— “Sorry, no WiFi 4 U”
by Arthur Lazarus, MD, MBA January 29, 2023
Here I am, on vacation at a luxury resort in Hawaii with my wife and two of my four children and their three children. It’s 10 p.m. and I’m beginning to write this essay while everyone is snug and tucked away for the night. Earlier in the day, sitting around the swimming pool, I’m glued to my iPhone. My son, who resides in Honolulu, comments, “Dad, you’re so wired in. Play with the kids (my grandchildren) in the splash zone. Take them on a ride down the lazy river. Relax with us.”
But like many physicians, I’ve forgotten how to relax. Patient care has been front-and-center since the pandemic started — in addition to the usual crises and emergencies — and we’re increasingly burned out or using substances to cope. Our clinical performance has diminished, resulting in increased errors and other quality concerns.
The one thing we’ve been good at, it seems, is neglecting our own health. Researchers found that physicians who were wedded to their jobs experienced lower quality of sleep, greater levels of depression, and lower levels of general well-being. Plus, they exhibited more stress at work.
Everyone knows that doctors need to take time for themselves and relax in order to stay healthy. Providing doctors with opportunities to relax is correlated with better health outcomes for themselves and their patients. Trips to far-away or exotic locations can be helpful but are not guaranteed to afford relaxation. Sometimes simply walking 30 minutes each day, partaking in a hobby, meditating, and other activities are all that is needed to recharge your batteries.
However, some doctors find it difficult to engage in relaxing activities. I admit, I’m one of them. I have a collection of several hundred DVD concerts; approximately half are unopened and waiting to be viewed. I’ve purchased dozens of books not yet read. What makes it difficult for doctors like me to sit down, relax, and watch a DVD or read a good book? The answer, according to experts, lies in our brain chemistry and conditioning.
Our brains want a dopamine rush, and our sympathetic nervous system is stuck in overdrive. Physicians rely on a steady diet of distressing news, disturbing deaths, and clinical disasters. After years of medical practice, excitement fades, replaced by boredom and panic. Our brains seek a quick chemical hit to rekindle. Rarely do we have a chance to debrief over critical incidents and reflect on what happened. We just move on, tense and stressed out, always in a hurry to “get to the point,” bypassing important cognitive ramifications of our work.
In terms of conditioning, we’ve been primed, prepped, and propelled toward academic and career success since high school, perhaps earlier. Along the way, we’ve been challenged by automatic negative thoughts: “I’m going to flunk this test,” “I can’t handle the work load,” “I don’t measure up,” “I’m an imposter.” Automatic negative thoughts can result in fatigue, depressionanxiety, and symptoms typically associated with trauma, especially hyperarousal, which contributes to our inability to relax. Anyone who grew up thinking they had to be the “best” is likely programmed for stressful perfectionism incompatible with relaxation.
I first noticed difficulty relaxing while in medical school. Absorbing the basic sciences was like taking a drink from the proverbial firehose — a tsunami of new information crashed upon me as soon as I felt up-to-date. During clinical rotations, I was anxious and on guard, waiting to be pimped by a senior resident or an attending. I invested energy in all clerkships. In reality, no specialty other than psychiatry appealed to me. I became chief psychiatry resident thanks to my unsurpassed achievements and devotion to training. However, the work involved “staying ahead” of my peers and precluded relaxation.
Once in practice, I thought my nerves would settle down, but they didn’t. I read The Relaxation Response. The good advice in that book was offset by a personal, stressful mission to “find the way to myself” — the raison d’être espoused by Emil Sinclair, the protagonist in Hermann Hesse’s Demian. Sinclair wanted to know why it was so difficult “to live in accord with the promptings which came from [his] true self.” Our search for meaning is an exhaustive process, fraught with uncertainty and fear. How could anyone relax under those conditions?
Yet, I identified with Sinclair, especially the passage in Demian in which he realizes that “[man’s] task was to discover his own destiny — not an arbitrary one — and to live it out wholly and resolutely within himself. Everything else was only a would-be existence, an attempt at evasion, a flight back to the ideals of the masses, conformity and fear of one’s own inwardness.” I certainly didn’t want my existence to be “arbitrary.”
So, I embarked on a journey of self-discovery with the help of a wise and compassionate psychoanalyst. He provided expert guidance for my travels. However, even after therapy, I was consumed by free-floating anxiety. I never felt totally relaxed, and even to this day, at a time when I consider myself semi-retired, I’m always looking over the horizon for the next challenge, the next big fix, the next accomplishment, the next op-ed to write.
Apparently, patience is not a virtue of many doctors. I’ve read stories about physicians in various specialties — not only psychiatry — who have struggled to relax when off work. Only 60% of doctors report feeling “happy” outside of work. Fortunately, some physicians have managed to compensate for their unhappiness and restlessness.
An emergency medicine physician finds bicycle riding a great way to decompress. He becomes “lost” in his thoughts as he rides, sometimes forgetting specifics along the route.
A family medicine physician turns to prayer and religion to relax. Other activities such as walking on nature trails and even sitting by the fireplace remind her there’s more to life than practicing medicine.
An otolaryngologist who specializes in head and neck cancer surgery engages in outdoor activities like camping, boating, and fishing with his family. His stress is reduced by working with his hands, enjoying hobbies such as woodcarving and tinkering with cars.
A pulmonologist and critical care physician paints and makes craft projects with her son. Yoga and cooking are her favorite ways to unwind.
I’m thinking about leaving my computer and smart devices at home the next time I take a vacation. I informed my son of my intentions. He took me to his favorite coffee café. “Everyone’s connected and engaged here,” he said, pointing to a sign that read: “Sorry, No WiFi 4 U.” A smile crossed my face. I began to relax.
Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.
