Edgerton VR, Fleshner MR, et al. Neurobiology of Exercise*. Obesity. 2006 Mar;14(3):345–56.
6. Rilling JK, Glenn AL, Jairam MR, Pagnoni G, Goldsmith DR, Elfenbein HA, et al. Neural correlates of social cooperation and non-cooperation as a function of psychopathy. Biological Psychiatry. 2007 Jun 1;61(11):1260–71.
7. Random Acts of Kindness [Internet]. Random Acts of Kindness. [cited 2017 Sep 29]. Available from: http://www.randomactsofkindness.org/the-science-of-kindness
8. Feinstein L, Vorhaus J, Sabates R. Learning through life challenge report. Foresight Mental Capital and Wellbeing Project, London 2008:p20
9. Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioural Medicine. 2008 Feb;31(1):23–33.