Who Takes Care of Those Who Take Care of Others?

Jake is a physician in a private practice. His specialty, plastic surgery, allows him to define his own schedule with greater freedom that many others in medicine. Yet Jake takes little time off to be with his young children or to care of his own well-being. His reason? At first, in examining his reasons Jake can give none. As he ponders the question it dawns on him that caring for his personal life which includes his kids, spouse, aging parents and his own well-being is almost invisible to him as a value or intention. Upon further reflection, Jake indicates, “If I am not working, I am idle and not productive; it’s how I’m wired.”

Trudy is a Psych Nurse with a Masters in Nursing and holds a significant role in hospital administration. All around Trudy are nurses and other health care providers who are complaining about burnout and exhaustion. When I pose to her why her self-care seems so unimportant, she replies, “All my career I have been trained to think of my patients’ needs, not mine. I don’t know which came first, my family inculcating a lack of regard for my own well-being or whether this was developed in nursing school and eventually becoming a nursing professional? All I can say is that my self-care is the last thing I think about.”

This is quite common; health care providers often put their own lives and well-being on the back burner and inherently, their well-being deteriorates.

What is Burnout?

Simply put, burnout is simply loss of sense of value and enjoyment in one’s craft. It’s often preceded by discontent, indifference, and physical deterioration.

One of my colleagues once mentioned, “The reason I went into medicine is that I saw as a noble path to service to people, and now, 10 years into my profession I am sick of patients, I hate going to the hospital, and cannot stand one more complaining patient who is not following through with my prescription. Do they think I have unlimited energy to keep caring for them if they are not going to cooperate?” Sadly, this is a reality.

Altruistic Egoism

Margaret is a community pediatrician working in a semirural clinic. She takes no days off unless she is sick and even then has a hard time calling in sick unless she is obviously contagious. “My sense of duty is so strong and unfortunately I am the only Pediatrician within 100 miles. If I don’t forego my time off there is no one available with my training.” I asked Margaret how that was working in the long term and she said “quite frankly, I am thinking about moving away from this area and getting a job in a health care system.” My concern for Margaret and others is this: “Is it really the circumstances or is this a pattern that would repeat if she moves to a city or suburban hospital?” I assert that Margaret has a lack of skills in self-care and is not likely to learn them until she realizes that her exhaustion is somewhat self-induced and can only be cured by caring for herself with the same vigor as she cares for her patients.

Hans Selye, the MD and Biochemist who conceived the Stress Theory stated that health care providers needed to adopt a mindset of “Altruistic Egoism.” According to Selye,

"people should not try to suppress the natural instinct of all living beings to look after themselves first. Yet the wish to be of some use, to do some good to others, is also natural. We are social beings, and everybody wants somehow to earn respect and gratitude. You must be useful to others. This gives you the greatest degree of safety, because no one wishes to destroy a person who is useful."

His theory basically indicates that if you don’t take care of yourself, selfishly, you are not going to have what it takes to care for others. One must find the proper balance between taking care of themselves while taking caring for others.

Avoiding Burnout

There are both immediate and longer-term strategies care providers can take to develop a lifestyle that balances their self-care with care for others.

Simple Steps to Avoid Burnout – The Short Term

  1. Place, in your time management device self-care be it exercise, mindfulness practice, a deep relaxation or getting support from a friend. If it in your calendar it is now a default rather than something you have to remember to place in time.

  2. Take one minute five times a day to stop, breathe deeply and relax your body’s tension spots. Place prompts in your calendar, outlook, iPhone or whatever device can help you remember.

  3. Sleep more than you think you need. This year several health care insurers are making sleep and the getting of better, higher quality and lengthier sleep a priority for their insured. Makes sense that it will be of value to you too as the practitioner for the insured to follow good advice like this.

  4. Get out of doors, recall your connection with nature, walk in the wild or park, and get to the beach, mountains or anywhere that feels beautiful and restful.

Skills for Self-Care-the foundation of Mindfulness – The Long Term

Mindful Awareness of Four Human Experiences: The body of knowledge regarding development of Mindfulness can be categorized in four buckets or domains

  • Breathing and Mindfulness of the physical bodies experience.

  • Mindfulness of emotional tones-pleasant, unpleasant and neutral (neither pleasant nor unpleasant)

  • Mindfulness of specific emotions and thoughts

  • Mindfulness of habit patterns like cognitive biases or distortions.

There is a fundamental value in the distinctions between emotional tones which give rise to the most basic human instincts:

  • Pleasant to desire

  • Unpleasant to aversion

  • Neutral to confusion

  • Doubt and awareness of specific emotions like anger, sadness, joy and happiness.

So, back to the original question, who takes care of those who takes care of others? It’s YOU!

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