The Physician Philosopher Podcast
TPP #60: The Importance of Physician Self-Care
Hey everyone, I know it has been several weeks since you last heard from me.
In that time, a lot has happened. As you know, I took some time to write a book on empowering burned-out physicians. I tackle tough topics in medicine, including how we ever ended up in this place where so many physicians are burned out and exactly what is leading to the problem in the first place. I’ve developed a framework to help departments and institutions think through their decisions as well as to empower individual doctors to realize why they feel the way they do.
At this point, the book is at just under 70,000 words. I’ve finished my first draft and first edit. Now, I need to comb through it a few more times until I am sick of it to know that it is where it need to be before handing it over to a professional editor. For reference, my first book The Physician Philosopher’s Guide to Personal Finance was just under 50,000 words and was a pretty quick read for most coming in around 200 pages. So, this book will probably be closer to 250 pages.
But I also want to be transparent, because I think it is important to de-stigmatize certain things in healthcare. I didn’t take a break just for the book. I also took a break because I struggle with depression and my depression – or the Black Dog as Winston Churchill called it – started rearing its ugly head again. Unfortunately, I have a pretty troubling family history with depression. So, I try to practice what I preach and I realized that I couldn’t help take care of other people if I didn’t first take care of myself. I needed a break, and so I took one.
After a couple of psychiatry visits for the first time in my life and some soul-searching, my mental health is in a much better place. While some of the work that needed to be done for me involved organic etiology in the form of depression and anxiety, there has also been a tremendous amount of growth in my thought work as I’ve written my book, read a bunch of other books, and worked through the bigger reasons behind my struggles enjoying the journey.
So, let’s just go straight to one of those topics. Right to my soapbox. Ready? Here it is – I am sick and tired of doctors being sick and tired. In fact, doctors historically haven’t even been allowed to be sick. Well, until the COVID-19 pandemic when all of a sudden when a physician wasn’t feeling well, they were encouraged to stay home.
Think about that, it took a pandemic for doctors to be allowed to admit when they were sick. That sort of thinking is exactly why so many physicians are burned out and looking to make a change.
We are asked to put everyone and everything ahead of our own self-interests. Even when it comes to our physical and mental health. And I think that’s not okay. Truthfully, it isn’t sustainable either. Many doctors are sick and tired of being sick and tired.
A part of the traditional definition of burnout is emotional exhaustion. This sort of exhaustion is certainly exacerbated when physicians do not have the opportunity to take care of themselves. In fact, self-care and self-compassion are often some of the first things to go in the burned-out doctors we coach inside the Alpha Coaching Experience, which will open up in February for the first of two times in 2022. Make sure to join the ACE waitlist, if you are interested in learning more about that by visiting thephysicianphilosopher.com/waitlist
Self Care and Self Compassion
Let’s look at self-care and self-compassion of these in turn. To me, self-care is defined as performing any activity that is good for your health or well-being in either the short or long term.
Self-care tasks include things like:
- Sleep hygiene
- Meditating, or spiritual practices like reading scripture
- Having the time to eat well
- Date nights with your spouse (or partner)
While these things are some of the most important tasks in life. They are also often the first things to go when doctors get busy. Particularly sleep, eating well, and exercise.
Yet, we know all of these things impact us on both a short and long-term basis. And they aren’t the only things to go.
In fact, I know doctors who haven’t taken a week of vacation in more than a year. This is often due to their work burden and the feeling that they will lose money when they aren’t working. Most of these doctors are in a production-based practice.
One reason that I see doctors skip self-care tasks is that they convince themselves that they are too busy. There aren’t enough hours in the day. Yet, they rarely consider how long their life will be that way. It isn’t like doctors who have figured out how to fit in the stuff that really matters have more time in the day than the rest of us.
We have to be honest with ourselves about the problem, too. Is life really going to slow down at some point in the next 5 or 10 years? Or are you just telling yourself that will be the case?
It is the never-ending argument that “I will take time to do x, y, or z” when things slow down a bit. This was actually what I was telling myself about writing my next book. I’d write it when I created the time, but the amount of time it takes to write your own book, read many others, and do the research necessary to write the book takes a lot of time. If I didn’t slow the podcasts down where my creative efforts normally go, I simply wouldn’t have the time or mental bandwidth to write the book that had been in my head for the last 12 months.
Perhaps yours sounds different. Maybe you tell yourself that you will have more time when the kids start school. Or finish school. Or that things will get better someday when you become a partner or get that promotion. Maybe the most common thing is the idea that someday everything will be better when you can go part-time, change jobs, or retire altogether from medicine.
This is what is sometimes called suffering from Someday Syndrome. “Someday” I will take the time to exercise more, eat better, or pray. It is the same line of logic people use when they say things like “I’ll sleep when I’m dead.”
We are constantly prioritizing putting out the fires in front of us instead of prioritizing the things that will provide the best short and long-term benefits to our health and well-being.
And this brings us to the second important aspect of self-care – self-compassion. Some have argued that self-compassion may even be the antidote to burnout for many physicians.
The word compassion is composed of two roots – pati which means to suffer and com which means with. This is why compassion is often defined as meaning “to suffer with”. Interestingly, compassion is usually considered an outward projection toward other people. In other words, to suffer with someone else. However, that is not the only way that compassion can be utilized. It can also be directed inwardly. This iteration is called self-compassion.
Unfortunately, self-compassion is not something we are taught in medical school. Kristen Neff – a psychologist, researcher, and author of Self-Compassion – states that self-compassion is composed of three parts. This includes self-kindness, common humanity, and mindfulness.
According to Neff, the first element in self-compassion is self-kindness, or the idea of being warm to ourselves. One way to think of this is to look at yourself in an objective third-person kind of way. For example, you might look at your situation and what has just happened and find yourself being self-critical.
Being warm or kind to yourself is a skill that can be employed in a variety of situations. For example, when you drank one more beer than you “should” after a tough day. Or when you raise your voice at your kids after the thirteenth time they ask you to buy them a phone. Clearly a couple of situations I am very familiar with at this time in my life.
How can you put the skill of being kind to yourself into action? By asking a simple question. If someone else I knew was going through the same thing that I just went through, what would I say to them? What would I say to a friend who had two beers instead of one after a bad day at work? I’d tell them that we all need to take a load off sometimes. I’m just as guilty as the next guy.
What would I tell them when they raised their voice after having to say the same thing over and over? That they’re a human having a human moment, and that their kids need to see them fail so that they can also see what repentance, forgiveness, and reconciliation look like after we have the bad-dad (or mom) moments in life.
Answering this question for others made it much easier for me to have this compassion toward myself. It helps to silence that perfectionistic inner critical voice that often drowns out all the other noises. This first part of self-compassion is unfortunately rare in the physician world, and it is one of the biggest benefits of group coaching for doctors as they learn how to have self-compassion as others show them the compassion that they deserve through a group dynamic.
The second part of compassion, Neff points out, is captured in our common humanity. In other words, it is the idea that we are human and “To be human is to err”.
I often capture this sentiment with my residents after they make a mistake and I see they are beating themselves up about it. I turn to them and sarcastically say, “You know, I’ve never made a mistake in my life.” After they laugh, I usually follow that up with, “You know what you can learn from me? If an imperfect guy like me can be a good anesthesiologist, then so can you. Keep your head up. This is how we learn.”
Speaking this way is a lethal blow to our perfectionist tendencies. It is necessary to realize that we all make mistakes, each and every day. We have survived 100% of our bad days, and – if we are being honest – those are the days that we learn the most. So, when we share in the shared consciousness and experience of being human, it turns out that we can have a little more self-compassion when we have a human moment, including when we fail.
The third part is just as important, and just as lacking from the physician community at large. It is the idea of being mindful of when we are having a hard time. When coaching clients, we call this process “holding space” for someone. It is the process of serving as a non-judgmental mirror for someone else. In this space, we can find that sometimes life is hard.
In practice, this might look like admitting that things suck sometimes. This is not about negating the feeling or trying to escape from it. Instead, it gives us the ability to allow it and to treat ourselves with the same kind of empathy we would give someone else. Think about it. If when told by a friend that they missed a diagnosis on a challenging patient, would you look at them and say, “you must be a terrible physician!” Of course not. Instead, many of us provide a much more mindful comment like, “Man, that sucks man. I’ve totally had something like that happen before. Keep your head up.”
Self-compassion does not come easily to many physicians. Fortunately, like any other skill, self-compassion is something that we can hone as we practice its use. In the same way, you learned how to perform a physical exam or operate, you can learn how to wield self-compassion with consistent and steady use. This isn’t the only work that we have, though.
So, wherever you are in your journey… whether you are doing great or you are struggling… are you practicing self-care and self-compassion? Are you taking care of yourself so that you can take the best care of others?
Or are you suffering from Someday Syndrome when it comes to self-care and practicing perfectionism when it comes to self-compassion?
Take a note from my book, and take a break. You are worth it. Don’t wait to get the help you need or to have the self-compassion that you deserve.
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