Pediatricians Also Need to Follow Good Advice and Get Some Rest

Xinshu She, MD, MPH, FAAP

September 15, 2021

I can still feel the cold sweat I broke out in as I smashed my foot against the brake just before hitting a stopped car in front of me after a 30-hour call during residency. The intense fear and sudden wakefulness coursed down my spine like a chilling icicle. Thankfully the other driver and I walked away from the accident unharmed. It could have been much worse.

Many of us physicians have had close calls like this on our way to or from work, or, though less discussed in public, in the form of medical mistakes at work.

In 2017, the Nobel Prize for Physiology or Medicine was awarded to three American scientists for discoveries on the genetics and physiology of circadian rhythms. Their 15 years of research proved the vital importance of sleep and mealtimes by relating them to energy metabolism, endocrine and immune functions.

Disturbances of these wake/sleep cycles not only lower quality of life, but can increase risks of obesity, metabolic syndrome, infections, autoimmune conditions, and neuropsychiatric disorders — this last one makes us and our patients especially vulnerable during the COVID-19 pandemic as the entire medical system comes under stress and uncertainty, not only at work but also at home. Furthermore, sleep deprivation is associated with decreased empathy, the key to therapeutic relationships and job satisfaction among providers, especially during a pandemic.

Many physicians do not get the sleep they need to function at their best. Nearly half of us believe that our work schedules do not allow for adequate sleep, according to an American College of Chest Physicians survey. Call hours during training and in the practice of medicine, especially during early careers, desensitize us to the importance of sleep. For example, having a meeting post-call can be considered “normal” in our current work culture.

How can we advise parents and adolescents to improve sleep hygiene and limit screen time, when we ourselves ignore the scientific evidence behind it?

“Prioritizing adequate sleep is vital to patient safety as well as to physician wellness.”

Prioritizing adequate sleep is vital to patient safety as well as to physician wellness. We pediatricians especially need to better model healthy sleep for children and families, leading by example and optimizing our professional performance.

I especially became aware of the importance of sleep after my daughter’s birth. Not only were the newborn and infant periods incredibly challenging for my family and work life, but my daughter, who is 3 now, copies everything that my husband and I do, which is certainly a new opportunity for growth but also a huge responsibility for us as parents.

As a female physician, I have increasingly become aware of my own struggles to prioritize wellness despite all my academic research and work in mental health and physician wellness, especially during this pandemic in which child care has been a constant challenge for many. Nearly 3 million women left their jobs in the U.S. in 2020 at least partly due to this challenge, according to a CBS News story in February.

Women are socialized to be agreeable and generally find saying “no” harder than men do. Prioritizing sleep, including saying “no” to things that would jeopardize our wellness, regardless of their professional value, may seem like a loss of productivity in the short term. But it is a small yet significant step toward surviving/thriving in this pandemic. Every time we do so, we gain health as individuals and credibility as physicians.

As we mark Women in Medicine Month, let’s take care of ourselves, encourage our colleagues to do so as well, and find ways to lobby our institutions to prioritize well-being. Let’s stop applauding working like a dog and not sleeping – it’s not smart and it only perpetuates this unhealthy behavior.

Having said that, I am going to bed. And so should you.

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*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author

Xinshu She, MD, MPH, FAAP

Xinshu She, MD, MPH, FAAP, is a Global Health pediatrician at Stanford University. She is an AAP representative at the national Women Physician’s Wellness, Equity and Leadership (WEL) Alliance. She has published on urban-rural health disparities and mental health epidemiology in Chinese youth, quality improvement using participatory art, and elevated lead levels in Haitian Children. She also is a mentor at the AAP national ELEVATION program for URM students and an abstract advisor at the Consortium of Universities for Global Health.