“If you think adventure is dangerous, try routine; it is lethal” ―Paulo Coelho
My wife, Pam, and I recently returned from a fantastic sailing adventure in the Bahamas aboard the Liberty Clipper, part of the Boston Harbor Liberty Fleet of Tall Ships. The 125-foot gaff-rigged schooner is a modern replica of the small merchant vessels that plied the American coast in the 18th and 19th centuries. While the steel-hulled ship caters to tourism in Boston during the summer, taking guests on short sails around Boston Harbor, it overwinters in the Bahamas out of Nassau, providing weeklong cruises throughout the islands for those looking for something different in cruising.
This cruise is more of an adventure tour. The food was outstanding—my glass was never empty—and the scenery was incredible (we sailed the isolated Bahama Exuma islands), although the cabins were consistent with a working sailboat. While we did have a private bathroom, we slept in bunks, and Pam and I could not pass each other in the cabin without one leaving the room.
As a sailor, I had no issues with this, but some might find these conditions difficult. There was so much to do that little time beyond sleeping was spent in the cabins. Guests could involve themselves in working the boat as much or as little as desired, which I loved. Hanging out on various Exuma beaches and snorkeling around untouched coral reefs was incredible. The captain’s nighttime lecture on the stars and constellations was terrific. In short, it was a fantastic vacation.
Beyond just finding a great way to spend a week away from work (kudos to Pam for finding this trip), I feel one of the most relaxing aspects of this excursion was freedom, for seven glorious days from email and my cellphone. Granted, when I returned from the journey, my inbox certainly overfloweth, and my cellphone “dog-leash” buzzed and vibrated for minutes once I turned off airline mode. I am not complaining, and I guess it is nice to be needed, but I am also not embarrassed that I enjoyed the break. Pam and I needed some time without work distractions to reconnect, and I certainly appreciated the protected time to do things for no more significant reason than I enjoy them. I consumed three books during this week, reading material that required no editing from me, and the content had absolutely nothing to do with work or medicine (pure joy).
The healthcare profession depends on individuals with an innate desire to give of themselves to others. Federal healthcare workers have the added element of service to the country that requires further giving. I would suggest that those who devote themselves to a career in federal medicine are self-selected altruists. By definition, or at least within the field of zoology, altruism describes the behavior of an animal that benefits another at its own expense. Certainly this definition seems a little strong, since we are monetarily compensated for the work we do in federal healthcare, and I feel my career has benefited me professionally and provided substantially for my family. However, the job can become consuming in an unhealthy way.
The topic of healthcare provider ‘burnout’ seems to be a recurrent theme in the medical literature of late. Burnout is described as a combination of fatigue, cynicism and perceived inefficacy that results, long-term, in increasing job stress. A 2019 meta-analysis in the Annals of Internal Medicine concluded that, “Burnout in health care professionals frequently is associated with poor-quality care in the published literature.”1 I think stress in healthcare is an unavoidable component of the profession, when decisions and actions by providers can have such a fundamental and lasting impact on other people’s lives. Few occupations require such personal and individualized interaction with other people outside of family relationships. Pile on top of that the ever-present anxiety associated with interacting with a federal bureaucracy, the potential for burnout becomes understandable.
Healthcare providers, by their very nature, are gluttons for punishment. We thrive on the long hours, the drama and the less-than-spectacular working conditions, right up to the moment we do not. I think it is a reasonable generalization that, as a profession, we have no problem telling others how to be healthy. Still, we are often terrible at recognizing unhealthy activities in ourselves. It is certainly easy to use the excuse of patient care to allow the administrivia (it is a word, look it up) of our work lives to become the all-consuming purpose of our lives. While I am no guru on the meaning of life, I am pretty sure it is not found on my cellphone or within my endless work email.
After more than 30 years in federal medicine, I think I have figured out that I cannot be a pleasant, healthy provider for my patients if I invest no time in my own pleasant and healthy activities outside of work. Perhaps this idea will be a stretch for many readers of this column, but, when I take a vacation it is not only for myself, it is also for the many people, patients and co-workers, that I leave behind for a week. Taking care of one’s self is not just about vacation, though. It is also living by example for our patients. Healthier diet, routine exercise, mindfulness training and interests outside of work are as important for us as they are for our patients. In this aspect we truly need to set a good example for our patients by practicing what we preach. Burnout is what happens when we neglect our body and mind out of the erroneous attitude that, as healthcare providers, we are immune to such mundane basic human needs.
I love my job and have been immensely satisfied with my career. I live well and have been fortunate to put three daughters through college. Despite all that, sometimes I would rather be sailing. That is OK. It does not mean I am not committed to the profession, and I would argue these outside interests are in my own and my patient’s self-interest.
1Tawfik, Daniel S., et al. “Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis.” Annals of Internal Medicine (2019).
