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Staying Well in Changing Times
10 ways to keep right-side up
when your world turns upside down
By Flora Johnson Skelly
This article was originally published on January 17, 1994, in
American
Medical News, the weekly newspaper of the American Medical
Association. It
is republished here by permission of the author, Flora Johnson
Skelly.
This is an account of the 1993 meeting of the Society for
Professional Well-Being, a forum for mutual support and information among
physicians and other
professionals. The article discusses nine strategies for "staying
well in
changing times":
- Get in touch with who you are.
- Be more than a physician.
- Take care of your body.
- Be your own best friend.
- Be flexible.
- Have a sense of humor.
- Connect with other people.
- Listen and communicate.
- Don't be afraid of change.
The article is also accompanied by information on how to reach people quoted.
About 30 people, most of them physicians, stand in a giant
circle, hands on
one another's' shoulders. They count: "One, two, three ..."
And sit down. There is a loud collective gasp, as they realize
they are
sitting on one another's' knees. (And no one is sitting on a
chair.)
This scene took place in October, 1993, during a "well-being
celebration"
held at the annual meeting of the Durham, N.C.-based Society for Professional Well-Being.
Participants
in the conference, held in San Antonio, Tex., also enjoyed other
noncompetitive
games, danced, did stretching exercises, and in general
discovered that it is -- yes, it really is -- possible to relax
and enjoy
life even if the health care system does seem to be falling apart
around
you.
And that's just what psychologist Jim
Polidora, PhD, who led this celebration, wanted. Having spent
more
than a decade teaching wellness skills to medical students at the
University of California, Davis, he is trying to help physicians
better
cope with the changes now enveloping the system.
He and other "change artists" who attended the meeting offered
these
"top 10" strategies for staying well in changing times:
Physicians typically "come into the profession with certain
expectations
about internal and external rewards," said Ahnna
Lake, MD. The former medical editor of a Canadian magazine
devoted to
physician well-being, she recently moved to Stowe, Vt., to start
a
consulting practice. "But the internal rewards -- such as feeling
that
you're making people's lives better and that people appreciate
what you're
doing -- often are not realized."
When internal rewards prove elusive, physicians may be tempted
to
substitute external rewards, such as income. "But they never get
over the
sense that something is missing." Now that changes in the system
are
threatening physicians' external rewards, "that's almost a gift,
because
it's a chance to stop and think, to reassess."
But this means you must devote time to yourself, said John-Henry Pfifferling, PhD, director
of the Society for Professional Well-Being.
"Take the
time to understand your vision, your mission, your values, what
services
you do and do not wish to deliver, what promises you do and do
not want to
make, how you want to relate to partners, staff, family, and
friends."
Having done so, you'll be better able to cope with change as
it
happens, he said. "Instead of waiting for the external world to
constrain
and define your practice of medicine, you can begin to plan,
organize, and
work toward a practice defined as you want it to be. Instead of
dwelling
on the past, you can actively create a future."
Return to summary at the top of this
page
We all tend to identify with certain aspects of ourselves or our
lives,
said Dr. Polidora. Perhaps it's a
job or
authority or an expensive car or good hair. No matter what we
identify
with, however, we tend to react defensively when it is
threatened. This,
in turn, leads to hate, resentment, fear, anxiety, and other
self-
destructive emotions.
Thus, one of the best ways to cushion yourself against change
is to
never, as it were, put all your identities in one basket. "You
have more
than one identity. You're a physician but also a physical body, a
spiritual being, possibly a spouse or parent, perhaps someone who
grows
roses," Dr. Polidora said.
Return to summary at the top of this page.
As long as we are alive, we are physical beings, said Dr. Polidora, and bodily pleasure
can be a
resource in times of need. Exercise is a great stress-reducer and
health-
enhancer, of course. But Dr.
Polidora is more concerned that physicians
take time, regularly, to remember what a joy it is simply to be a
living
being. "Acknowledge and accept that you are a body on a periodic
basis,
and your body will be a source of succor."
To achieve feelings of physical well-being, he recommends
exercise,
stretching, relaxation, adequate sleep, and good nutrition;
meditation or
breathing exercises; and even something as simple as yawning or
taking a
deep breath. The body is always there for us, he said: "You don't
leave it
in your other pants."
Return to summary at the top of this
page.
If you made a mistake, or if things didn't quite turn out as
you'd
planned, your best friend wouldn't give you a hard time. But many
physicians treat themselves in ways no friend ever would.
In medicine, perfectionism is sought after, inculcated, and
rewarded.
However useful this may be at times, perfectionism makes it
harder to cope
with change. If you're not allowed to make a mistake, you're
probably not
going to let yourself try anything new. You also will cut
yourself off
from the chance to learn, because making mistakes is an
inevitable part of
learning. "You learn by making mistakes, if you can avoid an
overly self-
critical attitude," said Elizabeth
Adams, a
Chapel Hill, N.C., counselor who devotes most of her practice to
physicians.
Some things are not within your control, Dr. Polidora said. For instance,
whether a
patient has a good outcome is only partially determined by your
skill.
"Learn to base your self-esteem on what you do have control over
-- your
efforts -- not on results."
Return to summary at the top of this
page.
"Typically in medicine, we solve problems from a complex but
clear set of
possibilities," said Dr. Lake. "Faced
with
change, we tend to use uncreative solutions."
Physicians often react to stress by working harder -- a
"solution" that only makes the problem worse. Another common
response is
"to not accept change but resign yourself to it with resentment."
Eventually, the resentment shows itself in symptoms such as
deteriorating
relationships or health problems. "Another response is to give up
or give
in, which can lead to drug dependency or depression."
Physicians may have to fight ingrained tendencies if they want
to adapt
to change in healthful ways. "To move toward flexibility can take
deliberate effort sometimes," said Adams.
Learning to be more flexible can be as simple as keeping an
open mind,
noted Dr. Pfifferling. Consider the
possibility that there are other ways to do things. Make a
conscious
effort to respect other people's points of view.
One powerful strategy is "reframing," in which you consciously
find a
new way to think about a set of circumstances you can't change.
Can you
find a silver lining in this cloud? (Does a changed work
situation afford
you the opportunity to spend more time with your family?) Can you
still
pursue your goals, though it may mean earning less money or doing
things
in a completely new way?
Return to summary at the top of this
page.
"Yes, you do serious work,'' said Dr.
Pfifferling. "But sometimes, you have to take a step back.
Otherwise,
you can get so overinvolved that it becomes pathological."
"We don't have to make babbling fools of ourselves," said Clifford C. Kuhn, MD, a Louisville, Ky.,
psychiatrist who spent nearly six months on the road as a
stand-up
comedian. "But we do need the momentary detachment that humor can
give.
Given that brief respite, we can restore a lot of frayed edges in
an
efficient manner. We don't need a minute of laughter for every
minute of
stress."
If you're already so burned out you've forgotten how to laugh,
Dr. Kuhn
suggested, "First and foremost, make a conscious commitment to an
attitude
of permitting yourself to be amused. If you can take your
responsibilities
seriously but take yourself less seriously, half the battle is
won."
Next, cultivate awareness of "the amusing stimuli going on
around you
all the time. It is rare to be in a situation where you can't
find an
absurdity." You can play with words, for example. Or you can
exaggerate.
"If you're really angry and can imagine giving that anger full
vent,
sometimes it can put the anger in perspective. Suddenly you see
how
ludicrous it is."
That moment of detachment could make all the difference, said
Dr. Kuhn.
"Laughter is the shock absorber of life."
Return to summary at the top of this
page.
"Most physicians have had experiences, whether litigation or
training,
that are based on distrust of others rather than on
cooperation," said Adams. "If you can stretch the
boundaries around
yourself to include other people, that can go a long way toward
creating
the support systems we all need."
In reaching out to others, most people start with family. But
spending
time with the right friends and colleagues can also help. Look
for people
"who will help you move toward your goals and dreams,'' said Dr. Lake. "Look for people who will help
you
brainstorm around solutions as opposed to finding reasons why
you'll never
be able to do what you want to do."
A more formal way to connect with others is to create or join
a support
group, in which people with a similar life situation come
together
regularly to share information, experiences, and feelings.
"Support groups
are the single most powerful and cost-effective intervention for
reducing
occupational stress," said Dr.
Pfifferling.
Return to summary at the top of this
page.
Therapists have long known that simply describing feelings to an
empathetic listener is enormously therapeutic, said Adams. To participate in this healing
connection, however, you must learn to listen to others without
discomfort or interruption. You also must develop greater
"internal
awareness," as well as trust, so that you too can talk about what
it feels
like to be you.
Physicians' training often leads them to look for and demand
solutions
to every problem, said Adams. "It's
ingrained in the culture to rush in
and make everything all right." But this can interfere with
empathetic
communication. She suggested working first on "listening without
having to
fix things." Next, learn to "describe your feelings to other
people
without the expectation that they will do something about
it."
Return to summary at the top of this
page.
Change is a necessary part of life. In fact, people typically
experience a
tremendous sense of relief when they finally accept its
inevitability.
"Admitting that I have no control over the uncontrollable feels
more than
good," Dr. Polidora said.
Yet this, like many of the other lessons the change artists
offer, may
be difficult for physicians to accept. To fully comprehend this
message,
you may need an experience that brings it home to you in a way
words
cannot. For instance, you might have to sit down on, well,
nothing but your faith in others -- to learn that you never know
what you
and a group of trusted colleagues can do until you do it. That's
why Dr.
Polidora incorporates experiential learning, such as the exercise
described earlier, in his workshops.
If you're still waiting for lightning to strike, Adams suggested adopting the serenity
prayer:
"Grant me the serenity to accept the things I cannot change." But
the
ultimate goal, she said, is "to accept change as a process."
Yes, change can be good for you. Without change, life would be
dull and
we would "sink into ennui," said Dr.
Polidora. Without challenge, we
wouldn't grow. "Health and wellness grow out of challenges."
Change forces you out of your rut and makes you think about
what you
really want from life. A creative response to change can restore
your
sense of mission and purpose. Said Adams: "It's an opportunity to have
your life come back to you."
Return to summary at the top of this
page.
10.
There is no 10.
We asked you to be flexible, didn't we?
Return to summary at the top of this
page.
Help for physicians coping with change can be as near as the
telephone, if
you have a network of supportive colleagues and friends. The Society for
Professional Well-Being provides each member with lists of
other members
in their area, in order to facilitate networking. The society can
be reached at Colony West Professional
Park, 21 West Colony Place, Suite 150, Durham, N.C. 27705, (919)
489-9167
or (800) 473-5880. Memberships are $55 a year and include a
newsletter.
Return to summary at the top of this page
John-Henry Pfifferling, PhD, and Elizabeth
Adams can
both be reached through the Center for Professional Well-Being,
Colony West Professional
Park, 21 West Colony Place, Suite 150, Durham, N.C. 27705, (919)
489-9167
or (800) 473-5880. The
center offers keynote addresses, workshops, seminars, retreats,
and
individual consultations, including burnout intervention, goals
clarification, and marriage counseling.
Dr. Pfifferling is quoted in:
Elizabeth Adams is quoted in:
Return to summary at the top of this page
Clifford C. Kuhn, MD, can be reached at
the Dept.
of Psychiatry, University of Louisville School of Medicine,
Louisville,
Ky. 40292, (502) 588-7647. He offers keynote addresses,
workshops, and
individual counseling.
Dr. Kuhn is quoted in 6. Have a
sense of
humor.
Return to summary at the top of this page
Jim Polidora, PhD, can be reached at
the Aviva!
Wellness Institute, P.O. Box 2035, Healdsburg, Calif. 95448;
(707) 431-
8835. He offers education programs, audio tapes, wellness
consultations,
and conference presentations.
Dr. Polidora is quoted in:
Return to summary at the top of this
page.
Ahnna Lake, MD, can be reached at the Center
for
Empowered Thinking, P.O. Box 119, Stowe, Vt. 05672; (802)
253-9369.
Dr. Lake is quoted in:
Return to summary at the top of this page.
Copyright © Flora Johnson Skelly, 1994
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