Our working environment has changed enormously over the last few decades. The workload, intensity and patient complexity have grown exponentially. In parallel, the time and space that we have at work and at home to recharge and support each other has become massively compressed.
My last post looked at the factors that make doctors vulnerable to mental ill-health. Today, I want to share some ideas looking at what we can control, strategies that might help keep us buoyant, happy and thriving, rather than just surviving.
These ideas are not exhaustive and come from a mixture of sources and people. They are what I use to keep myself afloat.
1. Invest in activities that allow you to re-charge and have fun
There are many things that we do that we know ought to make us feel happy, but in reality don’t, or can actually leave us feeling worse. For example, dashing off on a Friday night for a weekend away to ‘recharge’. The reality often being that we put ourselves under more pressure to get away from work on time, with a tiring and stressful journey there and back.
As we have seen before with the exhaustion funnel, when we are busy, or things are getting on top of us, the first things to go are the activities that seem optional; the activities we enjoy; the very things that energise us and keep us in balance.
2. Develop positive life habits
Positive life habits are the routine behaviours that are beneficial to our physical and emotional health. This means prioritising sleep, paying attention to what we eat (more in another post!), getting regular physical activity and making time to see friends and family that energise us. And avoiding those that drain us!
It is also about avoiding negative habits such as the alcohol/caffeine cycle and excessive screen time.
Optimising our physical health puts us in a better position to cope with the pressures in our work and home lives.
3.Build our support networks at home and work
This may seem obvious, but often when we are under pressure we often see less of the people that we most want to spend time with. Or we isolate ourselves more at work, staying late, or arriving early, not feeling that we have enough time for even a brief conversation.
An old colleague recently told me that he would have left medicine after a particularly nasty complaint if it hadn’t been for the support of his colleagues around him. They buffered the battering his confidence and self-esteem took.
If we have a good support network both at work and outside work, we are more likely to enjoy our work and home life and have a safety net for those more challenging times.
A recent study in the BJGP looked at resilience in GPs working in areas of socioeconomic deprivation. Three main themes emerged; one being that resilience was enacted through teams rather than through individual strength. This highlights the importance of nurturing those connections at work.
And those connections don’t just need to be within our immediate workplaces but may be with other colleagues further afield who share similar interests. Social media (not without its warnings) can also be a good way to do this. When I was struggling I connected with others through social media, who had been in a similar boat but were further on in their journey than me. Many are now friends and the support they gave me was invaluable.
4. Be kind and compassionate to others
As doctors, we are usually pretty good at being compassionate to our patients. But often, we give so much to our patients that we have nothing left in the tank for our colleagues, or we fear taking on their problems or supporting their time off for what it might do to our own perhaps fragile state. We may not even notice a colleague is struggling as we are so absorbed with our own workload and problems.
A cup of tea, a few nice words, small things that don’t have to take up a lot of time might make a huge difference to someone’s day.
5. Be kind to yourself
We all have an inner critic. That voice inside that can judge us mercilessly. And when we are feeling low, that critic usually gets more air time.
Being kind to yourself is about giving yourself a break and extending the same kindness, care and compassion that you would give a good friend. Kristin Neff, founder of the self.compassion.org has extensively researched this field and her website has lots of guided meditations, tips and exercises to practice.
6. Recognise and minimise stress where possible
As doctors, our drive to do well or please others means that we often ignore stress through habit, overriding our awareness and leaving us open to taking on too much and feeling overburdened.
However, most of us are good at problem solving. So if we can make the time to step back a bit, we might be able to work out ways that we could reduce our stress. This might be by identifying triggers, organising our time better, or addressing the causes that we can change and learning to accept the things we can’t. Doing this with someone else – a friend, a family member, or perhaps better, someone external such as a mentor or coach to see where we might be stuck, and come up with some practical solutions and actions can really help.
7. Change the way that you think
Sometimes, we focus on all the negatives of modern day practice and forget what we actually enjoy about our jobs. I recently did an appreciative enquiry exercise looking at what made us happy at work. It was incredibly energising and the whole atmosphere in the room shifted. So flipping our thinking round by reframing and looking at the positive is one way to change the way that we think and feel about our situation.
Practising gratitude is another. Gratitude is about taking the time to notice the good things in our lives. All too often we spend our time worrying and ruminating about what is wrong and we forget about the small things that might have brought a smile to our face or that made us feel good. Research shows that focussing on the positive helps boost us psychologically and socially. Finding three good things each day is the way that I do this.
Learning to accept imperfection and being “good enough” are also key. I find this hard, as do many of us. Not helped by the current culture of increasing public scrutiny and rising complaints. For me, challenging my thoughts helps, asking myself what a colleague would say or do, what the worst case scenario might be or thinking about how I will feel about something in six months time.
8. Housekeeping and managing our emotions
Working as a clinician can be challenging and require a lot of mental energy. The emotional labour is high – we may switch from breaking bad news, to an angry patient, to a problem in the practice all in the space of a few minutes. As health professionals, we still have to maintain a professional, external state regardless of what we might really be feeling inside.
Taking a pause and a few deep breaths when we feel stressed or overloaded can help recalibrate. It might be enough to help us think more clearly about our next move or to focus more effectively. The pause might stop us reacting unproductively or having a negative conversation with someone that we might regret later.
Dr Roger Neighbour calls this ‘House Keeping’, recognising in his landmark book, ‘The Inner Consultation’ that “a consultation is not over until you are ready for the next one. ”
9. Tapping our inner strength
One of the hallmarks of burnout is feeling a lack of personal accomplishment. When we are finding things difficult, we often lose our self-confidence – I know this has taken ages for me to build back up. It is still not back to where it was. Shame and guilt have been big hurdles to overcome.
Reflecting back objectively on times that we have done well (the wall of achievement) and learning from our mistakes helps build back our sense of self worth.
10. Seek help
There are many barriers to seeking help, one of which might be our own lack of insight or the expectation that we should be able to treat ourselves. In addition, shame and guilt, concerns about confidentiality or simply getting the time off to see someone are amongst the challenges.
Once we do access help however, and take off that metaphorical white coat, it can be transformational, as data from the Practitioner Health Programme has shown.
In reality, we all want to be doing more of what we enjoy and most of us will recognise that making time and space for ourselves to do this is important. However, when we are feeling under pressure, particularly in the current climate, self-care is often the first thing to go. Yet it is perhaps the most important thing that we can be doing to help maintain our wellbeing and prevent chronic stress and burnout.