Writing for Personal and Professional Wellness

Abstract

Writing is a part of every academic career in medicine, yet many busy clinicians have difficulty finding time to write and may see it as extra work during their time off. This professional development perspective offers a reframing of writing, not as extra work, but as a wellness activity. The National Academy of Medicine’s (NAM) National Plan for Health Workforce Well-being identified seven priority areas where action should be taken to increase wellness in the workforce. Professional writing can “support mental health and reduce stigma” (an explicit NAM priority area) by allowing workers to express gratitude, practice reflection, and write without a deadline. Writing also addresses the NAM priority area of “create and sustain positive work and learning environments and culture” by giving opportunities to support your colleagues, invest in your team, celebrate success, find satisfaction in the sciences, and seek and find healing. By intentionally writing to process emotion and manage work stress, we shift the paradigm for busy clinicians to improve their well-being while simultaneously contributing to academic success.

Academic clinicians have multiple demands on their time, and many find themselves without enough time to work on scholarly pursuits. This problem is near universal, and while promotion criteria are changing, written products are still a significant part of the process. Therefore, writing is a skill that all of us in academia will need to find time to practice.

The best solution to finding time for writing is to have protected or supported time during the workday. We suggest an alternative approach to how the work of writing is perceived, especially when it is done on nights and weekends or other times of inconvenience. Because of high rates of burnout among family and other physicians we suggest writing for wellness. By writing for wellness, we mean using writing to deal with the stressors and challenges of work; increased clinical and educational demands and the minority tax for those faculty who are underrepresented in medicine. Writing for wellness could be an approach added to the resources to help physicians deal with burnout.¹

Faculty members participate in activities for wellness in their personal lives, whether that be spending time with family, exercising, vacations, etc. Those wellness activities are typically performed in their free time. If writing is seen as a wellness activity, then faculty members may choose to write during their free time. We understand that our approach to writing for wellness may be antithetical to popular culture. It may take some a lot of processing to arrive at the point where something seen as intrusive to personal time, labor, a chore, a difficult task, can be viewed as a path to wellness. Considering writing as wellness is a total reset to our thinking and approach. All avenues should be explored that have the potential to help promote wellness for academic physicians. The National Academy of Medicine’s National Plan for Health Workforce Well-being identified seven priority areas in which actions can be taken to ensure that the health workforce can find healing and well-being.² Two of those areas, "create and sustain positive work and learning environments and culture,” and “support mental health and reduce stigma,” are places where writing can be used. In Tables 1 and 2, we explain the benefits of writing for wellness, and the article types that fit into that category.

Table 1.

Writing Supports Mental Health and Reduces Stigma

Writing benefit	Article types	Explanation
Express gratitude	Narrative	When we record patient and personal stories and how they affect us, it helps us to process our work. Many journals publish narratives, and they are a healthy way to deal with the issues that our profession is facing today. They can also be used to express gratitude.3 Gratitude journaling is associated with reductions in depressive symptoms and anxiety scores.4 Narratives can be published in the Journal of the American Board of Family Medicine, Family Medicine, Annals of Family Medicine, and many others.
Practice reflection	All writing products	We reflect on our work in our free time. Scientific manuscripts all have a place for reflection; in the introduction (where we state how the study/paper/manuscript will help) and in the discussion (where we place the work presented in the context of things that are already published).5 Because reflection can be a free time activity, putting it on paper is the natural next step. Reflection helps faculty become better teachers and doctors and teachers,6 and being good at a profession supports employee wellness.7
Write without a deadline	Perspectives, opinion pieces, special articles, letters to the editors	A key consideration in writing for wellness is to write without a timeline whenever possible. That doesn’t mean that there isn’t a project manager and that you don’t have some loosely organized schedule. It means that there isn’t the stress of deadlines, especially those that are rigid and converge with other responsibilities. We have found that our loose timelines promote wellness in that the stress of deadlines is de-emphasized. Many years ago, we saw colleagues react poorly to rejections from journals. One colleague was so embarrassed that they did not further seek publication in another journal. This experience, with others, prompted us to write “Submit it Again! Lessons Learned from Rejected Manuscripts,”8 published 8 years after the original idea.

Table 2.

Writing Helps Create and Sustain Positive Work and Learning Environments and Culture

Writing benefit	Article types	Explanation
Support your colleagues	Letters to the editor	There is a great need to support one another in our careers. A letter to the editor allows for you to support your colleagues in a way that benefits them (citations) and you (publication). It allows you to amplify the work of a colleague—or many colleagues—even when you cannot be there to do it in person. This is one of those areas where service to others has a tangible professional benefit; as service, the letter to the editor also contributes to wellness.
Invest in your team	All writing products	Teaching members of our teams to write prepares them for success now, and for the next step in their career, which is likely to be with a different team. While it is counter-intuitive to think that preparing someone for success somewhere else is valuable to you, it is clear that when you invest in others, they want to stay on your team.7 For those of us who find that writing itself actually contributes more stress, partnering with skilled academicians can allow newer writers to contribute, learning tools to consider how to break writing down into bite-sized pieces that serve as steppingstones to academic work.
Celebrate success	All writing products	Articles are excellent ways to celebrate the success and completion of any project. Celebrations contribute to a positive work environment and adds value for your team.
Satisfaction in the science	Original articles	Designing a scholarly project and looking into the science of the question and writing a manuscript to deal with it, cannot only satisfy the faculty member, but can also be a source of wellness, especially when the literature may provide advice different than that the faculty member received. An example of this is when author K.C. was told by a tenured leader that tenure does not matter for him (K.C.); K.C. and J.R. proceeded to design two studies looking at tenure and faculty who are underrepresented in medicine.9–11
Seek and find healing	All writing products	Writing can be used to manage anxiety, stress, and complexity. Faculty should know that they can always write about situations, in response to situations, to help process situations and to share outcomes of situations no matter what career rank, work role or assignment.

Incorporating writing into a busy career is a difficult task. Tips for incorporating writing are in Table 3. Making writing a priority, like exercise, can benefit the rest of your day. Thinking of it as a wellness activity legitimizes its use outside of work hours.

Table 3.

Tips for Incorporating Writing Into a Career

Tips for incorporating writing into an early career	Example
Talk about it	When you come across experiences that elicit an emotional or strong reaction, talk to someone you trust to commiserate, process, and articulate the problem you have encountered. This can be a nidus for a new manuscript.
Write at the beginning of the day	Authors K.C. and J.R. have a weekly, standing morning meeting to discuss and write on issues that are important to them. Early-morning writing is a time of freshness of approach and ideas. Some of the best ideas come early in the morning and spending this time writing together before the start of the workday sets the stage for a productive day and for a perspective for work that helps meet challenges head on.
Write immediately	Unlike writing a manuscript from a defined project, writing for wellness is a data dump, free flowing and spontaneous. All you need is a blank sheet of paper and to allow your thoughts to flow. When an idea comes, record it immediately. There will be opportunity later to edit and format the content for a peer reviewed submission.
Create writing groups	Writing groups provide opportunities to converse with others who may be dealing with similar challenges. Writing in groups creates accountability and allows for healing when members discuss issues that can be processed through writing.12,13
Ask for help	Conversations with senior leaders in academic medicine can help you process your emotions and capture your feelings on paper. They may have the experiences, perspective, and comfort to help process challenging experiences. Talk to senior authors at conferences, seek mentors, and ask how writing helps them.
Write for you	While the wellness of others is important and should be addressed, writing for wellness in the context of this paper is about writing for your wellness. Writing should be personally satisfying, bring a feeling or release and should be calming for your soul. This is a difficult career, and when you write you process issues. You can deal with strong emotions that are provoked by the injustices that all of us witness and experience in our jobs.

Early-career faculty should see writing as part of their jobs, no matter what their academic percentage is. Presenting writing as wellness offers an achievable reframing. When we are ill, we seek medical attention, sooner rather than later. When we are seeking wellness, the same urgency should apply. Immediate actions can get us to a better place.

The COVID-19 pandemic taught us that as stress increases the coping must rise to meet it, regardless of whether we are a patient, physician, or both. The coping skills that have assisted faculty members through years of training, medical errors, balancing childcare with clinical demands, and other difficult situations in their careers might not be enough as stressors compound. Faculty need to identify emotions and their related physical symptoms and seek interventions to ensure long-standing success in medicine. Faculty need to be self-aware to match the appropriate level of intervention to the level of distress. Writing for wellness can be an additional coping strategy. Writing has been shown to be impactful for a variety of medical conditions and as a stress reliever.¹⁴ This approach means that there is an access portal to wellness that a faculty member can traverse when needed, especially in times of stress or disorder. Writing is a tool that a faculty member can always access for wellness.

In this professional development perspective, we have discussed writing as a potent tool to promote both personal and professional wellness. Writing narratives help us process our work and writing letters to the editor help us support each other and those we supervise. In addition, writing provides the ability to celebrate successes and practice reflection. Because we already spend our nonwork time in the activities listed above, it is natural to take what we are already doing and allow it to benefit our careers. While we present writing for wellness as something that can be done during free time, institutions can support time for writing during the workday as a wellness initiative for individual faculty members. Harnessing this tool in a way that improves not only our own personal health but also contributes to the national dialog and career promotion is a three-for-one impact that even the most efficient of us can appreciate.