As I start the new year, I decided that instead of reviewing an article, I would begin by sharing some personal thoughts.
It’s Harder Than Ever to Take a Vacation
When I was in high school, I often had some trouble getting to sleep. I had so many ideas rushing through my head about what I wanted to do and what I needed to do the next day, the next week, the next month and so on. One trick I learned was to teach myself to write down these thoughts before I went to bed and to pick them up when I woke up. So when I went to bed, I knew I would not forget all these urgent ideas. After a while I realized that I really did not need to write everything down, but went through the same mental process of putting the ideas aside until the morning. This helped a great deal and I’ve been a good sleeper for a long time. In fact, when I started residency, at first I would sleep through pager alarms.
In medical school, I learned about the idea of dissociation. For me, at that time, this meant focusing on a clinical problem without worrying a lot about the personal aspects of how this problem affected the individual. I think I had a carefree attitude and did not bring problems home with me.
Over time, it became harder to separate the clinical work from the emotional aspects. While empathy can be a wonderful attribute, when one truly understands the suffering that others endure, it is hard not to take that home with you. Despite this, I find that I don’t discuss clinical issues at home. While there are patient privacy issues to consider, the biggest limiting factor is that talking about difficult situations doesn’t seem to help. So, when I get home, I either focus on these issues on a solitary basis or focus on something else entirely (eg. journals, books, exercise, etc).
What I lament these days is how with an interconnected world it is harder and harder to dissociate. Weekends are not long enough. If an issue pops up, it is so easy to reach out to providers like me with direct emails from families, texts from colleagues, or by other methods.
It used to be that when I went out of town, I was definitely on vacation and I would worry if a complicated patient ran into a problem; of course, the reason I worried about it was because it often seemed to happen. Then I would hope that my absence did not adversely impact the patient’s care. Even within a group of 14 highly competent colleagues who are eager to cover, it still seems like it takes a few days to really relax when I’m on vacation. Since I am most familiar with the patients that I have seen, there is always the temptation to check on emails and access the clinical portal (computer records). Even if I don’t check, having a smartphone almost always, except perhaps when out of the country, guarantees unwanted intrusions. That 7:30 am call when I was planning on sleeping in. Crap! I should have gone into the settings to change the blockout times.
Even if I don’t check any electronic devices, my thoughts periodically wander off thinking about the patients who were having some trouble and hoping they are OK. This is perhaps the biggest intrusion of all. Perhaps, I need to go back to the tricks that worked for me in high school, though I wonder if that could really still work. Maybe the biggest problem is that it’s harder to take a carefree vacation because I am much less of a carefree person.
These issues are not unique to physicians/healthcare providers. Anyone else want to comment on whether they have been affected too?
Jay, congratulations on 20 years of doctoring!
I really appreciated reading this blog entry. There were two elements you brought up that prompted me to respond. The first: it deals with the fact that we are all changing over time. Who we are now was not who we were when we started medicine. Of course, this change is not unique to physicians, but I think we experience daily encounters with people – people who are often suffering or desperately trying to find better health – that can really cause accelerated burnout or creeping cynicism (because let’s face it, caring is tiring!) if doctoring is all we hold on to day in and day out. The solution is obvious but harder to achieve: one’s core identity can’t be “being a doctor.” The second: it deals with the fact that good doctoring through intellectual and emotional involvement in other people’s lives everyday can have collateral effects on our own families. This past week, for the holidays, I took some time to be with my family and out-of-town guests. No matter how hard I tried, I had to respond to at least a few emails, text pages, or phone calls almost every day. I guess I could’ve blocked it all out, but continuity-of-care would’ve been compromised or the personalized plan for each patient might’ve been missed. The point is that this takes away from the undivided attention my family deserves. I am trying to find that delicate balance between being available for my patients and leaving patient care before entering my front door. With that, I’m open to learning from others further along in the journey.
KT Park says: “I am trying to find that delicate balance between being available for my patients and leaving patient care before entering my front door. With that, I’m open to learning from others further along in the journey.” Could not have said that better. Unfortunately, success or failure at this task contributes to doctor burn-out. I have never seen so many docs struggling with very serious burnout. BTW, Jay, your picture is someplace I want to be in January!
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