Finding Joy through Teamwork and Boundary setting

I'm in between sessions at the #IHIforum right now. What an amaaaazing conference. If you have not been, you should really consider it. The intrepid leaders at Doctors of BC (DoBC) have designed a Joint Collaborative Committee scholarship that may fund you to attend. Email [email protected] for more info if you're a DoBC member.

In multiple sessions at IHIforum, thousands of health professionals are speaking about how we are raised in a culture that encourages us to just keep giving and giving to our workplaces. That has caused me to reflect on my own beliefs about work and my journey into and beyond burnout as a family doctor.

I’ve always held the idea that I'm supposed to be a helper. Thirteen years ago, I went running full steam into family practice. I built up a massive panel of patients and really got stuck grinding on the treadmill many family doctors are on. After five or six years, I worked myself until I was physically unwell. I was trying to put out fires everywhere without looking at my own fire. I hadn’t prioritized my own self-care and as a result, I was suffering.?

Students come to the field of medicine with that ethos of being a helper, of wanting to heal. Their mentors and their professors tell them to do their due diligence and give patients everything they have. As students we’re instructed to understand our patients fully if we're going to help them. We’re told the system is not perfect, but we’re not really offered solutions. No one is modeling self-care. All students see is the need for hard work and a culture where the job is never finished.?

For myself, coming out of burnout took some hard conversations. It took self-reflection and meeting some great coaches. Initially though, it took the courage to reach out and say, ‘hey, I need some help. I need some coaching.’ It wasn’t easy to admit I wasn’t happy and wanted to do things differently. Grappling with our own vulnerability is not something we’re taught in medical school.?

There are so many of us in medicine, especially in primary care, that struggle with boundaries. We see ourselves as boundary-less. By definition, we're generalists. We're general practitioners, and often that leads us to explore everything and anything about a particular person's life. We view ourselves as a patient’s protector, as their advocate, as their helper, as their physician and even as their friend or social worker. There are many really good humans in family practice, and they give everything. They give their own health in order to be present for their patients. They are healers in the community. But often, I don't believe they are serving themselves when they sacrifice all their boundaries in the aim of being helpful. There is a profound loneliness in creating space for others but not taking any yourself.?

When you adopt a team approach, it lightens the load on everybody. Within a team there is opportunity for collaboration and reflection. A piece of self-care is taking time to consider the work you're doing and to feel good about it. If a physician doesn’t pause, they won’t get satisfaction from reflecting on their work and appreciate their accomplishments.?

Intentional time to celebrate, and recognize achievement together, is so important and something few physicians do. Instead, they’re onto the next fire. It's time family doctors start tooting our own horns. We’re too humble. There is so much we do that goes unnoticed. As physicians, our culture has conditioned us to do the work right in front of us, with our heads down, but there’s much to be seen if we look up and around at one another.?

Excellent care isn't designed to be delivered on our own. There is great value when a group of physicians in a neighborhood looks at their data together and realizes, they have similar aligned challenges or patient issues. These physicians could ask themselves, ‘how can we use the collective data we see within HDC Discover to advocate for more social workers in our neighborhood? Or more diabetes specialists or more dieticians?’ The data is there, but we need to come together to use it for quality improvement, for ourselves and our patients. This is where I see true value and utility in #HDCDiscover.

As we head into the holiday season, I think one of the ways forward, to sustain ourselves through 2023, is that physicians review their own personal boundaries and establish healthier boundaries aligned with what really serves them.? Joy in work comes from knowing you did a great job to help others. It’s an environment where you're not carrying the extra burdens that are not yours alone, or at all, to carry. There is a healthy freedom that awaits you from a healthy understanding you are not responsible for everything and everyone. I invite you to free yourself from unnecessary self-criticism which drains your energy and that does not serve you. Our system has not yet been designed for us to work together - but WE can change that. I strive to model boundaries and self-care for my team and colleagues. What we see around us is often what we emulate and then what perpetuates.?

Here's a first step. Come join us on HDC Discover and include your data to the aggregate. Let’s start working as a team. Our collective contributions allow individual physicians to review and make decisions based on community information. It offers confidence that decisions are being made based on our collective numbers and recent statistics. Prioritizing the time to contribute to our collective professional understanding through data takes some initial investment but it often saves time and enhances quality care in the long run. Reflect on how many hours you have in a day and understand what your values are. Truly think about what makes you feel fulfilled and then budget and redesign your schedule to be in alignment with those values.?

Holding boundaries with your time can be really difficult, especially if we've been out of alignment with your human limits for a long time. It can be disruptive to realign with our limits and values, but those efforts make our lives potentially way more joyful and fulfilling. There will be times when we will need to say no. Saying no will be uncomfortable at first, but it's critical to help us focus on what really matters. Setting these boundaries is important if we want to stay healthy and joyful and functional within our work and personal lives.?

Dr Don Berwick was kind enough to visit with the Canadians at the IHIforum last night. He once reminded us "your natural state is joy..." To me this means we may NOT need to do MORE but in fact we need to DO LESS in order to create spaciousness to BE more Joyful.

#ShawnAchor spoke to us yesterday at the IHIforum and reminded us that Joy IS the MEANS to more success in life...Joy does NOT often RESULT from work-based success.

Each of us has unique talents that add value to our community. I encourage you to take time over the next few weeks to think about yours and how you’ve honoured them lately. Our system is changing in British Columbia with the recently announced February 2023 payment model option for longitudinal family doctors - in that context, what might we do differently to look after ourselves in order to offer the best care to our patients?

Wishing everyone a joyful holiday season and a chance to recharge, reflect and set boundaries for the new year. Please reach out if you’d like to chat or share your experience. Message me on Twitter @gatewaymedic to chat anything QI or primary care of Joy in Work. I love learning and facilitating conversations about these topics! We are in this together! #OneTeam #FTS #FTSintheFonda #FTSintheZoom