July 22, 2017

There’s A New Guy In My Life

So there’s this new guy in my life named Andy.

He’s kind of bald. No, not kind of. He’s bowling ball bald. But it looks good on him. He sports a lovely British accent and just the sound of his voice calms my mind. When I listen to him, I’m more aware of my breathing and better able to be in the moment. When I can’t sleep at night, his softly spoken words help me drift off. During the day, if I’m in a tizzy, he reminds me to not get reactive and to observe my thoughts.

As helpful as Andy is, I doubt he has any real interest in me.

We’ve never actually met, and probably never will.

Some of you may have guessed…

Andy Is Andy Puddicombe, a meditation and mindfulness expert, and the voice and co-founder behind the acclaimed meditation app “Headspace.” And I might add, Andy is happily married to a gorgeous woman.

When a physician client of mine, a man’s man kind of guy, told me he was using this app called Headspace, and meditating every morning, I was intrigued, but skeptical. Having always done silent meditation, I wasn’t sure about someone talking during a meditation. Was this “meditainment” – some gimmicky New Age thing?

Yet during subsequent coaching calls, my client would tell me how he was more patient with his family, had less anxiety at work, and hadn’t missed a single morning of Headspace – for months!

Hmmm……..Maybe there is something to this, I thought.

Now you may be skeptical too, but before you run off, saying meditation is not for you, you don’t have time, or it’s for fruity people who wear yoga pants, please hang with me just a bit.

Instead of meditation, I prefer the term “mind training.”

Mind training helps with being present, letting go of rumination over the past, and anxiety over the future. It increases your ability to self-observe without judgment, and when you do that, you’re better able to choose how you respond to people, situations, thoughts, and feelings. “Mindfulness” is a term often used to describe this type of practice and it has been shown in studies to help reduce physician burnout.

Do any of you experience that Sunday night dread or pre-call anxiety?

You’re at home, and you’re not on call yet, or seeing patients. Instead of enjoying time with family, your mind is filled with anxious thoughts. It’s pre traumatic stress, and it robs you of any enjoyment of the present. As much as you wish you could stop those pesky thoughts, they have taken over! They are the boss of you. 

Sunday night dread is just one example of the mind having its way with you. If you suffer from any of these common issues, mind training may help:

Dwelling on the past

Worrying about the future, perseverating

Feeling distracted and unfocused

Not being present

Being reactive to people and circumstances

Difficulty sleeping

Anxiety during surgical cases

Self-doubt, lack of confidence

Every week I hear from physicians who have excellent training, are highly skilled, and have a great track record caring for patients. Yet they often have thoughts of self-doubt and not being good enough or smart enough. They may second guess their decision-making and surgical skills. For no good reason.

It’s the thoughts, not anything based in reality that’s getting in the way. Mind training helps us to identify that these are just thoughts, so we don’t get overly caught up in them.  We then have a clearer (head)space to find out what’s actually true.

There really are no idle thoughts. They can empower as well as sabotage us. They can unleash our highest potential, or literally drive us crazy. But we don’t have to be at the mercy of an unruly mind.

We use personal trainers to help achieve better fitness. Why not use one for mind training?

With a mind training app, you can have your own personal trainer for less than the cost of a potato – 26 cents– a day! And we’re talking 24/7 access! Yes, your trainer is on call for you all the time!

What I love about Headspace:

You have a highly trained teacher at your fingertips.

There are meditation “packs” which have meditations on specific topics such as:

Self-esteem, Patience, Forgiveness, Happiness, Creativity, Focus, Health, Work and Balance, Athletics, Sleep, Pregnancy, Depression, and much more. 

The guided and unguided meditations range from 1 to 20 minutes ( you can hit pause to lengthen the meditation).

To support the training, Andy gives “assignments” for you to bring into your day to reinforce the concepts he introduces in the meditation.

With an unobtrusive headset, you could do a 1, 3, or 10-minute meditation at work. This little break could potentially reset your mood from cranky to calm, or from scattered to focused.

To be clear, I am not implying that the purpose of mind training is to make it so you can tolerate a dissatisfying or dysfunctional situation. Rather, one primary aim is to help you be more aware of your thought patterns and reactions so you are better able to discern what works for you and what doesn’t, and take constructive action.

And as I mentioned in my last blog, Creating Your Personal Pan Retreat, a meditation app is a great resource to use as an anchor for your own retreat.

Click here for the Headspace app.  You can try 10 sessions for free.

Promo Code: GETSOMEHEADSPACE – gives you 25% off the annual subscription.

Click here for some other popular meditation apps.

OK – gotta go. Andy’s waiting.

Create Your Own “Personal Pan Retreat!”

I’m calling it your “Personal Pan Retreat” in homage to those tasty little pizzas you get to design with your very own choice of toppings. Want extra cheese? You got it. Hold the anchovies? No problem. Extra sauce? Check!

Why a retreat?

Life on the proverbial hamster wheel has such momentum that it’s difficult to slow down and find the time to reconnect with our deeper self. When we do get a break, we may be on a whirlwind family vacation, fixing up the house, hosting company – or all of the above. A retreat can certainly be a vacation, but it has a specific focus.

I’m planning a one-day Personal Pan Retreat at the end of the month to do some visioning for my next 5 years. I’ve been wanting to make some changes for a while now, but gosh darn it, in order to figure out exactly what kind of changes, I need some devoted time and space. And I get nowhere thinking about it while carrying on with my day-to-day life. Can you relate?

Using a retreat to create a vision for your future is only one possible focus, below are some other options that exist:

Meditation and Mindfulness
Yoga
Writing
Spirituality
Healing and Renewal
Leadership
Art/Creativity
Visioning
And yes, even Physician Burnout retreats!

You can find a retreat to join. However, you can also create your own retreat for free, right in your own home.

How to plan your Personal Pan Retreat

First, decide on the focus of your retreat. It could be like mine, for visioning and goal setting, but it could also be for reconnecting with yourself by doing art, yoga, writing, woodworking, meditation, prayer, gardening, singing, etc. It’s not so much about the “what” you are doing, but “how” you are doing it. Many retreats are done in silence, or partial silence, in order to create a space for being fully present and focusing on each moment, rather than being lost in thought or activity. From this space, ideas and inspiration may flow.

Second, figure out the length and location. You can plan your retreat for ½ a day, a full day, overnight, or longer. You will want to have undisturbed time, so whether this means clearing the decks at your own home, going to a cabin, a seaside hotel, or a local bed and breakfast, the choice is yours. Some retreat centers offer their facilities for individuals to come and do their own retreats on the premises. You may join in on a formal treat if you prefer, or plan a retreat with friends or family.

Just for fun, here are some tongue-in-cheek themes for Personal Pan Retreats!

#1 Burnt to A Crisp No More! – Are you burned out from practice? Take your white coat off for a day or two and create a recipe to end the burnout.

#2 Who Stole My Cheese? – Feel like something’s missing in your life? Get that cheese back and then some by channeling Sherlock and tracking down the likely suspects.

#3 The Picassoroni – Bring out your inner artist and creative spirit through painting, drawing, woodworking, or whatever medium beckons.

#4 The Greek Goddess – Ladies – leave work, the laundry, the cooking and kids for a spell and rediscover your identity apart from any role. Keep your location a secret.

#5 The Whopper – Want to have it all? Take the time to set some juicy goals for the next 5 -10 years and make a plan to make it happen.

#6 Olives N’ OM’s – Simple, yet not easy. All that is required is to breathe, meditate and be present.

#7 The Man Cave – The Man’s Man retreat. He-man stuff, you know. Not sure on the details here. Ask a man.

Once you have your theme and location, then you can make a schedule. Below is one example where I use the theme of Creativity. What your day looks like is of course entirely up to you!

7:00 AM Wake up
7:15 AM Exercise
8:00 AM Breakfast
8:30 AM Guided Meditation (can use an app*)
9:00 AM Creative Activity – Draw, paint, write, play music, do wood working, pottery, gardening, cooking, crafting, photography, etc.
10:30 AM Reading: preselected reading related to your creative activity or creativity in general
11:00 AM Creative Activity
12:30 PM Lunch
1:00 PM Walking Meditation or Mindfulness Exercise
1:30 PM Journaling: jot down some notes on your experience thus far
2:00 PM Creative Activity
4:00 PM Refreshment/Tea Break
4:30 PM Meditation or Mindfulness Exercise
5:00 PM Wrap up: how you would like to bring more creativity into your day-to-day life?

You don’t need to have your time this structured, but I would at least have a rough schedule and gather the supplies you want to have and plan your meals. Allow some time for a little journaling and self-reflection.

If you like the idea of a retreat yet would rather not have to create your own, click here for some options.

* A Meditation App is an optional resource for your retreat. I personally love Headspace but here are a number to choose from. Even if you are not doing a meditation-themed retreat, you can use the app for 10-minute meditations throughout the day to help stay focused and grounded.

If you decide to do a retreat – homemade, frozen, or at a retreateria, I would love to hear about it!

Til next time,

Buon Appetito!

ER Doctor Transitions Into Teaching – As Told By a Curious Surgeon

Dear Readers, you are in for a treat today with this guest post by my client Dr. Sue Zimmermann, an orthopedic surgeon. As part of her career transition process, she met with and interviewed one of my former clients, Dr. Rob Baginski, who made the leap from Emergency Medicine into teaching in 2013.

Before the interview, Dr. Zimmermann shares some of her journey. Take it away Sue!

I started working with Heather over a year ago. At that time I had been in clinical practice as an orthopedic surgeon for over 23 years and was very unhappy in my job. I loved doing surgery and taking care of patients, but I was tired of being on call, having increased pressure to do more, being micromanaged by administrators, and feeling anxious over not being able to help everyone. I was planning to retire in a few years, and I wanted to plan for my future career doing something I was passionate about. The coaching process was my lifeline; it gave me something to look forward to, and every step I took brought me a little closer to my new career. I started teaching at a local medical school as a volunteer, working with a small group of students doing case-based learning. I discovered that after each class, I felt energetic and excited. It was not only rewarding to connect with students and guide them through the learning process, it was also fun! I decided that I wanted to incorporate teaching into my future plans.

The future arrived sooner than I had expected. I was recently laid off from my job with no warning, and I suddenly had a lot of time to explore a new career. It was a shock, but my preparation over the past year gave me a head start. Heather introduced me to a former client of hers, Dr. Rob Baginski, who had been a full-time Emergency Medicine physician and is now the Medical Director of the Physician Assistant program at a university near me. We initially met for lunch at an art museum, and during our conversation he told me about a program which brings PA students to the museum for lectures on the relationship between medicine and art. I was also able to observe one of his courses. What follows is our conversation about the path he took to become a professor at this university in Boston.

SZ: What were you doing before you started teaching? 

RB: I was working as a full-time EM physician. I had worked in various settings – a trauma center, community hospitals, and freestanding ERs. I started working with Heather as my coach because I just didn’t feel fulfilled in my work.

SZ: How did you start teaching at the University?

RB: Believe it or not, I was driving down the highway and I saw a sign advertising a teaching position at the PA school. I decided to apply for it. As part of the application, I had to give a lecture to the committee. My lecture was on Evidence Based Medicine, which is a big topic nowadays, and I was hired.

SZ: What previous experience did you have that helped you get the teaching job?

RB: I was a clinical preceptor for both medical students and residents. I had also given a lecture series for paramedics when I was the Director of EMS at a hospital where I used to work. I had also been an instructor in Health Sciences at a local community college for a few semesters prior to applying for the job at the University. Finally, I provided lectures and didactic instruction for the Emergency Medicine residents at a local hospital program.

SZ: What is your schedule like? Are you still doing clinical practice?

RB: Yes, I am still working one day a week in the ER. I teach four days a week, and as part of my position I serve on several academic committees. Most full-time academic positions require some committee involvement. I also do a lot of work outside of class preparing lectures, writing syllabi, grading assignments, creating exams, and evaluating students. As part of my job, I need to be current on educational theory – which is very different from clinical practice. For example, schools are emphasizing “differentiated instruction” to address students’ different learning styles.

SZ: What are some of the differences between teaching PA students and medical students?

RB: The PA program is two years; the first year is didactic and the second year is all clinical. So we have to teach a large amount of information in one year. Our curriculum includes traditional lectures and exams, and obviously the students have to prepare for their Board exams. We also have three medical simulations per semester. The simulations involve clinical scenarios in which the students have to make a diagnosis and come up with a treatment plan. We have different scenarios for each discipline in the health science school (i.e., nursing, physical therapy, physician assistant), and we conduct interprofessional simulations as well. Some of the simulations are geared toward diagnosing and treating illness, while others deal with, for example, how to give bad news to a patient and family.

SZ: What is “interprofessional” education? I’ve heard it mentioned a lot recently.

RB: Interprofessional education includes different disciplines in health care, such as MD’s, PA’s, nurses, pharmacists, physical therapists, etc. Students are taught to work as part of the health care team, using case-based learning. A lot of schools are moving toward this type of instruction.

SZ: Do you have any advice for physicians who want to go into teaching?

RB: My advice would be to get as much teaching experience as you can. The pay for part-time or adjunct instructors is minimal, so expect to be basically volunteering your time in exchange for experience and to extend your CV. You can approach schools in other allied health professions, although nursing schools tend to prefer nurses as instructors.

SZ: Do you miss treating patients? Doing procedures? I think I would miss doing surgery.

 RB: Well, I still do some surgery. I am a volunteer at a local aquarium, and I was asked to assist with a gastrostomy on a seal! I couldn’t find any seal anatomy references, so I read up on dog anatomy the night before – I figured it couldn’t be that different. When I arrived at the aquarium, I found out that I would be the surgeon, not the assistant! Fortunately the surgery was successful and the patient is doing well. I have also assisted with mandible resections and digit amputations.

SZ: Wow! So maybe I can still find a way to do some surgery in my future career. Thank you so much!

RB: You’re welcome – I’ll let you know about coming in to observe one of our simulations.

Postscript: I was able to attend a simulation a few weeks later. The students were given a scenario of a patient in an emergency room. They had to speak to the “patient,” examine her, and come up with a differential diagnosis and treatment plan. There were distractions coming from a “nurse” going in and out of the room and from the patient complaining of pain and asking for relief. After the simulation, the instructors met with the students for a debriefing.

I was impressed with the simulation, which was quite realistic. From my research, it appears that medical education is moving toward more simulation and case-based learning. Some schools are drastically cutting lectures, and are instead having the students learn the essential facts on their own and coming to class to apply the material. I think it will be a great improvement over the endless lectures that I attended in medical school, and I’m looking forward to becoming more involved in medical education.  

By Sue Zimmermann, a recovering orthopedic surgeon who lives in Massachusetts. 

A big “Thank You!” to Dr. Sue Zimmermann and Dr. Rob Baginski for their great contributions to this blog!

 

 

Leaving Medicine and Reentry – Know Before You Go!

doctor thinking

Hold onto that medical license and keep your stethoscope handy!

If you’re thinking about leaving clinical practice, don’t retire that license too fast or stay out of practice too long – unless you‘re lock, stock and barrel sure you’re not going back. Even then, it’s wise to keep everything current.

You may be burned out, wanting more time with your children, or needing to care for elderly parents. Perhaps you’re shifting into administrative work or have been enticed away to a start-up company. You might only intend to be away from practice for a year, but then before you know it, 5 years or 10 years have passed, or more. Maybe your financial situation has changed. Is it too late to return?

What is required to return to practice?

Depending on how long you’ve been out, your specialty, and other factors, it could be as simple as making a few phone calls, or it could be harder than climbing a double Mount Everest to return. And as with summiting Everest, no one guarantees your success.

Dr. Christine Stone, an internal medicine physician was gone for 14 years before she decided to return to practice. In her blog, Reentry Physician, she chronicles her return to primary care, which took 27 months and cost $40,000. To begin practicing again, Dr. Stone had to get her license back, pass her board certification, find a preceptor willing to supervise her, and then find a job. Every step took longer and was more difficult than she anticipated, but she made it and offers her blog as a way to help other reentering doctors.

What are the challenges to reentry?

Where do I start? First of all, each state sets their own policy on reentry, and close to 50% of the medical boards do not have a formal reentry policy (AMA fact sheet on reentry). Per the AMA’s 2011 medical board survey, 2.8 years is the average length of time out of practice after which some type of reentry program is required.

Second, the programs for reentry are few and far between, and they are not inexpensive. Each program has different features, but at a minimum, they involve some type of assessment to determine the physician’s knowledge base and clinical competence. The assessment phase on average runs around $10,000.  If there is a patient care component offered, it may be more of an observership or involve direct hands-on patient care.  The fees for this phase can be $10 – $20,000+, not including living expenses.

Dr. Stone did the CPEP Program (Center for Personalized Education for Physicians). CPEP is for physicians from any specialty who left medicine in good standing and involves two phases. Phase 1 is an assessment of clinical skills and knowledge base. Phase 2 involves practice-based learning which is usually done in the physician’s home community. It’s the physician’s responsibility to find a preceptor (supervisor), and this can be daunting.

After getting a lot of “No’s” when trying to find a preceptor, and even wondering if after coming so far, she was going to fail to meet her goal, Dr. Stone finally found a preceptor through a personal connection and was able to fulfill her reentry requirements. She is now working again in primary care.

Dr. Gould, a psychiatrist who had been out of practice for years filling several executive roles in healthcare, did the CPEP program as well. He also had an incredibly hard time trying to find a preceptor for the necessary supervision. About his reentry process, Dr. Gould recounted,

“Prior to starting the process I requested a meeting with the Minnesota Board of Medical Practice, having submitted my basic credentials to them, and asked them outright if, with the proper re-training, would they be willing to license me. If not, I wouldn’t waste my or their time. They were generous in being willing to preview my application and told me if I worked with a company they knew and had confidence in, like CPEP, they would. So, I immediately contacted CPEP and did whatever they wanted me to do, so when I returned to the Board, I had their approval.  Finding a clinical supervisor turned out to be the biggest problem in the whole process. I had my own malpractice insurance and was willing to pay a supervisor their hourly rate for supervisory time, but I needed some program that would let me see their patients as a mature trainee.”

After months of trying to find a supervisor, Dr. Gould’s persistence paid off and a connection from 20 years ago came through for him.

“All in all, Dr. Gould said, “the whole process took about 18 months and cost about $20,000.”

How About a Mini-Residency?

A reentry program in Texas has a solution to the challenges of finding a willing preceptor. The KSTAR/UTMB Reentry Program (A partnership of Texas A&M and The University of Texas Medical Branch) offers a mini onsite residency at UTMB in Galveston.

Physicians need to do a two-day assessment first to see if they qualify for the 3-month mini-residency. Most specialty and subspecialty programs will be possible for those who are eligible. Reentry physicians function as part of the medical team and have access to performing procedures. Liability insurance is available.

Another option is The Drexel Reentry Program in Philadelphia

Eligible specialties for the Drexel Program are internal medicine and subspecialties, pediatrics, OB/GYN, radiology, and anesthesia (other specialties may be possible). While there is no direct hands-on patient care, there is an extensive assessment followed by clinical rotations on the wards, simulated patient encounters, instruction, and feedback.

Lifeguard is a program in Harrisburg, PA open to physicians seeking reentry, including those who have been involved in disciplinary action or may not have finished a residency (depends on the state).

In an interesting twist on reentry, the Physician Retraining and Reentry Program (PRR) in California offers an online program for physicians wanting to reenter or transition into adult primary care. Physicians do not need to be from primary care to be eligible, and doctors from a variety of specialties, including surgery, have enrolled in this program. As a case in point, former urologist Dr. Michael LaRocque became restless in retirement and decided to do the PRR program. He now works as a primary care physician seeing patients at a federally qualified health center in California.

Is a formal reentry program necessary?

Every physician’s situation is different, depending on specialty, time away, state licensure, CME hours, etc. My recommendation is to find out what your state board requires.

One of my clients who left internal medicine for over a decade to raise her children just landed a great job at a progressive primary care clinic. She had kept her license active, and took an intensive Harvard Review Course to prepare for her boards, which she happily passed. She shared this information about her reentry for the blog,

“When I was starting my process, before I took my boards, I contacted Drexel, because I wanted to enroll. They told me to apply for jobs first, and if the employer required me to do a refresher program, to call them back. My current employer did not require me to do a refresher program. Before I started I did some shadowing of one of the primary care physicians. They are starting me slowly, seeing about 10 patients a day. So far, it’s been like riding a bike. My main questions are related to the EMR, and not clinical.”

If I’m transitioning to a non-clinical job, do I need an active license?

Many doctors are surprised to learn that a good number of non-clinical positions require an active license and even board-certification.

Do I need to keep clinically active to some degree?

If you are in a nonclinical job and are able to do some intermittent patient care (locums, volunteering, urgent care shifts, teaching, etc.) you could have a much easier time returning to medicine if you so choose. While this can be impractical for some jobs and specialties, it is worth considering and seeing what’s possible.

Does this mean I can’t take a break?

Absolutely not. I’ve seen doctors take significant time away and return without missing a beat.  Obviously, this depends on your particular situation, but for a reasonable time period, there is more latitude than you might think. Giving yourself time to recover from burnout, flex some different muscles, or devote time to family, can give you an entirely new perspective. Do your due diligence before you go, and if you plan to be out for a while, you might want to set aside some money in a “reentry jar,” just in case.

 

Is Guilt Putting a Monkey Wrench in Your Career Transformation?

There are many kinds of guilt, Catholic Guilt, Jewish Mother Guilt, Generic Parental Guilt, Couch Potato Guilt, Not Feeling Guilty Enough Guilt, and so on. Guilt is such a pervasive emotion it will likely never be on the endangered species list, and as painful as it can be, it is not something we should try to completely eradicate like small pox. Guilt serves a worthy purpose to keep us in line, however, it can also unnecessarily hold us back. As I see it, guilt can be divided into two types:


Guilt Trip
Appropriate guilt: when you’ve done something wrong (or not done something you should have) and you rightly feel regret and hopefully make amends.

Inappropriate guilt: when you feel guilty about feeling a certain way, or wanting or needing something, yet these feelings and desires are healthy and valid.

Inappropriate guilt often arises when you’re feeling conflicted about what you want to do versus what you feel you should do.

Of course there are many instances when we need to put our shoulds over our wants. We may not want to answer a page at 1 am, but we know we should, so we do.

What I often see happening with my physician clients is they feel inappropriately guilty when it comes to making their needs and wants more of a priority, and the SHOULDS win out because guilt is a very uncomfortable and PAINFUL emotion. They end up make decisions based on avoiding the feeling of guilt, and these are not necessarily the best decisions.

Common GUILTY THOUGHTS that can get in the way

“I feel guilty taking my kids to daycare on my day off.”

“I feel guilty taking a job where my income is less; my family shouldn’t have to sacrifice because I’m  unhappy.”

“When I think about leaving my patients, I feel guilty.”

“If I don’t stay in medicine I feel guilty wasting my training.”

“If I work part-time, I feel guilty knowing others are working more.”

“I feel guilty wanting to do something by myself when I don’t get enough time with my family. Sometimes I wish I were single, not really but….”

“I feel guilty for wanting to be happy. Shouldn’t I just suck it up? How many people like their work anyway?”

Guilt is tricky. It’s good we can feel the emotion of guilt, so we have some starch to go with our moral compass. But too often we set unreasonable expectations, putting ourselves at risk for rubber-stamping “Guilty” on our psyche like a bored government worker. We don’t take the time to really understand why the charge of guilty. The gavel comes down and Bam! We’re Guilty! Case closed. No further discussion.

We keep doing what guilt tells us we should be doing, all the while building up resentment and frustration. Nothing really changes except change seems even harder.
Q – What is the way out of inappropriate guilt?

A – Take the time to understand what’s underneath the conflict you’re feeling and reassess your situation without judgment.

A “How To Guide” for Putting An End to Inappropriate Guilt

 To make this more concrete, I have included an example of a physician who wants more time for him/herself,  but feels guilty taking time from family.

Identify what you’re feeling conflicted about that’s creating guilt.

I’m not finding time to do the things I need and want for myself. Work already takes up too much of my time. I feel guilty taking more time away from family.

Write down your underlying feelings, needs, and wants in this situation (It’s key to write these down, get them out of your HEAD, and see them on paper).

All day long I am giving to patients. When I come home, I am giving to my family. After the kids are in bed, I finish my charting and I’m exhausted. I get up the next day and do the same thing over again. I don’t have hardly any time for myself. At the very least I want to exercise more regularly, and eat healthier and get more sleep. It would be great to be able to work on improving my career and just do something for myself, anything!

Look for where you are judging yourself or comparing yourself to others in this situation.

I feel it’s selfish to take time away from my family.  I made the decision to have these children and they should come first. Dr. So and So seems to find time to work and be the perfect parent. I waste what little time I have procrastinating and internet surfing.

Write down the potential benefits if you meet this need.

If I take more time for myself, I will:

Be able to exercise more and feel healthier and less stressed
Be more patient and present for my loved ones
Feel better about myself
Have better relationships (avoid jeopardizing my marriage and job)
Be able to work on my career and make progress
Be healthier and happier for the long run
Not build up underlying resentment
Realize how important my happiness is, and make it a priority

 Write down the potential negatives of meeting this need.

 If I take more time for myself:

My family could feel neglected
My spouse could feel I’m not doing my share of the household duties
I might cut my work hours and see a drop in income
My family might have to see some budget cuts
I could discover I HAVE TO make some changes and that’s scary
Others may see me as being selfish

Write down the cost to you and others if you continue to deny this need or want.

I continue to be unhappy
I become more grumpy, irritable, and resentful
I damage my relationships at work and home
My health suffers; I develop some illness or disease
I grow to hate getting up every day and feeling overwhelmed
I feel like I am wasting my life
I end up not doing anything well

Step back and look at the whole situation. Ask yourself what choices will lead in the direction of optimum mental, physical and emotional well-being and health – for you. Then make any changes you can that will support this overall move towards, not away from, healthy and joyful living. Nothing has to change overnight. Making even small steps over time in the right direction can profoundly change the course of your life. And remember – innocent until proven guilty!