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Cultivating Joy in the Journey of Medicine - Maintenance and Language Matter.

We conclude the Finding Joy in the Journey of Medicine series this week.  After touching on awareness, expectations, intentionality, and perspective, we now move on to maintenance and language.


I’ll break maintenance into - physical care, mental fitness, and emotional health (including healthy coping strategies and boundaries). Neglecting self-care leads to poorer physical, mental, and emotional health. Putting time and attention toward self-maintenance, on the other hand, goes a long way to improving how you experience life.


I won’t spend too long flushing these out as I’ve written about them previously. 


Let’s review the foundations of your physical health that are fairly universal – restorative sleep, good nutrition, and movement. What do you need to change to accept that self-care isn’t selfish? What is your body telling you is missing? How will you be kind to yourself and make the changes you need?


Mental fitness relies on autonomy, relatedness, and competence. What do you want to focus on to bolster your psychological wellbeing? When your inner critic or resistant brain says, “But there’s no way to do that!” you can brainstorm without critiquing, which interrupts the flow of ideas (you can do this solo or with wise people you trust). Once you brainstorm various options, look at each one and see the obstacles in the way. Now put your brain on task of how to overcome those obstacles. Then reflect. Which one is best for you in the current situation? Then decide. Then act.


I like to think of Emotional health as encompassing coping mechanisms and boundaries. Life can be demanding on its own. For physicians, it is a whole other level.  We see patients (and staff and colleagues) during some of the most challenging times in their lives. They may not always show up as their best selves. Our systems cause intense emotions to surface when they appear to obstruct patient care. In addition to those situations, there are times when we don’t have the answers for patients or when the answers are devastating. The job can seem overwhelming at times. 


How we cope directly affects our ability to have professional and personal fulfillment and can make difficult situations worse by adding more stress.  We can intensify challenging circumstances by numbing through various vices that lead to negative results. Or we can detach to avoid emotions, thinking that will protect us. But we know this also affects our ability to enjoy good feelings. Or we can react in ways that we later regret or that affect our relationships.  There are several more positive ways to cope – some are needed in the heat of the moment, others later in healthy external and internal strategies. Learning to process emotions is an ultimate skill.  What coping mechanisms do you recognize may not be in your best interests? What healthy processes work for you? What will be possible when you utilize the healthier ones more often? What strategies would you like to grow?


Often, to institute best coping practices and limit the number of stressors, we need to define healthy boundaries. We then must grow in our self-respect to honor them ourselves. And finally, we need to decide how we want to handle the situation when others cross our boundaries. This doesn’t necessarily have to be confrontational. You can find ways to say or do what you need in a way that aligns with your character.


The flexibility comes after we establish and maintain good boundaries. That is when we can learn to flex a bit as needed in ways that still preserve our health and goals and align with our values and purpose. What is the next thing you need to do concerning a boundary? How will you put it into action?


Self-maintenance is SO worth it! Embrace the changes. Make one small step in the direction you want to go, then another, and then another. You will see the unnecessary suffering melting away and your joy becoming fuller.


Finally, I offer my take on language. If you’ve been reading my blog for any length of time, you likely already know that I’m not an eloquent grammatical master who commands the English language. However, that doesn’t mean that I don’t appreciate the different impacts various words can make, and I am growing in nuanced expression.


As you toil in this noble career and your non-job-related activities, be gentle with how you describe your life, situations, and especially challenges - even inside your own mind.  Most of the physicians I have coached know I stress a few shifts in language.


Here are my favorite substitutes:


 “Yes, and” in place of “But” (a former mentor passed it on after a leadership course, and it has stuck.)


“Challenging” in place of “hard” or “difficult” (I’m not debating that it’s not hard or difficult at times, but “challenging” makes room for a bit more hope.)


“Constructive” in place of “negative,” especially regarding feedback. (In other words, there are constructive and non-constructive types of feedback. And that view allows more agency in deciding its’ impact).


“Impostor Phenomenon” in place of “Imposter Syndrome” (I have assumed the position of Dr. Pauline Clance, the first to describe it. it’s common among high-achieving individuals such as physicians – it’s not a disease state or a defect.)


Here are some other terms/phrases I like to employ in personally challenging times (as opposed to public ones or traumatic times):


“It’s an adventure.” (…as I set up a tent for the night during a rain downpour.)

“We will figure it out.” (…as I fired my nanny with no obvious solution and with two-physician resident work schedules.)

“It’s never boring.” (…as we tried to direct a frankly psychotic patient to a room.)

“This too shall pass” (…during a six-admission call night.)

“It is what it is” (…as the pipes burst from freezing in our house under renovation.)

“There is never a wasted hurt.” (…as someone mistreated a loved one.)

 “We’re making memories….” (…as a faculty colleague and I tried to figure out how to put in admission orders in EPIC the first time without an inpatient resident team. They were all out with H1N1. Let’s just say it bordered on comical).

 “It’s another cold dark night on the side of Everest.” (…as the needs and numbers of the patients exceed our time and ability.). Click here to read of the origins of the phrase


These stop short of condemning the current situation, allow for acceptance without endorsement, and leave open the possibility of a more appreciative perspective in the future. It doesn’t heap more pain onto the current circumstance. You don’t have to dismiss all the good due to the challenges, nor do you have to dismiss the actual difficulties – you can embrace duality. They normalize the rough patches along the journey.


I would love to hear what shifts in language help you.


You don’t have to keep looking over the fence wishing you were in greener pastures that lead to the arrival fallacy.  Whether you utilize the marathon approach to your career or the sprint, rest, sprint method (or a combination of both), you can learn to find joy in the journey of medicine to thrive instead of just endure. You deserve to flourish – now.


Have a joy-filled day, career, and life! Tonya

Download the first three key steps I recommend for increasing your joy now in your life and career. Click here 


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