Book Review: "Rest: Why You Get More Done When You Work Less" by Alex Soojung-Kim Pang

Many of us in medicine struggle to justify why we should slow down and give ourselves a break.

We’re used to putting others’ needs before our own.

We’re used to unrelenting unrostered overtime; oncall callbacks at 3am; weekend shfits trickling into birthdays and holidays; and working through illness.

If only there was a book that helped us justify to our evidence-based selves WHY we need to rest.

Alex Soojung-Kim Pang does this brilliantly in his easy-to-read manual, “Rest.”

Alex is a Silicon Valley consultant used to seeing that other modern group of trophy chronic overworkers - tech workers.

No longer is “hustling,” “crushing” and “burning it” a badge of honour for your work.

And no longer are you badgering yourself for not “working hard enough”. You probably already are. This book teaches you how to work SMART.

Doctors know well (or should know!) that as physiologic stress hormones, chronic raised adrenaline and cortisol (which are essential hormones that help regulate our daily functions in normal health, not an evil in themselves!), can lead to raised blood pressure; heart disease; higher stroke risk; obesity; cancers; some thyroid disorders; some autoimmune conditions; and other conditions. As part of the body’s natural homeostasis/resetting, we all need sleep; good nutrition; regular exercise; and unregulated downtime- sitting and doing nothing, allowing ourselves to drift to boredom and creativity. (They say having bouts of boredom in our lives actually helps fuel creativity and innovation- hence why people struggle when they try to find a “job they love” that never bores them 24/7- the fact is, those peaks and troughs even in your dream pursuit, help you stay stimulated, curious and engaged with your passion!)

When we set that homeostasis out of whack due to shift work; chronic long hours (and everyone has a different set point for when they feel tired after a certain number of hours - your 40-hour week may be someone else’s 100-hour week!); irregular sleep habits; poor diet; and basically being “on” all the time; eventually, our bodies catch up and physically can’t take it anymore without an even longer rest, if it ever recovers.

Workplace burnout has recently been recognised by the World Health Organization as a “workplace syndrome” classified by the International Classification of Diseases (ICD)-11. This makes it even easier for us, whether we’re in medicine, tech or otherwise, to recognise signs of burnout, and the need to switch off and rest as part of our work/life routine.

Alex’s book gives tips from his research and work on this subject, and illustrates it with anecdotes from scientists who’ve raised productivity through napping; Stephen King’s writing routine; the benefits of walking; and other simple, inexpensive and time-effective measures for longevity in your work-life continuum. Like most books we recommend, it’s easy to read on the train, in bite-sized pieces, or all at once during your favourite reading time.

So, no more excuses. You deserve to Rest!

(The Medical Startup is an affiliate for Book Depository.)

Fear is the Enemy of Creation

Something I’ve been thinking of recently.

Is Fear synonymous with Perfectionism?

Fear of screwing it up?

Fear of not getting it right the first time?

Fear of looking like a fool (a usually unjustified concern)?

Fear you’ll launch and sell not one item?

Fear you’ll screw up your job interview and miss out on your dream job?

Are you fearing what others might say and think about your choices?

Does it really matter?

As long as you’re choosing something you’re passionate about, and believe in, by action you can convince yourself.

It’s all about learning along the way.

And acknowledging your fear.

Seth Godin says here to “acknowledge” the fear and shame. Don’t fight it. “I listen to it and do it anyway. And that is where we’re going to make the impact.”

It’s being mindful of it.

And recognising your power to conquer your fears.

What are you scared of most?

Is it really that bad?

Write down three actions you can take to challenge it.

Deceleration as a Tool for Identity and Preventing Burnout

I was listening to The Tim Ferriss Show (his podcast), Episode #295, where he goes into “The 4-Hour Work Week Revisited.” If you’ve read any of his books, or even if you’ve just heard of “The 4-Hour Work Week,” I highly recommend listening to it. He has some thoughtful insights from the unprecedented response to his most famous book on working well, productivity and “lifestyle design”, and answers some of the most commonly asked questions he’s received since first publishing it over ten years ago.

Approximately midway through the episode, Tim discusses what he believes is the most important and overlooked chapter, “Filling the Void.” In a nutshell, the chapter is about what the reader could do after finding their success on their terms; automation, fantastic cashflow, a great team, flexibility, low stress; as detailed in the book. However, Tim has found that people too often mistake the chapter as being a treatise on the benefits of lifelong idleness after achieving “success” in this manner. Furthermore, he believes people who misread this chapter may misunderstand how to relax well.

“It’s about contribution; getting yourself out of a ‘me, me, me!’ focus, so that you’re hopefully putting a positive dent in the world, in a way that extends outside of yourself and your immediate family, and hopefully has some persistence over time,” says Tim. “And taking the tools you’ve developed in a business capacity, and applying them to impact in some fashion. I expect many people skipped (the chapter) because they don’t expect to succeed…. But (perhaps) what started out as a party or a celebration ends up being really lonely, they feel isolated and don’t know how to address that…. and by thinking about filling the void, about starting to incorporate those pieces into your life, BEFORE you end up in a challenging psychological position where you end up being reactive, … since you haven’t filled the void with anything non-business related, you’re going to continue to work for work’s sake. This is really common for people who succeed in any capacity. .. It’s really rare you see someone who’s been in sixth gear for a very long time, who then retires and is really good at chilling out. Learning to relax and enjoy other aspects of life, and engage with people around you- friends, community or built community- those are skills you need to practice and develop, just as you need to develop and practice the skill of split testing (ie. A-B testing) to anything else. It’s not a default ability you have as soon as you stop.”

“They can be really existential (issues) for someone. If the business has been your identity for a long time, and all of a sudden you want to replace that, if you don’t have a compelling replacement, you’ll just continue working because you don’t want to have to sacrifice that identity.”

(If you don’t have a business, feel free to replace it with “work” in the quotes above to apply to your situation.)

I think this is why people have trouble taking a break; even if you haven’t felt that you’ve reached your ideal of “success” yet; even if you’ve failed or had a hard time and wanted to distance yourself from your work for a time; in order to recuperate. If your identity’s so wrapped up in your work (and don’t worry, you’re not odd- it’s very common in medicine and startup land), you’ll feel that strange sense of time stretching out, empty and unfilled, and you’ll perhaps feel guilty for having that free time, and try to keep “busy” by filling it up with quick dopamine rushes, which may be simply starting a bunch of new projects with too much zest (who doesn’t love enthusiasm?), or at their extreme, can include overspending, binge eating, even drugs and so forth.

Or maybe you don’t experience any of that, but you think that to fill that void, you have to go back to work ASAP. And if that work environment was toxic for you, or you had issues to work through that you didn’t get addressed while having time off, those issues can quickly reappear, or be amplified, creating an even worse situation for yourself.

And the worst is that you may feel you’ve trapped yourself.

But there’s always a good way out.

You can be proactive about this.

As Tim suggests, no matter where you’re at in life, you can start today by asking yourself if you’re enjoying enough time with your friends/loved ones; if you’re doing something meaningful to you that is part of your identity, like a hobby that isn’t directly related to your work; or you can start something new, a new activity or hobby that helps build your identity beyond your medical life or startup life. You need to know that you’re valued beyond the workplace. And if you do find that you want to go back to work, that’s okay, but you could consider an option of trying a different work environment; working fewer hours/part time; or changing your work style in some other way. (A burnt-out, bullied doctor shouldn’t necessarily jump straight back into the exact same workplace; locuming a couple of days in a different workplace, or volunteering your compassion, integrity and other qualities into a tutoring job for homeless children, let’s say, could help you recuperate and feel fulfilled beyond your initial job description.)

It takes time to decelerate; even a car doesn’t do it gracefully when the brakes are slammed on! Patience with yourself will go far.

Feel free to comment below with your thoughts!

Part 2: Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health

First published April 28, 2016

We hope you enjoyed Part 1 of our interview with Dr Gregory Sam of Conduit Health. His telehealth psychiatry service provides nationwide consulting services which benefit rural and remote or mobility-affected communities. Consults can be done from the comfort of a patient’s local GP clinic or residential care facility, with no sign-up fee for GPs, and bulk-billing for patients.

Greg hopes to expand one day into other areas of the globe. Learn more about his journey below.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

How did you go about funding your project?

I’m a big fan of lean startups. Not needing huge capital. Also a huge advocate of self funding. Conduit Health was completely self funded. I was confident I could make the business model work.

I didn’t seek outside funding. There are alot of strings that come with outside funding, and you’re suddenly answerable to the government or your VCs (venture capitalists) or your angel (investor), and I didn’t want to do that. So I self funded everything. The benefit of the lean startup was, it didn’t cost me anything. I set my budget and said, “this is what I have to work with, what can I do with it?”

I started my company in the garage at home and a small office– which used to be for boys’ nights! So I said, no more poker nights, and converted it into an office. Conduit started from there. No overheads, no rents or anything. Yes, it was a home, and my wife helped me with marketing, pictures- I remember days sitting in the back office packing thousands of letters to send to GPs nationally- just me and my wife. More and more, big successful companies have that kind of beginning, they don’t have the multimillion dollars to spend at the start.

Sometimes you have to be able to sacrifice the ego and go, I’m doing the secretarial work. I typed up letters for my psychiatrists. I needed to do all this for the company, and if I didn’t have the money to employ a secretary or typist, I’m doing it. It’s rewarding at the same time, you get to see the company growing. From one referral to multiple referrals a day.

You must be critical of what you do. I always think, is this the right thing to do? Reflect and analyse, ask, “in terms of the business strategy, is this a good idea?” Not being complacent, “oh I can spend all this money now,” it’s about growing your business. Some people create meaning without making money.

Often if a company has created meaning, they then create money. But often people focus on making money first.

What got you interested in entrepreneurship in general? 

Wanting to make a change on a larger scale, to create something and grow it organically. And it’s exciting. Hard to describe the feeling but it’s a huge challenge. Something that can consume every moment of every day. But very rewarding. 

What sort of doubts or worries did you come across?

I didn’t study business. The difficulty within the medical field is, there aren’t many entrepreneurial people. I keep thinking of so many examples where my medical colleagues have such great ideas but don’t have the support or environment to foster that development. 

And I think taking myself out of that comfort zone,being with my business friends, listening and learning from them, really addressed those doubts.

One thing I know is that I’m a doctor, I know the medical part as well as the business side of things. Psychiatrists I work with feel comfortable with me because I know what it’s like to be a psychiatrist, I know the difficulties they face, I know what it’s like to treat patients. Whereas if it’s a purely business person,  you wouldn’t know what to give the patient, or how to be a psychiatrist, you’d possibly be like “oh it’s good for business, let’s do it.” That’s my advantage.

I think a lot of doctors should see it as an advantage, “I’m in business but I have a medical background.” So my doctors and nursing staff, they all understand. Which is why I’m all for doctors getting into business. As a doctor you would be able to empathise, with a business heart.

The other fear was, I got into medicine to be a doctor, and do my clinical training and be a psychiatrist. The path is very set. Once you start thinking of deviating from that, it’s quite scary. The reality is, actually it’s very refreshing. Because all we’ve known for ages is patients, medicine, being a clinical doctor. So actually, its very liberating.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

 One of the problems when starting out with telehealth is the many barriers. Like technology, for example, Internet speed, willingness to try out technology, video technology, and costs.

I thought, what are all the barriers? One by one, I addressed them and ticked them off. We bulk bill, so patients don’t pay. GPs win because patients get seen by specialists for no sign-up fee. Patients win because they don’t have to travel. Psychiatrists win because they don’t have to have room fees, which can amount to $70-80K a year. It’s an untapped market. Lots of patients need help. Whereas the metropolitan market is completely saturated. So we’ve tried to knock down all these barriers, and create a win-win situation for everybody. 

I think less so that people choose entrepreneurship, more so entrepreneurship chooses people. I think about ideas all the time. There are all sorts of naysayers who will come and tell you it’s not going to work. Why does this person say it won’t work, and how do I prove them wrong? I take what he says, think of the meaning behind what he says, and maybe he’s thinking it won’t work for xyz reason, how do I address xyz?

I think more and more power to doctors who become entrepreneurs in the medical field, or outside of medicine. So that studying medicine doesn’t become this one-track path, you will see patients and that’s it. People can become disillusioned by it, it’s so straight, the path doesn’t have any chance to vary. Yes, medicine does offer many specialties to choose from. But it’s still so contained like a nucleus, and no one’s thinking of addressing the outer shells.

Specialty training itself is all-encompassing. It will suck your life dry so that you just focus on training and that’s it. Same thing happened to me til I failed a few times, then you step back, and I said I don’t want my life to just be about training and fellowship. I want it to mean more, and that’s where the value is. 

Did you have a mentor?

 I had a few different mentors for different things. I try to draw upon the things that I want to gain.Positives and negatives. I draw analogies with badminton training. I had a coach for 6-12 months, and I drew as much as I could their positives. A certain coach would be good on physical stuff, another would be on mental aspects of the game. Same with psychiatry training. One would be clinically good so I’d take those aspects off them. Another had a good lifestyle setup, so I wanted to draw upon that.

For a business, it’s more offsite. I’m a member of business groups. The guy who did my websites runs an IT company in Malaysia, from a business perspective I love bouncing ideas off him, and learnt lots of things from him.

It’s important to be able to have many mentors for different things, because there’s a risk, if you follow just one person, you absorb all their flaws, and are unable to see their flaws. That’s a risk in medicine, too. 

I also learnt heaps from watching talks by Guy Kawasaki and Elon Musk and a few others. 

Part 3 will be released soon! In the meantime, if you’ve got any comments or questions about our article, comment below.

You can view Part 1 here and visit Conduit Health here. 

If you wish to contact Greg for more enquiries about Conduit Health, or to sign up as a GP or psychiatrist for his service, please email enquiries@conduithealth.com.au. Conduit Health is also on Facebook.