Voices: Finding time to be balanced about wellness | Diljeet K. Singh, MD, DrPH

Finding time to be balanced about wellness | Diljeet K. Singh, MD, DrPH

When I first learned about the benefits of a wellness approach, my autopilot applied it to my patients and trainees. And when the “practice what you preach” got loud enough in my head, I put it on my to-do list, and whined to myself, “Really? Not only am I supposed to be mindfully treating patients with expertise and compassion, skillfully using the most up-to-date approaches by reading and teaching, thereby curing, etc., but now I need to be Zen about it all?” And to have a healthier “work-life balance,” I need to spend less time doing it?

Diljeet K. Singh, MD, DrPH

Diljeet K. Singh, MD, DrPH

Of course, there is “life,” i.e., raising the next generation, caring for the previous one, paying the mortgage, contributing to the community and planning for the future? And I can’t forget to spend time with the people I love. I can’t forget to exercise, meditate, live clean, eat locally, you know the drill. But when? And how? What does work-life balance mean? Is it an either/or? How bad is bringing my work home for me? Is it more like champagne or grain alcohol?

And aren’t “we” different? Gynecologic oncology doesn’t seem to lend itself to balance and wellness. Enhanced sympathetic tone is how we operate. Adrenaline allows us to multi-task and respond to crisis but doesn’t serve us when a word alone can stimulate a fight or flight response. Try phrases such as performance metrics, lawsuit, deposition, loss of insurance, uncovered service, or drug shortage.

Being a gynecologic oncologist is different. Every day there’s death and dying and pain and suffering and loss and grief and none of it seems fair. And we still live in the regular world where there is gender inequality, racism, poverty, climate change, violence against women, and injustice.

I struggled with finding “time for wellness” and fretted when hours at work were outweighing my “life” hours. However, working with patients on this topic made it clear to me that wellness cannot be a bullet point on a to-do list and work-life balance is not a math problem. Patients talk with us about what matters to them and goals for their palpably limited time. They are motivated by their diagnosis and prognosis to change an unhealthy home life or leave an unsatisfying job. In my mind I call these “soul goal” discussions, and I found myself applying this thought process to myself. What do I want to do with the time I have in this life? What brings me joy? What are my soul goals?

This was harder than I thought and for me the tricky parts were:

1) Separating obligations from responsibilities. Responsibilities are what we take on, ideally reflecting our goals and abilities.
2) Focusing not on the future achievement of a goal but on the day to day reality of it. (e.g., I want to run a marathon but I hate running.)
3) Letting go of judgment. Hiking on every continent is as worthy a goal as serving humanity.
4) Staying aware of how my soul goals evolve and shift in priority.
5) Giving my goals the time they deserve.

Time management is a learned skill. A week into a “30-day time diary” for a workshop, I realized I spent a lot of time doing things that did not matter to me and that I did not like to do. Delegating, outsourcing and delivery got me back 6 hours a week. Further, building my calendar with my soul goals in mind instead of letting my calendar tell me what to do opened up additional time that I was convinced did not exist. Self-care has been more doable with this “recovered time” and as a result my remaining hours seem more productive and fulfilling.

Being a gynecologic oncologist IS different. This job lets me pay the bills, use my brain and my heart, work with amazing colleagues, witness the strength and resilience of women and their families, help women save their own lives and so fulfills many of my soul goals. I don’t sweat the time I spend doing it.

Diljeet K. Singh, MD, DrPH, is a Gynecologic Oncologist at the Mid Atlantic Permanente Medical Group in McClean, VA.