What Marie Kondo can teach us about physician burnout

It seems you can’t open a magazine or surf the web these days without reading about Marie Kondo, the author of the New York Times bestseller, The Life Changing Magic of Tidying Up. Kondo has attained a cult-like status for her ability to help people improve their lives by radically reducing their stuff, and her new show on Netflix has inspired a national decluttering frenzy.

For those of you unfamiliar with her method, her core concept is quite simple: go through every single thing that you own, and ask yourself one question, “Does this item spark joy?” If not, get rid of it.

Simple in concept, hard to implement. One of the most striking things you see in each one of her episodes is the great difficulty people have as they begin to go through their possessions. It rapidly becomes clear that most of her clients have been busy living their lives, focused on getting things done, with little regard to the value or meaning of the many things they have acquired along the way.

It’s almost as though they have lost the skill of knowing what sparks joy. Everything seems equally important, or unimportant. Their lives have become full of things that represent other peoples’ priorities, or are a manifestation of self-imposed ideas of what they need. And the result is that rather than owning things, things own them. They find themselves paralyzed and unable to make progress.

What strikes me most about Kondo’s show is how similar her clients are to the physicians I work with. Whether stuck, bored, or burned out, the physicians I work with know what they don’t want: the status quo that is their lives. But when I ask them what they do want – what exciting, valued direction they want to move in – they don’t know. I will often ask questions like “if you could wave a magic wand at work and change anything what would it be?” or “if you could take a year off and try anything, what would you do?” These questions are often met with silence. Like Kondo’s clients, many of the physicians I work with have lost their sense of what sparks joy for them.

It is no wonder that this happens. In our medical training, we stopped asking what sparks joy the moment we decided that our personal needs and growth would take a backseat to our professional development. So the skill of recognizing joy began to atrophy.

Compounding this is the chronic stress of the practice of medicine and all that it entails; we spend our days looking for what is wrong and what could go wrong. Research has shown that doing this day after day changes our brains, further dampening our ability to be open, curious, and creative. Instead, we simply become emotionally detached and reactive to the world around us. Unfortunately, when we cannot connect with what truly sparks joy for us, either in our work or in our life, it makes it impossible to make the changes we need to move towards greater vitality.

So how do we recover this ability? The same way Kondo’s clients do – through practice. Knowing what sparks joy is not an intellectual exercise, but rather a skill. You don’t get any better by thinking about how to play the guitar or reading about it. Just like playing the guitar, recognizing joy is something that you must practice to improve.

So Kondo pushes her clients to keep at it, literally asking the question over and over as they tangibly hold their possessions in their hands. Sometimes they put a sweater in the trash pile, only to come back 10 minutes later in tears to pull it back out. Sometimes they sort through an entire room only to realize they put every single item in the “keep” pile, and then they have to start over.

As physicians, we too must practice by doing. We must take the time to slow down and check in with our own experience as we go about our days. Does this thing I am doing right now energize me, or drain me, and by how much? How engaged do I feel doing it? Instead of reacting to our day-to-day experience, we need to slow down and become responsive to each moment.

To do this, I have my clients keep a log of all of their daily activities, and rate their energy and engagement. This activity is akin to Marie Kondo’s clients holding each of their possessions in their hands. Some clients balk at this introspection, convinced that they already know the answers (“It’s all bad!” is a common refrain). Others may bristle that the exercise is overly artificial. But inevitably, after a few weeks of intentional practice, a switch flips. Just like Kondo’s clients, the physicians I work with suddenly gain clarity – the internal compass returns.

When this happens, we become able to objectively see all the ways in which we thrive or languish on a daily basis. Although there may be many things we cannot control in our work, there are often small opportunities to mitigate or magnify our activities. Research shows that if you can increase the time spent on meaningful and fulfilling activities in your work to just 20% of your total work hours, work-life satisfaction dramatically improves and burnout risk drops by 50%. But you have to know where to put the time and energy into effecting change in the first place.

We as physicians have been trained to ignore our own feelings, just as we have been trained to value thinking and analyzing as problem-solving tools. This works very well for the practice of clinical medicine, but not so well for making the changes needed to move towards greater vitality and fulfillment. Instead, the first step is that we must slow down, stop analyzing, and reconnect with our sense of what sparks joy for each of us.