Knowing When to Say When
“Know When to Say When.” Anheuser-Busch advertising campaign, now 40 years old (latest very creative ad here: Link )
One of the medical news stories circulating over the past few weeks has been a very touching photo of Dr. Joseph Varon, and intensivist and Chief of Staff at United Memorial Medical Center in Houston, TX, cradling a distraught and lonely Covid-19 patient on Thanksgiving. For those who missed the picture, here is a link to the picture and story. Link
As moving as the picture is, there was one aspect of the story I found quite disturbing. At the time the picture was taken, Dr. Varon shared that he had worked 256 consecutive days and the news reports noted this detail to be an admirable demonstration of the dedication and selflessness of healthcare workers everywhere. While I don’t know the circumstances at that particular hospital, I do know that it is neither admirable nor healthy for a busy clinician to have worked without a day off for 36+ weeks (and counting). And the fact that one of our colleagues would do so (and be on national news telling about it) makes it even harder for the rest of us to break out of the superhuman myth that has been drilled into us and that the public so badly wants to believe.
But where in our professional upbringing did we learn how to determine when we had worked “enough” – when we had done “enough?” Who taught us to “know when to say when” when it comes to our work?! As I reflected on this, my personal answer was “nowhere and no one.” Indeed, it took a “duty hours” mandate from the residency training accrediting body for any kind of limits to be placed on the amount of work a resident physician does in a week. While this might create a forced “enough” during residency (at 80 hours a week), it does nothing to prepare us for the demands of practice, where enough always seems to be “just a little bit more.”
This week I was introduced to the term “productivity shame.” Productivity shame is the feeling that you’ve never done enough, and the sense of guilt and shame experienced when you try to relax, because that would be “unproductive.” Sound familiar? The “voices” driving productivity shame can come from within and without, usually both. Unfortunately, most healthcare workplace cultures, knowingly or unknowingly, promote productivity shame. We’re made to believe that being passionate and driven to work more is both our ethical obligation for the sake of our patients and part of being a “team player.” But we know that’s not true. Our ethical obligation is to do the best for our patients when we’re working, not to give our lives over to patient care and our work. As I watched Dr. Varon being interviewed, my own professional programming kicked in, and I felt a twinge of productivity shame myself (what am I doing watching TV when he’s working 36 weeks straight!?”). And we know when you can’t disconnect from work, you’re leaving yourself open to all kinds of distress.
There are things that can be done to resist and reframe this “never enough” mentality, including not making productivity and achievements the sole metric of self-worth, not constantly looking for external validity, setting reasonable standards and goals that are in line with your values, defining what success looks like for you and working from there, and creating and protecting explicit boundaries. And perhaps most importantly, inviting someone into your professional life to help hold you accountable. For you, that “someone” could be your PeerRx partner.
This week be sure to explicitly schedule some not working (and not thinking about work) time and be sure to check in with your PeerRx buddy (and colleagues) to be sure they’re doing the same. To quote another famous advertising campaign, “Friends don’t let friends drive” themselves to exhaustion and distress. Let’s make sure we heed that wise council ourselves.