My name is Doctor and I don’t have a life.
June 2, 2017 11:49 AM Subscribe
I am a doc and I don’t have a life. Help?
I might be a walking cliché – I am a doctor and I don’t have a life. I work very hard and consider medicine to be my calling. I am single and I pour all my energy into trying to make life a little better for every patient I meet. The more I help people, the more people want my help. It’s not even that it’s hard for me to say “no” – it’s hard for me not to volunteer to help everyone around.
I’m coming home exhausted every day and yet there’s always some work left undone and a constant feeling of guilt for falling behind. I feel like I am truly making a difference and I feel really appreciated for what I do, by patients and coworkers alike. But after 12+ hours of work, I am coming home too exhausted to do anything but go to bed with a book. I feel loved and valued by family and friends and yet I often cry myself to sleep because of the loneliness I feel.
The hospital and clinic are often exhausting but at least I know how to do medicine. Wearing my scrubs, I feel smart, funny, and interesting. Outside of medicine, I feel like an ugly, fat, boring loser. I do have several close friends and am pretty close with my one living parent and my sibling’s family. But a little voice at the back of my mind keeps telling me that I am wasting my life and that one day I will be too tired to work anymore and then my life will just fall apart. And then I’ll just be the ugly fat loser 24 hours a day with no savings to support myself because I am spending all the money I earn on takeout and cabs to and from work.
I obviously do not want to end up like this but I can’t see a way out. It’s the same week after week after week… for the past X years. I know it won’t change unless I do but I just don’t know where to start. Are there baby steps I can take to not let medicine take over my entire life? I am considering therapy but I would be grateful for other tips as well.
I might be a walking cliché – I am a doctor and I don’t have a life. I work very hard and consider medicine to be my calling. I am single and I pour all my energy into trying to make life a little better for every patient I meet. The more I help people, the more people want my help. It’s not even that it’s hard for me to say “no” – it’s hard for me not to volunteer to help everyone around.
I’m coming home exhausted every day and yet there’s always some work left undone and a constant feeling of guilt for falling behind. I feel like I am truly making a difference and I feel really appreciated for what I do, by patients and coworkers alike. But after 12+ hours of work, I am coming home too exhausted to do anything but go to bed with a book. I feel loved and valued by family and friends and yet I often cry myself to sleep because of the loneliness I feel.
The hospital and clinic are often exhausting but at least I know how to do medicine. Wearing my scrubs, I feel smart, funny, and interesting. Outside of medicine, I feel like an ugly, fat, boring loser. I do have several close friends and am pretty close with my one living parent and my sibling’s family. But a little voice at the back of my mind keeps telling me that I am wasting my life and that one day I will be too tired to work anymore and then my life will just fall apart. And then I’ll just be the ugly fat loser 24 hours a day with no savings to support myself because I am spending all the money I earn on takeout and cabs to and from work.
I obviously do not want to end up like this but I can’t see a way out. It’s the same week after week after week… for the past X years. I know it won’t change unless I do but I just don’t know where to start. Are there baby steps I can take to not let medicine take over my entire life? I am considering therapy but I would be grateful for other tips as well.
I'm wondering if you're experiencing any compassion fatigue/trauma response? It's kind of orthogonal to your problem, but one sign is "not feeling like you're doing enough", or not feeling like you can turn down requests for help. I've been reading the book Trauma Stewardship, by Laura van Dernoot Lipsky, and found it really helpful for thinking about this kind of thing after working on a crisis hotline and as a volunteer in a hospital. I think understanding that caring for yourself IS enabling you to care for others is vital for both providing excellent care and for work/volunteer/life balance.
What did you enjoy doing before you went to medical school? What kinds of books do you like to read? Can you start out by taking one night out of the week that you reserve as sacrosanct for you? You can do whatever you want with this time, be that reading for longer than you usually do before you fall asleep, to going out with your close friends, to taking up a hobby, to working out, to exploring your town or city... whatever it is that makes you feel calm and centered and more like yourself. And if you don't know what that is, take this time to try things out to figure out what it might be. The only thing I would say about that time is DON'T use it to augment your medical career/calling--don't read primary research, don't do any kind of CME, don't use it to spend more time at the hospital or clinic--this is time for you to recharge and build yourself outside of your career.
posted by Illuminated Clocks at 12:47 PM on June 2, 2017 [4 favorites]
What did you enjoy doing before you went to medical school? What kinds of books do you like to read? Can you start out by taking one night out of the week that you reserve as sacrosanct for you? You can do whatever you want with this time, be that reading for longer than you usually do before you fall asleep, to going out with your close friends, to taking up a hobby, to working out, to exploring your town or city... whatever it is that makes you feel calm and centered and more like yourself. And if you don't know what that is, take this time to try things out to figure out what it might be. The only thing I would say about that time is DON'T use it to augment your medical career/calling--don't read primary research, don't do any kind of CME, don't use it to spend more time at the hospital or clinic--this is time for you to recharge and build yourself outside of your career.
posted by Illuminated Clocks at 12:47 PM on June 2, 2017 [4 favorites]
I'm not a doctor (well, not that kind!), but I am in academia, which is another total profession, one where there's always more to do and any project can absorb as much time as you allow. It's common for faculty, especially young and midcareer, to work 60-70 hours a week or more.
The principle that I try to follow is that beyond a certain point, continuing to work makes me worse as a teacher, scholar, and administrator, not better. If I'm exhausted, my work suffers. If at all possible, you should cut back the hours you work to a more reasonable load, and take the vacation time that you've earned. Given the choice between waiting a few weeks to see a well-rested doctor or getting an appointment tomorrow with one who's exhausted from overwork, I would choose to wait.
Once you're no longer exhausted, the other problems might seem less daunting. One thing that I find helpful is to have a hobby that engages me and that is significantly different from my work, not only because it's restful, but because it becomes another source of identity. I ride bicycles, and do routine maintenance on my bikes. The maintenance is mechanical work, unlike my largely intellectual work in the office, and it involves learning new skills from time to time. The riding is fun and exercise at the same time. I've met some interesting people through cycling. I also cook. Those hobbies also have a positive effect on my work life, because they let my co-workers see that I'm not just a historian and administrator.
posted by brianogilvie at 1:31 PM on June 2, 2017 [6 favorites]
The principle that I try to follow is that beyond a certain point, continuing to work makes me worse as a teacher, scholar, and administrator, not better. If I'm exhausted, my work suffers. If at all possible, you should cut back the hours you work to a more reasonable load, and take the vacation time that you've earned. Given the choice between waiting a few weeks to see a well-rested doctor or getting an appointment tomorrow with one who's exhausted from overwork, I would choose to wait.
Once you're no longer exhausted, the other problems might seem less daunting. One thing that I find helpful is to have a hobby that engages me and that is significantly different from my work, not only because it's restful, but because it becomes another source of identity. I ride bicycles, and do routine maintenance on my bikes. The maintenance is mechanical work, unlike my largely intellectual work in the office, and it involves learning new skills from time to time. The riding is fun and exercise at the same time. I've met some interesting people through cycling. I also cook. Those hobbies also have a positive effect on my work life, because they let my co-workers see that I'm not just a historian and administrator.
posted by brianogilvie at 1:31 PM on June 2, 2017 [6 favorites]
The following advice is very US oriented as that's a the only medical world I am familiar with.
Are you in residency? In case you are, post-residency life are significantly better for most people.
I echo the people above in that you may want to find other things outside of medicine that help define who you are. Some people consider medicine as a life calling, but the schedule can make a life miserable. It's hard, but you need to find people and hobbies that give you joy and meaning, even if you are in residency when free time is scarce.
In the long term, find job opportunities thats conducive to work life balance. I know from personal experience that, at least in America, similar medical jobs in the same city can have very different work load. One doc could be slaving away at 7pm at the computer, another doing the same things can turn off their pagers and enjoy a dinner with family and friends
posted by Pantalaimon at 2:07 PM on June 2, 2017 [2 favorites]
Are you in residency? In case you are, post-residency life are significantly better for most people.
I echo the people above in that you may want to find other things outside of medicine that help define who you are. Some people consider medicine as a life calling, but the schedule can make a life miserable. It's hard, but you need to find people and hobbies that give you joy and meaning, even if you are in residency when free time is scarce.
In the long term, find job opportunities thats conducive to work life balance. I know from personal experience that, at least in America, similar medical jobs in the same city can have very different work load. One doc could be slaving away at 7pm at the computer, another doing the same things can turn off their pagers and enjoy a dinner with family and friends
posted by Pantalaimon at 2:07 PM on June 2, 2017 [2 favorites]
My sister is a doc too. One thing that has made a big difference for her has been going to the gym and taking Zumba classes. She's never been into exercise, sports, or dance in her life (and she's probably quite a lot older than you) but now she swears by it and says she's got more energy than ever, feels more graceful, and has lost some weight. Small changes in how you feel about your body can affect other areas of your life. Find an exercise routine that makes you feel strong and graceful.
posted by mareli at 2:45 PM on June 2, 2017 [7 favorites]
posted by mareli at 2:45 PM on June 2, 2017 [7 favorites]
>it’s hard for me not to volunteer to help everyone around.
Right, because helping people is giving you much-needed validation. At work, you're able to use the skills you've honed over many years. Perhaps sacrificed other things to do so.
The thing is, by not seeking balance in your personal life, you're doing a disservice to both yourself now and your patients five years from now. Those patients will benefit much more from a doctor who's not burned out, and is filling their well so they have something to give.
How to start. Second keeping firm boundaries around time. Then you have to go home, then what? Begin with the very foundation of self-care - look at sleep, nutrition, and physical activity. Those are the basics everyone needs to cover for health.
If you don't have time to cook most days, do it on a *couple* days, maybe look at getting healthier meals delivered. "Physical activity" can just be walking for now. (Go to a park - being around green things is healing, it reduces stress.) Is there a team sport you've ever been interested in? It'd be a way to combine meeting people and being active. I don't know if your workplace has opportunities for social or charity events, but that might be a way to relax around people who already understand your profession.
Stealing from The Artist's Way (and I think anotyer book like that) -
commit one hour a week to something you find fun for the sake of it, no judgement. If in the course of your difficult study, you forgot what having fun means, or never let yourself have it, go to a bookstore and browse, see which titles pique your interest. Use that as a jumping off point. Or - it's hard for me to link to this from my phone - if you google "schedule of pleasurable activities", you will get a pdf with a bunch of ideas.
You need to figure who you are when you're not being a doctor. I think in many ways, "who you are" is simply what you *do*. So take some time to do things that appeal, for whatever silly reason (don't judge it). Give up some control and open yourself to exploration.
You can't do it if you don't have time, though, so you need to take some of that back.
posted by cotton dress sock at 2:57 PM on June 2, 2017 [5 favorites]
Right, because helping people is giving you much-needed validation. At work, you're able to use the skills you've honed over many years. Perhaps sacrificed other things to do so.
The thing is, by not seeking balance in your personal life, you're doing a disservice to both yourself now and your patients five years from now. Those patients will benefit much more from a doctor who's not burned out, and is filling their well so they have something to give.
How to start. Second keeping firm boundaries around time. Then you have to go home, then what? Begin with the very foundation of self-care - look at sleep, nutrition, and physical activity. Those are the basics everyone needs to cover for health.
If you don't have time to cook most days, do it on a *couple* days, maybe look at getting healthier meals delivered. "Physical activity" can just be walking for now. (Go to a park - being around green things is healing, it reduces stress.) Is there a team sport you've ever been interested in? It'd be a way to combine meeting people and being active. I don't know if your workplace has opportunities for social or charity events, but that might be a way to relax around people who already understand your profession.
Stealing from The Artist's Way (and I think anotyer book like that) -
commit one hour a week to something you find fun for the sake of it, no judgement. If in the course of your difficult study, you forgot what having fun means, or never let yourself have it, go to a bookstore and browse, see which titles pique your interest. Use that as a jumping off point. Or - it's hard for me to link to this from my phone - if you google "schedule of pleasurable activities", you will get a pdf with a bunch of ideas.
You need to figure who you are when you're not being a doctor. I think in many ways, "who you are" is simply what you *do*. So take some time to do things that appeal, for whatever silly reason (don't judge it). Give up some control and open yourself to exploration.
You can't do it if you don't have time, though, so you need to take some of that back.
posted by cotton dress sock at 2:57 PM on June 2, 2017 [5 favorites]
I'm a doctor, too. In your question, I hear depersonalization and emotional exhaustion, the key markers of burnout* rearing its ugly head. I don't know what specialty you are or if you are in training or an attending, but in some ways it doesn't matter -- burnout is the number one threat to medical practice -- more than 50% of physicians acknowledge burnout, and one in ten considers suicide.
I say this to reinforce that you are NOT alone in feeling this way. Medicine is a cruel and demanding master, as you know, but also rewarding enough that we keep at it. I think in some ways it's hardest for those who are conscientious because we feel there's always something more to be done.
Small scale things that have helped me:
- a decompress ritual on getting home (pajamas and a non-alcoholic drink -- tea in winter, spritzer in summer)
- a gratitude journal, which sounded kind of hokey at first but was really helpful in getting me to focus on the tiny beauties in life
- an exercise routine, including training for a local race
- Steps Forward has modules and whatnot that are more geared at work-unit level interventions. You can earn CME!
* A part of me really hates the term burnout because it makes it sound like the victim couldn't hack it or something. Medicine is such a macho culture (I recall one co-resident working through a full night shift with severe nausea and abdominal pain before stopping in the ED on her way home and then being whisked off to take out her ruptured appendix) that "burnout" feels like victim-blaming, analogous to rape culture. But it's the term we're stuck with for the time being, so trying to make the best of it.
posted by basalganglia at 3:20 PM on June 2, 2017 [14 favorites]
I say this to reinforce that you are NOT alone in feeling this way. Medicine is a cruel and demanding master, as you know, but also rewarding enough that we keep at it. I think in some ways it's hardest for those who are conscientious because we feel there's always something more to be done.
Small scale things that have helped me:
- a decompress ritual on getting home (pajamas and a non-alcoholic drink -- tea in winter, spritzer in summer)
- a gratitude journal, which sounded kind of hokey at first but was really helpful in getting me to focus on the tiny beauties in life
- an exercise routine, including training for a local race
- Steps Forward has modules and whatnot that are more geared at work-unit level interventions. You can earn CME!
* A part of me really hates the term burnout because it makes it sound like the victim couldn't hack it or something. Medicine is such a macho culture (I recall one co-resident working through a full night shift with severe nausea and abdominal pain before stopping in the ED on her way home and then being whisked off to take out her ruptured appendix) that "burnout" feels like victim-blaming, analogous to rape culture. But it's the term we're stuck with for the time being, so trying to make the best of it.
posted by basalganglia at 3:20 PM on June 2, 2017 [14 favorites]
Your post sounds like mild to moderate depression to me. Escaping a poor self image and low default mood through constant work is not uncommon.
But since you're looking for other ideas, I'll recommend finding one thing that gives you joy outside of work. Maybe bicycling? Rock climbing? Dancing? Just one thing that, as the end of your shift nears, you think "ooh, I'm so excited I get to go ___." If nothing comes to mind, maybe just join a big gym with a lot of options. Exercise might help your energy and physical self-image, and I think it's one of the non-med interventions for depression that is supported by research, no?
Hmm, on a re-read, you sound more exhausted than depressed. There might be sort of a vicious cycle going where the more you work, the more exhausted you are, and the more exhausted you are, the more you feel compelled to work all the time? E.g., your anxiety goes up, or you know that you're just going to collapse at home. (I remember this happening to me in grad school.)
[I'm feeling like this comment probably isn't super useful and hoping some other docs chime in. Good luck!]
posted by salvia at 3:59 PM on June 2, 2017 [1 favorite]
But since you're looking for other ideas, I'll recommend finding one thing that gives you joy outside of work. Maybe bicycling? Rock climbing? Dancing? Just one thing that, as the end of your shift nears, you think "ooh, I'm so excited I get to go ___." If nothing comes to mind, maybe just join a big gym with a lot of options. Exercise might help your energy and physical self-image, and I think it's one of the non-med interventions for depression that is supported by research, no?
Hmm, on a re-read, you sound more exhausted than depressed. There might be sort of a vicious cycle going where the more you work, the more exhausted you are, and the more exhausted you are, the more you feel compelled to work all the time? E.g., your anxiety goes up, or you know that you're just going to collapse at home. (I remember this happening to me in grad school.)
[I'm feeling like this comment probably isn't super useful and hoping some other docs chime in. Good luck!]
posted by salvia at 3:59 PM on June 2, 2017 [1 favorite]
This advice is cliche and normally I would be loathe to give it, but have you thought about dating around a bit? Maybe particularly looking for people who aren't involved in medicine?
My partner is an md and I know several other couples where one partner is medical and the other isn't, and it seems to be a pattern that the non-medical person can provide some much needed emotional support/ and essentially a good distraction at the end of the day for the overworked doctors.
Anyway you sound like a fantastic person, I know it's hard to let go of negative self-talk but this stranger on the internet is very impressed by your drive to make the world a better place!
posted by loquacious crouton at 4:33 PM on June 2, 2017 [1 favorite]
My partner is an md and I know several other couples where one partner is medical and the other isn't, and it seems to be a pattern that the non-medical person can provide some much needed emotional support/ and essentially a good distraction at the end of the day for the overworked doctors.
Anyway you sound like a fantastic person, I know it's hard to let go of negative self-talk but this stranger on the internet is very impressed by your drive to make the world a better place!
posted by loquacious crouton at 4:33 PM on June 2, 2017 [1 favorite]
Bicycling for transportation, especially to work, is the easiest way to add some exercise to your daily routine and make it stick. Or so I tell my primary care physician every time I see him, because I like him and hope he keeps doing what he's doing. I know you've got patients who feel the same way about you, so I hope that one of our ideas sounds like a good one to you (even if it's not mine!) Good luck.
posted by asperity at 6:22 PM on June 2, 2017 [1 favorite]
posted by asperity at 6:22 PM on June 2, 2017 [1 favorite]
Mod note: From the OP:
Thank you for your kind answers. I'm not sure if I've made my situation fully clear, so I'll try to clarify.posted by restless_nomad (staff) at 6:43 PM on June 2, 2017
I am not in the US and I am also no longer in training. Our country has socialized medicine so instead of paying to see a doctor you *wait* to see a doctor. Waiting times to see a specialist like myself are very long. This means a lot of people don't get timely care. I'm trying to see my patients as often as medically necessary so instead of X appointments in a clinic day I often see 2x patients. And I'm not an outlier, most of my colleagues do the same, it doesn't make sense to see a really sick patient once a year. We just "squeeze them in". Everybody does. It's not that we are trying to be heroes, it just doesn't make sense otherwise. But over time, I get more and more patients whom I have to squeeze in. Plus, many of them are elderly and feel lost in the system so I do a lot of explaining, arranging other specialist consults. So, just say no" does not seem to cut it.
I come home from work at nine pm several days each week, I'm just physically and mentally spent. I don't cook, or work out. I just go to sleep. There are days I'm crying with exhaustion.
I'm looking for ideas on how to set boundaries in my work without feeling like I let my patients down.
US-based physician here, and I've found myself in a very similar mindset. Hopefully you're finding some comfort in the comments here. And give yourself some credit and pat yourself on the back for taking a very productive first step in talking about your concerns.
The cliche goes: "doctors make the worst patients." There's some truth to this, and I think it can be expanded to: "doctors make the worst everything" without much difficulty. It stems from the idea that we think we know a lot, and we might, but there's a whole lot that we don't know, especially when it comes to ourselves. This is only reinforced by the fact that people look to us for answers, that our work involves making decisions based on science, and science and evidence can't be wrong, can it? But that we're not infallible.
I used to hold onto the notion that I'm the best version of myself when I'm working: intelligent, compassionate, and charismatic. Even attractive! And yes, when I came home, I felt the complete opposite: lazy, irritable, and most definitely not a special snowflake. I'd tell my friends, "friends: I wish people could see me at work," because then they'd see me at my best.
My friends, being good friends, would tell me: "you're a fucking idiot." Well, one did, in those words. Other friends would tell me that they didn't need to see me at work: that it was clear to them that whoever I convinced I was at work was who I was outside of work. The good that I am invariably spills over into my non-work life and time. And when I wasn't so self-deprecating and had some honest, introspective conversations with my friends, it was clear that I was, more often than not, and at the very least, a reasonably nice guy.
It also became clear that the inverse was true: how I was outside of work spilled into how I was at work. And then everything just sort of came into focus.
It's so cliche to say that you've got to take care of yourself, first. If you can't take care of yourself, you can't take care of other people. Et cetera. Don't discount these phrases because they're cliches. They're cliches because they're so common and they're fucking true! I'd spend so much time and energy working my ass off for years because I felt like it was my duty, and how could I do my best for other people if I didn't work all the damn time?
Things came into focus when I realized I could do better for my patients if I were doing better for myself. Beginning with the basics: taking time for myself. Sleeping better. Eating better. Going out. "Enjoying life." Ha ha. See how simple it is? I kid, which is why I put that bit in quotation marks. Enjoying life when you're used to not enjoying life because you've been pouring everything you've got into work is difficult.
As I'd said in the beginning: talking about this is a fantastic thing to do. I'd encourage doing more of it with your family or friends, if possible. Don't... not pursue talking with them because you don't think they'll understand. I guarantee you that they will. Write about things. Blog, even if and perhaps especially if you've no audience. And if you have any difficulty finding people who'll listen, and if you feel comfortable with chatting with strangers on the internet, feel free to MeMail me. Only do not feel like you're being a burden on anyone, or that you're simply complaining. You're not doing either: you're taking a big step in what is hopefully a happy direction. You know: the way toward cake and sunsets.
So write. Then logic your way into taking time for yourself somehow, even if it's half an hour or an hour a day. Then look into specific actions, such as finding coverage for your patients, or working less. Your patients will understand, even if you're convinced that they can't. Even if you feel like the only way they'll get timely care is if you continue to work as much as you have over the past years.
Then look bigger, dream bigger of things that may have seemed impossible in the past or still seem out of the realm of possibility: taking a weekend off and going out of town. Attending (gasp!) regularly scheduled classes at the gym, or classes in, say, watercolors. Dating? Holidays in another country!
Strongly consider seeing a therapist and carving out time for one.
And finally realize that it's not going to be easy. Nothing involving change of self is. It will be a continuous process of self-improvement and mindfulness, checking oneself before continuing to wreck oneself. Even as I write this I remind myself that I'm still a slowly aging bachelor with a schedule and workload that continues to be nearly all-consuming. I still take on more responsibilities than I should, and speciously justify my actions with my role and job title as the head of my group.
But all that being said, and even though I'm working this weekend as I do most weekends, I'm still slacking off and checking MetaFilter and writing this reply. I'd spent the past couple of hours doing nothing but listening to music I haven't listened to in a while, guided by a friend's recent visit and branching off tangentially based on mood and song lyrics. I haven't fully been able to avoid work this evening, having checked my work phone after dinner, but I have successfully ignored a text message, not listened to some voicemail, and have continued to allow my unread e-mail message count increment up to 168 unread messages.
I consider these to be minor victories. The amount of time and my happiness with life outside of work has ebbed and flowed over the years, and I continue to struggle from time to time. But that's ok. I've got some great friends and family, and have learned that I can count on them when things get rough. I wish you the best of luck. Don't discount yourself or your value, not just to your patients, but to, well, everyone. Because while you may feel like that you're not very fantastic outside of work, I guarantee you that you're at least one person's pretty damn special snowflake.
Incidentally, please don't think that racking up a large number of unread messages for work is a bad thing. It's not. I mean, I don't do it as a contest or goal, except on occasion. Apart from what I'd written above as reasons for ignoring certain work-related things when not at work, I've learned that I can carve out more time for myself by not doing certain things when I'm not at work, like checking my e-mail.
Over the years I've been working, I've consistently half-joked that I'm pretty good at catching up on my work e-mail by pressing and holding "delete." That's pretty close to true. Also, I've learned that, while I can't Block Sender/Mark As Spam people who are within my organization, I can set filters to move their messages to the trash. Not everyone's. Just the ones not key to my job.
Point is: everyone at work knows that if there's something of import, that they should call me. That way I can prioritize and manage my time, I tell them. Prioritization of my time works especially well for work when I can lump things into one of two categories: Do This Now, or Fukkit: Trash.
posted by herrdoktor at 8:45 PM on June 2, 2017 [3 favorites]
The cliche goes: "doctors make the worst patients." There's some truth to this, and I think it can be expanded to: "doctors make the worst everything" without much difficulty. It stems from the idea that we think we know a lot, and we might, but there's a whole lot that we don't know, especially when it comes to ourselves. This is only reinforced by the fact that people look to us for answers, that our work involves making decisions based on science, and science and evidence can't be wrong, can it? But that we're not infallible.
I used to hold onto the notion that I'm the best version of myself when I'm working: intelligent, compassionate, and charismatic. Even attractive! And yes, when I came home, I felt the complete opposite: lazy, irritable, and most definitely not a special snowflake. I'd tell my friends, "friends: I wish people could see me at work," because then they'd see me at my best.
My friends, being good friends, would tell me: "you're a fucking idiot." Well, one did, in those words. Other friends would tell me that they didn't need to see me at work: that it was clear to them that whoever I convinced I was at work was who I was outside of work. The good that I am invariably spills over into my non-work life and time. And when I wasn't so self-deprecating and had some honest, introspective conversations with my friends, it was clear that I was, more often than not, and at the very least, a reasonably nice guy.
It also became clear that the inverse was true: how I was outside of work spilled into how I was at work. And then everything just sort of came into focus.
It's so cliche to say that you've got to take care of yourself, first. If you can't take care of yourself, you can't take care of other people. Et cetera. Don't discount these phrases because they're cliches. They're cliches because they're so common and they're fucking true! I'd spend so much time and energy working my ass off for years because I felt like it was my duty, and how could I do my best for other people if I didn't work all the damn time?
Things came into focus when I realized I could do better for my patients if I were doing better for myself. Beginning with the basics: taking time for myself. Sleeping better. Eating better. Going out. "Enjoying life." Ha ha. See how simple it is? I kid, which is why I put that bit in quotation marks. Enjoying life when you're used to not enjoying life because you've been pouring everything you've got into work is difficult.
As I'd said in the beginning: talking about this is a fantastic thing to do. I'd encourage doing more of it with your family or friends, if possible. Don't... not pursue talking with them because you don't think they'll understand. I guarantee you that they will. Write about things. Blog, even if and perhaps especially if you've no audience. And if you have any difficulty finding people who'll listen, and if you feel comfortable with chatting with strangers on the internet, feel free to MeMail me. Only do not feel like you're being a burden on anyone, or that you're simply complaining. You're not doing either: you're taking a big step in what is hopefully a happy direction. You know: the way toward cake and sunsets.
So write. Then logic your way into taking time for yourself somehow, even if it's half an hour or an hour a day. Then look into specific actions, such as finding coverage for your patients, or working less. Your patients will understand, even if you're convinced that they can't. Even if you feel like the only way they'll get timely care is if you continue to work as much as you have over the past years.
Then look bigger, dream bigger of things that may have seemed impossible in the past or still seem out of the realm of possibility: taking a weekend off and going out of town. Attending (gasp!) regularly scheduled classes at the gym, or classes in, say, watercolors. Dating? Holidays in another country!
Strongly consider seeing a therapist and carving out time for one.
And finally realize that it's not going to be easy. Nothing involving change of self is. It will be a continuous process of self-improvement and mindfulness, checking oneself before continuing to wreck oneself. Even as I write this I remind myself that I'm still a slowly aging bachelor with a schedule and workload that continues to be nearly all-consuming. I still take on more responsibilities than I should, and speciously justify my actions with my role and job title as the head of my group.
But all that being said, and even though I'm working this weekend as I do most weekends, I'm still slacking off and checking MetaFilter and writing this reply. I'd spent the past couple of hours doing nothing but listening to music I haven't listened to in a while, guided by a friend's recent visit and branching off tangentially based on mood and song lyrics. I haven't fully been able to avoid work this evening, having checked my work phone after dinner, but I have successfully ignored a text message, not listened to some voicemail, and have continued to allow my unread e-mail message count increment up to 168 unread messages.
I consider these to be minor victories. The amount of time and my happiness with life outside of work has ebbed and flowed over the years, and I continue to struggle from time to time. But that's ok. I've got some great friends and family, and have learned that I can count on them when things get rough. I wish you the best of luck. Don't discount yourself or your value, not just to your patients, but to, well, everyone. Because while you may feel like that you're not very fantastic outside of work, I guarantee you that you're at least one person's pretty damn special snowflake.
Incidentally, please don't think that racking up a large number of unread messages for work is a bad thing. It's not. I mean, I don't do it as a contest or goal, except on occasion. Apart from what I'd written above as reasons for ignoring certain work-related things when not at work, I've learned that I can carve out more time for myself by not doing certain things when I'm not at work, like checking my e-mail.
Over the years I've been working, I've consistently half-joked that I'm pretty good at catching up on my work e-mail by pressing and holding "delete." That's pretty close to true. Also, I've learned that, while I can't Block Sender/Mark As Spam people who are within my organization, I can set filters to move their messages to the trash. Not everyone's. Just the ones not key to my job.
Point is: everyone at work knows that if there's something of import, that they should call me. That way I can prioritize and manage my time, I tell them. Prioritization of my time works especially well for work when I can lump things into one of two categories: Do This Now, or Fukkit: Trash.
posted by herrdoktor at 8:45 PM on June 2, 2017 [3 favorites]
OP, I wonder if you can cut back on your work a little bit. Say an hour a day. Three days a week, you go to the gym or for a bike ride at lunch or before you start the day. This will give you some energy and endorphins. Three days a week, you work on some sort of project, maybe mentoring med students and encouraging them to go into your specialty, so that there are more of you. And you hire a homemaker to cook and clean and run errands, because you have other things to do. With those basics taken care of, maybe you can work in some time for a hobby or to hang out with friends or date. You sound like someone I would like to be friends with or date and I'm sure there are other people who would be similarly inspired by your dedication to medicine and I'm guessing you make for intelligent conversation. But if you put in these basics for you and start to breathe again, you might feel like you have a life. And you do have a life. You might also want to think about therapy -- I'm a pro therapy kind of person and I really think there's no substitute for having someone to hear what's going on and help you tackle problems.
posted by shockpoppet at 8:47 PM on June 2, 2017
posted by shockpoppet at 8:47 PM on June 2, 2017
socialized
Oh god, you're in Canada. Ok. Listen. I'm on a 12-month waiting list to see a specialist. Yeah, I definitely have feelings about that, like some of your patients probably do. But you know, we understand that it's not the doctors' fault that we have to wait. We all understand that it's the system, that there's just not enough money for everything everyone needs. There is an endless sea of misery and pain out there. You aren't personally responsible for every drop of it. I imagine it feels like that, because you're seeing individuals, day in and out - but it's not up to you to help everyone - you can't! Just logically, it can't be down to you. If a genie arrived today and magically cleared your schedule for the next six months, it'd just fill right back up again. It is a systematic problem. We are in need of reform (like I need to tell you.)
The care you are able to give (and that I am able to get) doesn't exist in some perfect world scenario. Between the doctor and the patient is a third thing, the system. And just like there's an unknown element in life/healing/sickness/death - a who knows what kind of chaotic thing that goes into anyone getting better or sicker despite a doctor's best efforts or statistical predictions - there is the same kind of wildness of fate happening at the level of the system, and you are just as caught up in it as your patients are. It is not just down to you.
You have to say no to some people (for a bit of time) so you can say yes to others. It's not you making that call, either, don't take that guilt on. It is the system. You get the people that come when they do.
Can you get advice from colleagues about ways to share the burden of explaining things to patients who need more of that kind of time (maybe bring in a nurse or PA just for that? Really don't know, but I'm sure someone has ideas )? Get an office manager who can be nimble about missed appointments/waitlists and make that time count for more? Perhaps there are some little tweaks that could make a small difference, if that would help relieve your guilt. But the bottom line is there are just not enough doctors, there isn't enough money, and there are too many patients for everyone to get matched up in any kind of timely way. You have to accept this as a socio-economic and political fact, and not a moral judgement of you personally.
(If you think it would help you manage your feelings about this, it might be an idea to get involved in politics that you think might make a difference. In like a year, during which time you should be devoting yourself to sleeping and eating and feeling more like a full human being. This system mistreats everyone involved in it. It's not right - but it's not down to you.)
posted by cotton dress sock at 9:56 PM on June 2, 2017 [6 favorites]
Oh god, you're in Canada. Ok. Listen. I'm on a 12-month waiting list to see a specialist. Yeah, I definitely have feelings about that, like some of your patients probably do. But you know, we understand that it's not the doctors' fault that we have to wait. We all understand that it's the system, that there's just not enough money for everything everyone needs. There is an endless sea of misery and pain out there. You aren't personally responsible for every drop of it. I imagine it feels like that, because you're seeing individuals, day in and out - but it's not up to you to help everyone - you can't! Just logically, it can't be down to you. If a genie arrived today and magically cleared your schedule for the next six months, it'd just fill right back up again. It is a systematic problem. We are in need of reform (like I need to tell you.)
The care you are able to give (and that I am able to get) doesn't exist in some perfect world scenario. Between the doctor and the patient is a third thing, the system. And just like there's an unknown element in life/healing/sickness/death - a who knows what kind of chaotic thing that goes into anyone getting better or sicker despite a doctor's best efforts or statistical predictions - there is the same kind of wildness of fate happening at the level of the system, and you are just as caught up in it as your patients are. It is not just down to you.
You have to say no to some people (for a bit of time) so you can say yes to others. It's not you making that call, either, don't take that guilt on. It is the system. You get the people that come when they do.
Can you get advice from colleagues about ways to share the burden of explaining things to patients who need more of that kind of time (maybe bring in a nurse or PA just for that? Really don't know, but I'm sure someone has ideas )? Get an office manager who can be nimble about missed appointments/waitlists and make that time count for more? Perhaps there are some little tweaks that could make a small difference, if that would help relieve your guilt. But the bottom line is there are just not enough doctors, there isn't enough money, and there are too many patients for everyone to get matched up in any kind of timely way. You have to accept this as a socio-economic and political fact, and not a moral judgement of you personally.
(If you think it would help you manage your feelings about this, it might be an idea to get involved in politics that you think might make a difference. In like a year, during which time you should be devoting yourself to sleeping and eating and feeling more like a full human being. This system mistreats everyone involved in it. It's not right - but it's not down to you.)
posted by cotton dress sock at 9:56 PM on June 2, 2017 [6 favorites]
Thanks for the clarification. I think my comment above was off base, but I'm not sure I have much to add, just wanted to acknowledge that, because you sound really kind and struggling, and I wish I had an answer for you. I can see why you'd feel like you were letting your patients down. Yet it's clear that you are at a level that is personally unsustainable. And maybe you'd even be able to give better care if you had more boundaries. I wonder what would happen (internally) if you just rigorously stuck to boundaries, say, for two weeks. Could you try an experiment like that? I think sometimes the internal pieces shift after the behavior shifts. Good luck; this sounds hard.
posted by salvia at 10:04 PM on June 2, 2017 [1 favorite]
posted by salvia at 10:04 PM on June 2, 2017 [1 favorite]
Do you have any say about recruitment at your clinic? It sounds like part of the issue is that there aren't enough doctors to see all the patients and to deal with the administrative burdens of the system. Do you have the influence needed to persuade the clinic to recruit more staff, either another doctor in your specialism or an administrator who can deal with more of the bureaucracy (and explain it to patients)? If not, I think it may be time to start looking at other jobs in your field and getting a sense of whether there are workplaces where you might get more support and better resources. It sounds like your current situation is inherently unsustainable.
I also think you need to reframe the choice to work less. It's not simply about doing what's best for you vs doing what's best for your patients. It's doing what's best for all your patients, present and future. While it's admirable that you want to do everything you can for every patient who could be in front of you right now, the net effect of the situation is that a great doctor--driven, compassionate, smart--is being worn away to a point where she won't be able to help anyone to the best of her ability someday. You want to be treating patients in ten years time, I assume, so that they can have the benefit of your experience in your specialism. That's not going to happen if you don't find a way to cut some of the hours you're working, by sharing more of the burden or moving elsewhere. You have to think not only of the patient in front of you but all the patients who deserve to see you over the years, and to have a doctor who isn't a burned-out and exhausted wreck. The boundary you need to draw isn't a selfish one about preserving me-time in the face of your patients' overwhelming needs. It's about preserving you--your own health, physical and mental--as much for the sake of your patients as yourself.
posted by Aravis76 at 10:37 PM on June 2, 2017 [3 favorites]
I also think you need to reframe the choice to work less. It's not simply about doing what's best for you vs doing what's best for your patients. It's doing what's best for all your patients, present and future. While it's admirable that you want to do everything you can for every patient who could be in front of you right now, the net effect of the situation is that a great doctor--driven, compassionate, smart--is being worn away to a point where she won't be able to help anyone to the best of her ability someday. You want to be treating patients in ten years time, I assume, so that they can have the benefit of your experience in your specialism. That's not going to happen if you don't find a way to cut some of the hours you're working, by sharing more of the burden or moving elsewhere. You have to think not only of the patient in front of you but all the patients who deserve to see you over the years, and to have a doctor who isn't a burned-out and exhausted wreck. The boundary you need to draw isn't a selfish one about preserving me-time in the face of your patients' overwhelming needs. It's about preserving you--your own health, physical and mental--as much for the sake of your patients as yourself.
posted by Aravis76 at 10:37 PM on June 2, 2017 [3 favorites]
One other idea occurs to me. You've been getting really good at being a doctor. These other pieces are like underused muscles. That naturally leads to avoidance ("let me stop bumbling around with this and go back to what I'm good at"), and labeling yourself an "ugly fat loser" (assuming that wasn't a joke) can't help. Maybe frame it for yourself that way -- you're out of practice (with relaxing), you're still learning (financial management strategies), but that just like you became a great doc, you'll get good. Give yourself some time to develop skills, routines, etc., for whatever time off you have. And for whatever you do with that time (aside from getting some rest), you might want to try to structure things so you gain some sense of progress and competency. Getting in shape might do that. Going to the same coffee shop / park to read the newspaper might lead to you becoming a regular and learning other regulars. That sort of thing. Rather than randomly try three different things in hopes that something different won't leave you feeling like a loser, maybe think about what you could do repeatedly so that it'd become comfortable? Just a thought.
posted by salvia at 9:12 AM on June 3, 2017
posted by salvia at 9:12 AM on June 3, 2017
Mod note: From the OP:
Thank you Metafilter!posted by LobsterMitten (staff) at 9:48 AM on June 3, 2017
I wish I could mark everyone's answer as best. So many thoughtful tips, and so much encouragement. Thank you for taking your time to read my question and respond. I've read through all the links and have started reading "Trauma Stewardship" on my Kindle.
I know it's going to take time to make changes but I'm glad I asked this question. I appreciate your kindness, everyone.
A few words I hope will be easy to remember when stressed: there are real limits to what a body can do. Just like healthcare funding, *you* are a finite resource. It is responsible to manage this resource well. We need caring doctors like you. We need you to be healthy so you can do what you're great at. When you leave - not later than 6, ideally - tell yourself, "it's for the patients".
posted by cotton dress sock at 10:14 AM on June 3, 2017 [2 favorites]
posted by cotton dress sock at 10:14 AM on June 3, 2017 [2 favorites]
I'm a therapist, so similar-ish issues sometimes. In addition to the great advice above, I find it's helpful for me to think about how I'd want my clients' lives to be. Generally, I hope for balance for them, with time for work and play and relationships and fun and meaning; I would not hope that they spend their entire waking life working. In fact I spend a great deal of my work life trying to help people find that balance. So it would be hypocritical of me to spend my entire waking life working, and I would be modeling extremely bad behavior to my clients if I were to do so.
It's kind of a self-care cheat to take care of myself so that I can take care of others, but it can be a good initial motivator toward self-care because I'm worthy of self-care.
posted by lazuli at 10:31 AM on June 3, 2017 [3 favorites]
It's kind of a self-care cheat to take care of myself so that I can take care of others, but it can be a good initial motivator toward self-care because I'm worthy of self-care.
posted by lazuli at 10:31 AM on June 3, 2017 [3 favorites]
I'm a nurse who has been feeling similarly burned out at work lately, and I found it immensely helpful to go on a weekend retreat to SORT. IT OUT. I rented a cheap air bnb in the middle of nowhere. I brought healthy but super-easy-prep food to eat (grilled chicken breasts from the deli counter, frozen veggies, fresh fruit, tea, whole wheat english muffins and peanut butter). I brought my journal, and a big sketchpad for mind mapping, and a yoga DVD (I've done yoga like 8 times in my life before), and Rachel Naomi Remen's book My Grandfather's Blessings (which has lovely short anecdotes and essays about finding meaning and strength in healing professions).
Before I left home, I printed a list of ideas from my own thoughts and from articles I found online about dealing with burnout. I used a combination of brainstorming and mindmapping to capture on paper every little thing I do in my job, and then I considered which parts give me joy vs which parts drain me. I brainstormed ways to do more of the parts I love, and ways to minimize the parts I don't love. I came up with a list of new boundaries that felt reasonable to me, and phrases I could use with myself, my coworkers, my boss as needed to help me enforce those boundaries. I read somewhere that "burnout is basically a state of depleted resources," so I made lists of things I can do at work and outside of work that help "fill my cup," and I looked for ways I'm being drained that I can change as well. I considered what coping skills I've used to deal with difficult times in the past, and came up with ideas of how to apply those skills to my current situation. I listed the negative thoughts I've had repeatedly about myself and about my job, and tried to find more positive things I could think to myself instead. I imagined in great detail, moment by moment, what my perfect day of work would feel like, from the moment of waking up until the moment of going to sleep. I just did everything I could think of to revamp my attitude and my approach to work. Some of it felt helpful, and some of it didn't. If something didn't feel helpful, I let it go and moved onto something else.
I meditated, and I did super amateur yoga, and I went for walks in a nearby park, and I even cranked up some music and danced like no one was watching. I slept until I woke up without an alarm. In each moment I did whatever felt like the thing I needed to do most at that moment. When I got sick of problem-solving, I read a bit. When I got sick of sitting, I did something active.
At the end of the weekend, I wrote out a 4-part action plan: Things to Do Immediately, and Things to Change Long Term, with sections for At Work and At Home in each category. I've been working my way through this action plan for about a month now, and it has made a huge difference in my life. I know this boot-camp/retreat approach isn't for everybody, but I found it really necessary to get out of my usual environment and just focus on myself for a while. If that sounds at all appealing to you, I would totally recommend it.
posted by vytae at 5:39 AM on June 13, 2017 [3 favorites]
Before I left home, I printed a list of ideas from my own thoughts and from articles I found online about dealing with burnout. I used a combination of brainstorming and mindmapping to capture on paper every little thing I do in my job, and then I considered which parts give me joy vs which parts drain me. I brainstormed ways to do more of the parts I love, and ways to minimize the parts I don't love. I came up with a list of new boundaries that felt reasonable to me, and phrases I could use with myself, my coworkers, my boss as needed to help me enforce those boundaries. I read somewhere that "burnout is basically a state of depleted resources," so I made lists of things I can do at work and outside of work that help "fill my cup," and I looked for ways I'm being drained that I can change as well. I considered what coping skills I've used to deal with difficult times in the past, and came up with ideas of how to apply those skills to my current situation. I listed the negative thoughts I've had repeatedly about myself and about my job, and tried to find more positive things I could think to myself instead. I imagined in great detail, moment by moment, what my perfect day of work would feel like, from the moment of waking up until the moment of going to sleep. I just did everything I could think of to revamp my attitude and my approach to work. Some of it felt helpful, and some of it didn't. If something didn't feel helpful, I let it go and moved onto something else.
I meditated, and I did super amateur yoga, and I went for walks in a nearby park, and I even cranked up some music and danced like no one was watching. I slept until I woke up without an alarm. In each moment I did whatever felt like the thing I needed to do most at that moment. When I got sick of problem-solving, I read a bit. When I got sick of sitting, I did something active.
At the end of the weekend, I wrote out a 4-part action plan: Things to Do Immediately, and Things to Change Long Term, with sections for At Work and At Home in each category. I've been working my way through this action plan for about a month now, and it has made a huge difference in my life. I know this boot-camp/retreat approach isn't for everybody, but I found it really necessary to get out of my usual environment and just focus on myself for a while. If that sounds at all appealing to you, I would totally recommend it.
posted by vytae at 5:39 AM on June 13, 2017 [3 favorites]
This thread is closed to new comments.
I'm so sorry to hear you feel that way, and are calling yourself those names, and it's great that you're considering therapy. I think therapy is definitely a good idea and perhaps your first question for the therapist is not "how do I find time to get a life, when I'm so tired?" but "why do I feel so angry with myself and what can I do to believe I deserve to be happy?" Anyone who repeatedly calls themselves ugly and boring and a loser is likely to feel too tired to face the world, whatever they do for work -- those words themselves will be depleting your mood and energy and making it harder for you to make plans for your weekends and your future.
You sound like an amazing person, with or without your scrubs. Whatever you end up doing--whether that's staying in your current role or taking up a medical job with less demanding hours or switching careers--you will remain smart and funny and compassionate and interesting. I think tackling this belief that somehow your whole personality vanishes when you leave work--that your friends and your family and your patients and coworkers value the scrubs, instead of the whole person inside them--is the first step. Once you've addressed that, you'll be in a better position to calmly decide how sustainable your current life is and what changes you want to make.
posted by Aravis76 at 12:40 PM on June 2, 2017 [10 favorites]