Chipper in his bow tie, our senior physician approached balancing a tray of milky black tea in his hands. He passed each of us a steaming mug. The scones followed, warm and crumbly, slathered with golden butter and glistening raspberry jam.
We sank into the tweed couches of the hospital lounge eager for a pause. Morning rounds had been a whirlwind of chest pain, strokes, intractable headaches, alcohol withdrawal and diabetes. We had two dozen less acute patients still to see, but first, a break.
Our minds welcomed the distraction. Our tense brows relaxed, shoulders softened, feet relented. We shared jokes and weekend plans between bites and sips. We soon returned our ring-stained saucers to the counter, rejuvenated, ready to better attend to each patient.
As a visiting medical student at a community hospital in Scotland, I found this teatime ritual foreign, but I savored it.
Back home in New York City, morning rounds were relentless. We bounded up and down the wards, scarfing down broken granola bars and smushed Snickers as we took the stairs two at a time. We snuck off to the bathroom, hoping our break went unnoticed. We ended after 12 p.m. with our heads throbbing and guts gnawing.
With so many patients to see, stopping for a rest seemed irresponsible. Our patients were suffering. Our pain, nausea or fatigue was not the priority. Our discomfort was a necessary sacrifice. A good doctor always puts her patients first … we thought.
Trained in this culture, we become skilled at self-abnegation. We ignore our full bladder to perform a spinal tap. We leave our lunch uneaten to see that next consult. We skip pumping breastmilk for our own child to tend to someone else’s. When we’re sick, we load up on Tylenol and don a mask instead of taking time off to heal.
We chose to practice medicine because we wanted to help and heal. We took an oath to attend to others. But when our sacrifice is left unbounded, it depletes. Without allowance to care for ourselves, we are left hollow, exhausted, hungry and ill. Eventually, we become bitter and resentful — unrecognizable to our former selves and in no shape to care for others.
Our health care system often reinforces this, taking advantage of our professional tendency toward self-sacrifice. Health care administrators and insurance companies demand more with less: see more patients, discharge them faster, complete more paperwork, meet more administrative requirements. Physicians are left without enough time to listen to patients, chat with a colleague about a complex case, eat lunch during a long shift or leave clinic on time to attend their children’s basketball championship.
The epidemic of physician burnout, alarming number of physician suicides and growing patient dissatisfaction show our current situation is not sustainable. It is malignant for both physicians and patients.
Throughout my training, my own malignancy forced me to consider self-care. A rare tumor diagnosed just before medical school kept me from ignoring my body’s needs. When I tried to survive on cat naps and crumbs amidst 32-hour shifts, marathon studying sessions, and vending-machine dinners, the tumor recurred to remind me. After tea and scones in Scotland, I cemented my resolve to care for myself as I cared for others.
I purposefully chose a residency program that valued the well-being of its trainees. Though as challenging as any — with long hours, high volumes, sick and complex patients — our program had a strong culture of care.
Every Saturday evening around seven, our pagers flashed “Dinner in the ICU!” We’d cocoon ourselves in the conference room for half an hour, enjoying steaming plates of take-out, sharing a laugh or a cry with residents from other services.
We made sure to learn everyone’s breakfast favorites so we could treat each other post-call. The sight of your oncoming colleague entering the workroom with a smile and handing you a hot coffee and an everything bagel with veggie cream cheese brightened post-call morning rounds.
But care went beyond food and companionship. Our program leadership was understanding when personal illness or family tragedy required a short leave. And we covered for our colleagues because we knew such support would be there for us.
So when my cancer returned again in my third year of residency, I knew I could take time to attend to myself. I ended up needing several organs removed along with my tumor. Their absence now keeps me from self-denial. With only one kidney, I must keep a full water bottle beside me. Without a complete colon, I must eat healthily. With no spleen, I am vigilant about my vaccines.
Forced to face my physical limits and the specter of mortality, I learned to protect myself so that I can protect my patients. When I am hydrated, fed and rested, I am a much better doctor — more patient, more focused, more open.
I am grateful that my mentors — and cancer — taught me such balance early in my medical career. I am thankful to be able to work now in a place that supports the practice of self-care.
But how do we spread the culture of care to all physicians?
Much of the solution is complex, requiring broad changes in insurance reimbursement, administrative load, and health care leadership. But as we advocate for such changes, we can, through your own small acts, nudge our culture toward compassion. We must begin to treat ourselves and each other with the same care we aim to give patients.
We must collectively stand up for our own needs — the time and space to eat and drink, use the bathroom, pump milk for our child, get some sleep, take a quick coffee break to share a laugh with colleagues. We can cover a half hour for a colleague, fill another’s water bottle, take a few minutes to meditate. We can pause to give our students, residents, and fellows restorative moments.
Such acts may seem insufficient to prevent physician burnout, but they are the blocks that build a foundation of well-being. Let’s start building — take ten minutes to put our feet up, have a scone and sip some tea.
Julia Michie Bruckner is a pediatrician who blogs at Julia, M.D. She can be reached on Twitter @JuliaMDWriter.
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