Enjoying the life of a physician

Greg Hood, MD, Internal Medicine, 09:51AM Aug 28, 2011

Delayed gratification is the mantra physicians maintain from their time as medical students for years on end. Delayed gratification has its rewards, and its pitfalls. Holding of on the excitements and fun in life can become so ingrained that it becomes second nature, perhaps even first nature. So, how does one enjoy the life of a physician? This is not the issue of what to do with a comparatively high income. This is a question of how to enjoy life. Once the heat on one's life thermostat has been reset for so long it is common to lose a degree of perspective on life. Are others living life this way? Are you missing out on excitement in life? Will you even enjoy the things that you aren't doing in life if you attempt them? Furthermore, are you even able to get motivated to start something new? With its myriad of problems the world can seem to be a disenchanting place. Given the stresses within healthcare as a whole and the lives of physicians (reference the previous two blog entries via the blog's front page) in particular, it is unsurprising that physicians consistently rate at least double the burn out and depression rates of the general population. Some of this is due to cause, such as the personality traits of physicians. As noted in the (unscientific) poll responses for "Marriage and the Business of Medicine" a substantial percentage of responders indicated that "I expend too much effort controlling my emotions rather than sharing them" and "It has always been in my nature to be more comfortably detached from other people". For others it is an issue of effect, or a combination of the two, as noted in the responses for "I commit too much time to achieving success and status to still have time to nurture my personal relationship" and "I'm too burned out to engage in the effort required". Prospective physicians tend to be among the more idealistic of their college peers. They dedicate themselves fully to the long hours and years required to become a physician in their quest to make the world a better place and help their fellow man. Mounting frustration is common in the profession as some find the realities and practicalities of life disenchanting as they pursue what they thought were their dreams. In a sense this should not come as a surprise. If one asks any adult in their 30s, 40s, 50s or beyond what it felt like to be a teenager or how they arrived at decisions and goals as a teen and they will struggle to recall or to relate to themselves as a teen. And yet, the ideals and goals of becoming a physician are the dreams set by teenagers for their adult selves. Perhaps this is one reason for the higher percentage of physicians who are the children of physicians. In spite of a strong domination of physicians discouraging their children to enter medicine in the poll for the blog post "Doctors' children and the business of medicine" the children of physicians understandably have a more realistic worldview of what is entailed in living the life of a physician. Those who do not grow up in a physician household may be more easily dissuaded from pursuing the unfamiliar, rigorous path. It is unfortunately common for physicians, though grateful for what they have and receive, to feel unexcited and unfulfilled. Living a life of service without feeling an inner joy is a damned existence and a tragedy which society as a whole and the physician community in particular must strive to overcome. When the personal and patient care achievements do not gratify one of our colleagues then the very credibility of the dream upon which they have built their professional and personal life comes into question. Physicians are trained to understand many things, and anticipate even more. It is not good as a physician to get a "surprise". We work very hard to keep surprises out of our patients' lives. However, this can bleed over into the rest of life, where nothing is exciting to the emotions any longer, nothing surprising. This tepid existence is an abhorrence to nature, and to those living such lives. How then does one get excited about life? The most difficult questions in life are often the ones that can be so simply and succinctly asked. Of course there is no one answer, no simple answer. There are a number of avenues and steps one may take in life to try to address this fundamental question of the human existence. 1. Make incremental positive changes. At Annual Session the American College of Physicians offers sessions called "Multiple Small Feedings of the Mind". This concept, that small steps for positive change can be effective, is an important one. In order to make dramatic changes in one's life the paradox is that it is the small changes that will often lead the greatest overall change. The steps of eating just a little healthier, exercising a bit more, and others, nourish productive habits, which may grow into ways to get excited about life. Ironically, this approach again smacks of deferred gratification, but it is a familiar approach for physicians and can turn the opponent into a new opportunity. It does take some energy and motivation to get started with these small changes, but not very much. Indeed, if you are reading this article you likely have enough motivation to get started. Just getting started and doing something will give some momentum. Soon those wheels which have been grinding you down will begin turning in the other direction and a positive turn of changes can ensue. 2. Cast out negative thought patterns. Focusing every day on death, deterioration and disease can be a real downer. However, negative thoughts are not the fuel for a fun time. One cannot maintain excitement and enjoy life if this is where the heart is. It truly is a matter of deciding. It is one way or the other. Think back to the positive patient encounters, the ones in which a patient has lost 30 pounds, or has made a meaningful and constructive change in life, based in your advice. How did that make you feel? Taking that seed of positive energy and how it made you feel and focusing your daily mental energy on feeling like that will not only help you, but help your patients as well. 3. Seek the silver lining. There is a lot to be negative about in internal medicine, for example. However, it is important with each patient to seek the positive. Finding the small victories in life can be very powerful for endurance within this profession. Heart trouble is a major killer still, yet we have ways through our advice and prescriptions that we can make the patient more comfortable, and more likely to live to see their daughter graduate. Antibiotic resistance is a terrible problem, but still every day we help people live through what would have been fatal infections a few years ago. The EMR server is down, but this is an opportunity to go for a walk with the family. 4. Exercise. Some believe exercise should be a four letter word. Nevertheless, it is something our bodies were built to have. Sitting on the Chesapeake in a sailboat with no sails is no fun. Sitting in the middle of life and not moving/exercising isn't either. Negative energy goes into peoples' thoughts about their appearance, their energy, their health problems and mortality. The number one, most effective treatment for over 85% of the health problems I see in the office is daily aerobic exercise. The most effective means to reduce or eliminate most medications I prescribe every day is daily aerobic exercise. The human body was designed for seven to twenty four hours of aerobic exercise each week. Starting with what one is capable of today, and building up to a minimum of seven hours a week is life changing, life-energy changing. 5. Value loved ones. As noted in the last two blog entries family members are integrally involved in our lives, and as such, the success of the business of medicine. Showing those in your life that you value them, investing time and energy in them will help you, both in the short and the long term. It gives them an opportunity to show you their returns to you. It also allows you to see life stages and life experiences from other points of view. 6. Rediscover your hobbies. Whether it is an income producing hobby or not there is value from doing off-career-topic hobbies that you love. If building furniture or painting is your hobby and it brings you income then that's the cherry on top. Reading, playing music or modeling for your own pleasure is a worthwhile investment of time and life energy because it injects energy into your life. If you don't have a hobby that you are passionate about then start exploring and trying new ones until you find yours. 7. Surround yourself with excited people. Working with competent but negative people is perhaps the biggest negative secret in the business of medicine. No one can destroy the energy and morale of a practice like a jaded, faded negative coworker. By contrast, when you work with excited people, and feed excited energy in yourself, the experience changes completely. 8. Make a point to recharge. Sometimes the drained unexcited feeling can't be shaken. This is an important time to take a break, even from your usual recharging or vacation activities. Use the frequent flier miles to go to Bermuda instead of selecting more free magazines for the waiting room. Go somewhere you haven't been before. There are often great places within your state to go - that you've never been before. When we were in California Sequoia National park became one of my top three favorite places on Earth. Getting somewhere new, somewhere completely different is a way to decompress one's perception of time again. Events which adults are familiar with are routinely perceived to take minutes or seconds whereas to children experiencing the same thing for the first time it feels like hours. This is called time perception compression. If you allow yourself to experience wholly new experiences then you have the opportunity to slow the pace of life down, and see it through more of a child's eye again. 9. Accept feedback. Most physicians don't like feedback, or at least have trouble accepting and believing positive feedback. They sense that there is another shoe out there that might fall... someday. Each person on this planet is mortal, so yes, one day even the patient with the most remarkable "save" you have made will still die. But positive feedback is positive energy, encouragement. It is a gift back from the patient to carry you a little farther in life. When you get negative feedback, if it is constructive, then use it to get better. If it is hateful, which is rare, then keep perspective that it is a personal tragedy in that person's life that their soul is so diminished. When you receive praise practice accepting it, letting it sink in, rather than just expressing gratitude and not letting the other person's positive energy truly touch you. 10. Help others. Many physicians ultimately find their positive energy in mission trips, overseas and otherwise. There is a lot to be negative about in such travel, the jetlag, the disease, unsanitary and distasteful conditions. Yet, one never hears those who do engage in such trips coming back drained or disheartened. Rather, the ways in which they help others, whether trivial or life-changing, infuse so much positive energy in their lives that no burdens inherent in the delivery of the service are able to detract from the experience.