February 2001 Bulletin

It’s time for a tune-up

Get it all together at home and in your practice

By Sandra Lee Breisch

Now that you’ve forgotten all your New Year’s resolutions, it’s time to really make a change in your life. Balance your home life and work, learn how to avoid debilitating stress, restore your enthusiasm for practicing medicine.

Balance your life

Do you push yourself to the outer limits? Work harder and longer hours to achieve efficiency by skipping lunch, social functions and exercise? Never feel relaxed? Does your family ask you to spend time with them, but you feel pressured to work instead? And are you constantly multitasking to get everything possible done?

If so, you’ve probably lost some balance in your home life due to a work addiction that is heavily reinforced by clinical culture.

So says Margaret A. Chesney, PhD, professor of medicine, University of California, San Francisco, and a nationally recognized expert in behavioral medicine with a focus on interventions for prevention and coping with chronic disease.

"This kind of frenetic pace to life in the clinic is like an addiction, if you will," explains Chesney. "To physicians, multitasking means ‘don’t waste a second.’ They work harder to do as well or better and this reinforces polyphasic activities. And what happens is a physician’s daily work activities get reinforced in an immediate way by patients’ and colleagues’ feedback that says, ‘this is really important,’ and ‘you’re doing the right thing.’ It’s really a cultural support network. And physicians attribute their success to this developed lifestyle by pushing the limits, taking minimum or no vacations.

"They feel, ‘I’m really going to be a failure if I don’t get everything done.’ Physicians who exhibit this stress-proned behavior take pride in it. And they don’t tend to respond to what their body needs, often skipping meals, burning the candle at both ends, drinking coffee to wake up or wine to calm down."

But it is possible to achieve balance in your home life and work. But this means you have to "row against the tide," says Chesney. "It’s something physicians really, really struggle with.

"One way to retune workaholic behavior is to give yourself a wake-up call. We’ve all had wake-up calls in our lives where we’ve had deaths in our family, or when a loved one is very ill. Suddenly, we remember what is important. It is the people in our lives.

"We all know this but think that we can give to those people as soon as the work is done. The problem or fallacy in this logic is that with clinical work, it is never really done. There are always more charts, more calls and more articles to catch up on than there is time. Someone pulls up the colored shades and you see the sunlight. Then, you know it’s a wake-up call when you suddenly drop everything because you’re reminded about who and what’s really important in your life such as your family and friends."

Chesney provides some helpful suggestions:

It’s also important to rid yourself of words or thoughts that can put your home life on the backburner. Strike: "We’ll be able to do that just as soon as I get past this." Why? "Because that becomes a mantra and you never get there," says Chesney.

Remember, there is a point where you cannot push efficiency anymore. "A lot of us have reached that point because it leads to exhibiting anger, outbursts or acts of incivility," she says. "When people see this behavior they’re hoping you’ll have some time to breathe and crash. And you really need it before you get a real wake-up call."

Beat stress

On a daily basis, physicians experience all kinds of stress–some good, some bad.

"Stress is not always a bad thing," says Shari Kirkland, PhD, clinical psychologist at Kaiser Permanente’s Union City medical offices in Hayward, Calif. "There’s good stress that can enhance a physician’s performance and increase concentration levels to reach a peak level of efficiency."

But the problem occurs when stress goes beyond optimal levels.

"That’s when we see a negative impact from stress such as anxiety attacks or panic," explains Kirkland. "Sometimes these attacks occur when we least expect it. For instance, they might occur when we’re someplace where we can’t move–when we’re in traffic or standing in line and we know we’re going against a time crunch. And basically at that point, our minds are just racing ahead of our bodies."

But if you practice some quick fixes and long-term stress management techniques, Kirkland says you hopefully won’t surpass optimal levels of stress. They include:

"Although these quick fixes are good–they’re superficial–meaning that it’s really a temporary Band-Aid," stresses Kirkland. "So beyond these relaxation techniques, there are some longer-term methods that people can do to help with stress."

"Change the way you talk to yourself," recommends Kirkland. "It’s a huge issue on how negative thoughts effect our stress levels. If we constantly say, ‘it’s not fair, it’s not supposed to be this way,’ if we’re making irrational demands about circumstances that we cannot control, then we’re going to feel less empowered. And our stress levels are going to increase."

Get motivated

Fed-up with practicing medicine? Can’t find meaning in your work anymore?

If so, you just might be suffering from emotional exhaustion and don’t even know it.

"Most physicians do not even know when they get to that point," says Rachel Naomi Remen, MD, a pioneer in training physicians in relationship-centered care who has counseled people with cancer and their families for 20 years. She is also cofounder and medical director of the Commonweal Cancer Help Program in Bolinas, Calif. and clinical professor of family and community medicine at the University of California at San Francisco.

"I’ve worked with many physicians at the edge of burnout who could not recover because they could not find the meaning in their work," says Dr. Remen, "Recovering the meaning in medicine is so important for doctors because it enables us to maintain our commitment to the work. It’s difficult to stay motivated when your work has lost its meaning for you. Physicians need to draw upon their sense of meaning for strength."

Dr. Remen has organized a nationwide self-help movement among physicians with the goal of helping other physicians recover from emotional exhaustion and regain a sense of the meaning of their work. This simple approach which physicians themselves can set-up involves meeting in a small group of peers once a month to share their stories about a chosen topic.

Physicians choose topics relevant to the Hippocratic values of medicine, the daily experience of medical work. Typical topics are healing, loss, integrity, suffering, covenant, compassion and mystery. "The meaning of our work is in our stories," Dr. Remen says. Physicians tell stories from their personal or professional life or from the world literature, or they may bring a poem, an exercise or a piece of art that helps enable the group to explore the evening’s topic in greater depth.

"Most of us lead very meaningful lives," she says. "Finding meaning is about seeing the familiar with new eyes; sharing stories with other physicians has a powerful effect on us. We get to talk about things that turn out to be very important to us."

Matthew B. Zwerling, MD, a Santa Rosa, Calif. orthopaedic surgeon who has organized one of these doctor’s story-telling groups, attests to the importance in taking this journey to discover meaning in his life.

"Some time ago, I became aware that I had lost my enthusiasm for my personal and professional life," he shares. "I was struggling in my practice and family life. I started exploring who I really was–not who my father wanted me to be, not who I thought my wife wanted me to be or who my peers wanted me to be.  This all came as a rude awakening. And I started taking off my masks."

Today, Dr. Zwerling says he "feels heard and alive in a way" he’s never felt before. "Because I was supported by other physicians in the group, I was able to share similar experiences, beliefs and feelings that physicians rarely talk about to each other," he shares.


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