EXPERT ANALYSIS FROM THE AMERICAN COLLEGE OF PSYCHIATRISTS MEETING

SCOTTSDALE, ARIZ. (FRONTLINE MEDICAL NEWS) – Linda L.M. Worley, MD, was stunned when a meeting she’d requested with her supervisor to address a shortage of beds turned into a rebuke.

“You’re on the tenure track, Linda. If you want to keep your job 6 years from now, you’d best pick up the pace. You need to see 20 private patients a week, and get moving on your research and publications,” Dr. Worley remembers the supervisor saying. At the time, she was a 32-year-old mother of two, wife, academic faculty physician, and sole attending running a general hospital consultation liaison psychiatry department and the college of medicine student mental health service. She also worked as the 24/7 on-call psychiatrist for a week at a time, said Dr. Worley , now a staff psychiatrist in the Fayetteville, Ark., Veterans Health Care System of the Ozarks and chief mental health officer for South Central VA Health Care Network .

Dr. Worley’s immediate response was to go home and “collapse into anguished sobs,” she said in an interview. Her ultimate response, however, was to change tack, as a sailor does to make the most of how the wind is blowing. “When I told my husband I couldn’t manage and felt as though I was capsizing, he told me to ‘reef in my sails,’ ” she said, describing the technique sailors use to reduce their exposure to dangerously strong winds. “That was the day my Smooth Sailing Life nautical metaphor first crystallized.”

Over the decades of an academic medical career complete with tenure, and dozens of published articles and book chapters, Dr. Worley has developed a system for achieving success while avoiding burnout, based on nautical references. In a session cofacilitated by Cynthia M. Stonnington, MD , chair of psychiatry and psychology at the Mayo Clinic’s campus in Scottsdale, Ariz., Dr. Worley presented her tips for self-care at the annual meeting of the American College of Psychiatrists.

“I use the nautical framework as a bio-psycho-social-spiritual model,” Dr. Worley said in an interview. “I teach it to medical students; I teach it to residents; I teach it to distressed physicians. I even teach it to patients when I am explaining a framework for a necessary treatment approach. With sailing, you have to stay in balance. That’s the same with taking good care of ourselves so we are less likely to get sick physically and mentally,” said Dr. Worley, who commutes to Nashville, Tenn., several times a year as part of her appointment as an adjunct professor of medicine at Vanderbilt University.

Her “Smooth Sailing Life” seminars have evolved over the past 20 years and are rooted in her training in psychosomatic medicine, which she said emphasizes the complexity of the entire person. “It’s about the biology and about the emotions, and the bridge between them,” according to Dr. Worley, who has a website, SmoothSailingLife.com , and is working on a book aimed at helping to meet what she said has been a steadily growing thirst for her approach to developing resilience.

“I am not studying anyone, but I am helping people to self-diagnose. I teach people how to avoid having to see a psychiatrist or a mental health provider but also to feel good about reaching out for help when necessary,” she said. “Life is far too short to suffer needlessly.”

In the interview, Dr. Worley said she adapts her presentations to the venue and the time allowed. Key aspects of her system include:

• Care for your yacht, which is the body, including the brain. “You only get one, and if you’re going to have a chance of winning the regatta, you have to take care of it. This means getting good sleep, nutrition, exercise, preventive care, rest, and rejuvenation, including vacation,” Dr. Worley said.

• Chart your course; have a navigational plan that includes your life goals and aspirations. Identify and rely upon “landmarks,” such as being a good spouse, mother, physician, or friend for the most authentic definition of personal success. “These are like buoys that keep us sailing in the right direction,” she said.

• Reef in your sails, meaning mind the “winds that come at us from every side,” she said. This includes triaging tasks and not letting perfectionism get in the way. “Perfectionists take too long to tack; they don’t know when it’s time to turn in the other direction,” she said. “If you want to finish the race, you have to do the best you can in the time you have.” This was the lesson Dr. Worley said she learned that day when she was a young physician feeling overwhelmed.

• Empty your bilge, the nautical term for removing waste water from within the hull. Dr. Worley uses this as a metaphor for identifying and expressing negative emotions of fear, anxiety, sadness, and frustration. “These vital emotions are giving us important messages. It is important to recognize that they are present. Name and accept them, and understand what they are trying to tell us. Is it a symptom of an underlying illness that needs treatment? A conflict in a relationship? A need not being met? Are you living your deepest values? Express the emotions and sort through the best response,” she said. “It’s all part of emotional intelligence.”

• Keep an even keel, which is Dr. Worley’s way of stating the importance of being connected to love and to living your deepest values. “The keel is your character, your connection to meaning, a spiritual connection. In medicine, we shy away from that. I have only lately ventured into talking about this,” she said, noting that this connection can come in numerous ways, such as meditation, and being in nature or with animals. “It’s very personal. It’s hard to quantify, but I have witnessed it and its healing power within the therapeutic alliance.”

In break-out sessions during her well-attended talk at the meeting, Dr. Worley listened as psychiatrists of all levels of experience and responsibility, ranging from medical directors to those in private community practice, shared the kinds of concerns she said she often encounters in her role as a core faculty member of the Program for Distressed Physicians at the Vanderbilt Center for Professional Health.

“Changes in medicine have been so frustrating; physicians are at their wits’ end. We don’t recruit people into medicine because they have a skill set for expressing their emotions, or taking care of themselves, or dealing with conflict,” she said. “That’s okay. They can learn it.”

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

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