I have confessions to make about self-care and avoiding burnout that will surprise and may even shock you. As it happens, much of (but not, as youll discover, the most important part) my own self care routine was installed over the seven weeks from March 25th until May 13th of New Zealands Level 4 Alert response to COVID-19. Before we get to the specifics, Id like to start with my story of how life seemed to change in New Zealand during our lockdown. After all, what better year to be pontificating on the importance of looking after ourselves than 2020?

When NZ entered Alert Level 4 we were asked to stay home, stay local, only be in near physical contact with those we were already living with, wash our hands, and to be kind. All businesses except those providing essential services were to remain closed, with travel only permitted for people providing those services. The centre of Wellington where I live fell near silent, the perpetual weekday hum of vehicles and commerce replaced by birdsong. The streets emptied of traffic, and my bicycle commute to work became quicker, more enjoyable, and felt infinitely safer. A few weeks in, I noticed entire families out biking together. When I walked, the air was clearer and people Id never met smiled and said hello (while keeping their distance). I felt inspired to go out running daily, and I noticed hundreds of other fellow runners and walkers out too, spilling out onto the roads whenever we pleased. A usually near deserted local park came alive: people worked out in the sun, kicked about balls, threw frisbees, or exercised pets in their bubbles. And it really did feel like we all shared a common purpose as part of a team of 5 million’.

For my part, despite continuing working, I slept well, exercised, ate healthier than ever, enjoyed the end of summer sun, and read a lot of books. While I know many peoples experience of lockdown was one of stress and uncertainty, I suspect I was not the only one making the most of some of its positives. On May 13th we started reopening. Cars returned to the roads en masse. Promised temporary bike lanes were largely forgotten and then vociferously opposed by business owners. Our air quality reduced back to normal. One of the most eagerly anticipated and celebrated changes here was the reopening of fast food restaurants: New Zealanders queued for hours (usually in their cars) to pay for highly processed, low quality food. Noise returned to the centre of our cities, and the birds disappeared. The local park fell back into disuse, people went back to minding their own business, and fewer ran or walked when I did. Now, even though we are still not 100% open for business, life for the most part feels 100% where it was prior to March – with a few exceptions, we are back to normal. I would hazard a guess this is similar in most parts of Australia too.

This begs the question of what normal’ means when it comes to the lifestyles and self care of New Zealanders and Australians in 2020? Well, it is normal for about 2 in 3 of us to be overweight or obese, and it is normal for about 1 in 3 of our children to also be overweight or obese1,2. Its also normal for over two thirds of Australians and close to half of New Zealanders not to manage to eat even 2 servings of fruit a day3,4. It is normal for less than 4% of Australians and less than 1% of Australian children to manage to eat the minimum recommended amount of vegetables, beans and legumes3. In New Zealand, its normal for over a third of us to consume less than three servings of vegetables a day4. In New Zealand and Australia it is normal for about half of us not to meet the recommended minimum physical activity levels (30 minutes a day, 5 days a week)5,1. Its normal in New Zealand and Australia for over a third of us to sleep less than 7 hours a night6,7. It is also normal for stress to affect the mental health of almost two thirds of Australians, and for almost two thirds of New Zealanders to report being stressed weekly8,9.

However, Im writing for a specific audience here. We health practitioners spend years training and a career learning not only to understand the importance of health, but also that nutrition, physical activity, sleep, relaxation, and connection are all important to achieving and maintaining it. This intensive, ongoing education should be reflected by a group of professionals role modelling healthy behaviours and presumably demonstrating better health outcomes than the general population. The reality is that health practitioners do not fare much (if at all) better. In the United States, 53% of primary health care physicians are overweight or obese, and in England almost 86% of nurses and 63% of other health professionals are too10,11. In Scotland, two thirds of nurses and over half of other health professionals do not meet the government guidelines for fruit and vegetable intake12. Almost a quarter of hospital doctors in Ireland are physically inactive, and in Scotland, almost half of nurses and other health professionals failed to meet physical activity guidelines13,12. In the US, physicians average 6.5 hours sleep a night, and a study of California physicians found over a third reported getting six or fewer hours of sleep14,15. In this same study over 53% of physicians reported experiencing moderate to severe stress, and the findings of a number of other studies show almost half of physicians reports symptoms of clinical burnout14,15.

Therefore, somewhat staggeringly, what is normal for the general population is more or less normal for health practitioners too. Presumably then, a factor that is largely shared with the general population contributes to our lack of self care and high levels of burnout. What is it that stops us from regularly engaging in the very lifestyle habits we know are essential to health and that we ourselves recommend to our patients? A clue is that medical students are universally recognised as also faring pretty poorly. Nearly 7 out of 10 New Zealand medical students can be classified as disengaged, and almost 8 out of 10 suffer from exhaustion16. Over a fifth of them report currently seeing a health provider for mental ill-health. Australian medical students also report higher mean depression, anxiety and stress scores than the general population17. We also know that medical students are more likely to report depressive symptoms than are other students18. The remedy, of course, appears no different than what we would expect: Australian research has demonstrated that higher levels of self-care among medical students are associated with lower levels of psychological distress19.

Most of us can probably hazard a guess as to the cause of medical students’ woes. I vividly remember the heart-sink moment during my interview for medical school when one of the interviewers explained that many first year students study 60 or more hours a week. Obviously I managed to recover from this untimely revelation well enough to pass the interview, but sadly this turned out to be a fairly accurate representation of the workload and required time commitment.

Could it be then that the reason most of us arent as healthy as we should be, and that we are stressed and burned out, is simply that we are all working too hard and too much? I believe so. It would be hard for our ancestors to fathom that despite the panoply of labour saving devices now deployed in the workplace and the majority of women (rightfully) entering and remaining in the workforce the 40 hour’ work week that was established in New Zealand 180 years ago this year has remained exactly that for most of us (and an aspirational luxury for others). Without even considering the time spent preparing for, travelling to and from, and unwinding from work, almost all of us spend the vast majority of our daylight hours and at least half of our waking hours working. And we expect to do this five out of every seven days for all of the best years of our lives. It should come as no surprise then that the things that we need to do in order to be healthy become an afterthought for most, including, as we have seen, even the group of workers who arguably should be the most highly informed and motivated to engage in these.

Level 4 gave us a tiny glimpse of what our society might look like if we had more spare’ time. New Zealanders apparently decided to increase their activity levels en masse. Old hobbies were returned to, and, where possible, new ones embarked upon. People had time to spend with their families, pets, and even to communicate more intentionally with their friends using the various technologies available to us. A cynic might contend that we were just choosing to do so because there was little else that could be done, but regardless of motivations there are surely benefits for our health and happiness in having more sovereignty over how we choose to spend our time (which after all is our most important and finite resource). Some will contend that our current hours of work maintain our expected levels of wealth and productivity, but the relationship between income, happiness, and life satisfaction is complicated: the American Time Use Survey suggests that happiness peaks among those earning between $50,000-$75,000, with people earning $100000 less happy and in fact no happier than those earning $2500020. Theres also been plenty written about the importance of comparative wealth – we actually seem to be happier when we are similarly well off to everyone else around us. The same American Time Use Survey also reveals, consistent with our earlier hypothesis, that happiness and sense of purpose are at their highest among people working between 21 and 30 hours a week20.

Even when it comes to productivity, its far from clear that there is a linear relationship between hours worked and productivity achieved. Inspired by an article citing studies of office workers in Canada and the UK that revealed they were productive for 1.5-2.5 hours of a typical work day, New Zealander Andrew Barnes of Perpetual Guardian began trialling a 4 day work week for his staff in 2018. Productivity, engagement, job satisfaction, work-life balance and employee wellbeing all improved (you can watch him tell this story in this TedX talk). It is also normal’ for most of us not to be particularly enjoying work: Gallup has been tracking employee engagement in the US since 2000, which has reached a new high’ this year of 40%21. Their often cited (but comparatively dated) worldwide analysis suggested the number was a mere 15%, with Australia and New Zealand faring slightly worse with 14% of our workers being engaged in their jobs22. Finally, it is worth mentioning that the pandemic has also provided a visually striking insight into the effects of our current work at all costs model on our environment – the many before and after pictures illustrating rapid improvements in air and water quality truly are worth a thousand words.

So this leads on quite nicely to my confessions. Firstly, one of the main self-care measures I take is working only 3 days a week. The fact that this may shock or unsettle, that I feel somewhat guilty about this, and also that I am adding the caveat that I use the extra two work’ days largely volunteering my time to organisations (and occasionally doing private consultations) demonstrates the pervasiveness and power of the concept that we each have a societal responsibility to work away most of our lifetimes (see David Fraynes rather excellent book The Refusal of Work for a very interesting discussion and critique of this23). I do appreciate that Im privileged to be in this position, but I also believe that finding ways to spend less of our time on or at work, when we are able to, can be something very positive for both our own and our societys health and wellbeing. At the very least, enabling people to pursue more flexible work arrangements, such as working from home when feasible and preferred would be a step in the right direction for business and policymakers to consider. Ultimately what is needed is a cultural shift away from only considering and recognising time spent in paid employment as of value, and it is likely that adoption of a guaranteed or universal basic income would go a long way towards this.

My second confession is that I think I could still do a lot better at self-care, and despite the activities that I am currently regularly engaging in to improve my physical and psychological wellbeing (daily bike rides, bodyweight training and running 4 days a week, whole foods plant-based diet, occasional meditation) I still find myself becoming burned out. This may further irritate or even enrage many of you who are needing to work a lot more hours than I am, but I do suspect that when it comes to self-care things are inevitably and unfortunately a little more complicated than just working fewer hours. Furthermore, from a practical perspective for most people it doesnt seem that the reduction of work hours is on the current agenda, even though there has probably never been a better year for this discussion than 2020.

Fortunately, behaviour change experts like BJ Fogg, PhD and UK GP Rangan Chatterjee may have a solution in the meantime, at least when it comes to helping us to adopt new health promoting habits. In his 2019 book Tiny Habits, Fogg explains that starting with small changes can prove very effective in generating new habits, and in fact in most cases may be the only way these are likely to be maintained in the longterm. Chatterjee argues convincingly that in fact significant time investment is not required for activities to generate noticeable improvements in health and wellbeing. He has written an entire book on this subject providing numerous examples of 5 minute health snacks’ that we can choose from to engage in at times convenient to us24. Im planning to start following some of their guidance for improving my own self-care, and their ideas and prescriptions should be especially helpful for people on a tighter schedule.

More time for all of us to spend on health promoting activities, and less time to be spent on work should be a goal for our society. Clearly, simply educating people about what they should be doing, and preaching the doctrine of personal responsibility is not working – even for the health professionals who we could expect to be a shining example of doing all the right things. I still have some hope that ideas like the 4 day week may become part of the conversation for the public and our leaders and policymakers as we look to how to respond to the social, economic and environmental challenges currently facing us. I hope also that some of you who may be able to reduce your time spent on or at work feel more empowered and less guilty about doing so. In the meantime, theres certainly comfort in knowing that even small changes are worthwhile when it comes to improving our own health and wellbeing, and by extension those of our patients.

  1. Australian Institute of Health and Welfare 2018. Australias health 2018. Australias health series no. 16. AUS 221. Canberra: AIHW.
  2. Ministry of Health. Obesity statistics. Ministry of Health website. November 12 2019. Accessed September 28 2020. https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-statistics
  3. Australian Bureau of Statistics. Australian Health Survey: Consumption of Food Groups from the Australian Dietary Guidelines, 2011-12. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0122011-12?OpenDocument#Publications. Accessed September 28, 2020.
  4. Ministry of Health. Eating and Activity Guidelines for New Zealand Adults. Wellington, New Zealand: Ministry of Health; 2015.
  5. Ministry of Health. Activity levels in New Zealand. Ministry of Health website. August 30 2016. Accessed September 28 2020. https://www.health.govt.nz/your-health/healthy-living/food-activity-and-sleep/physical-activity/activity-levels-new-zealand
  6. Lee CH, Sibley CG. Sleep duration and psychological well-being among New Zealanders. Sleep Health. 2019;5(6):606-614. doi:10.1016/j.sleh.2019.06.008
  7. YouGov. One in three Australians not getting enough sleep. YouGov website. March 21 2019. Accessed September 28 2020. https://au.yougov.com/news/2019/03/21/one-three-australians-not-getting-enough-sleep/
  8. Australian Psychological Association. Stress and wellbeing in Australia survey. 2015.
  9. Gray A. Revealed: what’s making us stressed. Southern Cross website. October 3 2016. Accessed September 28 2020. https://www.southerncross.co.nz/group/media-releases/2016/what-makes-us-stressed
  10. Bleich SN, Bennett WL, Gudzune KA, Cooper LA. Impact of physician BMI on obesity care and beliefs. Obesity (Silver Spring). 2012;20(5):999-1005. doi:10.1038/oby.2011.402
  11. Kyle RG, Wills J, Mahoney C, Hoyle L, Kelly M, Atherton IM. Obesity prevalence among healthcare professionals in England: a cross-sectional study using the Health Survey for England. BMJ Open. 2017;7(12):e018498. Published 2017 Dec 4. doi:10.1136/bmjopen-2017-018498
  12. Schneider A, Bak M, Mahoney C, et al. Health-related behaviours of nurses and other healthcare professionals: A cross-sectional study using the Scottish Health Survey. J Adv Nurs. 2019;75(6):1239-1251. doi:10.1111/jan.13926
  13. O’ Keeffe A, Hayes B, Prihodova L. “Do as we say, not as we do?” the lifestyle behaviours of hospital doctors working in Ireland: a national cross-sectional study. BMC Public Health. 2019;19(1):179. Published 2019 Feb 11. doi:10.1186/s12889-019-6451-8
  14. Stewart NH, Arora VM. The Impact of Sleep and Circadian Disorders on Physician Burnout. Chest. 2019;156(5):1022-1030. doi:10.1016/j.chest.2019.07.008
  15. Bazargan M, Makar M, Bazargan-Hejazi S, Ani C, Wolf KE. Preventive, lifestyle, and personal health behaviors among physicians. Acad Psychiatry. 2009;33(4):289-295. doi:10.1176/appi.ap.33.4.289
  16. Farrell SM, Moir F, Molodynski A, Bhugra D. Psychological wellbeing, burnout and substance use amongst medical students in New Zealand. Int Rev Psychiatry. 2019;31(7-8):630-636. doi:10.1080/09540261.2019.1681204
  17. Casey D, Thomas S, Hocking DR, Kemp-Casey A. Graduate-entry medical students: older and wiser but not less distressed. Australas Psychiatry. 2016;24(1):88-92. doi:10.1177/1039856215612991
  18. Moir F, Yielder J, Sanson J, Chen Y. Depression in medical students: current insights. Adv Med Educ Pract. 2018;9:323-333. Published 2018 May 7. doi:10.2147/AMEP.S137384
  19. Slonim J, Kienhuis M, Di Benedetto M, Reece J. The relationships among self-care, dispositional mindfulness, and psychological distress in medical students. Med Educ Online. 2015;20:27924. Published 2015 Jun 24. doi:10.3402/meo.v20.27924
  20. Dolan P. The money, job, marriage myth: are you happy yet? The Guardian website. January 6 2019. Accessed September 28 2020. https://www.theguardian.com/books/2019/jan/06/happiness-index-wellbeing-survey-uk-population-paul-dolan-happy-ever-after
  21. Harter J. U.S. employee engagement hits new high after historic drop. Gallup website. July 22 2020. Accessed September 28 2020. https://www.gallup.com/workplace/316064/employee-engagement-hits-new-high-historic-drop.aspx
  22. Gallup Inc. State of the Global Workplace. Gallup Press; 2017.
  23. Frayne D. The refusal of work: the theory and practice of resistance to work. Zed Books; 2015.
  24. Chatterjee R. Feel better in 5: your daily plan to feel great for life. Penguin; 2019.

This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.

Dr Luke Wilson is a New Zealand-based General Practitioner Board Certified by the International Board of Lifestyle Medicine, and co-founder of Two Zesty Bananas.

Interested in learning more about Lifestyle Medicine?