HALT: A Self-Coaching Stress Management Tool for Physicians

As a physician coach specializing in burnout and professional transitions, I've seen firsthand how the current state of healthcare can push even the most resilient doctors to their limits. Unchecked anger, frustration, and passive aggressive behavior can often be symptoms of the times.

By now you probably know that burnout is not your fault. Nor is it a mental health issue. Instead, it’s the consequence of a broken system.

At the moment, this is the system we are living in. While some headway is being made, the forces that are driving the burnout epidemic are not likely to improve overnight. And while it can be tempting to lash out when you’re stressed, it’s likely to make the situation worse, straining your relationships with colleagues, staff, and patients.

Beyond burning your bridges, the effect that an emotional outburst can have on your own well-being is profound. What’s more, healthcare systems are cracking down on behavior that’s deemed inappropriate or unprofessional.  

Although you didn’t cause the problem, it’s important that you remain mindful of the far-reaching implications of your communications and actions, regardless of the high quality of care that you provide.

To get you back on track, the simple acronym "HALT" – Hungry, Angry, Lonely, Tired – can be an important tool for self-awareness and self-care.

HALT was originally developed by David Streem, MD, a psychiatrist and addiction specialist, as a reminder to stop and identify the triggers that might lead to a relapse.  But for physicians, the acronym is also an intuitive tool that can remind you to mindfully take a pause and check in with how you’re feeling, and why, when something or someone triggers a reaction.

By using HALT, you can slow your roll before impulsively acting in ways that might harm your personal and professional relationships.

Here's how HALT works:

Hungry

When you're hungry, or “hangry”, even small problems can feel overwhelming. Hunger can make your patience wear thin and your trash your tolerance for stress and difficult interactions.

If you’re like many physicians, being hungry may be your default mode. Although it shouldn’t be the norm, it’s painfully common for physicians to skip meals or eat irregularly due to hectic and overbooked schedules.

Junk food from the snack machine or physician’s lounge might fill you up, but it can make you feel even worse. One straightforward strategy that can help is to pack simple but healthy food for the next day each evening.

But hunger isn't just about food. It's often about other unmet needs, whether emotional, physical, or intellectual.

Take action on hunger by getting in a 10–15-minute break to reset your mind and body once or twice daily whenever possible.  You’ll probably find that when you fill up the tank, even out your blood sugar and slow down your sympathetic nervous system, you’re able to maintain a more balanced mood and energy level.

In the long run, the few minutes you set aside to care for yourself will pay off in more respectful relationships, improved productivity, and better health.

Angry

Anger is a natural emotion, but how you handle it in the workplace is crucial. Unchecked anger can lead to conflicts with colleagues and unpleasant meetings with administrators. When it carries over to the bedside or operating room, it may impact the doctor-patient relationship, undermine teamwork, and even affect patient care.

Become aware of this emotion, and how it feels in your body. When you find yourself getting angry, take a moment to pause and step back. Give yourself time to process, reflect, and move on.

Deep breathing, a short walk, or even bluntly but respectfully discussing your feelings with a trusted colleague can open up a fresh perspective and prevent words and actions that you’ll regret later.

Lonely

If you’re feeling lonely, you may react harshly to stress out of a sense of isolation. Although you’re likely surrounded by people all day, medicine, our profession, ironically, can be a lonely one.

The burdens of responsibility, the fear of making mistakes, the ever-present perception of competition, and the need for confidentiality can all leave physicians feeling isolated.

Acknowledging loneliness is the first step towards seeking connection.  Regular interaction with friends, family, and community, even if brief, can hold back isolation and create a sense of belonging. Finding a hobby that gets you out of the doctor mindset or working out with a group of like-minded people can help as well.

Tired

When you’re tired, everything just feels harder. It’s no surprise that fatigue is a common issue among physicians. Long hours, high stress, and fractured sleep while on call mean that more than 40 percent of doctors surveyed report that their work schedule simply doesn’t allow for adequate sleep.

Chronic tiredness can impair your judgment and your empathy. Although it can be hard to feel compassion for your staff and others though the fog of fatigue, noticing what’s driving your irritation can soften your reaction to stress.

How to Use HALT in Your Daily Practice

• Check In: Before reacting, run through your HALT checklist. This simple pause can reset your frame of reference.

• Be Proactive: Make time for healthy meals, use brief but meaningful stress-relief techniques like mindfulness, get regular exercise, cultivate a life outside of work, and do your best to get restful sleep.

• Seek Support: Don't hesitate to seek professional help if you're struggling with anger, loneliness, or fatigue. Therapy, coaching, and peer support groups can all be helpful, depending on your circumstances.

• Communicate with Colleagues: Foster an environment where it's safe to respectfully express what you’re feeling. This openness can build stronger, more supportive team dynamics.

When you’re feeling reactive, upset, or tempted to lash out, use HALT to take a pause. Are you Hungry, Angry, Lonely, or Tired?

Simply becoming aware of your inner state can help you to defuse a situation and craft a different response. It’s also a great reminder that caring for yourself is neither selfish nor optional if you want to work at your optimum.  

When you take care of your own needs, you’ll find that you will be better equipped to care for those whose lives and well-being depend on you.

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