Brigid Schulte’s bestselling book, Overwhelmed, began as a mission for an audience of one: Brigid Schulte. The stressed-out journalist, wife, and mother set out to find out why her life had drifted into a cycle of meeting work and family obligations, always feeling behind, and rarely pausing for leisure — a journey that led her to discover what researchers call “time serenity”: the feeling that there actually is enough time to do what you want and need to do.
Her findings, published in 2014, hit home for millions of Americans who feel overwhelmed by the demands of daily life — a feeling that’s particularly intense among medical students, physicians, and researchers. Schulte found that people across the country, especially in knowledge professions like medicine, have absorbed a cultural obsession with busyness that causes significant harm: robbing them of living full lives, causing burnout, and impeding the quality of their work.
However, she also found ways that individuals and institutions can reduce the sense of being overwhelmed and find more balance between life and work — hence the book’s subtitle, How to Work, Love, and Play When No One Has the Time.
Schulte will discuss her observations in a dedicated one-hour session at the AAMC’s annual conference, Learn Serve Lead 2020: The Virtual Experience, on Nov. 16. Now the director of the Better Life Lab at the New America think tank in Washington, D.C., she talked with AAMCNews about how her findings apply to medical professionals. Below are excerpts from the conversation.
When you published Overwhelmed, you couldn’t imagine that within just a couple of years, Americans’ feelings of being overwhelmed would be even worse. Your message about stepping back from stress about work and things we can’t control is even more relevant now — certainly for medical professionals.
The stress is off the charts. We’ve got a global pandemic. And for workers on the front lines, for health workers — doctors, residents, nurses — it’s created this additional level of intense stress that, by going to work, you are literally putting your life on the line.
Layer on top of that, economic downtimes and fears. You layer on top of that, if you’ve got children, they’re not in school, you’re not sure what’s happening with child care, their activities are shut down. Layer on top of that the racial justice reckoning. On top of that you’ve got this divisive political climate.
We just feel the world is spinning out of control.
What can you tell health professionals about how to handle that loss of control?
People in medicine are expected to perform miracles under the most difficult circumstances. What this [COVID-19] showed is that there’s a limit to that ability to perform miracles when the system isn’t working.
You have to be really aware of what you cannot control. What the medical professional cannot control is that we had a weak response from our political leadership. They did not get the personal protective gear in a timely and consistent manner. They were not given the support they needed.
That’s not easy to reconcile. You need to put it in larger perspective. When there are massive system breakdowns like this, we all need to be asking, “How do we fix this system?”
Medical workers have been urged to recover from the stress by taking time off through vacations or short work breaks. A lot of doctors, researchers, and faculty say that sounds nice, but they can’t pull back because their work is too important — especially now.
We make it so difficult in this country to have work-life balance. Our culture celebrates the image of an “ideal worker” as someone who is always on, always available, never needs to sleep, or has no life outside work. And we have almost no public policies that support combining work and life in meaningful ways — no national paid family and medical leave, no national paid vacation policy, no investment in child or elder care.
The pandemic makes that even more difficult. We don’t have recovery time. Plus, during economic downtimes where there is a threat of layoffs, it’s human nature to try to show how irreplaceable you are: “Don’t furlough me, I’m important!”
You see busyness as a status symbol more among more educated workers. You see it in medicine, you see it in law, you see it in journalism, you see it on Wall Street. It’s the culture.
I’m doing work now trying to understand busyness through the lens of behavioral science. What is our fascination with — almost addiction to — busyness? It’s a very American phenomenon. Some of it’s rooted in the Protestant work ethic; there’s always been a strong sense that our most salient identity comes from work, and a belief that hard work will pay off.
What we’ve found in working with organizations, we hear over and over from staff, “I’ve been busy all day long.” Yet they get to the end of the day and they haven’t even started their most important work. So work spills over into weekends and evenings. People feel like they’re never not working.
Yet your research found that working more can produce worse results.
There needs to be some interrogation of the idea that long work hours lead to better work. The data is incontrovertible that it doesn’t. The way we work is not only dysfunctional, it’s killing us.
Look at the burnout statistics. A frighteningly high share of people in the medical profession are experiencing at least one symptom of burnout.
Work used to be measured by the time you spent doing it. The thinking went, “If you spend more time working, you must be doing better work.” Now that work has changed so much, we need different metrics, like performance outcomes, to measure what is good work and how to reward it.
What’s an example of how busyness can be counterproductive?
In behavioral science, you see this practice called “tunneling,” when you get in that busyness tunnel. It’s like your vision collapses and you really only see the next thing in front of you.
If you’re doing surgery, tunneling can be a good thing. It can really focus you on what is right in front of you that you have to immediately attend to.
But oftentimes, we’re not focused on the most important thing. We plow through emails and go to meetings. We end up being very attentive to what appears in front of us. We don’t do our most important work. Instead, we stay in the tunnel, we stay busy. We can’t see a way out — of doing things any differently.
That suggests that some of our most important work is doing things where we don’t look busy.
A lot of times in knowledge work, the busier you are, the less able you are to think strategically, the less able you are to be creative. When you’re tired you cannot create, you cannot innovate. You end up perpetuating status quo thinking.
The research is really clear: To have insight, to have innovation, requires a couple of things. You need to be well-rested. You need to be in a calm state of mind. The ideas come when you’re in this diffuse, day-dreamy kind of mode. Your brain is wired to have the best ideas when you’re taking a walk or you’re in the shower.
When you make time to rest, to get out of the tunnel, it actually makes you work better. You’re fresher. You’re able to think about problems in a new way.
What can medical institutions do about that?
Focus on well-being instead of wellness. If you have a wellness program but the environment is built around the at-work-all-the-time culture, all you’re doing is creating more cynicism. You’re giving me a lunchtime yoga class and yet expecting me to work a million hours and answer emails all evening? That isn’t well-being.
I often speak with corporate executives who also have this sense of overwhelm. One said, “Maybe the millennials will come in and lead the way. They’ll teach us about work-life balance.” I said, “Shame on you. You cannot expect the most junior people with the least power to change the culture. You join an organization and you quickly adopt the culture that’s already set.”
It’s really important, if you’re a manager or a leader, to think about, “What is the work culture you’ve created? What are the values you’ve communicated?” People follow the leader. If you’re a boss and you say, “You should take vacation,” but you’re answering emails at midnight, that’s remote overwork. It’s boundary-blowing.
What should health care workers do for themselves?
There are changes we can make in policy and culture — big changes — but while we’re working toward those changes, there are things you can do in your own life.
Give yourself permission to have leisure time. It’s almost like that’s a dirty word — the thing that has made life worth living. Find a way to bring that into your life, that sense of joy and awe. It’s going to make you better at your relationships, better at your work.
Connect with what’s most important to you and make time for that. You can start really small. Maybe it’s doing 10 minutes of something you look forward to. It doesn’t have to shift your entire day.
Start your day by getting clear on what’s most important to you. What’s your one thing today? Sometimes it’s a work thing, sometimes a home thing, sometimes a personal thing.
What’s one thing for you?
It depends entirely on the day. My running partner and I often finish our run asking each other this question. It helps focus the mind on what’s most important. You may not be able to do 75 things in a day. You may not even be able to get to your top three to five. But you can focus on one.
I’ve tested positive for COVID. My daughter came home from college feeling sick one weekend and wound up bringing it home. So the other day, my one thing was to rest and heal. The next day, since I’d been feeling better, my one thing was to be present and helpful for some virtual mentoring sessions I promised to do.
When you focus on one thing, not 75, and you do it well, the day feels more like a win.