PracticalDermatology

Many of my friends and colleagues told me they could relate to the last editorial of 2016, and I hope for all of our sanities we all found a break and took some time to be better to ourselves…and yet, since the turn of the year I haven’t found a free minute to breathe between meetings and a manic two-year-old tearing up the house. But in the past few weeks I was reminded about pacing and taking those steps back like I mentioned in that December editorial (Of course most of you are probably reading this on the treadmill, on the plane, or with your phone in your other hand…busted!).

(Watch Dr. Bhatia in a special behind-the-scenes episode of Derm Insider now for more on finding balance!)

One of my so-so favorite movies is The Replacements from the year 2000, probably made to give Keanu Reeves a break between The Matrix movies. There was a scene where the players in the locker room confided about their fears, and the one his character — the quarterback trying to revive his career— brought up was the concept of quicksand. The analogy was how the game takes a turn, and slowly one bad outcome leads to another, and the harder the struggle to get back on track, the deeper the team would sink. The concept of sinking in quicksand, although not to be found in any big city, is that once you step in it your reflex is to struggle to get out rather than stay still, breathe, and use your wits. Now maybe Dermatology isn’t as dramatic as this, but there is no question that we are usually responsible for a version of this when things get a little crazy.

The football scenario is about momentum, breaking the bad rhythm, and turning the ship around in time to still be in the game. It’s an interesting concept about how crazy things can get between juggling career and family, but even more sobering when we look at how we can be our own worst enemies…we take on heavier and heavier loads, which push us deeper into quicksand, but we know we can so we don’t say no. Even worse is when we are reminded by others that we do something well so we agree to yet another task: another lecture, another patient, another committee, another family activity, and even another editorial! But if we start to sink and struggle to get out of our own quicksand, the tasks at hand start to suffer, and all too often there isn’t anyone around who can pull us out.

As I write this with the winter meetings wrapping up and the AAD meeting approaching (and will be over by the time you read this), I am reminded by how much we try to take on year after year, and the high achiever in all of us continues to fight back and appease our fatigue. But as the past journal issues and editorials have reviewed physician burnout and being better to ourselves, we should look at the tendencies that get us deeper into quicksand. Is it the inability to say no? To be more vertical than horizontal with our inbox? Or are we still blinded by rookie ambition and the restless dreams of youth that we just want to do everything to prove we can? Maybe there’s a blend of all of these that make us who we are.

Usually, there is a list of references and articles that support these observations, but this time we are stuck with the reference in the mirror to tell us what to do. Our pacing and our methods of managing our time can, in the end, be managed by the same discipline it takes to get out of the quicksand…not with struggle but with strategy. A strategy for time management, saying no without burning bridges or FOMO (this is the new millennial term for fear of missing out that I learned at work), and the hardest task of self-reflection are the best approaches to release from the quicksand that we created for ourselves. Whether it is missing out on a meeting, skipping one of our kids’ games, or denying ourselves that extra hour of sleep, we struggle in the quicksand of FOMO rather than take on the strategy of saying no to what is lower on the priority list. Of course, I’m also writing this on a day that I should have left work in time to pick up the kiddo and was 15 minutes late because I didn’t beat traffic.

Easier said than done, right? I wish I had some pearls of wisdom that matched the gray hair but that would make me a hypocrite since there is no question that I am guilty of all of the above. Let’s see if the chaos of the winter gives way to the solace of spring, or “meeting season,” as we say, and a relief from the struggles in the quicksand.

Disclosure: quicksand is actually a colloid hydrogel, but don’t put it on your skin.

—Neal Bhatia, Chief Medical Editor