Well this is scary… It’s only day 4 of the A to Z Challenge and I’m already feeling blocked! ACK! I had what felt like a semi-brilliant idea for ‘D’ –a week ago. I even wrote a short draft. But now I’m embarrassed to continue—it feels redundant and self-indulgent. I’m a little paralyzed by fear. What to do now?

I signed up for this challenge partly to make myself sit down and write every day, or at least attempt it. I’ve kept a running list of my favorite words, declared a theme, committed to a program. I am now accountable. It is up to me to practice the Discipline of daily writing.

I can’t imagine that writing this blog will ever become Drudgery, because if it ever does I can just stop. The blog itself is beholden to no one. But it’s something I created, something that I want to cultivate and develop. Quality of the content is bound to vary; I cannot be the perfect culmination of my best writer self every time! So regardless of how I feel about this post, I have resolved to publish something today, and I will have to find a way to make it good enough. It’s hard work, and it’s what I signed up for.

So this gets me thinking… How many physicians think of their work as drudgery? Sadly, the answer is more than we’d like to admit. Statistics abound on the alarming increase in burnout among physicians, physician suicide, and the associated decline in patient satisfaction and health outcomes. The defining features of burnout in any field are depersonalization, emotional exhaustion, and low sense of personal accomplishment. That’s as good a description of drudgery as I’ve ever seen.

Most of us experience some symptoms of burnout at one time or another. How do we get through it? Many of my colleagues rightfully look to operations—promoting streamlined workflows, simplifying documentation and coding, and standardizing protocols. But these changes come slowly, and we must function in the existing, cumbersome and inefficient systems while we advocate for the changes we want. So in the meantime, we forge ahead with gritty discipline.

Medical training remains rigorous, though in recent decades we have made it more merciful. From the premedical curriculum, to clinical rotations, to on-call responsibilities as attending physicians, our professional lives require us to be there for our patients when we’d rather be communing with friends, attending our children’s school plays, or just sleeping. We made a commitment, took an oath. And for the most part, our work rewards us with rich opportunities for lifelong learning, hearty fellowship, and the privilege of caring for humanity in the most intimate ways. The discipline—the commitment to the work—pays off in spades.

In my reflections on physician health and well-being, however, I always come back to another domain of discipline—that of self-care. Medicine attracts caregivers. Sometimes we are also control freaks, and exhibit somewhat masochistic tendencies. When we let these traits take over, they upset the balance needed to thrive in the complex medical milieu. We need to maintain objectivity with compassion and sensitivity, calm and clarity with intuition and judgment. We cannot do this effectively if we constantly run on empty. When we neglect our body/mind/spirit, we get irritable, and our work and relationships suffer. Ever seen a toddler clunk her head on some furniture while walking? If she’s well-fed and well-rested, she’s likely to keep moving, intent on getting to her favorite toy on the other side of the room. If she is tired and hungry, however, the same innocuous thump may trigger a full-scale meltdown of epic proportions. It’s no different for adults. We need regular feedings, rest, and playtime just as much as our children do. For my part, when I speak to colleagues on burnout and resilience, I focus on the discipline of self-care. It’s what we can control now, while we continue the necessary work of systems change.

Fortunately, I have chosen a profession that feeds my soul. It is a calling, a vocation. I have also chosen to indulge in a hobby, writing, that fulfills me similarly. Both require commitment, discipline, and practice to be done well. Both run the risk of becoming drudgery, under certain circumstances.

This post has been an exercise in Disciplined Writing. I wanted to write while inspired, and it just was not happening. So I had to simply sit down and get to work. But as Liz Gilbert discusses in her brilliant new book, Big Magic, inspiration did visit me, however briefly, in the process.  That will keep me coming back to practice. I will continue this exercise all month—thank you for bearing with me!