If you are feeling burned out, you might sound like an excuse machine -cranking out justifications and apologies for your human limitations, sprinkled with a bit of helplessness, resentment and anger at the system that demands so much of you. News flash – no one needs to hear your reasons. Save your breath. If this sounds harsh, read on.

For context, I recently posted about my decision to say no to everything I could for an entire year. I received a lot of feedback – some public comments on social media, and a small avalanche of private DMs and emails. Lots of support. But also, lots of criticism from strangers (some of whom would later admit they hadn’t read the post, but were reacting to the headline or a quote). They said I was selfish. I was part of the problem in medicine, selectively choosing what I felt like doing while throwing my altruism and obligations to society and the medical insitution out the window. Picking what I wanted to do and leaving the rest as a burden for others to bear. Leaving the hard work for people who can’t or won’t say no. I’m not going to bother to defend my choices to strangers. But because many of you have asked, I am happy to explain in more detail what happened, and my thoughts about my decisions both then and now.

Let me back up.

I took my husband out for his 40th birthday. It was a surprise party. The next morning, his voice was gone. We weren’t worried or even that surprised – we’d stayed out late, shouting our conversations with friends across a noisy bar. But after 5 days of tea with honey and throat lozenges, it was no better. And it wasn’t just hoarse. It was literally gone. He couldn’t speak at all.

He asked me if he should go to the doctor. Actually, he’d been asking all week, and I’d been saying no – what would they do for acute laryngitis that would resolve in a few days? But now, I was thinking maybe he should, just in case he had some kind of URI linked to his hoarseness that would clear up with antibiotics or something. Then my kids reminded me that I’m a doctor, and helpfully supplied me with my stethoscope. Mostly for their entertainment, I listened to his chest. Left apex clear, right apex clear. Left base – hmmm. Nothing. Right base clear. Left base again…still nothing. So off to the primary care doc he goes. When he gets home, he tells me he was prescribed a course of steroids after a chest x-ray ruled out an infiltrate in that left base. He says the x-ray showed a ‘shadow on his heart’ – probably nothing – but the doctor ordered a CT scan for the following week just to be safe.

He got the scan, and a day later I got a text. I was in a big meeting, almost didn’t check my phone. A large anterior mediastinal mass. I walked out of the meeting and began to wipe my calendar clean of items big and small, important and trivial, professional and personal.

It was the overwhelm of his diagnosis that led me to make some extreme choices, and because his treatment and recovery lasted the better part of the year, they were long-term changes. I had a real need to take stock of every obligation and make a decision about it. With all of my attention on my family, I came to realize just how much of my time and energy I had allocated for work, and how little of it I reserved for them, or for myself. There was a crazy irony to all of this. I had explicitly referenced focusing on only a few priorities and deliberately letting go of others in my yearly goal-setting reviews at work – I had it in writing! Plus, I had been leading a group for women physicians on productivity and life balance. I’d been talking the talk, and thinking I was walking the walk, but I wasn’t.

So, back to all that criticism. Lots of people assumed (from the title?) that I was doing some kind of resilience or productivity exercise to prevent burnout. That’s not the case- I didn’t feel burned out. But maybe it was just a matter of time, since society at large and the medical community in particular seems to imploding with burnout. And with self-management needed to remedy the burnout, I’m seeing people go to great lengths to defend themselves, perhaps in part because they fear the judgment and backlash of people who disagree or don’t understand. They explain all of the moving parts and competing priorities and conflicting pressures. They apologize for their perceived shortcoming of not being able to ‘do it all’ – or they get mad at the system that expects them to. If you’ve found yourself doing that, I’m inviting you to stop right now.

physician burnout from trying to do everything

If you are making deliberate choices for your own wellness, kudos and congratulations! You don’t need to defend those. I’ll say it again – no one needs to hear your reasons for your priorities, and they certainly don’t need to agree with them. If you allow it, your life will be designed by other forces, and there will come a time when you regret that. Don’t do it, and don’t feel you have to explain or defend or justify or meet anyone else’s standards for hard work, family commitments, or any definition of personal success. Be accountable to your morals and values. Be clear in your priorities. Say yes and say no to whatever it is that is right for you. Don’t waste any more precious time or mental energy explaining yourself. Just start doing a better job at living. Start now. And if you want to, let me know how it goes.

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