From triple helix - winter 2018 - The busy modern doctor: life in all its fullness or just a very full life?
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Defining the problem - the diagnosis
How would you describe last week at work? Would words such as fulfilling, peaceful, or joyous feature in your description? I suspect that for many of us routinely balancing multiple clinical and non-clinical commitments in an ever-changing NHS, the words busy, full, or frenetic would instead feature very highly. Indeed, nowadays, the reflex reply 'I am well, just very busy' seems to have become our universal response when someone asks us how we are!
Doctors and nurses have always been busy. The difference today is that we are expected to balance multiple responsibilities simultaneously in a culture of ever increasing deadlines and regulation. Such multi-tasking is compounded by the fact that many of our spouses also work long hours, our children have similarly full lives from the moment they enter pre-school (I was amused recently when a competitive mother proudly relayed that her newborn had been given a perfect Apgar score!), and when not working, we are balancing busy church, and social lives. Like those remarkable plate-spinning acrobats, metaphorically we are being asked to do this on a daily basis, constantly worrying that some of our 'plates' will start wobbling or even fall and break.
Our lives are certainly very 'full'. My personal assistant uses the term shoehorning as she tries to squeeze another appointment into an already overfilled calendar. Some of you may even identify with Ellen Goodman's description of the absurdities of 'normal' modern life: 'Normal is getting dressed in clothes that you buy for work, driving through traffic in a car that you are still paying for, in order to get to the job you need so that you can pay for the clothes, the car, and the house that you leave empty all day in order to afford to live in it'! (1) And yet, when we read Jesus's words in John 10, we see a stark contrast to today's 'treadmill' existence: 'The thief comes only to steal and kill and destroy: I have come that they might have life and have it to the full.' (2) I suspect that for some of us, we have continued to follow Christ faithfully in many ways, but have slipped into lives that are full in content, but that lack the true fullness that Christ offers.
Understanding the causes - the aetiology
Before considering the root causes of the problem, it is helpful to ask whether it is wrong to be busy per se? To answer this, we look to Jesus as our model. Throughout the gospels, we see that he was busy in terms of the number and intensity of activities that he engaged in. As Kevin De Young helpfully suggests: 'if Jesus were alive today, he'd get more emails than any of us. He'd have people calling his mobile all the time… If you love God and serve others, you will be busy too'. (3) However, De Young also makes the important point that 'He (Jesus) was busy, but never in a way that made him frantic, anxious, irritable, proud, or distracted by lesser things.' What then causes us to be so busy that we are easily robbed of the balance and fullness of life that Jesus demonstrated?
Do you start most days anxious, knowing that you are scheduled to do more than can possibly be achieved? Is your diary so full that there is no space for unplanned events? When with people, are you frequently thinking about your next commitment? Do you check and reply to emails as soon as you wake up and throughout the day until you go to bed? Do you eat lunch alone in your office most days while continuing to work? If you answered yes to these questions, you, like me, have a problem with extreme busyness and a condition Dr. Meyer Friedman termed 'hurry sickness'. (4)
Certainly, many aspects of busyness are inherent to being a modern doctor or nurse. The modern clinical workplace is a highly pressurised and regulated environment with intensive workloads and exacting deadlines, all undertaken in a highly emotionally charged setting. Combined with unrealistic performance targets being set in the context of decreasing resources, it is easy to understand why 'work-related stress' in the NHS is so high. Most of us have little control over our weekly timetables. The start times (and increasingly the composition) of our clinics and theatre lists are dictated by our managers, not by us. We find ourselves in that most stressful of situations, having high levels of responsibility, but relatively little control or autonomy. And yet, Jesus's promise of fullness of life was not given with a proviso that we don't work in the NHS or in the clinical academic arena! There must be ways that we can address the external causes of busyness, such that we can serve God faithfully in the modern medical workplace, while avoiding the dangers of 'hurry sickness'.
Whilst there are certainly external factors that lead to ungodly busyness, we need to examine ourselves as fallen creatures for any intrinsic drivers that lead to our predicament. Do we actually have more control over our busyness than we choose to exercise?
We practise medicine in a culture in which busyness is often considered as a surrogate for success or failure. If someone says that a colleague 'takes his or her work-life balance seriously', this is seldom a term of endearment and usually implies that the colleague is considered to be 'work-shy'. On the other hand, we often use long clinic lists, long operation waiting lists, high numbers of publications, and numerous speaking invitations, as evidence that someone is doing well. However, whilst such measures are partly understandable, ultimately such drivers can easily arise from and propagate pride in its different forms, including ambition, status, and power. Extreme busyness can also be driven by personal insecurity, expressing itself as a constant need to gain the approval of colleagues or patients, or by the chasing of insatiable wealth. As Jon Ortberg comments: 'Hurry is not just a disordered schedule. Hurry is a disordered heart.' (5) If I am honest, there are things that I regularly add to my already overpacked schedule that I really don't need to, and which, when God's light is shone on them, highlight subconscious motives and habits that need his transforming power. Rather than conclude therefore, that the causes of our predicament are all external and out of our control, we need to evaluate ourselves transparently, so that the 'treatment' can be appropriately targeted.
Finding a godly solution - the treatment
As I have attempted to address some of my own shortfalls in this area over the last few years, I have found a number of approaches helpful. I share these with you:
Examine your heart for what really drives you
Based on the above, it is important to start by examining our hearts before our all-knowing God for what really propagates our busyness. We each need his help to discern between busyness that arises from a Christlike servanthood, and busyness that is driven by selfish ambition, hidden insecurities, or a disordered diary. In all that we do, we do well to heed John Wesley's advice to 'Hold loosely to all that is not eternal.' (6) We take comfort in the fact that we have an almighty God who forgives and restores.
Regularly review your commitments to ensure that they reflect God's unique calling for your life
As Christians, we believe that God has made us as individuals, and that he has a unique calling for each of our lives. However, modern medicine tends to encourage homogeneity. Do your diary and job plan reflect your uniqueness, or have you filled your schedule with activities that someone else should be doing? Before taking on any new commitment, consider it prayerfully in the light of what you are already doing and in the light of your God-given gifting and personal calling. Review your diary on a regular basis to ensure that you are living a life that is focussing on what your heavenly Father has called you to do (in all areas of your life), and where you are able to, be radical in removing things that are diluting your effectiveness. At the advice of a close friend, I now include in my annual appraisal a list of the invitations and activities that I have declined or dropped over the previous year, as well as those I have undertaken and achieved. I have found this a helpful discipline and would commend it to you.
Cultivate Christlike rhythms of work and rest
We have been reminded that Jesus lived a busy life while he was on earth, but that he avoided the pitfalls of 'hurry sickness'. Indeed, he demonstrated what it really means to have a perfect 'work-life' balance'. What do we learn from the way he lived? Jesus encompassed what is sometimes called the 'Discipline of Slowing'. This was not simply about him taking sufficient rest or leisure, although those things were and remain important. Within his rhythm of work and rest, he routinely spent times of quiet and solitude in order to be in his Father's presence. We too are called to spend time regularly 'being still and knowing that God is God' (Psalm 46:10). At the start of each day, we need to heed CS Lewis's wise counsel: 'The moment you wake up each morning, all your wishes and hopes for the day rush at you like wild animals. And the first job each morning consists in shoving it all back, in listening to that other voice, taking that other point of view, letting that other, larger, stronger, quieter life come flowing in.' (7) Jesus's rhythm of life, like his father before him, also emphasised the importance of maintaining a 'Sabbath rest' into the weekly schedule. Again, this is a rhythm of life that we are called to adopt, not as a legalistic ritual, but because this is how we function best as creatures made in God's image. Tim Chester puts it like this: 'the pinnacle of creation is not a person made to work, but a Sabbath made for the glory of God'. (8) Jesus also took time to think and reflect, something that modern busyness often prevents. In short, Jesus was 'living life in all its fullness', not 'merely existing'. He was busy, but with kingdom priorities. We are called to cultivate Christlike rhythms of work and rest into our lives and into those of our families.
Champion cultural change in your workplace
If we are truly to address the external causes of busyness in modern medicine, we need to champion a fundamental cultural change in the workplace. As leaders within the profession, we need to address unreasonable deadlines (such as major grant deadlines that always fall after the Christmas holidays!), depersonalisation in the workplace, measures of success that damage relationships, and rhythms of work that are fundamentally non-Christlike. We all need to promote a Christian counterculture in which relationships are prioritised over frenetic activity, and godly love for our patients and colleagues replaces mistrust and self-centred competition. We need to teach our medical students and trainees that there are more important things in life than endlessly building their CVs and encourage them to adopt rhythms of work and rest that still involve working hard, but that are driven by selfless giving of themselves to other people.
Prioritise relationships over activity
A sad consequence of busyness is that important relationships can become neglected or damaged. I will never forget the day when, as a busy paediatric surgical registrar, my seven-year-old daughter asked me why I spent so much time looking after 'all the other children' and so little time with her. Jesus's encounter with Martha and Mary reminds us of the importance of prioritising relationships: 'Mary has chosen what is better and it will not be taken away from her.' (9) In our busyness, we need to prioritise relationships over activity - relationships with our spouses and children, with our friends and colleagues, and most importantly with our Saviour. We need to ring fence quality time in which we can be totally present and giving of ourselves and keep sufficient flexibility in our schedules to be adaptable and available. We need to spend quality time in the presence of our Father, worshipping him above everything, and seeking his ongoing direction for our lives.
Nathan Foster highlights the impact of such a change in priorities: 'I cannot think of a greater way to bring about genuine transformation in the spiritual life of the Church than to become a people who say 'no' to busyness, hurry, and distraction, and willingly organise our lives in such a manner to be fully present to God and each other, living a life learning to love well...' (10) If we are to exchange a 'very full life' for the 'fullness of life' that we have been promised, we must prioritise our relationship with the One who came to give this. As Kevin De Young concludes: 'It's not wrong to be tired. It's not wrong to feel overwhelmed. It's not wrong to go through seasons of complete chaos. What is wrong - and heartbreakingly foolish and wonderfully avoidable - is to live life with more craziness than we want, because we have less Jesus than we need.' (11)
Paul Johnson is a Professor of Paediatric Surgery at the University of Oxford
1. Ellen Goodman. American journalist (1941-present)
2. John 10:10
3. De Young K. Crazy Busy. Nottingham: IVP 2013
4. Dr Meyer Friedman. American cardiologist (1910 - 2001)
5. Ortberg J. The Life You've Always Wanted. Grand Rapids: Zondervan 2002
6. John Wesley. English theologian. (1703 - 1791)
7. Lewis CS. Mere Christianity. London: Macmillan Publishers 1952
8. Chester T. A Busy Christian's Guide to Busyness. Nottingham: IVP 2006
9. Luke 10:41-42
10. Foster N. The Discipline of Slowing. Denver: Renovare 2014
11. De Young K. Op cit