The two biggest issues that arise around self-care is the misconception that self-care is selfish or we simply don’t have time. Even in defining self-care it can sound like an encouragement to neglect others to indulge yourself. But proper self-care isn’t that at all. Everyone needs personalized methods and practices to reduce stress and re-energize. Without them, it is nearly impossible to function at our best. And let’s be honest, as physicians, we naturally place others before ourselves, making us great at caring for people but terrible at caring for ourselves.

In this episode, I discuss the topic of proper self-care. I start with my definition, which is simply making sure you have what you need to be at your best. When you’re at your best you can actually be a better physician. What makes each person better varies and that’s okay. The important thing is to have routines that prioritize your stress-reduction and fuel your good in the world. So let’s talk about why self-care matters and it isn’t selfish.  

“What if not taking care of yourself is depriving the world of what you’re here to accomplish? What if not taking care of yourself is procrastinating in doing your work in the world?”  – Dr. Sara Dill

What You’ll Learn

• Defining self-care
• Being honest about what you need
• Why self-care is not selfish
• The uncomfortable necessity to occasionally disappoint others
• Always saying yes is a form of lying
• Busy vs Choosing
• A better calendar = A better you

Contact Info and Recommended Resources

I recommend pairing today’s podcast episode with my one about Boundaries. Click to listen!

Connect with Sara Dill, MD, The Doctor’s Coach

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• Email: sara@saradill.com
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• Get Dr. Dill’s book The Doctor Dilemma: How to Quit Being Miserable Without Quitting Medicine
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I’m Dr. Sara Dill, and this is the Stress-Less Physician podcast, episode number eleven. Welcome to the Stress-Less Physician podcast. I’m your host, Dr. Sara Dill, MD. Using my unique combination of coaching and mindfulness tools, I will teach you practical ways to reduce your stress level, feel happier at work, and create a better balance between your medical career and personal life. If you are a busy practicing physician who wants to design a life and medical career that feels good to you, you are in the right place.

Hey everyone, welcome back to the podcast. I’ve been thinking about what I wanted to talk about next, and I have so many ideas, so I just picked one. I’ve actually been thinking about this a lot for myself and sort of reconfiguring some of my own scheduling, and some of how I prioritize what I wanted to talk about today, which is self-care.

So, I think that self-care both gets over-talked about, especially in coaching and wellness groups. And yet, also miss talked about. But I also think it’s incredibly important, so I’m going to talk about it too, so, anyway, let’s do it. So, you know I like to define my terms. I think of self-care as simply, what you need to be at your best, and the practice of learning how to make sure you take care of yourself first, rather than last.

I always like to go to the dictionary however, just to see. And the dictionary, the Oxford dictionary define self-care as: “The practice of taking action to preserve or improve one’s own health, as well as the practice of taking an active role in protecting one’s own well-being and happiness, in particular, during periods of stress.”

So, I like both of these definitions. These definitions make it sound not touchy, feely, right? Preserving or improving one’s own health, and taking an active role in protecting one’s own wellbeing and happiness, in particular, during periods of stress. What could be more important than that? I mean, especially as physicians, what we do is to preserve and improve other people’s health, so why not our own?

So, self-care can be lots of things, self-care might include getting enough sleep, which could look like seven or eight hours of sleep at night, or going to the gym, or a yoga class, or working out regularly. Self-care might look like eating healthy foods, or taking a lunch break. It might include hiring a house cleaner, or having a date night every week with your spouse, your partner.

I just want to mention for non-physician listeners, most physicians don’t take lunch breaks, this is not necessarily a common thing. And I want to say that, especially for any physician listening, I would encourage you at the end of this podcast, to think about whether you want to take a lunch break and why you don’t. So, I take a lunch break every day, even though I don’t even eat lunch most days, I still like that break, I leave the office, I take a walk, I go run errands, I just get outside. I do this pretty much regardless. And it’s incredibly important for me, and it’s something that I really honor, even though it’s challenging sometimes to make it happen. So, that was just a little aside.

As physicians, we tend to be really good at taking care of everyone around us, but we tend to be terrible at taking care of ourselves unless it’s sort of an emergency. So, I was thinking about this in terms of a client I used to work with who is a resident. And she really resisted acknowledging that she needed a good seven, eight hours of sleep at night to feel good and function well.

And as you know, during residency, sometimes that’s a time when sleep is not really a priority, and it might be difficult to get enough of it, especially when you have a lot of other things going on. By realizing and acknowledging to herself that getting enough sleep helped her to perform better and be more productive, it made it easier for her to then prioritize sleep and her own wellbeing, and to structure her work and life to set herself up for long-term success.

And this is me too, I need seven hours of sleep minimum, which means I have to be in bed for at least eight hours, because I tend to wake up a little bit here and there. And if I don’t get seven hours of sleep, I’m really just not the best version of me, it makes everything a little bit more difficult, I’m a little bit more easily riled, work often doesn’t go as smoothly. So, if I get seven plus hours of sleep, I really am the best version of me. You can ask my friends, you can ask my boyfriend, this is very clear. They all encourage me to get enough sleep, which helps me encourage me.

But again, it’s a work in progress, this isn’t stuff that’s always easy. So, self-care is often not glamorous or fun, it’s not soft and easy all the time, it actually can be very challenging and uncomfortable to prioritize our own wellbeing and health and happiness, especially if we aren’t used to it.

So, I just want to ask you, how many physicians do you know who are good at prioritizing their own wellbeing? Who don’t work too much, too often, and who get enough sleep, and make time for exercise and downtime, and have a healthy lifestyle? Maybe not that many, right? There’s something about the very idea of prioritizing yourself as a physician that seems to fly in the face of being a “good doctor.”

And this is a big reason why burnout and exhaustion and overwork are such problems in today’s medical world, in my opinion. And why so many physicians and other healthcare providers, and I would say actually, this is true across many fields, why so many of us are considering leaving their medical practices, or retiring early. And this is exactly why self-care in the long run is not selfish and why self-care is really required, and why self-care isn’t just frivolous and lightweight. So, I would argue that self-care isn’t selfish, because without it, burnout, overwhelm, exhaustion, resentment, overwork are the inevitable result.

I would suggest that taking care of you is taking care of your loved ones. Any conflict you perceive here, I would suggest is a miss perception, or only part of the perception, or perhaps too narrow a perception. What happens when you step back and look at the bigger picture? Can you see where taking care of yourself is taking care of others?

The mantra I learned in my medical training however, and the one I even taught to my residents, was the patient always comes first. It’s probably familiar to many of you. Somehow, this also seemed to mean however, that my own needs and wellbeing came last. This is such a problem that the new Hippocratic oath actually includes a new clause, or at least one of the versions. This new clause states, “I will attend to my own health, wellbeing, and abilities in order to provide care of the highest standard.”

Are you attending to your own health and wellbeing and abilities? If not, why not? So, let’s talk about what self-care really is. There’s a quote, many of us have heard it, I couldn’t find to whom it was attributed. But the quote is, “You can’t pour from an empty cup, take care of yourself first.” Fill up your own cup so that then you can be of service or give to others.

So, what is self-care anyway? On social media, it appears mostly is getting massages, or pedicures, maybe a nice meal, girls’ night out, or just a very large glass of wine or a cocktail after a hard day. And yes, I would say these can all be self-care activities, but perhaps slightly superficial ones in my opinion.

True self care is often really challenging, it may be saying no to seeing a late patient so that you can eat lunch. It may be not baking cookies for your child’s school fundraiser, or not being on the board of a cause that you really believe in. It may be cutting back your work hours, or going to bed on time, rather than zoning out on the couch with Netflix.

Self-care is really about prioritizing your wellbeing, so that you can then be of service to yourself and to the world in whatever ways you wish to be. So, I would argue that self-care is not easy, if it were, you would probably already be doing it, right? So, let me ask you, how do you currently prioritize yourself and what you need to be healthy, happy and thriving in a sustainable way? Versus your work, your patients, your family, or your friends?

Do you prioritize yourself in a way where you’re near the top, or maybe near the bottom? You need to know so you can assess if this is something to work on, and why, for you. I would suggest that you should consider making you and your wellbeing your top priority. You are your number one, who else is going to do it? If not you, who?

I coach my clients all the time to explore why they must not sacrifice their own physical, mental, and emotional health for the sake of anyone else’s ever. At least that’s my thought. You can start by noticing how and when you do, and what are the costs and the consequences of sacrificing your own health and wellbeing for others? What are the consequences for you? What are the consequences for your family and your friends, for your patients? Even for the world. What is the consequence of not taking care of yourself? If someone really needs you, they need you to be healthy and available. Once you start taking care of yourself, you will often discover you have so much more to give to others, it really is a win-win situation.

Again, what if taking care of you is taking care of your patients, your family, and your loved ones. What if not taking care of yourself is depriving the world of what you are here to accomplish? What if not taking care of yourself is procrastinating in doing your work in the world? I think COVID and the additional demands we’ve all experienced in the last couple of years has simply made this even more clear.

It’s one thing to decide to temporarily work more, sleep less, try to meet the rising demand of a global pandemic, maybe homeschool your children, and do all the things. But it is not sustained. In the end, you cannot do more than you can do and trying to do more at your own expense, in the end it does not benefit anyone. Burnout, exhaustion, illness, and what people are calling the great resignation, I think are the result of this.

Typically, a lot of my coaching clients discover the reason they’re not taking care of themselves is because they’re putting others ahead of themselves in a routine fashion. Remember the instructions on the airplane, I know it’s a cliché, but it’s a cliché for a reason, right? Put on your oxygen mask first before helping others with theirs. This includes your children, your family, and your patients. Are you putting on your own oxygen mask first?

They’re always going to be demands on your time and energy and availability. There’s always something. There’s never going to be a time when you easily have time for you with no choices or decisions to make, or at least I have yet to experience that. So, it can help to understand why are you putting other people’s wellbeing or happiness ahead of your own? Maybe think about a recent situation when you put someone else’s wellbeing ahead of yours. What are some of the reasons you do this? Can you see how likely right now you might be more willing to disappoint yourself than others. What would it take for you to be willing to disappoint others, rather than to not disappoint yourself?

I found that until you are willing to disappoint other people, rather than yourself, you will continue to end up depleted, and likely feel resentful. Resentment and irritation are often signs of poor or non-existent boundaries. Setting healthy boundaries can prevent a lot of unnecessary friction. Again, a boundary is not a way to control other people, but it’s a way to protect yourself and maybe your own energy, your own wellbeing. It may seem like boundaries separate us from others, but really, they do quite the opposite. I just did a podcast on boundaries, maybe two episodes ago. So, definitely go back and listen to that if you need more help with boundaries.

So many of us physicians are also chronic people pleasers. Again, this is normal human behavior, but you can notice that it’s not contributing to our happiness, or to creating a life that feels like our own. Humans are social creatures, and the threat of not being liked or approved of or accepted as a very primitive fear. The way I think about it that makes sense to me, is to consider that it probably comes from how we as humans evolved, maybe centuries or even millennia ago, in small groups or tribes. Being exiled, or isolated from others probably meant literal death.

And I believe we still have this instinct to get along, to be a part of the group, to make sure other people are happy, and make sure people like us. Maybe because that was so important to our survival for so many years, for so many centuries. I think that’s why it can feel so intense to have people not like us, or be mad at us. I think that’s why it can sometimes feel like life and death—only it isn’t that way anymore.

So, there’s nothing wrong with wanting to be liked and accepted by others, I think this is normal. The problem is when we say yes to others at our own expense. When we do this, really, what we’re doing is lying, right? We’re providing bad information, we’re saying yes when we want to say no, we are setting ourselves up for martyrdom and resentment.

I would ask yourself honestly, if you tend to be a people pleaser. Do you say yes to things you don’t want to do to make or keep others happy? Are you worried people won’t like you, if you were to speak and behave more honestly with them? Do you feel like you need outside validation and the approval of others to feel good about yourself?

How much do you worry about people seeing you as lazy, uncaring, selfish, or egocentric if you were to do what you actually wanted to do? Most physicians answer yes to all of these. I used to as well. I still struggle with letting people think whatever they want about me. However, I have some bad news, is that they’re going to think whatever they want about you anyways.

For so many years, I deferred my dreams, because I was so worried about making other people happy, or getting their approval. And I still like to do things that I think might bring happiness or pleasure or enjoyment to other people. The key is that I make sure it comes from a clean place, of not needing their appreciation or approval. And it does not come at my own expense, this is really the.

So again, there’s nothing wrong with wanting other people to be happy. If doing things for someone in your life brings you happiness and doesn’t come at your own expense, go for it. Just make sure that you are not placing someone else’s happiness and wellbeing above your own. In the end, you are not responsible for making anyone else happy, and in the end, you can’t make other people happy. Have you ever done something you didn’t want to do to please someone and then gotten upset when they weren’t happy with it? I’ve totally done this. So, frustrating, right? Typically, we just want other people to be happy so we can be happy.

And because we can’t control how other people feel, because how they feel is caused by their thoughts, remember? I recommend cutting out the middleman and making yourself happy. Again, you don’t have to make yourself happy at their expense, but you just don’t want to try to please other people at your own expense. And typically, when you are happier, those around you are happier, too.

One of my favorite thoughts is this, that my being happy sets other people free to be happy. My being happy sets other people free to be happy. I think that is so powerful. Being a happier physician leads to a better working environment and probably to happier and healthier patients. Being a happier spouse or a happier parent likely makes every aspect of your life and your loved one’s lives better.

One of the most powerful and difficult exercises I have for my clients, is practicing giving an honest yes or no. So, you could just notice, what would it be like if I just said yes or no honestly? Can you practice not saying yes when you want to say no? It’s going to feel uncomfortable. The other thing to look at as part of self-care is this idea of being too busy.

So many of my clients, and let’s face it, pretty much everyone else, are often saying that they’re busy, too busy, but I would offer that busy as a choice, and busy is often an excuse. We all have the same amount of time, are you spending it in the way you wish to? What is busy to you? What does busy look like for you? Can you make a mental list of what typically keeps you busy? What is really important on that list? This ties into your values as well.

If someone who didn’t know you looked at how you spent your time, could they guess your values, your priorities, and what is truly important to you? Is there something else you actually want to be doing with your time? Again, I would challenge you to practice saying no to those things that you don’t want to do, and that are not really important to you. See if you can delegate some of those tasks or outsource them, or maybe just delete them altogether. Start small, but definitely start.

Next time you find yourself saying you’re too busy to do something, you can consider rephrasing your answer a little bit more honestly. So, if you find yourself saying you’re too busy to take care of yourself and work out, you might try saying: I’m choosing to make my kids’ needs more of a priority than my own, right? Or I’m choosing to stay late at work rather than get to the gym. If you keep staying up too late, you might notice, I’m choosing to watch movies and lie on the couch rather than go to bed on time.

Of course, I want you to have plenty of time to spend with your kids, and time to watch Netflix and relax. I’m a big fan of relaxing and free time. I just want that time not to come at the expense of your long-term well-being. How can you do both? How can you finish charts and get to the gym? Usually, the answer is to say no to things you truly don’t want to do, and don’t value doing or having done.

As Oprah used to say, no, is a complete sentence. Learning to say no is a skill. Typically, we say no, and then give a bunch of reasons, or we say yes, and then feel resentful that the person even asked. I want you to practice saying no, practice with your spouse or partner, practice in the mirror, practice in less risky situations, practice, practice, practice. An honest no means that people can trust that when you say yes, you really mean it. I have sort of a funny story about this.

So, I have a friend, and I guess this was maybe a year or so ago. He said he really wanted to tell me something, and that it was a little hard for him, and that he really valued our friendship. But that he found it sort of hard to do things with me, because I only said yes to things that I really wanted to do. And I really appreciated him saying that, and I had to agree with him, it’s true, I do only say yes to things that I really want to do. And again, that may make it a little bit difficult for people to plan things I guess, with me. But it also means that people can trust that when I say yes, I really mean it, right? I don’t say yes out of obligation, I don’t say yes, out of a sense of needing to people please. So, I appreciated his feedback, and it also made me really proud myself in sort of a funny way.

So, the other thing that I would really encourage you to consider doing, and if you adopt only one habit, I recommend in my podcast, I want you to do this one. And I want you to try to do it every week, and this is the habit of scheduling your life on your calendar first. I think this is the most important thing you can do to prevent your own burnout and ensure that you feel happier and more fulfilled, and enjoy your life more. Doing this recharges you so that you have more energy and enthusiasm for your work, and for the rest of your life.

So, what I want you to do is schedule your non-work priorities on your calendar. Put anything you want to do on your calendar. Preferably do this with the other people that you live with, or spend time with. A spouse or a partner, children, you could do this with some friends, this way everyone can be involved, and you can create a shared calendar as well as a personal calendar. So, you can have a family calendar, as well as your own.

You can do this in either a calendar app. I use my apple phone calendar, or on a paper calendar, if that works better for you. And then you can take a photo of that paper calendar of with your phone. It has to be accessible for review and checking in with on your phone. If you can’t refer to it and keep track of what you have planned, those activities likely will not have.

Having your calendar on your phone also allows you to check it when someone at work asks you to switch call, or work late, or attend a meeting, or do something else. You can’t wing it, especially if you aren’t very good at saying no. If you aren’t already keeping a calendar like this, I would say this is why you currently don’t have enough free time set aside for you, and maybe why you miss out on things that you really want to do.

So, I want you to start blocking out time for you and your friends and family and other loved ones. Do this every week or every month. Events you should include on this calendar include the following: Fun activities that help you relax or recharge, such as gym time, yoga, running, dance, hiking, swimming, massage, manicures, and pedicures, whatever that is. This can include movie time or TV time. For me it includes bedtime, I put bedtime on my calendar every day.

This should include free time, right? So, maybe try blocking off an afternoon, or a whole day off to devote to anything, or even better to devote to doing nothing. This would include time with friends and family, this might include a weekly or biweekly date night, maybe a girls’ night, something you enjoy doing. This should also include time to schedule the next week or next month on the calendar, right? You want to give yourself a lot of time here.

One of the secrets to having more free time is to block it off on your calendar in advance. Whenever possible, block off your free time and fun time. Write all your self-care time and activities before you schedule your work activities. And then you can do whatever you want to do in that blocked off time. This can include spending time with your family, or enjoying solo time. Scheduling time off in advance actually allows you to be much more spontaneous in the moment. Try it and see, it sounds weird, but I swear by it.

This calendar again, it needs to be on your phone, so that when someone asks you to do something, you can pause and say, “Let me check my calendar,” and then you check your calendar. If you have something scheduled on your personal or family calendar, you can then tell them no, right? You can say no in so many ways, “Thanks for asking, but I’m not available. I have a prior commitment. I’m not free then.” You don’t have to give details, notice if you want to, but it’s also fine to simply tell the truth.

No, that’s my time with my kids, or my date night, or my workout class, it’s totally up to you, this will probably be really hard, and it is so valuable to strengthen your self-care muscle, and get comfortable saying no. Again, practice this, role play with other people, it’ll feel silly, but it’ll be helpful. Make practicing saying no fun and natural, and then you honor your calendar.

So, let’s sum up what I talked about. I feel like I went over a lot today. Self-care in my mind is not some feel good, nice to have, but optional thing. Self-care is not just Instagrammable photos of mani, pedis and lounging poolside. Although it can totally include those, if those are activities that contribute to your wellbeing, health, and happiness, I’m a big fan.

Self-care requires you to set your future you up for success. I like to think about future Sara, right? Is future Sara going to be happy that I said yes or no to this activity or work or whatever? Is future Sarah going to wish that I had made a different choice today? How can you have your future selves back? I think about this a lot when I try to get to bed on time.

So, I usually try to wind down around nine, in bed by 9:30, asleep by 10. I often don’t want to, in fact, almost a hundred percent of the time, I don’t want to go to bed when I tell myself I should go to bed, and when my little calendar reminder pops up. But then I think about Sara tomorrow, and I think about Sara at the end of the week, and I think about how good I’m going to feel when I wake up tomorrow, if I go to bed when I’m sort of supposed to. And by supposed to, I mean, when I know having done the math, when it’s good for me, based on when I wake up, right? So, I really like thinking about future me as a way to motivate myself, to honor my decisions that I’ve made.

Self-care requires you to no longer do things at your own expense, right? It requires you to refuse to let being busy steal your wellbeing, your health, and your happiness. Self-care means being willing to disappoint others, rather than yourself. It requires you to get to know yourself and what you need to be at your best, so you can do what you are meant to do in the world, both personally and professionally. It requires honest yeses, and honest no’s. It means you schedule yourself and whoever else you care about first.

Thank you so much. I hope you enjoyed this episode as much as I did, definitely sign up for a free mini consult with me, if you have any questions, anything that you struggle with. I also want to just shout out that I’m going to be starting my next small group coaching program in June, it’s going to be three months, and I currently have one spot for a one-on-one client.

So, if you want to get on my email list and find out when that small group starts, definitely head over to my website, Saradill.com, S-A-R-A-D-I-LL.com or send me an email at Sara, S-A-R-A, at Sara Dill, S-A-R-A-D-I-L-L.com. And make sure you are in the loop, okay? Can’t wait to talk to you soon. Bye.

If you are a busy practicing physician ready to start feeling less stressed, enjoy work more and learn how to create a more balanced and sustainable medical practice and life, sign up for a consult call with me at Saradill.com. That’s S-A-R-A-D-I-L-L.com. It would be my privilege and pleasure to work with you.