Mitchell Cohen, MD, likes to share an old joke popular among trauma surgeons:
“What’s wrong with being on call every other night? You miss half of the good cases.”
It’s long been a fact of life for surgeons, especially trauma surgeons, he says — an always-working, always-on mentality and reality that often leads to poor sleep and burnout.
“We're hardcore self-abusers, we have high rates of burnout, and we have high rates of chronic inflammatory diseases,” Cohen says of trauma surgeons and other medical professionals who work long hours with disrupted sleep and high stress. “As a profession, we are at higher risk of cardiovascular disease, cancer, all these things we're not supposed to get when we get older — and it's likely because we got the crap beaten out of us working that many hours for that long.”
Burnout isn’t just a problem for the physician experiencing it. “It can be very costly in terms of human toll, financial toll for the institution, and likely the consequences for our patients,” Cohen explains.
Using data to help
It’s a problem Cohen is trying to tackle in the Division of GI, Trauma, and Endocrine Surgery at the University of Colorado Department of Surgery through a new pilot program that tracks users’ biometric data and helps them optimize their routine and performance.
“Instead of the weakness mindset of, ‘I need to rest, it's too much,’ we want to frame it as performance,” says Cohen, professor of GI, trauma, and endocrine surgery. “We are world-class performers no different than the elite athlete, musician, artist, or military operator.
“You wouldn't let the superstar athlete do anything to harm their potential performance. They will do any performance hack to gain even the smallest gain. Similarly, we work hard, play hard, travel a lot, and have busy personal lives, then we come in and do life-saving surgeries as high-performing surgeons the next day. And we don't think about anything in the periphery.”
The pilot program is all about the periphery. Conducted in conjunction with Arena Labs, a health care coaching company, the eight-week program is collecting biometric data via wearable devices. Participants — a mix of surgeons and advanced practice providers — are working one-on-one with a coach who will help them figure out the best way to get better sleep and decompress and optimize human performance.
“The coach has a PhD in performance psychology and lots of experience coaching high performers, so it will be really interesting to see what she tells us,” says Cohen, who has published a large body of research on sleep and burnout in surgeons, including research that used the WHOOP biometric device to measure the effects of in-hospital service calls on sleep and burnout. He also published a recent commentary in the journal JAMA Surgery on the risks to patients of postoperative sleep disruption.
“Recovery and performance is a personalized medicine problem,” he says. “What I should do after I'm on call is different than what one of my colleagues should do. Maybe my thing is running long distances, and somebody else's thing is cooking or art, and somebody else's thing is yoga or meditation. We want to use those things to get better.”
Increasing overall efficiency
The Arena Labs platform also includes on-demand prerecorded coaching sessions led by top athletes, elite military members, and other high performers. Cohen is hopeful that the combination of data and coaching will help the overall outcomes of the division. If the pilot proves successful, he hopes to roll the program out across the Department of Surgery and possibly the entire CU Anschutz School of Medicine.
“This will benefit us, but it also will benefit our patients,” he says. “It makes sense that if we're better, then our outcomes will be better, our patients will be taken care of better, and from an institutional perspective, the cost of health care will go down because our mistakes will be fewer, our lengths of stay will be shorter, and our overall efficiency will be better.”
