The absence of burnout does not equal wellness. While the focus on physician burnout as an epidemic is finally gaining more attention, we may be missing a larger issue. Most physicians are not burned out. We are able to function. We get through our days, make it to some of our kids’ activities and even manage to go out to dinner on the weekends. We survive the work week as we look forward to our next vacation. We do this because that is what we have always done. We put our heads down and do our work. We become masters of delayed gratification. We develop the mindset of: I’ll be happy when — I get into medical school or match into a good residency spot or make partner or have enough money to retire etc.
Along the way, we may have some bright spots — falling in love, having kids, taking great vacations. We may even reward ourselves for our hard work with a new car or nicer house. We deserve it. But deep inside, “something is missing.” We have achieved most — if not all — of the goals we have set for ourselves. Yet despite our hard work, many of us remain unfulfilled with our careers and often with our lives. What is it that we need? A better job with more money? A different car? A different title? Better vacations?
I have struggled with these questions and many more. How do I stop wanting what I don’t have and start wanting what I do have? How can I fully enjoy the present while also preparing for a better future? How can I spend quality time with my kids while they are still around? How can I have a career that uses all of my potential? Of all the questions that I’ve asked myself, the most important one was this: How can I learn to flourish and not just function?
Fortunately, I found answers in the relatively new field of positive psychology, which is the scientific study of human flourishing. Unlike traditional psychology which alleviates distress and moves a patient from a -8 to a 0 or +1 (if they are lucky), positive psychology focuses on a patient that is functioning at a +1 and tries to move them to a +8 on the flourishing scale. We need both areas of focus. There are many people that are functioning well by most standards but are nowhere near their potential level of fulfillment.
So how can we reach our highest potential by applying positive psychology? One key principle that positive psychology has elucidated is hedonic adaptation. We adapt to all positive things in our lives which are constant. Think about the initial thrill of getting into medical school or landing that first attending job. While exciting at first, we quickly adapted. Although hedonic adaptation is a huge obstacle in improving and sustaining our well-being, it did provide us with an evolutionary advantage. If we didn’t get used to old stimuli that were constant, we would not be able to recognize new potential stimuli (threats) from old ones that should have faded into the background. Nature just wanted us around long enough to procreate but didn’t care how happy we were along the way. This is a critical principle to understand and should be taught in schools.
How do we stop taking all the good things in our life for granted? The key is attention. What we focus on becomes our reality. Appreciating the good will make the good appreciate. How do we do this? The simplest way is through the cultivation of a gratitude habit. This has been heavily studied in positive psychology and is perhaps the field’s greatest contribution. Grateful people are happier, healthier, and have greater life satisfaction. Writing down three things that you are thankful for every day can be transformative. It helps to go beyond the usual health, family, and food. Look for moments or experiences throughout the day that you will write about in your journal. It can be as simple as playing catch with your daughter, having an uninterrupted conversation with your son in the car on the way to practice or a glass of wine on the deck with your spouse.
Another effective antidote against hedonic adaptation that has worked well for me is negative visualization. Rather than write about the positive aspects of my life, I mentally subtract one and imagine what life would be like without it. This takes less than a minute and is easily done on the ride home from work. Long day at work? Imagine if your job was eliminated and you had to find another one. Kids arguing with each other? Imagine if they were no longer living with you and how much you would miss them. Bad is stronger than good — which means that we are wired to respond to potential loss more than we are to possible gain. This is the power of negative visualization.
These two habits of gratitude and negative visualization have worked well for me. They can be done in less than ten minutes per day. They are backed by science and have been preached for thousands of years by religions and ancient philosophers. As physicians, we are often too busy to worry about our own happiness. Many people depend on us. We are used to dealing with stress. But the health care system will only be as healthy as we are. There is considerable evidence linking physician wellness/burnout, medical errors, and patient satisfaction. We owe it to our patients, families and most of all ourselves to prioritize our own well-being. Positive psychology can help. It can move us away from burnout, beyond functioning and straight toward flourishing.