The Train Is at the Station

By Michael Maddaus, MD | October 14, 2021

During residency and at the start of our careers as physicians and surgeons, our natural, and understandable tendency, is on excellence in our care of our patients. It is, as it should be, a top priority.

Unfortunately, our mental and physical health often takes a seat in the back of the train of our fast-paced lives, when in fact it should be at the front of the train, in charge.

Top-flight performance demands top-flight mental and physical health, a fact embraced and operationalized by the highest performing athletes and special forces in the world, but often not by the high-performance surgeons and health care workers where the pressures of patient care can often escort our mental and physical health to the back of the train.

Prior to the pandemic, the STS conducted a practice survey revealed that a staggering 56% of cardiothoracic surgeons reported feeling burned out. And COVID has fueled the fires of overwork, stress, and burnout.

Unfortunately, our mental and physical health often takes a seat in the back of the train of our fast-paced lives, when in fact it should be at the front of the train, in charge.

Understanding critical relationship of physician wellness to performance and career satisfaction, the STS surgeon leaders created a new Task Force on Wellness, with me as its chair. I filled the roster with other cardiothoracic surgeons, a former Navy Seal officer, and a pioneer in the fields of health psychology, resilience, and work-life balance for high performing people.

The mission of our Task Force is to inspire cardiothoracic surgeons to be their best selves in and out of the OR using scientifically proven tools and recovery strategies from the world’s top performers

One of our first initiatives was to create The Resilient Surgeon podcast which began airing on July 9. Our first guest was Dr. Monique Valcour, an executive coach who shared advice and strategies on workplace burnout and resilience. We also covered real world strategies that one can use to diminish and mitigate burnout and the difficult topic of when to leave a job that is just too toxic.

Additional topics for the podcast follow, in general, those reviewed in my paper The Resilience Bank Account: Skills for Optimal Performance published in The Annals of Thoracic Surgery (January 2020). They cover six keystone habits: sleep, exercise, meditation, gratitude, self-compassion, and connection with others.

My original formulation of The Resilience Bank Account included three additional keystone habits - Saying No, Nutrition, and Dopamine Projects - that could not be included in the review article due to word count limitations. The Resilient Surgeon podcast will cover all nine habits, and more.

Keystone Habits

As James Clear, the author of Atomic Habits says: "Your outcomes are a lagging measure of your habits. You get what you repeat.” Habits play an incredibly powerful role in our lives, for good and for bad, so it pays to intentionally develop the right habits.

Habits can be broadly divided into two camps. One-off habits, and keystone habits. A one-off habit is me making coffee in the kitchen in the dark at 5:00 a.m. No thoughts, just memorized actions that happen automatically, with the end result being a cup of coffee.

The other category is keystone habits. A keystone is the stone at the top of an arch that supports the entire archway, and a keystone habit is one that influences multiple aspects of your life, and the lives of those in your orbit.

Take sleep as one example. Insufficient sleep syndrome (ISS) is a voluntary” pattern of less than 7 hours of sleep per night. ISS contributes to a multitude of health problems including cardiovascular disease, weight gain, metabolic syndrome, and dementia.

ISS also impacts the people around us, both at home and at work. In one of the upcoming podcasts with Dr. Christopher Barnes, a professor of management at the University of Washington, we discuss the impact of ISS on leadership and our interactions with others. His research has clearly shown that ISS makes leaders (i.e., all cardiothoracic surgeons) more irritable, abusive, more likely to be unethical, and less inspiring.

Clearly, sleep is a keystone habit, in both directions. Too little can lead to poor health and poor interactions at work and at home. Good sleep leads to good health and positive leadership and relationships, at work and at home.

All nine habits of The Resilient Bank Account are keystone habits and The Resilient Surgeon Podcast will cover all nine and other topics crucial to developing personal wellness and resilience.

If you haven’t done so already, take a listen. The first seven episodes are available in the Wellness Resources section of the STS website, with more to come. The episodes also are available on your favorite podcast platform on the STS Surgical Hot Topics channel.

I and the members of the Wellness Task Force sincerely hope you find these podcasts useful. We sincerely welcome your feedback and any suggestions that you may have for any other contributions the task force can make to help promote the wellness and resilience of our community!