Doctor's Orders for a Cheerful And Healthy Internal Garden
Finally, the sun's warmth is reaching the pacific northwest and new growth is sprouting, blooming, and growing everywhere. What will your harvest be this year?
Because there may be some seeds in your garden that you didn’t plant or mean to plant. Seeds of discontent and burnout, born out of stress and dissatisfaction due to the pressures of our daily lives.
I believe deep-seated systemic problems plant the seeds of burnout. When we feel powerless and devoid of agency, these seeds find fertile, moist ground in which to thrive. Focusing on what you can’t change brings nutrients and other growth elements. Because when you think you’re trapped, you feel trapped. And then the seedlings germinate and grow relentlessly. Like weeds.
Once above ground, they can reach your conscious awareness. When this happens, there is an opportunity to uproot them. If you don’t, they will get bigger and stronger until you can’t pull them out. Now they must be dug up, along with the soil that surrounds them.
If your garden has been neglected you will have to work much harder to get it back to even an acceptable growth situation. My brother experienced this firsthand recently when he spent precious weekend hours clearing extensive blackberry bushes from a local park – a laborious endeavor due to the garden not being rigorously tended.
Ideally, we should tackle these weeds while they are still small. By carefully evaluating what can and cannot be changed, we can identify which issues can be effortlessly uprooted. And which ones will require a more potent metaphorical weed killer. Sometimes, we need to seek additional support and take action to eradicate the underlying causes.
But just like with weeds, this is not a one-time task. You must remain vigilant to keep your inner landscape free of undesired growth. By cultivating ongoing awareness, you can stop growth before it becomes deeply rooted and prevent the weeds from taking over. As time goes by, it will become easier and easier.
As you tend to your garden this year, dedicate yourself to the continuous effort of maintaining a healthy and flourishing inner landscape. Remember that you alone have the power to find your available options, and free yourself from the invasive weeds of burnout and discontent.
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More Musings
Last week I drove to my favorite trails in Point Defiance Park. The roads seemed oddly empty and quiet, even for “the time between the years” as I’ve heard it called. Perhaps I hadn’t noticed it before, since in medicine it’s always been just another week when most people don’t work, but we always had a full schedule.
The day was overcast, as it so often is during winter in the PNW. The trails seemed unusually quiet and dark as well, with fog surrounding the woods and blanketing the Sound.
This year I have become reacquainted with grief. Grief is not anyone’s idea of a desired companion. And yet, to be alive, to be in the world, to love, is to inevitably invite grief into your life. Grief is an interesting emotion. Unlike some which blaze and extinguish, grief rolls in and out like the tide, catching you off guard when you take your eye off it, it can slap you to the shore when a rogue wave hits you, unsuspecting and unprepared.
Summer marked the start of medical school, with July being when clinical rotations commenced in the third year and when the transition to the fourth year occurred. July was when internship began, followed by each new year of residency. Fellowships began later but still in the summer. Each year brought advancement and a new role commenced, finally culminating in graduation to being an attending. An independent practitioner. Free to practice medicine out in the real world. With each advancement, I found myself thinking, “I’m not ready for this. And yet, I can’t imagine what would have prepared me further.” This makes me wonder, did I receive informed consent for medical education and training? Did you?
Doctors have been conditioned since childhood to experience not knowing information as a trigger. Daily messages telling you you're not doing it right bring back memories of implied or overt criticism from school and training. There are steps you can take to minimize this effect.
There have been changes to how residents are taught, with the hours they work. There has traditionally been a lot of pushback to this.
The unhealthy pushback goes like this: “I was trained that way. I’m fine. I survived, they can survive too!”
The healthier pushback also has concerns: “If they work fewer hours, they’ll see less patient care, participate in fewer surgeries, and not see the same evolution of a patient’s condition, following the clinical course from beginning to end. This could hurt their eventual knowledge base and clinical acumen.”
I recently read a story written by a friend and business coach about a time when she volunteered at an event. During the event, she had given away all her food to support others. Now she was hungry and the event was still going on. Instead of being praised (as she had expected) by one of the more senior volunteers, she was told “If you don’t take care of yourself you can become an emergency someone else needs to tend to.”
That’s what has happened to our healthcare system.
It’s become an emergency that someone else has to tend to.
“Until I know you better, I will be telling you how to breathe!”
It’s my first day at the Pediatric Orthopedic Hand Specialty Clinic on my peds rotation in my third year of residency.
I have just been barked at by the Professor Emeritus, a retired Army colonel, who runs the service.
Acceptance means taking stock of the situation and not fighting it. Instead of judging it or having a strong emotional reaction to it, take a deep breath. Stop arguing with yourself or others about how it “should” be. You can easily argue that you’re right about how it should be. But being right won’t really help you. It just keeps you stuck fighting an illusion. How it “should” be is a distraction. It is different from the reality you are actually facing.
You already know how to round on patients. Now you need to learn how to round on yourself. Self awareness is critical to your health and effectiveness as a physician. Your physical, emotional and mental health.
One of the biggest lessons I’ve learned about perfectionism is that done is better than perfect. In my medical school and residency, we learned about “The Enemy”, a shortened version of “The enemy of good is better.” This is a well-known aphorism that originated in the 1700s and not in medicine.
Perfectionism seems to help physicians succeed in school and in training. Chasing perfection appears to be the acceptable standard during that time. But after we arrive at our intended destination–medical practice–it can make our life miserable if we continue to adhere to it. Not just work life. All life. It is no way to create a happy life because it adversely affects our relationships, both with ourselves and with others.
World events have me thinking about boundaries. Boundaries are created over time and they often change for a variety of reasons. So too are our human boundaries. Physicians need boundaries as well to function at their best. We can mean the physical boundaries of our skin or the cell’s boundaries of membranes. Or we mean the psychological or social boundaries that we live with, and sometimes without. These boundaries can protect us from burnout and enhance our sense of well-being.
Recently I’ve been sharing some coaching tools that can help doctors experience more of what they want in life and less of what they don’t. But just like in medicine, it’s not enough to memorize facts or steps in a procedure. Practice is necessary to really make progress.
We think we need external autonomy, and control of our surroundings and activities (and other people) in order to be happy, but what if awakening internal autonomy is all we need to shift to a more positive mental and emotional state?
Previously, I published a post entitled “Stop Triaging Your Life”. I had worked on it for quite a while until I was pretty happy with how it turned out. Then I realized that I had missed the first step in triage.
I’m currently reading “What Happened to You” by Oprah Winfrey and Bruce D Perry, MD, PhD, and being reminded that when I am in a trauma activation, I react rather than respond. When that happens, I don’t have access to higher cortical functions like critical thinking.
Last year I had the opportunity to hear Gabor Mate, MD speak over several days at a conference. He is the epitome of the compassionate witness, the person you’d want sitting in a confessional.
I first learned about the art of triage watching MASH with my parents growing up. I also learned about the critical timing of one-liners. Both followed me into a career in pediatric orthopedic surgery, which I practiced for 21 years.