3.2 - Family and Medicine

How can we live a strong family life with a busy medical career? How do we balance the demands of a flourishing profession and a flourishing family? How can we develop our family relationships in the demanding time of medical training? Join us as we explore the beautiful struggle of pursuing both family and medicine. Come away with some practical tips to love family well amid the particular challenges of medicine.

21 minutes • Published Dec 30, 2024 • Download • Transcript

Recommended readings

The Positive Impact of Family Life on Physician Well-Being, Elizabeth Landry
Physicians and their primary relationships: How to be successful in both personal and professional realms, Gordon Cochrane
Doctors and their families, Susan Benbow
Medical Marriages, Jennifer Casaletto and Gillian Shmitz

Transcript

[Intro music]

Welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.

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.

Thank you for joining us and we look forward to engaging with you through this podcast.

Hi and welcome to the Hippocratic Society Podcast, where we aim to help physicians and trainees thrive by giving them the tools to pursue and practice good medicine. My name is Michael and I'm John.

Today we'd like to talk about family in the context of medicine.

So as you probably saw, there's the larger topic that we talked about, flourishing in the context of medicine. And so this is our podcast on one of the subtopics within that larger topic.

And here we'll talk about family and medicine.

And Michael, maybe we could start off by talking a little bit about what does family in the context of medicine actually encompass?

Absolutely. As we mentioned in the previous podcast,

Dr. Tyler VanderWeele from the Harvard Human Flourishing Project identified five common aspects of happiness, health,

purpose, relationships, and virtue.

Although not extensive, he argues that these five aspects are generally present in all flourishing situations.

Furthermore, in order to reach all of these five aspects, he identified four family, education,

work, and religious participation.

So today we would like to look at medicine and family in terms of how we can truly live well in a family in a way that leads to our flourishing.

So I'd like to start with a story to kind of frame the topic.

Let's say you have a wife who's pregnant and you, you're an emergency room physician.

Today is your kids middle school award ceremony and he's been talking about it a lot the past week. You can tell he's really excited.

However, you are just finishing up a two week 12 hour day rotation and even though it's very important to your son, you know you're going to have to rush right at the end of work in order to make it.

With 30 minutes left in the shift, you are paged to consult on Mr. Jones.

You've gotten to know Mr. Jones over the last year very well and you know that he is very chatty and always has a litany of issues when you talk to him.

You're not going to make it to the ceremony.

Moreover, your pregnant wife will have to handle any outbursts herself and she's already frustrated with how little you've been home recently.

So as you can tell, very fun situation. But probably one that's not super out of the ordinary for many doctors and residents.

So, John, in light of this story, what are we talking about when we say family in the context of medicine?

Yeah, thanks, Michael. Definitely not a fun situation at all.

Right.

And family medicine has to do with how we reconcile our roles as doctors with our roles as husbands, wives, sons, daughters, fathers, mothers. Right. There's a continuity here where we don't just suddenly stop any of those identities that we have when we're working as physicians.

And so we have to then also reflect on how we properly order those various priorities.

And that just as an understanding the podcast here is, it's not meant to be an instruction manual, but rather going off of the fact that we're trying to form physicians in the practice and pursuit of good medicine in this virtue ethics framework, that this is really about helping form the sense of practical wisdom or prudence in then applying the principles to guide our thinking about the topic and then also help us to exercise this within the context

of the virtue of prudence.

Wow. So clearly we have a big topic to discuss here, John, and I'm sure this is on the minds of many doctors and especially many students as they look forward to their prospective careers.

So, I mean, there are a lot of demanding jobs where people have to spend long hours at work and struggle to maintain a good work life balance. But why is this important,

particularly for medicine?

Sure, Michael. And yeah, as a, as a doctor, I think about this a lot as well.

And I think it's important to just start off with this idea that family has a major impact on flourishing of everyone involved. And it's one of the primary ways of forming close social relationships.

Right.

Because the family is the foundational unit of society. It provides the structure in which we can explore what it means to love and care for one another unconditionally,

to sacrifice ourselves, our needs, our desires for others,

to create this culture of mutual respect and create an environment in which stable bonds there, in the context of family, can then be a means in which we can grow bonds or relationships with others.

And that includes our colleagues, patients, and even our friends outside of the home.

And so, besides personal well being, there's also the benefits of a strong and supportive family that help physicians in their work.

Research shows that the emotional energy derived from a family environment is reciprocated in a physician's work, and it contributes to a more positive and compassionate approach to patient care and also creates a dynamic where resilience is fostered within the home and enhances a physician's capacity to handle challenges at work and vice versa.

And so there's a sense in which there's a renewed sense of meaning and purpose in work that drives a physician when they are also supported at home.

Research also shows that a supportive spouse or partner has been shown to decrease the risk for physician burnout and that higher levels of marital satisfaction are associated with increased physician work satisfaction and marriage.

And so the commitment that is part of marriage is associated with greater satisfaction, happiness,

mental and physical health,

personal growth,

lower levels of loneliness, and higher levels of positive relationships. And that comes from the work, as we mentioned, of Dr. Tyler VanderWeele.

And so, as a result, if we are to flourish, it makes sense that we would give major importance to family life and how we live. Family life is not isolated from how we live at work.

There is this necessary unity of life between the two.

Right.

Where the ordering of that which is most important to me is stable across all aspects of my life, including work and including at home.

I remember when I was a palliative care fellow, I had this sense in which there was this deep importance of prioritizing more meaningful time and space to recover, both at home and at work.

Because I was having these very deep conversations with patients about navigating end of life decisions, and I realized that I need to have at least some good hours of sleep in order to make sure that I have the emotional availability for those patients and to be able to then have the attention in order to show that love for the patients at work.

Right.

And that I also found that there was a much deeper connection at work and home than I realized in terms of how one affects the other. Because when then I also am at work and perhaps spend maybe an unbalanced amount of time at work,

then I also am affected by how much I can then kind of give that emotional energy and also that compassion and care for when I am at home.

Wow. So obviously this is a huge deal,

as you just explained in your own life, but also, as you were saying, for flourishing for everyone and especially physicians,

and definitely easier said than done to live family life well.

So where do we go from here? How do you students, doctors and residents give family its due priority and keep a strong family life despite their limited time, long work hours, difficult exams coming up, all that.

Yeah. Thanks, Michael. And this is kind of the crux of our podcasts, right? The sub themes of the practical aspects. And I love this quote by Dr. Jamie Coleman, who is an authority in this because she's a trauma and critical care surgeon, but Also a mother.

And she says. And she's. She's a blogger, and she says, quote, my best advice is to stop thinking of work and life as a balance.

That implies that they are opposing forces and will only set you up to fail.

Surgery doesn't stop my life, and my life doesn't stop surgery. I am a better surgeon because I am a wife and a mother, and I am a better wife and mother because I am a surgeon.

And so there is a sense where Dr. Coleman talks about this idea that there is this unity of life again between her identity as a wife and mother and also her identity as a surgeon, which is also something that she holds very dear.

And so we want to kind of reflect then on how can we balance these priorities and make sure that family is one of those, and perhaps the most important one of those priorities.

I had a friend from medical school who I'm still impressed by,

who went through residency and currently in fellowship,

where during residency, she got married and she recently had her third child.

And so it's one of those things where it is possible.

And I'm sure we all can know people around us who are able to do these things.

And it also means that we have to be very intentional with our time whenever possible.

Research actually shows that long physician work hours don't cause marital problems, but often result from a desire to escape marital tensions.

It's also a process of reflecting where we may be placing our intentionality and perhaps using certain things as escapes rather than forming them as spaces in which we can grow deeper in our bonds.

And so I thought that we could talk briefly about five practical points of deepening one's family life.

So, number one, setting aside time each day.

So in medicine, we talk about this idea of protected time for research, right? And I'm sure all of you have heard this before.

And without protected time, you can't actually do the research work, because clinical work always overflows into all aspects of kind of our life, right?

And so, similarly, we need protected spaces of time for family and our schedules. And this time has to be truly protected. A research mentor once told me that if I'm not strict about guarding my protected research time, I will never be a successful researcher.

But it's also important to note that not all times of the day are created equal. So kids are at school during the day, for example.

And therefore, one way to kind of block out this protected time is dinner time. That can be sacred, right? That is almost protected no matter what. With very, very few exceptions, perhaps there are some kind of ways in which, obviously, when there are big events that that might be changed,

or perhaps there's a little bit of variability on the weekends, but that there is a sense in which there's a routine of setting aside time each day.

I think two is this idea of ordinary versus extraordinary.

So we talked about dinners as being this ordinary protected time, but we also need extraordinary protected time, right? This includes trips on weekends or going to school, concerts, celebrating special occasions in the life of your family.

Cal Newport,

who is kind of a famous both writer and professor, talking about ways in which one could do their work well, talks about this idea of time blocking.

So time blocking is when you plan ahead in your schedule and block out periods of time where you know that you'll need that time to do XYZ task, right? And so these have to be in your schedule, and you have to time block no matter what, in order to make sure that that is something that you do and you get that thing done ahead of time or that thing that you need to get done ahead of time

and that you have time to do that in the future.

And it's important to just note that time blocking is important not just for the task itself, but we also have to time block for. For planning for that task. Because,

you know, like the anecdote that we talked about at the beginning of this podcast,

you know, perhaps that emergency room physician needed to just make sure that he had time blocked ahead of time so that that shift could be covered by somebody else,

so that he didn't schedule in that shift at a time where he didn't have enough space to get to his kid's concert.

Three is preparation.

So preparation. What do I mean by that? That we have to be very intentional about how we approach this protected time by preparing ahead.

So, you know, let's say I get a consult for a patient with a new brain mass.

The visit will only go smoothly if I've given myself enough time to review the history in the chart, what the patient's prior treatment plans are, when their surgery was, has there been any radiation, pathology,

their current vitals, nursing, communications, medications, they're on. There's a kind of sense in which I already have a set way in which I approach a patient's chart to make sure that I have a comprehensive idea of.

Of the patient. And that requires a lot of preparation.

But similarly, we could be intentional about how we approach protected time, including what types of questions I want to ask at dinner, for example, in order to facilitate deeper conversations.

So rather than being like, was your day good,

which leads to just like a yes or no answer. We could think about asking questions such as what was the part of your day that you found yourself most excited about?

And this way it could be an open ended question where it leads to deeper discussions about things that drive your spouse or your kids, things that make them excited,

things that also perhaps were more difficult.

And in that way we prepare well for that period of time. And preparation for that could actually be done even in the car, but it just has to be intentional.

Four is quality.

So we're not going to have infinite time, but making the time that we do have be very high quality.

So routine dinners are important, but quality time should also be spent with one on one with each of your children and spouse.

There's this physician that I know, Dr. Fernandez del Castillo at Mass General, who's a surgeon and so obviously very, very busy,

but he has nine children and makes sure to spend individual time with each of his children and of course also with his spouse. And I think that that's like a shining example of somebody who's living and making sure to live that and understand that individual quality time is important with each of his children.

And then lastly, five, Everyone is different.

So we could sometimes be a little self centered in our approach to the world and mistakenly think that others, including those closest to us, think or respond in the same way that we do.

And there are different frameworks for understanding this. Like for example, there's perhaps you've heard of Chapman's five love languages of how people express or receive love.

So for example, he talks about words of affirmation, quality time, physical touch, acts of service and receiving gifts.

But there are also different frameworks of understanding how people react to different things. Right? There's the temperaments or the 16 personality types.

And the idea of these different kind of categories or frameworks are not to put people in boxes, but they can help us understand that people have different ways that they process, think and work through challenges,

express emotions and also express deep needs of being loved.

And so to recognize that your spouse and each of your children will have different temperaments, personality types, love languages can help you then respond to each person as an individual and filling their greatest needs.

I remember this past weekend, I actually spent the weekend with my brother,

his wife,

our parents, and also my brother's three kids. And there was this moment where he kind of got suddenly angry at my mom because his kid Theo was kind of running around and had gotten hurt and she hadn't noticed it, et cetera, but it Wasn't that he was actually angry at her.

It's just that it was an expression of his moment of stress, not true anger.

And that's just a totally different temperament than me. I tend to not show emotion that much or actually at least extremes of emotions.

And so it used to be this kind of at stake between our. In our relationship with my brother where he would kind of react that way and I would kind of get hurt.

And it was only more recently in the past year or so that I realized that it's just the way that he reacts and the way that I react and we're just different people and that I also have to not be so kind of worked up by how he reacts either.

Right.

And lastly, sometimes we can play this victim card, right?

Because it seems like in medical training that we have no control over our lives.

But actually a lot of medical training and attending life are actually in our control. Right. Starting with what specialty we choose and what program we go to for training that may give us a better balance and.

Or emphasis on time with family.

And so here, of course,

this doesn't mean that you only make that decision in isolation,

but that's where the virtue of prudence or practical wisdom gives us the ability to see that the balance of deep personal family relationships and meaningful work are both important in finding happiness and flourishing.

Thank you, John. That was all extremely helpful. It sounds a lot of really just setting your priorities and reflecting and really trying to be intentional with the time that you do have.

And I know personally, a lot of what you've said really resonates with my experience,

Even just the point about quality over quantity. I know even in the times where I'm a little more busy, maybe studying for school or studying for exams,

I know that when I do have just a little bit of time with people and I don't spend it intentionally and we just kind of hang out and talk about random stuff.

I know I always feel like I kind of wasted that little moment of time that I had with this friend or with my family and know that I definitely could have spent it better.

And yeah, so just as a review,

just review the five practical points that you had mentioned. There was setting aside time each day,

the ordinary versus the extraordinary protected time, so needing both types of time,

preparing for that time,

choosing quality maybe over quantity, but quality in any sort of quantity that we do have,

and a recognition that everybody is different and the world isn't just revolving around how you think and everyone reacts to different things differently.

And that overall point of just Prioritizing family life as much as you can and reflecting on where you put your values and where your time is going to pursue your ideals.

So, returning to the story of the award ceremony from the beginning, I know you mentioned that maybe the emergency room physician could have prepared his time a little better.

Do you have any final reflections about how this overall aspect of family and medicine affects patient care?

Thanks, Michael. Yeah, and it just makes me think of the story actually from a couple weeks ago where I was taking care of this young man who had or has a 7 year old daughter and he was hospitalized for metastatic cancer, specifically, specifically for pain.

And we were having this conversation and I was on the palliative care consult team and the team told me, yeah, he's leaving on Saturday no matter what.

And I went to kind of explore that with him because my instinct was to say,

I mean, if your pain is not controlled, you can't leave.

But explaining that to him and kind of exploring why he said that his daughter has a dance rehearsal or a dance concert actually on Saturday and that she has been looking forward to him being there for months and that this is like his top priority and he will go no matter what,

even if he's in pain. And so that story just kind of moved me because if we follow typical medical guidelines, we would maybe have said like, we highly advise against that you're just going to end up being back in the hospital.

We, hmm, it's already Friday.

We may not be able to do this, et cetera, but here, practical wisdom and understanding that which is truly important to the patient, that is his family,

can help us do all we can to whether that's slightly bending the rules or really, in this case, making an individualized plan for the patient so that we can make sure that he goes to that which is most important to him, to his family.

So understanding the context of how family is truly important in the context of our patients too,

is super important when we live out also family life that is well ordered within the context of our own lives as well.

Thank you for that, John. That was very touching. And thank you so much for breaking open this topic in terms of how we can flourish as future and current clinicians and also how we can help our patients flourish.

So thank you very, very much all for joining us. To learn more about the Hippocratic Society,

sign up for our newsletter or donate, visit us at our website, hipsoc.org thanks so much, Michael.

Thank you very much for joining and reflecting with us today.

Keep up with new episodes by subscribing to the Hippocratic Society Podcast.

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And as always, we'll see you next time on the Hippocratic Society Podcast.

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