8 ways to make morning transitions (with kids!) go more smoothly

Recently I’ve found that the best way to get my kids (ages 2.5 and 4.5) to play nicely together is to announce that it’s time to get in the car.

I’ve never seen anything like it. The second I call out “socks and boots!”, they dive right into a game of Restaurant or Trapping Imaginary Monsters or Let’s-Pretend-These-Empty-Laundry-Baskets-Are-Boats. It’s cute and all, but it’s a little maddening too. Where is all this goodwill when I want them to entertain themselves on a random weekend afternoon?? And once they’re engaged in a game, it is even harder to move them through space.

This issue of how best to shepherd kids through the morning and get them out the door has been a common theme across my therapy sessions in recent weeks. Some people get irritable and end up shouting at their children, and then feel bad about it later; others maintain calm but are chronically late (and therefore frustrated/in need of a solution). Either way, it highlights the inherent stress that mornings generate for so many families.

With all that in mind, I’ve compiled some tips for a smoother morning departure. A lot of these pertain more to younger kids, but many can be adapted to older children as well:

    1. Set a timer. Kids often respond better to an external alert that is not you. An alarm grabs their attention more effectively than your voice, especially if you change the sound periodically (“when you hear the ducks quacking, it will be time to get your shoes on!”) It also shifts the authority onto your phone or kitchen timer, which can take some of the emotional “charge” out of the interaction and prevent a power struggle from developing.
    2. Have a routine. Make sure your kids know how the morning will unfold and what they’re expected to do, especially if something is going on that will disrupt the usual routine. It’s really helpful to do things in the same order each day so that your kids can start to move on autopilot a little bit. A white board or piece of paper on the fridge with a checklist can be a fun, interactive tool and can help kids keep track of where they are in the sequence of events.
    3. Allow them to make some choices. Kids of all ages do better when they feel like they have some control over their environment and their life. You might let them pick their own clothes, their own snack for the car, or the song or podcast on the way to school. Save the authoritative determinations for when you really need them (like setting and enforcing the time of departure). If you find yourself saying no all morning long, your kids may be less cooperative overall.
    4. Leave enough time. This seems obvious, but it really is true that rushing around creates a lot of unnecessary stress. We often think we can accomplish more than is possible in the time we have. If your child is a slow eater, or has particular trouble with transitions, you need to budget a realistic amount of time for the whole routine. You may be surprised how much it helps to get yourself (or even your kids) up 15 minutes earlier.
    5. Help them transition whatever they’re doing to the car if possible. If they’re engrossed in a book or a writing project or a game, see if there’s a way to continue this in the car in some modified fashion. You might give them a clipboard so they can keep doodling, or allow them to choose one toy to bring with them in the car. Even if they’re not in the middle of something, inviting younger children to pick out a toy to bring with them can ease the transition and prevent meltdowns.
    6. Be specific with requests. Saying “let’s go!” over and over again is not as effective as “It’s time to get your socks and boots on, and then we’ll walk out to the car together.”
    7. Make it into a game. For older children, you might try timing how long it takes them to accomplish their tasks, or finding another way to incentivize their cooperation. Maybe it’s a coin in a jar for every morning they go through their checklist without reminders, and at the end of the week they can trade in the coins for a reward.
    8. Communicate with your partner. If you have a partner who’s also part of the morning scrum, make sure he or she is on board with planning the routine. Assign/take jobs based on logistical considerations and/or your strengths. And make sure things feel equitable, or you may find yourself seething with resentment — a behind-the-scenes stressful emotion that can increase irritability and decrease patience.

 

 

What challenges do you face when trying to get out the door? What works for you? Shoot me an e-mail and let me know.

 

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The power of Wise Mind

In my women’s dialectical behavior therapy (DBT) group, we’ve been discussing the simple but powerful concept of Wise Mind.

In DBT we talk about three main mind states: Reasonable Mind, Emotion Mind, and Wise Mind.

If you’re a healthcare professional, Reasonable Mind will be very familiar to you. It’s likely where you are when you’re seeing patients, especially if you work in a discipline like emergency medicine or surgery in which decisions have to be made quickly. When you’re in Reasonable Mind, you get sh*t done. You’re logical, rational and focused on facts. Your own emotions are not in play. There’s no space for them.

Emotion Mind is on the opposite end of the spectrum. It’s the blazing fire to Reasonable Mind’s cool, placid lake. In Emotion Mind, you’ll find yourself in an impulsive, passionate place. You may say things you don’t mean or do things without thinking them through. Choices made in Emotion Mind are driven by anger, sadness, desperation, euphoria — you name it. Your ability to reason and apply logic are nowhere to be found.

Wise Mind is the balanced blend of both. When you’re in Wise Mind, you have excellent judgment. Wise Mind allows you to stay connected to your feelings (important, because your feelings give you critical messages and information) while simultaneously accessing your logic and reasoning. You can be compassionate, empathic and authentic. You are aware of the needs and emotions within yourself and of others, and aware of what’s in your own best interest, of what makes the most sense. It’s an integrative place — a synthesis of intuition and facts.

Making decisions, having difficult conversations, expressing your feelings, asking for things, managing crises…pretty much any interpersonal situation you can think of will be better if it comes from Wise Mind.

Getting to Wise Mind and staying there consistently takes practice. One of the main building blocks for accessing Wise Mind is cultivating a basic awareness of your thoughts and feelings. It sounds simple, but many of us do not have this awareness. If I were to ask you right now how you’re feeling, there’s a chance you’d stammer and say, “Um…let’s see…I don’t know? Fine? OK? Nothing? I’m just reading an e-mail!”

You might try asking yourself how you’re feeling a bit more often, just to see what comes up. What do you notice in your body? What thoughts do you have when you’re feeling peaceful, frustrated, depleted? (An important distinction: Thoughts are sentences in your mind; emotions are one word. Examples of thoughts: “I want pizza for dinner,” “I can’t seem to stay caught up at work,” “Am I a good mom?” Examples of emotions: content, relaxed, angry, sad, furious, betrayed, untrusting, despairing.)

You can also learn a lot from reflecting on times when you’ve been in Wise Mind. Even if you tend more toward Reasonable Mind or Emotion Mind, chances are you’ve had some experiences of being in Wise Mind, when you are in tune with yourself and others. What was going on that allowed you to inhabit this space?

If you’d like more support around any/all of this (coping with endless winter, identifying emotions, accessing Wise Mind…) e-mail me or give me a call: 585-568-7044.

 

10 ways to curb chronic stress

I recently visited The United Way of Greater Rochester to talk about BURNOUT PREVENTION, and we had a fantastic discussion about these 10 chronic stress-busters. I wanted to share these ideas with you.

Some may see super obvious…but if you find yourself thinking “yeah, yeah…I know that already” and yet you have not successfully been able to implement the suggestion, you might want to ask yourself what that’s about.

Which one resonates with you the most? What gets in the way of taking action on certain ones?

  1. Be honest with yourself about what recharges you.

If you’re an extrovert, it’s probably social time with friends; if you’re an introvert, it’s probably alone time. Or maybe you’d like a mix of both. The key here is to find ways to include more restorative time in each and EVERY week, and ideally each and every day, without getting bogged down with guilt. Time to recharge is not a luxury item, it’s a necessity.

  1. Take care of your body with exercise.

Notice how this is phrased: exercise should feel rejuvenating and restorative, not like a punishment. If you love Beachbody workout videos, that’s awesome! But intense workouts are not the only way. Walking is more than acceptable, and if you wear the right clothing, you can even walk in winter. Try adding music or a podcast or audiobook to your routine to make it more appealing. Or find some yoga workouts on YouTube. Or get a jump rope and head out to your driveway or garage. Be creative!

  1. Feed yourself delicious, healthy food that you like to eat.

Eat when you’re hungry, stop when you’re satisfied. If you tend to snack or stress-eat, or see food as a primary source of pleasure or entertainment, you may want to take a closer look at this pattern. Sometimes food seems like the ultimate treat/reward after a long day, but over time turning to food in this way can create weight issues and exacerbate feelings of guilt and powerlessness.

  1. Set better boundaries with technology.

You don’t have to be at the mercy of every text, email and push notification that comes your way. Figure out who the people are that you absolutely have to respond to in real time (your kids, your boss) and manage your phone so that you do not get other alerts. Put limits on social media use. Carve out time when your phone is off or on silent so you can put your full attention on other activities.

  1. Find ways to nourish yourself that truly are nourishing.

There may be nothing wrong with the occasional Netflix binge or margarita, but these aren’t sustainable ways to take care of yourself and can have pretty negative consequences when done too often or too much. One way to get to the bottom of what truly lights you up is to ask yourself what you loved to do as a child that you lost sight of as you became an adult. Coloring? Reading fiction? Playing board games?

  1. Get enough sleep.

What gets in the way of your ability to get a full night’s sleep? Maybe you have a child who doesn’t sleep through the night or maybe you get caught in a worry cycle; maybe you go into perfectionistic mode with work responsibilities or find yourself going down a Facebook rabbit hole every night. Being sleep deprived is like walking around with stress-tinged glasses on all day. Your patience will be low, you’ll be more prone to overreacting or taking out your frustration on the people you love. It’s worth troubleshooting this as much as you possible can so that you are giving yourself the best chance possible of recharging each night.

  1. Pay attention to your dreams and wishes.

This includes acknowledging your deepest desires, no matter how ridiculous or impossible they may seem — a happier marriage, a better relationship with your teen, a healthier body, more rewarding friendships, more money. As adults, we sometimes get used to pushing aside what we want, focusing instead on pleasing others. Your dream may not seem attainable right this second, but even taking small steps toward it each day can feel empowering and energizing. You may even find it helpful to do some journaling: imagine how you’ll feel and what you will think if you get what you want. Can you start acting as though these dreams have already come true? What kinds of think would you think about, feel and do if you were already where you want to be?

  1. Cultivate self-compassion.

Have you ever listened in on the monologue that goes on in your head all day? You may be surprised to realize that you’re not all that nice to yourself, particularly when you make mistakes. But the truth is, if you’re striving for improvement or change in some area of your life, you’re not going to get it perfect — and beating yourself up along the way will not help you get where you’re going any faster. In fact, it will almost definitely stall your progress. Change starts with accepting yourself exactly as you are right now and imagining what you want for yourself, believing you are deserving of good things, and creating the thoughts and feelings you want to have in the here and now. Meditation can really help with this, particularly loving-kindness meditations.

  1. Cut down on decision fatigue.

We make hundreds of decisions every day, and this can really add onto our overall stress levels. You may not think that choosing what to wear or what to eat for breakfast is a big deal, and in and of itself, it’s not… but research shows that we really can use up our mental energy when we bombard ourselves with decisions all day. One way to cut down on decision fatigue is to create routines or protocols for certain things. You may decide to eat the same exact thing for breakfast every day for a week, or have a rotating “schedule” for your outfits. You might not check e-mail until after 10:00 a.m. to give yourself an hour to work on longer-term projects before getting caught in the response-mill. Find ways to make decisions for yourself ahead of time and see how this affects your overall energy level.

  1. Get high-quality therapy.

OK, I’m biased here. But I think therapy is so worth the investment in time and money. Especially if you need another perspective as you sort out some of the above suggestions! The cornerstone to a fulfilling life is mental wellness — i.e. the ability to recognize and regulate your emotions, ask for what you want and need, create healthy and happy relationships. Therapy is so much more than just talking or venting. It’s about exploring the blocks and barriers specific to you and your life, getting your relationships in order, understanding more about why you do the things you do, feeling happier and more in control… the possibilities are endless.

Let me know which ones you’ve tried — which work for you, which have bombed, and which ones you’re going to try to integrate into your life.

Also, quick reminder that my new co-ed process group, Relationships Group, starts on Tuesday 3/6! This is for anyone who could stand to do better with communication, arguing fairly, identifying and expressing emotions…it’s going to be awesome.

I also have a women’s DBT skills group starting on Monday 2/26.

Limited spots remain in both groups. If you’re interested in either, fill out an interest form here.

Beyond sleep hygiene: a 5-step plan to get a better night’s sleep

Sleep problems can cause a fair amount of frustration for healthcare professionals. That’s because sleep hygiene is something that a lot of us — especially those in primary care or mental health/psychiatry — advise patients on every day. So if you’re struggling to get a good night’s sleep yourself, it can be hard to feel authentic in the suggestions you make to patients. You may find yourself having thoughts like “Does any of this really work?” or “I should really take my own advice.”

The truth is, sleep is critical to your ability to function. Without sleep, you’re way more likely to be irritable, short on patience, and low on empathy. This might show up as yelling at your kids, lashing out at your spouse, or making snide comments about difficult patients. Being in so-called “sleep debt” also makes it harder to think clearly and make quick, efficient decisions. You’re at greater risk of making careless medical errors or even getting into a car accident, depending on how badly deprived you are.

You probably know all this on an intellectual level, but so many of us downplay the importance of sleep in our own lives.

There are a few common reasons why physicians, nurses and other helping professionals get inadequate sleep:

  • Home life factors: new baby, disruptive pet, child illness or a child’s chronic sleep problems
  • Environmental factors: bedroom is too hot/too cold (or too light if you work nights and sleep during the day)
  • Mental health factors: chronic anxiety or depression, or attentional/perfectionism issues that cause you to stay up too late
  • Lifestyle factors: poor diet, overconsumption of alcohol, stimulating screen time before bed, insufficient exercise
  • Situational factors: worries about finances, loan debt, aging parents, the threat of a lawsuit, being behind at work, your child’s well being
  • Job factors: shift work, unpredictable or inconsistent schedules, too many demands on time

The culture of health care in some ways perpetuates sleep deprivation. Even with new restrictions in place, many medical residents don’t get enough sleep due to the crushing demands of documentation and other responsibilities. Some of this “I can get by” mentality can end up spilling into the rest of your career. And I hear from a lot of nurses who struggle with the way their employer requires alternating day and night shifts; this can make getting good-quality sleep really difficult.

You know basic sleep hygiene. It’s boilerplate. Here’s what to do if you’re still stuck:

  1. Go through the list of factors above and jot down anything that seems like it’s relevant to your current situation. BE HONEST WITH YOURSELF! You don’t need to commit to changing any of it just yet.
  2. Does anything stand out as relatively easy to change? e.g. If you consistently go to bed too late because you lose track of time, try setting a recurring bedtime alarm on your phone or watch and stick to it for a week. If you are always waking up in a sweat, turn down the thermostat or dress in lighter clothing. These sorts of things may sound obvious, but sometimes we don’t acknowledge the easy tweaks we can do to make sleep come more easily.
  3. Implement a bedtime ritual. Make a commitment to set your phone aside an hour before bed, and use this time to read, take a shower, meditate, listen to music, or otherwise wind down. If you find yourself shooting this idea down because you’re too busy, then start with a 10 minute ritual. The ritual is not only meant to help relax you, but to cue your brain that it’s time to fall asleep. It’s a cognitive-behavioral strategy.
  4. Free write for 5 minutes before bedtime. This is especially helpful if you struggle with anxiety or racing thoughts at bedtime. Jot down anything and everything that’s on your mind: to-do’s, worries, problems. Tell yourself that you will revisit the list in the morning, but at this point you’ve done all you can for today. Fold up the paper and put it in a safe spot.
  5. Choose one of the more complicated interfering factors and begin brainstorming solutions (but not at bedtime). Maybe it’s your alcohol use or your diet… maybe it’s chronic worries about your job or undertreated depression… whatever the “big” or seemingly impossible problem may be, there may be ideas or solutions that you haven’t tried. And if you’re resisting change, it might be worth seeing a therapist to talk through what’s getting in your way.

This isn’t to say that basic sleep hygiene strategies aren’t useful. It never hurts to take a look at the timing and quantity of caffeine consumption, for example. And one of my favorite sleep hygiene suggestions is getting out of bed if you’re having trouble falling asleep. If you are lying in bed getting frantic about how many hours are left in the night, it won’t help to keep lying there for two hours, staring at the clock. You’re better off getting up, putting on some lotion and reading a calming book until you start feeling sleepy again, and then returning to bed.

What works for you? What doesn’t seem to help?

Self-care is more than “treating yourself”

Let’s talk about self-care for a sec. True self care.

Before you groan or roll your eyes, hear me out. The term “self-care” has gotten a frivolous reputation in some circles as fluffy, optional, escapist — a way that millennials avoid “adulting” (ugh, that WORD, can we ban it please??). But that is just not how I see it.

True self-care does not come from a place of indulgence, but from a place of love and compassion. It’s essential.

Self-care is not the same as spoiling yourself or treating yourself.

+ It’s about saying “no” to self-sacrifice and martyrdom.

+ It’s about recognizing that as humans we ALL have needs and desires. No one is exempt, including you.

+ It’s about tending to your particular needs and desires — for healthy and delicious food, enjoyable movement/exercise, intellectual and creative stimulation, spiritual growth, relaxation, and loving relationships.

+ It’s about recognizing that if you can identify and honor your own needs and desires, you will have more space and empathy for the needs and desires of others.

I actually see self-care as a responsibility we have to ourselves, especially as helping professionals. We often neglect our own needs and try to put the needs of our patients and families ahead of our own, leaving ourselves depleted, stressed, and even resentful.

True self-care is complex in the sense that first, you have to know WHAT IT IS YOU WANT.

Yes, this involves tuning into yourself and figuring what it is you’re not getting. Maybe what you want seems impossible or ridiculous or stupid to you, but that’s OK. Ignore that judgey voice. Give yourself permission to acknowledge whatever it is that you want. (Hint: It’s OK to want something for no reason at all! There is nothing inherently wrong with wanting. You may not choose to act on this desire, but don’t shut it down before you even get the chance to experience it.)

Then, once you are clear on what you want…a healthier body, more alone time, more patience, dedicated time for lunch, a new friend, a happier marriage, a vacation…you can start investigating what’s interfering with your ability to make this a priority.

There may be an emotional block somewhere, e.g. guilt about carving out time to go to the gym, self-worth issues, lack of confidence. Or a faulty belief: “I don’t have time,” “I’m too busy,” “It’s not that important.”

Believe it or not, GROUP is a fantastic way to explore some of this stuff: What we want, why we do what we do at work and in our relationships, why it’s so hard to assert ourselves or advocate for what we want in an effective way, how we can show up differently in our lives. If you’ve been thinking about joining one of my groups, send me a message here on FB or fill out an interest form for the co-ed therapist group or the general co-ed process group so we can explore next steps.

*** If you are struggling to come up with a desire or a goal to guide your self-care, don’t overthink it. Try adding a small, concrete practice to your routine and test it out. I always suggest meditation to people because I’ve seen how freeing and empowering it can be. I recently started meditated with the Headspace app and LOVE it. It combines meditation with brief snippets of education and inspiration. It has helped me cement my meditation into a habit that I look forward to every single day.

Doctor suicide: 5 ways to tell if you, someone you love, or a colleague may need more support

A POST I WISH I DIDN’T HAVE TO WRITE

This piece is weighing so heavily on me today.

It’s called “What I’ve learned from my tally of 757 doctor suicides” and it ran in The Washington Post on 1/13. A colleague of mine sent it to me last night. (This issue has actually been on my mind for the past few months — ever since I myself heard about a local doctor suicide and the circumstances surrounding it.)

The author of the piece was inspired to dig into the issue of doctor suicides about five years ago, when she attended a memorial service for a doctor who had died by suicide — the third doctor suicide in 18 months in her local community.

Since then, she has been on a crusade to understand this phenomenon better. Distressed medical students and doctors at all phases of practice began to contact her to share their experiences of stress, exhaustion, shame and guilt in the wake of errors, and a culture that often prizes “gutting it out” and being strong and stoic.

As it turns out, first-year medical students start out at LOWER risk of suicide than the general population, but this risk spikes during medical school and residency, and never returns to the lower baseline (Privitera et al 2017). There’s some variation in risk depending on specialization, but the fact that doctors are at greater risk for suicide is something most people don’t want to talk about.

 

From the article:
+ One million Americans lose their doctor to suicide each year.
+ Male anesthesiologists are at greatest risk.
+ Doctors who kill themselves often appear “happy” and well-adjusted on the outside.
+ Malpractice suits can be absolutely devastating and can set some physicians on the path to suicide.
+ “Assembly line” working conditions that focus on productivity and force physicians to see very complex patients in short slots can create a pressure-cooker situation, pushing some doctors to their limit.
+ Many doctors fear that their mental health treatment will not remain confidential, preventing them from accessing needed support.
Does any of this resonate, even a little bit? You may not be able to imagine getting to the point of taking your own life, but it’s so important to see the signs of chronic stress, overwork, posttraumatic stress and depression long before it reaches that point.

 

5 ways to tell if you, someone you love, or a colleague may need more support:

  1. You feel disconnected from your practice, lack patience and empathy, and have trouble accessing the passion and satisfaction you used to have for being a physician. These are signs of burnout and can spiral into depression and even suicidal impulses when left untreated, especially when accompanied by passive thoughts of death (e.g. “I wish I’d fall asleep and never wake up” or “My family would be better off without me.”)
  2. You’ve experienced a trauma at work. Maybe you made a mistake and a patient died, or you lost a patient and can’t stop thinking about what you could have done differently (even if others around you aren’t blaming you). Maybe you’re up at night, or you can’t shake feelings of dread, guilt or shame. Let someone help you with this. Time alone will not necessarily heal what you’ve experienced.
  3. You are facing financial or legal problems. If there’s an active malpractice suit against you, you may feel hopeless, scared, and/or unable to talk about this with friends or colleagues. You may fear the loss of your ability to provide for your family. You are human and humans make mistakes, but this essential truth can get lost when there’s a legal proceeding going on.
  4. You are abusing substances. This could take many forms ranging from mild to severe. It could be occasional alcohol binges that create conflict in your marriage, or a flat-out addiction that you’re hiding from the people you work with and the people you love. Secrets are destructive. Substance abuse is a common way that people manage overwhelming emotions, but there are so many other ways. Since abusing substances lowers inhibition, it can create a scenario in which a person acts impulsively to take their own life in a moment of despair or fear.
  5. You know that you want or need therapy, but you’re afraid your care will not be confidential, so you’re putting it off. Therapists are bound by HIPAA. If you are worried about your records being confidential within the system in which you work, find a therapist in private practice whose records are not connected in the same EMR. Pay cash for utmost privacy. Don’t delay needed treatment because of this fear — talk through your doubts or anxieties with your therapist in the first appointment.

This post is not meant to substitute for professional mental health treatment. If you are suicidal now, reach out for help immediately. The national suicide hotline is 1-800-273-8255, or you can visit https://suicidepreventionlifeline.org/ to access the online chat. If have concerns about someone you know or love, talk to them directly or involve someone you trust in coming up with a plan.

And if you’re not worried about suicide right now, but you are struggling with chronic stress, burnout or relationship issues, please get in touch with me so we can explore next steps. Don’t let worries about confidentiality or the thought that you “should” be able to power through on your own prevent you from getting the help you need and deserve.

Send me an e-mail at dobbinlmft at gmail dot com or check out the rest of my website for more information about how I work, my rates, and the types of services I offer.

How to know if you’re headed for burnout and 3 things you can do to turn the tide

How to know if you're burning outIt might sound strange that you could be hurtling toward burnout and not know it, but it happens all the time.

Burnout is a bit of a tricky phenomenon. You might be so conditioned to stress that you don’t realize you’re at your limit until you’re already over the edge, ready to give up on your career or run away from home (I’m only partly kidding here).

This is because a lot of us are really good at ignoring early signs of overwork and chronic stress. We set aside our own needs as unnecessary or unrealistic, or incorrectly attribute how we’re feeling to some other issue (“I’m sick again…must be the kids bringing home a ton of germs,” or “I can’t stand that patient — so entitled and demanding.”) You may actually be getting sick a lot because you are carrying around an unhealthy amount of emotional stress and your immune system is compromised. You may be ready to fire your patient because your fuse is short and your empathy supply is running dangerously low, both warning signs of burnout.

Burnout is characterized by three main criteria (thanks to UR’s Dr. Michael Privitera for breaking it down so well in his July 2017 article “Physician Burnout as an Individual and Public Health Issue”).

The examples are written in terms of what physicians or other health care professionals might encounter, but the basic criteria are the same regardless of your profession — and can even show up in the context of home if family life is what’s burning you out:

  • Emotional exhaustion: procrastination of important patient/client interactions (i.e. returning phone calls), self-isolation, irritability, low mood, “short fuse.” The people in your life, including patients, family members and/or friends, are beginning to notice a change in you and might even comment on it.
  • Depersonalization/callousness: distancing from patients during appointments, decreased listening & compassion, more cynicism and sarcasm when discussing patients/clients (i.e. when staffing a case or consulting with another provider)
  • Decreased efficacy: low confidence, worries about ability to perform work tasks, perceived poor decision-making (which in time will become *actual* poor decision-making), decreased ability to engage in the thinking and problem-solving necessary to the job — e.g. sorting through the facts of a case, making accurate diagnoses, considering all possible differential diagnoses, and making a sound care plan.

It snowballs. At first you’re tired, physically unwell, increasingly unpleasant to be around. You start to lose perspective and so-called difficult patients become harder and harder to tolerate — you just don’t have the bandwidth. You start to question your abilities and as symptoms get worse, your cognitive functioning deteriorates. You’re so overloaded, your brain lapses into “habit memory,” and does a less effective job at synthesizing facts and information. You’re more prone to mistakes, sometimes very costly ones.

Burnout is treatable. Here are three things you can do today to start shifting out of burnout and into a more energetic and empowered space:

  1. Recognize what is within your sphere of control. When we are feeling lousy, it’s easy to focus on all the stuff that we can’t change (e.g. the intense demands imposed by the EMR) while ignoring very real, very powerful things that ARE within our control (e.g. how much energy you put into your notes; putting the phone away when you get home on nights you’re not on call; your mindset — what you think and how you feel about yourself).
  2. Make one small change to your routine. Choose one thing that’s under your power and consider shifting it. Is your Netflix habit keeping you up too late? Is the midday vending machine trip causing you to crash 30 minutes later? It may sound overly simplistic, but if you can identify one thing that’s interfering with your sleep or diet and cut it out or modify it, you may unlock some additional mental clarity and energy. Do not underestimate the power of one small change. You need to start thinking about easy ways to conserve or bolster your energy.
  3. Stop seeing self-care as an unrealistic or pointless exercise in self-indulgence. Ideally, self-care should be integrated into your life in a seamless way, without a side of guilt. Many other cultures do this SO MUCH BETTER THAN WE DO. And there’s a lot about the subculture of medicine that perpetuates unrealistic expectations and the value of “gutting it out.” Get creative here! I can’t tell you how often I hear people say that they can’t make time for therapy or a therapy group (which I see as one of the highest forms of self-care) but when something is important enough to you there is ALWAYS a way. True self-care may not be super comfortable or blissful in the moment…exercise, therapy, writing/journaling time, a few hours carved out to make art or music…these activities require you to push past the initial resistance, but it’s in service of a larger goal of a fulfilling, productive life.

***

As always, please reach out if you would like to come in for a session and strategize what burnout prevention would look like for you. And if you might be interested in joining a transformative therapy group in 2018, complete an interest form here 🙂 HINT: group is always transformative!