Stress management as a Junior Doctor – Part 1

Working in health care is emotionally and physically draining. Burnout and low morale are rising. Stress is endemic amongst the medical profession. 80% of junior doctors report excessive work-related stress 1,2, 38.4% of NHS staff went off sick with work-related stress in 2017 3 and 61% say their work-related stress had risen in the past year 4. This has resulted in an ever reducing number of junior doctors continuing directly into speciality training 5 and a quarter of them experiencing burnout 6. It is not only paramount that the current status quo is improved for the wellbeing of junior doctors, but for their patients too, whose safety is threatened in light of poor morale and extreme stress 7.

The answer to doctors’ work-related stress is likely a multifaceted approach, including culture change, improved support at the institutional and governmental level, and personal resilience.

So, initially I thought of doing this blog as a more science-based post, the research says x, y and z. But I decided to make it a more personal one. I’m going to share with you the things that I have found have helped me personally cope with stresses whilst being a junior doctor. In doing so I hope that anyone, doctor or not, could take this tool kit and apply what resonates with them and practice it in their own lives to lead a more fulfilling one where stress doesn’t dominate.

I honestly did not enjoy my foundation training years as a whole. A lot of hospital medicine isn’t me, I don’t do well without sufficient sleep and living in hospital accommodation (basically the top floor of the hospital) didn’t give me enough space between work and home. I’m going to share with you some of the lessons I’ve learned from my personal journey through work-related stress is.

Knowing your limits and saying no beyond them

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Full time working in the hospital was making me unhappy. I didn’t have enough balance to prioritise aspects of my life which were really important to me, the people in my life mainly. I made the decision to go part time for specialist training. I needed to put the effort in to make it happen for me, as usually you are only allowed to go part time for raising children or being ill, but I made it work. Now I’m a part-time GP trainee doing a Masters of Public Health alongside this.

The key message behind this is that identifying your limits is a really important lesson for yourself. Everyone will be different. It will depend upon many things, your resilience, how much you enjoy the time you spend at work, your home life etc.

It can be challenging to stick to these limits whilst being a junior doctor. I know where I work it’s not uncommon to be asked to fill antisocial hours at the 11th hour. Saying no to this can be a real challenge and you can be made to feel guilty for doing so. Remember, you have to look after you to be able to look after others.

 

Find the Blue Zones in you – finding your passion and purpose

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Feeling that you have a purpose creates a shift change towards happiness. This doesn’t need to be related to your work, it can be, but it doesn’t need to be. It will be different for everyone. If you’re unfamiliar with the concept of Blue Zones, check out my blog on it here: https://emmaatthelifestylepill.com/2018/08/31/blue-zones/

Researchers of the Blue Zones discovered a Japanese concept whilst studying the Blue Zone of Okinawa, that of ‘Ikigai’. This translates to ‘your reason to get up in the morning’. Find something that makes you want to lift your head off the pillow with a smile.

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Picture source: https://marionoioso.com/2017/11/14/ikigai/

Whilst Ikigai is a great concept, I think you can achieve it by putting all the components together with several aspects of your life. I personally feel this makes ‘ikigai’ a more achievable goal. For many of us our passion lies outside our working lives and we don’t get paid for it, but this doesn’t distract from what it can bring to our sense of purpose and fulfilment. Dr Rangan Chatterjee discusses this in his framework ‘L.I.V.E.’, which serves as a solution bringing the philosophy of ikigai into the practicalities of modern life:

L – Do something you love

I – Do something with intent

V – Develop a long-term vision

E – Do something that makes you engage with others

He specifically discusses how each of these can be achieved through different areas of your life. One aspect might need more work than others, that’s ok. It just provides a framework to highlight what you might be lacking and what you can work on the minimise your stress.

Finding something you’re passionate about is also a great stress reliever. This could be a field of medicine to pursue, but it could be outside of work. Over the past few years I’ve become increasingly excited and interested in the wellness side of health. Learning more about lifestyle medicine, wellness and starting ‘The Lifestyle Pill’ as a passion project has given me this.

 

Talk about it – family and friends, trained professional.

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As the old saying goes, ‘a problem shared is a problem halved’. And it couldn’t be more true. Find someone who you are comfortable opening up with and talk about your stresses with them. You can do this officially through supervisors at work if you feel work is impacting your wellbeing significantly enough change has to occur within the workplace and you can’t instigate this at an individual level. It can also be to family and friends, offloading is not a sign of weakness.

I listened to a recent podcast by The Irish Balance (Dr Ciara Kelly) with Joe O’Brian (@headfirst0 on Instagram). You can listen to the episode on Podbean, Spotify and iTunes (I believe, it maybe on more platforms now), a link to it is here: https://theirishbalance.podbean.com/. It reminded me the importance of emphasising how talking to a trained mental health professional is not just for those with a diagnosed mental health condition and is not something someone should be embarrassed or ashamed to do. If you are struggling this is a great option to get some professional advice and insight.

 

That’s where I’ll stop this week but I’ll pick up right here next Sunday for the second half.

 

Emma x

 

References:

  1. Sahib, B. Five ways to improve junior doctor morale | The King’s Fund. (2018). Available at: https://www.kingsfund.org.uk/blog/2018/02/five-ways-improve-junior-doctor-morale. (Accessed: 18th January 2019)
  2. Royal College of Physicians. Being a junior doctor | RCP London. (2016). Available at: https://www.rcplondon.ac.uk/guidelines-policy/being-junior-doctor. (Accessed: 18th January 2019)
  3. Rimmer, A. Staff stress levels reflect rising pressure on NHS, says NHS leaders. BMJ 360, k1074 (2018).
  4. British Medical Association. BMA quarterly survey. (2017). Available at: https://webcache.googleusercontent.com/search?q=cache:w3cYU-rUEB8J:https://www.bma.org.uk/-/media/files/pdfs/collective%2520voice/policy%2520research/education%2520and%2520training/bma-quarterly-survey-may-2017.pdf%3Fla%3Den+&cd=3&hl=en&ct=clnk&gl=uk. (Accessed: 25th January 2019)
  5. Rimmer, A. Fewer foundation doctors are going straight into specialty training, says GMC. BMJ 354, i4128 (2016).
  6. General Medical Council. National training surveys 2018: Initial findings report. (2018).
  7. Rimmer, A. Junior doctors’ low morale is putting patients at risk, Royal College of Physicians warns. BMJ 355, i6493 (2016).

 

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