2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

SELF-CARE FOR ONCOLOGISTS
herself best, each oncologist is encouraged to adapt this sort
of list into a realistic and effective self-care plan.)
Given oncologists’ hectic schedules and competing demands,
these recommendations can be challenging to implement.
It is useful, therefore, to identify and enlist
facilitators. For example, having a regularly scheduled personal
trainer can help ensure that strength training occurs;
making a standing weekly commitment to walk, run, or bike
with a friend can help ensure cardiovascular exercise. Engagement
of a housecleaning service can liberate weekend
time for hobbies and other personally fulfilling activities. A
life coach can help establish time management practices
that support balance and identify pragmatic ways to reach
lifestyle and balance goals. Something as simple as purchasing
a water bottle and carrying it at all times can help
remind a busy physician to stay well hydrated and set a
positive example for staff and patients.
Stress reduction warrants special mention as key to avoiding
burnout. There are many options for alleviating or
reducing stress, defined by individual character and interests.
Spending time outdoors; meditating; participating in a
favorite sport; pursuing a hobby, such as playing a musical
instrument; simple relaxation, such as reading a novel in the
evening; and activating one’s sense of humor all represent
effective approaches to stress reduction while also meeting
self-fulfillment needs. A complementary and alternative
medicine practitioner, such as a good acupuncturist or
massage therapist, can become a valued ally in stress
reduction. Resources such as meditation, relaxation, or
guided imagery CDs are readily available and can make
stress reduction both convenient and enjoyable. There are
many forms of deep relaxation, including listening to ocean
waves or soothing music, sitting or walking meditation,
biofeedback, transcendental meditation, visualization,
mindfulness meditation, neurofeedback, and progressive
muscle relaxation. The restful alertness (relaxation response)
induced by these interventions differs neurophysiologically
from the sleep state; it enhances mental clarity
and lowers body catechol levels, cortisol level, oxygen demand,
blood pressure, and pulse.
Although more than 90% of Americans believe in God or a
universal higher power, 22 spiritual self-care is not commonly
recognized as one of the oncologist’s duties. Some
individuals may believe that the stress management recommendations
listed in this chapter adequately address their
needs in the spiritual domain. Others, however, must engage
in a regular spiritual practice (e.g., daily prayer or
meditation or weekly attendance at religious services) to feel
that they are attending well to their spiritual dimension.
Finding meaning and higher purpose, beyond individual
satisfaction and gain, in one’s profession can support a sense
of spiritual fulfillment. Self-care in this deeply personal
domain requires self-knowledge and a certain level of intimacy
with one’s self; cultivation of inner connectedness in
whatever way the individual chooses can satisfy self-care
needs and support well-being.
Interpersonal. Like all people, oncologists live within a
social context, a web of relationships. The extent to which
the oncologist attends to his or her responsibilities to self
therefore has an effect on others. Family commitments to
significant others, spouses, and/or children require, above
all else, time—a commodity in short supply in the oncology
profession. Inability or failure to meet commitments (im-
plicit or explicit) to one’s family can induce considerable
dissatisfaction and distress in all involved. A vital part of
oncologists’ self-care is thus attending to relationships.
In spending time with others, both quality and quantity
are important; no level of quality time, however exceptional
in quality, can compensate for spending the bare minimum
quantity of time with loved ones. Critical is the ability, in
whatever time is available, to be truly present with others,
rather than multitasking with mobile device in hand or
being so exhausted as to barely engage in conversation.
Strategies for ensuring that relationship responsibilities are
met include family rituals, such as game night or Saturday
breakfast out, and a regular date night with a spouse or
partner. Making a commitment to a family dinner at least 5
or 6 nights per week can be considered an evidence-based
intervention; studies have shown that family dinners are
associated with healthier eating patterns in older children
and adolescents, 23 healthy adolescent development, and less
engagement in risk behaviors. 24
Social support is an important facilitator of well-being in
busy individuals and those with plenty of time for socializing.
Friends and acquaintances provide an emotional outlet
and an opportunity to give and receive ideas, thoughts,
feedback, concern, and affirmation. Although technology
and social networking provide endless opportunities for
connecting with others, there is no substitute for face-to-face
encounters in conveying a true sense of support.
Recognizing burnout in one’s self and colleagues and
taking responsible action are important interpersonal duties
of each oncologist. Signs and symptoms include the following:
frequent irritability or anger, depression, disengagement
and depersonalization, apathy, chronic fatigue and/or
depressive symptoms, and substance abuse (e.g., alcohol,
recreational drugs, and inappropriately used pharmaceutical
drugs). These are neither normal nor acceptable attributes
of an oncologist. On identifying these symptoms, seek
a psychologist’s or counselor’s help for one’s self or, in the
case of a colleague, either refer the individual to a practitioner
who can provide direct help or report the concern to a
senior supervisor or associate, as appropriate.
In medicine, a system for accountability and attention to
each other is often lacking. When a colleague is demonstrating
unhealthy behaviors, one’s responsibility and course of
action are often unclear. Whom should we tell? How can we
enlist help? Can we ensure appropriate follow-up? Although
clear lines of authority and accountability exist in other
disciplines, such as nursing, we in medicine are frequently
unsure where to turn. Although lack of line management
affords us a valued measure of autonomy and flexibility, it
also leaves us unclear of how to maneuver when a colleague
is troubled. In the absence of clear directives, oncologists
should take seriously the responsibility to attend to each
other and should discuss within their professional teams a
system for encouraging one another’s well-being and intervening
when warning signs emerge. Until such systems
become explicit aspects of the oncologists’ workplace, it will
remain important to share a common understanding of this
responsibility.
Different Cultural Approaches to Duties to One’s Self
An individual’s exploration into and definition of his or her
duties to self will depend not only on personal factors, such
as individual values, preferences, capacities, and circum-
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