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Join Scott Abramson, a neurologist, as we delve into the complex interplay between work and home life for physicians. Scott shares his personal experiences and reflections on how challenging periods in his family and personal life led him to seek solace and support in his professional work. Discover the emotions and coping mechanisms that drive physicians to spend more time at work during overwhelming or difficult times at home. Through his own journey, Scott offers a message of solidarity and reassurance to colleagues facing similar struggles.

Scott Abramson is a neurologist who blogs at Doctor Wisdom.

He discusses his KevinMD article, “The secret life of physicians: work, home, and the battle for balance.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Scott Abramson. He is a neurologist. His most recent KevinMD article is titled “The secret life of physicians: work, home, and the battle for balance.” Scott, welcome back to the show.

Scott Abramson: Thank you, Kevin. It’s good to be here. I always read your blogs, and I always get something interesting out of them, so keep up the great work.

Kevin Pho: Perfect, and thank you so much for sharing your stories and contributions. We’ll talk about your article in a little bit, but for those who didn’t listen to our first episode together, just briefly share your story and journey.

Scott Abramson: OK. Well, I worked in the Kaiser Permanente medical system from 1979 until I retired in 2020. I was a frontline neurologist there, so I’ve been retired about three and a half years now. During that time, in addition to my neurology duties, I was very involved with the Kaiser mission to improve communication between patients and doctors, improving, so to speak, bedside manners. I was also involved in our physician wellness endeavor. So that was a big part of my life at Kaiser in those 40 years.

Kevin Pho: So you mentioned that you were on a committee to improve bedside manner. What do you see as the biggest problem right now when it comes to physicians’ bedside manner?

Scott Abramson: Yeah. Well, Kevin, I believe I may have mentioned this last time too, but I really think it boils down to just one word. Just one word, and that word is not an important word either, really. The word is “the,” T-H-E. That’s what it boils down to. That’s the biggest problem.

The way I was taught, the way I practiced for the first 20 years of my life, my approach was, “What’s the matter? What’s the matter?” And then I would try to find it and fix it and explain it. My approach was “What’s the matter?” You know: “You’ve got a pain here. Let me try to figure it out. I’ll tell you what you have to do,” and so forth.

But in the last 20 years of my career, I learned these communication techniques from our Kaiser mission, and the greatest lesson I learned was to eliminate the word “the.” The lesson that I learned was “What matters? What matters to patients?” That was the key thing, and that’s what made my practice so much more enriched during those last years.

In other words, it’s not about, I mean, you have to know what’s the matter. That’s part of our job. But a lot of times we leave it at that. So: “OK, you’ve got a cough, Mary. Great. It looks like it’s an allergy. Let me give you some allergy medicine.” OK. But if you approach it from what matters, it might be something like, “So you’ve got this cough, but before we try treatment, let me ask you something. Is there anything that you fear this cough might be related to?”

And maybe in the back of this patient’s mind, it may be something like, “Gee, you know, Uncle Joe had lung cancer, and they told him it was allergies.” And if you get to it, it’s not just giving a pill for an allergic cough. If you get to reassure somebody that their cough is not a cancer, boy, what a blessing that is for you as a clinician. How improved is your life, your clinical life, that day? You walk out of the exam room, and, man, I didn’t just cure a cough. I relieved someone’s fear.

Kevin Pho: All right, wise words. Thank you so much for sharing. So let’s talk about a different take on work-life balance. Your KevinMD article is titled “The secret life of physicians: work, home, and the battle for balance.” Tell us, how did your article come together?

Scott Abramson: Well, Kevin, I think the way it came together is that I’m kind of an opposite guy. If someone says something, my first reaction is to say, “Let me be opposite.” The last article I wrote was about how people have been writing that perfectionism is bad: You’ve got to set boundaries and have some balance and all that. And that’s great, but the article I wrote then was about how maybe there’s something positive about being perfectionistic. Maybe that’s a good thing.

So I always see a lot of articles in your blog about work-life balance: We’ve got to spend more time at home, spend more time with families, we’ve got to do mindfulness and meditation and do some goat yoga and all that stuff. And so I’m thinking to myself, OK, that’s all good, but what’s the flip side of that? What’s the flip side? And in the article, what I wrote about was the flip side of work-life balance. I don’t know, I think I originally titled it something like “Work-life balance upside down.”

So in that article, Kevin, would you like me to sort of summarize the article, then?

Kevin Pho: Yeah, yeah.

Scott Abramson: OK. So in that article, and again, I understand work-life balance is a great thing, but sometimes, and I went back to my own experience with this, sometimes it works the other way. Sometimes doctors, in their life experience, find that work gives them comfort and solace, which they don’t get at home.

I went through a period like that with my own family. I’m not going to go into the details, but we had two teenage sons at the time, and they had issues, I guess, and it affected the whole family. It affected my wife’s and my relationship. During that time, I wanted to go to work. I wanted to get out of the house. I got into the office about two hours before everybody else. You know how, when you turn on your computer, it has that little musical sound? Well, that was music to my ears. Hearing that music, just turning on the computer, because that was safe.

I would look forward to being on weekend call. And in the evenings, I would look for things to do so I wouldn’t have to go home and face the issues there, you know, let my wife take care of it, and by the time I got home, maybe it’d calmed down a bit.

And so what was happening, I realized, is that during that time I was getting respect at work that I didn’t get at home, and consequently I just worked harder and harder. Sometimes it wasn’t even productive work. I’d be there, I’d see my last patient, and I’m looking at my inbox and saying, “Oh, yeah, well, maybe I’d better call this patient,” or “Oh, yeah, maybe there are some more X-rays I could review a little more,” or “Let’s look at this lab work.”

Fortunately, Kevin, things have worked out for me, and my life has been blessed with my family and so forth, but it was a rough patch. So what I would say to folks is, if there’s a kernel of truth in this and you are going through some of this, and you find that turning on your computer in the morning kind of turns you on, or you’re sitting there in the evening with those borderline chloride levels, reach out and get some help. Really, this is not a good thing. This is not a good look for work-life balance.

Kevin Pho: How sustainable was that, in terms of going to work to escape whatever the home situation was? Was that a prolonged period of time?

Scott Abramson: It was. I would say it went on for probably a couple of years, really. Yeah. And, you know, we docs can do just about anything, right? We put our nose to the grindstone, we pay the piper, we just work. We can do what we want to do. It wasn’t a healthy work-life balance, but it happened. It happened to me, and I’m just assuming that it might happen to other people.

Kevin Pho: And when you were at work during those times, with everything going on at home, how did it affect your family dynamic?

Scott Abramson: Yeah, honestly, I mean, it couldn’t have been good, because from my wife’s point of view, it’s like, “Where is he? Why is he always at work? Why does the burden always fall on me to do these things?” I remember she used to say, “Oh, people at Kaiser, they all think you’re so nice. They ought to see what you’re like at home.”

And it couldn’t have been good for my kids. I should have been there more with them. I should have toughed it out. But in a way, I think I took the easy way out. It was so easy. At Kaiser, at any kind of job like this, you know what to expect. Things are safe. You know how things are going to go. You have some control, right? You have some control, and you get respect. A lot of times at home, that wasn’t happening.

Kevin Pho: So it sounds like you had to make a little bit of a sacrifice in terms of your relationship, both with your wife and kids, during this time.

Scott Abramson: Yeah, I did. I did sacrifice my time with them, and not just my time, but my spirit, my soul. And again, getting back to the article, I do think that this may be affecting other people too: You’re finding safety, control, and respect at work, and you don’t get it at home, and it leads to a vicious cycle.

Kevin Pho: What broke that cycle? What made you spend more time at home after a couple of years of making work a priority?

Scott Abramson: Yeah, well, that’s a good question. That’s a good question, Kevin. I can’t point to one thing, one incident. It wasn’t one of those signature moments.

One of my colleagues, Dr. Miriam Zylberglait, I heard her telling a story. She said that one time her six-year-old son came to her. She’s a very busy physician, a very busy clinician, all that, and her six-year-old son comes to her and says, “Mom, if you have a cell phone, why did you have me?” She said this was a signature moment in her life. At that moment, she sort of changed just about her whole style of practice. I didn’t have one of those kinds of signature moments, but I think life has a way of working out.

Kevin Pho: Now, if you were to replay that whole scenario again, is there anything that you would have done differently?

Scott Abramson: Oh, gosh, so many things. So many things, Kevin. I wish I had had more realization about what I was doing, because I would be telling myself this sort of myth: “I’m a dedicated physician. That’s why I’m here. I’m taking care of patients. That’s the important thing. And we all have to make sacrifices at home.” You can have all sorts of rationalizations for why you do things. If I had realized, had more introspection about what was happening, I think things would have been better.

Kevin Pho: Any regrets about prioritizing work over your family during a difficult time?

Scott Abramson: Yeah, I mean, there are regrets. I wish I had done better. I wish I had spent more time, spent more real time. I wish I had been taking some of the burden off my wife. I do have regrets. I do have regrets. And maybe if one person listening to this podcast can hear this and they’re in kind of the same situation, then maybe it was worthwhile writing that article and coming on this podcast.

Kevin Pho: We’re talking to Scott Abramson. He is a neurologist. His KevinMD article is titled “The secret life of physicians: work, home, and the battle for balance.” So for those other physicians, I think the scenario that you describe isn’t uncommon: stress at work, stress at home. What kind of insights, what kind of pieces of advice do you have for these physicians who may be going through some difficult times at home?

Scott Abramson: Yeah, or difficult times, really, or difficult times at home, and they go to work as a salvation. In general, Kevin, here’s what I would say to folks: Have you ever heard this expression, “The best physicians are destined to hell”?

Kevin Pho: I have not.

Scott Abramson: Yeah. OK, well, this actually comes from the Hebrew Bible, and it seems like a strange thing, but what it means is that sometimes the best physicians are often the most prideful. And because they’re so prideful, they don’t ask for help, or they don’t think they need help, and if they do think they need help, they’re too proud to ask for it. I know during my career there have been times when I wanted to ask for help, but I felt like, I don’t know, I’d seem stupid or incompetent or anything, so I didn’t ask questions that I should have. Because these doctors don’t ask for help, they fail their patients, and they’re destined to hell.

But I think it works another way too. Sometimes the best physicians, the hardest-working and so forth, are emotionally worn out and facing burnout, and we too don’t ask for help. We do what we always do. We just put our nose to the grindstone, we pay the piper, we just work harder, because when the going gets tough, you know what happens. And we suffer in silence.

So what I would say to folks is, if you’re on this path, if you’re destined to hell because you’re the best physician, don’t take the journey alone. Reach out to somebody: a trusted colleague, a psychologist, or someone in your faith community. And I would also say to my colleagues that if you see one of your colleagues heading down this path, don’t let them take that journey alone either. Reach out to them. Give them a helping hand. I think it comes down to this, Kevin: Friends don’t let friends become the best physicians.

Kevin Pho: My final question is, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Scott Abramson: Basically, like I say, if you’re at work and you’re finding that work is giving you things that you’re not getting at home, comfort, safety, control, respect, think about that. Something may be off. Try to correct things, try to have insight into that, and reach out for some help.

Kevin Pho: Scott, thank you so much for sharing your story, time, and insight. Thanks again for coming back on the show.

Scott Abramson: Thank you, Kevin. I appreciate it.