By: Sonja Van Hala, MD, MPH, FAAFP
I went to a great yoga class today. The instructor spoke of finding the balance between effort and lightness. We often push too hard, and instead of riding the current, we force ourselves out of it; by lightening a little, we can find our way back into the current and feel the ease and power co-exist harmoniously. This metaphor is apt in medicine.
Pushing hard is familiar territory in becoming and being a physician: pushing through premed courses, then medical school, residency, fellowship, early career years . . . pushing, pushing, pushing. Being a physician is anything but easy; but what about that ease, what about that lightness?
We all know the ingredients of a medical career: long hours, high stakes, and demands of all sorts. During my formative years in medical training, mostly I saw my peers and supervisors steeped in work and their resultant exhaustion. Occasionally, I’d see what was left in the wake: marked unhappiness, regret, substance abuse, medical error, poor health, dissolved marriages. I haven’t yet experienced suicide by a colleague, but I know well enough it has flirted around. If you look at the statistics, a career in medicine is a dangerous one.[i]
What was less visible during these years was how my peers managed to keep themselves well. Why was this opaque? Perhaps it’s because our social norms in medicine are warped. We give ample permission to expound on our clinical and academic accomplishments, and we reinforce tendencies of compulsion, perfectionism, and overachievement. What hasn’t had much space in medicine, ironically, is wellness. If we are doing things outside of work that keep us well, we aren’t sharing them, at least, not well enough to teach each other how to do things differently.
What would it look like if we were intentional about cultivating wellness in ourselves and our work environment? What would it look like if we were transparent about it?
In a blog by Vivian Lee, MD, PhD, MBA Senior Vice President for Health Sciences and Dean of the University of Utah School of Medicine, she described how she prepares casseroles over the weekend for the upcoming week’s family meals. It seems an obvious solution, yet I hadn’t tried it. Once I did, the weeknights were easier and I had more time to connect with my kids. A little bit of ease.
How do we share our realities and our strategies? A friend of mine recalls an ICU attending with whom she worked as a resident, who would “go get a haircut” at lunch. He quietly revealed that he played paddleball during those times to stay sane and take care of himself. Over a decade later, my friend still remembers his example. Some lightness.
At a residency retreat, I described the challenge of running (terribly) behind in clinic as a trade-off for my talkative practice style that brings me joy. A resident responded with both amazement and relief that her residency director (me) ran behind, a struggle she, too, often had. What she was really saying, though, was: “You’re imperfect too?” Yes. Yes, I am. Isn’t that liberating?
A resident shared with her peers that she had agonized about leaving her newborn after maternity-leave to return to residency. Her husband sat her down and explained her options: she could either quit residency and stay home with her baby or return to residency to complete her training. She knew that she would finish her training, and in her words, “Since then, I haven’t felt sorry for myself.” A reframe and shift in perspective brought contentment.
By recognizing our choices, we have the power to change our attitude or the conditions. When our clinical practice transitioned to extended hours, I struggled with adding a late night of evening clinic. I found acceptance by protecting that morning for play, which usually means tennis and a lot of laughter. Now I look forward to that day of the week.
What about sharing how we falter, how we manage, how we succeed, how we prioritize our activities, how we care for ourselves?
I love seeing my colleagues come to early faculty meetings in their biking clothes or with swim-goggle marks on their face. I so appreciate when my partners cover a few hours of my call so I can attend my child’s school performance. I aim to do the same. I appreciate these kind of cultural norms.
In discussing a faculty mentorship program, my colleague suggested that wellness is not traditionally included in faculty mentorship. This is true. By design, we have missed many opportunities to share what works to stay healthy, engaged, and productive in our careers. Let’s change that design.
To transform our medical culture into a culture of wellness, we must examine our norms. Amazingly, the power to change our norms rests with you and me. Let’s change our paradigm to one of transparency in wellness.
[i] McClafferty H, Brown O. Physician Health and Wellness. Pediatrics 2014;134:830-835
Sonja Van Hala, MD, MPH, FAAFP is the Program Director and an Associate Professor with the University of Utah Family Medicine Residency Program in the School of Medicine