With the official start of summer just last weekend, and so much sunny, sandy, poolside cabana-filled life waiting right outside your hospital’s sliding doors, I wanted to use this opportunity to remind you of the importance of unplugging. However, in my cursory search of Pubmed, OVID, and UpToDate, I’ve been unable to find any good evidence-based reasons for you to drop your instruments and go outside.
As is often the case, Google has been more helpful. Now that smartphones and email have become deeply integrated into our very existence, it’s possible to remain connected to your work every second of every minute of every day of [what remains of] your life. Perhaps as a reaction, there’s lots of material online about the virtues of unplugging from technology. Many refer to the internet as a sort of addiction – the instant but fleeting reward of answering an email, combined with the unpredictable timing of that reward, leads to dopamine release akin to a gambling addiction. So the mosquito-like buzz of our smartphones holds our attention just long enough to impair our ability to focus, interfere with our short-term memories, and drop our IQs by 10 points.
But, I have a hard time believing that surgeons are really yearning to refresh their Facebook feed mid-case, or that we pathologically overuse Snapchat. I think the true utility of unplugging for surgeons can be found in longstanding studies in education and training. The work of Swedish psychologist K. Anders Ericsson, who has spent decades examining the habits of elite athletes, musicians, and scientists, yields surprising insights into how the best become the best. Among the most striking findings is the interplay of practice and leisure. Across a remarkably wide range of disciplines, his top subjects – violinists, writers, runners – pursue deliberate practice, (which consists of pushing yourself beyond your best work) for only about 60-90 minutes without rest. Compared to others in their fields, prodigiously talented people rarely practice more than four hours in a day. Several take an afternoon nap. This downtime complements the rigor of their deliberate practice, preventing burnout and allowing for a higher level of performance after the break. Thus in the end, over the many years that they are followed, Ericsson’s highest achievers accumulate several more hours of quality practice than everyone else in their field.
This concept of idleness as a necessary component of productivity is born out in functional MRI studies, in which the brain in its downtime is actually quite active. People resting but not sleeping – daydreaming – in an fMRI show simultaneous activity in disparate parts of the brain necessary for things like vision, attention, complex problem solving, and memory. As Mary Helen Immordino-Yang of the University of Southern California writes, idleness provides an essential opportunity for the brain to make sense of recent experience, reground itself, and to make the creative connections that the effortful mind would not.
Coincidentally, searches on Google for the term “meditation” have almost doubled in the U.S. over the past 5 years, now closely rivaling the popularity of “Adderall” (the most searched-for medication), and far outpacing interest in “Jack Daniel’s” (the most searched-for whiskey). Meditation is different from idleness in that it encourages an intent awareness of one’s own mind. It’s about “the pause between your breaths,” as the exuberantly Zen yoga instructor at my West Coast gym would say. A growing number of small studies have shown that short regular periods of mindfulness meditation can improve mental acuity and well-being. Daily meditation improved sympathetic activation in ICU nurses at risk of burnout, in a study at Ohio State University. And in U.S. marines facing combat-related stress, as little as 12 minutes of mindfulness meditation a day helped protect working memory capacity and may have improved morale.
So what is that special ingredient that turns a break into real valuable mental downtime? Certainly reading disjointed Twitter commentary about the new season of True Detective is as passive as idleness, maybe requiring just enough attention to quiet the cacophony of our minds?
A look back at Ericsson’s early studies, of those genius violinists, is revealing in yet another way: those people, in their idle time, were way less idle than we know how to be. A good 30 hours a week could be spent on things like “listening to music,” or “playing violin for fun,” or “professional conversation.” In addition to the 4 hours daily of what would be called deliberate practice! These people loved their work – music surrounded them, infected their conversation, dictated their social groups and colored their perceptions of fun.
So maybe this restless urge to sever the technological connections that have probably made our lives more efficient (if fractionally increasing our workload by making us more available) is misleading. The mind just wants to go back to the real thing – that visceral thrill of life in the OR, where things seemed sort of wrong but mostly seemed pretty awesome and you were perfectly effortlessly focused, plus you were really going to help someone – and it’s OK to think about it when you don’t have to. The social media distraction tricks our minds by separating us from ourselves, forcing us to look outward, at things we can’t touch, that aren’t relevant or useful to our real lives. But that same ubiquity of technology makes it possible to put our work in a back pocket and take it out of the hospital, with a warm summer breeze under the blue sky and stars.
Your mind already knows what it really needs. So go outside, let those dormant mental circuits spring to life. I probably shouldn’t join you because I’m on call, but I will sit in a patient’s room – the one with the ruptured aneurysm who at the last minute changed her mind about an operation – and listen to the pauses between her breaths.