Disclosures: Sweetenham reports no relevant financial disclosures.
September 10, 2020
5 min read

Separation anxiety

Disclosures: Sweetenham reports no relevant financial disclosures.
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My wife and I are just completing a 1-week vacation/road trip, which included a visit to our sons and another opportunity to see our now almost 11-month-old grandson. It’s a real joy to see him thriving and developing so quickly.

He is now at the age when he is distressed by separation from his mom or dad, even for the shortest period of time, and although he is distractible for a few minutes if they are not around, he quickly needs reassurance that they are close by before he can relax and play happily.

Of course, separation anxiety is a relatively short-lived developmental phase we all go through in infancy. As I reflect on my vacations over 40 years as a physician, I’ve realized that separation anxiety may manifest itself differently in our professional lives, but for many — myself included — it’s a real phenomenon.

John Sweetenham

At a time when concerns for physician wellness and burnout are so prominent, it’s ironic that our ability to disconnect from work has become much more challenging. Advances in technology, ever-increasing connectivity and the recent lessons learned from the COVID-19 pandemic have made it more difficult than ever for us to completely switch off and let our colleagues take care of things while we take some time out.

‘Simpler times’

From my own personal perspective, the nature of separation anxiety has changed over time.

As an intern and resident, there was a sense of guilt in taking time out, partly because this meant an extra burden on colleagues who would be picking up the slack while I was out, and partly because of a feeling that I was abandoning my patients to others.

The second of these fears was, of course, completely irrational. There was a highly competent team taking care of our patients, and my fears in this regard were most likely a product of my inexperience and of the codependent relationships that can develop with patients, especially early in one’s career.

But, those were simpler times — there were no cellphones, there was no internet, email didn’t exist and the only regular methods of communication were through land lines and a pager. Once I turned off my pager and left the building, I couldn’t be reached for a week. I might worry about what was happening “back at the ranch,” but I had no influence over it and, after a few days, I could switch off for a while.

That all began to change in the late ’80s and early ’90s, as cellphone technology developed very rapidly, the internet took off and email became the mainstream method of communication for most of us. Although these media were widely regarded as enabling technologies that were going to make our lives easier and buy us more time, the reality was quite different.

I remember an inspired sketch from a British comedy TV show in the early ’90s, featuring Andrew Sachs (of Fawlty Towers fame) as a stressed businessman trying to get to a meeting in Amsterdam from London. As he is delayed getting to the airport, he navigates multiple cellphone messages, changing flight schedules, incoming faxes (remember those!) and changes of the meeting location. His life becomes increasingly frenetic, culminating in him arriving in Amsterdam to a voicemail letting him know the meeting had been canceled.

In simpler times, he would have missed the original flight and gone home.

Staying engaged

My own vacation-related separation anxiety began to change — now I could be reached while out of town and, more alarmingly, I could easily call in to find out what was going on. My anxiety transitioned from worrying because I didn’t know what was happening, to worrying because I did.

Even though I was now in the picture, my ability to influence events back home was still limited. The more prophetic aspect of this change was that I now began to feel that I should check in from time to time, just because I could. Even worse, I began to worry when no one contacted me — maybe I wasn’t indispensable after all.

As technology has continued to advance, especially with smartphones and other mobile devices, connection to work has become increasingly seamless and separation from work has become a much more active process — a skill that many of us, including me, have struggled to develop.

Full connectivity with work is now very easy and, if I am honest, almost a badge of honor. To be fully available while on vacation can be seen as a noble sacrifice of one’s own time to the greater cause of patient care.

I, and many others, can justify this constant checking of email during vacation — a practice that those around us can find very frustrating — as a way of reducing the crunch and minimizing the catch-up time when we return to work. To some extent, this may be true, but I think there is a part of us (or of me, at least) that needs to stay in contact and to let others know that I may be away, but I’m still on top of things.

I’m reminded of a trip I took to Japan many years ago. My host came to dinner late one evening without his jacket, which he explained that he had left over the back of his office chair so that if anyone looked in, they would assume he was still at work. Maybe checking and responding to email is my electronic equivalent of the jacket on the chair — letting everyone know that I may be out, but I’m still engaged.

Benefits of restorative time

As COVID-19 has affected us, and we have all become so familiar with virtual meeting platforms, this has opened even more opportunities to alleviate separation anxiety — now it’s easy to join a meeting while on vacation, too.

I considered doing this as well until I came to my senses and realized that there was no meeting during my week away that couldn’t go ahead without me — my motivation for considering this had more to do with my desire to feel needed than with any substantial contribution I could make.

In a time when work-life balance is so difficult to achieve, “enabling” technology is working against us to make it easy to be in constant contact.

Ignoring the ping of your cellphone indicating an incoming email takes self-discipline, with which many of us struggle. Maybe even turning the phone to silent will help control the urge to be permanently on top of things.

Perhaps it’s also important to remember that the remarkable advances in cancer care of the last 50 years probably haven’t been due to our ability to check email wherever we are and whatever the time. What’s more important is that we put aside the anxiety of separation from our day-to-day work and take restorative time — in the end, this benefits our patients, our co-workers, our families and ourselves.

I could write more, but it’s time to get back on the road, and I should probably check my email before we leave.

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