11.2 - Balance
In this episode, John and Michael discuss the importance of balance as a virtue in medicine, emphasizing the need for integration of work and life rather than separation. They explore how unity of life can enhance relationships and personal growth, and offer practical tips for achieving balance through self-reflection and prioritization of meaningful relationships.
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[Intro music]
John Rhee
Hi, and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.
John Rhee
In the podcast, we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.
John Rhee
Thank you for joining us and we look forward to engaging with you through this podcast.
John Rhee
Hi, and welcome back to the Hippocratic Society Podcast.
Michael Egan
Today we're following up on our episode with Jay Lynch where we talked about the physician patient relationship. And one theme that came up in that episode was the theme of work life balance.
Michael Egan
And so we wanted to talk today about balance as a skill and a virtue and a concept in medicine.
Michael Egan
And so, John, why don't we just start off, what are your initial thoughts about balance? What does that mean to you as a virtue and a concept?
John Rhee
Yeah, I think with balance, like all of the different virtues that we've been talking about,
John Rhee
there has to be a directionality towards the good. Right. And so we first have to identify in our lives what are the ultimate goods that we're trying to live towards or try to grow in.
John Rhee
And within that context,
John Rhee
find out how we can then integrate, well, all of the different aspects of our life into a whole.
John Rhee
And so I think there are a couple different ideas there that we could talk about.
John Rhee
One is this idea of integration into the whole. And sometimes I like the idea of integration and wholeness more than balance, because balance almost feels like you're kind of like just juggling between many things.
John Rhee
I think there's also an idea there talking about knowing or reflecting on one's own tendencies or maybe predominant weaknesses.
John Rhee
Each person may have a different predominant weakness that they struggle with. And how to think about that in the context of integration or balance.
John Rhee
And then thirdly, how to think about one's priorities and within that context, thinking about how to ensure that one is living each day with a clear sense that one is living one's priorities well in that integrated whole.
Michael Egan
Yeah, so I'm hearing a couple themes that maybe we can dive into through this episode. One about the predominant fault, one about the day as a sort of microcosm of balance,
Michael Egan
and then one about not just separating work and life, which seems to be the bigger thing. So, yeah, I guess why don't we start with that. How does integration in the busy culture of medicine right now, where trainees are working so many hours, clinician attendings and physicians have clinic and research,
Michael Egan
and all these things that blend into their life, you Know, they take work home, they're always available by email, you're on call. All these things.
Michael Egan
How does integration.
Michael Egan
How is it sort of a solution to it? Rather than I'm at work now, I'm at home now, I'm just gonna be present at home versus present at work. And let me try to balance those two things.
Michael Egan
What does integration look like there?
John Rhee
Yeah,
John Rhee
I think maybe I would introduce the idea here of unity of life. And.
John Rhee
And what I would say this idea of unity of life is, is that we are not different people in different places.
John Rhee
And what I mean by that is also like that we're not particular type of personality or person or temperament in a certain place, while we are another type of person or personality in another place.
John Rhee
And that there's a consistency to us. And so we. There are other virtues here. Right, Too, perhaps one could say sincerity. Right.
John Rhee
Because the sincerity in which one lives both at work and at home is the same.
John Rhee
But then we should also be living those priorities of what's most important to us throughout this as well.
John Rhee
And so even at work, we should have a sense in which we are thinking about our work,
John Rhee
where we're working. Well, of course, because that is in some sense a unity of life. Right. Like that. If we are doing our work virtuously by seeing it as a means of growth,
John Rhee
by seeing it as a means of transformation,
John Rhee
foreseeing it also as a means of deepening our relationships or deepening love, all of these things are then the same virtues or values or ideals that we would be living at home.
John Rhee
Right. And so the end good that one is trying to achieve is then the same. And that unity is achieved both through the processes in which one works, both at work, but also at home.
John Rhee
I think that that also gives us a sense of how we love our work as well.
John Rhee
What I mean is the priorities, because when we think about priorities, we also want to make sure that those things that are most important to us are coming out first.
John Rhee
Right.
John Rhee
This is something that I talk about a lot with patients who are seeing me for palliative care.
John Rhee
Oftentimes we talk about what's most important to them and what is.
John Rhee
What's something that I often see is that for many people, I would even say majority of people,
John Rhee
that there is some amount of disconnect between what they say is most important versus how they might live their lives each day.
John Rhee
And that could be for different reasons. I mean, there are also different times in our life, different tempos at different times in our life,
John Rhee
different priorities that may be more Pressing also at different times in our lives. And so this is not to say that there are also other things that maybe play in an individual person's life that may make this a little bit more nuanced, one could say,
John Rhee
but that even if there's some type of more temporary time pressure for a particular thing,
John Rhee
that we have to have an eye towards that ultimate list of or way in which we're approaching those things that are most important to us.
John Rhee
And I think the other thing that's really interesting there is that oftentimes when people talk about these things that are most important,
John Rhee
it's talked about in the context of relationality.
John Rhee
So people,
John Rhee
for the large majority of people, people, other people, come out on top of that list in terms of what's most important to them. And so the sense of unity of life has to also revolve around that.
John Rhee
Like, how are we thinking about relationships, deepening of relationships both at home but also at work.
John Rhee
That work doesn't just become then a pure efficiency driven thing where I'm at work and I'm just trying to get this done and trying to get as much done as possible,
John Rhee
because then that itself is in some sense a shallow approach to work. If we are not building our relationships with those we are working with, those we are serving as physicians,
John Rhee
those we are also working alongside of. That all of these things requires a certain sense of unity of life in which we are balancing and also integrating and also growing in those priorities throughout all of these different aspects of our life.
John Rhee
Mm.
Michael Egan
So it sounds like for the trainee maybe who doesn't have so much control of their schedule where they're working 80 hours, 90 hours a week,
Michael Egan
it sounds like this integration where they're still pursuing the relationships or the virtues or the qualities that they want to,
Michael Egan
that they hold most dear even in work and life. Maybe this idea that work wouldn't become such a burden, it's no longer just a task to get completed and you itself can become life giving.
Michael Egan
I'm just thinking in terms of these busy schedules and feeling like overwhelmed with work and never having time for life.
Michael Egan
What does that look like? Or how does this integration maybe not solve that problem, but fit into that challenge?
John Rhee
If we approach, and this is something that we talk about in the Hippocratic Society often, right? This idea of the little things or how we live the little things.
John Rhee
But if we approach our work and in some sense medicine makes it more,
John Rhee
I would say more easy.
John Rhee
Although of course there are these complications or difficult circumstances of just a number of hours that we Dedicate to what we're doing. But it does make it easy in the sense that we are serving people,
John Rhee
other human beings.
John Rhee
And if we practice in every interaction the sense of the priority of the relationships and deepening those relationships, and that can be practiced. And that most important aspect in which we live by which is this understanding of deepening of relationships with others can be practiced,
John Rhee
like with each of the patients we encounter or each of the persons we encounter as colleagues too.
John Rhee
And it is very human and also stems from the idea of virtue theory that if we practice that day in and day out, that we will also naturally live that with our relationships outside the hospital too, because it becomes an integrated whole.
John Rhee
Like, it's not a separated thing. That what we do at work with our patients is something different than what we're trying to do at home. And vice versa.
John Rhee
When we try to grow in those relationships,
John Rhee
take advantage of the small ways in which we try to deepen our bonds with our friendships and our families,
John Rhee
that could sometimes even look as small as like making daily or every few day, just quick call on the way home to somebody that you're thinking about,
John Rhee
loved one parent, et cetera.
John Rhee
Again, all of these small ways in which we could be growing in those things.
John Rhee
And I think that there's an aspect of generosity there too, right. Where sometimes after work, if we think about work as this, like, totally separate thing from our life,
John Rhee
we could also see it as like,
John Rhee
oh, I'm out of work and all I want to do is like, rest.
John Rhee
There is a sense in which that could lead to a kind of like, this is now my time outside of this time that I had less control over or whatever.
John Rhee
And it creates this duality, it creates this like, separation.
John Rhee
And then therefore, it results in the time that we spend outside of work as like way in which we try to control it or be less generous and therefore see it as a time in which we may not want to serve those around us or love those around us.
John Rhee
And that, I think then impacts how we see time outside of work as well.
Michael Egan
Yeah, yeah, that makes a lot of sense.
Michael Egan
And so on that I think that's a good transition to another theme that you identified at the beginning, which was the day as a microcosm of balance and how you're setting your priorities reflected in your day.
Michael Egan
And if I may, I think that also is more long term and you can see priorities reflected across the.
Michael Egan
The choices that you make over a month or a year or years,
Michael Egan
a lifetime. So, yeah, I guess could you talk more about that and how we can sort of examine our days in that sense and also grow in our priorities, showing up in how we schedule our day.
John Rhee
Yeah,
John Rhee
maybe one idea to introduce here is this idea of the predominant weakness or fault because in some sense this may look different for different people.
John Rhee
And what I mean by that more is that there may be different areas of growth that are needed for different people.
John Rhee
I was having an interesting conversation about this with a friend actually a few days ago.
John Rhee
We were talking on the phone and he was telling me how he was struggling or had been struggling. Now he's doing very well, but he had been struggling with just this idea of feeling like so much pressure at work,
John Rhee
trying to be super, super productive,
John Rhee
getting a lot of stuff done and feeling this like pressure to get more work done.
John Rhee
And that included also like taking on more students to mentor, taking on more projects, more committees, all of these things which is like very familiar to somebody in academic medicine where we're trying to in some sense like find balance among these competing responsibilities of patient care,
John Rhee
administrative responsibilities,
John Rhee
teaching responsibilities, some research.
John Rhee
In some sense we're expected to do all of that well,
John Rhee
even if one of those things might itself be a full time job. And so he found that actually he had gotten, he was talking with another friend and they had spoken about just this idea of maybe in his case,
John Rhee
because he has a lot of really good virtues of working hard and working well,
John Rhee
but that it had become almost too obsessive or too duty bound or too pressured that his friend had told him,
John Rhee
maybe for you for a period of time it's better to actually force yourself to do the minimum that's asked for you. Not minimum in a sense of laziness, because he knows that this mutual friend of ours is never going to do that, which is lazy.
John Rhee
So not in terms of advice,
John Rhee
but because it was creating almost an anxiety in him that he felt like he had to take all of these things on.
John Rhee
And therefore there was a frenetic kind of non stopping,
John Rhee
no time for silence in his life.
John Rhee
And initially he said he resisted that a lot, but then he was like, yeah, maybe I need to try. And he did do that for a couple of months. He didn't take any more students for research projects, he didn't take any more projects.
John Rhee
He said no to basically everything,
John Rhee
every additional thing that he was asked to do and just tried to do well, the things that he was asked to do.
John Rhee
And he found that he was doing each of those things really well.
John Rhee
And he also started to realize that each of those things he Was doing with a greater sense of devotion, a greater sense of love, a greater sense of care.
John Rhee
Because he didn't have this crazy sense of lists of things. He was also not working just for sake of efficiency.
John Rhee
And then after that, there was a point in which he was able to say, like, okay, now that I have this down, I could take on things here and there, but now with a sense of knowing what I am taking them on for.
John Rhee
Not just for the sense of ambition or just this duty to do more, or the sense that he has to just do more always,
John Rhee
but for the sake in which he feels like he could do a good thing for that person by taking them on as a mentor or contributing something substantial or just like being able to integrate this into his life in a way in which he doesn't feel like he would just be kind of doing it just for the pure sake of doing it.
John Rhee
And just was describing to me how not only did it make his life much more enjoyable,
John Rhee
but he also felt that he was doing each of the things much better as well.
John Rhee
And probably many people in medicine,
John Rhee
because of the fact that they chose medicine,
John Rhee
lies a little bit more in this camp,
John Rhee
rather than the opposite camp of,
John Rhee
like, doing too little for the sake because of a vice of laziness.
John Rhee
There's a sense in which probably most people listening to this tend to take too much on.
John Rhee
But it is important to then notice that if you take too much on that it does fracture us,
John Rhee
mostly because we are not able to. A part of an integration requires a wholeness that resides in the pieces of our lives being integrated into that whole. And that that wholeness requires both space and silence for that glue that holds everything together,
John Rhee
which requires a sense of interior life, or this interior awareness of self,
John Rhee
one's priorities,
John Rhee
the reasons why one is doing things,
John Rhee
and therefore having a clear sense of the why in our lives.
John Rhee
But that why cannot be at the center of all of those things and create that integrated whole, Cannot. If we are doing things in a frenetic or fractured way,
John Rhee
which oftentimes is related to taking on too much.
John Rhee
I will say that this is, I know, a struggle that I have. And so though I talk about this, it's an ongoing struggle.
John Rhee
Every time I have my monthly meeting with my department chairman,
John Rhee
it's always the question comes up of, like, john, what else did you say yes to this month?
John Rhee
Even though I told you not to say yes to more things?
John Rhee
And then there's like, a.
John Rhee
There's kind of this, like,
John Rhee
slightly shameful, like,
John Rhee
sense where I'm, like, Yes, I know I shouldn't have,
John Rhee
you know, so I mean, I'm also struggling with the two as well as I imagine, like most people who are listening to this.
John Rhee
But I think, yeah, there's that identification of like, if this is something that I struggle with, then and sometimes like to find the golden mean that we often talk about in virtues, we may have to shoot a little bit in the other direction to be able to recalibrate.
John Rhee
Because sometimes we're like so in one direction that it's hard to recalibrate without kind of pushing ourselves fully more fully in the under direction to find again where that that correct mean is.
Michael Egan
Yeah, that's very clear example.
John Rhee
But yeah, maybe we can just dive
Michael Egan
into your faults real quick on this.
John Rhee
Oh yeah, sure.
Michael Egan
No, let's move on.
Michael Egan
Just some practical tips. Yeah, I guess maybe from your own experience. And besides maybe taking on less, what other practical tips can we do to integrate our lives and follow that thread that really motivates us throughout all the activities that we do?
John Rhee
Yeah,
John Rhee
I think the first step is this step of finding pause or reflective space,
John Rhee
silence to both be honest with oneself as to where one is perhaps on this spectrum of kind of busyness for the sake of busyness,
John Rhee
which requires both a deeper look at the why in which we're living our lives. Like what, what am I doing this for? And why?
John Rhee
An honest,
John Rhee
in some sense honest discussion with oneself about that.
John Rhee
To be honest, I think sometimes those who are closest with us can have a better gauge of this.
John Rhee
Because the problem with this is that the thing that oftentimes we can't see well about ourselves is whenever there's something also associated with the vice of pride.
John Rhee
And usually these things have some aspect of pride associated with it, whether our end goal has shifted to just some made up God of success.
John Rhee
And usually that has to do with what Aristotle would talk about in terms of these ends that we tend to create for ourselves that are not really compatible with flourishing, whether that be success from glory or money or whatever these other things may be.
John Rhee
And so sometimes when pride is involved, it's hard for us to see ourselves.
John Rhee
We are blind to ourselves in terms of like at times, like why we're doing things or what we're doing things for.
John Rhee
But sometimes those around us can show us that or tell us that this is also why having deep friendships with people who will be honest with you, who will tell you,
John Rhee
for the sake of love and for the sake of your growth,
John Rhee
the places that you may be doing things without noticing that you're doing things for not the best reasons or maybe just like slightly misaligned reasons that happened over time due to small decisions.
John Rhee
I mean, we all have those.
John Rhee
And so, yeah, this kind of reflective process I think is really important.
John Rhee
This also, I think, reflects to us why it's so important to then have deep friendships.
John Rhee
And comes full circle back to why these relationships are also so important. Because they not only feed something deep inside us that's so important,
John Rhee
that life really consists of these meaningful relationships, but also the fact that,
John Rhee
that true friendships are those in which each are trying to grow in virtue together and that true friendships can then help us to be able to grow closer to practicing all of these virtues.
John Rhee
The virtues of balance or integration, but also the virtues of generosity, sincerity, all of these things. Right?
John Rhee
And so I would say, like deepening of those relationships and realigning that to the focus of one's life and how to do that practically, I think does depend on each person and each person's circumstance in a very practical way.
John Rhee
But if one were to say even today after this podcast, like, yeah, the most important thing to me are my relationships, whether they are relationships with my parents, my wife, husband, children,
John Rhee
friends,
John Rhee
God,
John Rhee
right,
John Rhee
that am I really living a life where I'm deepening these relationships every day? And if I'm not,
John Rhee
then how can I make small changes,
John Rhee
even if it is again like a five minute call, Whether it's like making sure that I spend some time each day deepening relationships in my day,
John Rhee
how can I realign the way that I'm living now with the people and practices that are truly most important to me?
Michael Egan
Yeah, that sounds very helpful and requires a lot of sincerity. So virtue builds on virtue, I guess.
Michael Egan
Anyway, well, thank you, John. This was very, very helpful and we will see you all next time on the Hippocratic Society Podcast.
John Rhee
Thanks, Michael. Great to be here.
John Rhee
Thank you very much for joining and reflecting with us today.
John Rhee
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John Rhee
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John Rhee
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John Rhee
And as always, we'll see you next time on the Hippocratic Society Podcast.