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Monday May 08, 2017

I Filled My Prescription Against Burnout at the Gym

Life is demanding. It can be downright unfair.

However, I have been reminded since I started a new job eight months ago that we each have a choice to either sit in the midst of all of life's pressures or push back against them.

In fact, as a family physician, I have spent a significant portion of my career challenging boundaries. My position as a young, black, female family physician seems to invite skepticism at times

If it's not my scope of practice or even professional competency, it's my productivity or lack of quality time with my family. The reminders of my perceived inadequacies seem almost endless.

Working out with my coach, John Duncan, has helped me treat burnout.

After moving across the country, starting a new job and transitioning the family into a new routine, I found myself slowly losing sight of my purpose in practice. Evaluating the new situation, I questioned whether my work-life balance had actually improved compared to the chaotic lifestyle I had left behind.

In reality, I was tired, drained and becoming apathetic. I was burning out. I found myself eating terribly, sleeping more and unable to find energy for life.

It quickly became clear that inconsistent levels of exercise contributed to my decline in resilience. As someone who thrives on the positive effects of regular physical activity, my ability to cope with stress had been vastly depleted.

To this point, my story likely doesn't sound much different from those of countless physicians across the United States. Certainly, this kind of scenario contributes to the fact that physicians, as a profession, have among the highest levels of suicide(emedicine.medscape.com), and it is one of the reasons that many physicians are leaving clinical practice(www.aamc.org).  

Of course, we physicians are trained to act as if we are in control despite extreme circumstances. Actually, this is in part a necessity. Nobody wants a doctor who faints under pressure. However, the system has failed us. We have become accustomed to working our hardest without the support necessary to be efficient, yet we are left with the blame when things go wrong.

Sadly, what we tend to do to counter these crushing demands is work even more.

For me, part of how I cope is by focusing on exercise and physical wellness. Since medical school, I have pushed my body in the same way that my mental faculties have been challenged. Exercise is my sanctuary. Interestingly, every period of my life where a major change presented itself has also been marked by a major physical accomplishment. In medical school, I ran my first marathon while raising more than $10,000 for a Haitian orphanage. After completing residency and having my second child, I started high-intensity interval training and endurance running. During my first job, I completed my first triathlon and summited my first "fourteener" (a mountain peak with an elevation of at least 14,000 feet).

Anyone looking at these accomplishments will either respect the discipline required to train for these events or understand the insanity against which that discipline protected me. Each endpoint was amazing and even exhilarating, but what I continue to crave most is pushing my body to capacities that seem impossible.

That was exactly my purpose when I stepped into my local CrossFit gym eight months ago. It was a step toward taking back ownership of my life, my purpose and my well-being. My physical abilities were a shadow of what they had been just a few years earlier. At two years postpartum, my body lacked stamina and strength, but my coaches saw my potential and encouraged me to move past my perceived weaknesses and dig deeper.

In his blog, family physician and burnout expert Dike Drummond, M.D., discusses the pathophysiology and reversal of burnout(www.thehappymd.com). He writes that one aspect of treating burnout is to get back in tune with your physical, emotional and spiritual well-being. Who knew that I could do all three at my local gym? Walking into a place filled with positive encouragement and a focus on functional strength -- CrossFit's core principles -- in hindsight seems so fitting for a person who was losing ground on what gave meaning and importance to her life.

As people see the outward changes resulting from my training, I personally marvel at the internal reconstruction and improvements I have experienced. Just yesterday, as I looked at the day's workout plan, I wondered to myself, "How can I possibly accomplish this?" I am sure my coach saw from my face that my confidence was waning slightly. In most cases, I go into autopilot and focus on taking one step at a time, with my coach helping me along the way and my classmates giving words of encouragement.

The physical reminders of my limitations are humbling, yet that connection with my humanity allows me to maintain my empathy. Ironically, the process that teaches physicians to shoulder the weight of life and death fails to prepare us for the impossible demands placed on us by the health care industry. I find this to be part of the dissonance behind the waning of our initial hopes and dreams to heal and touch lives. For me, training reminds me that I am at my best when I am keenly in tune with my humanity. It keeps me grounded in understanding that I am an important part of vital care to others, and that regardless of what I may feel, my presence and my work matter. My progress in training continues to remind me that my humanity and its limitations are not weaknesses. They are actually what make me a great family physician. Just as I grow in my agility and strength, I am growing in my skills as a family doctor.

If any of this resonates with you, I encourage you to start by taking a moment and deciding to commit time for yourself. Allot yourself grace and remember that life's journey is about taking one step at a time. Breathe and allow yourself to be in the moment. Each of us must find our own ways to keep mentally, physically and spiritually well, but it doesn't happen without a plan and a commitment to take that first step.

Marie-Elizabeth Ramas, M.D., practices family medicine, including maternity care, in Nashua, N.H. She enjoys spending time with her husband, Ray, and three children, ages 9, 6 and 2.

Posted at 03:28PM May 08, 2017 by Marie-Elizabeth Ramas, M.D.

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