Sixteen months into retirement, the absence of any externally imposed schedule still leaves me partly edgy. Medicare, COBRA, and cell phone bills come due at expected dates. The check goes out the next day, but it could wait another day or a week. Shabbos commences and concludes as the cycles of nature require. If I miss a meeting or an Osher Lifelong Learning Institute class, there are no demerits. In the absence of self-initiated activity, one can unfold into the Maytag repairman, who waits for a call that never happens. At funerals for esteemed medical colleagues, often, the theme of the eulogies expresses engagement and availability. Patients have always come our way passively, creating great satisfaction as we tend to their needs. We are often important contributors to committees or house staff education.

Eventually, those participatory invitations or mandates cease, causing us to seek out replacements on our own. Idleness just seems foreign, but how to overcome it challenges many physicians who no longer practice.

One of my former institutions created a committee to meet the needs of late-career and retired physicians. Many of us have lived through the progressive devaluation of the physician that has taken its toll in the form of burnout or abandonment of our practices in favor of employment, or for some primary physicians discontinuing the pageant of the hospital altogether. It can be a time of being involuntarily solitary, as we watch the decline of many medical societies from afar, or our places of worship no longer attract the young people that they once did.

This committee has assembled periodic presentations for us, including one on bringing social capital to our post-career years to supplement what most of us have achieved professionally as human capital.

While the concept of social capital has floated through the sociology literature for many decades, it reached mass public awareness with Robert Putnam’s “Bowling Alone,” now 20 years past publication.
This book looked at the decline of organized and informal groups over several decades, trying to tease out causes, ending just as the internet started becoming readily available to enable those of us disconnected to expand our interactions, particularly with strangers of common interests.

But instead of looking at people, he analyzed communities, demonstrating that cohesive interacted groups made their participants safer and healthier. Our speaker looked at this as its impact on individuals. The people who attend senior projects like the Osher Institute or play Mah Jongg or serve on committees seem happier by many accepted measures and seem to have a longevity advantage.
No individual enters that post-retirement phase without an established past. Indeed, Professor Putnam’s research showed that while the decline in communal activity progressed over decades, individuals engaged at the start of each interval were still engaged while the decline is from failure to bring younger people into the loop, much as many aging places of worship experience now. What our speaker did not address was the ability to take people like Dilbert, who is happy and productive in his cubicle and out of necessity make them into pro-active schmoozers when their health depends on it. Myers-Briggs types INTJ or INTP, the classic successful loners, can be excellent physicians. But do we have a version of Henry Higgins to make them more socially successful that will override their innate personalities?

Recent literature suggests that we might. A journalist from the UK’s The Guardian recently described a week of forcing himself to socialize daily, which he entitled “Faking It. Could I go from being an introvert to an extrovert in one week?”

He based this self-experiment on a larger experiment from an American university in which 123 subjects were asked to act like extroverts for a week, then as introverts for a week. The participants were able to do this and did not abhor acting contrary to their long-entrenched dispositions. Analysis of these two weeks showed the acting extroverts to experience an increment of personal satisfaction, as did the journalist when he did the same to himself. Retirement lasts longer than a week, though. On a longer scale, Jessica Pan, in her 2018 book, described being an acting extrovert for a year in “Sorry I’m Late, I Didn’t Want to Come.” The project proved doable, though challenging at times, with errors made along the way.

As physicians, we do many things that run contrary to our druthers, from sleep deprivation to following rules that we know to be asinine. After retirement, we schedule exercise when we’d rather watch TV or take medicine that makes us dizzy because of future benefit. Exerting initiative to enhance our social spheres may become one more of those things you just have to do because it is the right thing to do. Even if contrary to a lifetime behavioral pattern, the evidence suggests that it can be done successfully and with future benefit.

So, it’s best to watch what you eat, take what a doctor other than yourself says to take, don’t make excuses to avoid a scheduled treadmill session, and set a daily schmooze quota. Whether socializing ever really becomes as habitual as exercise for those who would ordinarily avoid it has not been established, but it might.

Richard Plotzker is an endocrinologist who blogs at Consult Maven.

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