Making Changes to Improve Physician Work-Life Balance

I am attending a leadership development course this week. One of the facilitators was remarking that when you have an imbalance in your life, for example, by working too many hours each week, you are the one responsible. Not only are you the one responsible, you are the one who is responsible for changing it. He identified that anytime you face a situation with which you are unhappy, you can do one of three things: accept it, deny it, or change it.

I think of the situations that frustrate me - patient care situations that leave me feeling impotent, scheduling conflicts, over-commitments of every flavor. I have to own that I spend a lot of time blaming all the forces of the universe that brought me to the place of discomfort. I play the ever-popular, never-helpful "what if" and "if only" game. I wait for "things" to change - the patient to start taking my advice, the schedule to magically improve simply by virtue of being entered into my smartphone, or "no" to start coming as easily as "yes" seems to. I almost never sit down and critically evaluate the true options - acceptance, denial (always a favorite defense mechanism), or change. Truth is, there's a role for each.

Acceptance is necessary in all aspects of our lives. I need to accept that our elected representatives can't get their stuff together and make healthcare reform any better than an absolute nightmare. As such, I can try to change the current frustrating provisions of Medicare reimbursement or I can accept that it is what it is and move on. I also need to accept my patients for where they are and what they are ready to do. Finally - and this is the hardest for me personally - I need to accept that bad things happen to patients I care for and about despite my best efforts.

Don't knock denial. It's everyone's favorite coping strategy for a reason. My patient (customer) satisfaction surveys indicate that approximately one in five of my patients do not think I am the best thing that ever happened to medicine. I can accept that but I don't actually find this survey represents my patients' opinions of me accurately. I could change it but am already doing the best I can, so I am fresh out of ideas about how to be even more patient-centered (although I'm sure there are areas I can improve). In essence, I've chosen the warm fluffy blanket of denial in the cold, dark landscape of one version of truth. I think that may be the best use of my time for this particular issue.

Finally is the hard one - change. I learned a lot of clinical pearls along the way from attendings and residents, textbooks, and lectures. I spend a fair amount of time trying to unlearn the pearls that are actually wrong and change my clinical practice in a way that is most evidence-based balanced with common sense. 

So, this week, as you look around at the parts of your life that aren't working, consider what you can do. Sometimes just accepting things is the way to go. Other times, despite what your therapist may tell you, denial is a powerful tool. And, finally, think about the things you need and want to change. Good luck in your search for balance.