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Cultivating Joy in the Journey of Medicine - Intentionality

We are continuing to unpack ways in which to begin enjoying the joy in the journey of medicine as we work toward our goals. We have already discussed awareness and expectations & acceptance  -  this week we are focusing on intentionality - scheduling, mindful presence, and alignment. I implore you to look through a self-compassionate lens on this week's topic. Don't allow your inner critic to beat you up. Look for one or two small tweaks you can make and build consistency in. This is a process to build up over time. 


So many of us have been deceived by the arrival fallacy in which we believe things will be better when (insert next milestone) only to be disappointed. To avoid that, cultivate a life and way of living that you enjoy now. It will require deliberate action to create time and space to avoid putting off the “good stuff.” 


Intentionality in scheduling is helpful with busy lives, but it doesn’t always mean everything needs to be scheduled to a tee. You can also get creative by creating “white space” (picture a paper calendar for your schedule in which nothing is written.) I heard one physician describe it as a trauma room. It’s an empty but prepared space that can be used for anything that rolls into the ED. You can choose in the moment what you want to prioritize there. Do you want to use it for the endless work on your 'to do list,', to reach out to a friend, engage in some form of self-care, read the latest journal article, or for just silence? 


A key in successfully scheduling items such as white space and other activities mentioned below is losing the all-or-none thinking. If you think "I need an hour every day." that may keep you from getting started and lead to feeling guilty. Maybe it's 5-10 minutes a day; maybe it's 30 minutes twice a week. Or maybe 2 times a month. I really love baseline minimum to ideal maximum in these situations as some weeks, 5 minutes a day will feel like a luxury. Flexibility will support you in your scheduling. 


In fact, it's helpful to prioritize the first things that go on your calendar to be foundational for rejuvenation. For the time investments in your well-being - those can be the FIRST things that make it onto your weekly schedule. One thing is for sure, down-time and self-care rarely are checked off by default for most of us. And these are the very things that will keep you up and running. Rest and renewal energize you to make you the most efficient, effective, and present you can be for all of those other people and tasks. Learn more about prioritizing your schedule from a previous blog


Intentionality in Mindful Presence. What things would improve your day-to-day experience if you were more intentional to notice? Being fully present as busy physicians, also rarely happens by default - but with practice. Being fully present with the person or task at hand is even more challenging when we are busy or stressed and our minds wander. And nothing has gone wrong, continue to practice and pull your attention back once you notice you've drifted off. 


One common area involves of mindfulness is in our relationships. It is so easy to get caught in the daily grind and allow it to dictate what we do (or likely not do) and with whom.


We have discussed how vital relatedness is to our overall wellbeing. When you are feeling isolated at work, how can you become more intentional in forming or improving relationships? Where can you be more purposeful in conversations, reveal your authentic nature, or be more present? How can you be more deliberate in experimenting with the balance of clinical efficiency and fostering a connection with staff members? Even during patient encounters, being fully present with the person in front of you adds a sense of connection, helps you deliver better care, and enhances your professional fulfillment - and can actually add to efficiency. (Not to mention how therapeutic it can be for the patient). Our brains like to say, "being present costs too much time," but actually - it may be worth challenging that notion to test it out. The Academy of Communication in Healthcare has some good studies in support of it.


In the work setting, it doesn't necessarily mean you have to carve out new time for relationships. What sources already exist to meet and discuss shared experiences, brainstorm solutions to common issues, and give and receive encouragement? How can you participate? What will help you be more present during those opportunities?


As far as personal relationships – friendships, family, and partners. Even with our long-term partners and/or family, waiting until x, y, or z happens to finally enjoy time with them is a set-up for disappointment. How often can you intentionally have time alone? Date nights? Family nights? Get-aways or staycations? Think quality over quantity. What will you do to remember to stay focused fully on them when you are with them? What transition tools help you when you arrive home? (More on this in a future blog). When you find your attention has drifted, what will help you non-judgmentally refocus?


It's worth being explicit here that the type of organically-derived friendships that form in your cohorts during school, college, med school, and even residency -  happen less frequently for many after training. As busy physicians, sometimes starting in residency and continuing into attending life, it takes effort to foster and maintain those connections. It won’t often happen outside of being intentional. It doesn't have to be a large amount of time - just quality time and not allowing them to fall off your radar. Phone calls, meeting for coffee, meeting on the trails, going out after work, fun group texts. Who are the people you already have a connection with? What are the easier achieved actions to be more intentional in maintaining those relationships? To whom do you want to reach out to and begin forming a connection? If you don’t have anyone currently in your social support realm, what ideas can you trial out for meeting others? Where will you carve out the time to prioritize it? 


I have seen some of the most remarkable humans in my time as faculty who created time and space for so much outdoor activity even while working 80 hours a week on average. Two come to mind who were backcountry skiing at every chance they got. And it served them, their friends, and their patients well. And others maximized their time together by sitting in a coffee shop, going for a walk after work, or making the most of scheduled meetings to connect. 


Intentionality in lifelong learning also adds to the enjoyment of your career as you feel more current in delivering patient care and you grow in your knowledge and skills. Competence is the third of the three foundational blocks of psychological fitness. The other two - agency we mentioned last week, and relatedness above - all combine to allow the baseline fitness for joy. You can get creative here. Maybe it's listening to Curbsiders or the AFP podcast on the way to work. Maybe it's reading one section of the Prescriber's letter each day over lunch.  Meeting up with a friend to attend a CME conference to double your investment.


Intentionality in Alignment - you may never have 100% alignment with the organization's stated and lived values. But, it is key to make changes within your job or to your job if you are mostly out of alignment for your core values and purpose. Intentionality of knowing your values and defined or discovered purpose, choosing a work environment that is mostly in alignment, and being intentional to live and practice from those will serve your joy bucket well!


Yes, there are only 168 hours in any given week. You may not fit everything in all the time. But being intentional in scheduling, learning, and relationships by being fully present and finding where work is in alignment (shifting when necessary) during those hours can be incredibly rewarding.  Where else might intentionality serve you?


Next week, we will leverage perspective to enhance your enjoyment of the present.

Have a joy-filled week! Tonya

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Original post 5/2022, updated 4/2024


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