Month: April 2019

Money, Money, Money…A Tool For Living

Money is a loaded topic.  It carries a lot of emotional baggage for many.  It is useful, but can also be destructive if utilized in harmful ways.  It can be kept, spent, or given away.  There are so many choices with what to do with it.  I think one thing that has shifted within me in terms of my mindset on money is thinking of money as a tool to get what I want from life.  Instead of seeing it as a roadblock, or as something to accumulate and collect, I see it now as something to earn, use, and trade for things I truly value.

Kids on Trampoline
Thinking about money can be exhausting.  Let’s lay down a bit, relax, and enjoy the sunshine.

Something that has helped me is learning to spend my money on what brings me utility and enjoyment in life.  I am starting to more systemically strategize my own financial plan.  Before, I would have a nebulous, and often frustrating goal of earn more, save more, spend less.  Now, I am breaking this down and making it more concrete via online calculators and the old nerdy standby of Excel spreadsheets.

Seeing things laid out before me in my financial plan has helped me shift how I see my weekly and monthly expenditures.  I am eager to create some breathing room between my necessary expenses and what I have accumulated in the bank.  I get satisfaction from my job, but at the same point, I do not want to be forced into a working position where I have to work to pay the bills.  I think this shift in mindset has helped me start to spend my money more meaningfully, and use money again as a tool to reach my life goals and my financial goals.

The book, Your Money or Your Life, by Vicki Robin and Joe Dominguez, highlights this in the idea of analyzing what you have spent.  After you tally what you are spending in each category in your life (e.g. housing, groceries, restaurants, hobbies), you can then analyze each spending category by giving it a grade – whether it is right where you think it should be, whether you should be spending more in that category, or whether you should be spending less.    I found this idea really helped me start to spend my money strategically, and feel less guilt in spending on what I think is important to me.

Maddie in full pose action
Life is short. Money is useful but never the be all end all. As Maddie displays here: never take yourself too seriously…and never be afraid to pose for the perfect shot.

I hope to also teach good money habits to my children, via how I spend my own money and how I speak about money.  As my children get older, I hope to show my children how money and wealth are a tool to be used, and also how this fits into the bigger picture of the economy of our neighborhood, our city, our nation, and our world.  The book Silver Spoon Kids, by Eileen Gallo and Jon Gallo, had a very interesting chapter in it describing how a huge chunk of the nation’s wealth is concentrated in a very small percentage of the country.  It offers the idea to do an exercise with your children dividing up 10 cookies among your children, to illustrate the distribution of wealth in the country.  As described below in terms of the breakdown in wealth, what happens is one child gets several cookies, another few children get also a fair distribution of the cookies, and the majority of children are forced to break up and share a tiny portion of one cookie.  This is astounding, heartbreaking, and eye opening.  This book was published in 2000, so I suspect the statistics on the distribution of wealth in the United States have probably gotten even more lopsided.

But according to Silver Spoon Kids, around the time the book was published (2000), 40% of the wealth is in the upper 1% of the population, 30% of the wealth is owned by 2-10 percentiles, 29.8% is owned by the 11-60 percentiles.  And the bottom 40 percentile of the population owned only 0.2% of the nation’s wealth.  This is crazy to think about. And I am sure this trend may continue.    I think that part of the book really gave me pause and think very differently about money, wealth, and how it is utilized as a society and an economy.

Money is valuable, but I see that it is simply a tool in life.  As described in the book Your Money or Your Life, you are trading some of your time or life energy for your paycheck.  You can then use this money from your paycheck to go to the stores and get other things you want in life (e.g. groceries, a roof over your head, a new set of headphones, a tank of gas).  By using it more deliberately and carefully, I hope to be trading my time during my work for something I truly want. This is a work in progress, of course, but I hope to continue to get better at spending my money wisely.  And I also hope that by leading by example, I can teach my children how to use money wisely, too.

Burning Out and Reigniting the Fire

About 2-3 years ago, I begrudgingly saw that I was not doing well mentally.  In retrospect, I was feeling the tell-tale signs of burnout.   I saw my day as adversity, full of roadblocks and things keeping me from a sense of happiness, peace and wellness.  I of course, refused to see this until it had gradually set in and became my new normal.  I took a burnout quiz on AAFP, the Maslach Burnout Inventory (MBI) and scored quite high.  This, in retrospect, was not a good sign. I was only about 2-3 years into my attending career path at that point.  The long stressful hours were taking their toll. And I predicted another 30+ year career – seeing myself in this role for that long was difficult, and I could see this was not going to be sustainable.

Maddie is displeased
Maddie’s face reveals that sometimes life just doesn’t go your way.

Physician burnout is well summarized and described on various sites on the Internet.  I like the AAFP article linked here that summarizes physician burnout well.  Physician burnout can be likened to a battery running out of juice.  I definitely can relate to this analogy. About 2-3 years ago, I wasn’t quite a dead battery, but I was pretty close.  I was run down, a battery at maybe 10-20%, fizzling out.  I felt exhausted in every aspect – mentally, emotionally, and physically.  This was a slow process over several years, so my recognition of the problem was poor.  It took me time to admit to myself there was something wrong.  My natural inclination was to get more rest.  But in spite of getting more hours of sleep, I felt a constant tiredness.  And I could feel a subtle, diminished quality in my ability to care and feel, both in my job and with my family.   I also went for medical care, and was diagnosed with hyperthyroidism.  I did fortunately get this treated and managed, and felt great improvements, but I still felt twinges of something abnormal in my life.  I often found myself feeling wiped out, way out of proportion to my exertion level or work load.

I began to analyze other things I could change.  I began exercising regularly.  I resumed running.  I tried to rest more.  I resumed hobbies I previously enjoyed (reading, writing).  I analyzed my life, and my life priorities, and shifted things around so they brought me better peace.   I made a scary leap into a new job.  And I am very glad I took all of these steps.  I quit treading along in a pathway that was not good for me.  I currently feel valued, balanced, and in better alignment with my personal ideals.

Kids eating
Take time to stop and smell the roses…and eat carbs.

I still struggle with tendencies toward burnout.  I think this stems from a drive to do more each day than I probably should.  My tendency is to be a workaholic and perfectionist and superwoman.   I have a driving need to prove to myself I can do more.  But, as I grow older, I am learning to recognize and admit I am human.  I have a set “tank” of energy – my battery life is sadly not infinite.  I need to rest, digest, and recharge.  I cannot always go, go, go. It is not laziness or weakness or wrong to rest. It is a necessary and natural part of life to rest. Looking at the human body, there are processes for high octane stressful situations in life (i.e. the sympathetic nervous system, or the “fight or flight” system), and also natural, needed ways to recuperate and simply be still/less active (i.e. the parasympathetic nervous system, or the “rest and digest” system).   Life should be no different – there needs to be balance in life.

When I do too much now, I am getting better at recognizing the tell tale signs of overwork and pending burnout – a nag of irritation at myself or others, a feeling of mental exhaustion out of proportion to my work load, physical feelings of tension in my back, shoulders, and neck.  I force myself now to take a step back.  More breaks.  More recreation.  Focus on my hobbies and things outside of medicine.  More time with family and nurturing relationships.  Looking at the big picture.   Practicing gratitude.  With all of these tools, I am slowly learning how to reignite my fire for medicine and my passion to care for my patients, and I hope to prevent fizzling out again any time soon.

Goals: Breaking Them Down and Taking Some Names

Over the last year or two, I have begun breaking down my long term goals into more doable chunks and shorter term goals.  This has really helped me overcome a tendency to build mountains out of mole hills and procrastinate.  Instead of staying vague, I have forced myself to take my goal and really break it down into doable, shorter term steps.

A useful book that I recommend that describes this idea is  Stick with It: The Science of Lasting Changes, by Sean Young.  I like how this book logically breaks goal setting down into 3 levels: Steps (small tasks, taking 2 days or less to complete); Goals (short term goals, which take about a week to complete; and long term goals, which are comprised of the short term goals, and take up to about a month to complete); and Dreams (goals that take 3 months+ to complete).

Maddie and her champion doll
Maddie’s alter ego exhibiting her power pose – Set goals, perform, and win!

One example is my current financial goal to payoff my student loans.  This has seemed like a very challenging and sometimes insurmountable dream for the last 4+ years.  One helpful tactic for me has been to break down this vague and huge goal (“I want to payoff my student loans as soon as possible”) into something more concrete and specific.  For example, I set goals to reach certain number milestones each month, each 6 month period, and each 12 month period.  I focus on the present (e.g. the present week or present month), estimating my budget of spending and income, and then calculate the extra money I can send toward my student loan.  And then, I analyze my progress at the end of each month and the end of each year.

Another example is setting my goal to run a marathon.  Rather than getting too overwhelmed and giving up due to inexperience, I read several blogs and books to help me.  I chose a marathon training plan, and wrote down the workouts each week on my calendar (doing this really helps me – I hate to leave something on my calendar undone).  And then, rather than continuously seeing the 26.2 miles and getting too overwhelmed, I tried to focus my attention on what was before me: each month, each week, each day, each workout, and each step/stride.

By breaking down a huge 26.2 mile distance into doable chunks (e.g. each workout with a set distance and time goal), I was able to minimize the overwhelm, and instead slowly chip away at my goal.  I was most importantly able to feel a sense of accomplishment with each of my small goals – that is, completing each of my daily workouts.  Then, on my race day, I was able to smoothly and confidently meet my long term goal of finishing the long race.  I had plenty of practice in hitting my daily and weekly goals, and thus, race day, though challenging, did not seem so foreign and daunting.  In other words, I felt read and prepared.

Sliding Through Life
Take Luca’s example – slide through life smoothly, with small, doable goals in mind.

Even in planning out my week each week, I attempt to set 2-3 big overarching goals, both in my work/career and in my personal life. Then, I strategize how to really, concretely, make this happen, e.g. carving out 30 minutes of time on Monday for my goal of reading, or setting aside 20 minutes of time on Friday to exercise.  Instead of rolling through life, letting my life’s responsibilities control me, I feel a sense of focus, having been able to set small doable goals for the week, day by day.  There are 168 hours in each week, 24 hours in each day.  And unfortunately, time is a precious finite resource.  It cannot be brought back once it is gone.  I think goal setting in this logical, step-wise way, i.e. breaking big things down into smaller doable goals, has helped me better manage my time and actually finish more of the tasks I set out to do.

Good Enough: Letting Go Of Perfection

I’ve come across a concept recently via several blogs and podcasts that sometimes “Good enough” really is good enough.  Perfection can be overrated.  I kind of tie in the idea of the 80/20 rule into this.  The 80/20 rule was introduced by Vilfredo Pareto, in 1895, in regards to economics and the idea of income distribution.  In essence, Pareto’s principle noted that 80% of the wealth (in his example, 80% of the land in Italy) was controlled and owned by about the top 20% of society.  This 80/20 rule, though, can be extrapolated to other areas of life.  Including the efforts to accomplish goals and be productive.

Maddie on Piano
Maddie practicing the fine art of piano playing.

Take an example of the work it takes to perfect a hobby, like playing a piano piece. You can spend a manageable amount of time (e.g. 20%)to get to about 80% mastery.  The piece, when played, sounds pretty decent, and you can recognize the melody, but there are some errors.  You are by no means a concert pianist, but the song when played makes you happy and is pleasing to your ears.  The effort required, however, to get the extra 20% of mastery can be huge.

And, in reality, is that extra 80% effort worth it?  With professionals (i.e. the top 20% of performers), I could see that yes, this can make a difference between sounding mediocre and sounding excellent.  And for them, I think the extra blood, sweat, and tears makes a difference.  But for the many (i.e. the 80% of the rest of us who see piano playing as an enjoyable hobby), the extra effort may not really be worth it for the goal we are trying to accomplish.

Another way to interpret the 80/20 principle is in our “to-do” lists. I have found this concept of productivity to be crucial and helpful for accomplishing what I want to do.  Instead of blindly checking boxes off of my list, I try to prioritize tasks with the most lasting impact and things that will truly accomplish goals in my life that I value.  Is the task on my list in the 80% (i.e. accomplish 80% of the effect) or the 20%?

Kids Bowling
Practice, practice, practice.

Going back to the analogy of learning to play a song on the piano, is it something crucial to be able to “hear” a good tune, or is it simply “something nice to have” that cleans up the rough edges and corrects subtle errors?  It may feel good to cross this task off the list and follow the task all the way from 0% to 100%, i.e. from start to finish.   But for the majority of us, that extra 80% of effort really won’t make a big audible change in how good our song sounds.  Instead, we could have spent just 20% of our time and energy to get to “good enough.”

So instead of always striving for perfection, I have tried to instead focus most of my efforts on getting too good, i.e. the 80% mark.  And then, in a select few circumstances, if I feel the extra effort and hours to get the extra 20% is time well spent and important to me or my career or my family, great.  But, if I think 80% is pretty darn good, and good enough for my purposes, then it is time to move on.

I am slowly learning to let go of perfection, and value my time and energy.  Live to fight another fight.  If my current accomplishment is getting me to where I need to go, it is time to put aside my “good enough” project, and move on to the next goal in my life.  My acceptance of “good enough” in my work is a work in progress and I am still learning how to do this properly and consistently.  But it is definitely liberating, and has helped me to get more done, in less time, and with less stress and worry.

Meditation: A Way to Mentally Focus

I have dabbled a bit in meditation over the last couple months.  And I have found this exercise to be beneficial.  I have started to do this before my workdays and I find it has helped me focus better and sometimes perform better mentally.  I unfortunately sit a lot at my job, so by taking 5-10 minutes each morning to do a short mindfulness exercise or breathing exercise helps my mental and physical stamina.   I feel better able to focus my thoughts as I strive to diagnose and treat my patients.  I have also felt less stressed in the evening as I interact with my family members.

Ballet bar
My children exhibit the importance of balance and strength. Meditation can be a way to harness these two concepts mentally, to better tackle your day.

I have used various meditations tracks myself: Audible, Aaptiv, and Breathe.  I think there are dozens (if not hundreds) of other options out there, both free and for a fee.  Of course, just glancing out the window, or closing my eyes, and focusing on my breath for several breaths is another good way to meditate briefly when I get a free moment in between patients, or when sitting in traffic, or sitting in a waiting room.

My kids love to pose.
My kids love to ask me questions. And try my patience.  And to pose. Please excuse the cat toy and garbage can in the foreground.  #RealLife

I think it has been so easy for me to occupy all of my free time with more and more things to do.  Chores.  Reading.  Podcasts. Audiobooks.  TV.  Streaming services online.  I find that meditation has forced me to take a  moment for myself, away from all of these distractions.  To close my eyes or stare off into space for a brief moment, focusing on my body and emotions, focus on my breathing, focus on the moment.

Mental health is easy for me to take for granted.   But when it is out of balance, I definitely feel it.  There are several moments in my busy life when my mind is frazzled and tired.  December can be stressful, when preparing long and hard for the Christmas season.  I get worried and anxious when preparing for my children’s birthday parties.  I also feel wiped out at the end of a long and trying work day, or when I have a “bad day.”

I strive to physically exercise several times a week now as I have become dedicated to my running.  After resuming running several years ago, I would sorely miss this if I went back to a life without regular physical exercise.  Running regularly was not easy at first, but has grown to be more enjoyable after 6-12 months of dedicated practice.  I just started exercising my “mental muscle” via meditation.  As I am a beginner, I often find the practice difficult and challenging.  But in time, I suspect it will get easier and more rewarding.