October 2008 | Welcome to Finding Balance eNews.

Workaholism in Medicine
What if there was a substance that made you stay away from home until very late and kept you awake at night? What if this substance created multiple family problems to the point of destroying your marriage? What if this substance decreased your efficiency and your ability to concentrate, and made you irritable and fatigued? What if this substance increased your risk of back problems, gastrointestinal disorders, heart disease, and stroke? What if you felt that discontinuing the use of this substance meant that your success and your self-definition would cease to be?

This is often how addicts feel about their drug of choice. They are so identified with the drug that they would lose themselves without it. On seeing a patient with these self-destructive tendencies, most of us would try to convince them to seek therapy or find other forms of help to eradicate the destructive substance from their lives. Unfortunately this is how many practicing physicians begin to approach the work of medicine. We become work addicted!

The practice of medicine becomes our drug of choice. We live in a culture that supports the practice of medicine above all else, which can often exclude our families and our health. If we stopped being a doctor, who would we be?

Unlike alcoholism, workaholism is rewarded with accolades and financial success, making it a very difficult process to stop. A workaholic has lost the ability to slow down and find value in anything other than work. Workaholism is a compulsive behavior and is probably related to other compulsive behaviors and addictions. I tend to think of it as a pre-disposition which can be modified by learning new behaviors, but for some, the compulsion is so invasive that medical treatment may be needed.

Workaholism is not measured by the number of hours you give to work. If that were the case, you would all be workaholics at this point in your career. It is more about the way you approach work and how it controls you and your ability or inability to focus on things unrelated to your career. Workaholism can also be measured by how work affects your life outside of medicine. If you have trouble shutting off your thoughts about your work and career, you may be a workaholic.

Intriguingly a wonderful psychiatrist friend of mine, upon filling out the work addiction test (below), realized the level of his work addiction. When we got into discussion about this, he insisted, “But I love my work.” I then asked if his work has had an adverse effect on his life. His response was, “On my first marriage, yes.” This is work addiction. If work is damaging your health and relationships, you may wish to consider this as a possibility.

We are often in denial about these behaviors because they feel productive. In a workshop, one colleague told me that she could cut down on her work anytime she wanted to. On saying these words, which many alcoholics in treatment have said to her, she knew that she was stuck!

Work Addiction Risk Test
The test below will help you evaluate your level or potential for work addiction. It is taken from Bryan E. Robinson’s book, Chained to the Desk: A Guidebook for Workaholics, Their Partners, and Children, and the Clinicians Who Treat Them (New York University Press, 1998).

The following test was devised to help you evaluate yourself. Score yourself as follows:

1 = never true; 2 = sometimes true; 3 = often true; 4 = always true

Total your score, and then look at the scale below.

_____1. I prefer to do things myself rather than ask for help.
_____2. I get impatient when I have to wait for someone else or when something takes too long.
_____3. I seem to be in a hurry and racing against the clock.
_____4. I get irritated when I’m interrupted while I’m in the middle of something.
_____5. I stay busy and keep many irons in the fire.
_____6. I find myself doing two or three things at once, such as eating and writing a memo while
            talking on the telephone.
_____7. I over commit myself by biting off more than I can chew.
_____8. I feel guilty when I’m not working on something.
_____9. It’s important that I see the concrete results of what I do.
_____10. I’m more interested in the final results of my work than in the process.
_____11. Things never seem to move fast enough or get done fast enough for me.
_____12. I lose my temper when things don’t go my way or work out to suit me.
_____13. Others complain that, without realizing it, I ask the same question after I’ve already been
             given the answer.
_____14. I spend a lot of time planning and thinking about future events while tuning out the here
             and now.
_____15. I find myself continuing to work after my coworkers have finished.
_____16. I get angry when people don’t meet my standards of perfection.
_____17. I get upset when I’m in situations where I cannot be in control.
_____18. I tend to put myself under pressure with self-imposed deadlines.
_____19. It’s hard for me to relax when I’m not working.
_____20. I spend more time working than on socializing, hobbies, or leisure activities.
_____21. I dive into projects to get a head start before all the phases have been finalized.
_____22. I get upset with myself for making even the smallest mistake.
_____23. I put more thought, time, and energy into my work than I do into relationships with
              other people.
_____24. I forget, ignore, or minimize celebrations such as birthdays, reunions, anniversaries, or holidays.
_____25. I make important decisions before I have all the facts and have thought them through.

Scoring:
25–56 You are not work addicted.
57–66 You are mildly work addicted.
67–100 You are highly work addicted.

The Realities of Work Addiction This material is also adapted from Bryan E. Robinson’s Chained to the Desk.

• Work addiction is a compulsive disorder that workaholics carry into the workplace. It is not created by the workplace.
• Work addiction is a mental-health problem, not a virtue, and it can create more problems than it can solve for the workplace.
• The superhero facade masks deeper emotional and adjustment problems that workaholics shield with their accomplishments.
• Workaholics do not sacrifice free time and family time for their work; they do it for ego gratification.
• Although most workaholics say that they enjoy their jobs, work satisfaction is not a prerequisite to work addiction.
• Workaholics become chemically addicted to their own adrenaline because of the stress they put themselves under, and they crave additional crises to maintain work highs.
• Work addiction can be a primary addiction or a secondary one that blends with other addictions.
• Workaholics do not have to be gainfully employed to become addicted; it can happen with any compulsive activity.
• Recovering balance after work addiction improves work quality and productivity, and helps workaholics become happier and more effective at what they do.
• Achieving balance from reduced work addiction requires more than cutting back on work hours; it involves deep personal introspection and insights, as well as attention to the parts of life that have been neglected.

I am not trying to pathologize us all, but I do believe that work addictive tendencies are highly prevalent in the medical community. Like other addictive behaviors, work addiction can’t be ‘treated’ by the individual.

If you score high on the above test, I strongly suggest Chained to the Desk as a great place to start. I also cover this in great lengths in my own book, Finding Balance in a Medical Life, which will be available in October, 2007.

Fun Stuff
For those of you who love sweet jazz guitar, my pick of the month is Laurence Juber’s “I’ve Got the World On Six Strings”. This is a beautiful solo acoustic guitar album where Laurence interprets the work of Harold Arlen, composer of “Over the Rainbow”, “Stormy Weather” and “That Old Black Magic”.