Battling Exhaustion in your P4 Year

By Luke Smedley posted 11-27-2016 17:37


Hello, everyone! My name is Luke Smedley, and I am in my P4 year at Purdue University in West Lafayette, Indiana. I am so so SO excited to be one of the ASHP Featured Bloggers for the 2016-2017 year! I plan to write at least one blog per month, and I am so thrilled to share my experiences with all of you. This is my first blog post (literally ever), so I am a little nervous, but we'll see how it goes!

When I was trying to decide what to write this post about, I asked a ton of my friends, "Hey, what is something that you've struggled with this year?". I got some interesting answers. Some said that having to transition from lecture-based learning and patient cases where everything works perfectly to learning on the fly and serving patients who are far from perfect was the most difficult thing. Others said that they were having difficulty being far away from their friends. Pretty unanimously, though, one thing that I heard was that everyone was just exhausted. At first, I thought, "PREACH!", but then I decided to delve a little deeper into this widespread issue. Why is everyone tired? Is this a real problem, or do we just need to get over it? What can we do to fix this? I will admit, a lot of these questions were difficult to answer, but I realized a lot myself when I pondered them.

To begin, let's start with the first question. Why is everyone tired? I mean, rotations can be tiresome, but are they really that difficult? The conclusion that I came to was that yeah, rotations require a lot but what truly exhausts us is all of the other tasks we take on. I'm sure many of you have personalities like me, and you want to get the most out of every opportunity that you are offered. In almost every one of my final evaluations, my preceptors have said, "Luke, you are doing great, but you need to learn to say no!" they ask me to do something else for them. The issue for me is that I REALLY want to do all of these things. I love helping. I love doing. However, when you are a teaching assistant for two separate courses, working on four different research projects, and staying at the hospital for 13-14 hours a day, you WILL become tired. This answers our second question, and I say YES, exhaustion is a real problem in P4 students, but listen to me when I say that this isn't necessarily a bad thing.

Now, what do I mean? I will admit, I have not done a residency (hopefully soon, fingers crossed!), but from what I've heard, it's pretty exhausting and stressful. You are pushed to your max because that is where you will learn the most. Maybe it isn't quite so bad that P4s are tired because it just prepares them for what is to come, should they decide to pursue a residency. I know that I would not want to go into a residency program entirely clueless about the exhaustion I would experience. That would just make it so much worse.

How do we fix this? Long story short, we don't. The main thing we can do, though, is to teach students how to cope with it. For me, I schedule "mental health" time every day. I make myself crawl into bed at a specific time, and then I take half an hour to read funny articles on Buzzfeed or flip through Instagram. I do NOT let myself pull up a topic discussion I need to write or look up patients for the next morning. This is time that I need to take for myself, so I make myself do it. If I decide that I really need more than half an hour, I take as much time as I need. I just work to make sure that I have time to destress and focus on me because I know that my patients deserve care from someone who is well-rested and at the top of their game. I have also started learning to say "no." Not all of the time, and not very often, but when I am about to cry because I have a to-do list the size of Mars, I say no (but only if my career or grade doesn't depend on it). I explain to them that I would love to help, but I have a large number of commitments right now, and I need to take some time to finish those. I also ask if their project needs to be done now, or if it can wait, and kindly offer to help when I get time if they are willing to wait. Surprisingly, THEY DON'T GET MAD. They understand. If they care about you and your success, they will be happy that you are caring about your mental health. For me, just taking this small step has helped me so much, and I feel so much more prepared to tackle everything that residency will require.

I'd love to hear everyone else's comments on this! P4's, what do you do to battle exhaustion? Residents and new practitioners, what did you do your P4 year and what do you do now to deal with it all? Any and all comments are welcome and appreciated! I hope everyone had a wonderful holiday, and I look forward to sharing my other experiences with you all!