The Facebook Confession
The other day, while scrolling through one of those physician-only social media groups – you know the ones, where we drop our professional facades and speak the unvarnished truth – I came across a post that stopped my thumb mid-scroll:
“I get 7 hours of sleep most nights, but I’m still exhausted all the time. I’ve had my thyroid checked, my iron levels are fine, and I drink enough water to float a boat. Why do I feel like I’m underwater by mid-afternoon? Is this just what practicing medicine is now?”
The comments piled up: “Same.” “Following.” “Have you checked your B12 levels?” “Are you iron deficient?” “Sounds like burnout.”
As an integrative and internal medicine physician practicing Direct Primary Care, I’ve spent years exploring the intersection of conventional and holistic approaches to wellness. Something about this physician’s struggle resonated deeply with me. I replied: “Maybe you’re sleeping but not resting.”
“What do you mean?” they asked. “Sleep is not rest?”
I explained the critical distinction between sleep and recovery – a distinction I only discovered after doing the digging myself, after experiencing the same exhaustion despite adequate sleep. The physician’s response was illuminating: “I need to try and incorporate actual rest. I’ve never thought about it this way before.”
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The Physician’s Perpetual Pendulum
We pride ourselves on performance – pushing past points of prudence through punishing schedules. Medical school taught us endurance, residency reinforced resilience, and practice perpetuates this pattern. We work frantically through frenzied shifts, fielding calls, filling charts, and facing emergencies. Then we crash – a collapse so complete it could be confused with catatonia – until the next shift shatters our slumber.
But I’ve begun to question: is this crash-and-burn cycle really living? Or are we merely surviving in suspended animation between shifts?
Sleep vs. Rest: The Seven Types We Need
Here’s the diagnosis many of us miss: sleep and rest are fundamentally different concepts.
Sleep is physiological – a non-negotiable neurological necessity. Our bodies demand it, eventually enforcing it when we’ve depleted our reserves beyond reason. We track our sleep in hours, measure it on smartwatches, and still wear our sleep deprivation like badges of honor in hospital corridors.
Rest, however, is revolutionary. Rest is intentional. In her groundbreaking work, Dr. Saundra Dalton-Smith, a board-certified internal medicine physician and researcher, identified seven types of rest we all need:
1. Physical rest: Beyond sleep, allowing our bodies to recover without motion or exertion
2. Mental rest: Creating space where our minds aren’t required to solve, analyze, or decide
3. Sensory rest: Finding quiet in our visually and auditorily overwhelming medical environments
4. Creative rest: Experiencing wonder and beauty without clinical interpretation
5. Emotional rest: Expressing authenticity without the weight of others’ expectations
6. Social rest: Engaging with relationships that revitalize rather than deplete
7. Spiritual rest: Connecting to something larger than the healthcare system’s demands
As physicians – particularly those of us in direct primary care where boundaries blur between professional and personal – we excel at diagnosing deficiencies in others while remaining remarkably rest-deficient ourselves.
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The Crash Cycle Conundrum
Medical culture has conditioned us to operate in crash cycles. We work ourselves to exhaustion, proud of our stamina, until our bodies and minds finally surrender. Then we enter “recovery mode” – a frantic attempt to recharge depleted batteries before the next shift.
The problem? Crash recovery isn’t restorative.
When we collapse from exhaustion, our recovery is compromised by:
– Guilt about what wasn’t completed
– Anxiety about what awaits upon return
– The physiological impacts of stress hormones still coursing through our systems
– Insufficient time to truly process and integrate experiences
The physiological toll of this crash cycle is immense. This pattern doesn’t just leave us tired – it fundamentally alters our body systems. It disrupts hormone balance, triggers weight gain, exacerbates anxiety and depression, and often leads to unhealthy self-soothing behaviors like overeating, excessive alcohol consumption, or compulsive behaviors. We’re trying to fill needs without correctly identifying what actually needs nourishment.
It’s a bit like repeatedly running your car until it’s completely out of gas, then wondering why the engine eventually fails despite your diligent refueling.
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Sleep Well: Bridging Science and Health in Sleep Medicine
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Physicians on Autopilot: Present for Patients, Absent from Self
The administrative burden in medicine has grown exponentially, yet our call schedules haven’t adapted. Unlike the regulated hours of residency, practicing physicians – even surgeons – can be on call for a week or two at a time. We’re scrubbed in for marathon surgeries or bouncing between patients without breaks, accepting this as normal even as it drives talented physicians from the profession.
We become medical automatons – meticulously monitoring patients’ vital signs while ignoring our own internal alarms. We excel at presence with patients while practicing absence from ourselves. This isn’t just a matter of self-care – that overused and underimplemented concept. It’s about fundamental neurological integration.
When we operate in prolonged states of stress without adequate recovery, our nervous systems literally lose the capacity to return to baseline. The “rest and digest” parasympathetic function becomes increasingly difficult to access.
No wonder physicians are leaving clinical practice in record numbers. It’s not just system frustrations – it’s physical incapacity. We’re literally too tired to work, not because we don’t sleep, but because we don’t rest.
I explained the critical distinction between sleep and recovery – a distinction I only discovered after doing the digging myself, after experiencing the same exhaustion despite adequate sleep.
Sulagna Misra, MD
I explained the critical distinction between sleep and recovery – a distinction I only discovered after doing the digging myself, after experiencing the same exhaustion despite adequate sleep.
doctorsonsocialmedia.com
The Playful Prescription We Never Write
Perhaps most tragically absent from physician life is play. Yes, play – that supposedly frivolous activity that research now shows is essential for cognitive flexibility, creativity, and nervous system regulation.
When was the last time you engaged in an activity purely for enjoyment, with no productive purpose? When did you last lose track of time doing something that brought you joy without achievement?
For many physicians, the answer is measured in years, not days.
Play isn’t a luxury; it’s a neurobiological necessity. It helps recalibrate our threat-detection systems, creates novel neural connections, and allows for the integration of experiences. Without it, our perspective narrows, our resilience diminishes, and our capacity for innovation evaporates.
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My Personal Rest Revolution
I’ve been on this journey of understanding the sleep-rest distinction myself. Despite adequate sleep, I was constantly exhausted until I recognized what I was missing. Now, I’ve shifted focus to activities that genuinely restore me – gardening, spending time with my dogs, building real community, and dramatically reducing social media scrolling.
I’ve learned to evaluate everything in my life through the lens of Maslow’s hierarchy of needs, which forms the foundation of my integrative medicine approach. I’m constantly asking: does this activity or relationship truly nourish me, or is it depleting me? Just because I love doing something doesn’t mean it’s good for me – like an allergy, some things can negatively impact our wellbeing despite our attachment to them.
Planned Recovery: The Prescription We Rarely Write Ourselves
What if, instead of waiting for the inevitable crash, we prescribed ourselves planned recovery? What if we approached rest with the same intentionality we bring to our treatment plans?
Planned recovery means:
– Scheduling rest before reaching exhaustion
– Creating boundaries that protect restoration time
– Recognizing rest as a productivity tool, not a productivity enemy
– Understanding that our quality of care depends on our quality of restoration
For direct primary care physicians, who often have more control over their schedules than hospital-employed colleagues, this represents both an opportunity and a responsibility.
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Sleep Well: Bridging Science and Health in Sleep Medicine
The science of sleep is too important to leave to internet guesswork. This expert-led SoMeDocs collection helps doctors and the public understand sleep disorders, treatments, research, and practical strategies for better health and well-being.
The DPC Difference: Potential for a Paradigm Shift
Direct Primary Care offers a unique opportunity to restructure this relationship with rest. Without the productivity demands of volume-based care, DPC physicians can theoretically design practices that incorporate intentional recovery.
Yet many of us carry our crash-cycle conditioning into our DPC practices. We replace insurance paperwork with expanded accessibility, trade hospital rounds for 24/7 availability, and continue treating rest as something that happens “when everything else is done” – a time that never arrives.
What if DPC became not just a model for better patient care, but also for physician sustainability? What if we demonstrated that quality care emerges not from constant availability but from intentional presence made possible by regular restoration?
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The Restorative Revolution
This interaction made me reflect on how many physicians might be in the same position – getting adequate sleep but severely lacking in true rest. How many of us are missing the critical distinction between these two different physiological needs?
As my own journey has shown me, implementing authentic rest practices has transformed my wellbeing despite the ongoing challenges of practicing medicine. It’s not about abandoning our commitment to patients, but about sustaining ourselves so we can continue to serve them with presence and clarity.
As physicians, we have the knowledge to understand the physical and psychological importance of rest. As DPC physicians, we may have the autonomy to implement it. What we’re missing is the permission – from ourselves, from our culture, from our training – to prioritize it.
So consider this your prescription: Rest isn’t optional. It isn’t what happens when everything else is finished. It’s what makes everything else possible.
The question remains: in a profession dedicated to healing others, will we finally take our own medicine?
