Taking Time for Reflection Amid Beauty of Desert

With physician wellness now a national topic of concern, a conversation I had with Mike Langley-DeGroot, M.D., as we hiked in the Mojave Desert comes back to me. Mike is a psychiatry resident at UC San Diego(UCSD) whom I had met through the APA/APAF Fellowship Program at APA’s September Component Meetings. We became quick friends and got together when I passed through his neighborhood in California recently on a trip to Palm Springs. We decided to take a day trip to the Joshua Tree National Park, which brings together two distinct desert ecosystems—the Mojave and Colorado—in southeastern California. It is the only place in the world where Joshua trees grow. As we made our way through the desert, Mike and I talked about work/life balance, leadership skills, effective career management, and regional variations in psychiatric practice.

Mike and I both described psychiatry as a special field of which we feel privileged to be a part. Psychiatry is involved in observing and helping change human behavior, which can be daunting and emotionally taxing. To stay effective, we both acknowledged the importance of taking time off from residency to reflect about the challenges and stressors of clinical work and investing in ourselves to stay healthy and maintain our usefulness to others. Sometimes just taking a minute away from the clinic for internal reflection or meditation suffices to boost our well-being.

In addition to life balance, Mike and I also talked about our career visions. Articulating a career vision can help us be more focused and effective in our work and serve as a guidepost for choosing to participate in activities—such as serving on a particular committee or doing a research project—that will support career advancement. I plan to work on developing accountability by innovating and implementing metric-based processes to deliver consistently high-quality care for patients through administrative leadership. Mike talked about preparing the next generation of psychiatry leaders to deliver and expand excellent clinical practice within large academic centers.

An important ingredient of a career vision is finding mentors who can create and suggest opportunities to help us better define and reach our career vision. Both Mike and I have benefited from our participation in the APA/APAF Fellowship Program, which has given us the opportunity to meet some of psychiatry’s preeminent figures and get involved in addressing issues of importance to psychiatry.

With regard to leadership skills, Mike and I discussed strategies for time management, navigation of power dynamics, and emotional regulation within work settings. An important skill to develop is the ability to say “no” to opportunities that may not fit with one’s career vision. Investing time in activities that take us away from our focal areas can contribute to feeling overwhelmed and burned out.

As our conversation shifted to how geography influences psychiatric practice, we discussed the challenges in our respective health care systems. Mike’s practice in San Diego is impacted by the high prevalence of patients on methamphetamine presenting in the emergency department. He has seen urine drug tests positive for cocaine or heroin only a handful of times. In contrast, in Connecticut I see positive urines only from patients using stimulants for ADHD. Our psychiatric ED is more heavily filled with patients who have used heroin or cocaine; in Connecticut alone, more than 900 people died from opioid-related overdoses in 2016 alone.

Mike and I are both motivated to teach and mentor others. An award-winning resident educator, Mike talked about the need to teach junior residents to interview patients by being curious about patients’ problems—such as homelessness and social trauma—instead of running through a symptom checklist during a diagnostic interview. I talked about helping patients through communicating genuine concern and building rapport through honest, empathetic conversation.

The Mojave Desert hike that Mike and I shared gave us a chance to take a physical and mental break and exchange ideas on the delivery of compassionate clinical care and tips on becoming stronger leaders by breaking through personal barriers and defining career visions. I will remember our Joshua Tree National Park experience fondly and hope that you, too, are mindful about taking meaningful breaks from your work (however briefly) to rejuvenate, reflect, and find renewed purpose. ■