Jordan was a third-year resident, in the middle of her emergency department rotation, when she discovered she was pregnant. She forwarded her positive test result to her husband, John, a physician in the same hospital system. Telling him via text was a bit impersonal, but their shifts overlapped and she couldn't wait. She knew it would make his day.

John was a decade older, had been married once before, and was eager to start a family. He came from a long line of physicians; both his parents were doctors. He was confident his second marriage would succeed where his first had failed, primarily because Jordan was a physician and she would understand the demands of the profession.

Jordan was the first doctor in her family. She was also excited to start a family but worried about balancing multiple roles as mother, spouse, and doctor. Her parents had always put family first, and her mother was a homemaker. She remembered the dinner table of her childhood as the site of critical conversations — where family traditions were passed on, favorite colors identified, secret crushes revealed, ambitions embraced, fears faced, and the highs and lows of each day discussed. Jordan wanted the same thing for her own children. She envisioned her workload and autonomy improving after residency and convinced herself that if she put in more hours now, she would have time for family later.

Of course, work-life balance didn't turn out to be that simple.

Jordan and I are friends — both family physicians with similar stories. We watched each other's children grow up and learned from each other. This article includes lessons we've gathered over the years about protecting quality time for family — especially “table time.”

NURTURING THE FAMILY IN FAMILY MEDICINE

Humans are social creatures, and social health is a core part of overall wellness. Family well-being is critical to the health of individual family members and, conversely, personal health fosters family well-being. Family is our most important team.

Teams rely on each other for support, and relationships are strengthened when team members spend time together. But the time demands of practicing medicine can be particularly hard on physicians and their families. Physicians often rely heavily on their families for support, and family members in turn need additional nurturing to be able to provide that support.

Marriage rates are higher in physicians than the general population, and nearly one-fourth of all physicians are married to other physicians.¹ Dual-medicine partners report the benefit of identifying with each other's stressors, but physicians with non-medical mates report the benefit of having partners with flexibility and autonomy in their schedules.²

While physicians as a whole do not have higher divorce rates than the general population, the rates are higher among female doctors and within some medical specialties and institutions.^3,4

Rates of burnout, depression, and suicide are increasing in physicians, and each of these add additional challenges for families.⁵ Compassion and communication skills, which come from trust and investment in relationships, are particularly necessary when a family member is suffering.

Protected time is critical to families, whether they have one or two physicians. Allotting time for something portrays a message of value. But in our harried schedules time slips away, and that message of appreciation is lost. Scheduling time for families to meaningfully connect must be purposeful — particularly for those in demanding professions like medicine.

SOCIAL CONNECTIVITY IN THE AGE OF THE INTERNET AND THE CONTEXT OF COVID-19

In this digital age, connectivity has taken on a new meaning. Merriam-Webster now defines connectivity as “the quality, state, or capability of being connective or connected; especially: the ability to connect to or communicate with another computer or computer system.”

But often the more connected we are to our devices, the less connected we are to other humans, including our families. Social connectivity requires time, and the lack of face-to-face interaction can threaten traditional family bonding.

The smartphone came to be in 2006 and was owned by a third of the U.S. population by 2011 and two-thirds by 2016. In 2015 the average U.S. resident got their first smartphone at age 10, and the average user checked their phone more than 100 times daily — about every 10 waking minutes — and spent five hours online a day. Nearly half of the population now refers to this device as a necessity they “can't live without.”⁶

Virtual connectivity has benefits, including access to knowledge and communication with family and friends around the globe. Thanks to technology, work is now home-based and flexible for many, which is particularly a boon during outbreaks of infectious disease like COVID-19. The worldwide pandemic has forced us all to swim in uncharted waters. Changes to our typical social connections can be extremely stressful, but they also have the potential to add value to our lives. Social distancing means avoiding contact with most people, but it also could mean spending extended periods of time in close proximity to our families. Being homebound is an opportunity to redefine and rejuvenate family connections and traditions — a treasured silver lining of COVID-19.

But that's only possible if we address the downside to the convenience of digital life: Work can be conducted around the clock, and screens become a convenient way to distract children.

It is easy to slip into unhealthy digital habits, particularly during times of social distancing. But habits set early in a family's development are critical because they can become fixed and their consequences can extend over a lifetime. Imagine a child who is permitted to watch movies during meals, grows up texting during play dates and parties, and checks their “likes” on dates. No one notices the effects of these habits at first, but before long traditions like sharing during meals have died.

We are only beginning to understand the impact of excessive screen time on face-to-face socialization. Challenges going forward will be to 1) Understand what we give up when we increase time online, 2) Establish strategies and boundaries to allow devices to complement and not deplete our lives, and 3) Take time to turn off so that we, like our phones, can recharge.

Technology can be integrated into some activities to enhance family time. For example, using video-calling apps such as Skype to call grandparents shows how digital tools can help maintain social connections.

But we also need creative strategies and routines for connecting and unplugging when families have extended time together, to solidify family traditions at each stage of development and create positive memories, even in challenging times. These strategies are more important than ever in a world more and more dependent on technology.

SCREEN TIME BOUNDARIES BY AGE

Setting limits on screen time during shared activities such as dining can keep technology from seeping into all aspects of life.

Newborns, toddlers, and preschoolers. At this age, kids shouldn't have their own smartphones, tablets, and computers. If the only digital devices in the home belong to adults, the adults set the standard and establish the routine, and should model healthy behavior. The “inability to log off” is associated with statistically significant increases in stress, according to the American Psychological Association. Those who describe themselves as “constantly checking” email, texts, and social media accounts report much higher than average stress levels.⁶ Maintaining phone-free zones even when children are not present validates the value of a spouse and sets a standard for the rest of the family. Here are some ideas to make device-free dinners special with this age group:

• Describe what went well and what was challenging in each other's day (a “rose” and a “thorn”),

• Explore creative and healthy menus,

• “Dress up” for dinner and plan theme nights,

• Have after-dinner dance parties,

• Occasionally swap child care with other parents so you can have date night.

School-age children. A study published in 2014 indicated 87% of millennials claim their smartphone “never leaves their side.”⁷ As soon as phones or tablets are introduced to children, talk to them about how to drive their device and not be driven by it, and model this behavior yourself. Provide feedback on how disappointing it is when they are not part of the conversation and share that “it is not that we don't like phones, but that we love you.” Other ideas for this age group include the following:

• Co-write a formal “no phone” policy with your child that honors table time and other key times, such as bedtime (to avoid interference with sleep),

• Share meal planning, shopping, preparing, and cleaning duties with all family members,

• Give each family member a night of the week to own the menu or plan an activity,

• Establish a family group text to share calendars and daily messages,

• Invite family members to set timers or alerts on their devices to limit screen time,

• Create a drop box outside the kitchen door to hold devices during meals.

Adolescents and adult children. “The World Unplugged” project at the University of Maryland found that the majority of university students across the globe experienced increased distress when asked to go without devices for just 24 hours.⁸

Individuals in this age group sometimes feel like they don't need parents at all. Connecting is easier if it has been part of a child's culture growing up, but it's never impossible. Preserving unscheduled time and listening with an open mind — both tricky tasks — can spur unexpected conversations. Here are some ideas:

• Formally invite your child for dinner,

• Say “yes” when invited by them,

• Plan an unplugged “staycation” at home,

• Ask how their friends address “family time” in their homes,

• Welcome new ideas when guests visit,

• Adapt changes to their suggestions,

• Pose “table questions” about lessons learned, careers, goals, or friends,

• Be vulnerable and share fears experienced along personal career paths,

• Reminisce about past conversations,

• Reintroduce “roses” and “thorns.”

PROTECTING TIME FOR FAMILY

Jordan took three months off when her daughter was born. After extending her residency, she accepted a full-time academic position. Over the next three years, she and John added two more children to the family. Jordan describes those years as a blur. When she was home, she felt needed at work; when she was at work, she felt needed at home. She was late for everything — late to see patients, late to write notes, late to pick up the children, late for supper, late to bed, and even late to her own children's well-child appointments. The promise of quality table time rarely came to fruition, as most often no one went to the table.

It's easy to identify with Jordan's plight. Protecting family time is a challenge when other important duties compete for our attention. Whenever I find myself saying, “I don't have time” to focus on myself or my family, I am reminded to reassess how I choose to spend my 24 hours a day. A time log (see “24/7 time log”) is a tool you can use to record your hours, just as you would use a food log to record dietary choices. Family members can complete time logs independently or together to look for patterns and identify opportunities for shared activities.

Families can also work together to complete a SWOT (strengths, weaknesses, opportunities, and threats) analysis. Young families can make SWOT questions into a game. Families with middle schoolers or teenagers can answer the questions independently and then share with each other to validate individual voices. The goal is for each member of the family to contribute at least one item in each of the four SWOT quadrants. It may not be feasible to take a trip to Tahiti (an idea my daughter suggested at age 11), but all ideas should be welcome and discussed.

SWOT family prompts can include:

• S: What do we love about our family? What do we do well to care for each other?

• W: What could we do better to understand and support one another as a family?

• O: What could we try doing to make us more connected as a family?

• T: What negatively impacts or limits our family's well-being?

There are other ways to take stock of whether you're properly prioritizing family time. The Personal Health Improvement Plan tool (also available at http://www.MyPHIT.org with daily reminders) can be adapted for family use. Start today and continue for at least 21 days.

Reflect together on your collaborative SWOT and prioritize one “SMART” goal for protected family time, such as the following:

• Specific - Have daily device-free dinners as a family to increase connection.

• Measurable - Process: Did we meet our goal today (yes or no)? Outcome: On a scale of 1 to 5, how “connected” do we feel?

• Achievable - How confident are we that we can achieve this goal (scale of 1 to 10, with 6 or greater required)?

• Relevant - How important is it for us to achieve this goal (scale of 1 to 10, with 6 or greater required)?

• Timely - Begin today, and continue for 21 days.

Increase your likelihood of success by giving all family members a vote on what to prioritize. Keep a list of ideas and try another after your first success. Celebrate and recognize each member's contributions.

RECOGNIZING WHEN WE'RE STRETCHED TOO THIN

Jordan was determined to replay her own childhood for her children. After self-identifying as burned out, she reassessed her choices using a 24/7 time log. She knew that connecting to family would require protected time, so she requested a reduced schedule from her employer. But her request was denied. Jordan made the hard decision to leave her academic job and went part-time at a community hospital. She learned that with every choice there are gains and losses, but the well-being of her family was not something she was willing to sacrifice. John agreed to alter his work schedule so he could help out more with the day-to-day duties as well.

With the help of John and the kids, Jordan established “table time.” Her focus on family paid off. Her children are now grown and remain well-connected. Jordan is now working full time again, and still enjoys table time at home with John as empty-nesters.

Like Jordan, we must protect our time and stay connected to those we depend on and who depend on us. Sometimes that means making hard choices. But committing to our family's well-being affects our own health and sets the stage for broader, more long-term success.