We talk a lot about work life balance in medicine partly as result of high rates of burn out and other consequences of our demanding work environments. Demands in time and high levels of responsibility combined with an ingrained sense of duty conspire with our training environments to deprioritize our own well-being. This is a time-limited and dedicated period which emphasizes a duty to rise to every occasion with the imperative that this will save lives. An often heard rationale is that when a trainee sleeps they are missing valuable exposure and an opportunity to fine tune diagnostic and treatment skills. Consecutive hours of awake working hours continues to be controversial in training environments which rely on the low paid labor of interns and resident trainees. There is a recognition of the need for sleep but this is always balanced with the need to acquire an enormous body of knowledge, confidence, and the skill set to manage illness which can only come from experience. All of this conspires to minimize the importance of almost every other aspect of life during training.
One problem with this approach is that we move into our profession with no attention to long term sustainability of practice. And if there is any truth to the adage that we become our choices made over time, who are we if all we do is work? For some the question is what else would I be doing with my time? For some relationship in the constraints of work feels comfortable. Within the framework of positive psychology which has identified and studied parameters of a rich and satisfying life, accomplishment hardly seems to need much attention except insofar as putting this parameter back into perspective. Perhaps it needs leveling with meaning, relationship, engagement, and that part of ourselves often deliberately buried in a medical career, our emotions and feelings.
Over the long term this imbalance likely contributes to the high rates of burn out, depression, anxiety, substance use, and completed suicide identified in the physician population. In this context, talk about boundaries, perfectionism, conflict negotiation, mindfulness, and understanding and accepting our more difficult feelings takes on urgency. It is difficult to know what brings meaning to our lives if we simply have no time to reflect. How can we know our feelings in this circumstance even if we did allow them to rise to the surface? But these are the variables of a full and rich life which we rob ourselves of if we cannot deviate from a path of constant immersion in responsibility. In practical terms it is difficult to be an effective healer from a position of chronic depletion. Therapy hopes to catch you after you’ve fallen, coaching hopes to prevent free fall in the first place. Both offer opportunities for a deeper understanding for yourself, your relationships, a space to consider your needs, redefine priorities, and how to effectively make sure these are met wherever possible.