Work-life balance: Dr. Sheryl Haut

Work-related stress and burnout are common in physicians, with rates of burnout estimated between 25% and 60%. These stresses impact physician health, patient care, and health care systems as a whole. Sharp Waves spoke with Dr. Sheryl Haut about strategies to identify work stress and mitigate burnout.

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Transcript

[00:00:00] Nancy Volkers: So welcome to another episode of Sharp Waves. In this episode we are going to be talking about work life balance, and I have with me an expert on this topic who's spoken about it several times, and I would like her to introduce herself.

[00:00:16] Dr. Sheryl Haut: Thank you so much. I'm Sheryl Haut. I have been involved in the idea of work-life balance for quite some time. And I sort of formalized that with a series of lectures that I began giving as part of our leadership course through the International League Against Epilepsy, and have also spoken about it at the recent American Epilepsy Society meeting. 

And I wish being called an expert meant that I actually did this for myself and have perfected it. But you know, the truth is far from that. And I think that's an important acknowledgement at the beginning, that this is honestly a lifelong journey. Certainly a career long journey. And I learn from it every time I do talk to groups. So I hope I'll be able to give you some tips today. But really it's very much a work in progress. 

[00:01:11] Nancy Volkers: Thank you. So can you set the stage for us a little bit about what are the issues surrounding work life balance and how you specifically became interested in learning about it and maybe employing some tips in your own life?

[00:01:27] Dr. Sheryl Haut: You know, I think work, the issue of work-life balance is not a new one, but thankfully it's just gotten more and more recognition, particularly in medicine. And I think you know, focusing on this as early as medical school and training is very important because if you start out early with good habits, that's something that you can continue to be cognizant of. You know, when I started really thinking about this, and I'm not going to give the whole days of the giants talk, that's all done, you know, they weren’t great—the early days of training were brutal and there was no work life balance and that was wrong. So no one should ever tell you that it was better then. It wasn't. 

But you know, I did spend over a decade as a program director for our neurology residency, and I started to recognize in those 12, 13 years, I recognized that generations of trainees have changed and there's different expectations, which I very much respected and wanted to understand better. And in that time, the advent of EMR changed things dramatically because first of all, doctors and other related clinicians were being given roles that didn't used to be what we did. We didn't used to bill, we didn't used to type. We used to just see the patient, do a little dictation, and someone else did the rest. And so taking on these new roles really meant we had less time to do the clinical work. That is why we came into this to begin with. And where was that time coming from, right? 

So that's sort of how it started. Then also, the fact that you could do this work at home was, I think is, sort of underratedly one of the most critical elements that has challenged work-life balance. It used to be that you had to do everything while you were in the hospital. You had to stay late an hour or two to get all your notes done, whatever. But once you got home, you were done. Your time was your own to spend with your family, to read, to cook, whatever it is that you like to do. And until you came back into the workplace the next day, be that at the hospital or the office, you were free. 

That has changed between email and EMR. We are working all the time and maybe you get to leave your workplace earlier because you can do some work at home, but it also means you've moved some work into your home.

And so over time, I think I've just gotten more aware of how much we've taken on, in the clinical world and in the research world, that we've moved to the home and how important it is to recognize and deal with and establish boundaries. 

So I would say my interest in this started in my years as residency director and my subsequent involvement with trainees and then coming to the ILAE with leadership training. It took us some years to realize we have to incorporate this topic into leadership training because it's important both on the personal level for our future leaders as well as to help them lead the next generation. So with every year, I'm realizing more and more how important this training is and how difficult it is to actually do. 

[00:04:35] Nancy Volkers: Can you speak a little bit about the importance of work-life balance or work-life integration or whatever you'd like to call it? Not only to the individual, but also to patient care, research, everything that is impacted by those individuals. I'm trying to get at burnout without saying the word burnout, but that's where I'm going. 

[00:05:24] Dr. Sheryl Haut: Well, I think we should say the word burnout, you know, because that is what's happening and it's been recognized, right? There's an ICD-11 entry for burnout that has a definition, and I'm going to just list the definitions now because this is very, very relevant for really all workplaces, but particularly medical workplaces. 

This concept of burnout is described with three elements. One, the feeling of energy depletion or exhaustion. Two, an increased mental distance from one's job or feelings of negativism or cynicism related to one's job. And three, a sense of ineffectiveness and lack of accomplishment.

And when you think about this, none of these mean you're working 23 hours out of 24 hours, right? No one is saying that burnout just means that you're working too hard or too many hours. There's multiple elements that go into this, including how you feel about the job you're doing. Do you feel you're accomplishing, or that you're constantly being put down or being told by others that medicine is, you know, the worst field or whatever field you're in, it's, it's not what it used to be and it's a dead end. 

These all go into a very strong, both physical and emotional sense, that what I'm doing is not satisfying and is not really bringing joy. And this is important for individuals, but it's a must for institutions to look at what they're doing and how are they treating their employees and what is leading to burnout, because we know it's an epidemic, right? I mean, everyone is talking about it. It's fueling a lot of a sense of despair, particularly among young clinicians and young researchers.

An individual may not have the ability to change their workplace, but you can try, you can ask, request, demand certain changes to be made. How can institutions address burnout? 

First of all, the idea that when you're off, be it on vacation or when you're sick, you really are off. You don't have to worry who's covering or who's doing that job. You have to be off. You must take that time and, you know, give yourself the freedom to be off work. And sometimes that's coming from above; people who are on vacation are still getting called by their bosses or by the administrators. “Well, I know you're not here, but you're the best person to answer this question.” You know what, find someone else to answer the question.

But these are the kind of things that you have to sort of demand from your employers. 

Work schedule, flexibility and autonomy. That's a biggie, right? People want more remote work. Certainly in medicine it's hard. But that’s I think a struggle right now in our current climate of how much remote work is okay. Are people really working at home? But for sure, remote work helps to reduce burnout to the degree that that can be fit in. And then, you know, making sure that the workplace is a safe place. You're not discriminated against. You feel that your health and wellbeing is cared for. 

And the pandemic—I think the pandemic was one of the turning points for burnout. You got people being sent out there without adequate PPE and everyone is just supposed to do it because that's what we do. We take care of patients even at our own risk. That was really a violation that I hope will never happen again. But that definitely led to burnout. 

So I think that there's, you know, there's both techniques that people can do individually to reduce their risk of burnout or to treat the burnout if it's occurring. But also, we need to hold institutions and bosses and the administration accountable for their part to reduce this. 

[00:09:42] Nancy Volkers: Great. Thank you. Can you talk about some individual strategies, so maybe some that you have employed or some that you suggest that people employ on their own to put up those boundaries that you were talking about?

[00:09:59] Dr. Sheryl Haut: Absolutely. When we think about what are our individual strategies, there's sort of some clear boundaries that we need to draw both at work and at home and in personal life, et cetera.

Boundaries is very, very important. Then there's also giving yourself the mental and emotional freedom to be off. They're not the same thing, you know? So if I go on vacation and I put an away message in my email and you say, “I’m not going to be checking email. Call this person or that person.”

We've all done this. Do you really do it when you are? So I was on vacation last week. It was awesome. This was planned for six months and when I wrote my out of office email this time, I said, “I will not be checking emails.” I don't always say it as clearly as that. And by doing that, I was sort of giving myself permission to truly make that boundary. I'm not going to say I didn't do it at all, but I did it much less than I've ever done. It was an effective exercise, like typing that out, “I will not check email while I'm away,” helped me not do it.

And I think that's an example. If you say you're not going to check email, really don't check email. We need that time, we need that mental freedom that we are not working. I did give myself one afternoon that it was close to the end of the trip that I knew I needed to, I didn't want to come back and be hit with everything, so I gave myself an afternoon to kind of catch up on things. And that helped me when I got back. But that was a conscious decision. 

So I think things like putting boundaries around your time off even, even considering that time off could be more than a whole vacation, but just a day sprinkled in where you truly are off, you give yourself a mental break. These are very healthy techniques. 

And it all comes back to how much time do we have? When I do this talk in a large group, we often start with an exercise where I ask people to fill out a life inventory. In a typical week, how many hours do you think you spend on this, and how much time would you like to spend?

It's a very powerful way to look at how your time is spent, because no matter how many things you say yes to, there's only so much time in a week. I know everybody's heard this before, but it couldn't be more true: Everything you say yes to, you're saying no to something else. It might be no to sleep, right? The time has to come from somewhere. And so thinking about time as this discrete resource that you have to dole out I think is the best approach to thinking about work-life balance.

If you want to make sure you have enough time for your life, you need work to fit into a certain box. And there are strategies that we go through in these talks where you can farm out certain responsibilities to free up your time.  Even buying like pre-chopped vegetables in the grocery, which doesn't add a lot, that could shave off time and cooking, if you don't enjoy cutting up vegetables. So it all has to do with what people enjoy. But there are ways to time save so that you do have more time to do what you like to do.

I do mention the concept of two-fers. So, for example, I need to talk to one of my colleagues frequently, you know, just to review issues. So sometimes we'll walk while we do it, take a walk around the hospital, or if it's a nice day, even do this outside. So rather than just sit at our desks and meet, we're getting some physical exercise as well. 

So, you know, you can think about ways to do more than one activity, although I don't want to confuse that with multitasking because we all do too much of that. But thinking about efficiency and combining can be something that's very helpful.

Our hospital sends us a snapshot: What time of day are you working? How much time are you spending meetings? How much time are you on your email? Which apparently they can measure. What times are you sending emails? And I'm horrified when I get tha,t because it shows me I'm checking email in the middle of the night. It's good to see that because that is unacceptable, you know? 

So finding ways to see how you're spending your time, looking for ways to cut out activities that don't bring you joy. Like paying for someone to clean the house, if you can afford that, or buying groceries that are already prepared for cooking, et cetera, or buying prepared meals.

It's really a matter of thinking about it, being mindful as to how are you spending your time? Are you good at putting up good boundaries between work and life outside life? And recognizing that you're not going to get it right all the time. There is no such thing, but these are not all decisions that are forced upon you. You have the power to make some positive changes in this area in your life. 

And of course, you have less power to do this when you're in training, when you're a resident, when you're getting a PhD, when the demands of work are extremely high. It will get better. Does get better. And as you transition to having more empowerment over your schedule, you've got to think about how you're delegating this time.

[00:16:07] Nancy Volkers: But even if you have less power as a trainee, you can still be mindful of where your time is going. And then later on you'll maybe be better positioned to… 

[00:16:19] Dr. Sheryl Haut: One hundred percent. Start it early. Because if this is part of how you approach, you know, your life and your decisions, you will continue to do it. And I do want to say, on top of the job, you also have career development. And often that's work that you’re not necessarily given time in your day to do. Sometimes that's the type of work that creeps into your personal life, like joining an ILAE committee. You might end up doing after-hours Zooms, especially because you're dealing with a lot of time zones.

And I always say for every opportunity like that, you’ve got to break it down and see, what is the benefit, what is the time cost, how is it going to help me in the near future? How is it going to help me in the far out future? And many of these opportunities are very worth it for the purpose of building career. That's how you grow. It's how you network. It's how you advance. But if you say yes, there will be something that you're saying no to.   

[00:17:26] Nancy Volkers: So you talked a lot about boundaries specifically with email and meetings. Are there also boundary issues for clinicians? Just because. Patients have more access to them now than they used to through like EMRs and sometimes even email or WhatsApp. And how, how can clinicians manage those?

[00:17:48] Dr. Sheryl Haut: This is a huge topic, and I will admit, this is where I'm trying personally to put a lot of my efforts now because I haven't been doing a good job of it. All of us are in this because we really care. We want to help. But that, the constant access, it's sort of similar to a constant email. You're, on a hamster wheel. The minute you clear your inbox, it's filled up again. 

So the only, the best way to deal with this is again, making sort of a structure. I will check and respond to patient messages the first hour of my day, and then the last half hour before I go home. Whatever else I haven't gotten to, the patients will know that there's no guarantee of a 24 hour, you know, immediate response.

And you have to give yourself limits. You're not going to finish everything. You're not going to respond to everyone. Some clinicians opt to not respond at all to patient messages. 

But the boundary issues are more than that. You'll often at work be asked to just take on more than you think you can handle. You have to know what you are capable of doing, what you've been given enough time to do. That includes various tasks, that includes patient care and messages. And if you are finding that the work is more than the time allotted you, you have to have the voice and say, “Look, I can't do this. Let's talk about what I can take off my list so that I can do what you're asking me.”

You know, so much of this is not just in medicine. It's really, it's across all jobs. We all struggle with this. 

Mindfulness is really the key. Everything I've been talking about here is, is really towards that, becoming mindful about all of these issues. And I do think that doing a life sector audit, if you look online, you can find many of them. You sort of take a chart and just assign how you're spending your time, how you'd like to spend your time.

Some of them will ask people, individuals to keep, like, for a week, just keep a diary of how you're spending time, you know, every hour of the day, what are you doing? And it could be a lot, but it's probably worth it to invest that time to look at what you are doing in a day. You may discover that you're on social media for two hours a day, and that's why you feel like you don't have enough time at home.

It's worth going through. One other point that I'm going to say is that there are a few online happiness courses. There's one at Yale that's quite well known, but there are a few and you can actually watch YouTube videos of some of the key lectures. Tremendously helpful. 

Once you start to give yourself time to learn about this and think about this, you're going to get better at work-life balance. It's inevitable because half of the problem is how much you don't think about it. We just keep saying yes and going and running. So stopping and researching and writing an inventory, you're going to get better. You will find that you're getting more control. 

[00:21:08] Nancy Volkers: Excellent. Thank you. Is there anything else you wanted to mention before we wrap up? 

[00:21:13] Dr. Sheryl Haut: No, I just, I very much appreciate that the attention that this topic is being given. And I think the more we think about it, the more we talk about it. And I look forward to, you know, future programs if you have other various speakers on this. 

[00:21:30] Nancy Volkers: Great. Thank you so much.