From the Editor

From the Editors: Finding joy


While basking in the fading glow of the holidays, I have been reflecting on the dynamic of stressful professional lives of surgeons combined with the negativity local and world events engender that can push us toward burnout.

The holiday season is a time when people tend to engage in activities that have been shown to improve mood and outlook: connecting with old friends, sharing memories of a happier time, spending time with children and grandchildren, sitting around a warm fire, enjoying the sights and smells of bright decorations and fragrant candles, attending traditional holiday plays, concerts, and ballets. The holiday traditions, no matter what your ethnic or religious background, create community and warm feelings. The workweek may be shortened, people take a little time out, smile a bit more. For many of us, these activities can be a tonic.

At the same time, the days become shorter, colder, and grayer in most of North America. The normal frustrations of our day-to-day professional lives may seem more profound during the winter, and some experience SAD (seasonal affective disorder) or even burnout.

Dr. Karen E. Deveney, professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland

Dr. Karen E. Deveney

Much has been written in the past decade about burnout. Although I am by no means an expert on the subject, I have read a lot about it, and the purported causes certainly make sense. Human beings, especially surgeons, seek control over their environment. They work hard and want to be rewarded for that hard work rather than being asked to do still more. Surgeons’ daily lives have always been full of stress and high pressure, but unrealistic expectations seem to have expanded and become unmanageable. Add to that a steady stream of negative news that greets us every day from the world around us: wildfires and other natural disasters taking innocent lives and leaving others homeless; senseless and random attacks by deranged or fanatic people on other human beings as they just go about their normal lives in churches, schools, and other public places. Awareness of troubling events in the world at large can magnify distress in surgeons already under a lot of pressure.

If we are not affected by these events, we may be missing the compassion gene. But I would suggest that an acute awareness of a world of trouble around us compounded with our own heavy load as surgeons is a recipe for burnout. It may not be within the capacity of any of us to alter the reality of our present world, and the surgical profession is not going to become a low-key occupation any time soon. But we can control our response to all this and take steps to attend our own emotional health.

I have found that the single most effective measure to combat negative feelings is to connect with colleagues, friends, and family to share positive, enjoyable experiences: a potluck dinner, a concert, a hike (or snowshoe trip) in the woods. We should seek out optimistic, glass-half-full individuals. We all have some of these folks in our lives and they do us a world of good.

With regard to professional stressors, reaching out to colleagues to work together in identifying remedies for a dysfunctional workplace may not only address the problem, but also allow you to recognize that you are not alone in your distress. Joining forces as a team to forge a solution can be satisfying and empowering.

Nevertheless, surgical practice remains intense, stressful, and demanding. As surgeons, we tend to be perfectionists, wanting to dot every “i” and cross every “t,” no matter how trivial. It is critical to set realistic expectations for how much you can achieve. Identify and prioritize personal and professional goals, make the most important goals take front and center, and delegate (or just allow to disappear) items that are less important. This may be the single most important strategy to avoid burnout: Prioritize what is essential and let the rest go.

A great deal has been written recently about resilience and mindfulness – facile concepts that don’t address the struggles of individuals feeling helpless and overwhelmed by the onslaught of demands on his/her time. Even though clichés about mindfulness can ring hollow, I have found that taking small steps to build my own inner reserves can help.

Here is my advice: Take a moment several times a day to appreciate something beautiful around you: a textured sky, a peaceful field, city lights, a nearby river with the ripples of wind on the water. Smile and greet someone on the street or in the hallway at work. Say a good word to someone on a job nicely done. Reflect on how doing these things affect you. Do they make you feel calmer and happier? “Rest your brain” every 2 hours for just a minute or two; cognitive fatigue occurs after 60-90 minutes and drains your energy if the “pause button” isn’t pushed.

Many of us neglect our personal health. It goes without saying that we are all far more likely to avoid burnout if we have a balanced diet, adequate sleep, and some exercise. We should all have a primary care provider for regular checkups and preventive exams. We speak with great authority when we counsel our patients to do this, so what possible excuse do we have for neglecting our own health?

One of the most important habits that I cultivate to improve my own mood is to end each day reflecting on three positive things that happened that day. Amid all of the calamities that occur every day in the world, it should not be difficult for those of us who live a life of relative privilege and plenty to find positive things in our lives. A strong association has been demonstrated between a sense of thankfulness and individual happiness and contentment. As surgeons, we have a ready source of positive reinforcers – the gratitude of our patients. I have a “feel good drawer” for “thank yous.” I open that drawer and read some of those messages from grateful patients. Reflecting on how we have been able to help our patients can do us all good when we are having doubts about our professional lives.

I want to encourage all surgeons to take a little better care of themselves this year. Take some specific steps to attend to your physical and emotional health. Do some activities the only purpose of which is to rest, to reflect, and to find joy.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.

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