Sunday, January 22, 2017

What is Done, and What is Left to Do

It will probably come as no surprise to anyone who reads my blog that I am feeling pretty burnt out at the moment, as the few posts that I've had the mental energy to write over the past few months have been all about work stress and feeling exhausted and being too much of a grouch to even want to buy Christmas gifts.  I think I've done a decent job of hiding my dissatisfaction at work, but my poor partner, M, has had to put up with some pretty spectacular wallowing when I haven't been working.  It is frustrating, and frightening, to have put 16 years into training only to find myself feeling this level of unhappiness with my work.

So I've been thinking a lot (i.e. pretty much all the time) about what to do about it.  I've been reading blogs and journaling and talking M's ears off in an attempt to figure out some way of becoming happier.  (I haven't actually been exercising or meditating, of course, because those things might actually work.)  I even bought a book about physician burnout, despite absolutely hating the last physician burnout book I read.  And, much to my surprise, the book has been kind of helpful.

One of the ideas in the book is that, as physicians, we are always focused on what remains to be done: how many letters we need to dictate, how many patients we need to see, how many bloody multi-page forms we need to fill out.  By constantly thinking about what still needs to be done, however, we inevitably feel like we aren't accomplishing anything, and we get discouraged by the seemingly neverending to-do list.  Instead, we'd be much better off putting our focus on what we've already done, so that we are positively celebrating our accomplishments instead of always negatively dreading the work to come.

It's a pretty simple idea, and it requires pretty minimal energy and absolutely zero time, so I decided to try it out this week.  No longer was I going to count the patient files on my desk that needed to be dictated (about 20 at current count); instead, I was going to count the ones in my outbox that were already done.  Instead of focusing on the number of patients remaining to be seen, I was going to focus on the ones that had already been dealt with.  Pay attention to the positive, not the negative.

It sounds cheesy to even write this...but it kind of helped.  It made me realize that my list of things that I have already accomplished is pretty enormous, and it dwarfs the few hours of paperwork that I left undone at work on Friday.  It felt surprisingly good to be a bit of a cheerleader for myself, instead of the evil taskmaster who is always yelling at myself to work harder! and faster! and better!

It worked so well that I decided to apply this mindset to an area of my life that causes my unnecessary anxiety:  my finances.  I'm in pretty good financial shape for being 17 months into practice, yet I waste a lot of energy thinking about how far away I am from being able to retire.  This week, instead of constantly thinking about the minimum of 10 years of work that I will have to do to save up a decent retirement fund, I took a few minutes to list the major financial accomplishments I've made over the past 17 months:
  • Saved up enough money in my investments that I could pay off my line of credit if I wanted to;
  • Saved up enough money that, between M and me, we can make a 20% downpayment on a nice house in our chosen neighbourhood; and
  • Saved up enough money in my investments that I could live at my current level of spending for approximately one year (or for a very long time if I stopped eating out so frequently).
That list makes me feel vastly better than saying to myself "I have to work at this miserable job* for another 10 years before I will feel happy again" all the time.

I know that there are still a lot of things that I need to do to feel happier with my work, but I think that changing my mindset has been an important first step.  Despite being on call again this week**, I've been in a much better mood than I have been since my really stressful department meeting.  I now have six weeks of no call, which includes a one-week trip to Cuba, so hopefully there are even better things ahead.

*My job isn't actually all that miserable.  I'm just feeling so exhausted by it that I am having a hard time seeing the good things.  Which I'm working on.

**I sat down this week and figured out just how much call I've been doing lately, and I realized that I've been on call 1/3 of the time for the past 3.5 months.  That's the amount of call that I should be doing in a 6-month period, and it's equal to the maximum amount of call that a resident is allowed to do.  Suddenly I don't feel so guilty for feeling tired!  As a result of this realization, I've reviewed my call schedule for the upcoming year and identified a few similar problem periods that can hopefully be improved by a bit of swapping with my colleagues.

Friday, January 20, 2017

Today's Patient Encounter

The waiting area for my clinic has a big-screen television, and it was of course* broadcasting the inauguration ceremonies this morning while I was seeing patients.  I called a new patient into my examination room just as the swearing in was about to start, and as we were walking away from the waiting area she said:

"Oh thank God you came when you did.  I can't stand to watch that vile man become president!"

My patients are awesome.

*By "of course", I in no way mean that I "of course" chose to show the vile man becoming president.  I share my waiting area with multiple other physicians and sadly have no say over what is played on the tv.

Sunday, January 8, 2017

2017 - The Year of Saying No

I suspect that I'm not the only person in medicine who is a people pleaser.  Since elementary school, I've always been very academically successful, and the resultant praise from teachers and relatives has given me a lot of pleasure and personal satisfaction.  Going to medical school and becoming a doctor took this to the next level, as suddenly patients and even strangers were regularly praising me for the work I did. 

The big problem with getting so much validation externally is that you start to be dependent upon it.  You need people to tell you how important you are and how no one else can do what you're doing.  And so you constantly seek ways to keep that validation coming.  You say yes to giving one more presentation or fitting another patient into your clinic or teaching one more tutorial.  Even when you don't really want to be doing any of those things.

Over the past few months, I've been feeling depleted, as I keep telling my partner.  I've been feeling overwhelmed by work; I've been having difficulty sleeping; and I've been hit with a bone-weary exhaustion that reminds me of my residency days.  I had hoped that a recent trip to a cabin would fix things, but four days away just wasn't enough.  I'm tired. 

And despite this, people keep asking for more.  Start a research project.  Do more training.  Teach another academic half day.  More, more, more, when all I want to do is stay in bed with my cats.  It has reached the point where I feel anxious not only when my pager goes off, but also when my inbox pings, signalling the arrival of another email asking for my time and energy.

So this year, I'm going to learn to say no.  Thank you for the opportunity, but that isn't my priority.  My priority needs to be finding balance, a level of work and engagement that I can happily sustain for the next 20 years, not saying yes to every single request that comes my way.  I need downtime and sleep and yoga classes and running and home-cooked food and time with the people I love, not another item on my to-do list.

No.

It sounds straightforward, but it goes against the very essence of medical culture.  Physicians pride themselves on being able to work a 28-hour shift and then go climb a mountain on their post-call day.  Medicine is the North American worship of busyness and achievement taken to the extreme.  Saying no means being inadequate and not measuring up to the standard.

And Medicine doesn't always listen to no.  A few weeks ago, I was emailed a request to help someone out with a presentation.  My stomach sunk when I read the email, because it was something that I really didn't want to do, even if I had had an abundance of time in which to do it.  So I sat on the email for weeks, debating the merits of saying yes versus no, until I finally got up the guts to sent a polite email declining the request.

The response?  Within seconds, a return email that basically said "Can you do part of the work for me?".

No! 

I'm still completely flabbergasted by the response.  Why is my attempt to protect my happiness and my time not respected?  Why am I expected to say yes to every request that comes into my inbox?

Learning to say no isn't going to be easy.  It's going to mean letting go of the need for other people to tell me how wonderful I am and what a good job I'm doing.  It's going to mean letting go of the belief that if I were just better, just like every other physician, that I would be able to say yes to everything.  It's going to mean ignoring the blogs of the overachievers, who have a medical practice and children and exercise daily and cook healthy food, and setting my own standards for achievement.  Because ultimately no one cares about my happiness as much as I do.  And no one else in Medicine is looking out for my well-being as much as I am.

Wednesday, December 21, 2016

My Anti-Consumerism Christmas

I've written before about how much I dislike gifts.  It's not that I intentionally want to be a Scrooge, it's simply that I don't have a lot of material wants and needs (by privileged North American standards), and those that I have are easily met on my physician salary.  What I want far more than a sweater that someone else picked for me or another gadget for our overflowing kitchen drawers is time.  Time to rest, time to read, time to do the 1000-piece puzzle that I ordered from Amazon.


For years, I've been trying to convince my family members to simplify Christmas by giving fewer gifts.  And for years, I've been met with a desire to maintain the status quo of everyone giving gifts to everyone else.  This year, however, possibly as a result of my years of wearing down rationally discussing my views with my family members, people have finally agreed to cut back on gift giving.  Success!

Here (in case this is interesting to you) is how it is all working out:

Girlfriend (M):  M is the one person I enjoy giving gifts to, because she has a long running list of things that she wants, which makes her really easy to buy for.  And, unlike me, she loves getting gifts.  Last year I took this way too far, to the point where it was awkward for me to give her gift after gift in front of her family members.  This year, we are giving just one larger gift and one "stocking stuffer" to each other.  Our cluttered apartment will appreciate the (relative) self restraint.

Mom:  Normally my Mom gives everyone multiple gifts, many of which end up being returned or donated to the thrift store because she bought them months earlier to "save money" and they can no longer be returned.  This year, she is planning on one physical gift for each person (maximum ~$30) and one gift card to a preferred store.  Some of the physical gifts are still of questionable quality (sorry M), but at least they are smaller, and at least the gift cards will get used.

Because I hate shopping, I once again bought my Mom season's tickets to our local theatre.  We go to the theatre six times per year, and it's a great way for us to spend some dedicated time together and to do something we both enjoy.  Way more valuable than anything I could find in a mall.

Brother and Sister-In-Law:  I consider this my biggest win of the year!  My brother and sister-in-law have crazy busy lives, which have gotten even busier since bringing home a new puppy, so I managed to sell them on the idea of no gifts between couples.  I'm far happier to spend an hour or two more with them than I would be running around trying to find them a half decent gift.

Nieces:  When I suggested to my brother that we not exchange gifts, his first reaction was "But you'll still get the girls something, right?"  To which I sighed.  Because my nieces have everything.  There is literally nothing in the world that either of them needs.  Clothes, makeup, music, movies, ski equipment, a new puppy.  They have everything.  For their birthdays this year, I copied my idea for my Mom and gave them both season's tickets to our local children's theatre.  But for Christmas?

One of the things that makes me sad about my nieces is that neither of them really reads for fun.  When I was a kid, my single favourite thing was to visit the bookmobile that would come to our neighbourhood once a week.  I would return home with shopping bags full of books, which I would then proceed to binge-read until my parents forced me to turn out the bedroom light and go to sleep.  (Sadly, I didn't own a flashlight for reading under the covers.)  I really want to get my nieces more into reading, so once again I decided to get them books for Christmas.  I was very successful with Chris Colfer's book last year, so they will probably always get books from me.  Whether they want to or not.


 And that's it.  Christmas shopping done with only two trips to the mall.  Success!

If you celebrate Christmas, how are you doing with your shopping?

Edited to add:  Ummm...or Hanukkah.  Of course.

Thursday, November 24, 2016

Gathering my People

This has been a really, really rough week.

Really.

I didn't expect it at all.  I finished call at 8 am Monday morning; I had lots of uncommitted time in the evenings to relax with my couch and my cats; and there didn't seem to be anything unusually stressful in my calendar.  It was supposed to be a good week.

And then we had a department meeting.

There are changes happening at my university, and while logically I expect that the changes will all be fine (if not actually good), they do create a lot of uncertainty.  And as an anxious person, uncertainty is not my friend.  I've spent the whole week calculating how long I can survive off the money in my bank account, wondering what I could do if I was no longer a physician, and being tortured by my sensitive GI system*.  It's been miserable.

While lying awake on the couch in the wee hours of this morning, wishing that my cats would consent to me squeezing them like a security blanket, I realized that I needed to do something differently.  I can't live with this level of anxiety for the ten years or more until I've squirreled away enough money to retire.  This isn't working.

Thankfully, today was a paperwork day, so I had lots of time to figure things out.  And what I figured out was that I need a support system.  People who have been through what I'm going through who can offer me some advice.  Unfortunately, in Medicine this is a really, really hard thing to find.  We are supposed to all be perfect and to not need anything from anyone, so finding someone with whom we can discuss our challenges and vulnerabilities isn't easy. 

Coincidentally, just last week I had run into an attending who, years ago, had given a talk to my residency program about the challenges she had faced as a resident and young attending.  When I realized this morning that I need more people, my brain went "Ah-ha!".  That was who I needed.  Except...she is an attending that I don't know personally.  And I run into her about once every 3-6 months. 

So, going against every instinct of mine to be shy and quiet and never ask for anything, I emailed her to see if she would meet me for coffee.

And she said yes.

And then I emailed another attending.  Who also said yes. 

Suddenly, after a week of feeling alone and scared, I don't feel so much of either.

*For the record, none of this is rationally necessary.  Everything is going to be fine, one way or another.  This is just anxiety.

Sunday, November 20, 2016

How Am I Doing So Far?

This week was my first week of call since I wrote my post about how to not hate call so much.  (I've been on call for 21 of the past 42 days.  Too much call.)  As the week approached, I tried very hard to say no to anything but the most essential of activities.  I deferred dinner with a friend until next week.  I said no to doing anything with my Mom.  I was ruthless with turning people down.

And then the week arrived.

Monday night a group of medical school friends whom I only see a few times a year were getting together for dinner, and I couldn't say no.

Tuesday night my girlfriend's parents invited us over for a birthday dinner.

Wednesday night a friend was visiting from Egypt and wanted to meet for dinner.

Thursday night we decided to go see a new house that had just come onto the market.

Friday night was trivia night at my girlfriend's church.  And I love trivia.

Over the weekend, we have seen three more houses, gone out for breakfast twice, gone for an impromptu coffee with my Mom and brother, watched my niece in a volleyball tournament, shopped at two craft markets, seen Romeo Dallaire speak, and gone for another birthday dinner with my girlfriend's friends*.

I apparently am incapable of just saying no to anything.  If it sound remotely interesting, and especially if it involves food, I am there.  Regardless of how tired or extroverted out I may happen to be.  Regardless of how much I need to just be quiet and still after the stress of a call week.  Regardless of what I say in my blog posts.

And yet...somehow this week worked for me.  I gave myself the option of saying no to things, but when it came time to exercise that option, I never wanted to.  I got to do a lot of fun and interesting things with people whom I love over the course of the week, and it felt pretty good.  I'm not quite sure why it was okay this time when it wasn't the last time I was on call, but somehow it was.  Maybe it was knowing that I could say no to things without guilt?  Maybe it was only being on call for one week and knowing that I would have a long stretch of recovery afterwards?

I haven't the foggiest clue, but I'm very glad it did.  And I'm hoping that it will continue to do so when the next stretch of call comes around.

Monday, November 7, 2016

Ignoring Money

As a medical trainee, I pretty much ignored my finances.  Having been a disciplined saver of at least 10% of my earnings since I turned 18, it was depressing to watch my savings first disappear and then turn into a six-figure debt.  So I didn't.  I stopped looking at my bank account, I stopped filing my taxes*, and I essentially pretended that money didn't exist.

I existed in this world of willful ignorance for eight years, until a scare at work made me question whether I was going to get to be a doctor.  Suddenly the debt that I had thought would be easy to repay grew monstrous, as I imagined paying it off without a physician's salary.  So I started paying attention.  And budgeting.  And slowly I got myself to a point where my net worth went up a bit every month.

And then I got my adult job.  And suddenly my net worth was going up a lot every month.  Within 10 months of starting as an attending, I had saved enough money to repay my debt.  It felt pretty awesome.  But it also felt pretty obsessive.  Every day when I came home from work, I would check my bank balance and my credit card balance and my payment owed balance to figure out how much I was worth.

Every single day.

It got to the point that I was attaching too much of my self worth and feelings of security/insecurity to a single number.  On days when I'd have a good clinic (or, even better, have a good clinic and be on call), I'd feel happy, confident that I was moving towards a future of security and happiness.  On days when I'd pay my rent or my car insurance, however, I'd be miserable.  Any downward movement in my net worth felt like a failure.

So I stopped looking.

For all of October, I kept my net worth file closed and simply ignored it.  I kept tracking my earnings and my spending, and I must admit that I tried to mentally estimate my net worth a few times, but I didn't check my net worth obsessively.  And it felt so much better.  I didn't get angry at patients who failed to show to clinic, viewing them as a lost revenue stream.  I didn't get upset when I had to, or chose to, spend money.  I knew that, regardless of what was happening day to day, overall my net worth was going in the right direction.

I was going to be fine.

Ironically, October had the second biggest net worth increase of any month since I started working.  This was in no way related to my behaviour, and in every way related to the 15 days of call that I worked, but it was still really comforting to know that I could let go of my hypervigilance about money, and it would still be okay.

Now that October is over, and I can check my net worth as often as my heart desires, I'm trying hard to not fall back into my old patterns.  I don't want my happiness to be tied to money.  I don't want to be anxious on the days when my spending exceeds my earnings - which is every single weekend day.  I don't want to be constantly comparing myself to all the personal finance bloggers and feeling inadequate.  I want my money to be in the background, slowly growing, while my much more exciting and fulfilling life goes on in the foreground.

*This is a really, really dumb thing to do. 

---

Wondering what my November goal is?  ABSOLUTELY NOTHING.  I'm feeling burnt out at the moment, and all I can think about is spending four days this weekend at a cabin with my girlfriend.  And books.  And nachos!

Self improvement will have to wait for December.