American College of Physicians: Internal Medicine — Doctors for Adults ®


Feeling worn down? Take a look at your life

Down time, nonphysician friends and a knack for juggling are just some of the keys to stay invigorated

Copyright 2003 by the American College of Physicians.

By Jason van Steenburgh

SAN DIEGO—Everyone gets worn out on occasion, but if the only triumph in your future is surviving the day, it's probably time to make some changes.

"Satisfaction is such a low bar," said Linda Hawes Clever, MACP, clinical professor of medicine at the University of California, San Francisco, and a former College Regent. "We can aim higher."

Dr. Clever, who is also president of Renew, a nonprofit group that helps physicians and others revitalize themselves, led two Annual Session presentations designed to help physicians avoid exhaustion and lead more fulfilling lives. (She also led a session for guests and spouses of Annual Session attendees.)

Exhaustion, she said, often comes from giving so much attention to your professional life that other important responsibilities and personal pleasure fall by the wayside. Here are some signs of trouble—and potential solutions—that Dr. Clever and members of the audience shared during the two presentations.

A few questions

Dr. Clever suggested "checking in" with yourself daily to see if you are living a sustainable life.

At the end of every day, she suggested, ask yourself what surprised you. Recapturing the sense of wonder and joy that every six-year-old child takes for granted, she said, will lift your spirits. If you are never surprised, she added, you may be numb.

Check on your sense of humor, Dr. Clever said. If you can't laugh and have fun, she noted, you may be missing out on a valuable way to relieve stress. (She also said you might be depressed.) You are also missing out on one of the best medicines for you, your patients, and your family and friends.

Audience members suggested some other questions to help provide perspective: When did I last sing? When did I last dance? When did I last listen to a good story? When did I last enjoy the sound of silence?

Down time

You may be taking on an ever-growing list of responsibilities because "that's what physicians do." While a few doctors are able to pack it all in, others need down time.

If you know you need to take a step back once in a while and relax, reconsider trying to be the busiest physician in the world. Perhaps that isn't the best for you or your patients.

In one session, an audience member described a colleague who needs only four hours of sleep per night. Dr. Clever replied that those of us who need more sleep to function well can't put as much on our plates as that physician. The important point, she said, is not to feel bad about it.

She pointed out that taking a power nap during the week or weekend can help improve your judgment and decrease errors. "This is something to be proud of," Dr. Clever said, "not something to feel guilty about."

Taking time for yourself is a crucial part of managing work and "life," said Dr. Clever. Don't feel guilty for taking weekends off.

She also said it's important to leave work at work. Time away from work—even the simple act of taking vacations—makes most people more efficient. Time away from work can also help re-establish connections with friends and family.


Several audience members said one thing missing from their lives was friendship. One internist said that she decided long ago she didn't have time for friendships outside of her colleagues and family, while another reasoned that she didn't have friends because she didn't have anything interesting to tell them.

"I can't just tell them what happened in the lab," she said. "They aren't interested."

Dr. Clever warned against confusing colleagues with friends. While some people can be both, developing friendships away from work is essential.

All too often, she said, friendships with colleagues fall apart when competition or jealousy get in the way. They also tend to fade when you stop working together.

So what exactly is a true friend? It's someone who would gladly take you in during the night if you ever need to "run away."

Dr. Clever asked the audience to consider how many true friends they have. "Who would take you in?" she asked. "It's not the hospital administrator, it's not the board members and it's not your patients."


Toni J. Brayer, FACP, a general internist in San Francisco and a panelist in one of the presentations, speculated that internists' personalities are part of the problem.

Because so many internists feel driven to learn as much as they can about everything, they often take on too many responsibilities. While Dr. Brayer said this attribute has served her as a doctor and a person, she acknowledged that she often doesn't have enough time in the day to get everything done, especially for herself.

Dr. Clever suggested that audience members they examine the "balls" they are juggling in their lives, such as work duties, personal health issues, family and friends, research, publishing and hobbies. Next, she said, decide which are glass and will shatter if they are dropped, and which are rubber and will bounce if dropped.

She extended the analogy by asking the audience to view some responsibilities as cement balls that are simply too difficult to juggle. Her advice? Don't bother even picking these balls up in the first place.


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