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The statistics are bleak: doctors have significantly higher rates of depression, divorce and substance abuse than the general population. The physician suicide rate is more than double the national average. Burnout and depression are associated with more medical errors. Medical schools, hospitals, and other healthcare organizations are scrambling to try to address this problem with a variety of wellness programs, and most of these seem to involve yoga.
I hate doing yoga. If I am going to exercise, I prefer long trail runs that make my lungs and joints hurt, or doing pull-ups until I can’t brush my own hair. I also like leaving work early to take naps. I like eating cereal with half-and-half on it for dinner while watching Brooklyn 99 reruns. One of my favorite activities is sitting between my two teenage daughters on the couch while we scroll through our phones and share funny Instagram memes with each other. As a physician, I can’t necessarily endorse such flagrant disregard for screen time limits, healthy sleep practices and cholesterol guidelines, but this kind of activity (or lack thereof) definitely contributes to my overall well-being.
Wellness is not a yoga class, or a lunchtime speaker series, or a 30-minute survey put out by the hospital administration about wellness. It’s a state of mind where you give yourself permission to take care of your own needs first, and then get to everyone else’s. It involves letting go of perfectionism and ambition, and instead embracing periodic mediocrity. It means turning down committees, projects, lectures, and other professional opportunities (code for “extra work”) without feeling like a slacker. It means not sacrificing what brings you joy to get a top test score, an accelerated promotion or a fancier job title.
So much of this is contrary to physicians’ very nature. We go into medicine because we want to help people, and that often means putting their needs before our own. We have to be perfectionists, or we couldn’t have scored well enough on the MCAT and earned a high enough GPA to get into one of the coveted medical school slots. And if the prestige of our work and the admiration of others didn’t matter to us (“Oh, you’re a doctor!”), we could all satisfy our need for long hours and public service by becoming school teachers.
When we evaluate medical research, we often proclaim that correlation does not necessarily imply causation. But this wisdom is somehow cast aside when we talk about physician wellness: we blame the medical education system and our work environments for the high rates of depression, substance abuse, and suicide. And with electronic medical records, increased patient loads, and complex documentation requirements, there are plenty of external pressures that make it hard to feel balanced and content as a physician today. But what if some of these pressures are actually internal? And what if our system doesn’t create them, but selects for them?
I was a perfectionist once, too. That’s how I got here — earning straight A’s in my pre-requisites, working long hours as a medical assistant in rural clinics, cultivating the right leadership extracurriculars for my applications. Then, mid-medical school I had two children in rapid succession, and any illusions I had about being a top student quickly faded into oblivion. As a lifetime lover of good grades, it was hard for me to admit it, but I was suddenly very grateful to be at an institution with a pass / fail grading system.
The first time I allowed myself to really suck at something was on my third-year surgery rotation. I knew that no matter how much I liked surgery, it couldn’t be my chosen specialty. I was terrible at anatomy, I loved sleep, and by the time the clerkship rolled around, I was pregnant and had a one-year-old at home. I wouldn't survive a surgical residency; I couldn’t even make it through a minor procedure without having to scrub out to pee. Since medical student responsibilities were largely limited to holding open the abdomen with retractors and passing out warm blankets to trauma patients, I decided that, just for this one clerkship, I would do the absolute minimum needed to pass without causing any harm.
Over the course of the two months, I spent less and less time in the OR and waddled further behind the team on rounds. I didn’t ask questions, and no one called on me, because all my attendings had forgotten my name. Once, my resident tried to borrow my stethoscope, and I told him I didn’t have one on me. Disbelieving that a student could render themselves so useless, he inspected the pockets of my white coat for the requisite reference materials and medical equipment, only to discover that they were packed with snacks. “Wow”, he said, with a blend of horror and admiration, “You've really given up.”
I was not a good student on that clerkship. I most certainly failed to live up to my full potential. But I passed, I graduated medical school, and I haven’t yet needed any of those abdomen-retracting skills in my psychiatry practice. For me, this was part of wellness - knowing that as a pregnant third-year student with a toddler at home, I needed a break. So I found a way to give myself one where the collateral damage was mostly to my own ego. It was hard to admit I couldn't be good at everything, but it was also kind of a relief.
So here is my advice for wellness: allow yourself to suck at things. Pick the top few things that are really important to you, do them well, and feel good about that. (I choose: spending time with my family, patient care, and teaching.) Then, decide what things you can slack off on and do it. (Mine are: cleaning my house, attending conferences, washing my car, volunteering at my kids’ schools, flossing, financial planning, organizing photos, grating my own cheese, folding laundry, doing required online trainings, and a few hundred others.) Say no to that after-hours work meeting, and don’t give a reason. Write marginal clinic notes so you can get out in time for that yoga class (or that nap). Or take on the extra interesting patient and stay late, if it brings you joy. Wellness is about fueling yourself, and the great thing about medicine is sometimes that fuel comes from our work. Just realize that nobody can do it all, so it might be a good night to make cereal for dinner.
