Oncologist heal thyself: hallmarks of happiness

Commentary

Oncologist heal thyself: hallmarks of happiness


C. Jacobs, MD*, M. Clemons, MD*, A.A. Joy, MD
*Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, and University of Ottawa, Ottawa, ON;, Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB.



doi: http://dx.doi.org/10.3747/co.22.2706

It is 18h30 on a Friday; clinic ran late again. I promised the kids I would pick them up an hour ago. We are supposed to be going out for a celebratory dinner tonight with friends. I will be late, again. My pager keeps buzzing. A colleague wants me to “squeeze” a new patient into my already over-booked next clinic. I still have to go to the inpatient unit to talk to a dying patient and her young children. No one is going to be happy today—not the patient, not my spouse, not my kids, and certainly not me. I wonder: Is this the life I really want?

As health care professionals, we have chosen a vocation dedicated to helping people enhance both the quality and the quantity of their lives. However, to do that, we must also take care of our most precious—and often underappreciated—resource, ourselves. If we do not look after ourselves, how can we provide the best possible care for anyone else?

Hanahan and Weinberg’s “Hallmarks of cancer”1,2 helped to simplify and define the complexities of neoplastic disease. Is it possible to organize and optimize our lives in a similar fashion? Could a “hallmarks of happiness” provide a better framework on which to arrange all the necessities of a fulfilling, or better yet, flourishing, life?

In this commentary, we propose that several core areas in life should be of equal importance to know, understand, and practice for anyone involved in cancer care. It is our sincerest hope that, by reflecting on each hallmark, readers will be able to establish better habits to optimize their own lives, while continuing to ensure nurturing, healthy relationships with family and friends, and to provide excellent clinical care. Table i lists some practical tips for achieving those goals.

TABLE I Tips to enhance your happiness

 

REFLECTION OR PURPOSE

Whatever your beliefs about life, religious or otherwise, taking time to pause and reflect is important. Self-reflection or self-knowledge is a timeless and worthy pursuit. In our increasingly hectic and demanding lives, it is often hard to make time simply to pause, let alone try to make time to actually reflect on life. While reflecting, take time to define or refine your purpose in life. Having a “purpose” is different from simply having “goals.” Goals can be objectively defined, quantified, and tracked, but having purpose is more expansive and personal in nature.

To define one’s purpose, it is important to dig deep and ask the necessary and tough “why” questions. Why are you here? What is it exactly that you truly feel you were meant to do? Defining one’s purpose in life can help in maintaining focus, minimizing distraction, and helping to steer all future decisions.

Mindfulness is a form of self-reflection—a practice of intentional acceptance and nonjudgmental focus of attention on present-moment emotions, thoughts, and sensations3. There is evidence that the practice of mindfulness alleviates a variety of mental and physical conditions and improves resilience to stressful and difficult challenges49.

GROWTH

Growth in the form of personal and professional development is important and includes the maturation and expansion of positive life skills and healthy self-esteem. By our very profession, we are already motivated to grow in our knowledge and understanding of oncology. We have to ensure that we are doing likewise in other areas of intellectual, emotional, physical, and social pursuits. Challenge yourself with new activities and venture outside your comfort zones. Make pursuing growth one of your core values.

FITNESS

The simple act of sitting too long at a desk has been associated with a wide range of ailments1012, including premature death! Our bodies were designed to move. Commit to regular physical activity, of varied intensity, throughout the day. Try not to view it as a chore—or even worse, a punishment. Forgo some of modern life’s conveniences designed to make your body move less (elevators and cars, for instance), and use your body more instead (choose the stairs or a bicycle). Sit less. Stand, push, pull, walk, and run more.

REST OR REJUVENATE

During the Day

Make sure to take regular breaks throughout the work day13. How else are you expected to feel refreshed and to be able to deal with the responsibilities of patients, colleagues, multiple telephone calls, and the never-ending notifications on your handheld device?

At Night

There is no single “magic number” for the right amount of sleep that an adult needs. General estimates place the requirement at about 8 hours per night. Physicians report an average of 6.5 hours of sleep per night14. So, while some colleagues might brag that they require only 3–4 hours of sleep at night, research demonstrates that insufficient sleep leads to a significant reduction in the performance of complex mental tasks, to irritability, and to impaired judgment.

During the Year

Take your allotted holidays. One survey reported that fewer than 20% of oncologists take more than 4 weeks of holidays per year15. That number contrasts with other procedural and service-based specialties, almost 50% of whose members reported taking more than 4 weeks of holidays per year. Most likely, some of the responding physicians considered themselves “too busy” to even take holidays.

Instead of thinking of all the work that has to be done (which, by the way, will still be there whether you take a break or not), ask yourself instead whether you are really too busy to enjoy time with yourself, your family, and your friends? Adequate rest, work–life balance, and physical activity have all been shown to correlate with career satisfaction, an improved sense of well-being, and decreased burnout in physicians16.

SERVICE OR ALTRUISM

How can talking about service to others be helpful when our lives already seem to be so full of service? Service to patients, administrators, learners, colleagues, family, friends—the list goes on and on.

Stop thinking about service in terms of work, remuneration, or obligation. Consider service in the form of altruism. Change your attitude and perceptions about the service that you provide and those that are provided to you. In doing so, you will realize that true fullness of life is achieved only in the process of serving others, not just oneself. See it as a privilege and an honour, not a burden.

GRATITUDE

It is always easier to complain than to commend. We are all creatures of considerable privilege. Most readers of this article have all of their basic necessities such as food, shelter, clothing, and sanitation in place. Furthermore, we are all greatly educated, and—despite what you might profess to other colleagues—likely all well remunerated for our work compared with the rest of the population17. Although we by no means are suggesting that the individual concerns and difficulties of physicians are less relevant than anyone else’s, reflecting about how good things really are and expressing gratitude regularly are important.

CONNECTION

Just as health professionals have embraced a multidisciplinary model of patient care, it can be rewarding to have more people integrated into and involved in our own lives. Developing positive, caring connections to self, others, community, and environment reaps substantial rewards. As in medicine, where we acknowledge that we are not subspecialists in all facets of patient care, we should acknowledge and embrace what others have to offer to and share with us.

The practice of oncology demands a lot of time in close contact with patient or family anxiety, distress, and premature death. Over time, that exposure can easily lead to burnout and withdrawal or a hardening of oneself as a protective mechanism18,19. It can even lead to poorer outcomes for our patients20. Know that you don’t have to carry the burden alone. Reach out to those that you are already associated with, and reach out to others to make new connections.

EMBRACE UNCERTAINTY

As much we tend to think that we are in control and can plan every facet of our lives, life is constantly changing, and all of the potential variables can never be accounted for. As we take life’s journey alongside our cancer patients and their respective families, we don’t have to look very far to have demonstrable proof of that axiom. In times of crisis, it is completely understandable for humans to desire the perceived safety of certainty and stability, but unfortunately, there are no real guarantees of attaining those touchstones. We all need to plan and prepare for the future21,22. And we need to look forward to a positive future; it helps to drive us and to add fuel to the fire of our lives. In the same breath, however, we owe it to ourselves and must understand that things don’t always go according to our plans.

BALANCE IS THE CONCLUSION

Trying to find balance in all aspects of happiness is near impossible, but in and of itself, that impossibility does not make the pursuit worthless. Happiness the feeling, happiness the experience, happiness the virtue—all are worthy aims. When asked what they would do if facing a terminal illness, physicians overwhelmingly chose quality of life over quantity. Life can be seen either as a terminal illness or as a daily new beginning. In either case, we suggest not leaving the pursuit of happiness right to the end. We should not live under the pretext that all will be fine later. Delaying or denying yourself the opportunity for true happiness or fulfilment doesn’t seem sensible if viewed objectively.

In the end, don’t let anyone (especially three oncologists) tell you how to live your life. Everyone’s life is different, but openly reflecting on life’s common elements can be helpful. Most of us obtain immense satisfaction from the many facets of our profession. But profession alone does not define our lives. Seek, find, and enhance the rest of it. We need to live it and enjoy it to the fullest. Choose to be happy now. No one is promised tomorrow. All we have is today.

CONFLICT OF INTEREST DISCLOSURES

We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none.

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Correspondence to: Mark Clemons, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Box 900, Ottawa, Ontario K1H 8L6. E-mail: mclemons@toh.on.ca



Current Oncology, VOLUME 22, NUMBER 6, December 2015








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