Physician (un)Wellness and the Passion Paradox

When it comes to physician wellness, I’m type A noncompliant. That realization struck me midway through my last vacation, which was notable because I didn’t travel anywhere, and the most extraordinary activity involved sleeping through the night.

Shift work, especially overnight shifts, has a way of inflicting sneaky havoc upon the body and minds of the delusionally hearty. After twenty years as an emergency physician, I should know better than to grind the gears of my circadian clock. Sleep isn’t a potholed construction of naps.

Academic emergency physicians are aberrant physiologic organisms prone to a particular form of unwellness. Clinical shifts often don’t mesh with various educational and administrative duties. Medical schools live during the day. When well-meaning colleagues or students offer to meet at a time that works for me, never does this imply 2 am, after an evening shift, though I often slump into ‘day’ meetings clutching a coffee at what is affectively my 2 am.

What’s equally damaging, I believe, isn’t so much this distortion of time, but a distortion of purpose. When my ‘weekend’ falls during the week, only an extraordinary strength of will can resist the urge to take this time as anything but an opportunity to get work done. This insidious mindset is nothing less than self-compassion blindness.

Vacations should serve as a panacea of sorts for such thinking, an opportunity to reclaim the shape of the week and synchronize my clock with family and friends. That said, by traveling nowhere this last vacation, I cleaned my head of new excitements and other distractions. I also confirmed a sense of melancholy that has crept into my vacations the past few years, an experience I couldn’t previously identify or explain.

I stumbled upon a possible answer on the 5th or 6th morning, after a few nights of uninterrupted sleep. My body was refreshed and energized, not just awake and lacking fatigue. I rarely run in the morning–though I often plan to–but off I went. In the sweaty cooldown, my brain tingling as if freshly scrubbed, I recognized what happened– I’d returned to myself.

Return to myself? Language wrapped in such spiritual cloth appears at once empowering and vague, but the feeling was undeniably uplifting and joyous, as well as strangely bittersweet.

Why bittersweet? I was clear-headed and rested enough now to appreciate the distorted state of my state of normal before this vacation, one that was difficult to recognize when I was in the middle of it.

Somehow, a screwed up logic emerged from this thinking, a warped analogy between vacation and the ethical concerns raised by certain early Alzheimer’s researchers regarding treatments that takes patients who are well into the throes of dementia and improves them only enough so they’re aware of their situation.

Never would I equate physician unwellness to a devastating, and at the moment, irreversible disease. But once my vacation was over, I’d return to the very habits responsible for this different me. The clinical and academic expectations hadn’t taken a vacation: caring for patients and documenting for hours at home, developing and teaching classes and courses, mentoring students, and writing a range of academic and creative pieces.

But these obligations aren’t to blame. Dare my younger self to describe his future medical career to a sketch artist, one guided more by gut than good sense, and it would be colored by emergency medicine, teaching and creative writing. If I’m to blame anyone, he snickers at me in the mirror. “You are a creature of your own design, you lucky bastard.”

I’ll soon meet with my department chairman for my annual review and he’ll ask what I’ve said ‘no’ to. For I have a serious ‘no’ problem. Like many others, I love working on projects for which I’m passionate about, collaborating with passionate colleagues, mentoring and helping passionate residents and students.

My ‘no’ problem is really a ‘passion’ problem, resulting in a passion paradox. Contained within these burdens that contribute to my unwellness are the very things that invigorate and inspire, that impart meaning to my career. But dosed inappropriately, these potential antidotes to burnout and cynicism risk causing burnout and cynicism.

Admitting that you’re overworked is hard, even painful, for physicians. Recognition is the first hurdle. Then we risk having concerns interpreted as complaints, or serve as evidence to question our competence or ability to multitask efficiently. When we nerve up and say “no” to a meeting or a project or a conference, we may fear the aftertaste of criticism and disappointment from others. Lost in the well-heeded call for more physician empathy in patient care is the importance of more empathy from educators and academics for one another.

Physicians in general are burning out, abusing substances and taking their lives in alarming numbers. Even friends and colleagues throughout the country involved in meaningful and rewarding medical work aren’t immune to these ‘crispy’ feelings. These grave worries  lurk in the shadows, and yet, many physicians are reluctant to share these feelings with their directors and co-workers. Burnout is considered in the abstract, as a distant threat that’s terrorizing others.

The term physician wellness is partly at fault. It gives the impression that anyone beyond the wellness line is not well, when most of us probably function in a wellness netherworld between extremes, still caring and productive, but who might benefit from a forum where concerns are nonjudgmentally and constructively discussed. Instead, conversations bubble up incidentally, after we’ve finished signing out to one another, as if the process of sharing our patients problems creates momentum for discussing our own.

Physician wellness and burnout are complicated experiences with fuzzy borders. Standing at the precipice of a new academic year, my calendar and to-do list staring me down, I write this short essay as a small gesture of resistance. Only by sharing our particular stories can we begin to understand physician wellness in all its complexity, and restore and preserve the humanity and passion in ourselves that we desperately seek to nurture in our students and residents.

Jay Baruch (@JBaruchMD) is Associate Professor, Department of Emergency Medicine at Alpert Medical School of Brown University, as well as a writer, baffled participant in healthcare, and unabashed advocate for more creativity in medicine. What’s Left Out is his latest fiction collection.

6 responses to “Physician (un)Wellness and the Passion Paradox”

  1. Jay M. Baruch says:

    Thank you, Libby. The question turns to strategies that counteract feelings of “my profession closing around me,” as part of the professional worklife as an emergency physician (or any physician or healthcare provider) Vacation shouldn’t bear this burden. It provides distance and a departure but doesn’t address the very issues that, as you said, feels “like a blanket that blocks other points of view.” Being a healthcare provider is rich with meaning and purpose, and draws some extraordinarily intelligent and passionate and caring individuals. Innovation in healthcare should include physician health and wellness as a concern.

  2. libby nestor says:

    had a very similar vacation/transformation recently. When I started, I figured that I could hang on at this pace until this November, no later, and by the end of the vacation, had extended that until June. I have another week off at the end of August and I wonder if I will be able to go back to my original plan of june 2016. The feeling of my profession closing around me as I face the next shift, like a blanket that blocks other points of view, is almost overwhelming. It’s an interesting job, it makes us feel powerful and purposeful, but the phrase ‘all-consuming’ has more than one meaning.
    anyway, thanks for this, as always –

  3. Jay M. Baruch says:

    Thank you, Mollie. You’ll figure out how EM, teaching and writing fit together. This might not serve as sound advice, but I’ve learned that career planning involves healthy doses of career editing.

  4. Mollie Chesis says:

    Thank you for all your insights. Right now, I am the younger self, hoping I can somehow figure out how to merge Emergency Medicine, teaching, and creative writing. I agree wholeheartedly with being an advocate for more creativity in medicine, and your stories have been helpful at generating ideas on ways to do so. I look forward to more.

  5. Jay M. Baruch says:

    Thank you for these wonderful comments, Francois, and bringing your experiences to this issue. I love your closing line. “Exhausted, but happy.” Amen.

  6. Francois Luks says:

    I found this account fascinating and enlightening, because I represent the “other” type of specialist. Those of us who do not work in shifts struggle with our own issues with sleep deprivation, wellness and social skills. Surgeons (not me, but others) are typically morning persons, and we often work long hours – to be followed, every three or four days, by night call. The newer generations of physicians have grown accustomed to shorter hours but, since the work still needs to get done, the only viable solution has been a push toward shifts. The often-quoted issue about night floats, and going home after a night on call, is the lack of continuity (we’re abandoning “our” patients), but it seemed better than having exhausted physicians increasingly prone to medical errors. Now comes a testimony that shorter, but more irregular hours are just as tiring as longer, but predictable spans. We may amble half asleep, but at least our other half is awake when everyone else is; and we can use our vacation time to recharge our batteries, not reset our circadian clock. In the end, there may not be a good solution for physician fatigue. That is the life we chose, however, and if we get personal satisfaction from what we do during normal work hours, it’s ok if some of that mental wellness spills over into the nighttime – whether on- or off-duty. Exhausted, but happy.