Been There, Tried That, Learned This: Two Physicians’ Life-Care List for Colleagues



 

Linda Hawes Clever, MD, MACP1; Sharon Krejci Mowat, MD, FAAP2

Perm J 2020;24:20.027

https://doi.org/10.7812/TPP/20.027
E-pub: 09/08/2020

INTRODUCTION

We wish to provide philosophical foundations and practical “life-care” guidelines for women—and men—physicians so they and their families can lead whole, healthy lives, just as we hope for our patients. Frankly, when the opportunity came along to write this commentary, we grabbed it. Both of us have been fascinated by the world of health care and by the brave and vulnerable clinicians who inhabit it. We have spent years in that world, trying to figure out how our own care of patients could be more pleasant, efficient, and effective. At the same time, we have been deeply involved with our communities outside of medicine. We also feel strongly that, devoted as we are to our calling, we and those close to us should not suffer just because we practice the profession we love.

Everyone knows that our work and our lives interact. This mix may be silky smooth; it sometimes feels more like a rolling catastrophe, however. Women are at special risk for distress because of our many roles: professional, daughter, sister, family chief executive officer, friend, community volunteer, parent, and more. And what about ourselves?

There are no quick fixes, of course, to the sometimes baneful complexities of caring for patients as well as our home and personal lives plus community responsibilities. This is especially true now and whenever we see that our environment may be beyond our control. Nonetheless, if we want to have professional and personal fulfillment, we need to set actionable goals and move forward.

Before we started to write this commentary, we reflected on references,1 resources,2 conversations, and our own values and experience. We asked others for their suggestions. We wanted to stretch beyond “satisfaction.” We hope that our list of 14 suggestions both support and lift your life and that adopting some of them will change it for the better.

THE LIST

1. Put yourself first. Make time for yourself. It is not selfish to take care of yourself. It is self-preservation, so you can do what you want to do and what you need to do. Reflect on your hopes, dreams, circumstances, and resources. A leader we know hesitated to take on additional professional responsibilities even though her spouse and children supported her doing so. She finally realized that managing everything all the time was exhausting her. Work, home, and parenting were always on her mind no matter where she was. “It was the constant follow-up that was consuming all my thoughts.” Conversations led to adjustments. Her husband was happy to assume the responsibility of taking the children to the dentist, school transportation, and more. Suddenly, with just a couple of shifts, she had a smaller checklist to manage. That made a huge difference. It was a perfect example of RENEW’s “fatigue prescription”: “Awareness Reflection Conversation Plan and Act.”3

2. Take some big breaths. Breathe in for 4 counts, hold for 7, breathe out for 8 and do this 3 times. This will help settle your amygdala, that boiling area of your brain that manages other “A” words such as anxiety and anger. You can then focus on your personal values. Values that people list often include, for example, honesty, kindness, excellence, hard work, faith, and family. Reconnecting with your own values will help you set priorities about ways to spend your time. That is essential, because all you have is time, and time is love.

3. Know that you are not alone. Seek out good company to go beyond the “BMW” (Bitch, Moan, and Whine) syndrome so you can develop strategies and solutions. Seek out like-minded friends to lift and inspire you. It takes allies to contend with the gender bias, microaggressions, and sexual harassment that still affect us all as female physicians. Being a female physician can bring daily stresses: patients wanting to see the “doctor” when you are standing right there; others (men) taking credit for your (women’s) ideas; not reaching for a new opportunity because you think you have a lack of experience or skills. Working together with your allies, you can a make a positive difference.

4. Get help! Whether you need counseling, child care, or a hand with an older parent or housekeeping, spend some money and get that help. Your time is better spent with family, your partner, or yourself instead of doing laundry, unless laundry gives you true, boundless joy, and not just the feeling that your mother would approve.

5. Meet your leaders. Get your leader’s ear by going beyond complaints. Have some ideas about ways to solve challenges. Be a partner in improving policies and workflows. Follow your passion and let your leaders help and mentor you. Don’t be afraid to network with people. It is important for others to know what interests you have and where your passion lies.

6. Do your own checkup.4 Women can be woefully neglectful when it comes to our own health. Have you had your screening tests? Your annual flu shots? And shingles shots, if you’re the right age? In addition to these “body” checks, do a “sense of humor” check (only if you have—or had—one, of course). A sense of humor can get you through a great deal. Viktor Frankl, a psychiatrist who survived the Holocaust when his whole family was killed, wrote Man’s Search for Meaning.5 He led “sense of humor” workshops in the death camps and observed that if you can laugh at something, it changes everything. It lifts you out of the muck. The loss of a sense of humor means the loss of a major defense mechanism and is a sign of trouble. Pay attention to the results of your entire checkup, including your laughs, and follow up on your findings (see item 4).

7. Attitude counts and shows. Viktor Frankl5 also pointed out that your attitude is a choice. Indeed, he said that choosing your attitude is the last human freedom. That means you can choose to be a victim—or the opposite. You can choose to approach family and work with compassion, empathy, and curiosity. This puts you in a forward-moving state and emphasizes what you can contribute and grow, rather than shrink, shrivel, and resent.

8. Do something you love. One always busy, hard-pressing woman physician said her husband and child pointed out that she never did anything fun. She said, “My husband has music; my daughter has theater. What did I do? I really had to explore what was fun for me. I am still exploring, but I have done horseback riding, thus making exercising more fun vs a chore. I also added nights out with friends and made it a priority [before COVID-19’s shelter in place]. Just the process made me generally happier and not so resentful.” If you love being with others, what might you do if you cannot get together in person? Try a video chat platform such as Skype, FaceTime, or Zoom. Read a book (not work-related) and chat online to review it. Sort pictures and make a family album once you’ve joined forces to figure out who’s who. Get out into nature. When you can bring family and friends along, laughter, activity, and community come together for a memorable experience.

9. Think appreciative inquiry.6 This approach to building an effective workplace can also be used at home. It posits that if an organization, clinic, or classroom is doing well, that means at least some procedures, equipment, and people must be doing well. Look for what is succeeding and then emphasize, copy, and expand them. This is not intuitive since our reptilian-like, negatively biased brains usually dwell only on what is wrong or deficient. We, therefore, actually need to campaign against our dark side to become continuously improving beings. We can move ahead—as long as we work together, accentuate the positive, and do not get stuck trying to make every outcome perfect.

10. What’s good for physicians and their families is good for patients and their families and vice versa. If you do something smart and healthy, this will carry over to your patients. If your patients are thriving, so can you. Being smart and healthy may mean being organized at work and at home. Try different methods—apps, paper calendar books, alarm clocks, and so on—and use what works for you. Another good practice is decluttering. Decluttering at home and work can declutter your mind and make you more effective and fulfilled wherever you are.

11. Keep on learning. Do this in your professional and personal lives. What continuing medical education course will you take? What new friend or cookie recipe will you make? What will you do to confront professional, personal, and civic challenges, such as bias? Engage in work, life, relationships, and continual learning to enhance your brain’s plasticity and vitality so it doesn’t dwell on gloom and offenses. More importantly, being involved and engaged will reinvigorate your purpose in your career and your life.

12. Nurses and other health care professionals can be your new best friends. These clinicians may know more about particular patients than you do, because they usually spend more time with them. They are teachers, advocates, and care coordinators. They may know techniques that can supplement yours, such as massage, acupuncture, aromatherapy. We all know that taking good care of patients—and ourselves—is a team game, not solitaire.

13. Be professional. We all profess—take an oath—to act appropriately. Part of this means that we must take care of each other as well as ourselves. That requires being aware, noticing when trouble looms, and then intervening. We are on the front lines of primum non nocere for ourselves, our colleagues, our families, patients, and more.

14. Know that you do have the answers. Developing the answers and solutions will take pausing, looking around, finding allies, listening and learning, holding conversations (not just texting and posting), experimenting (remember that having no errors means you didn’t try), polishing, and then, yes, celebrating success.

CONCLUSION

As you consider these life-care guidelines, consider your own situation. What would you add to the list? What would you remove? What are your values and your dear ones’ values? How will you define success? What will you do that is new, renewing, refreshing? What will you do first? What will you do next? How will you reward yourself? You do deserve a reward, you know. The best reward is your own good health. You have chosen a noble profession, and you must care for yourself so you can be there for your patients and communities, as well as for the family and friends about whom you also care.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Acknowledgments

The authors thank Eliza Lo Chin, MD, MPH, Executive Director of the American Women’s Medical Association for her ideas, review, and encouragement.

Kathleen Louden, ELS, of Louden Health Communications performed a primary copyedit.

Author Affiliations

1Department of Medicine, California Pacific Medical Center, San Francisco, CA

2Department of Pediatric Hospital Medicine and Physician in Chief, The Permanente Medical Group, Diablo Service Area, Kaiser Permanente Medical Center, Antioch, CA

Corresponding Author

Linda Hawes Clever, MD, MACP ()

Author Contributions

Linda Hawes Clever, MD, MACP, and Sharon Krejci Mowat, MD, FAAP, participated in the drafting and submission of the final manuscript. Both authors have given final approval to the manuscript.

References
1. Templeton K, Bernstein CA, Sukhera J, et al. Gender-based differences in burnout issues facing women physicians [Internet]. NAM Perspectives 2019 May 30. DOI: https://doi.org/10.31478/201905a
2. National Academy of Medicine. National Academy of Medicine clinician resilience resources [Internet]. Washington, DC; National Academy of Medicine [cited 2020 Jan 29]. Available from: https://nam.edu/search-results/?keywords=NAM+Action+Collaborative+on+Clinician+Well-Being+and+Resilience&searchpage=0
3. Clever LH. The fatigue prescription: Four steps to renewing your energy, health and life. Berkeley, CA: Viva Editions; 2010:65-81.
4. Renew-O-Meter [Internet]. Portola Valley, CA: RENEW [cited 2020 Jul 22]. Available from: https://renewnow.org/r-o-m/
5. Frankl VE. Man’s search for meaning. New York, NY: Simon & Schuster; 1984.
6. Cooperrider DL Jr, Sorenson PF, Yaeger TF, Whitney D, eds. Appreciative inquiry: Foundations in positive organization development. Chicago, IL: Stipes Publishing; 2005.

Keywords: guide, health, physician, women

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