How We Need to Define Self-Care in Medicine
In the Medical world, caring for ourself is a non-existent topic
“Can someone tell us what Self-Care means and how we can improve it for our residents?” -NEJM, Chief Resident Physician Discussion
For most people this is simple. Take care of your needs as they arise. Sleep, eat naturally high nutrient-dense foods, meditate, connect with yourself, connect with loved ones.
You are your #1 and this world’s biggest asset.
In the athletic and business world, this is a celebrated fact. Those who take care of themselves are peak performers. They’re more creative, innovative, and treat their customers well. Companies pay big bucks for peak performers.
The first step to peak performance is understanding how to care for “Self”.
In the Medical world, caring for Self is not talked about, thought about, or taught about. It is a non-existent topic.
Most of us get through medical school by sheer exhaustive work. We “will” our way through hours and hours of studying to get that A, pass the USMLE, and the Boards. We push through many sleepless nights in residency and we’re celebrated for it.
Medicine functions in tradition, hierarchy, and apprenticeship. Some senior faculty and attendings were not taught Self-Care. They don’t know how to a role model or teach it. Some can’t imagine breaking away from old habits and traditions.
The early-career physicians know that this is an issue but they don’t know where to start.
Let’s talk, think, and teach about it then.
Self-care is the act of Caring For Self. Simple, huh?
Medicine only talks, thinks, and teaches about caring for the Other.
“Why aren’t you on vacation with your family right now?” “They’re gone for a few days. I only take a vacation if I can take 4 weeks off.” “That’s great! When was your last vacation?”
Thinking to myself, our prestigious GI faculty will excitedly say “last year,” then we’re going to talk about his exotic vacation spot and all the fun he had. His answer, “I don’t know.” With a somber look blanketing his face. “We’re not young and healthy forever, you know.” “Yea, you’re right.” You could see the wheels turning.
“I tell my fellows to keep doing things that they like doing. It’s important.” “You’re right, it is important to keep our connection to our humanity.”
We parted ways. I thought to myself if we don’t live the life that we preach, how can we expect others to follow our guidance? None of the GI fellows I know take time to themselves. I guarantee if I ask them to define Self-Care, they’ll look at me blankly, like so many other physicians.
Is Self-Care taking a 4-week long vacation at a time? That’s a nice thought. I would love to be at the beach sunbathing as I sip on my refreshingly cold cocktail for 4 weeks straight. Not many of us have a 4 week stretch for vacation. We may have that kind of vacation time every 10 years. Maybe never. Is all hope lost?
Let’s change our perspective to solve this issue. If we can’t take a vacation for long stretches, can we break up our vacation throughout the year? Throughout the month? How about throughout the day?
How can we implement a vacation in our daily life?
Steven Covey talks of Sharpening the Saw. He was an educator and a wise businessman. His book “7 Habits of Highly Effective People” was one of the first books I read as a first-year faculty. His principles blew me away. No one ever taught me any of it.
One of his principles became my Self-Care mantra: “Sharpen the Saw”.
Scenario 1
Imagine if you’re an old-school lumberjack. You have the assignment of cutting down 10 trees per day for a month straight. Your saw is sharp. It cuts down the first 3 trees very efficiently. You decide to never stop to sharpen it. If you stop to sharpen it, you’re losing precious time.
You decide to push through instead. You get to the 5th tree and the saw is dull. You’re pushing through with your “will”. Not much is happening to the tree. Your hands, forearms, arms, shoulders, neck, back all hurt, but you don’t stop.
You can’t stop now. You have to keep going to get the 10th tree down. Your efficiency is plummeting exponentially.
What is efficiency? Technical definition: “The ratio of the useful work performed by a machine or in a process to the total energy expended or heat taken in.” -Google Dictionary
You get to the 10th tree with a super dull saw. You achieved your goal for the day. Hooray! How are you feeling? Horrible, exhausted, sore, achy, irritable, agitated, frustrated. You come home at 7:30 pm, you’ve missed the family dinner. Your 3-year-old daughter wants to play and you bark at her, you feel bad. Your husband comes to give you a welcome home hug and a kiss, you brush him away.
You feel guilty. Whatever energy you had left after a hard day of work is now gone. You can’t even participate in your lovely family life. Now your 3-year-old and your husband are both upset too. “Why is mommy not playing?” “What did I do wrong?” You don’t feel like talking about it. You’re too exhausted with your ego at full swing.
You make the excuse that mommy has worked too hard today and doesn’t have to explain herself to anyone. Everyone goes to bed upset. You feel the distance that’s built inside. Repeat tomorrow.
How familiar does this sound to you and your family after a long day of clinical work?
Scenario 2
With your sharp saw, you cut down the first 3 trees very efficiently. When you get to the 4th tree, you recognize that your saw isn’t cutting as efficiently. You take 10 minutes and sharpen the saw. You cut down the next 3 trees in the same amount of time as the first 3.
The cycle continues. You’re much more efficient. Less energy is put into cutting the trees. You get to the 10th tree at 3 pm. Home at 4 pm. You have a lovely family dinner. You get to play with your 3-year-old. You give a big hug and a juicy kiss to your husband. You take a refreshing shower, minimal muscle ache, no irritability, no agitation.
You have the energy for yourself and for your loved ones. Everyone goes to bed happy, bonded, loved. Repeat tomorrow.
Which of these 2 scenarios appeal most to you?
I remember myself in Scenario 1 often in medical school, then in residency, and as a new attending. Then I decided something had to change to live my best life. Not compared to anyone else’s life, just to mine. To live a life that’s worth living. To live a conscious life. Now. Today.
Life is too short not to live it with enjoyment. We deserve it.
How do we get there?
Take intermittent short breaks throughout the day to Sharpen your Saw.
Some Neurobiology performance research indicates that our brains need a break every 90 minutes. After 90 minutes the brain needs sharpening for about 15 minutes.
I’m a physician leader at my academic institution. I chair large meetings, they can be draining. I take 10–15 minutes after the big meetings, close my eyes, connect with my breathing, put on noise-canceling headphones, observe my thoughts go by, connect with the chair that I’m sitting on and imagine how it connects me with the earth beneath me. I stay still. My saw has been sharpened.
I feel refreshed and I’m now ready for my next big meeting.
My next break is lunch. I’ll put all technology away. I eat my lunch without distraction. I note every flavor that hits my tongue and palate, the texture of the food I’m eating. I enjoy every bite. I may even make genuine “mmmm” noises. I feel the delicious food going down my esophagus. I close my eyes after, engage with my breathing.
My saw has been sharpened. It’s time for me to reply to emails and continue working on projects.
After 2 hours of highly effective work, it’s time for me to take another short break. I go to our garden and meditate in the sun for 20 minutes. I absorb the warmth of the sunlight. I let it wash through my body and connect me to the earth. I listen. There are birds chirping in the distance, I hear a tractor, I hear the tire of the cars on the asphalt in the far distance. I hear the wind blowing through the leaves. I feel still. I feel refreshed. I know I can efficiently cut down my last 3 trees without much effort.
I am connected with myself. I’m connected with my family. We’re playing foosball and having a blast. Living our best life. We deserve it.
-ConsiousPhysician.org
