BOOK REVIEW: FINDING BALANCE IN A MEDICAL LIFE By P. Bradley Hall, MP, Medical Director, West Virginia Medical Professionals Health Program...A guided program to help you reclaim a sense of balance in your busy life in medicine
Have you ever wondered why physicians have a burnout rate of about 67% annually and why we struggle to work our way out of this rut? After all, we are very smart, creative, and well-meaning people. It should be easy to address our own unhappiness. The medical profession is unique, particularly as practiced in the United States, with extraordinary challenges and demands made upon its members ... a practitioner tax per se. Life balance is often a goal, a moving target not achieved on a day-to-day basis. Recently, I read Lee Lipsenthal’s Finding Balance in a Medical Life which I felt compelled to share.
In the first half of his book, Lee describes how we are set up for burn out, fatigue and a state of feeling incomplete. Part of this is due to the increasing complexity of our health care system and associated stress with 28% of doctors showing above threshold levels. Another facet of this is due to the underlying personality type that is attracted to medicine in the first place. We are intelligent, caring, inquisitive, sensitive and people oriented individuals. We are also type A, perfectionist (pre-disposed to a selfrighteous and judgmental attitude), compulsive, hyper-focused, goal oriented and competitive who have a tendency toward co-dependency and “overcaring” to our own detriment. although these attributes are not considered by most to be positive, it may very well be difficult to survive medical school and postgraduate training without them. However, they don’t serve us well in our personal lives. We are so busy caring for others that we no longer take care of ourselves. The challenge is not learning how to be a great doctor, but learning how to live a great life while being a doctor. These attributes are further engrained and enhanced in the training process. Fear of failure enhances type A and competitive behaviors. Fear of error enhances perfectionism to obsessive levels. Social isolation is increased with our long hours and exhaustion. The learned emotional dissociation (dehumanization), in order to remain objective and functional under extreme stress, tends to shut down our compassion and ability to connect with others, especially those outside the patient/doctor relationship. This is exemplified when referring to patients as “the chest pain in room 201, etc.” The emotional connection needs to be with self, social, family, and others outside the emotional disconnection required at times in the workplace. In his book through a process of self-analysis, selfawareness and a deeper level of understanding of influences and expectations, Lee teaches us how to be better teachers and leaders for our communities, patients, students and families; ultimately, enhancing the ability to obtain life balance. The book expounds on various techniques to be utilized for maintenance, restructuring, and crisis. He shows us a simple way to balance extrinsic and intrinsic life values by monitoring the four key areas of life and development: the physical, emotional, mental, and spiritual.
The basic body needs must be met. This includes food, water, exercise, and sleep. The first two, physicians do well with; it is the latter where we are deficient. Lee describes how our physical health affects our emotional health, mental well-being and ultimately our performance and happiness in life.
Lee leads us through many steps toward emotional well-being as follows:
✦ Stop whining and complaining. This is energy draining and leads to no positive outcomes in the long run. Those who can use this energy to think creatively and solve problems can create positive changes in their practices and lives. The ego centric central position of “it’s all about me” is a sure fire way to remain out of balance and unhappy in life.
✦ Accept that life is change. Change is inevitable. Do not let change in medicine or your life upset you more than necessary. To paraphrase John Lennon, “Life is what happens when you are busy making other plans.”
✦ Be willing to give up some control. Physicians live and work within a large, interdependent system. Be realistic about what you can change. As the serenity prayer says, “God, grant me the serenity to accept the things I cannot change (other people, places and things), the courage to change the things I can (my action and attitudes), and the wisdom (which requires some serenity, and preferentially a power greater than yourself) to know the difference.”
✦ Forgive yourself the errors you have made. As physicians, we make multiple decisions daily, at work, and at home. Which one of us does not make mistakes in the course of a year? Remember, we are human and have the right to be perfectly imperfect. It is reasonable to review these errors to learn from them. It is unreasonable to obsess about these errors and drive yourself crazy! Ask yourself, “What would I say to a colleague who made this same error?” We are often much kinder to our patients and friends than to ourselves.
✦ Learn to manage stress. Yoga, meditation, exercise, prayer, family time, and hobbies are all great stress management techniques. If you have one that works for you, do it at least four times outlet or take a class.
✦ Enhance the relationships in your life. Spend time with and be in contact with those whom you most care about. Be grateful that you have these relationships! An emotional connection with others makes us happier and more complete.
He gives us concepts and tools to enhance our mental well-being including the processes of learning, creating, and experiencing personal growth. He also discusses the concept of emotional intelligence, the idea that emotions affect your functionality, performance and outcomes.
Lee also addresses spirituality and how it can be defined in many ways that incorporate religious practices and beliefs or can be of a non-religious nature. His approach is non-sectarian and supportive of religious endeavors. He defines spirituality as a sense of connection with others and a connection with something larger than us.
Putting it all together
Lee puts this all together in a way that becomes manageable, not adding more to your plate, but showing you how to shift your perception and creativity to manage what is already on your plate. I might add that I would like to see the concepts of his book being taught in medical schools and residency programs. Fortunately, it already is. Lee has created a curriculum that is being used in multiple residencies and medical schools throughout the country
I highly recommend this book to all of us; young, old, in private practice and in academics. As we approach the changing world of medicine and for the future, we need to learn to create and flow with change and not to resist and then complain! If we help create the next chapter of medicine with love and compassion toward ourselves, our families and our patients, it will be a better vision of the health care system than exists today. Finding Balance in a Medical Life is a must read personal call to action that may help you save a very important life - yours!