Balance

[Admin]

We have not spent too much time in class talking about "balance" and leadership. Yet, I have seen this directly in how you feel coming to class when you are overwhelmed with other classes. We also saw this directly when reading Mountains Beyond Mountains many times. In Chapter 17, Tracey Kidder reports that:

"[Farmer] didn't out much work aside for Peru, not for his duties in Haiti, or his service at the Brigham or his teaching at Harvard or his growing number of speaking engagements." p150
"Farmer was so sick for a time that he could hardly make his voice audible...I wondered at his recklessness... his habit of disregarding his health hardly seemed like a way of expressing 'pragmatic solidarity'. Given the responsibilities for other lives he'd taken on, it seemed to me he'd done the opposite." P151-152

We also saw impacts of Paul Farmer's leadership and work on his relationships.
Let us explore it a little more about balance through your thoughts.

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1) In defining and creating a life of service and physician leadership, what is the balance you are seeking?
2) A balance of action and contemplation? family and work? leisure, work and service?
3) Do you have some strategies you can share that help you lead a balanced and cohesive life, even as a medical student?

[Weaver]

1. I believe the balance I seek will be at least somewhat dependent on all the factors brought up in this prompt, so it's difficult to say exactly how I'm going to do it. Realistically, if I'm going to be completely dedicated to my career as a physician-leader (we can argue as to what this means because I don't know {are we talking social, professional, or academic leadership?}) and a life of service, it will be necessary to make focused commitments to one or a select few service opportunities. I think the worst thing we can do as physicians and leaders is to stretch ourselves too thin and not be able to effectively manage the professional and service-oriented aspects of our lives. Paul Farmer is an outlier in my opinion (Kidder did write a book about him, after all), and even his Adonis DNA appeared strained and stressed at times under the weight of his commitments. Most ordinary people simply cannot handle the loads Farmer placed on his shoulders, so I believe an important lesson to be learned is how accomplish more by doing less.

2. It's imperative that a leader maintain a balance between action and contemplation. Obviously, many of the more difficult choices we make involve deciding when, how, and whether to act on an issue. A definining quality of a leader is his/her ability to remain composed in tough situations and contemplate the best course of action; however, when we do decide on acting, we must do so with full enthusiasm and confidence. The responsibilities of maintaining a family and a job overwhelm me at this point in my life, but a person like Farmer should contemplate his situation and determine whether having a family is compatible with his personal vision for himself and his career before moving forward; the converse also holds true.

3. For me, medical school is the top commitment in my life. Training to become a physician is something to which I've dedicated much of my life, and I want to maximize this experience to further my personal and professional aspirations. However, with that comes a balance between studying and maintaining mental, physical, and emotional stability. I try not to procrastinate on my work, so that I may enjoy our rare off days doing extracurriculars. I also try to make time for exercise each day so that I can be physically fit and also to give myself a break from studying. It's important that we all have interests outside of medicine because these things will help us better understand and connect with our patients int he clinical setting.

[Adriel]

1) This is a tough question. I want to do a good job in whatever filed I go into, obviously whether its fixing fractures or working in the emergency room. On top of more more typical job, whatever it will be, I hope to pick up a few service opportunities that I can take a lead on. I am really interested in international work. I would like to volunteer my time and resources and help the underserved in other countries and ideally figure out a way to provide them with continual access to healthcare even when I am not there. ( i guess kind of similar to Dr. Farmer).

2)Yup, its sure important to have a balance between action and contemplation. You don't want to rush into things without having planned them out, but you also don't want to delay getting the work done because you are focusing on too many minute details. Obviously, I am not planning on sacrificing my family life for my work life, but I do believe that I will make sacrifices in both to achieve what I want and have to achieve.

3)So usually, I go to small group and then either attend lecture or study on my own depending on whos teaching that day. I then, around noon, eat lunch and workout so I have all of this taken care of before one and allows me the rest of the day to study for a few hours and then go home, relax, watch tv, run errands, and do whatever. Its a pretty sweet life so far. It will be interesting to see how this changes third year. I imagine I will have to make sacrifices in certain areas (most likely my leisure activities).

[Angie]

When I think of balance, I think priorities. I may be super committed to a project, but if it interferes with doing well on an exam or spending time with family, I will probably take some time away from the project. It has to be a give and take with all things that are important to me, but you can't have balance if you don't know what needs to be on your plate and what can be/needs to be taken off.
The balance for me will be between family and work. But in my mind, work also includes service to my community outside of my job as a physician and family also includes leisure time. Again, it is a matter of priorities. My family time and sanity (leisure time) is most important to me, so I have to put my work and service at a close second. Therefore the balance will be to always make sure I have my priorities straight when deciding how to spend my time, efforts and emotions.
I certainly wish there was a magic bullet to having a balanced and cohesive life in medical school. I tend to be a high stress person which can be counter-productive at times. So, my way of being balanced is similar to what Adriel and Weaver already said. I just make sure I put time aside for myself, to have fun and to relax. I make a schedule for myself on google calender so that I can see when my little breaks and fun times are as kind of a motivation to keep studying when I'm getting tired or unmotivated.

[Megan]

1) Continuing a bit on what Weaver said, a doctor (or anyone really) who is stretched too thin risks depriving the quality of his/her work and family life. Whereas I admire Farmer for his work with the impoverished and his passion to serve, the whole image is tainted when I try to think about how his wife and daughter must feel. Especially knowing how much of a study/work-aholic I tend to be, one of my biggest ‘fears’ is unintentionally pushing my family/friends aside.
2) The balance I am seeking is one in which I can spend adequate time building relationships with my family (including my closest friends who I consider to be family) and those I serve. I’m not very good at ‘sitting still’ most of the time but I do want to have just enough leisure in my life to keep me energized and passionate so that I can serve more effectively. I think Adriel’s response pretty much covers my thoughts on action and contemplation too. Different situations and circumstances tend to call for a different balance between the two and I believe experience is the only thing that can really give you a good idea about when each is more called for.
3) To keep me balanced, I try to keep more focused on my service activities because these are what give me a sense of fulfillment. And, as I said, I tend to be a study/work-aholic (granted, I believe there are many of those in med school); but, thankfully, I’m surrounded by several close friends (including my roommates) who help keep me sane. It helps too that both my roommates are studying in different fields – one in law school and the other in seminary school – because it keeps the conversation from always defaulting back to the topic of what’s going on in med school. I also talk to my family almost every day to keep updated on what my 11 year old brother is up to with his baseball and 5th grade sweethearts, how my mom’s venture back to school is going, and what all is new with my dad.

[Jacob]

Echoing what others have said, I envision myself being a leader and integrating service with my work. I think a big key is to pursue opportunities professionally and in service that overlap. For instance, in Mountains Beyond Mountains, I think that Dr. Farmer's job in ID at Mass General dove-tailed well with his ventures internationally. Beyond the obvious common focus on infectious disease, the hospital job gave Dr. Farmer accesses to resources (lab equipment, drugs, etc). Although not specifically mentioned, I'll bet that many of his co-workers were able to help Dr. Farmer in various ways.

As medical students and future doctors, I think that leading a balanced and cohesive life is something we all struggle with. I've noticed in the transition from first year to this year that I have had to drop some of the "redundant" activities I used to be involved in, while adding some new ones that combine different interests. I imagine, like Adriel, that when 3rd year rolls around more of these activities will have to be dropped. That being said, I am sure I will always find a way to keep fitness, family, and friends in my life.

[Sarah]

For me, the idea of balance is more than just doing what I need to do to achieve my main goals. We all recognize that in order to do well in school, we need to study, which means we need to be healthy, which means we need to eat/sleep well and to exercise, etc. However, I think that balance is also a reflection of the energy applied to the things in which we choose to invest our time. For example, many of us mentioned being happily married or having other fruitful relationships in addition to a successful career when we wrote our vision statements at the beginning of the semester. Reaching those goals requires an investment of time and energy that cannot be postponed indefinitely. So I would suggested that a second definition of balance, then, is dividing your time and energy in a way that accomplishes all of your goals, not just the most prominant one.

It seems to me that how people choose to spend their time says a lot about what they care about and what they stand for. For example, Paul Farmer's goals are clear: To improve individuals' health by providing primary care in Haiti, to improve global health by addressing socioeconomic disparities, and to mediate others' ignorance and apathy and get them involved, too. He spends a lot of time, money, and energy working toward these goals, and he does a great job. He does not, however, seem to invest very much in personal relationships. For example, his relationships with Ophelia and Jim seem to be neglected at the expense of Paul's work (or sometimes his pride). Also, he lives apart from his wife and daughter for most of the year. To me, this says that Paul probably values his relationships less than his work. (Of course, I recognize that this is a generalization that isn't always true. At times, 'you've got to do what you've got to do' to get something done, even if it means temporarily sacrificing things that are important to you. Also, it may be that there are other forces at work, e.g. a time-sensitive obligation/project or a demanding boss.) I'm interested to hear what you all think.

[Cameron]

I believe great leaders master the art of balance. Without balance things do not come together as they should. How could a leader direct a group without balance in his own life.

I strive to get balance in my life and it takes a lot of effort. Concious attention to exercise, attention to eating right, attention to friends and family and loved ones. Sometimes it would be easier to just eat fast food and study. Balance is a constant goal of mine and I know great leaders understand it well.

I have heard that a lot of being a good doctor is taking care of yourself first so you are in the best position to help someone else. Kind of like the idea behind putting on your oxygen mask first in an airplane emergency then helping those around you. I can see how that would make some of the best doctors and leaders.

[Kelly B]

I will continue to echo most of what other people have already said. Success seems to come from being able to identify priorities in your life while maintaining a healthy balance with everything else. I think it's important to realize that priorities can change though. I learned this during my first year here at UNC med. At first my priorities were studying and running. I didn't want to give up racing so I tried to fit runs in during most of my spare time - either with my dog or with friends - which let me kill 2 birds with 1 stone. I didn't notice until it was too late that my family had been pushed down to a lower priority than they should have been and since then have re-evaluated my priorities and brought new balance into my life. I just hope to maintain that same balance during clerkships and internships in the coming years.

[Sarah B]

I agree with Cameron that finding balance takes effort. Perhaps there will be a day when I have all the time in the world to do all the things that I want to do, but for now, it seems that a lot of my balance is scheduled into my Outlook calendar. On the other hand, I think a big part of achieving balance is being flexible. An example of this would be a couple of weeks ago before one of our tests. I had planned on studying the entire weekend when a friend called, having just found out some bad news, and asked if I could come see her. Although it ended up being a day-long excursion that took away from study time, it was worth it because being a good friend and building supportive, fulfilling relationships is as much a part of my life as medical school is. Overall, for me, finding balance is a process more than it is an end goal.

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