Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Put down the knife: A neurosurgeon explains the importance of a work-life balance

Marc Arginteanu, MD
Physician
March 26, 2021
543 Shares
Share
Tweet
Share

In his novel Buddhism Without Beliefs, Stephen Batchelor observed that “death alone is certain and the time of death is uncertain.” This knowledge should guide us in one of our most important decisions: How should we spend our limited amount of time on earth?

Why do you work so hard?

There are many different reasons why people might work too hard. Often they toil out of necessity. Some people work their fingers to the bone and still have bills that they can’t pay. Others work too hard for non-monetary rewards. As a neurosurgeon, I sometimes fall into the latter category. 

When I speak about lovely human anatomy (at least in public), I often refer to the junction between the brainstem and spinal cord (craniocervical junction). The contrast between the beige, wrinkled cerebellar folia and the smooth, gleaming white floor of the fourth ventricle is breathtaking. Pulsations of clear, colorless CSF wash across the upper spinal cord’s surface like waves across the shore.  

The most common problem at the craniocervical junction that I surgically treat is called a Chiari malformation. This abnormality occurs when, for unknown reasons, a patient is born with a distortion of the skull, lower brain, and upper spine. In most cases, Chiari malformation is a mild anomaly and does not cause any symptoms. But sometimes, the malformation is serious enough to cause severe symptoms and warrants surgery. Chiari malformation typically responds well to surgery, and the patient’s neurological symptoms improve. 

It is hard to exaggerate the gratification I feel after successfully repairing a Chiari malformation. Surgery brings the concomitant adulation of the patient and her family and admiration of colleagues, staff, and students. Mine is a noble profession, and each successful surgery adds to the greater good of the community. Doing surgery is so rewarding that it is difficult to avoid falling prey to the temptation to add case after case, day after day, week after week, year after year.

Why is it bad to work so hard?

A wise colleague explained the danger of incessantly performing surgery. “One missed dinner with the family turns into many. It is easy to convince myself that I have more important things to do than help the kids with their homework, but it is harder for them to be convinced. At the end of my career, I would not remember whether I treated a hundred patients with Chiari or one hundred and fifty. “But,” he said, “I will remember coaching my daughter’s third-grade softball team. I will remember the look on her face after she cleanly fielded a grounder and threw the lead runner out at second. I won’t forget the dozens of times different girls from each team asked, “Are we winning, coach?” after every out and between each inning.”

Can working too hard be bad for your brain?

King Solomon said, “Whoever quarries stones may be injured by them.” He observed that our occupations take a toll. Especially a job that requires us to trade our time and sweat for our daily bread. Those who “live to work” will eventually work themselves out of life. The admonition to a surgeon to “put down the knife” can be generalized. Does your profession exact both physical and psychological costs? 

Burnout

Neurobiological research has demonstrated the importance of a work-life balance. Experiments have demonstrated that the failure to scale back on work carries high physiologic costs. Simply put, working too hard will damage your brain.

Researchers in Great Britain explored the effects of overwork on the brain. The government-sponsored investigators, known as Whitehall II, published their work in 2009. The researchers administered a battery of cognitive tests to more than two thousand British civil servants to obtain a baseline level of performance and then repeated the tests five years later. The tests evaluated verbal memory and skills, fluid intelligence (associated with short-term memory, abstract thinking, creativity, and problem-solving), and crystallized intelligence (learning accumulated over the life span in education, work, and cultural experiences). Compared with those who worked no more than 40 hours per week, Britons working more than 55 hours per week had lower performance scores in all the cognitive realms tested. The negative association between long working hours and cognitive function was not altered by several potential confounding factors, including age, sex, marital status, education, occupation, income, physical diseases, psychosocial factors, sleep disturbances, and health risk behaviors.

People who chronically overwork, especially those in high-stress jobs, tend to burn out. Burnout, first described in the 1970s, emerges when job demands outstrip a person’s ability to cope with stress. At its worst, burnout manifests as an overwhelming sense of exhaustion, feelings of cynicism and detachment, and a sense of professional ineffectiveness and lack of accomplishment. Mounting neurobiological evidence shows that burnout takes a profound physical toll that extends beyond our professional lives; it extends to our brains.  

In 2014, scientists from the Karolinska Institute, Sweden, reported on the effects of burnout on the brain. They studied 40 subjects suffering from burnout symptoms attributed to chronic occupational stress and 70 volunteers who served as controls. They performed fMRIs on both groups to assess the brain circuitry. They discovered the functional connectivity between the amygdala (area of the brain involved in emotions and memories) and the front part of the cingulate cortex (an area involved with emotion, learning, and memory) was significantly weaker in the burnout group. The researchers also noted a deficiency of the connections between the amygdala and back and side parts of the prefrontal cortex (an area responsible for executive function) in the burnout group. On the other hand, the investigators reported that connectivity from the amygdala to the cerebellum (the area that controls coordination) and the insular cortex (a part of the brain active during psychological conflicts) was stronger in the burnout group than in the controls.

In another study at the Karolinska Institute, researchers recruited 40 control volunteers and compared them to 40 patients who suffered from burnout. MRI studies of these patients determined that it was not only the circuitry that was affected by the burnout but also the size of the brain structures. Compared with the controls, patients suffering from burnout showed volume loss in the prefrontal cortex. Burnout patients appeared to also have shrinking in their dorsal striatum (caudate and putamen nuclei (areas that modify movement) and hippocampus (an area involved in emotion and memory),  but an increased volume of tissue in the amygdalae.  

So, put down the knife. Keep a work-life balance. Don’t burn out. Working too hard is bad for your brain.

Marc Arginteanu is a neurosurgeon.

Image credit: Shutterstock.com

Prev

Why this plastic surgeon chose to become a high school science teacher [PODCAST]

March 25, 2021 Kevin 2
…
Next

Being a doctor is my heart-song

March 26, 2021 Kevin 1
…

Tagged as: Surgery

Post navigation

< Previous Post
Why this plastic surgeon chose to become a high school science teacher [PODCAST]
Next Post >
Being a doctor is my heart-song

More by Marc Arginteanu, MD

  • Why do smart doctors sink money into silly investments?

    Marc Arginteanu, MD
  • The ramparts of the neurosurgeon’s mind were unassailable

    Marc Arginteanu, MD
  • 2 questions you should ask when choosing a surgeon

    Marc Arginteanu, MD

Related Posts

  • There’s no such thing as work-life balance

    Katie Fortenberry, PhD
  • Does work-life balance really exist for young mothers pursuing medical careers?

    Sheindel Ifrah
  • How to balance confidence and humility online

    Brian A. Primack, MD, PhD
  • Ethical humanism: life after #medbikini and an approach to reimagining professionalism

    Jay Wong
  • The life cycle of medication consumption

    Fery Pashang, PharmD
  • My first end-of-life conversation

    Shereen Jeyakumar

More in Physician

  • Breaking the cycle of failure in modern medicine

    Kortney West, MD
  • From license to loneliness: the dilemma of retired physicians

    Richard Plotzker, MD
  • Unlearning our habits: a journey from intelligence to wisdom

    Brian Sayers, MD
  • Beyond pizza and pens: National Doctors’ Day should be about saving lives

    James Young, MD
  • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

    Asha Padmanabhan, MD
  • Physicians are a finite resource we need to protect

    Jack Resneck, Jr., MD
  • Most Popular

  • Past Week

    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Collaborating with occupational therapists: a game-changer for behavioral health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
  • Recent Posts

    • Collaborating with occupational therapists: a game-changer for behavioral health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Breaking the cycle of failure in modern medicine

      Kortney West, MD | Physician
    • ChatGPT: the Napster of the AI world?

      Harvey Castro, MD, MBA | Tech
    • The missing piece of physicians’ financial plans

      Daniel B. Wrenne, CFP | Finance
    • Counterfeit drugs: a hidden danger lurking in your medicine cabinet

      Emily Kahoud | Meds
    • How understanding cultural backgrounds can lead to better patient care [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Is Surgery Riskier After a COVID Infection?
  • The Best Medicine for Healthcare Workers: A Living Wage
  • Meat Consumption and UTIs; Air Pollution's Effects on Health
  • 'Early Birds' With Sleep Apnea May Get More CPAP Benefits
  • Mental Health Care Goes Beyond Just the Patient

Meeting Coverage

  • VTE Risk in Recurrent Ovarian Cancer Increases With More Lines of Chemotherapy
  • Obesity's Impact on Uterine Cancer Risk Greater in Younger Age Groups
  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Most Popular

  • Past Week

    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Collaborating with occupational therapists: a game-changer for behavioral health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
  • Recent Posts

    • Collaborating with occupational therapists: a game-changer for behavioral health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Breaking the cycle of failure in modern medicine

      Kortney West, MD | Physician
    • ChatGPT: the Napster of the AI world?

      Harvey Castro, MD, MBA | Tech
    • The missing piece of physicians’ financial plans

      Daniel B. Wrenne, CFP | Finance
    • Counterfeit drugs: a hidden danger lurking in your medicine cabinet

      Emily Kahoud | Meds
    • How understanding cultural backgrounds can lead to better patient care [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...