You seem like an incredibly dedicated doctor who spends a lot of her time working. How do you manage to keep your mental health at its optimum? My grasp of healthcare is that it is both physically and emotionally laborious. I know that often, you have shared with us that has been difficult to maintain a work life balance. Do you feel that medicine itself is fulfilling for you?
Thank you! It’s an immense privilege to be able to share some of my thoughts and experiences with you.
You’re right that it’s hard work. Physically, night shifts and long days do things to your body that you didn’t quite realise before you went to med school. It can mess up your eating patterns, sleep patterns, and set off any other conditions you have, for example. I find it much harder to maintain a normal daily rhythm than I used to; after months or years of telling your body ‘you’ll eat/sleep/rest when I have time’ rather than listening to it, you get less good at listening to what your body is telling you that you need. Plus maintaining a healthy diet becomes harder…
Emotionally, it can be draining. Difficult cases. Stressed out patients or relatives. Stressed out colleagues. Too many things to do in too little time; the feeling that you’re always just trying to get by. The background feeling that the NHS is going downwards instead of changing for the better.
I don’t spend more time working than my other colleagues (in fact, right now, this month, being on a gap-year of sorts, I spend *less* time doing so). But I have worked some particularly difficult rotas where it felt like I was always on-call. I’m not more dedicated than anyone else, I’m just lucky in the placements I’ve had. Hard work, but with supportive colleagues and friends who have made it possible to stay focused and sane. Not everyone is so lucky; some people had more problems to begin with, or happened to work in departments that are much more understaffed and poorly supported. Some people have to deal with unhelpful or abusive colleagues. Or with patients and relatives far worse than the ones I encountered. Perhaps they don’t have the same support from friends and colleagues that I did, or they have a lot more problems to deal with. Some people really struggle, but that’s not because they are worse doctors, or worse people. It’s because they’ve got a lot more on their plates. And medicine really does load our plates unequally. Some people get stuck with unfair circumstances, others are much luckier. I count myself lucky.
I was talking abot this with a close friend the other day; there is little difference between me and a doctor who hates medicine, or my colleagues who sadly took their lives. Those of us who got by without major burnout (or worse) arent’ stronger, or better; under the right circumstances we too could really struggle. There were a few times during the more challenging parts of my job when I could really see myself coming close, and I began to understand just how easy it is to be sucked into despair. Any of us, could, under the wrong set of circumstances, end up in their shoes.
How to look after yourself:
This is why we all need support. I rely heavily on my medical friends and our whatsapp groups. When I’m having a bad day, or when I need stress relief, or when I’ve had a learning point to reflect on, or an interesting case, or genuinely don’t know what to do, they are there. It’s not just them; reaching out to close family and friends is vital, because isolating yourself harms you in the longterm, even if it feels protective.
Choose a living situation that works for you.Personally, I like living with flatmates, because it’s nice to come home and rant to someone (and I usually live with medics so they have an idea how it is) and when you get on, it really works well. I’m a bit of an introvert, so whilst I’ll gladly go to the pub with friends (or out for a meal, film, etc) I don’t really put myself out there every night socialising with strangers, particularly if I’m working out of London and I don’t know anyone locally apart from colleagues. If I lived alone I’d find it more difficult to motivate myself to go out. And I know a lot of my friends feel the same. But when you live with friends or flatmates, you encourage each other to do stuff, and also take care of each other. We’d take it in turns to clean and buy food etc so nobody would have to come home from a horrific batch of oncalls to find no food in the cubpoards and that it’s their turn to do all the cleaning.
Ovbiously, you can substitute ‘partner’ for ‘friends and flatmates’, or even ‘family’ if you decide to live at home.. I’m not saying you can’t or shouldn’t live alone; some of my friends love their alone-space. But interestingly, these are usually also the friends who are super-organised, really motivated to meet up and organise things, and get out of the house, so it works well for them. But rather that it helps to build in support into your life, especially if you have a tendency to isolate yourself, or are starting somewhere new and far from friends and family.
This goes hand in hand, but also support each other at work. Be a team, in the truest sense of the word. Be there for your nurse colleagues, and your team. Be kind to the other teams you work with. Look out for the juniors. Be supportive to your seniors. And they’ll do the same for you. In FY1 we used to help each other out all the time; it made a chaotic year much more fun and manageable and helped us make firm friendships. during my paeds job it usually meant gently walking the surgical/ENT/ortho SHOs through bleeding and cannulating kids when they asked our team to do it (because secretly they didn’t know or felt terrified at the prospect). Whenever you can, act in the spirit of kindness rather than being obstructive; if you have the time and energy to help, consider doing it. There will be times when you have to stick up for yourself and will be cross, but try not to let that be your default response.
Having hobbies and interests outside of medicine is also important. It’s easier said and done. Ask me how many novels I’ve read in the past few years and I’ll laugh in your face. I count myself a prolific reader, but something has to give; when you’ve got one or two hours in a long day to eat and de-stress before bed, you ealise how finite your time and energy are. Even the things you decide to prioritise might not cooperate with you; medicine can sap you because it leaves you with little time and energy. Even when I had time to create, you can guess how creative I felt after a difficult week at work. Sometimes you look forward to days off ages in advance, but when they come around you are so knackered that all you can manage is cleaning your flat and going to the park.
Part of keeping your health as good as you can is trying to maintain some semblance of rhythm in your life. Eat when you know you have ot eat, sleep when you know you have to sleep. Even (as I mention below) when you don’t feel like it). Make time to see your dentist and your GP if you need to; that’s all part of self-care but we are usually the worst at sorting our own problems.
You’ll need to put extra effort into your social life. Plan meetups in advance, because I promise you that when your day off comes, you’ll feel too tired to plan something last-mintue then, unless your friends and family drag you out. Give yourself things to look forward to, but be kind to yourself if you decide you aren’t up to them. This can be a whole other layer of challenging when your friends are either also working hideous rotas, or are married with kids/live on the other end of the country etc; sometimes I look back at when we were all 16 and could just meet up without any effort and wonder at the difference.
Is medicine fulfilling?
I love doing what I do. I don’t find it horrible working sets of nights or picking up that second long day in the week because when I’m at work, I’m not miserable with what I’m doing. Sure, sometimes it’ll be a stressful day (I arrive in A&E and 9 patients are waiting for me to see them, it doesn’t get better the entire shift) or I’ll be stuck with a colleague who stresses me out and makes me feel inadequate. But on the whole, most of the time, I leave work with a feeling that I’ve done OK, good even. And I don’t dread going back the next day. Even though I’ve got a lot to learn, and I still feel nervous with my ever-increasing responsibilities, I enjoy being ‘clinical me’. I’d say it’s fulfilling.
But medicine can take over your life, not just when it makes you miserable and you hate your placement or colleagues (and boy, can it make you miserable if that’s the case!), but also even when you like what you do. Because working all those shifts, and staying late, can really affect how much time you have to spend being you. The ‘ouside of hospital’ you. It’s just physically much harder to stay in contact with friends and family when you are working all hours of the night or day. When you have projects, and audits, and exams outside of work (which you will do, there’s a ton of stuff behind the scenes which you have to do in your own time in order to continue doctoring), they also take up your precious free time in ways that your 9-5 colleagues don’t have to deal with.
I’ve been very lucky; I’ve generally enjoyed my placements, and worked well with my colleagues, and found medicine itself to be really fulfilling. It’s not all nice things; there’s the mundane and the stresfful, but overall I’ve enjoyed it more often than not. I know that’s not true for everyone, and I think how fulfilling it is can depend a lot on finding the right specialities for you. I’m still working on finding the right balance, but I’ve got a good idea.
It’s not that medicine isn’t fulfilling for me, but rather that because it is, it can take over your life. It’s because what you do feels important. Because you enjoy it. Because you care. Because you want to be a better doctor. Medicine can take up a lot of time and energy, and it’s hard to carve out a space in your life that it doesn’t take over. It’s something we all have to work on. I love my job, but In the long run, neglecting my out-of-medicine-life wouldn’t be fulfilling.
You can be happy in your job but still feel unfilfilled in your life outside of it; if you let friendsips fall by the wayside, or neglect relationships. If you don’t have kids but want them, or have kids and feel you are never there for them. If you miss important life events for work and feel you are never there for the people you love. If you give up the passions in your life that make you happy. You can still love your job but miss out on the other things that make you happy. There’s no easy choice; you have to find a balance that works for you.
It’s one of the reasons I am not planning to stay on in paediatrics, for example. I love the job despite the stresses, but the timetable decimated my personal life; the idea of combinign that with exams made me realise I’d be happy with my job but miserable that I got to do little else. In the long run, I don’t think it would make me happy. Because happiness is more than just enjoying what you do at work. It’s also having time and energy to do the other things that make you happy.
So I’ll have to work to find a balance that suits me.