5/30/2021 0 Comments
I’ve witnessed and experienced unimaginable suffering, both personally and professionally during my 25 year physician career.
It's a privilege to hold space for the challenges and traumas that people face when they are ill and unwell. It's sacred work. Healing work.
Having been blessed to work with hundreds of medical students, trainees and colleagues, I can say that most physicians enter the professional as a calling with a desire to facilitate healing and make a positive difference in the health and well-being of others.
A Facebook post in a physician only group reminded me that this profession is one that is now threatening the lives of those who were called to serve.
The focus of the post was on the plight of the current day physician, especially those in primary care.
There have been several articles published in the last 2 years highlighting the accelerated rate of departure of women physicians from clinical practice. And while this is true, our male colleagues have also been significantly impacted.
May is mental health awareness month and yet there still isn’t the needed awareness about the growing rates of physician suicide. We’ve lost so many physicians colleagues and there are many more who are suffering in silence.
My response to the original poster is shared below. It has been edited for readability. My hope is that it may initiate a dialogue on what we can do collectively to support our physician community and address the current healthcare system in the US. And if these issues are impacting physicians in other nations, I want to hear about it.
To the original poster who serves as a primary care physician: First and foremost, thank you for what you do and for who you are. It is clear from your post how much you care about the work that you do.
Second, know that you are not alone. So many physicians have been suffering for decades, but the intensity and frequency has been accelerated recently with many docs suffering alone in silence and thinking something is wrong with them.
I left clinical practice 5 years ago after almost 21 years in pediatrics at an academic medical center.
My wake up call came when I ended up in the ER for a rule out MI (myocardial infarction, more commonly known as a heart attack) after experiencing chest pain in clinic.
Fortunately it wasn’t an MI, but the scariest part for me was realizing that I had let work become my important than my life (was willing to keep seeing patients in clinic and figure out the chest pain later; thank God for my Internal Medicine colleague who convinced me to leave clinic and go to the ER).
I made the decision to put my health and well-being first...to be around to see my grandson grow up and be that grandma who is present and available like my grandma was for me. I’m now thriving in my nonclinical career and feel valued and appreciated for the work that I do...grateful to still have an impact on child health. And I know that leaving clinical practice is not the answer for everyone...
The habits we develop in medical training to work past the point of exhaustion and ignore our own health and well-being comes at a cost and follows us into whatever we choose next...
And for most of us, entering medicine was a calling so how do we facilitate healing and make an impact on the health of people in the current environment with the state of the healthcare system being what it is?
I’m genuinely curious about what we can do to make a difference. This post has inspired my blog article for today. Thank you for initiating the dialogue. 🙏🏽❤️
How can I quit working when there’s still so much left to do?
This is a question I used to ask myself often. As the work day should have been wrapping up, there were still unread emails in my inbox and unanswered voicemail messages, not to mention the list of unchecked boxes on my to-do list.
It feels like there was a time when I could feel a sense of satisfaction that I’d checked everything off my list and neatly wrapped up the day. With the advances of digital technology over the last decade, this is no longer the case.
When the electronic health record was being introduced, I was told that it would save time and create a more efficient workflow. This was far from the reality that me and my colleagues experienced.
After transitioning to a 9-5 corporate position, I quickly learned that the problem was not exclusive to medicine. After a honeymoon period during my initial transition, work creep began to grow and spread. Landing in overwhelm became a more frequent occurrence and fueled the need to work longer days and some weekends.
Just like in medicine, I began to long for holidays, cancelled appointments and vacation days as an opportunity to “catch up”. Fortunately, my tolerance for working this way long-term was zero.
I sought solutions from time management and productivity resources, focused on learning how to master the concepts of prioritization and inbox zero. I believed that if I could just find the right strategy, then all my problems would be solved.
While I was working on figuring out a more sane approach to work, I heard an episode of The Life Coach School podcast where Brooke Castillo was talking about overworking as a form of buffering.
Having worked for years in a pediatric obesity clinic, I understood the concept of buffering with food...eating in the absence of hunger, usually to avoid experiencing uncomfortable emotions. But, I had never heard it applied to working.
As I listened, I began to see for the first time how I could be using work to avoid dealing with feelings I didn’t want to feel. Staying busy kept me from having to focus on thoughts of losing loved ones prematurely...of worrying about the path my son was taking...of finding all the ways in which I was falling short of my goals to prioritize my health by consistently eating well, exercising regularly, hydrating and getting adequate sleep and rest.
For those of us who are in service oriented fields, overworking can be insidious and feel justified. I just need to check email. I’m just going to finish up this one thing and then I’ll shut down for the day. How many times have you picked up the phone to check email and got sucked in for way more time than you’d planned?
Now, I can hear some of you saying, but I can’t control my clinic or call schedule. I have to work long hours in the hospital. I’m not talking about this type of work. I’m talking about occupying yourself with work to keep busy. Work that could wait until the next work day. You’ll know the difference by the way it feels.
For those of us who are overachievers (you know who you are), there is a drive that propels us to work hard. This in and of itself is not a bad thing. It’s often what helped us achieve our success. But, if we’e not careful, we can move into an extreme end of the range where we are working in such a way that is not sustainable and threatens our health and well-being.
Working is familiar. Those of us who are physicians have been trained to work long and grueling hours. This shift our perspective of what is “normal”. It makes it easier for us to work harder and longer after training ends. When life brings us challenges that we think are difficult, it generates emotions that are uncomfortable, that most of us don’t want to feel. So we default to work to stave off those thoughts and feelings. Staying busy protects us from our feelings...or so we think.
In the long term, we are suffering unnecessarily because we are not addressing these issues. In addition to overworking, we may numb out with substances, overeating, overspending and/or over drinking. These are all ways of avoiding negative emotion. One of the problems with this defense mechanism is that you can’t selectively numb your feelings. When you avoid the negative emotions you’re also not fully experiencing the range of positive emotions available. We are not truly experiencing the fullness of our lives.
So, how do we stop overworking?
Here are a few suggestions:
I have used each of the above strategies to help me on my own journey, in addition to coaching and therapy. I consider my coach and my therapist as a part of my inner circle success team.
The return on investment has been priceless. The photo above was taken from my recent trip to Kauai with my wife where we were both able to completely unplug from work and spend quality time with each other and ourselves.
I plan to write more on this topic of overworking as I’m finding through conversations with physicians and other professionals that this is a more common issue than I originally thought.
If you have a specific trigger or strategy that you’d like me to write about, please send me a personal note at firstname.lastname@example.org.
And if you are a physician who would like to be a part of a community talking about issues like this, I invite you to join The Physician Path Reimagined.
This week the CDC issued guidance on relaxing COVID-19 restrictions. Within my diverse social circles, the news has been both distressing and exciting.
As we prepare for the world to re-open, it’s understandable to feel ambivalent. Even for those who have strong opinions about the guidance on either end of the extreme, there is likely to be some doubt and insecurity that lurks beneath the surface generating more questions than answers. Is it safe to travel? If people who haven’t been vaccinated stop wearing masks will me and my loved ones be at greater risk? Will there be another surge? What about our children who don’t yet qualify to receive the vaccine?
There will be many more questions that arise in the coming weeks along with changes such as office re-openings, removal of mask requirements in public spaces and increased travel, just to name a few.
So how do we approach re-entry and the return to “normal”?
My good friends Maggie Reyes and Dr. Michelle Pearce had an enlightening conversation on this topic offering practical wisdom and sage advice.
You can listen to their conversation on iTunes, https://podcasts.apple.com/us/podcast/the-marriage-life-coach-podcast/id1497166414?i=1000521036558
Here are a few of my takeaways from their interview to help you navigate the transition:
Remember your power to choose
We always have an opportunity to choose what’s next...in our life, our relationships and our career. It’s easy to believe that we don’t have any say in how we live certain aspects of our life. When you say “I have to get up and go to work”, know that whether consciously or unconsciously you are making a decision to go to work on a day to day basis. It may be because you are inspired by the work that you do, you’re motivated by the compensation you receive or you fear the repercussions of not showing up. Regardless of your reasons, you get to choose. Understanding that simple, powerful truth can make all the difference in the world.
Intentionally create your “new normal”
For many of us, the pandemic provided an opportunity for us to slow down and pause the busyness that was our daily existence. As the world opens back up, you can be more deliberate about the life you want to create. In talking to family, friends and colleagues over the past year, many expressed how grateful they were for more quality time spent with family and a slower pace of life. There were also concerns about increased snacking and lack of consistent movement that resulted in unintentional weight gain as well as increased use of substances like alcohol and recreational drugs to manage increased anxiety and depressive symptoms. Take some time to reflect on the past year and determine what worked and what didn’t. Note anything you felt was missing. Then, be selective about what you keep and what you let go of.
As Dr. Pearce said, “We get to imagine, recreate and renegotiate what our lives are going to look like moving forward.” For me, I realized how much I was craving more space and time to simply unplug and give myself permission to rest mentally, emotionally and physically. At the start if this month, I set an intention to nurture all aspects of my being. I will allow this intention to guide my decisions over the coming months, saying no to things that will make it difficult for me to truly nurture myself and cultivate greater physical and emotional well-being.
Go at your own pace
You may or may not be feeling ready to return to life as we knew it. Honestly, I don’t think it’s possible for us to go ack to the way things were. The past year has been traumatic for many and as with any form of trauma, it takes time to heal. Only you will know what makes sense for you. Don’t dismiss that inner guidance. Our approach to life in a post-COVID-19 world will not look the same for everyone. Go at your own pace. Be patient with yourself and with your loved ones. During this time of tremendous change, practice kindness and compassion, for yourself and others and suspend judgment. We will come through this stronger. And we will heal.
It helps me to remember that I’m not in this alone. And to honor my feelings as they arise...taking each day as it comes and not leaping to far into the future.
I’m curious to know how you are feeling about the guidance and how you plan to navigate this transition. Let me know in the comments below or send me a personal message via email, email@example.com.
Happiness. It is what we want for our loved ones and for ourselves.
Unfortunately, it is something that is relegated to the future. There is an endless list of reasons why we decide we can’t be happy, yet.
The path to a medical degree is a long one. We invest time, energy and money to pursue our professional career. We’re told that once we achieve our goal and land the perfect job, then we can begin to live our life.
When I finish school (training), then I'll be happy.
When I get married, then I’ll be happy.
When I have a baby...when I pay off my debt...when I get a better job...when the kids leave home...when I retire.
There are several problems with this way of thinking. First, by the time we are nearing our goal, we are already looking towards the next goal. The result is shifting to a future focus without allowing for true celebration and acknowledgement of our current achievement. Second, if you hang your happiness on people, situations and things, you will be disappointed as they change (change is guaranteed over time). Happiness is the result of a decision you make in the present moment. To choose to see things in a way that generates happiness. And, to remember that we are not meant to be happy 100% of the time.
Notice if there's a pattern showing up in your life of deferring happiness. You don't have to wait for external circumstances to change to be happy.
Happiness is an inside job. It's a choice you make each and every day.
When you set an intention to be happy you will. When your happiness is dependent on life always going your way or others changing their behavior (something you don't control), it feels elusive. And it's often futile, like a dog chasing it's own tail. It will always be just out of your reach.
So, stop chasing happiness and decide to be happy where you are in this moment. But how?
What are your favorite go-to strategies to help you generate intrinsic happiness? Share in the comments below.
Lately I've been reading on the topic of career fulfillment. Many physicians and other high-achieving professionals reach out to me to talk about how unhappy they are at work. The pace has become unsustainable and they no longer feel the sense of satisfaction that they once did.
Considering a departure from a career that you've invested a significant amount of time, energy and money in, is a big decision and one not to be taken lightly.
It can be tempting to look for a "quick fix" or "easy escape" from an unsatisfying career; however, it's not a good long-term plan. Instead, take some time to genuinely consider whether a career transition is the best path forward for you at this stage of your life.
Making a decision from a place of clarity, confidence and courage is one that you will be less likely to regret.
So what do you do in the interim? Find ways to be happier at work in your current position.
Think it's impossible? Here are a few questions to consider. Your answers to these questions may just hold the keys to improving your sense of satisfaction in the short-term.
In what ways am I lying to myself about how I feel about work?
We can paint a pretty horrific picture when we share stories with others about our work. It's easier to list the things that lead to frustration. But, there is always another side. We overlook the moments of joy and pleasure in our day, allowing it to be overshadowed by the negative ones. Pause to consider whether the total negative moments of the day far outweigh the positive ones. In most cases, it does not. Start keeping a log of positive moments. You can do this by writing down 3 good things that occurred at the end of each day. At the end of each week, read over your list and notice if your feelings towards work begin to change.
How do I want to feel when I think about work?
Sundays can often generate feelings of dread as you prepare to start a new work week. What you don't realize is that the dread is being fueled by the thoughts you're thinking about work. "I have no control over my schedule". "I don't have enough time to manage everything that needs to be done". "I'm already behind before I even start the week". Although there may be some elements of truth to these statements, they will lead you to feel negatively about work before you even get there. Instead, begin to intentionally choose thoughts that lead to emotions you want to feel. Examples include "I make a difference", "I'm excited about who I will meet today", and "I'm grateful to have a job to wake up to today".
How can I simplify this task?
Fellow type As, let's be honest - we tend to overcomplicate and overanalyze things. In part, this skill helped us to achieve the success we currently have. And, it can sometimes backfire when it causes us increased stress and delays in decision-making.
Frustration can arise with many routine tasks that we have to perform for work. When you ask yourself how you can simplify a task, it puts your brain to work on looking for a solution. Another favorite question of mine that is related is "How can I make this easier?" When you sense those moments of irritation and stress over a challenging situation or task, ask yourself either question and notice whether it creates a bit more breathing space.
Regularly investing small amounts of time to reflect on the above questions may just help you to find a bit more satisfaction in your work as you decide whether to commit to your current career or find a new career path.
What strategies do you use to help you find greater happiness at work? Share in the comments below or send me a personal note, firstname.lastname@example.org.
The Physician Career Path Reimagined
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