Exploring lifestyle medicine as a foundation doctor

My name is Akshay, and I am a Foundation Year 1 doctor currently working at Northumbria Trust, a small collection of hospitals within the North-East of England. Thank you to the BLSM who have kindly provided an opportunity to share my experiences as a newly qualified junior doctor within the NHS.

Like many of the BLSM members, my first fascination with lifestyle medicine began as an empowered patient, educating myself through direct experimentation and experience, realising firsthand, the benefits behind a preventative approach to healthcare. Now, having recently undergone the transition from happy-go-lucky medical student to qualified junior doctor, I’d like to share my experience of applying the principles of lifestyle medicine in an ever-evolving role of responsibility and credibility.

It is no secret that the lifestyle habits of doctors have direct implications on patient care – this is a correlation that is not only logical, but well evidenced in scientific literature. I hope to provide an honest take on my experiences upholding these healthy behaviours within the structure of an NHS, at its most tested. I also aim to report the reality of lifestyle medicine within the hospital setting – both how it is currently being utilised, as well as any future areas that could be developed and benefit from this preventative approach. Given the six different specialities of exposure within Foundation Year, I am fortunate enough to have the chance to directly explore the potential for lifestyle medicine in a setting that may need it most.

As I write this blog, I have just transitioned onto my second rotation as an F1 in Accident and Emergency. As with the start of every rotation, this change comes with a new rota, a new team of colleagues, and a new work environment that has its own unique way of operating. Naturally these four-monthly changeovers present their own struggles – it takes time to assimilate all this new information and figure out the dynamics of each ward. But the truth is nothing quite compares to your first rotation as a junior doctor.

The stress and responsibility that accompanies this change is indescribable, literally. Truthfully, no amount of second-hand wisdom or ‘preparation’ can prepare you for hospital life. Despite this, there are certainly lessons I will learn with greater ease and grace, now I have completed my first rotation and had the chance to fully reflect on my experiences.

What’s empowered me the most is that any noticeable improvement in work performance has stemmed directly from insights gained introspectively, many of which can be mapped back to the various pillars of lifestyle medicine.

As I have settled into life as an NHS worker, I have noticed an increasing number of mixed messages that contradict the basic principles of lifestyle medicine. Whilst I have certainly had many positive discussions around the importance of applying lifestyle medicine as responsible healthcare professionals, I have also observed many examples of fatigued, poorly nourished, and sleep-deprived colleagues that sadly evidence the opposite effect. In my own brief time in the hospital environment, I have experienced difficulties reconciling these differences, starting with healthy eating.

During my first rotation in Trauma and Orthopaedics, there were often days where I would notice the temptation of an arms-reach box of chocolates or an on-hand selection of Haribo’s. Worryingly, these sweet treats were supplied not only by patients’ relatives but also by healthcare professionals, making it very challenging to maintain healthy eating habits throughout the day. Through trial and error, I discovered having a bag of mixed fruit available provided sufficient sustenance and energy through the afternoon. I did notice this approach was less common, with many doctors understandably opting for the all too tempting confectionary snacks that most people relied on for an afternoon lift. With these observations I noticed this was also a dietary problem that extends beyond the individual – the countless vending machines, hospital canteens and cafes that sell unhealthy food to both patients and staff highlight that this is a systemic issue that needs addressing on a fundamental level.

Researchers at the University of Aberdeen have also shown that, despite alternate options of fruit and vegetables in canteens, three quarters of best-selling items were unhealthy with high calorie, fat, and sugar content. Naturally, this begs the question: should a ban be imposed on the sale of junk foods in hospital completely? Will it require a measure as drastic as this to initiate the necessary paradigm shift in habits and mentality? Fortunately, this is an ongoing area of research, with many experts dedicating time and focus into backing up the evidence base behind what I believe should be a necessary change. The good news is that we are heading in the right direction. My hospital, for example, has recently introduced a Naked Deli situated in a brand-new wellbeing centre, purpose-built to encourage staff to lead a more active and healthier lifestyle.

The second pillar of lifestyle medicine that has profoundly affected my wellbeing during this transition is physical activity. As someone whose life revolved around sport and exercise whilst growing up, it was a pillar I had anticipated would be play a large factor in my ability to adapt to the stressors and environment of a new job. Truthfully, it was an area I struggled to balance when first starting, as I prioritised attendance to mess events and socialising with colleagues when outside of work. In my mind this was a necessary trade-off. The reality was the next two years of my life would predominantly be spent around this new group of people, and so it was important I made the effort during this initial period. Whilst this allowed me to befriend a great bunch of colleagues, I did not anticipate the struggle maintaining a regular exercise practice because of shift work patterns. In fact, the very nature of shift work had slowly started to affect me in areas of my life I had once taken for granted. With my shifts alternating between 08:00, 12:30 and 14:30 starts, I certainly had noticed a disruption in family and social life, a reduction in quality and quantity of sleep and a change in efficiency of performance at work. Despite these observations, the reality is that working long hours or abnormal shift schedules has been in existence for centuries and shows no signs of stopping. Fortunately, research is underway to investigate and mitigate the detrimental effects of shift work, with experts dedicating time to minimising the frequency of night shifts as these have been shown to cause a disproportionate number of problems. Future areas of change include rapid rotation of shifts and clockwise rotation (morning, afternoon, night) as preferred to counter-clockwise rotation. Personally, I have found solace through exercise with colleagues, which has the added benefit of synchronising timings together as well as the opportunity to enjoy time spent in an environment that is not work. Additionally, there are many friends that opt to cycle to work and successfully manage to incorporate their regular exercise within their daily commute. Encouragingly this is something that is promoted locally, with bike shelters and showers readily accessible, with my trust even forming part of the national cycle to work scheme where staff can save at least 25% on a new bike. For those cycle-averse amongst us, my hospital is in the process of assembling an on-site gym – another great way of incorporating regular movement into our daily lives.

Whilst I have been able to identify some potential obstacles to lifestyle medicine application and delivery in the hospital setting, I hope I have highlighted how employers and trusts are recognising the need for lifestyle adaptations and taking positive steps to address this issue. Having observed and applied the principles of lifestyle medicine within the broader context of the hospital, I hope to write in future about the potential role of lifestyle medicine within specific specialities, drawing from my experiences during my first two rotations. Thanks for reading!

References:

• Garber AK, Lustig RH. Is fast food addictive? Curr Drug Abuse Rev. 2011 Sep;4(3):146-62. doi: 10.2174/1874473711104030146. PMID: 21999689.
• Harrington JM. Health effects of shift work and extended hours of work. Occupational and Environmental Medicine 2001; 58:68-72.