John D. Kelly IV, MD, is a professor of orthopedic surgery at the University of Pennsylvania. He focuses his blog on helping surgeons reduce stress while achieving balance in their practices and families.

BLOG: Self-care is not selfish

I continue to write on the burnout epidemic in medicine because it continues to rage on, with no apparent end in sight. Declining reimbursement, insurance demands and the growing demands of the electronic medical record model have taken their toll.

However, despite increasing stressors, burnout can be averted if one makes a conscious decision to prioritize self-care. Decisions that protect our personal space and time may result in a slight drop in immediate income, but long-term effectiveness will be enriched as well as relationships, longevity and happiness.

Many of us were called to medicine because of a deep need to be needed. Those of us trained in the old days lived by the mantras: “My time is not my own” and “Patients’ needs come first.”

Indeed, we sacrifice much in our training and practice. Those of us who are responsible and dedicated do put our patients above ourselves. However, the data are clear: We have to set limits on our energy expenditure. Principles govern and if our biological, psychological, social and spiritual needs are not met, our bodies and minds begin to malfunction.

Raised in an austere Irish Catholic household, I was instructed that thinking of “number one” was innately selfish and that we are all placed on this earth to serve others. While service is indeed a noble pursuit, dedicating oneself to others without limits leads to emotional depletion and exhaustion.

My epiphany occurred in 2000 when I feel victim to a serious infection, uniquely seen in immunocompromised hosts. I was getting scarce and poor sleep, taking a lot level 1 trauma call while trying to be a good husband and father. The only person I was not thinking of was myself.

I am not speaking of an egoic, narcissistic self pre-possession: Resilient individuals emanate a healthy self-respect. Resilient surgeons know their limitations and are attuned to what they can realistically give. They set boundaries to their time and energy and protect precious hours with loved ones. Good sleep, nutrition and exercise naturally flow from a mindset that recognizes that self-care deserves primacy over caring for others.

We simply cannot give what we do not have.

Our goal should be to recognize that we are each endowed with basic immeasurable value and dignity by our creator. Those of us who enjoy long productive careers and satisfying relationships recognize that accomplishment and fame are evanescent and do not add one iota to our intrinsic worth.

We are already good enough!

Tomorrow try this:

1)     Stretch yourself each day by saying no to something you would ordinarily agree to.

2)     Start teaching others how to treat you. Do not tolerate abusive or critical language or any behavior that violates your dignity. What we allow conveys how we wish to be treated.

3)     Make a contract with yourself to start treating your body like the shrine that is really is! Before you reach for that donut, ask yourself: “Is this loving to my body?” Contemplate on how as little as 90 minutes of cardio exercise can change your mood and energy.

4)     Make a “no fly zone” on your schedule for family and important events. Tell your secretary or administrative assistant that this apportioned time is ironclad.

5)     Take up a hobby and invest time into it. Hobbies facilitate mindfulness, divert our thinking away from work stressors and promote wellbeing.

6)     Invest in your own spiritual development. Spiritual well-being is inversely proportional to burnout prevalence.

7)     Dedicate yourself to a life of integrity. There can be no real self-respect – which ultimately determines how you treat yourself and others – without a deep appreciation of one’s own goodness.

 

References:

Ames S, et al. J Bone Joint Surg Am. 2017;doi:10.2106/JBJS.16.01215.

Bowman J. Prof Case Manag. 2007;12(5):252-253.

Sanchez-Reilly S, et al. J Support Oncol. 2013;11(2):75-81.

Shanafelt TD, et al. Oncology. 2005;68(1):23-32.

Wachholtz,A, et al. J Contemp Med Educ. 2013;1(2):83-91.