Self-Care for Doctors: Your ‘Why’ is the Key
If you’re like me — though I’ve devoted my life to it — your eyes glaze over when you read the little hyphenated phrase, self-care. Meaning everything from a bubble bath to psychotherapy, or a vacation to the Bahamas, it started in the yoga/therapy/spa community and has naturally permeated the medical world as an antidote to burnout which, by many accounts, is at an all-time high.
There’s a plethora of articles, books, conferences and webinars devoted to the subject of self-care and a growing industry aimed at helping physicians with this worthy goal.
Self-help can mean everything. Or nothing. Or it can just completely off the mark, especially when it comes to physicians.
Holding a “wellness” weekend for physicians and requiring that they participate on their time off, for example, is oxymoronic at best. Indeed, much of the self-care aimed at the medical community is what many doctors call “help that’s not helpful.”
Most agree that they need help, but what does that look like? What is the help that is helpful?
First, you have to identify the problem.
We can point to the EMR, along with declining patient and administrative respect. Internally, many point to poor stress coping skills. Burnout-out is the result of a mismatch between work stressors and personal resiliency, according to Thom Mayer, MD, Medical Director, NFL Players Association and author of Battling Healthcare Burnout: Learning to Love the Job You Have, While Creating the Job You Love.
In other words, if work is stressful and resiliency is poor, the result will be deep discontent, burnout, or worse. There is much written and studied on both ends of this burnout formula — from teaching resiliency skills like meditation and yoga to changing the structure that bears down on physicians, choking out the very reason most of you pursued medicine in the first place: patient care.
Yet, there is a third place to look when it comes to physician malaise: Life purpose. The Big Why.
Why are you doing what you’re doing? And what exactly is the goal? Is it to “fix” patients at all costs — even if that’s not what they want? Or, is it to heal? And what does healing or fixing look like when the patient decides to throw in the towel? Not that long ago, medicine had few tools; the best physicians could offer was empathic listening, holding the patient’s hand. Now we have more treatments and cures than ever, which may in fact have physicians relying more on their “tools” and less on the “art”.
This patient-centered approach fundamentally changes how a physician views their vow to practice. At lease this is true for Robert Ellis, PhD and DO, Physician Director, Integrative Oncology Program at Northwest Permanente. “Do no harm” is a misreading of the ethics, says Ellis, who is also an assistant clinical professor at Washington State School of Medicine. “I’m always doing harm. Medicine is to do good. If you can’t do good, at least do no harm. Who’s good is it? It’s the patient’s good. Not my good. The patient is the only expert in the room. I have the knowledge and biases and technology and a crazy way of talking. It’s diagnosing, finding out if you should intervene or not — usually not — and then you grab your tool box and figure out what to use in that box.”
“Just because we can use a tool, doesn’t mean we should,” says Robert Ellis, PhD and DO, Physician Director, Integrative Oncology Program at Northwest Permanente. “What does the patient want?” Many physicians are turning to their tool box before they see the human being in front of them, says Ellis, trying to make the patient fit the cure. This “fixer” mentality is dangerously close to the ego. This unhappy pairing of the focus on fixing and the ego, becomes painfully clear when the patient says No. While many physicians will send that patient away in the case of refusing protocol, Ellis sees it differently. When the patient says No to chemo or radiation, for example, that’s when Ellis’ highest calling to medicine goes into action. “I didn’t profess to shrink tumors or diagnose and prevent cancer,” he says. “I only professed to enter into the suffering of people afflicted with illness and disease, and to relieve the pain and suffering of the human condition. And to use science and technology and my clinical wisdom as an instrument in that healing. That’s the practice of medicine.”
What does this have to do with “self-care” for physicians?
“If I am an instrument for the patient’s healing, then I’m going to go home and take care of this instrument. I’m going to take care of this body. I’m going to rest this body. I’m going to feed this body.” In other words, when physicians see themselves as instruments of healing, the meaning of self-care becomes much deeper. Self-care is about taking care of your instrument — your body, spirit and mind’ it’s about continuous self-discovery and, of course, self-care. This is what medical school should teach, says Ellis: How to take care of your instrument, because you are an instrument of divine healing. How can doctors be expected to sit with another’s pain and suffering, if they have not attended to their own each and every day as though their lives depended on it?
It’s important to add here that some specialties are better suited to this idea of entering into a patient’s suffering, while others, like surgery, are truly more about fixing. Even for the “fixing” specialties, what does your work look like when fixing is no longer an option? What does it look like to enter into an “active empathic engagement”, when your tools have reached their limits?
When you are an instrument for healing, taking care of the instrument — yourself — is no longer a nice-to-have, but the only way you can fully practice medicine, regardless of the limitations and stress the system exerts upon you. Through this lens of healing rather than only fixing, the calling is not only enter into the suffering of others, but also learning to leave it each day, to come home to oneself. This requires that you attend to your own feelings and emotions, that you in some way learn to enter into your own suffering, too. When you know yourself, know your calling, self-care has deep and essential meaning. This is the path to peace, at work and beyond.