Physician, Heal Thyself

"I am away from the office living my best life and will not be reading or responding to emails until I return."

I came up with the topic of this article on a plane ride from Boston to Miami during Columbus Day weekend. Self-care, wellness, burnout – the buzzwords floating around social media in the recent years. Some of the things that contribute to physician burnout are:

  • Meetings that should have been emails
  • Endless "reply all" emails that you did not need to be on
  • Continuous stream of patient messages in your EMR inbox that did not need a physician to manage
  • Paperwork
  • Peer-to-peer insurance requirements
  • Prior authorizations
  • Demanding patients
  • Bad attitudes
  • Endless required annual training
  • Imposter Syndrome
  • Meeting your "RVUs"
  • Searching for open hospital beds for patients
  • Disability forms
  • "I didn't go to med school for this" tasks
  • More paperwork
  • Unhealthy work environments
  • Medical school loans

Physician suicide is real – at times it is sensationalized and at times we find out a colleague "died suddenly." It has touched me personally as I lost a residency friend to suicide and a medical school classmate who decided he was done as an attending long after we graduated. The numbers are striking and they say we lose about 400 physicians to suicide each year, the equivalent of two to three medical school graduating classes. According to an article published in the New England Journal of Medicine, the suicide rate among male doctors is 40 percent higher than among men in general, while the rate among female doctors is 130 percent higher than among women in general.

Ironically, while also on a plane in 2015, I was struck by the heading of an article in TIME® that read "Doctors on Life Support." They mentioned a Stanford surgeon who was "once a tough, unforgiving surgeon prone to bullying his residents, [who] now calls himself a repentant sinner" after learning about the suicide of one of his star chief residents shortly after graduation. This incident pushed him and others to create a program that promotes psychological well-being, physical health and mentoring for residents. Stanford went on to be the first academic medical center to create a position of chief wellness officer in 2017, and many academic centers followed suit.

I am certain that some of the old-school, "back in my day" physicians think we are being coddled, and that physician burnout is nonsense because they spent their lives within hospital walls and wellness programs were not necessary. Well, I do not care what was done in the past. Today we can be happy, healed and well-cared-for physicians who do brilliant work, but also have outlets that promote self-healing, escapes outside of medicine and full lives outside of our professions.

We give so much of ourselves to patients that sometimes we lose ourselves in our careers. The best doctors are the ones who can talk to a patient about not just their illness but also other things going on in the world, such as last Sunday's NFL game, March Madness or the new casino opening in town. We do our best work when we feel good; we are less toxic to our colleagues, patients, friends and loved ones. We must take care of ourselves. Why? Because doctors who take care of themselves are better role models for their patients and children, have higher patient satisfaction and safety scores, experience less stress and burnout, and live longer.

As early career professionals, we get a lot offered to us and sometimes we have trouble saying no. I do not have that problem anymore because I realized the importance of setting limits. If you do not enjoy doing it, it does not make you money or it will not help you advance in your career, do not do it! Decide what your priorities are and get organized. I use my Outlook calendar for everything from Grand Rounds to dinner with friends. I have an old-school notepad with Post-it notes that I use for things I want to finish in the next couple of days. Reexamine your priorities often because they will change as life happens.

Have a life outside of medicine and find time for the things you love to do outside of work. Some of the things I do are:

  • Spend time with my "normal" friends (i.e. no connection to the health care world whatsoever).
  • Continue involvement in my sorority, Alpha Kappa Alpha Sorority, Inc. This allows me to connect with the community in ways outside of medicine such as building playgrounds and other service work.
  • Talk to my bright-eyed undergraduate student mentees.
  • Find trusting work buddies to connect and spend time with at least once a month to vent over dinner and drinks.

Some things I am interested in outside of work are:

  • Travel groups
  • LeBron James
  • Future Hendrix
  • Concerts
  • Manicures and Pedicures
  • College basketball

Disconnect from work when you are on vacation or off for the weekend – and I mean completely disconnect from email, texts and calls. Sign your pager out and put up an away message on your email (you can use the quote in the beginning of my article). Make it clear that you are disconnecting, and respect your colleagues when they are on vacation too. Do not bug them with work unless you really need them. That is why we have service models, because this is not the "back in my day" days. Make sure your patient respect boundaries.

Also, be present in the time you are spending with loved ones and friends. Years from now, these are the times that will matter. It is most important how you spent time with the ones who mean so much to you. And for heaven's sake, take your vacation days! I do not understand physicians who do not use them. The hospital will go on without you and your patients will be just fine, so take comfort in that.

We have the best jobs in the world and I cannot imagine doing anything else. We truly change people's lives and invest so much of ourselves both physically and emotionally. We deserve time away to disconnect, recharge, do the things we love, tend to our loved ones, be present in our lives outside of medicine and heal ourselves. We can simultaneously love our careers and our lives outside of them. We can be great at work and be great outside of it – it is the best of both worlds! So at least once a week do something you love, even if you have to do it alone. Your patients will be better off for it.

Go on my incredible colleagues and live your best life! Doctor's orders!

This article was authored by Nasrien E. Ibrahim, MD, FACC, heart failure and transplant cardiologist at Massachusetts General Hospital and Harvard Medical School in Boston, MA.