I am a physician, but I am human first
As a new graduate in family medicine, I looked forward to working in a clinic, meeting new patients, and applying the knowledge and skills I learned in residency. I was excited - and anxious - to delve in a world where I would be 'the doctor', and not the resident, clerk, or medical student.
As I began practicing, I realized how much more there was to learn about! Residency may have taught me the laboratory values that would dictate a diagnosis of diabetes, but it was a completely different experience communicating this with a patient in a succinct and clear manner. Residency did teach me how to support a patient in palliative care, but it was a different experience writing the death certificate and communicating with the family. Residency taught me to check my tasks and inbox, but it did not prepare me for an inbox that filled up the second I had emptied it!
Then came the part about 'self-regulation'. In residency, I was told to tell my preceptors that it was 'time for my break'. In fact, some preceptors were proactive and encouraged me to take a wellness break during my shift. But, during my days in clinic as a physician, this was not the case. We did not 'close for lunch'. I had to take the initiative to tell my administrative staff not to book patients during my nutrition break. I had to let staff know that I would not be available after 5 pm because this was the time I was with my family.
It sounds simple, right? Surprisingly, it is not always easy to advocate for our wellness or breaks as physicians. Why? Aren't we human? Do we not have needs for food, bathroom breaks, time for family and friends, and time on our own? Why is it so hard to say 'no, I am unable to squeeze in that non-urgent issue at the end of the day'? Why do we find ourselves apologizing for needing to take a day off, for needing to run to the bathroom because we have not stretched our legs for hours, or for taking a half-day off to get our minds off of work?
I'm speaking from experience, but I think it is something that many family physicians can relate to: we do the work we do because we genuinely have a desire to contribute to society by promoting and supporting the health of patients. We are in this career because we want to help others, and we want to use our educations to serve communities. We all take pride in the warm feeling that comes when a patient says 'thank you for listening to me' or the relief that comes when we catch a diagnosis that might otherwise have been missed. There is no doubt - being a family doctor is amazing. Although we all should define ourselves by more than our careers, being a family doctor is an integral part of our identity. Yes, we must have habits and hobbies outside of work, but we spend most of our time at work - and for the most part, we enjoy it.
But along with these joys comes responsibilities. And many of us are perfectionists. We like to do our work, and not just to 100% - but to 110%. Further to that, we care. We care about patients. We don't want them to get mentally, emotionally or physically unwell. We took an oath to 'do nor harm', and to stand by our patients. As a family physician, I want to help others, and I don't want to disappoint them.
But we all struggle with the 'what if's'. What if we ordered the test earlier - would the patient have been in better health? What if we forget to type something our notes - will we get sued? What if that patient is not seen today - will they get angry, will they get ill, or will something unexpected happen?
Put together, this makes our jobs as family physicians very difficult. As a new graduate, I have had days where I get home and cannot think but anything of my patients. My mind reverts to the people I saw in the day - did I finish charting everything correctly? Did I miss something? Will that patient's ultrasound come back normal? What will my inbox be like tomorrow? Should I check it now again to reduce my workload tomorrow? Do I have time to book a dentist appointment next week? How will I have enough time to buy groceries? When will I finally get to that project I have been wanting to do outside of work? Will tomorrow be as hectic as today?
If each day were like this, I would burn out. It is an ongoing process of self-reflection and awareness that keeps me going. The self-reflection process requires me to take a step back and attend to my needs as a human being, realizing that I cannot 'do it all' and am not 'perfect'. I am human. This awareness helps me to stop and breathe. I check-in with myself. Did I take time to nourish my body today? One of the things I have started doing is eating AWAY from my computer screen. I deserve to eat without doing clinic work (although starting to do this took a lot of discipline - seeing an inbox full of pending tasks is daunting!). I have also realized that I am not a bad person for telling my staff that a non-urgent patient issue can wait until tomorrow. I too deserve care and rest. I cannot be there for my patients if I am not rested with a clear mind.
I have also taken refuge in talking with supportive individuals. I am blessed to be working with a group of physicians who is incredibly open, honest, and 'down to earth'. Within our group, we are able to discuss patient cases together, encourage one another to take time off when we are fatigued, cover for one another, etc. We care about each other. This has, without a doubt, enabled me to continue enjoying work. When you have collegial coworkers, you realize that you are not alone.
Wellness also means taking time to be 'not a doctor'. I am a friend, sister, and daughter outside of the clinic. I love to read, write, colour, do puzzles, shop, and practice yoga. To be well - and to continue finding joy in my work - I need to dedicate time to these other parts of my life. With the support of my family and friends, I have tried my best to stick to a schedule that enlists boundaries between work and home. For example, each day at 8 pm is my time away from work, where I relax with my family and 'no medicine is allowed'. Each weekend is a time where I can have an hour to myself - whether that is to run errands, take a walk on my own, listen to some music while colouring, etc. This is MY time - and no, I am not selfish for taking it. We all need to spend time with people we love, away from our jobs. But we also need to spend time on our own, where we can renew our energy, indulge in the company of our own minds and hearts, and pause.
I am by no means perfect at this. I am still learning how to be compassionate with myself, how to say 'no' at work, how to create boundaries and schedule parameters between work and home, and how to take breaks without being tempted to work at the same time. It is a work in progress. What keeps me going is reaping the benefits of this practice. When I take time for myself at the end of a long day at work, I feel ready to go back the next day. I am just as excited and motivated to go into clinic and help patients, teach medical students, and see my colleagues. My body is nourished and rested, and my mind is clear. Certainly, there are days when I struggle to 'take a break' - but I am learning. It takes a village to do this - we need support from our colleagues, families, governments, and communities to be able to truly care for ourselves.
Yes, being a family physician is tough. There is a lot of clinical and administrative work involved in it. The work, to be honest, will not stop. Patients will be sick, reports will need to be attended to, students will need to be taught, and more. But all of this will not be possible if I am not well - physically, mentally, emotionally, socially, and spiritually. It is much easier than done, but remember - no one is perfect. Just as I took an oath to do no harm to patients, I have taken an oath to do no harm to myself. And that means being compassionate with myself, taking breaks, saying no when I need to pause, and breathing.
I am a family physician. But I am human first.
Dr Marina Abdel Malak is a family physician in Mississauga, Ontario. Her interests include medical education, physician and peer support, and holistic wellness. She is actively involved with the College of Family Physicians of Canada where she serves on the National Committee for Continuing Education, as well as with the University of Toronto where is a lecturer. In her spare time, she enjoys reading, yoga, puzzles, and spending time with her family.
