Consider taking care of a child, a pet, or a garden.

Do you ignore them for long stretches and attend to them periodically and call that good care?

Or does caring for pretty much anything or anyone you can imagine involve paying consistent attention to their needs and taking steps to meet those needs?

Self-care is often marketed as a complicated, time-consuming, and expensive endeavor. But, as we’ve discussed, this is frequently the opposite of genuine self-care. 

Self-care, like the care of others, requires regular attention. It is consistent but not continuous. 

There will be times when you cannot attend to your needs in the moment, or when you choose to delay satisfaction of those needs in service to another goal. These moments of delayed or deferred self-care are not per se indicative of poor self-care, but of a necessary flexibility.

At the same time, if we are frequently neglecting our own needs, we have moved past flexibility and into self-sacrifice.

We’ve talked before about ways you can increase your involvement in pleasurable activities and define your boundaries to allow yourself space for those kinds of activities.

It is also important to talk about possible internal barriers to self-care.

Self-care is, of course, caring for yourself. And that comes with the weight of all the messages you may have internalized from childhood, from societal assumptions, from professional expectations, and so on about whether it is okay to care for yourself.

Does self-care feel self-indulgent to you?

Selfish?

Like something you have to earn (e.g., “I’ll get some sleep after I……”)?

Deep down, if you take a moment to reflect, do you feel like you deserve to be cared for, by yourself and others?

There is an accumulating body of research about pre-professional and childhood trauma exposure rates among healthcare practitioners that helps shine a light on the burdens that people may bring into the work, where they then experience additional trauma exposures. 

Is it possible that the history you bring to being a physician makes it hard to take care of yourself as a physician?

It may be that you are required to work beyond your capabilities routinely. That’s an important subject, but not what I am discussing today.

I’m talking about the pressures you may put on yourself to ignore your needs and work beyond your endurance. To answer just one more email, read just one more journal article, return just one more phone call. 

When we do this, we’re hurting ourselves and not really helping others.

It is absolutely right and good that you take care of yourself for yourself.

No “you can’t pour from an empty cup” or “adjust your own oxygen mask before helping others” here, though they are useful in other contexts. 

I’m talking about you considering the possibility that you are worthy, and that you deserve to have a full cup regardless.

I’m talking about you adjusting your own oxygen mask because you need oxygen.

Sometimes a more comfortable first step may be understanding the importance of taking care of yourself in order to take care of others. But eventually it will likely be helpful to examine barriers to taking care of yourself just for you.

On the other hand, maybe you don’t think of self-care as selfish or self-indulgent, but as a cynical effort by healthcare systems to ignore systemic problems and maintain productivity.

After all, I don’t put gas in my car to let the car know that it is valued and appreciated. I do it so I can drive further. Institutional “self-care” programs and initiatives can feel like that sometimes, stripped of humanity and focused on always doing more.

Self-care and “resilience” interventions may be haphazardly piled upon healthcare professionals (often with a side helping of shame or blame) in a way that understandably creates resistance to interventions that could actually be helpful. Relying on self-care as the only (or even primary) response to broader systemic issues is unjustifiable.

But a wholesale rejection of individual-level interventions, many of which do reduce suffering, is also unhelpful.

There are mindfulness exercises that have shown demonstrated effectiveness in reducing anxiety among civilians in active combat areas, for example. Physicians who practice self-compassion have lower anxiety, stress, and burnout levels.

I would hate for someone to believe that they can’t feel better unless and until their work environment gets better. That’s simply not accurate.

As a final note on this, define self-care for yourself. If it feels like another obligation or you get tired just thinking about it, it’s probably not right for you.

There are considerable benefits to self-care when we allow ourselves to do it, and when we choose to do it rather than having it foisted upon us as an alternative to meaningful change.

At the same time, self-care is not some sort of panacea.  

Self-care in combatting burnout is getting a lot of well-deserved attention these days. But burnout is not PTSD or major depression. Despite comorbidity, it’s a stretch to assume successful management of burnout is successful treatment of another clinical condition.

Similarly, self-care is important, but it is not therapy. 

And therapy isn’t self-care. It’s not something nice you do to unwind. It’s treatment.

If you struggle to engage in self-care practices, or you engage in self-care without significant symptom relief, I invite you to consider whether therapy would be beneficial for you.