I am a family physician. Here’s what I know about work, health and family

How “family comes first” thinking will support your employees and your organization

Imagine your spouse is newly diagnosed with cancer.

Your child has a broken leg.

Your parent is recovering from surgery and unable to perform basic self-care and household tasks.

And you are … stuck at work, wrapped up in a stressful project you are unable to successfully tie up because your heart is miles away. You can’t do your best work, and you certainly can’t do your best as a spouse, parent or child, because you are almost literally torn in half.

I am a family physician. I saw these scenarios time after time in my patients. Heartbreaking instances of parents who could not take time off to bring their sick children to the doctor or adult children struggling to help their aging or ill parents make it to health care appointments.

Can you imagine? Maybe you don’t have to.

I don’t. 

As a leader of my own practice, and later as an administrator in academic medicine, I also saw these scenarios from another side, the workplace. I saw the folks in the sandwich generation with both children and aging parents. They were trying to do good work on the job, and yet they were being torn apart by competing priorities. These people often worked for and alongside me, and the workplace policies around us either made these situations easier … or they made them nightmarishly harder.

At the roots of my training in family medicine is not just knowledge of the complex biological systems that keep our bodies alive, but also the complex interpersonal and social systems that influence them and are influenced by them. Family units — and workplace units — are such systems. And when the competing priorities and demands of two or more systems in a single person’s life clash, that person’s mental, physical and spiritual well-being are threatened.

What I know from my years of working with families — as a doctor and also as a colleague and boss — is this: Family comes first. It has to.

The workplace context

Employers have many approaches to the notion of family in the workplace, and these inform their policies, procedures, culture and expectations. If you are an employer, you might:

• think like an entrepreneur: everyone has to work hard, we're just getting started, all hands are needed on deck, whenever and wherever we are.
• think like a traditional CEO: the bottom line is what matters, work is always in the office and 9-to-5, then we all go home when we finish. And if we are professionals, the hours don’t matter – you work till the work is done.
• think like a hybrid leader for our era: the bottom line matters, and everyone needs to work hard, but people will work better and more productively if we create a culture that values them and attends to what matters to them — as people and not just employees.

You can probably guess which camp I fall into. 

I think “family comes first" is a highly valuable (and valued) approach to workplace policies, and not just for steeped-in-family-medicine types like me. Setting up a false choice between family needs and the workplace can be detrimental to the business you are leading, whatever kind of business it is. Meanwhile, a family-comes-first mindset can improve your overall bottom line, the creativity of your team, and the culture that informs how your employees deal with each other and with your clients. The benefits of a supportive culture like this are immeasurable, for both the employer and employee.

The family fabric

Although all of us probably feel we have some sense of what it means, “family” — a term that is so familiar to all of us — is surprisingly difficult to define. Narrow definitions factor in blood or adoptive relationships or base delineations on households, while more flexible (and perhaps realistic) concepts recognize that family is a subjective term based on perspective. Your definition might include most or all of the individuals living in your home, but perhaps also your parents and a close family friend you have always called “Auntie.” My definition might be narrower or wider, depending on how I was raised and the relationships that are important to me.

Subjective definitions can pose all kinds of challenges for research (not to mention for workplace policies), but they are the reality of our complex world. Families constitute a colorful and rich fabric woven of the many forces – positive and negative – of our lives, and no one family is the same. Yet, regardless of how you define it, there are some common threads among families that are useful to consider.

Emotional threads: According to Family Systems Theory (FST), families constitute cohesive emotional units. Of course, emotions can be good and bad (and anywhere on the vast spectrum in between), but there is no doubt that families share an intense set of emotional connections.  

Social threads: FST also teaches us that family members each have specific roles, and each family has a set of rules that govern roles and interactions. These rules develop into patterns to which many of us adhere, and these patterns can be very interesting to explore as we try to understand ourselves and our experiences. These patterns may result in balance — or imbalance and even dysfunction. 

Physical threads: As a physician, the impact of family systems on health is of great interest to me. First, consider how emotions affect health. Dr. Murray Bowen, who developed the FST framework, argued that the evolutionary benefits of interdependency in families are a little more complicated in our modern world where we do not need to cooperate for survival in the ways we did thousands of years ago. Today, anxiety can spread through families as an emotional contagion, and anxiety is only one of many ways in which our family relationships can interact with and influence our health. 

(I relied heavily on this site for this discussion of FST and urge you to read it in full and to explore resources from The Bowen Center for the Study of Family.)

I got my first exposure to the interplay among family, work and health — and my first view of what "family comes first" looks like — in my own family system as a child. My mother worked outside the home for a good portion of my youth, and yet I knew firsthand that if I was ill or had some other significant need, she would be there. And my dad, as a school teacher and administrator throughout my life at home, was there along with my mom for most of my activities, and not just because it was part of his job. 

I heard them both talk about how if bosses treated people the way they would want to be treated, their employees would work hard and follow their leaders anywhere. My mother actually stood up to a number of her bosses about this issue, and my dad embodied this ethic of how to treat people from his position as a leader. The topic was common around our dinner table (yes, we had dinner conversations!), and became gradually woven into my own views.

Fast forward a bit, and I come to my own work experiences. When I finished medical training, I found myself at the helm of a solo private family medicine practice. My team of young and middle-aged women worked hard, and they helped me build a tremendous business very quickly. I found myself remembering the conversations around my childhood dinner table, and turned to my parents to ask, "how do I set up work for my team in a way that works for them and for me and my business?" My parents reminded me that people will (almost) always work harder for a boss who respects them and shows flexibility than they will for a rigid and rule-bound taskmaster. I set out to emulate the flexible and respectful approach.

When family doesn’t come first

Of course, not everyone sees the world in this way.

Early in my career, I was a family physician in a small community where a large manufacturer employed a number of my patients. While they ostensibly were given paid time off for things like medical appointments, my patients were penalized directly and indirectly if they actually used that time. Their pay would be docked, and other less visible penalties would apply, with consequences even more severe when the time off was taken for the worker to care for a family member instead of herself or himself. 

This meant health issues went unaddressed, but there were also the less obvious effects of working for an employer that did not respect the importance and needs of addressing not only one’s own health needs, but those of the family unit. As a family physician, this was contrary to everything I had learned in my training. The health and wellbeing of our families — not to mention our own physical health — is critical to our ability to contribute to our communities and our work. 

I've met men and women who are caring for elderly parents and young children while managing two or more jobs all at the same time, and yet they seem to be faring well. This is the power of family. And I've seen families facing perhaps fewer obvious challenges, and yet whose social, economic or interpersonal fabric has broken down. In these cases, nobody in the family unit is functioning well, let alone thriving. This is also the power of family. It plays an outsized role in how well we function — or don’t — at work and in life.  

In my small community with the big manufacturer, I did what I could to mitigate the challenges for my patients, by staying open late and advocating on their behalf. And I committed to a healthier approach to work-life alignment for my own staff. I decided in no uncertain terms that family must come first.

Family comes first in practice

Over my years of private practice, and in my time as a university administrator, I saw over and over again that people behave better if we treat them as human beings who have occasionally messy lives. They generally work harder, are more creative and give more than expected if they are allowed time, space and flexibility to care for themselves and those who matter to them. 

How should you go about developing your own approach to creating a family-friendly workplace? No matter what size or type of team you lead, you will need a set of guidelines. Some considerations:

What does family mean to you?

You’ll need to determine how to define the family unit. Restricting the definition of family by biology or household is probably not appropriate or practical for our modern world, but most employers will want some kind of definition. To the extent that you can, stay flexible and sensitive to the different ways your employees define their own families, and remember that no two families are the same.

Starting with the basics is fine

Some of the most important of these policies (flexibility for medical appointments, an ability to occasionally skip work to attend an important event, time off to grieve) do not cost much, and they yield huge loyalty. Examine your existing policies and add flexibility where you can, then communicate this clearly.

Large employers will have different approaches from small employers

There are things that large organizations can do more easily than small ones, such as onsite child care and workout facilities. However, large organizations can lean toward a more rules-based approach about other issues and may ultimately gravitate toward stricter time-off policies and more rigid definitions of family. Small employers have the benefit of being nimble and able to thoughtfully deal with requests on a case-by-case basis, but they may also have more trouble meeting business needs when employees are away. Whatever the size of your business, be sure you are being fair in your decision-making and keeping the complexity of human life top of mind.

Expect the best of people

Relatively few employees will abuse flexibility, and in those cases, a clear and transparent conversation about what is going on will often put an end to the issue. It's tempting to write policies designed to prevent and address those who will abuse privileges, but learning to have and document difficult conversations is a more effective way to deal with these isolated issues. Writing a restrictive policy to pre-empt abuse of a policy hurts more people than it can ever actively manage. 

Does your company culture value family?

People are human, with a variety of needs outside the workplace, but company cultures do not always emphasize this, to the detriment of employees’ emotional and physical health. You might start with these suggestions:

• Take a good look at your human resource materials and leave policies, considering the issues I have raised. Does your policy language empower or discourage people who use their benefits?
• Are your policies geared toward restricting abuse, or do they assume good intent and provide a mechanism for dealing with the relatively few who will take advantage of your policies?
• How many hoops do your team members have to jump through in a crisis in order to use their benefits?
• Are there other ways besides leave policies that you can enhance the family-friendliness of your workplace? Childcare is one (very expensive but meaningful) way, but what are some smaller things you might be able to do?
• Ask your team members what one or two things you could do that would make your workplace 20% more family friendly. Listen to their suggestions, and implement those that are feasible.

How will you keep the business lights on when family must come first?

Workplaces and business have real needs regarding customer service, timeliness and the bottom line. Recognize that this is true and that it may feel like a competing priority when family needs arise. Then, do what is needed to address it. You can borrow from a concept in public health called “surge capacity,” which speaks to meeting urgent needs in times of crisis. Extra resources are required, as is the ability to mobilize them quickly. 

Consider how deep your bench is for critical functions. If one or two of your team becomes unavailable to work, how will you cope? Can people cross-train to improve flexibility? Can you outsource some basic functions? Whatever your solution, you can go a long way toward building a family-first mentality by determining today what your next step would be if an employee came to you with an urgent need for time off at a critical moment for your business.

Revisit and revise

People, families and societies are always changing, as are expectations. That is one reason to continually revisit your approach to supporting employees and their families. But it’s also possible that some of the family-friendly policies you institute will not have the intended effect. So, as you make changes and optimize your approach to human resources, examine how your policies are being used, whether your employees find them too restrictive (or you find them too lax), and keep lines of communication open. If something isn’t working, you can always change it as long as you communicate it clearly and compassionately.

On the importance of family to all of us

Families are so complicated. Maybe you are reading this and throwing up your hands because of some difficult or painful situation in your own family. But the truth is, love them or hate them (or somewhere in between) … your family unit and how you have defined yourself within or beyond it is woven deeply into who you are, your emotional, social and physical health, how you relate to the world and … how you work. 

And there is a bigger-picture element as well. It is on the foundation of families that not just businesses, but communities and ultimately societies are built. The extent to which we support the health and well-being of families as employers and societies ultimately determines our resilience in the future. I guess that's the keystone of my reasons for advocating for family-friendly workplace policies. In the end, we all will benefit from such policies.

Share your thoughts

How do you manage the challenges of workplace policy-setting, flexibility to meet human needs, and having conversations around these issues? I hope you will share. 

For more insight on leadership, career management, productivity, communication and work-life integration, check out my website, and join my community! You'll also get my latest e-book Executive Presence for Leaders as a thank-you for joining!