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Don’t Let Your Goals Steal Your Soul: Balance and Self-Care in Medicine

Discussion in 'Medical Students Cafe' started by Hadeel Abdelkariem, Sep 30, 2019.

  1. Hadeel Abdelkariem

    Hadeel Abdelkariem Golden Member

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    Dr. John Mellinger, MD, FACS received his medical degree from Case Western Reserve University in Cleveland, Ohio. He served in the US Air Force, completed his internship at the University of Washington, and his residency in general surgery at Blodgett Memorial Medical Center/St. Mary’s Hospital. He then completed two fellowships: one in surgical endoscopy at Mt. Sinai Medical Center and a Surgical Education Research Fellowship.

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    Dr. Mellinger has held various roles in education and administration. He currently works at Southern Illinois University School of Medicine as a Professor of Surgery, Chair for the Division of General Surgery, Program Director for General Surgery Residency, Vice Chair for the Department of Surgery, and Medical Director for the Memorial Medical Center Advanced Hernia Center.

    Additionally, Dr. Mellinger has been involved at international, national, and regional levels serving as a member and leader of committees and boards including the American Board of Family Medicine (Board of Directors), American Board of Surgery (Director), Society of American Gastrointestinal and Endoscopic Surgeons, and American Society for Gastrointestinal Endoscopy (ASGE) to just name a few. He has received numerous honors and rewards and has given over 200 oral presentations, lectures, and instructorships from the regional to international level. He has approximately 80 peer-reviewed publications along with an extensive list of other presentations and writings that demonstrate his expertise in education and research.

    When did you know you wanted to be a physician?
    I started to think about medicine as a kid, even in a playful way. My mom had been a nurse, and I liked science in school and biology. That matured a little more as I got into junior high and high school. I found out that I liked science a lot, especially as it pertains to living things and biology, but also really liked being with people, working with people, understanding and communicating with people. So, I think it was a blend of those two things that had the biggest influence. Also, my father was a minister and I came to see the importance of devoting time in your life to serve people somehow. Medicine seemed like a good vehicle of all those things coming together, so that led to the interest.

    Did you ever have moments of discouragement or questioning during your training? How did you overcome them?
    Absolutely. Everyone encounters those things, and I think some of them for me included things that are common for all students. Questions about what this is going to mean for the rest of my life—is it going to consume me? Is it going to be so busy that I won’t be able to have a good marriage, a good home, and be influential in my kids’ lives as they grow up? People hear stories, see stereotypes, and see things on TV. It was certainly something I thought through a number of times.

    There was also the academic challenge. People tend to go into medicine with motivations, of what we hope would be and to serve others. But the academic environment at the undergraduate level is often a very competitive one that seems to reward personal ambition. Many students struggle with either ‘how do I either pursue this and have the right spirit about it?’ or just wondering if they academically can keep up with the competitive group they’re trying to run with. And I certainly encountered those kinds of challenges.

    In terms in processing it, I think of the things that helped me the most. A big part of it for me was my faith. I felt like this was something I was called to do, and if I was right about that, I could count on resources beyond my own to do the things that I needed to do. It was important that it not change my motivation, my heart for doing it, because then it wouldn’t be a calling but would be about me. Things like prayer helped and friendships with people who cared about and supported me. And honestly it is a lot of hard work. You have to enjoy that, find that fulfilling, and accept the challenge that you can have a growth mindset about those challenges rather than feeling like they will defeat you. I found that the classes that I feared the most—or were said to be the most competitive or the “weed-out” classes—were the ones that showed me that I could do this and could do it without becoming a different kind of person but be a good doctor. That process was able to refine my conviction that this is what I was supposed to do.

    Sometimes you see people lose that passion. They go in with the right intentions, but it seems to change them. How have you been able to keep that intention?
    One thing that is very important and that many people develop during training due to the pressures is resilience. Look at it as something that’s going to help you grow stronger, give you your insights, and help you care about others. And you do learn how to struggle with things yourself and you learn how to manage that and work through it and look at it as something that’s going to help you grow stronger.

    If you can develop those kinds of qualities and take care of yourself emotionally, spiritually, physically, I think you can do all those things. Where people make mistakes is they kind of sell their soul to the goal and put aside everything that keeps them whole in the process.They wake up one day and find that they are no longer whole and are paying prices that they never would have wanted to pay at the outset. So I think it’s a day to day thing, not a thing I can put it off for six years and come back to. You have to learn to be disciplined with habits and apply those to your life consistently to navigate that better, or at least that’s how it worked for me.

    What are some of the habits that have worked for you?
    There are several that I would say. One, again, was my faith and relationship with God, and that kept me accountable and gave me hope. Even if you look at addiction science and AA (Alcoholics Anonymous) and other groups, those things are really two cornerstones of how to get people through difficult things. And [faith] was my source for that.

    Another important thing was just good relationships around me, and I did that through church, recreational activities that I enjoyed like sports, through groups that I became involved with as a student that helped promote the kind of heart and mindset that made you able to do those things. So broadly, I would say take care of yourself physically, exercise and eating well, which most of us don’t do as young people. But exercise and your physical health are important. Good relationships, being part of some type of community that keeps you grounded, and being engaged in something, which for me is my faith, that gives you hope and accountability.

    Every part of the medical training process is so busy. Would you say it’s worth taking the time, even if it means studying less, in order to do these things?
    That’s a great question because that’s where the rubber meets the road. I think that the way it worked for me is I realized I could not become a good doctor if I didn’t say no to things that were pleasing or fun but were not good choices. I remember in college that a lot of my friends that wanted to be doctors would head to the fraternities Friday night, party all night long, and then crash for half the day to get over what they had done Friday night. Then they would try to pick it back up and study. I would often get together with some friends and have a restorative couple of hours with them and then study and go to the library. And you know, that was a choice. I had some friends who said I was missing out on the college experience, but I said, “this is a choice I am making—I don’t think I can be a good doctor if I don’t develop these disciplines, so I’m going to have to say no to things that they wanted to do”.

    But I didn’t say no to everything; I didn’t let it eclipse my life. I tried to follow kind of a Sabbath principle where I had one day a week that I retreated from my studies and focused on things that were restoring–with friendships, with recreation, with going to church and doing things that helped me spiritually. Establishing routines that don’t let the pressures of your work eclipse you, but at the same time [medical] life isn’t something you just tack on. This is a calling. It’s going to take the majority of your time, and you’re not going to be able to do it and be good at it if you think of it like a hobby.

    If one becomes very consumed by the work, would that actually cause them to do worse in their studies?
    You can sometimes exceed in the academic end, but I have had colleagues who have become consumed with pursuing their career goals without any balance. Then they would wake up in the 40s, successful in their careers but losing their marriage, having kids with problems that could have been prevented with a different kind of parenting relationship, making bad business decisions, or doing something unethical in their research due to time pressure. You have to be intentional.

    Another challenge is that it doesn’t always seem balanced. We think of balance as 50/50. There’s one person I know who’s a medical school dean. I heard him give a talk, and he said, “I don’t think I’ve ever achieved balance, but I did establish a rhythm.” And what he meant was that there were times where work seemed to eclipse his home, but there were times that he retreated from work to take care of home. And that sort of rhythm in his life kept him whole on both sides of the equation, but day-to-day it won’t be a 50/50 thing.

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