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Essential Keys To Work-Life Balance And Burnout Prevention During The COVID-19 Pandemic
When it comes to balancing one’s work and personal/family life, one size does not fit all. If the definition of balance is "a condition in which different elements are equal or in the correct proportions," then the term work-life balance is obsolete in today's world.1 Ask any working parent with children or millennials who will not put in a 65-hour workweek.
I will go out on a limb here and say nothing in a podiatric mother's life is evenly distributed or equal. I remember being told, "Oh, you're so lucky you work part-time! You have time with your children and do what you love!" The reality of this is not luck. It is not easy. When I am at work, I worry about my children. When I am at home, my concern about my patients does not dissipate. I am always "working." It is not like I wear one hat at work and a different one at home. It is just one hat. Whether I am taking calls from patients at home or the hospital, doing administrative work or answering a phone call from my daughter's preschool just before walking into surgery, it is not a balancing act. It is just a stressful, yet satisfying life.
Gender-related factors, such as women's predominant roles as family caregivers and frontline health-care workers, further exacerbate stress exposure.2 Additionally, being at home for an excessive amount of time taking care of children or teaching remote learning to children takes a mental toll on one's health.
Furthermore, the division of labor in the home places a heavier emotional burden on women. In the United States for example, 55 percent of employed women do housework in comparison to 18 percent of men and women tend to spend twice the amount of time with their children than men do.2 When schools closed due to COVID-19 and children needed to participate in remote learning, the responsibility for management of this fell disproportionately on women, A study by the international aid foundation, CARE, found this disparity is even worse in Latin America, with 95 percent of schools in the region shuttered and entrenched social practice putting virtually all of the childcare burden on women.3
Since the pandemic, a woman's, and especially a mother’s, days are blurred. Weekends off are a thing of the past, anxiety and stress levels are through the roof, and one's mental health has suffered. In a recent study conducted by CARE, investigators found that while nearly everyone experiences anxiety, worry and overall emotional fatigue of the coronavirus pandemic, women are nearly three times as likely as men to report suffering from significant mental health consequences (27 percent in comparison to 10 percent).3 This includes anxiety, loss of appetite, inability to sleep and trouble completing everyday tasks.3
How do working professional women and mothers better manage their hectic lifestyles and prevent burnout? The following suggestions and tips may help you. In fact, they can help everyone.
Rest And Relax When You Can
Power naps and mindful meditation. No, we don’t have time to take a 45-minute catnap. We are constantly moving. True relaxation begins by getting your body and mind into a state of NOTHINGNESS. Go to the bathroom. Sit on the toilet. Sit at your desk and close your eyes for five minutes.
A midday nap can also impact emotional perception. Over time, the repeated presentation of the same emotional stimuli induces emotional habituation. In other words, ratings of emotional stimuli become more neutral (i.e., less negative) with each subsequent presentation.4 Additionally, the definition of mindful meditation is awareness that is not thinking albeit with an awareness of thinking as well as awareness of each of the other ways we experience the sensory world (i.e., seeing, hearing, tasting, smelling, feeling through the body). Evidence shows that mindfulness-based stress reduction (MBSR) can mitigate stress, reduce burnout and improve empathy skills among medical professionals.5
Reassess Your Work Hours
Follow ACGME's guidelines? Work-hour limitations imposed by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 specify that resident physicians may work no more than 80 hours/week (averaged across four weeks) and no more than 24 consecutive hours (with six additional hours for transfer of care and educational activities); must have at least 24 following hours off per week, and at least 10 following hours off between shifts; and may take calls no more frequently than one night in three.5
A survey looking at the number of work hours versus the wellness of residents conducted at a university-based internal medicine residency in Seattle showed an increase in the proportion of residents satisfied with their career and a decrease in the percentage meeting the criteria for emotional exhaustion. Overall, most residents (65 percent) approved of work-hour limitations.5
Maybe it is time to take heed, self-reflect and self-impose similar guidelines to keep ourselves healthy.
Emphasizing Exercise
Exercise regularly. There is no debate on the overall benefits of exercise. Yet so many people avoid or struggle with incorporating exercise in their daily lifestyle. Prochaska (1992) identified a 5-stage process individuals undergo when attempting to make changes in behavior.6 Understanding this model will help physicians and clinicians better prepare themselves and their patients to reach their desired outcome.
Get on that Peloton! Okay, a Peloton may not be for you but there are many online resources, at-home workouts and other convenient options available. The bottom line is to get your body moving. From structured exercise programs to long walks, "physicians who participated in aerobic and muscle-strengthening exercises according to Centers for Disease Control and Prevention (CDC) guidelines had high quality of life scores."6
The Benefits Of Saying No
Say “no” more often. To learn the ability to say no, you must learn what you say yes to first. It is not unusual to lose sight of our core values during the long journey in becoming a physician. An essential step in preventing burnout is to reexamine core values.
Are you:
• regularly doing surgeries for a doctor because he or she chose not to do them;
• only treating nail care patients;
• always cleaning up the mess of a particular surgeon in your group;
• struggling in managing difficult patients; or
• frustrated with your hospital administration or boss creating an unobtainable bonus structure or overworked schedule?
Life is about choices and asserting oneself is a choice. In a guest entry on KevinMD.com, N. Bande Virgil, MD explains this perfectly:
“To defend against burnout and physician abuse, we must teach our new physicians the art of saying no. Helping our new residency graduates and medical students recognize these abusive work environments (and) prioritize their happiness and values so that they can avoid pitfalls is essential.”7 Furthermore, Dr. Virgil states, “the more we as attendings and seasoned physicians model this behavior, normalize balance and disavow the culture where physician personal needs are unimportant, the easier it will be to transform the landscape of medicine from the external pressures we face.”7
Get A Better Handle On News Consumption
Stop scrolling. How many social media sites have you been on during this pandemic? Watching the ignorance rage in America is incredibly harmful. Scrolling through anti-science, anti-vaccination, hoax and conspiracy theories will drive you to insanity or, even worse, moral injury. Manage the news consumption. Listening, watching, scrolling, etc., for hours instead of simply keeping informed (15 to 30 minutes a day) can be detrimental to one’s health.
Emphasize Gratitude
Create an attitude of gratitude. Keep in mind that your thoughts dictate how you feel and respond to situations that we experience. COVID-19, the political circus and financial uncertainty probably create anxiety and stress in many of you. When you feel anxious and stressed out, it may be due to your negative thoughts. These thoughts will indeed effect your overall attitude.8
With the vaccines at our fingertips, it is time to create a new attitude, an attitude of gratitude. Why is this important? A 2009 study of 400 adults found that grateful people had better sleep quality, were able to fall asleep faster at night and had less daytime tiredness.9 A 2013 study of 1,000 Swiss adults found that gratitude correlated with improved psychological health translated into a greater likelihood of engaging in health-promoting activities.10
Neuroscience teaches us that you can rewire the brain. To do this, as you lay in bed at night, try thinking about three positive things that recently happened to you and/or three things you are grateful for. Do not analyze them. just repeat them several times as you fall asleep.
And when all else fails, get your nails done, buy unnecessary and useless stuff at Target, discharge the difficult patients and be unapologetically you.
Dr. Levick-Doane is a Diplomate of the American Board of Foot and Ankle Surgery, and the American Board of Podiatric Medicine. She is a foot and ankle surgeon at Kipferl Foot and Ankle Centers in Des Plaines, Fox River Grove and Algonquin, Ill. Dr. Levick-Doane is also an affiliate attending for the RUSH podiatric residency program in Chicago.
References
1. MacMillan dictionary. Balance. Available at: https://www.macmillandictionary.com/us/dictionary/american/balance_1. Accessed December 17, 2020.
2. Spagnolo PA, Manson JE, Joffe H. Sex and gender differences in health: what the COVID-19 pandemic can teach us. Ann Intern Med. 2020;173(5):385-386.
3. Kluger, J. The Coronavirus pandemic’s outsized effect on women’s mental health around the world. Time. Available at: https://time.com/5892297/women-coronavirus-mental-health/ . Published September 24, 2020. Accessed December 16, 2020.
4. Mantua J, Spencer RMC. Exploring the nap paradox: are mid-day sleep bouts a friend or foe? Sleep Med. 2017;37:88-97.
5. Patel RS, Sekhri S, Bhimanadham NN, Imran S, Hossain S. A review on strategies to manage physician burnout. Cureus. 2019;11(6):e4805.
6. Romani M, Ashkar K. Burnout among physicians. Libyan J Med. 2014;9:23556.
7. Virgil NB. Burned out? Just say no and teach others to as well. KevinMD. Available at: https://www.kevinmd.com/blog/2017/06/burned-just-say-no-teach-others-well.html . Published June 15, 2017. Accessed December 16, 2020.
8. Gazelle G. Gratitude: how it can decrease physician burnout. Gail Gazelle MD. Available at: https://www.gailgazelle.com/gratitude-how-it-can-decrease-physician-burnout/ . Published May 7, 2014. Accessed December 16, 2020.
9. Wood AM, Joseph S, Lloyd J, Atkins S. Gratitude influences sleep through the mechanism of pre-sleep cognitions. J Psychosom Res. 2009;66(1):43-48.
10. Hill PL, Allemand M, Roberts BW. Examining the pathways between gratitude and self-rated physical health through adulthood. Pers Individ Diff. 2013;54(1):92-96.
