Shel Silverstein’s ‘The Giving Tree’ and health care

“Once there was a tree…”

Those six words begin one of the most deceptively simple and emotionally complicated children's books ever written. Shel Silverstein's “The Giving Tree” tells the story of a tree and a boy whose relationship changes as the boy grows older. The tree continually gives the boy its apples, its branches and eventually its trunk, until little remains except a stump.

Children may learn about love and generosity from the story. Adults often see a more complicated story about giving, taking, sacrifice, boundaries and whether unconditional love can become unhealthy when it is not replenished.

For those of us in health care, the story may feel remarkably familiar.

A new associate is asked to take over the practice's website. The new associate accepts the assignment. Then the office manager "suggests" that the new physician oversee the practice's social media presence on Facebook, YouTube and Instagram. Again, the new associate takes on the responsibility. Finally, the hospital administrator calls the office to invite one of the physicians to attend the Pharmacy and Therapeutics (P&T) Committee meeting the next day.

The new associate responds like the giving tree and accepts every request. This trajectory can end with you becoming a stump, with nothing left in the tank to give.

I have watched physicians begin their careers with an enthusiasm that makes them say yes to almost everything. I did it myself.

Health care attracts natural givers. Physicians, nurses, therapists, pharmacists, technicians, aides and countless other health care professionals routinely put others' needs ahead of their own. They work weekends, stay late, answer one more phone call, comfort frightened families, deliver bad news and sometimes return home emotionally exhausted after carrying the burdens of dozens of patients.

Most physicians recognize these scenarios. A patient is in pain, so we try to relieve it. The practice website needs more content, so we write another blog. We are asked to take call over a holiday weekend, so we give up time with our families.

In many ways, we are like giving trees. Generosity is one of the noblest characteristics of health care workers. The problem occurs when the system assumes the tree has an unlimited supply of apples, branches and wood until there is nothing left to give.

At first, the sacrifice may appear necessary. Staying late to help a patient can produce professional satisfaction. Answering a worried patient's call after hours may strengthen the patient's trust. Spending an additional 10 minutes explaining a diagnosis can make a frightening experience feel less worrisome.

But repeated demands can change the equation. The extra hour becomes expected. By accepting extra weekend coverage, we may soon be asked to give up another weekend. We discover that technology which is intended to make medical practice easier sometimes creates additional work. When this pattern is repeated often enough, compassion fatigue and burnout can follow.

The take-home message is that health care workers must take care of themselves. In fact, self-care can be considered part of our professional responsibility.

An exhausted surgeon is not necessarily a better surgeon because they worked for 36 consecutive hours. A sleep-deprived nurse is not necessarily a more compassionate nurse because she refused to take a break. A physician who answers messages at midnight is not necessarily providing better care than one who has set appropriate boundaries for accepting nonemergency calls.

The best practices should not reward employees simply for how much they are willing to sacrifice. They should create environments in which people can provide excellent care without sacrificing their physical, mental and personal well-being.

Good practices recognize that the metaphorical tree also needs care and attention. We have celebrated the heroic caregiver for generations: the health care worker who never says no, works through lunch, comes in early, stays late and is always available.

It may be time to celebrate the sustainable caregiver. That's the person who understands that caring for others requires preserving the capacity to care for ourselves.

Health care workers need their own sunlight, water and nourishment. Sometimes that means having a colleague who will listen. Sometimes it means having enough time away from work to sleep and reconnect with family and friends. It means having opportunities to learn and grow and, perhaps most importantly, permission to say, “I can't do everything.” Saying that doesn't mean we are weak; it means we are human.

We need to go from the “giving tree” to the “renewable tree.”

Another way to interpret “The Giving Tree” metaphor is to recognize that a healthy tree doesn't simply give. It also receives. A healthy tree receives sunlight, water and nutrients from the soil, and it has seasons to rest and recover. When the tree has the right conditions, it grows new leaves, flowers and fruit.

Lessons from “The Giving Tree”

We need to protect our ability to keep giving. That means recognizing when the demands of our work are becoming too much and making time to step back, recharge and recover. It also means creating a workplace environment where asking for help isn't seen as a sign of weakness. Sometimes, asking for help is exactly what allows us to continue doing our best work.

Health care works best when the relationship between the patient and the physician goes both ways. The physician brings knowledge, experience and guidance. The patient brings health-related questions and a willingness to participate in the decisions that affect their health. When both sides contribute, the result is better care, better patient satisfaction scores, better patient compliance and perhaps better outcomes.

Bottom line

Shel Silverstein's “The Giving Tree” can be read as a children's story about unconditional love. But for health care providers, it offers a challenging lesson. The best caregivers are generous with their time, but they must have limits and boundaries.

We need to give, but we also need to receive. We need rest, recognition, support and time to replenish ourselves.

The lesson isn't that we should stop giving. It is that we should stop pretending that giving is limitless.

A healthy tree needs sunlight, water, nutrients and time to regenerate. Physicians also need similar nourishment. If we want health care workers to continue giving their best to patients, we must learn to care for the tree as well as for those who depend on its fruit.

Neil Baum, M.D., a professor of clinical urology at Tulane University in New Orleans, Louisiana. Dr. Baum is the author of several books, including the best-selling book Marketing Your Medical Practice: Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.