Wellbeing is the state of feeling happy, healthy and comfortable. Writing this blog post could not have come at a better time because 11 months into being doctor and I can admit that I am not at the level of health or overall happiness that I was once at. Things were a lot worse, especially in the peak of the pandemic, but after taking some time off work and implementing the changes I am going to discuss, I can say that I am not where I want to be but I am not where I used to be.
Being a Doctor is a very fulfilling and amazing job (one I will not change and am very grateful to have) but with many things in life, it comes at a cost, especially in your junior years. We all know that medical school can leave you very isolated from your non-medic friends. I remember summer nights and weekends in which I missed house parties, festivals, weddings and even THE Afronation all in the name of OSCE practice and medical school exams!
I told myself that things will get better once I become a foundation doctor and I can confirm to you that, I was mistaken.
The transition from being the most experienced student in your medical school to the least experienced at work is one that greatly affects your confidence and leads to anxiety. Many medics have a Type A personality; so having to admit that I did not know everything, feeling anxious about my decision making, and having to understand hospital politics, led to several encounters that convinced me that I did not deserve to be a doctor.
Professional medical training is varied depending on the hospital you work at but one thing is guaranteed. That is, as a junior doctor, you will feel like a glorified secretary more often that not and you often have to tie up the loose ends with very little extrinsic affirmation. I say this not be pessimistic, but to give you a real insight into the emotions that many of my colleagues and I have experienced during our time so far. But as you progress and your emotional intelligence develops, things get a lot better.
I can recall a time in which I was doing a discharge summary, HANGRY (this is a colloquial term to describe the anger you experience when you are very hungry) and I prescribed a patients antibiotics as twice daily as opposed to three times daily. After being bleeped by the very polite screening pharmacist in order to clarify my prescription, I was convinced that I was the worst doctor and my patient would have gotten sepsis and died because of my prescribing skills. I went into a rabbit hole of pessimism and lost confidence in myself which in turn made the problem worse. After a prolonged period of self-development and deep reflection, I soon realised that my wellbeing was in a terrible state, and that was not due to my professional medical training, but due to the importance I had placed on my medical training.
Below are some tips I implemented which greatly improved my psychological and social wellbeing.
1. Everything has equal importance
This is a concept I learned very recently. Everything has equal importance or nothing has
importance at all. We often find that when we place too much importance onto something, we often achieve the very opposite effect to what we desired. One thrives in life when an equal importance is placed onto everything. The desire and drive you have to become an amazing doctor and making sure your DOPS are signed off, is the same you should have towards prioritising your mental health and ensuring that time spent with your family and friends is ticked off your check list.
Foundation training can be time consuming but with real intentionality and learning how to organise, you will find that you will have pockets of time to fit in exercise, socialising and self-care. Diagnosing a patient with a condition means nothing if you haven’t diagnosed yourself as needing rest. Recognise that your purpose is bigger than being a doctor, and in order to fulfil your purpose, you need to be a well rounded and holistic individual. Your wellbeing is made up of a perfect unanimous working of all the areas of your life. You will never achieve true happiness, health and comfortability if you are prioritising only one part of your life.
2. Learn how to say no and take breaks
If you do not know how to rest then you do not know how to work. When you first start work, your insecurity and desire to be liked or viewed in a positive light causes you to bite more that you can chew. You volunteer to become mess president, get involved in 100 audits, take on extra shifts and write essays of discharge summaries. Remember that people will treat you how you treat yourself. If you want to be a work slave then you will be treated as one. You soon learn what needs to be done urgently and what does not need to be done. As a junior doctor, you work as part of a multidisciplinary team and you are responsible for helping the other members of your team. It is okay to say no sometimes and admit when you feel overwhelmed. It is okay to ask for help, it does not make you less of a doctor. People will respect you more when you say no as opposed to say yes and do a half-hearted job.
‘No I unfortunately cannot cover that on-call because I currently feel burnt out and I worry that I will not be able to provide good patient care. Can I keep this day off to rest? I am still open to helping out in the future’. I remember days in which I would say yes to every request knowing that I have a million other things to do, I would stay at work until 10pm and only surviving on 4-5 hours sleep because I had spent all day saying yes to doing non-urgent bloods, cannula’s and catheters. One thing that I started to do is admit that I was overwhelmed and busy and would start to encourage the nursing staff to try. The conversations would go like ‘Doctor, Mr X’s cannula came out, can you come and do it please? ‘ My response would be ‘Sarah, I am currently really busy reviewing a patient and overwhelmed, could you kindly try to have a go or ask the ward sister to try and if you are not successful, give me a call back. I will come and do it before his next medication is due.’
3. Let work, work for you and not the other way round
My schedule is made up of my regular working hours, week and weekend on-calls coupled with my desire to decorate my Horus portfolio*. There is an unspoken competitiveness sometimes at work, and that coupled with insecurities, makes one put their all into their working day, going above and beyond not only for patient care to but to prove a point to your colleagues. Working all the time left me so tired, drained and burnt out. Even with my new found financial freedom, I still found myself too tired to engage in social activities and even conversations outside of work. I began to withdraw to the point at which the thought of social interaction used to give me anxiety and make me more tired. By the end of my zero days (the mandatory days you get off after on-calls), I found myself not feeling well rested and ready to begin the cycle again. What I soon realised is to maximise your time off by booking your annual leave around zero days and bank holidays. I would also say, if possible, take a day off on a Friday or Monday every 2-3 weeks in order to treat yourself to a long weekend. Swap your on-calls with your colleagues to dates and times that best suit you both. In F1, you all get paid the exact same amount and on-calls average out throughout the year. The truth is, as long as there is a junior doctor on-call for that shift, not too many people even sadly care. Every trust is different, but the majority are accommodating for swaps.
* (an online portfolio which all junior doctors must complete which includes reflections, teaching logs, summaries of patient encounters and directly observed procedures)
4. Recognise that you can only pour out what you are filled with
Recognise and remember the importance of self-care and days to replenish your stores. Have selfcare days and do what makes you happy. Mute the WhatsApp groups, turn off your notifications. Leave being a doctor at work, respectively, and remember that there is a lot more to you than your profession. A broken doctor cannot fix broken patients , you can only pour out what you are filled up with.
Dr Maame Benko