Habits

A new year is a time for resolutions, which are essentially an exercise in either changing old habits or making new habits.  Coincidently, I just finished reading The Power of Habit: Why We Do What We Do in Life and Business by Charles Duhigg (NY: Random House, 2012)* and it got me to thinking about the habits that I have on the job.  I don’t think that I spent enough time at the beginning of my career thinking about establishing good habits.  That’s not to say that most of my habits are bad, just that some of them may be… suboptimal.

Some habits are more productive than others.
(Carlos Paes, Wikimedia Commons)

According to Duhigg, personal-level habits are the brain’s shortcuts to perform common, repetitive tasks.  It begins with a cue, the habit kicks in, and a reward comes at the end.  By using habits to perform common tasks, like starting the car, our brain is freed to think about other things.  You don’t have to consciously think about getting your keys out of your pocket, unlocking the door, sitting down, putting the keys in the ignition, and all of the other steps in order.  It is an incredible evolutionary development to be able to think about your to-do list for the day while all of those other actions are going on. 

If the habit is a positive one, that is.

Think about the habits that you have when you are working.  You probably don’t realize how many of your actions are habitual:

• How you belt a patient onto the bed
• What you do right after you get a call
• What you do right after you decide to start an IV line
• How you approach a patient
• Your personal introduction and first few questions to a patient
• How you take vital signs
• How you give a verbal report
• Your initial actions when you walk up to a car crash
• How you check out your ambulance before a shift
• How you clean up your ambulance before a shift

There are dozens more.

What do you do when you get a call?  You put whatever you’re doing down, I assume, but do you put it away, or just toss it behind your seat?  Why? Do you look up the location on a map?  Why or why not?  When do you put gloves on?  Why then?

What objects do you grab when you need to start an IV?  Why do you choose those?  Do you toss them next to you or do you lay them out in a specific way?  Why?  Do you tear your tape beforehand or leave it on the roll?  Why?  What locations do you check first on a patient?  Which arm do you rope off?  Why?  How do you position your body?

How many of your habits were created through the thoughtful consideration of “I want to make this a habit”?  Can you explain what you are trying to accomplish and why?  If not, shouldn’t you reconsider your habits and whether there are more optimal ways to accomplish those tasks? 

For me, there are a few habits that I have thoughtfully established.  For example, I belt patients onto the bed the same way each time.  My habit is to pull the axial straps high up into the patient’s armpits and place the leg straps immediately above the patient’s knees.  I make sure the straps are snug without being tight, and I flip the buckle over so that the release button is down.  I do that on every patient because I don’t always know which ones will become unexpectedly violent enroute to the hospital.  It is easier to just habitually place the belts correctly, rather than to struggle to rearrange the belts after everything has gone pear shaped. 

Other habits have been incredibly hard to change.  I would love to make it a habit to listen to breath sounds after each blood pressure.  I could just move the stethoscope from the patient’s arm to their chest.  Instead, I have to make a choice to listen to breath sounds.  I keep working at it, though. 

Another example: I wish that I learned to start IVs left-handed.  Think about the orientation of the patient’s arm when they are lying on the bed in relation to your hands when you are sitting next to them on the ambulance bench.  Your left hand offers a straighter line to start an IV without excessively abducting the patient’s shoulder.  To comfortably start an IV with your right hand on the patient’s left arm, it is easiest to bring the patient’s arm to a spot that is almost perpendicular to the rest of their body.  My left hand has a straighter line. 

That’s it.  I’m gonna start all lines with my left hand in January.

Establishing good habits is a primary task when you are training, but you may not realize it.  Many of the habits that I have are the result of my first preceptors, trainers, and partners.  It is an important responsibility, and I wish we more clearly understood that that is what we are doing.  Trainers insist that trainees perform tasks in a certain way – the way that a secondary exam is performed, for example.  By repeating that lesson, a habit is established that will probably follow that trainee for the rest of their career.  If you are training, I hope that you are establishing sensible habits in your trainees. 

Now that most of you are established providers, challenge yourself to think about which habits you have, critically examine them, ask yourself why you are doing them, and change them if there is a better (more logical, more intellectual, more efficient) way to do the task.  Don’t be a slave to your habits.  Change what needs to be changed. 

A new year is a perfect time to start that process.

* I would recommend reading this book.  It is a pretty good read, in that it got me to thinking about this topic, but it also strikes me as a little bit shallow in its examination of the topic of habits.  It reminds me of superficial pop-psychology books like those written by Malcolm Gladwell.  I’m sure the details go much deeper and the case studies used to illustrate points are much more complex, but it is a fine book to spend some time with.  But I like Gladwell books (Blink and Outliers especially) because they make me think, too.