Take a centering moment before every patient appointment. Stand there alone in the hall or your office, for the length of a breath or two, to comport with your vocation, the occupation you have chosen and dedicated your career life to. A vocation is more than a job. It is a calling, something that is bigger than any one person, something that is like a river we step into and join for the duration of our work life.
Approach every patient, asking yourself “How can I help this person build their best life, to become the best version of themselves, whatever that might be?” Approach your interactions with them with devotion. There are people, of course, who act destructively towards themselves and others, including towards you. You certainly must have strategies for successfully dealing with toxic interactions and, at times, ‘fire’ patients who infract safety rules and perhaps other rules too, after receiving warnings. You should never be a patsy, act under conditions of duress, give in to requests that do not meet the standard of care. Otherwise you will come to resent the patient and yourself, and possibly harm the patient at the same time.
Focusing on the patient’s mental illness generally and on their chief complaint specifically is central to what we do. But the problem or problems identified exist in the context of that person’s life. Some mental illnesses are associated with such powerful biological / genetic susceptibility that the person is nearly fated to fall into the illness. But for many patients, their illness is a culmination of many experiential and environmental contributors. Second, every person has a set of resources available to them, oftentimes not used or underused. And third, the mental illness is only one aspect of that person’s life. They have or can have many valuable things to experience and to offer despite the pain and limitations imposed upon them by their illness. Learning about the contributors and resources and the aspects of life that give it meaning is crucial for knowing how to move forward, treating the illness – of course – but also guiding someone into a life worth living.
Of course, I’m sure we would all love to maintain such presence of mind throughout often long and challenging days. Managing the clinic and paperwork demands, often frustrating in their inanity and persistence, makes it difficult to maintain that centeredness though.
Reflect. Be your own therapist. Use the empty chair technique: sit in one chair facing the other and ask a question or share a conundrum about yourself or your life. Move to the other chair as if you were your own therapist. How will you respond? With advice? With questions in turn? What can you learn from taking this more objective stance? Usually a lot. We often know what we need to do if we just remember to ask ourselves, have enough respect and compassion towards ourselves to listen, and the courage to act.
Analyze your workday. Residents (and others too) often gain a lot of weight because they are so busy that they eat junk on the go or eat to self-sooth the stress of overwork and of not knowing how to address patients’ complex and often unresolvable problems. Make plans to turn what seems like combat into a sustainable lifestyle. What do you need? What can you change? Finally take that lesson on mastering the EMR. Say ‘No’ to administrative meetings. Prepare snacks ahead of time. Exercise during work, even if from your chair. Walk during breaks or phone meetings – cover half a mile in 10 minutes. Develop a better sleep routine. You will not ‘fall’ into a healthy lifestyle. Just the opposite: much of our environment is toxic: junk food, junk news, junk entertainment, junk tasks, junk interactions, etc.
One sign of burnout is increasing passivity and a sense of helplessness. You may feel you’ve reached the point of needing some help or advice. Seek out a therapist or a life coach. Or you may wish to take some steps yourself first before seeking outside help. You know how to ask questions. You know how to reflect and consider, discern and judge. Treat my little message here as a cue to initiate this self-conversation. I’m sure you’ll discover you’re quite an interesting person to talk to.
Thanks and take care.
“Life has no meaning. Each of us has meaning and we bring it to life. It is a waste to be asking the question when you are the answer.” – Joseph Campbell
“Life is problems. Living is solving problems.” – Raymond E. Feist
“No life is not worth living. But what is important is that you experience your life as worth living—one that is satisfying, and one that brings happiness.”” – Marsha M. Linehan
“How well I know with what burning intensity you live. You have experienced many lives already, including several you have shared with me- full rich lives from birth to death, and you just have to have these rest periods in between.” – Anaïs Nin