I’m pleased to introduce this guest post from Nishant de Quadros, an interventional radiologist in Columbus, Georgia. Always brilliant, and always kind, he was an IR fellow at Brown when I was a resident. Recently, we were tweeting back and forth, when the idea for this post was born. Here are his thoughts on learning to say “no.”

Medical schools, residency programs, and fellowships do a great job of teaching physicians how to care for patients, but a shockingly bad job of teaching them how to care for themselves.

I believe this has contributed to a growing surge of physician burnout. As someone who has taken Q2 IR and stroke call for 6+ years, I will readily admit, I have done a poor job of self-care for a long, long time. But I’m starting to understand that we have more control in our lives than we perceive!

Life Buckets

A couple of years ago, I attended a lecture where the speaker talked about life buckets. Each bucket represents a priority that requires an investment of our time to lead a balanced life. His six life buckets were family and friends, work, community, health, finance, and spirituality. Each day we choose to spend time filling one or more buckets. He was meticulous about the amount of time he spent on each bucket every week. It inspired me to reflect upon how I fill my own six buckets. The percentages were far from balanced. Without realizing it, I was devoting greater than 80% of my non-sleeping hours to the work bucket. And the irony was that work was becoming less and less fulfilling. I wasn’t living a well-balanced life, and some buckets like heath, community, and spirituality, were almost completely empty.  

At first I was ashamed.

How had I let my life get so out of balance? I started to realize it didn’t happen overnight. One decision at a time, I allowed others to determine my priorities for me. Initially, those extra tasks at work bought validation and fulfillment. So I did more and more, without ever saying the word “no.” Over time, the number of work responsibilities I accepted overwhelmed me. I had to relearn how to establish boundaries. I had to become intentional with my choices.

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So I decided I was going to create a better work-life balance. But what does that mean? Spending equal amounts of time at home and work is an unrealistic goal for most physicians and it doesn’t truly represent balance for most of us. Also, not everything about work is depleting and not everything about being at home or even on vacation is restorative. There are parts of my job that invigorate and inspire me. And there are things about vacation, like being in a crowded airport, I really dislike. Every person finds different tasks in life depleting or restorative.

I needed to understand myself better before I could make positive changes in my life. I needed to identify the tasks both at work and in my personal life that charged my batteries and those that drained them. By spending more time on the former, I could create more capacity and happiness for myself. And avoiding depleting activities would also bolster my mood.

This philosophy,

which is wonderfully explained in the book Restore Yourself by Edy Greenbalt, helped me create better boundaries at work. I identified tasks that I found depleting, and tried to delegate those to others that enjoyed doing those things. For example, I hate planning social events, but an IR tech in my department loves doing that and she is far superior at it. So I was able to delegate a task I found tiresome, to someone else that found joy in it.

On the other hand, I had accumulated so many administrative tasks; I had less and less time for uninterrupted patient encounters. But that was the primary reason I went into medicine! So I stepped down as the president of my local practice to focus more on patient care.

Obviously delegating doesn’t work for everything. So I’ve learned, sometimes I just have to say no. That every minute I spend on one bucket, leaves me with one less minute to apply to another one. My career is more of a marathon than a sprint. If I don’t pace myself, I will never make it to the finish line. When I stepped down as practice president it felt like a failure, but my career doesn’t have to be a linear assent to the top. It is fine to take a few steps backwards in order to stay healthy and balanced. New opportunities will present themselves in the future.

From burnout to Awareness

I am just starting to figure this process out for myself. Every week is not perfectly balanced, but I am more aware of how I spend my time and I am more mindful of how I fill my life buckets. I can already say that investing more time in restorative activities, like my once a week soccer league, has made my both my job and my life more enjoyable. And while I used to cringe at the thought of saying “no,” I now find that word to be less negative. It is really just saying YES to something else in my life.  

Dr. Nishant de Quadros can be found on Twitter @NdeQuadros.