R. RAND ALLINGHAM, MD
In describing his experience at Walden Pond, Henry David Thoreau wrote, "I had three chairs in my house; one for solitude; two for friendship; three for society." This concept reflects an approach to balance in our daily lives, including those of physicians. Most of us would agree that we have a chair for societal demands, including our relationships with colleagues, patients, and students of all types, and that we have a chair for friendship, whether of family or friends. Ironically, it is the first that may go missing, the chair for solitude.
Rather than try to find the time, I decided some years ago to take the time to pursue a selfish pleasure, fly-fishing (Figure 1). There can be something otherworldly about sending a fly line floating over moving water, carrying an elk hair caddis to a perfect soft landing. In this world, those supremely adapted creatures to which you cast are the judges of your talent. This is my time. I leave behind chairman, politicians, regulators, and the like. Fly-fishing has provided a lifelong, shared pleasure with my close friends and family. It offers limitless new
challenges—tying classic fly patterns, creating new ones, or even making my own rods. Having time alone in what I can only describe as God's country, however, has been the most important. Time with friends, family, and (very importantly) alone has been a key ingredient for balance in my life.
CYNTHIA MATTOX, MD
My strategy to stay sane can be summed up as organization and the outdoors.
Organization
Being organized at work requires me to be the sole keeper of my overall hectic schedule. Delegating this responsibility has never worked for me. Overseeing my own schedule allows me to say no when necessary.
I also have a crucial team of assistants and managers who keep me on track. Being "wired" is key. I depend on my iPhone and use MobileMe (both from Apple, Inc., Cupertino, CA) for syncing my devices. I depend on two applications for my iPhone, HanDBase for logs (DDH Software, Inc., Wellington, FL) and Jott (Jott Networks Inc., Seattle, WA) for lists and text reminders.
Consolidating my OR schedule into a few mega days at a surgery center has freed up time for my committee work with the AGS, AAO, and Health Policy. These more global activities bring balance and perspective to my direct patient care and teaching.
The Outdoors
In my personal time, I am always searching for ways to be outdoors. I enjoy tending my perennial gardens (Figure 2A) as well as picking berries and vegetables and volunteering at the local organic farm. Probably partly due to toiling indoors in the dark all day, I like to go outside and get my hands dirty.
While in my work I can be critical of myself when I feel I am falling short of perfection, I seem to be able to enjoy my mediocrity at a multitude of sports: biking, windsurfing, cross-country and downhill skiing, golf, tennis, sea-kayaking, and yoga. I have a supportive husband, and we plan a multiple-week vacation every year (Figure 2B). The first time I was away from the office for 3 consecutive weeks, I was amazed to find that the world did not come to an end. Of course, careful planning and my wonderful colleagues, fellows, and residents help to make that possible.
ROBERT J. NOECKER, MD, MBA
The truth is I am not sure how balanced my life is—hectic yes, balanced maybe. My wife and I have taken three steps to try keep it together.
No. 1. Use Technology
Technology is a double-edged sword. On the one hand, it allows me to come home so that I can spend time with my family (Figure 3). I chart records, write, review papers, and catch up on e-mail remotely. On the other hand, sometimes, my iPhone must be off so that I can give my undivided attention to my family. During those moments, multitasking does not work.
No. 2. Designate Family Time
I try to give my children a bath and put them to bed on most nights. They can expect this time with me, and I look forward to it as time together. On most days, I leave the house before they wake up. My wife and I also have several nights a week when we go out. Monday is our designated "date night," and we usually go out with friends on other nights.
No. 3. Get Help
Time is my most precious resource. For that reason, my wife and I have built up a network of babysitters that we use regularly. Also, I have gotten help for tasks that I do not enjoy (such as mowing the lawn) so that I can spend my time otherwise. For example, I like to maintain our pool and can collaborate on this project with my kids.
MILDRED M. G. OLIVIER, MD
Maintaining equilibrium is no small task. In addition to meeting my patients' medical and surgical needs, my schedule has to accommodate my family, friends, students, and colleagues. I also hold posts in numerous professional and service organizations.
I find that delegation is critical to protecting my workflow and that multitasking is essential. Various cues help to keep me on track. For example, I use my birthday as a prompt for scheduling required medical examinations. I have various routines—daily, weekly, monthly, yearly—that allow me to combine tasks and avoid getting bogged down. I adhere to my medical training, which taught focus and decisiveness, and I attempt to eliminate time-wasting rumination.
I do not hold on to paper. Itineraries, agendas, minutes, reports, and articles for review pile up quickly. I scan everything into PaperPort (Nuance Communications, Inc., Burlington, MA) and use Microsoft Outlook's task function (Microsoft Corporation, Redmond, WA) to handle items. I also make use of my cell phone's e-mail capabilities. Even if I do not have time to read messages immediately, I can delete unnecessary ones. Once I sit in front of my computer, I can group messages appropriately. When the postal mail arrives, I scan it and assign each piece a task, or I discard it. Several years ago, I upgraded my office to electronic record keeping. That has been a great time and space saver and has enabled me to access patients' charts from anywhere.
A sense of humor definitely helps me (Figure 4). Despite the best planning, there are delays, computer problems, traffic jams—all occurring at the worst times. Then, it is essential to take a deep breath and laugh. Laughter energizes everyone and makes the glitches pass faster. It keeps teams functioning efficiently and fosters the lightness of heart needed for shouldering big loads.
THOMAS W. SAMUELSON, MD
One might argue either side that balance is a desirable trait. Excessive balance may be no better than none at all. Equilibrium is a complex and elusive goal. At any given moment, my life may be completely unbalanced, yet my most basic personal credo requires that I remain ever mindful of the need for overall balance in my life.
Achievement and balance are often at odds. It would seem that the latter has more in common with mediocrity. This dichotomy underscores the difference between overall balance and perpetual balance. I strive for the former rather than the latter. The dedication needed to become a world-class athlete, best-selling author, composer, or musician requires frequent periods of imbalance, as do the lives of medical students, ocular surgeons, and clinicians. Undoubtedly, the pursuit of challenging goals demands that we be unbalanced at times along the way. I accept and embrace this fact. It fits with another credo of mine that dates back to my college days—simply put, Work hard. Play hard. The wave that crashes to shore with tremendous energy is offset by its recession back into the ocean. Likewise, I have always tried to harness the energy when it is there but to celebrate goals achieved and withdraw a bit afterward. Maintaining equilibrium in life, at least most of the time, is one of my most important goals.
No strategy suits everyone, but I know what works for me: family. I have always held steadfast to the belief that the day you get married, or the day you have children, is the day that you oblige yourself to be balanced. I rarely lament letting myself down, but I agonize over disappointing my family or friends. I believe that the concept of quality time is a myth. Quantity time with my wife and kids is a necessity. For me, my family counterbalances my basic tendency to work too much. Maintaining an active engagement in my marriage of 26 years and in the lives of my son (age 15) and daughter (age 11) is paramount to me and requires that I maintain a certain steadiness in life (Figure 5). Finally, a commitment to fitness is important to my personal balance. I get in a total funk if I do not run or go cycling several times per week. Other interests such as golf, reading for pleasure, theater, and sleep compete for what time I have left.
Does balance limit my career achievements? Yes. Does my dedication to family increase my golf handicap, limit my income, and contribute to my sleep deprivation? Undeniably! I am most fulfilled, however, when I temper my work with those things that are most important to me—certainly not all but most of the time.
GEORGE L. SPAETH, MD
Balance is an old word for a weighing device that has two pans connected to a central column. The material to be weighed is put on one of the platforms, and objects of a known, predetermined weight are put on the other side. If the object is heavier than the weights, the pan holding the object will fall so that it is lower than the weights. More weights are added until the two pans are at exactly the same height. The scale is then in balance, and one can determine the exact weight. Many people consider a balanced life to be rather like a balanced scale. I disagree.
What are the exact weights one can use to determine if one is in balance? Plato remarked that happiness, which in one form or other is what most people seek, is the consequence of having the different aspects of the self interact appropriately. Both he and his teacher Socrates stressed that self-knowledge, or what I prefer to call insight, is essential to a meaningful life. Shakespeare, in his play The Tempest, wisely chose the name Prospero for the protagonist. Prospero is shipwrecked on an unknown island—a metaphor for all of our lives. There, he finds two different aspects of his self: Ariel, his spiritual ephemeral part, and Caliban, his earthly component. They are rather like Freud's superego and id. Prospero learns how to control fully those differing components of his self so that they, as Plato advised, interact appropriately. Prospero thus becomes a magician, that is, able to do things that most people consider impossible, because they are not in control of themselves.
Throughout history, most of the truly great accomplishments (fictional or real) in every field have been made by those who are unbalanced in the usual sense—Prospero, Jesus of Nazareth, Marco Polo, da Vinci, Gandhi, Sappho, Mohammed, Mozart, Romeo and Juliet, John Donne, Henry Ford. The goal of life is not to have all its components in equal balance, as level as the two pans of a scale. Unless something is at least partially out of balance, it cannot move at all. Rather, the goal is to have all the aspects of what one does and who one is interact appropriately so that, as a result, one is in exactly the place where one wants to be and going exactly where one wants to go (Figure 6).Êo
R. Rand Allingham, MD, is the Richard and Kit Barkhouser professor of ophthalmology and the director of the Glaucoma Service at the Duke University Eye Center in Durham, North Carolina. Dr. Allingham may be reached at (919) 684-2975; allin002@mc.duke.edu.
Cynthia Mattox, MD, is the vice chair of ophthalmology at Tufts University School of Medicine and the director of the Glaucoma Service at the New England Eye Center in Boston. She acknowledged no financial interest in the products or companies she mentioned. Dr. Mattox may be reached at (617) 636-8108; cmattox@tuftsmedicalcenter.org.
Robert J. Noecker, MD, MBA, is an associate professor of ophthalmology, the vice chair for clinical activities, and the director of the Glaucoma Service at the University of Pittsburgh Medical Center. He acknowledged no financial interest in the products or companies he mentioned. Dr. Noecker may be reached at (412) 647-5753; noeckerrj@upmc.edu.
Mildred M. G. Olivier, MD, is in private practice with Midwest Glaucoma Center in Hoffman Estates, Illinois. She acknowledged no financial interest in the products or companies she mentioned. Dr. Olivier may be reached at (847) 882-5848; molivier@midwestglaucoma.com.
Thomas W. Samuelson, MD, is an attending surgeon at Minnesota Eye Consultants and a clinical associate professor at the University of Minnesota in Minneapolis. Dr. Samuelson may be reached at (612) 813-3628; twsamuelson@mneye.com.
George L. Spaeth, MD, is emeritus director of the William and Anna Goldberg Glaucoma Service and Research Laboratories at the Wills Eye Institute in Philadelphia. Dr. Spaeth may be reached at (215) 928-3960; gspaeth@willseye.org.
