The DO Book Club, Feb. 2024: ‘Real Self-Care’

National Women Physicians Day occurs on Feb. 3 every year to celebrate the birthday of pioneering female physician Elizabeth Blackwell, MD. Over the years, women physicians have made great strides in practice, academia and medical administration. They have also authored a number of well-written books about medicine.

Like their male counterparts, many female physicians have chosen to share their creative talents through memoirs, medical fiction and other genres of storytelling. I have reviewed several books by woman physician authors in The DO Book Club column.

Throughout my career, I have been inspired by a cadre of women physician authors. As a premed, I loved the classic “The Making of a Woman Surgeon” by Elizabeth Morgan, MD. In “Not an Entirely Benign Procedure,” Perri Klass, MD, also featured the engaging stories and lessons she learned as a pediatrician. Danielle Ofri, MD, has contributed several medical memoirs and narratives from her rich experience as a general internist at Bellevue Medical Center in New York City. Her book, “When We Do Harm,” is reviewed here. In 2020, Michele Harper, MD, shared her perspective as a Black woman who trained in and practices emergency medicine in “The Beauty in Breaking.”

These are just a few examples of the many incredible women physicians who have shared their stories. In my own case, after a career practicing emergency medicine, I wanted to send a message to physicians, nurses and other clinicians who are struggling with challenging patient interactions. I wrote “Changing How We Think About Difficult Patients” as a gift to all health care professionals. If clinicians can find ways to cope with their patients’ difficult behaviors, perhaps more will stay at the bedside taking care of the aging population of baby boomers like me.

Redefining self-care

Pooja Lakshmin, MD, is among the women physicians who have recognized the need to share their expertise and advocacy work with a wider audience in the form of a book. She noticed that the high-achieving perfectionist ladies in her psychiatry practice were struggling and that it was part of a wider, systemic problem. In response, she published “Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included).”

Dr. Lakshmin notes that the game is rigged against women in American society. Women are expected to work full-time jobs and care for the kids, pets and home—all with inadequate childcare, lower pay and scant parental leave. Throw in the stressors of online learning during a pandemic, appearing at kids’ sporting events, being a partner and caring for elderly or ailing parents, and it’s just plain overwhelming.  Dr. Lakshmin was not only feeling the overwhelm and burnout herself during the days of her psychiatric residency, she was noting the distress daily in the postpartum women who were coming to her for mental health treatment.

In response to the feelings of drowning, ladies are sold what the author calls “faux self-care” as the solution. Here is where the meditation apps, crystals, cleanses and bubble baths come in. Dr. Lakshmin notes that a mani-pedi, although lovely, will not solve the systemic issues of inadequate childcare and long work weeks. She writes that, “Real self-care, as you’ll see, is not a one-stop shop like a fancy spa retreat or a journaling app; it’s an internal process that involves making difficult decisions that will pay off tenfold in the long run as a life built around the relationships and activities that matter the most to you.” (p. XIV)

The author goes about explaining some of the systemic issues she’s witnessed by sharing her own life story as well as the typical experiences of several of her patients. Once people understand that many societal pressures have placed them in an impossible position, they can stop feeling blame or shame and make their own decisions. Women can take ownership of their choices and their time so they can feel more empowered in their work and personal lives.

The four principles

To accomplish this rather tall order, Dr. Lakshmin introduces four principles of “real” self-care with useful self-assessment exercises for readers to become more aware of where they fall on the scale. She advises to identify people in the green, yellow and red zones. People in the red zone are what I affectionately call a “hot mess.” We have all been there at one time or another. She recommends coming back to the self-assessment tools to guide useful actions and to judge your progress over time.

 The first principle is setting boundaries and dealing with the guilt and reaction of others. Boundaries are defined as the pause one makes before deciding. One can decide yes, something aligns with what they want and their values, or no, they do not. The second principle Dr. Lakshmin describes is self-compassion. She teaches how to adopt less critical self-judgement and more kind self-talk.

The third principle is getting clear on your values—this is hard for many women who are raised to put their spouse’s and families’ needs first. Dr. Lakshmin helps with more assessments and exercises. She writes, “It looks different for everyone, but it means that you feel connected with your values and are engaged in activities that align with them. Identifying our values in an explicit way emboldens us to make clear choices. And those choices lead to purpose and a sense of fulfillment.” (p. 164)

The fourth and final principle is recognizing your power. Although there is so much that is out of one’s control, there are dozens of daily decisions where one can exert her own power. Dr. Lakshmin advocates becoming more hopeful.

“People who are hopeful don’t pretend bad things aren’t happening,” she writes. “Rather, they understand that to move forward, we must integrate the good with the bad.” (p. 203)

This book is a short and useful read that people can revisit as needed. Dr. Lakshmin reminds us that, “Real self-care is not a thing to do—it’s a way to be.” (p. 197)

Related reading:

The DO Book Club, December 2023: ‘Code Gray: Death, Life and Uncertainty in the ER’

The DO Book Club, November 2023: ‘The Peter Principle,’ ‘How to Improve Doctor-Patient Connection,’ ‘Aging Optimally’ and ‘This to Me’