• Rosalind Kaplan, M.D.

Life Gets in the Way

I noticed today that it's been a while since I last wrote a post. I'm also, for the first time, a little behind on my work for my MFA, and feeling the pressure of my deadlines. And I have left a freelance medical writing project sitting in my inbox, hoping that the publisher is not in a rush. This is not my usual modus operandi. I tend to be a little obsessive and compulsive. I like to stay on top of my work. I have never been the kind of doctor to leave a bunch of open charts in my EMR, or the kind of writer who has to be prodded to complete my assignments. But the past couple weeks have brought a lot of chaos into my world, and I've decided that, rather than panic, I will go with the flow, and get caught up when I can. I think my fear has always been that I'll NEVER catch up, but am working on believing that I can, and I will.

For the first time in over 30 years, I am managing my own time, rather than having it dictated by a schedule of patient visits, classes to teach, and meetings called by my department or other parts of an institution. I only have one day a week set in stone- the day that I work at Urgent Care. During the rest of my time- six full days a week! - I decide what gets done and when it gets done. Consequently, all the personal emergencies that have arisen recently- including a loved one's medical problems, a couple of sick friends who need some help, an injured dog, and the ups and downs of my son's wedding plans- have taken a front seat, while I've pushed the work that needs to be done to the back.

The crises are all resolving, slowly, essentially in their own time. And what that made me think about is this: how did I handle it all when I had a much more structured work schedule? How does ANYONE handle it all when there is a structured work schedule? Looking back, there were always all kinds of personal emergencies. In fact, when I had young children, there were a lot more of them. I remember driving like a mad woman up the Schuykill Expressway when I was at work and got a call from day care that my son, age 3, was in the ER with a bleeding head wound. I remember coming home late on a Friday afternoon to find that one of my dogs had suffered a stroke, and rushing her to the veterinary hospital in 5 pm traffic. I remember a call about my father, who landed in the hospital with pneumonia and a mysteriously paralyzed diaphragm, hypoxia worsening his already fragile mental status, on a day when I had inpatients to round on as well as a full outpatient schedule. Somehow, I muddled through these episodes, teetering on the edge of exhaustion at times, but somehow making it through. I don't remember the exact arrangements I made for any of these little disasters. What did I do if I woke up on a work morning and found a kid too sick to go to daycare or school? What did I do when I was sick myself? It's all a blur, frankly. I'm thankful that I have the flexibility now to juggle my work and my private life according to priorities. But the truth is, I didn't have that for most of my life, and most people don't.

I read an article posted on Doximity last night. It was originally in Psychology Today. The article says that US workers, particularly women, are overwhelmed and exhausted by the need to balance work and life. And that as a well-to-do, industrialized nation, we are lagging way behind in setting up solutions for this problem. We have no guaranteed paid maternity leave or paternity leave in this country. Sure, we can take FMLA time, but who but the wealthiest people in this country can afford to do that? The wealthy are also the ones who can afford to hire good caretakers for their children or their elderly relatives, so they are the least likely to need the time anyway. In this country, we have little in the way of affordable, high quality childcare for children too young to attend school, and for children who are on vacation from school when parents still have to work. And there is even less available in the way of childcare for a sick child. Often, the only option is for a parent to take a day off of work. Most often, that parent is a mother. Then we ridiculously wonder why it is that women have a hard time staying on the 'fast-track' to leadership positions, or advancing in their given professions.

We also, in this country, have developed such a ridiculous expectation of workers in general that many people feel they cannot take a day off from work when truly ill. We go to work with contagious infections. We go to work with fevers, barely able to think. We go to work injured, and risk worsening the pain we already have. There is no way that this make sense, but also no obvious way around it.

Women now make up more than half of medical students in the US. Medicine should be a profession that takes the lead in solving some of these problems. Medical practices, hospitals, and institutions need to be leaders in ensuring that those who need a sick day take that sick day. Medical practices, hospitals and institutions need to help their employees obtain affordable, quality child care, sick child care, and adult daycare so that medical professionals can fulfill their duties to their patients as well as their families. Given the degree of burnout in the medical profession, it behooves the medical system to take a hard look at the factors that make balancing work and life so difficult and to start correcting those factors. It will go a long way towards improving not just morale, but also the continuity of patient care. It is also one of the steps we need to take towards gender equality.

In the future, I hope to be able to see a clear path for both moving forward in a medical career and also caring for one's family and managing one's personal life. I hope that I can look back to the years when I had a busy medical schedule and also had little children and aging parents to care for and say, 'back then, it was hard to do. But now we have the resources that make it possible to do it all.'

#physiciansatisfaction #selfcare #physicianwellness #physicianburnout #health #patientsafety #medicaladministration #affordablechildcare #eldercare #lifeworkbalance

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