“Occupied but not present,” have you ever been in such a situation? Maybe at a conference, talking with a colleague, a staff meeting, in a theater or at a dinner party? Your cell phone is tugging at your cryptic desires, your mind is elsewhere while numbly rumbling through the motions, thinking, wondering, interested in somewhere or something else?

Regardless of the distraction or the attracting alternative your presence in the moment has been stolen. Taking away from the now to think about a future that may never happen. You are no longer engaging in the full breadth of the moment and if sharing it with another or others you suddenly diminish your value to the moment and their perception of it. Eventually, you become a bore to not only yourself but others as well.

Likely, being occasionally distracted provides an evolutionary benefit to human existence, a survival mechanism to identify an immediately threatening situation or perhaps a split second opportunity. But if continuously distracted from the moment we lose the potential benefit gained by what is right in front of us, a plateau in existence and a social malaise ensues. Despite continuing with the motions the passion is lost, and subsequently we lose presence. Practices and livelihoods are put at risk, a “burn out” phase has entered. But if the creeping and malingering burn out can be recognized just before it slithers pass the entrance way and into our lives, can it be averted?

Physicians are increasingly being subjected to burnout, a 2016 Medscape survey of over 15,000 physicians in 25 specialties found that there has been an increasing rate of burn out. And while plastic surgeons fell near the bottom of the pack 20/25, dermatologist were even less likely 22/25, critical care specialist and ER doctors were the most likely with 55% reporting feelings of burn out. (1) There are many speculative reasons as to why those two fields, but for your consideration, three tenets of any occupation that in particular lead to burnout.

1. A job that is centered around the clock

2. An inability to control one’s own destiny

3. A job that lends itself to a routine

When completion of a work day is defined by a pre-set time then the progress of the day becomes measured by the movement of the clock hands not the moments created within those movements. When our destiny is controlled by another then a creative excursion to enhance our lot feels futile we concede to the mundane. And when an action becomes monotonous it no longer requires supratentorial input. A curious cerebrum goes elsewhere while a reflexive autonomic system caters to the task at hand.

Fortunately, when it comes to burnout, although admittedly bias the aesthetic medical fields may be inherently more resistant than other fields of medicine. While performing an aesthetic procedure it is very difficult to not be present in the moment because we are aiming to achieve two outcomes that cannot be easily attained, perfection, and/or the ill-defined notion of patient satisfaction. In either scenario it is different from other medical or surgical fields where end points are more clearly defined. In surgery an obstruction is relieved, an infection is cleared or in medicine a blood pressure is controlled a blood sugar is stabilized. Such medicine caters well to protocols, EBM, EMR and flow charts. (The mundane rat on a wheel). In contrast in aesthetics a procedure is completed when we feel that the patient will be satisfied with the outcome. This is a moving target which requires fluidity in our decisions of when to stop, couple this with the common character flaw of most creatives in that satisfaction in work is rarely if ever truly achieved. It is the reason many loved masterpieces are consider incomplete by the artist who created them. Hence when in the act of performing the procedure we are likely to be acutely present in the moment. It may contribute to the reason so many surgeons mention how much more they enjoy their surgical days over their clinic days.

Regardless we all fall risk to being occupied but not present at some point in our careers. And that maybe a higher relative risk today. It is not a surprise that burnout rates are rising in a profession slow to adapt coupled with an emerging smart phone screen dependency that scoffs at being present in a moment for more than a minute.

And what is the solution? Recently during a travel adventure, I surmised an answer: When risking something of value you immediately become acutely present in the moment. Whether jumping out of a plane, scaling a volcano or doubling down at the black jack table you can’t help but be completely present in the moment. A thrilling discomfort enters, your heart races your mind sharpens and you are present. Nothing else enters your mind other than the task at hand.

So how does that translate to our professional lives?

My hunch is we have to make an effort to occasionally venture outside of a comfort zone. When exploring something that we are not used to then there is no routine to fall into… we focus more intently our minds grow, new neurons sprout and relationships enrich. This is not necessarily an individual event though. Peeking out into the uncharted can be done in concert with family members, professional partners and even within our medical societies.

Physicians are traditionally appreciated for their safe behaviors, reliability and routines, but while such consistency may bring comfort beware the complacency for it always leads to demise. So both in our professional and personal lives we should consider a concerted effort to step into that zone just beyond the ease that keeps us present. I am not advocating high risk behaviors for individuals or collectively as a group, but maybe consider hiring a new employee, a new internet plan, a new laser, adopting a new procedure, maybe redoing the office, studying a new aspect of medicine or art that can complement a career. For us personally, maybe something completely outside of medicine: learning a new language, a new hobby or adopting a pet. And as a medical society perhaps welcoming in new talent, new educational platforms, exploring partnerships with those we never would have considered in the past. The more often we can venture outside ourselves and our comfort zones the more likely we are to be interesting, present in the moment and expand not only our minds but also our careers.