There’s this prevailing theme in modern medicine that I don’t understand—It’s called, “Do no harm to others, but neglect yourself.”
It’s perpetuated by ridiculous working hours, emotional, psychological, and sometimes physical stress, minimal vacation, and maximum pressure to always do a little more. Did you overwork yourself as an undergrad, watch your hair fall out during MCAT studying, then give up family and friends for a fire hydrant of information to the mouth in med school, while simultaneously volunteering, doing research, and maybe even juggling a couple kids or a second degree, just to watch yourself burnout in residency? Well then you should definitely do a fellowship.
After residency, did you add another three years of interest on a vomit-inducing sum of loans for a $10-an-hour fellowship that makes you only-just-competitive-enough for your dream job? Well, then you should consider churning out a few extra publications to beef up that CV!
Now that you are finally a working physician and have found an hour to spare every month to catch a fleeting glimpse of one of your children’s band performances, you should definitely consider being on the board of something. Don’t worry, you will be compensated! Not handsomely, but just enough for you to choose evening meetings over quality time with your spouse and kids.
Let me divulge a major trade secret. It. Never. Ends.
As a physician, you can never quite meet the expectations of each new level you reach, because as soon as you think you’re good enough, something else comes along. It’s like being in a never-ending game of Tetris – complete with flashy blocks of résumé builders that fall from the sky faster and faster until you suffocate trying to fit them into your life.
For some, the pressure and the expectations are indeed too great. We’re seeing more physician suicides than ever before— 28-40 per 100,000, which equals about one dead doctor a day. That’s more than double the suicide rate of the general population, and the highest suicide rate of any profession. The worst part is, even as we spiral into the lowest of our lows, there is minimal support for us as we constantly support others. Who takes care of doctors? An unsettling irony.
Which reminds me of the overhead speaker on a plane. While I’m zoning out and settling in for a nap, the flight attendant barks, “In the event that the plane loses cabin pressure while at altitude, oxygen masks will appear overhead. Please place the mask over your own mouth and nose before assisting others.” This selfish admonition ordering you to sniff some oxygen before helping your kids actually has a purpose: the only way you can be of service to others is if you help yourself first.
Today we see doctors losing consciousness everywhere as they put oxygen masks on just about everyone but themselves. Neglecting their own health and families to become bitter, overdrawn, jaded versions of their previous selves, increasingly unable to help their patients effectively as they continue to battle their own looming problems. When was the last time you saw a doctor take time off to go see their doctor? Ask your doctor about the last time they got their teeth cleaned, or when they last exercised. Ask them about the last time they got Christmas off, or went to bed without working on patient notes. Ask them about the last time they got reimbursed for doing their job without fighting tooth-and-nail with an insurance company. Don’t even bother asking them the last time they got a good night’s sleep. And we wonder why, despite their flashy Audis, so many physicians tell others not to become physicians.
They do manage, though. Honestly, doctors are super-people. Somehow they show up, give their all to their patients, raise families, take calls all night, teach classes at universities, do groundbreaking research, battle insurance companies, tread through $600,000 in loan repayments, and live up to endless “quality” standards. But, during all of that, we lose so many to the chaos, to depression, anxiety, and alcohol. We lose them to a bitterness that uproots the hopeful, compassionate medical students they began as.
Medicine’s motto used to be, “First, do no harm.” I think today it should be, “First, do no harm to yourself.” Put your damn mask on. As a physician, it is so important to find balance and moderation in your work. It’s easy to get caught up in more projects, directorships, manuscripts, and board positions. The idea of more money, more prestige, and more power is so enticing. But sometimes it is an excess of those very things that takes away from what allows us to flourish—our families, our communities, our hobbies, and all the little things that, alongside our career, give us true satisfaction and inner peace.
So I say, as a physician, indulge in yourself. Love yourself. Treat yourself. Take the time to travel, to read, to cook, to sleep. Go tailgate with your friends, spend time with your mom, or talk to someone about your own issues for a change. Take care of your own body—exercise and eat well. Cut back on the alcohol. Skip the meetings for an extra ten grand a year and take time to go to baseball practice/ballet recitals/camping/the movies with your kids. Remember that you are more than a physician, and nurture the other “yous”. The mothers and fathers, husbands and wives, the sons and daughters part of you; the athletes and artists, the readers and writers, the musicians and dancers, the hikers, gamers, builders, and explorers part of you. The best way to love medicine for a lifetime is to invest in all the other facets of you that keep you happy and keep you whole.
So here’s to a new medical motto: Take care of yourself first, so that you will always enjoy taking care of others.
Mariam Molani, DO, MBA is a 2nd year pathology resident in Omaha, Nebraska. She is passionate about physician health and wellness and social media education. You can follow her on Instagram @drmarmolani.
Thank you! And yea, DO!
Thank you so much for this, it’s exactly what I needed to read in the moment!
Very well written and true glad more women are speaking out against a “norm”that cannot remain the norm
Spot on — thanks for this excellent piece!
Women physicians are especially bad at self care. After 26 years of practice, I am finally realizing that it is fine to take some “me time.” I no longer have to prove that I am better than my male colleagues. I am worthwhile in my own right. The author is correct. If you don’t call halt; It. never. stops.
Hope to see you at the DO NO HARM film screening at UNMC December 5 th.
Well said. Thank you.
Beautifully written! Thank you.
Thank you! I’m sick with a head cold and just called out of work for the next 2 days. I WAS feeling guilty for taking care of myself. Your article reinforces that this type of self care is important and that I’m not a slacker for resting at times when I would encourage my patients to rest.
Thank you. So true and honest. You get us. It really puts things in perspective
Look up Dr. Mark Greenawald at the Carilion Clinic of Family and Community Medicine in Virginia. He has been a leader in constructive and creative ways to address physician burnout/ teaching physicians to care for themselves. He led a really good workshop on this at the Virginia Academy of Family Physicians annual conference this summer. See also this article
Very well written. Loved it.
My experience tells me it’s true and possible to ‘Be the change you want to see in the world’- Gandhi
When my patients notice how calm and healthy I look, I remind them of possibilities for a healthy lifestyle not by words but by being what I see possible in them. From that starting point we partner to improve what we can with and without meds. Ofcourse a lot of them still distegard it saying ‘oh you are young’.
This insight did not come easy though. It’s only after one major burnout, 2 kids and another burnout that I can say this.
Thank you for writing this.
I wish I could have read this article 50 years ago. Maybe it would have saved me from the feeling that I was swimming uphill all those years. Old habits die hard – I still have trouble putting myself first!
Thank you all for your overwhelming support! I’m lucky to be in the company of such talented, compassionate, and hard working women physicians. This article was written for all of us who spread ourselves a little too thin–I’m grateful to have made even a small positive ripple in your day.
Totally quit the private practice because I did nothing but work and was burning out quick. I was not compensated adequately for the 14hr days with only 4 days off monthly. I never made dinner for my family, never volunteered in class, didn’t go to the spa or gym for years. As the only female, the other providers didn’t get it, or care. When I spoke up about the injustice, I was threatened to be fired!
Now I work as an intensivist and have half a month off AND am fully supported by my team while making 1/3 more. I encourage all to seek happiness in their work. You certainly earned it!
Very well said. I have thought this since residency a decade ago. I’m finding my balance slowly. Let’s hope the public (and insurance companies) catch on to this crisis and loosen the noose.
This is wonderfully written, and it is so very true. We need more voices in medicine to speak up in this way, and say, “enough is enough!” If we don’t take the responsibility ourselves to halt this madness, it simply will continue as the status quo it’s always been.
Very well written. We physicians do have someone who can help us – a counselor. We just often don’t take advantage of this option. Counseling can help put things back in perspective for us type A, hyper-responsible, personality types.
Fantastic article and well put. I would venture to say that a large component of burnout is from the current healthcare system and how broken it is. To have to spend 2 hours on paperwork for every hour of patient care is NOT why we went into medicine. I would encourage primary care doctors to check out “Direct Primary Care” and how it can be a way to finally enjoy medicine again, break free from the bondage of many administrative tasks, be in charge of your schedule, prioritize your family and STILL have a rewarding medical career. I feel like we have found a lifeboat and I want to spread the word to everyone. Google “direct primary care” or “DPC” today.
What is the first rule of medicine?
First do no harm
First do no harm – to yourself
Thank you for your frankness on this important topic. I have been haunted by the voice of an old-school dinosaur who taught me in med school, saying “you must always put the patient first,” “never put your own interests above those of the patient.” As a psychiatrist specializing in complex PTSD and Dissociative Disorders (in adults with severe histories of childhood trauma), I realized earlier this year that I was suffering not just from burnout but from vicarious PTSD. I didn’t understand what was happening until not only my personal health but also my job performance was markedly suffering. Why did it take job impairment for me to hear the alarm bells? Because it was to the point of affecting my patients, and we can’t have that! (I’m not denying the importance of job impairment, just noticing how strong my indoctrination was, that personal distress is secondary to patient distress). Had I noticed and prioritized my own health sooner, it would have been better for me and also for my patients. By the time I took action, the hole I was in was very deep. I’m happy to say I’m close to recovered now, but I hope others can protect themselves better.