Kindlelife

Insight, Inspiration, Motivation

Catch ’em Early!


On my radio show, Stress Busters’ Corner, on the Health and Wellness Channel of Voice America, (http://www.voiceamerica.com/show/2423/stress-busters-corner), I was discussing with my guest, Wayne Markell, who is a Platoon Commander for the Emergency Medical Service (EMS), the issue of Stress and Burnout amongst the paramedics.

Wayne talked about how he encourages his staff to “raise their hands” and be vocal about how they feel, and when they feel distress. He talked about how the staff are encouraged to seek help, for the sake of their own mental health.

As a coach, who believes in (mental) Health Promotion, I think that is precious little, and unfortunately, that is how it is with most healthcare professions. We are expected to seek help, if and when we need it.

If a person is not seeking help, the automatic assumption is that they are coping just fine. Indeed, many of us would say just that, if asked directly, how we are doing! Therein lies the peril!

I strongly believe that all healthcare professionals should be aware of their own vulnerability, and be willing to reflect on their lives, and be able to recognize signs of impending burnout, and seek help long before it happens.

I would actually go one step further, and say that we should target people who are seemingly doing just fine, and help them become aware of their own strengths and weaknesses, their own stress triggers, and help them develop more tools to deal with stress. That way, we catch them before the stress becomes a problem in their lives, and the negative consequences are kept to a minimum – just as I like to say, that the best time to stop somebody from hurting themselves by smoking, is even before they light that first cigarette!

March 18, 2015 Posted by | Personal Journey, Psychology, Refocus and Thrive, Self Improvement, Stress and Resilience | , , , , , , | Leave a comment

God, grant me the serenity…


I read the recently reported survey on Medscape, about Burnout amongst Physicians, and the findings are scary! Thirty seven to 53 percent of the physicians who responded, reported burnout! Looking at General Surgeons alone, it was 50%. The scarier part is that this number has risen significantly (almost 15%) from what it was, just 2 years ago.

Looking at some of the reported causes for burnout, I felt I had to make some comments – hence this blog post. The top 5 reasons cited are: too many bureaucratic tasks, too many hours at work, income not high enough, increasing computerization of practice, impact of the affordable care act, and feeling like just a cog in a wheel.

Too many bureaucratic tasks: In this profession, there is a certain amount of ‘mandatory’ bureaucratic tasks. It depends on the kind of hospital you work in, and what positions you hold. The question you have to answer is – which of these is really mandatory, and which ones can you let go of? Ultimately, we each have to prioritize, and decide how to handle these tasks. It is also up to us to say ‘No’ to anything we don’t absolutely have to do.

Too many hours at work: This is something, again, that most of us can decide for ourselves. If you are employed by a hospital, and find the hours too much, then you can decide what you want to do about it. I am sure there are regulations on hours of work, and you may have to negotiate with the hospital, to reduce your hours. For those who work in private practice, it is easier, since many of you can do your own scheduling. Either way, the reason many physicians don’t limit their own hours is that the remuneration does drop, when you work less. Again, it is up to us to decide what is important, and what is the price we pay.

Income not high enough: I wonder how much income is ever “enough”! While there is a huge discrepancy in remuneration from one country or state to the next, within any given geographical area, physicians earn a decent income. It is also true that some physicians live lavish lives. And the most important thing is that we do not get any training on financial management, during our training. It is up to each one of us to acquire the knowledge, or get advice, and learn to manage our own finances. It is no use if you use all your time working to earn more, and then have to spend all of it to either fix your health problems, or pay alimony and child support, or fix whatever other problems arise as a result!

Increasing computerization of practice: Well, like it or not, computers are here to stay! The sooner you get used to the idea, the sooner you can learn to use these computers to your advantage. They do save us a lot of time, and make our work more efficient. We just have to decide not to fill up any time saved, with more work!

Impact of the affordable care act: Living and working in Canada, I am unable to comment on this, because my knowledge of this is minimal. But going by the general principle of trying not to resist what is, and trying to work with the system, can certainly reduce stress.

Feeling like just a cog in a wheel: This speaks to me of low self-esteem. I admit I feel like that at times too, but only if I allow myself to. The truth is that we do have a great deal to offer – and this goes for every human being, not just physicians. If we can understand that every cog in a wheel is indeed important, for the wheel to work efficiently, we can make ‘a cog in a wheel’ feel pretty significant.

So, at the end of the day, I think it is what we tell ourselves, and how we interpret things that really cause the stress, to a great extent. There are things that are within our control, and there are those that aren’t. It is imperative that we recognize the difference, and not play victims of the system.

Which is why, I remembered the serenity prayer:

God, grant me the serenity

To accept things I cannot change,

The courage to change the things I can,

And the wisdom to know the difference.

Please let me know what is your top stress factor, and what you do to manage it!

 

 

 

February 9, 2015 Posted by | Personal Journey, Psychology, Refocus and Thrive, Self Improvement, Stress and Resilience, Uncategorized | 2 Comments

Is ‘Stress-free Physician’ an Oxymoron?


I am back, with a year-end blog, this time. Today, the winter solstice has led me to do some reflection. I launched my new website, (www.stressfreephysician.com).

Is it really possible to have a ‘stress-free’ life at all? When I look around me, I see people who are complaining about the stresses in life, and in work. There seems to be no workplace today, that can be considered stress-free. No matter what people are doing, there seems to be this drive for efficiency, return on investment, better quality, greater quantity, and so on. The healthcare field – and in fact, any service sector – just seems to have a greater intensity of stress, because of the increasing demands, and the diminishing resources. There is the pressure from the business aspect, to get better results with lesser expense, while medical care is inherently more expensive. There are also increasing advances, and the pressure to do whatever it takes, to keep people alive longer. One very palpable effect of the global stress levels, is that people often take out their frustrations on anybody at work who does not have the power to fight back, or at home, on the people who are closest to them, and therefore often taken for granted!

So, the big question is: Can we really hope to achieve a stress-free state? More importantly, is any amount of stress actually good for you? My answer would be a resounding “No” to the first question, and an equally resounding “Yes” to the second.

Stress is the body’s response to a real or perceived threat. The purpose of stress is to get people ready for some kind of action to get them out of danger. The action can be the ‘fight or flight’ response. In other words, the action taken either helps the person overcome the danger, or helps them remove themselves from harm’s way.

Some stress can be a good thing. It can motivate us to focus on a task or take action and solve a problem. In this situation, stress is manageable and even helpful. In a questionnaire I remember doing many years ago, a wedding was described as one of the most stressful events in a person’s life.

When a person is unable to achieve either of those results, is when stress becomes a negative thing. This is perhaps the biggest problem facing people today. Often at work, they feel frustrated at not being able to perform in the way they feel is best, or feel that they are in an environment that clashes with some values they hold dear to their hearts. There are also feelings of not being appreciated enough, and the demand to do more and more, with very little emotional support.

It is when such stresses occur repeatedly in a person’s life, with inadequate recovery in between, that burnout occurs. Burnout is of course the stage where a person gets physically exhausted, emotionally drained, with a sense of detachment, and has a feeling of ineffectiveness. “What’s the point?” is often their attitude.

Instead of aiming for a stress-free life, I think it would be best if we accept the reality of life as it is today – the reality that stress is not something we really can avoid, unless we become monks and go into the woods to meditate!

Once we accept what is, then we can equip ourselves to deal with it. We can figure out methods to recover well from the individual stressful episodes and to protect ourselves from the harmful effects of stress, so as to prevent burnout.

December 22, 2014 Posted by | Personal Journey, Psychology, Refocus and Thrive, Self Improvement | , , , , , , , | Leave a comment

“Work – Life Balance” – The Very Term Seems Flawed!


I was at the biannual CUSEC (Canadian Undergraduate Surgical Education Committee) meeting in Ottawa last week, where burnout was a recurring theme in many of the presentations and discussions. Dr. Judith Brown, from the University of Western Ontario, gave a presentation titled ‘Seeking balance: The Complexity of Choice-Making Among Academic Surgeons.’

A very poignant question that arose from the discussions, (thanks to Dr. Geoffrey Blair, University of British Columbia), was the idea of ‘work – life balance.’ Geoff (rightly) questioned the term, because it seemed to imply a separation of “work” from “life”! While seeking a balance between one’s personal and professional life is what people really mean to convey, we have, for long, loosely used the term, ‘work-life balance.’ For a person (like most physicians), who enjoys his profession, this instantly produces a subtle discordance,and its pursuit, even a sense of guilt! Isn’t work supposed to be a part of our lives, and a very important part at that? Isn’t work supposed to bring us great satisfaction? Isn’t it supposed to make us better people, through the challenges we face and overcome, through the miracles we see, through the joys and the pain that we see and share, through everything we learn and teach?

When inserted into this particular term, however, the word, ‘work’ has such a negative connotation! The part of this work that we really need to balance out is the repeated stress and the exhaustion, from which everybody should get adequate time to recover, if we should prevent Burnout. The important thing is to make sure that other aspects of life are nurtured just as well. Make sure that we do not sacrifice everything else for this work, especially those things that make us happy.

Let me know what your thoughts are, as you ponder over these terms and what meaning they hold for you.

November 20, 2013 Posted by | Personal Journey, Psychology, Self Improvement | , , , , , , | Leave a comment

Is ‘WORK-LIFE BALANCE’ what I really want?


It has been a long time, since I have posted anything here! I have been very busy, and for a person who warns people to guard themselves against getting burnt out, I often thought I was spreading myself out too thin! I committed myself to 2 new projects – one, a fundraiser for children with cancer (Masquer-Aid 2014), and the second, a First Lego League (Robotics) team in Cornwall. Both are going great, and are bringing me immense pleasure and satisfaction. The downside has been that I have not been able to keep up with the blogging, and the website updates. Also, my house sometimes looks like the tornado just passed through, and I do fall behind on many a chore. The one thing I do make sure I am caught up with, is my work. Thank goodness for EMR, I have very little paperwork pending, and I catch up with my billing quite regularly.

The one question I have been asking myself lately is, how can I keep myself from burning out? I do find myself physically quite exhausted, and often mentally drained too. As for work-life balance, there really is none, in my life. If I do well in one area, another definitely suffers. On a day that I do the robotics program, I do nothing at home. The day I do house cleaning and laundry, I cannot go outside the house. When I have meetings after work, I cannot attend the robotics meetings. With all these new commitments, my coaching practice has been a little slow. When I have a medical student with me, my paperwork piles up. Something always has to give way for something else to be done well. I do not believe in doing anything half-heartedly. So, whatever I do, I do well. I just put off those things that don’t have a deadline, until I can do it well.

If I were to try and ‘balance’ things out, and do everything equally, I would end up either not getting anything done well, or not completing anything at all. What is worse, if I believed it was important, I wold stress out over it, and that would certainly lead to burnout.

I have therefore, come to the conclusion that it is most important to do things that make us happy. It is certainly important to have something outside of work that excites us as well. How can we make the best of it all, and prevent burnout? Here are a few tips:

1. Make sure you always plan time off, well ahead. It is best to have the entire year planned, with important days for self, and the family set aside right at the beginning. These dates should be non-negotiable. if they are blocked off ahead, then it is easy to ask for these days off early when schedules are being made.

2. Try not to fill the day’s schedule to the brim. Always leave a little free time, to adjust for the unexpected – the urgent, unscheduled patient who needs to be seen, the inpatient who takes a turn for the worse, the flat that needs to be changed, etc.

3. Following the 80:20 principle, 80% of the satisfaction comes from only 20% of the things we do. Similarly, 80% of the things we do give us only 20% returns. We could take some time to reflect on those 80%, and determine which of them we could totally eliminate from our schedule – either cut out completely, or delegate, or hire somebody else for. We could then focus more on the 20% that bring us the greater satisfaction.

So, what are some of your strategies for staying sane in this life? Do send me your suggestions and comments.

October 28, 2013 Posted by | Personal Journey, Psychology, Self Improvement | , , , , | 2 Comments

Burnout: Chinese vs US Physicians


Just read yet another article on Physician Burnout (http://www.medscape.com/viewarticle/803968). This one compared burnout amongst physicians in China and the United States. In order to keep the groups comparable, only the responses of physicians less than 45 years of age were selected – there were 6000 Chinese, and 7500 US physicians. I was specifically intrigued by one of the charts presented, which is reproduced here:

Options Chinese US
It is manageable and I’m not making any changes 36% 25%
It is manageable but I need to make some changes in hours/workload/etc. 52.2% 62%
I am thinking of leaving my current position 7.3% 7%
I am thinking of leaving medicine altogether 4.5% 5%

Forty two percent of US Physicians, and 82 percent of Chinese physicians who took part in the survey reported burnout. Of these, 52% and 62% respectively said they needed to make changes in their working lives. This is very significant in that 3120 Chinese and 4650 US physicians know they should do things differently. It would be interesting to know how many of them are really doing something about it, and how many simply feel stuck, and will sooner or later end up either resentful or leaving their jobs.

What is even more disconcerting is that almost 12% of the responders in both countries were thinking of either leaving their current job, or giving up medicine altogether. This means, 720 physicians in China and 900  in the US – all under 45 years of age). If we consider the entire physician population in both countries, this number would obviously be much higher.

These physicians who report burnout must have put in a lot of time, money, and sacrifices to get to where they are. The government also would have spent a lot of resources, training them.

I wonder, what would it take for these physicians with burnout, to decide to stay? What would it take for them to re-discover their love for the profession that attracted them initially.

Please let me know your thoughts, either through comments on this page or by e-mail: kindlelife7@yahoo.ca.

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June 17, 2013 Posted by | Personal Journey, Psychology, Self Improvement | , , , , , , , , | 2 Comments

Burnout – FAQs


In my last post, I answered one important question that physicians often ask, when the question of looking after themselves is brought up.

Another question that was asked of me recently, was this: “OK, so, I recognize that I am burnt out, but it is such work (sic) to get help! When I think of seeing a coach/counsellor, I worry that they are going to give me ‘homework’ and that is added burden to my already burnt-out life! So, I prefer to just go on, hoping that things will get better. Isn’t it better to do that, than to jump into something (coaching) and then halfway across, find that I am treading on thin ice, and then be unable to turn back?”

Quite a poignant point, don’t you think? Well, there are many points raised in this question, which I shall try and address.

The first point is that it is, of course, important to recognize burnout – but what is more important is to figure out, what is it costing you to stay in status quo??? If you are already aware of your situation, then either you are very self-aware, or something is already going wrong, in your life/career. Chances are, based on the question, that the latter is more likely. What is the price you pay, for not fixing the problem? Is it discontent at work, disrupted relationships – with colleagues/family members/friends, lack of time for self, illness-physical or psychological, or is it lack of recreation time, or a lack of well-being? How badly does this affect you, make you unhappy? How badly do you want to change this situation? Once you figure out the value of change, and if that value is big enough, then you will have the motivation to change.

The idea of “hoping that things might get better” is really hoping against hope, if you do nothing about it. You cannot sit on the sidelines of your life, and ‘hope’ for things to get better. It just doesn’t seem to happen, at least, not with any reportable frequency!

As far as coaches giving you ‘homework’, I think the term itself conjures up a very negative emotion! While most coaching sessions end with the client making a commitment to an action towards their stated goal, it is entirely upto the client to decide how they want to get to the goal, and what the reasonable action is, to get there. For example, if a person decides that they want to have a positive attitude at work, a simple step towards this goal would be to become aware of one’s thoughts/speech, at least a few times during the day, and if it is negative, replace it with a positive thought. Writing things down would make this exercise more effective.

This does involve some work, indeed, but if the motivation is to change one’s thought pattern, and if you want it badly enough, then you cannot help noticing your thoughts, and you would not consider this as unpleasant ‘homework’. The only way to change your life is to change something that you are doing – to that extent, there is homework to do. There are habits to change, and this can only happen with conscious action, done repeatedly.

The idea of turning back is interesting. The whole point of starting a new program is to make a significant change for the better in life. People only do this when they feel unhappy enough with their current lives. Any change, however, is a step towards the unknown. It is a step outside your comfort zone. And a person would only do that when their current situation is uncomfortable or unsatisfying. To expect things to e easy is rather naïve. When considering the idea of turning back, the question is – towards what? The same situation you were turning away from in the first place? What good would that do? Most worthwhile successes in this world have happened when people have stuck it out just past the point where they wanted to turn back! So, one can only start knowing fully well that any change is going to cause some discomfort, but it will be worthwhile in the end.

Please send me any questions/suggestions you have, that I can address in future posts.

 

 

May 28, 2013 Posted by | Personal Journey, Psychology, Self Improvement | , , , , | Leave a comment

Preventing Burnout


According to Maslach and Jackson, who created the Maslch Burnout Inventory (MBI), the symptoms and signs of burnout can be grouped under three headings:

Emotional Exhaustion,

Depersonalization (or Cynicism), and

Ineffectiveness.

The cost of such a condition, in a physician can be immeasurable – not just for the physician, but for the family, the colleagues, and for the community at large! Unfortunately, when trying to be strong, in the face of repeated stress,  physicians think they are doing the right thing, that has been taught to them, and is expected of them. They believe that everyone around them is looking up to them for strength and support, and any sign of weakness on their part would be harmful to everyone.

This, in reality, is far from the truth. We are doing nobody any favours, if we allow ourselves to suffer to the point of exhaustion, overwhelm and burnout. No patient would want to be served by a physician who is so emotionally depleted that he suffers from ‘compassion fatigue,’  nor would they be very understanding if a mistake was made by a physician who is exhausted, or didn’t really care enough! So, it behooves us to take care of ourselves, so that we can serve those whom we have committed to serve.

How do you prevent Burnout? Here are a few steps you can take, to avoid burnout.

1. Be Aware: Any change starts with self-awareness. We first need acknowledge that this is something we are all susceptible to, and that there is a certain courage in recognising problems and seeking help as required! If we think that we are in some way immune to the stresses, or that we are capable of handling it all on our own, we could be deluding ourselves.

It is important to know and detect the symptoms and signs early, and have an idea of what you are willing to endure, and for how long.

2. Be proactive: Smart people solve problems, by avoiding them in the first place. For example, every physician requests tests, and will receive the results in some form (electronic or paper). Isn’t it the smart thing to do, then, to set up a system, whereby the results will be looked at and acted upon, in a seamless way, least delay? Once this is in place, the chances of missing an important report can be minimised. Similarly, we can have different structures in place to deal with referrals, phone calls, etc. Maintaining a well organized and functioning office is perhaps the best thing one can do, from the professional point of view.

There are many things we can do on the personal level as well, like taking care of minor ailments to avoid major complications, clearing small misunderstandings in relationships to prevent build-up of resentment, and so on.

3. Be very clear of Your Values and Your Mission: You need to know what are the values that are most important to you, as a person, the violation of which will bring you pain. It will also help, if you know what you really hope to accomplish, through those values – in the near, and the distant future.

4. Prioritize: Once you know what is important, you can try to get more of what you want in your life. This includes knowing what is not important, that takes up our time and energy, that you can cut out of your life.  This also means being able to say “No” to things that encroach upon your priorities.

5. Take care of your body, mind and spirit: Eating regularly, eating the right foods, and exercising should not be something relegated to when you have time. It would help to have some activity outside of work, that can help stimulate you in a totally different way, and make you happy. Volunteering is great, not just to balance out the stresses, but also to get some endorphins flowing! A spiritual practice helps to navigate the ocean of life, the currents of which can at times be very turbulent. Make sure you take time for renewal on a regular basis.

6. Build a support system: Have a good team around you. Choose your colleagues carefully, if you are in a position to do so. Make it a point to cultivate good relationships with supportive people, whom you can call upon, when you need help. It also means that you should have trusted people you can delegate all those tasks to, that you don’t really need to do yourself.

7. Learn to be a good team-player: It is important to try and understand that people are different, and that having different people is what makes a team strong. So, when conflicts arise, remember that it is most likely due to a simple difference in mental wiring or a difference in priorities. If you learn to understand the differences, and can learn to negotiate, and to work together – then you can avoid a huge source of stress in your life.

 

I have simply put together a few suggestions, many that have worked for me, and some, that I am still working on.

Please e-mail me with any comments, suggestions or questions.

 

 

 

 

 

 

February 25, 2013 Posted by | Personal Journey, Psychology, Self Improvement | , , , , , | Leave a comment

Time for Reflection and Renewal


Christmas is gone, the New Year is fast approaching. What better time for self-reflection and renewal can there be?

Confucius said, “By three methods we may learn wisdom: first, by reflection, which is noblest; second, by imitation, which is easiest; and third, by experience, which is the most bitter.”

How does one go about this process? How does one know it is being done ‘right’?

The important thing is to set an intention. Then, set the stage, to quieten one’s mind, by putting aside about three uninterrupted hours for oneself. Create a space – where one can sit, without any distractions – a clean space, without any clutter, and those who like it can further enhance it with candles or whatever else they like.

As for the process itself, the first thing to do is, take stock of one’s life. I usually do this under different headings including physical, mental, emotional, financial, career, spiritual, family, friends, community, etc. I also specifically look at what went well in the last year and what could have been better.

If there are any experiences that are strong enough to still produce a significant emotional response, then try to work through them, by first acknowledging the emotion. It is important then to ask oneself some ‘smart’ questions, in order to understand the experience better, and to work through the lessons therein. If the experience was a negative one, and we want to improve things, then it makes sense to understand what made it a negative experience, and what needs to happen to make it better. The most important thing is to recognize our own role in the creation of that experience, and what we need to change within ourselves to create a positive experience in the future.

It stands to reason that one must be honest with oneself for this kind of reflection to work, if one is doing it without the help of a coach or a friend who can be objective. Writing things down is a great way to reflect, since one cannot deny what one has written, when reading it again later, no matter how surprised one may be!

Writing often helps to clarify matters a great deal. It is important that the writing be spontaneous and not edited, for good lengths of time, so that the subconscious mind has enough time to express itself.

Ultimately, it is imperative that one makes a plan, for all the reflection in the world does no good if no action is taken. The plan has to be as clear, as specific and time-bound as possible, with smaller steps laid out for bigger goals, and rewards also specified for achieving milestones.

Accountability is the one thing that is often forgotten, in all the goal setting that is done, and sets apart the 5% who are successful, from the rest! A life coach offers the best possibility of accountability, but in the absence of one, the best way to make oneself accountable is to have structures in place to counter any possible obstacle to following the plan. Obstacles may include lack of motivation, resources, time, energy… you name it. One has to foresee what these are likely to be, based on one’s lifestyle, and put in plans to overcome these as they arise.

While such detailed reflection and planning can be done at the end of the year, self-reflection ideally should become a daily habit, and will bring great rewards, if practised regularly, especially along with regular journaling.

December 30, 2012 Posted by | Personal Journey, Psychology, Self Improvement, Spirituality and Religion | , , | Leave a comment

Dreams and Dreaming


Just completed a one day workshop with Marcia Weider, America’s ‘Dream Coach’. What a great experience that was! Thought I would share some of the insights I had, from what Marcia said, at the workshop.

First of all, the idea that dreaming is bad – Marcia has spent 30 years teaching people to dream, and to do it well. It is not the dreaming that is bad.

Dreaming without strategy makes it just a fantasy . In other words, it is not enough to dream, not matter how big your dream is, but it is very important to take action – one step, however small- towards it, to make it work. This will open up the resources and the opportunities, that will help you realize your dream.

Most of us spend our lives with one foot firmly planted in ‘Reality’ and the other one in ‘Doubt’. We need to make the shift, and slide our feet so that one foot is now in our ‘Dream’ and the other one is in ‘Reality’, our present state, from which we can take our first action.

This does not mean that Doubt is a bad thing at all. The doubter within is actually the protective instinct, trying to warn us of what could go wrong. It does not help to suppress or ignore this voice, because it will not go away, if we do this. It will get louder if ignored, and if suppressed, it will get soft, and sabotage silently. The only way to deal with doubt is to face it, acknowledge it, and strategise for all the potential problems that it raises.

Some ‘doubts’ are mere beliefs, which are clearly not true (for example, the belief that many people hold, that “I am not worthy”). Then, there are doubts that require strategy to overcome. For example, the idea that there is not enough time. If a person decides to make one hour each day by cutting down on an unnecessary,time-wasting  activity  will get 7 hours a week and 365 hours a year!

Marcia also spoke about Integrity – ie, living your life on purpose. If we do not live our lives doing what is meaningful to us, utilizing our unique gifts, and being of service with those gifts, then we are not living a life of integrity.

When we live a life of integrity and believe in ourselves, dreaming will come easily to us. Dreaming means believing in something, simply because it matters to you.

So, what is your dream? What are the doubts that threaten you? what is the one step you can take, to commit to making your dream a reality?

 

August 26, 2012 Posted by | Personal Journey, Psychology, Self Improvement | , , , , , | Leave a comment

Why Physicians Burnout – and Why They Don’t Seek Help


In my last blog post, I wrote about the problem of surgeon burnout. Although the particular paper cited was about surgeons, burnout is not a problem of surgeons alone. It is common amongt all physicians, and even among medical students and residents these days. It is becoming more prevalent, as the stresses in life all around us seem to be getting worse.  I have been pondering on the reasons for this, and have come up with the following:

Physicians are High Achievers – Most of them have been high achievers from their school days, and have been consistently working hard, putting in long days and nights, through their medical school and residency, and even afterwards, in most cases.

Delayed Gratification that wasn’t! Many of them chose to “work while their companions played” (a little poetic justice used there), thinking that if they worked hard now, they could have the good life later (trust me, I know. My father promised me that if I worked really hard in the last 2 years before college, and got into med school, I would never have to work so hard again)! They often come out of their residency with huge student loans, that they find themselves working even harder to pay off. If they have a family, or other responsibilities, then it is one thing after another, and before they know it, they hit the middle ages, and feel cheated.

The Ever Changing Health Care System– It is becoming more and more difficult to practise medicine with the diminishing resources, and increasing expectations, that there is a great deal of frustration on a day-to-day basis.

High Expectations – Physicians are seen as knowledgable, and ‘life savers’ by their families and their patients, and when they do not get good results, they often find it difficult to accept. While they enjoy their successes, many take the treatment failures quite badly. They also want to be really good at what they do, and so are their own worst critics.

Sources of Strength – Physicians are the sources of strength for their patients and families, at their most vulnerable times, ie, when they are sick, or have a sick relative. Because they carry out this function really well, most of the time, they are somehow seen as strong people, and so, they try to live up to that image subconsciously, even in the face of their own stress.

Why do they not seek help?

Unfortunately, physicians are their own enemies, in that they are the last to acknowledge their own problems, and even when they do recognise it, are unwilling to seek help. This may be because of two main factors.

Fear of appearing weak – Physicians may not want to seek help because they are afraid to be seen as weak in any way, considering they are the sources of strength at home and in the community.

Lack of Support – There really isn’t much support to the physician at risk of burnout, or who is going through excessive stress. There are physician hotlines for when they have reached a pathological level that they are unable to function, and have either broken down completely, or worse, are considering suicide!

What we really need is coaching to help guide them through troubled waters, and PREVENT suicidal ideation, rather than treatment for it.

Tell me, what do you think might be some other factors in physician burn out, and what you have found helpful in your own experience, to overcome it.

March 10, 2012 Posted by | Personal Journey, Psychology, Self Improvement | , , , , , , , , , | 6 Comments

Burnout – Surgeons Consider Suicide


A national survey conducted by the American College of Surgeons reported that 1 in 16 surgeons considered committing suicide! (Shanafelt TD, et al “Suicidal ideation among American surgeons” Arch Surg 2011; 146(1): 54-62).  7905 (31%) of those surveyed took part in the anonymously conducted survey in 2008. What is most disturbing is that, of those who admitted to contemplating suicide, only one in four sought help. Burnout and depression were independently associated with suicidal ideation, according to the survey. The paper concluded that studies are required to determine how to eliminate Suicidal Ideation among surgeons and how to eliminate barriers to their use of mental health resources.

In today’s world, we are spending millions to make our bodies healthier. Governments are offering subsidies for exercise programs in schools, weight loss clinics are mushrooming all around us, smoking cessation programs receive great support, yoga, Pilates, zumba, and a number of other activities have also become intensely popular, to the point that if you do not take part in one or other of these activities, you are seen as a sloth!

Isn’t it ironic, then, that when it comes to mental health, all we can talk about is – SECONDARY or TERTIARY CARE – that is, treat the mental illness, preferably by a specialist, AFTER it has caused enough damage?

I would like to see us try to focus on our day-to-day lives – and try to achieve a certain mental energy – and maintain it fairly evenly, recharging ourselves intermittently. If we could manage to attain such a level of inner balance, at least 50 percent of the time, we could totally avoid the burnout, and the consequent mental problems that require treatment.

This, which I call mental HEALTH PROMOTION – I have achieved in my own life through life coaching, and daily reflection. It keeps me balanced, for much of the time, and makes  it easier to recover, the rest of the time.

December 6, 2011 Posted by | Personal Journey, Psychology, Self Improvement | 2 Comments

International Day of Non-Violence


October 2nd, according to my ‘Ultimate Calender’, is the International Day of Non-Violence. I love this ‘app’ on my ipad – there are many weird holidays as well. Today, for example, is also Phileas Fogg’s Wager Day (I’ll have to check that one out later), National Custodial Workers’ Day (I’m glad – but wish that was publicised a little more. They do need to be recognised), Techie’s day (wow!), World Communion Day, World Farm Animals Day (not quite sure how the animals decided that)!

Coming back to the Non-violence Day, it immediately struck a cord with me. Growing up in India, we always celebrated Oct 2nd as Gandhi Jayanthi (Birthday of Mahatma Gandhi). This was celebrated in the school at the assembly with a speech from the Principal, followed by 2 minutes of silence, and special songs and prayers which always included “Vaishnava Janato” (which was his favourite hymn), and most importantly, the distribution of sweets, which is what we kids always looked forward to. Even though as children, we did not seem to pay attention to the entire ceremony, as an adult, I realise just how much we did assimilate, how much the life of this great person did influence our own.

Mahatma Gandhi was motivated by the firm belief that all men were created equal by virtue of the divinity of their creation – the same principle that the American Constitution was built upon, the same as the basis of all religions, the same principle that every court of justice would follow. Because of this strong conviction that he had, he felt no fear and was able to lead a whole nation to freedom through a non-violent struggle that totally disarmed its opponents. The other great value that was important to Mahatma Gandhi was Truth. There are many stories, even from his childhood, that tell us about how he upheld truth at all costs.

It was fitting, therefore, for the UN Assembly to declare this day as the International day of Non-violence. We simply need more publicity and education, to get more followers for this principle. Every year, it seems like we need this more than ever. One lives in hope.

 

October 3, 2011 Posted by | Personal Journey, Psychology, Self Improvement | Leave a comment

What Else Happened on 9/11?


On September 11, 1893, Swami Vivekananda gave his opening address to the Chicago Parliament of World Religions. He got instant attention of the audience – and the world, by addressing them as ‘Sisters and Brothers of America,’ and went on to deliver a message of Humanity and Harmony.

WELCOME ADDRESS – Chicago, September 11, 1893.

Sisters and Brothers of America,

It fills my heart with joy unspeakable to rise in response to the warm and cordial welcome which you have given us. I thank you in the name of the most ancient order of monks in the world; I thank you in the name of the mother of religions, and I thank you in the name of millions and millions of Hindu people of all classes and sects.

My thanks, also, to some of the speakers on this platform who, referring to the delegates from the Orient, have told you that these men from far-off nations may well claim the honor of bearing to different lands the idea of toleration. I am proud to belong to a religion which has taught the world both tolerance and universal acceptance. We believe not only in universal toleration, but we accept all religions as true. I am proud to belong to a nation which has sheltered the persecuted and the refugees of all religions and all nations of the earth. I am proud to tell you that we have gathered in our bosom the purest remnant of the Israelites, who came to Southern India and took refuge with us in the very year in which their holy temple was shattered to pieces by Roman tyranny. I am proud to belong to the religion which has sheltered and is still fostering the remnant of the grand Zoroastrian nation. I will quote to you, brethren, a few lines from a hymn which I remember to have repeated from my earliest boyhood, which is every day repeated by millions of human beings: “As the different streams having their sources in different paths which men take through different tendencies, various though they appear, crooked or straight, all lead to Thee.”

The present convention, which is one of the most august assemblies ever held, is in itself a vindication, a declaration to the world of the wonderful doctrine preached in the Gita: “Whosoever comes to Me, through whatsoever form, I reach him; all men are struggling through paths which in the end lead to me.” Sectarianism, bigotry, and its horrible descendant, fanaticism, have long possessed this beautiful earth. They have filled the earth with violence, drenched it often and often with human blood, destroyed civilization and sent whole nations to despair. Had it not been for these horrible demons, human society would be far more advanced than it is now. But their time is come; and I fervently hope that the bell that tolled this morning in honor of this convention may be the death-knell of all fanaticism, of all persecutions with the sword or with the pen, and of all uncharitable feelings between persons wending their way to the same goal.

Speaking of the divisive forces, of bigotry, sectarianism, and fanaticism, he said, “their time is come” – and yet, in 2011, we find those forces are still alive, and causing untold misery and suffering in this world.

What will it take, to wipe them out?

 

September 11, 2011 Posted by | Personal Journey, Psychology, Self Improvement, Spirituality and Religion | 4 Comments

Self-Reflection


I was talking with a friend about self-reflection today, and he said, “well, a person can reflect on things that have happened, and easily justify his own actions, even if what he is doing is clearly wrong. So, how does self reflection really help him become a better person?”
Good question, indeed. Isn’t this what we do most of the time? We come away from any conflict, and go on and on about how upset we are about how somebody treated us, or how wrong the other person was. We keep talking about it to anybody who will listen, for days, months, sometimes even years afterwards, whenever an occasion presents itself in conversation.
The real question, however, is – what is the purpose of the ‘reflection’. Whom are you doing it for? Whom do you want to convince the most? What do you wish to achieve? If, after justifying yourself, you feel good, then there really is nothing to worry about, is there? Ultimately, we need to be at peace, and if you are at peace, then that is good.
When you do ‘self-reflection’, it is exactly that. The reflection is for yourself, on yourself. It is an honest look in a mirror that does not distort the image. It reflects both right and wrong actions and attitudes. A person who is unwilling to face what is reflected in the mirror, often does not go through with the process.
In order to take an honest look at oneself, one has to first acknowledge that one is human, and as capable of making mistakes as anybody else. It takes courage to acknowledge one’s ego, preconceived notions, or fears. Then, it is important to believe that ‘this doesn’t make me a bad person and that I am as deserving of love and forgiveness as anybody else’.
Finally, and most importantly, one must be willing to change – for once we identify something we are doing that produces an undesirable result, then we should be willing to change.
The best part of the whole process is that as soon as we acknowledge our willingness to change, we begin to see what we can change, and things automatically start to get better. Self-reflection becomes easier.

August 28, 2011 Posted by | Personal Journey, Psychology, Self Improvement | 4 Comments

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