Baker’s Dozen: a recipe for wellbeing

In the 16th Century when selling certain goods, bakers were obliged to sell goods by the dozen at a specific weight or quality (or a specific average weight). During this time, bakers who sold a dozen units that failed to meet this requirement could be penalised with a fine, including losing a hand. Therefore to avoid risking this penalty, some bakers included an extra unit to be sure the minimum weight was met, bringing the total to 13 units - or what is now commonly known as a baker's dozen.

So, it's been a rubbish year….what can you do to optimise your days? How about your own wellbeing prescription using the Baker’s Dozen skills? Anaesthetists are all experts at both learning and performing skills, and want to be active participants. As always, in order to get good at skills you are going to have to practise (and practise) and get feedback as to how well you’re performing. The implementation of these skills in your life will help energise your own body budget and help you to think and act in a way to navigate tough times. And anyone can learn them….today.

Here is the recipe for the Baker’s Dozen:

Ingredients: 

• A pen, to write the skills on your prescription 
• A piece of A5 paper 
• A fridge to stick it on

Method: 

• Write your name and address in the top right hand corner, along with today’s date 
• Put numbers 1 - 13 down the left hand side of the page 
• Stick it on the fridge and practise the following skills, based on the three ‘C’s of stoic philosophy, every day

Control what you can
Cope with what you can’t
Concentrate on what counts
(we discovered a fourth C this year – any ideas what that might be?)

Here are your skills:

1. Challenge or threat? Do you view your problems as challenges or threats, and which of these approaches is psychologically more healthy [1]?
2. Optimist, or pessimist? Whichever you are, learn some optimism skills. Check out the works of Marty Seligman. His original work was on learned helplessness, but subsequently performed more valuable research. Our minds are like Velcro when dealing with the negative and Teflon when dealing with the positive, so choose where you put your attention and focus on the things you can change. Don’t lose what you have to what you have lost [2]. 
3. Keep a gratitude diary. Write down three things you are proud of doing in the last 24 hours (or just one thing). Hunt the good stuff. 
4. Exercise. Check out the 7 minute workout® app [3] and Down dog for yoga instruction [4]. 
5. Meditate. Practise your box breathing every day. For the cynics among you, read 10% happier [5]. Google run the Search inside yourself training programme to improve performance, with a book available outlining the strategies [6]. Elite athletes use the Chimp paradox approach [7]. 
6. Become a stress management expert. To reframe your day, empty your stress bucket when leaving work so that when you get home you have a nice empty stress bucket, which you fill up with home stress and reverse the process when you return to work. For the naysayers out there, read Why zebras don’t get ulcers [8]. 
7. Discover the ultimate performance product. It has the following properties:
   • Live longer
   • Enhances your memory
   • Makes you more attractive
   • Keeps you slim and lowers food cravings
   • Protects you from cancer and dementia
   • Wards off colds and flu
   • Lowers your risk of heart attacks and stroke, not to mention diabetes
   • You’ll even feel happier, less depressed and less anxious
   
   It is of course, sleep – ban your phones from the bedroom [9, 10].
   
   
8. Make better decisions in life (and clinically). Use the WRAP model [11] – when faced with a decision:
   Widen your options - should I do a or b, or non-a/b?
   Reality test your assumptions - what is the likely outcome of your a, b or non-a/b decision?
   Assume distance - if you can come away from the decision and give it some space, try the 10/10/10 rule. Ask yourself the question how will I feel in 10 minutes/10 weeks/10 years if I make this decision?
   Prepare for failure… and I mean complete failure. Anaesthetists are very good at plan ABCD, but you can do everything correctly and sadly bad things will still happen. Have you got a strategy that you can implement to ensure that you can deal with that outcome? Practise the pre-mortem technique recommended by Gary Klein. When faced with a difficult decision you consider the worst possible outcome; for example a patient goes to ICU and then dies. Fast forward (cognitively) three months, you are being questioned by the coroner and she asks “In retrospect what would you have done differently?” If your answer is “Well I would have sited an arterial line/ got someone to help me” , what do you think her next question will be? We may expect a perfect life, but we are not entitled to it.
   
   Further improvements in decision making come from the next four skills:
   
   
9. Never ever be afraid to ask for help, no matter how experienced or confident you are. 
10. Learn how to deal with conflict. A life-long skill worth learning. Should you ever find yourself the victim of other people’s bitterness smallness or insecurities, remember, things could be worse…you could be them [12]. 
11. Learn. Become an expert at learning: in fact Learn like a pro [13]. In fact, learn a new skill every year… like peeling a banana, or tying your shoelaces or something even more interesting (unicycling perhaps?) If you have a fabulous skill that you think others should know about, then please share it with us. 
12. Become a human factors expert. Minimise the negative effects of HALT (hungry, angry, late, tired) in you and your staff [14]. And for the icing on the Baker’s Dozen cake: 
13. Smile. Make five random people smile every day. It works, even behind a mask!

For more information look at some of our wellbeing material: 

• Wellbeing Mind Map
• Coffee and a Gas: A wellbeing podcast

Now you have written your own prescription, make sure you sign it at the bottom. And try your best to follow it… Doctor’s orders.

Mark Stacey
Consultant Anaesthetist 

Nadine Jones
ST7 Anaesthetist
University Hospital of Wales, Cardiff 

Twitter: @airwayman1

References 

1. Frankl V. Man’s search for meaning, 6th edn. London: Penguin Books, 2021. 
2. Seligman M. Learned optimism. Boston: Nicholas Brealey Publishing, 2018. 
3. 7minuteworkout. The Johnson & Johnson official 7 minute workout®, 2021. https://7minuteworkout.jnj.com (accessed 14/9/2021). 
4. down dog. Down dog app, 2021 - https://www.downdogapp.com (accessed 14/9/2021). 
5. Harries D. 10% happier. London: Yellow Kite Books, 2014. 
6. Tan C-M. Search inside yourself. London: Collins, 2012. 
7. Peters S. The chimp paradox. London: Vermillion, 2012. 
8. Sapolsky RM. why zebras don’t get ulcers, 3rd edn. New York City: St Martin’s Press, 2004. 
9. headspace. Headspace app, 2021. https://www.headspace.com (accessed 14/9/2021). 
10. Walker M. Why we sleep. London: Penguin Books, 2018. 
11. Heath C, Heath D. Decisive. How to make better choices in life and work. New York City: Random House, 2013. 
12. Harris TA. I’m ok, You’re OK, 2nd edn. London: Arrow Books, 2012. 
13. Oakley BA, Schewe O. Learn like a pro: science-based tools to become better at anything. New York City: St Martin’s Press, 2021. 
14. Nance JJ. Why hospitals should fly. The ultimate flight plan to patient safety and quality care. Bozeman, Montana: Second River Healthcare Press, 2008.

Read next: Introducing Trauma and Tension Release Exercises (TRE) to support staff wellbeing at Addenbrooke's Hospital Cambridge