Below are the episode show notes and transcript. Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. Enjoy!
Taking care of your patients is challenging. But for many of us physicians, taking care of ourselves proves even harder. Check out this episode to explore the effects of ergonomics on today’s physicians.
Today’s Sponsor: White Coat Investor courses – looking for a course with lectures and CME around financial literacy and wellness. Check out a course today. Click Here
Hi, Doc! Where are you sitting today? Or standing? Bending? Lifting? When you think about those things, how does that make you feel?
It’s not just about the geographic location of your upcoming shift or the emotions that you experience throughout your day in medicine. Rather, today, we will examine how your physical work environment, ergonomics, and self-care all overlap to help you in your practice of medicine.
Welcome to the MedEdWell podcast, where physicians get empowered to take the next step in their wellness, personally, professionally, and financially. I’m your host, Dr. Ryan Stegink, a practicing general pediatrician and online entrepreneur.
Welcome back to another episode of the MedEdWell podcast. This is episode 9, and I am so thankful for your support and tuning in. I wanted to take a moment to share a 5-star review that really encouraged me from Dr A who said, “It is great to hear strategies to combat burnout from a physician who has dealt with it as so many of us have. Excited to follow along.” Yay, thank you so much Dr A! My desire is that this would be valuable to you, so please reach out if you have feedback or ideas, send me a DM over @MedEdWell on Instagram.
So today, we will be talking about where you work and how you feel when there. Not just your specialty and how much you like your job. No, rather we will be covering ergonomics, your work environment, and its effects on you. We’ll take a look at my own story and walk through current state, how that’s going, and finally what to do about it.
However, before we dive into the rest of today’s episode, let’s hear from today’s sponsor.
Getting a financial education seems daunting until you realize that you did way harder things in medical training. The White Coat Investor has been promoting financial literacy for doctors since 2011 and has great courses to help you make a financial plan, evaluate financial advice, and pursue your wellness. CME is included on some of the courses, making them a perfect fit for those unused professional funds. I have personally taken the Fire Your Financial Advisor course and found it super valuable in my own financial education. I encourage you to visit the link in the show notes and consider signing up for a White Coat Investor course today.
And now back to today’s show.
My journey in medicine
So today we’re talking about ergonomics in the work environment. Let’s take a moment and go back in time to join me for my journey in medical training. In medical school, I found that my best method of studying was to synthesize various materials, taking notes but in a way that forced me to understand the concepts. I guess this actually goes back to my time in undergrad. I really engaged well with both my physics classes and organic chemistry with professors who worked problems at the chalkboard or whiteboard. Any available notes were solely from taking them yourself. So my learning style was probably more kinesthetic, the combination of visual, receiving often audio input as with med school lectures, and then writing things out.
So I did that in med school frequently, from anatomy class to Step 1 and beyond, often just blank sheets of paper, subsequently filled with concepts, terms, and facts to remember. It was hard work, my hand was often sore and needed breaks. My brain needed the breaks too. Med school is tough, and spaced repetition is increasingly seen as a helpful tool in learning and memory, so the breaks were helpful for mind and body.
Fast forward, and I’m studying for pediatrics boards. So much material, I have my study materials, and yet, I know highlighting and underlining are not going to cut it for me. I go back to my trusty blank sheets of paper. My hand is pretty sore, but I make it. A few months later, I get the notification, “You passed!” “You are now a board-certified general pediatrician!”
Overuse or Just Chance?
Great, board certified! And up to speed with my schedule. Yes, that same schedule that had me on the road to burnout a few short months later. But then I feel my hand around that time or a little later. I realize there is a little bump on my finger, likely some sort of cyst. I get in to see a hand specialist and eventually have the cyst removed from my finger’s tendon. Thankfully I have had no recurrence, and while I know these sometimes just happen, I still think my overuse of my hand during my studying time may have played a role in my injury.
So, today we are talking about work environment, ergonomics, and selfcare in medicine. I will help you assess “Where are you?” Then “How’s it going?” And finally, “What are you going to do next?”
Where Are You?
First, “where are you?” I mean what does your day look like? Are you on the wards and dealing with various workrooms and workstations on wheels? Are you in the clinic? The procedural suite or the operating room? Are you sitting or standing? Or both, maybe leaning over a patient exam table, hospital beds, operating tables. They may or may not be easy to adjust the height relative to your own. You may be stuck in similar positions all day, just in different rooms. You may be standing at an operating table for hours at a time. We all have different environments in which we work in medicine. They each come with opportunities and challenges in caring both for our patients and ourselves as physicians.
In residency and after, I have been in clinics that were remodeled from buildings that were not originally designed as healthcare spaces. They could have been grocery stores, electronics stores, or other businesses. Being wise with resources, the health system used what they had and then outfit the space with medical equipment and supplies to provide patient care. Many of the exam rooms were built prior to the use of computers. And even when the angle of the desk and the patient chair is somewhat aligned, it requires the physician to be twisting somewhat when typing, either their head and neck, or entire torso. Moving back and forth between mouse and keyboard also requires consistent activation of shoulder muscles in some odd angles that risk repetitive strain as well.
And that’s just in the exam rooms. I go back to the workrooms to complete my charting. There are often desks with cabinets right above them. To sit with my shoulders relaxed and down and my hands in a neutral position just below my elbows, I have to adjust my chair higher, and then the screen often will not be able to come up high enough to the level of my eyes being able to look straight ahead. So in most options at my desk, I either need to sit a little lower and activate my shoulders more, or I sit a little higher and bend my neck forward to look down.
Your occupational hazards may look different, either hospital beds that need to be put up or down, that may or may not have current issues with the electronic controls. You may perform surgeries and need to be looking down or otherwise bent over the operating field with your neck or upper body. It could be any number of things, but it is so easy to overlook some of these areas where it may put you at risk for repetitive strain injury or repetitive stress injury (RSI) in medicine. You would think medicine is about health, and yet, we as physicians so often put the patients first and neglect our own self-care particularly when it comes to the design of and interaction with our work environments and the effects it has on our physical bodies.
How’s It Going?
So first, where are you? What is your working environment like? Then, number 2, how’s it going? How is your work environment and the opportunities for proper ergonomics or lack thereof making you feel physically?
Our bodies were not made to sit all day, particularly at a computer. They are meant to move. Exercise, both cardio and strength training can mitigate many of these threats to physical wellness, but it isn’t necessarily enough. So I had the cyst removed from my finger and thankfully, after working with an occupational therapist and doing my stretches, I was fully recovered within a couple months.
But then, I noticed some numbness and tingling down the outside of my hands. Compression of the ulnar nerve as I used the keyboard, twisting to use the mouse as I entered my orders. The tingling, the pain in my hands. It honestly scared me a bit. Is this really what’s going to be how I feel long term? I didn’t even think I was pressing that hard. But obviously something was off in my ergonomics and was otherwise using a computer mouse and keyboard day after day, patient after patient, chart after chart. After using some ibuprofen, icing my hands when I came home, I saw a little improvement, but it was still an ongoing issue.
I also found the twisting and issues around the computer workstations in patient rooms and using the mouse were leading me to use my shoulder in ways that were leading to tension and muscle strain. Not to mention that it is easy to carry in your shoulders and back the stress of work while charting while wanting to be home after clinic. Oh yes, and just hanging my stethoscope around my neck all day on top of that.
And I know it’s not just me.
What are you going to do?
We’ve covered first “where are you?” Then second, “how’s it going?” And third and finally, “what are you going to do?” Now that you have assessed yourself and your work environment as the patient, what kind of plan do you want to implement?
It will look different for you than it did for me, and you may need to see your own primary care physician or someone else depending on your symptoms. As a reminder, this is not medical or any other type of advice but for your education and entertainment only.
For me, I realized that I needed to make some changes. I started by just looking at ergonomic keyboards. I found one with good reviews, and it had a split in the middle, allowing my elbows to remain out to the sides with less compression of my ulnar nerve. I use that one for pretty much any keyboard typing at my charting workstation in the workroom. I later also found a contoured more vertical mouse, and together these have almost completely resolved my issues. It still flares up a little from time to time, but I am so thankful for these physical aids that have helped me.
Additionally, I have become more aware of my posture, how high my chair needs to be, and to not be twisting to use the computer. Sometimes it is moving the screen a little bit so I can still see the patient while charting, but in a few cases, it involves less charting in the room and just noting out loud to the patient when I am recording important details or placing their visit orders.
And yet, beyond just being aware of my posture, sometimes even that wasn’t enough. More recently, I have taken advantage of my organization’s onsite spa. Yes, you heard that right. I wouldn’t have thought of it either, but originally designed for some of the hospital’s burn patients, they also provide services to the community. After talking with my physician, I booked a back massage at the spa to help with some of my shoulder tightness. You know all that tension from typing and clicking all day. Only a couple sessions in, and it has been pretty amazing. Increased flexibility in my shoulders and a greater awareness of which muscles I use and overuse every day. Now, looking forward, I need to book another appointment and combine it with a more consistent strength training and stretching routine to support my personal wellness and self care.
Make Your Change
So now for your challenge. Maybe you are also in clinic frequently? Maybe you are still a medical student spending lots of time studying at a desk? In the operating room or procedure suite? I want you to take 5 or 10 minutes and reflect. Yes, this could be sitting or standing or going for a walk. Whatever helps you relax and give you space to think but still record your reflections.
- So take that time and consider “where are you?” Where are your workflows? What do they look like?
- Then how is it going? Do you like the workflow? Do you have any physical symptoms? Back pain? Neck pain? Numbness or tingling in your hands?
- Finally, what are you going to do? Any changes needed? Is it moving things around in your procedure suite? An extra stepping stool? An ergonomic mouse or keyboard? An ergonomics consult if your organization has those available to you? Could you apply some of the charting efficiency tips from episode 8 to reduce how often you go back and forth between the mouse and keyboard? Maybe decrease the amount of keystrokes you spend searching for orders by customizing your preference lists? Or do you need to talk with your physician or see a physical therapist?
Ok, now go ahead and pause and set a ten minute timer. Yes, take the time and go do this exercise.
Envision The Future
Welcome back, so how was it? What insights did you pick up? Hold those things in your mind, and imagine for a moment what it would look like if you did some of those action steps. Would you finally be pain free after a long day charting? Would you be able to sleep better? Would you bring less work home because your efficiency improved by not only using preference lists but also because you were switching less between mouse and keyboard? Even if you only had a partial improvement, how much more quality of life would you get back making these professional changes to help both your professional and personal wellness?
The specifics of your situation and your next steps will be unique to you, but there will be common themes among those of you who take this challenge and really engage with the physical nature of clinical workflows and your physical interaction with them.
Take a moment after finishing this episode and share the change you are wanting to make. Tag me @MedEdWell on Instagram or Twitter.
Thank you again for joining me here on another episode of the MedEdWell podcast. Please subscribe to the podcast and leave a review. Text the link to this episode to a colleague of yours or share on social media. Taking care of yourself involves your physical wellness and adjusting workflows and your physical environment. Take that next step in your wellness today and I’ll see you back here for the next episode! Have a great day!