Willpower: A Depletable Resource

In many instances, our focus on health and wellness amongst anesthesia providers focuses on diet, exercise, sleep, and smoking cessation. And while a positive impact on even one of these factors can significantly improve our physical health, the mental fatigue associated with our career is sometimes overlooked. Yes, there is great deal of attention paid to emotional anguish that can occur after an untoward patient outcome. But what about the day-to-day “grind” associated with the extreme focus and attention to detail that is required with our careers as anesthesia providers?

Exhibiting Self-Control

It is well documented, that cognitive function is often compromised during activities that demand high degrees of self-control and discipline. In each of our anesthesia practices, we are faced with a myriad of complex decision-making processes and episodes of high intensity, often leaving us mentally, emotionally, and physically drained. We are significantly more likely to commit a human error after these periods of physical and emotional stress. In recent years, significant focus has been placed on the physical stress associated with increased work hours as a patient- and employee-safety issue; however, only recently has attention been brought to the topic of ego-depletion, motivation, attention, and self-regulation.

In each of our anesthesia practices, we are faced with a myriad of complex decision-making processes and episodes of high intensity, often leaving us mentally, emotionally and physically drained.

Recent data in behavioral psychology literature demonstrate that willpower and motivation come in a limited supply, and can be drained by even the most basic of daily activities. In one study, a behavioral psychologist had participants fast for several hours. After this period of fasting, participants were exposed to the sight and smell of freshly baked cookies. The psychologist then divided participants into two groups. Group A was allowed to eat the cookies, while Group B was offered radishes. Both groups were then challenged with an unsolvable math problem. Those in Group B, having exhausted a greater portion of their self-control stores, quit at a notably faster rate than those in Group A. Thus was born the theory of ego-depletion.

Ego Depletion

The theory of ego-depletion asserts that the level of self-control exertion during one event impacts the level of self-control exertion during a subsequent event. This is of significant importance in the health care setting we face daily. In these environments, anesthesia providers are inundated with a multitude of complex scenarios, which in repeated succession, tax self-control stores. The degree of intense focus required in our health care settings has a profound impact on patient safety and employee quality of life, as the role of attention, self-control, and motivation in these complex environments are not independent, but, rather, linked together.

The prevalence of ego depletion amongst providers in our health care systems still needs further exploration. It is not a stretch, however, to surmise that the impact of self-control exhaustion is underappreciated. This leads to several questions: What impact, if any, does ego-depletion have on day-to-day decision-making amongst anesthesia providers? How does one “diagnose” anesthesia providers with self-control exhaustion? And once identified, what intervention, if any, is necessary to assist anesthesia providers with ego-depletion?

The consequences of ego depletion are extensive, and are predominantly characterized as behavioral effects. Those drained of willpower tend not to describe a “signature feeling”, but note a reluctance to take on difficult activities or decision-making processes, a reversion to the default state (“Propofol, sux, then tube”), and an intensification of all emotions. This, as you might imagine, has a whole host of negative impacts on a variety of subjects including interpersonal relationships, work performance, and diet and exercise, to name a few.

It is important to try and incorporate mental and physical breaks throughout the course of the day in our hospital environments.

A key point to remember when considering ego-depletion is that willpower and self-control is not a learned or acquired trait that can be enhanced through hours of practice. The lack of consistency in willpower from one task to the next supports the claim that it is, in fact, a limited supply that must be replenished when exhausted. We should, however, be aware of the limitations in supply of self-control and, in an ideal setting, avoid scenarios that place tremendous demands on executive function. This, of course, is difficult to do in the complex environment that is health care.

Instead, we might be more successful finding ways to automate or standardize tasks that in the past may have called upon significant willpower for completion. It is also important to try and incorporate mental and physical breaks throughout the course of the day in our hospital environments. Decision fatigue that is encountered daily in the operating room, in the pre-op clinic, and in communicating with others in our complex health systems might not be changeable, but the way we navigate these scenarios can certainly be altered.