Strategies to balance training, your personal life
From the July 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.
By Christine Kuehn Kelly
When Lisa S. Starobin, ACP-ASIM Associate, now a third-year internal medicine resident at Beth Israel Deaconess in Boston, learned more than a year ago that she was pregnant, she immediately began planning her pregnancy around the intense rotations she knew would come in her third year.
Although Dr. Starobin had to work the ICU during her third trimester, an experience she described as difficult, her scheduling allowed her to return from maternity leave with only six weeks of call left. As a result, she was able to fulfill all of her call duties and still spend more time with her newborn baby.
Dr. Starobin's experience illustrates the challenges that residents face when trying to balance the intense demands of training with their personal lives.
For many residents, the training environment can encourage such a high degree of compulsiveness and perfectionism that every other area of life, including family, health and emotional well-being, is sacrificed. Residents often become expert at delaying gratification—and put off sleep, vacations, proper nutrition, exercise and personal relationships.
"Well-being is not only eroded by physician compulsiveness, but by institutional and peer pressures," said John Christensen, PhD, a clinical psychologist and behavioral medicine training coordinator who works with internal medicine residents at Portland, Oregon's Legacy hospitals.
It's important to keep in mind that residency is an atypical slice of a physician's professional life.
The task-oriented coping learned in residency, however, may make it difficult to create a more balanced life after training—and it may affect your skills as a physician. That's why educators say balance is important not only for your personal life, but also for your success as a physician. “If you are a well-balanced person, you are a better doctor," said Chinazo Cunningham, ACP-ASIM Member, an educator and researcher at Einstein/Montefiore Medical Center in New York who is also a mother of three preschoolers.
Here are some strategies to achieve more equilibrium in your professional and personal lives:
Identify your priorities. Decide what is most important to you professionally, socially, spiritually and creatively. Studies have found that people who develop a personal philosophy or specific "approach-to-life" strategies tend to experience a greater sense of well-being than people using other "wellness promotion" techniques.
Once you have a clear sense of what you value, it is easier to accept your limitations. You can't do everything, so you have to ask yourself, “What am I willing to give up to get what’s most important?”
When Joanne T. Connaughton, ACP-ASIM Member, decided that she wanted to make more time for her children, she began working four days a week and temporarily put research aspirations and significant clinical responsibilities on hold. A senior assistant program director of the internal medicine program at Mercy Catholic Medical Center in Darby, Pa., Dr. Connaughton is also married to a physician.
She said the arrangement gives her more time to spend with her family and helps eliminate guilt that she is giving less than 100% to her job. "My family may affect my time commitment," she said, "but not the quality of my work. If I can't do something at some point, I make up the work at some other time."
Make time to reflect. Emotional balance can also be difficult to achieve during residency. Each day, you face intense emotions while dealing with patients’ suffering and death. Add in your own anxieties about competence, and it's no wonder that some residents withdraw and shy away from all forms of emotional involvement.
From a personal standpoint, relationships and mental health may suffer. From a professional perspective, residents' ability to practice compassionately may also diminish.
Writing in a journal or meditating daily can help you better process new experiences and knowledge, which can help relieve stress and enhance your ability to learn. "Take 10 minutes to quickly review the day, and in a nonjudgmental way reflect on how you responded to events," Dr. Christensen suggested. "Center yourself and look for guidance for the next day."
Ronald M. Epstein, MD, associate professor of family medicine and psychiatry at the University of Rochester in New York, said that becoming more self-aware can help physicians communicate with patients better, recognize their own errors, refine their technical skills, make evidence-based decisions and clarify their values.
Maintain social and emotional bonds. Residents benefit from the emotional and logistical support that family and friends provide. But the very qualities that make a good physician—compulsivity, dedication and putting oneself last—can also strain relationships.
Francine C. Wiest, ACP-ASIM Associate, a third-year internal medicine resident at Massachusetts General Hospital who is married to a pediatrics resident, advises residents who are on call to use some of their break time to phone home, touch base and refocus themselves. "You realize how much you appreciate that phone call when you are at home and not busy yourself," she said.
Dr. Wiest emphasized, however, that residents need to be realistic. “It’s hard to come home post-call and be chipper,” she said. “During internship, my husband and I had to get used to the idea that we were very tired. Doing things together was a big accomplishment. We decided it was OK to not have exciting weekend getaways, but that when we had vacation time, we would do something special."
Choose activities that recharge you. Regularly making time for leisure activities can go a long way in restoring inner well-being. Residents can benefit from activities that nurture the body (sports and exercise) and the mind (reading, listening to music and hobbies).
While working a typical 36-hour shift may feel like running a marathon, Massachusetts General Hospital first-year resident Alex Morss, MD, said he finds that running an actual 26.4 miles helps him balance the stresses of internship. "Training for the Boston Marathon is a major coping mechanism for me," he said. "I get an overall feeling of wellness that carries over the next day."
Dr. Wiest actively participates in her local ACP-ASIM chapter, goes bird watching and takes sailing lessons with her husband. And Margaret Fang, ACP-ASIM Associate, a third-year internal medicine resident at Beth Israel Deaconess in Boston, enjoys watercolor painting, reading nonmedical books and keeping close ties with her family and friends.
Keep an eye on the big picture. It's important to keep in mind that residency is an atypical slice of a physician's professional life. "Right now it’s hard to have perspective, but residency is finite and very different from what comes after," said Jess Mandel, MD, director of the internal medicine training program at Beth Israel Deaconess Medical Center in Boston.
There are times in training when the drudgery seems foremost, but residents need to focus on the opportunities to learn and interact with patients. “I tell our residents to remember why they went into medicine,” Dr. Mandel said.
It's also important to avoid the trap of compulsiveness when at work. Some things can wait until tomorrow. The challenge is to distinguish between the urgent, the nonurgent and what is "deceptively urgent” or an outright waste of time.
“When appropriate, I try to send my post-call interns home, “ said Massachusetts General's Dr. Wiest. “But sometimes they just don't want to leave.”
Seek support and advice. Because the Joint Commission on Accreditation of Healthcare Organizations now requires physician wellness programs separate from the disciplinary process, many institutions are taking a closer look at the well-being of housestaff.
At Beth Israel Deaconess, for example, on-call residents weren’t getting adequate rest because of increased numbers of severely ill patients. The program reworked its schedules so that residents would have less interrupted time on call. And the hospital now mandates one day off a week, whether residents are on weekend call or not.
The Massachusetts General Hospital internal medicine program organizes a session in which attendings talk about how they balance their lives. Residents in some programs say they seek out attendings and professors who appear have a sense of well-being and ask them about their strategies.
Christine Kuehn Kelly is a Philadelphia-based freelance writer specializing in health care.
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