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Looking After Ourselves - resilience & preventing burnout

No one is immune!

Working as a doctor can be stressful. Despite a lifetime of work spent offering advice to patients about healthy living, including diet, exercise and lifestyle modifications, doctors are not always  good at seeking appropriate help for themselves. Stress can occur at any point in a persons’ career, from training grades through to qualified GPs and even TPDs and those in Deanery/HEE positions.  Trainees face particular challenges with membership exams, shift patterns and night-time working, although many potential causes of stress exist for doctors at all levels.   And if that stress is not managed at an early stage, it progresses to anxiety, depression and/or burnout. Burnout is defined as a syndrome of emotional exhaustion, involving the development of negative self-concepts, negative job attitudes and a loss of concern and feeling for patients. Stress and burnout lead to maladaptive coping strategies, such as substance misuse.

  • The prevalence of depression in UK doctors is between 10% and 20%,
  • Burnout affects variously between 25% and 75% of doctors.   Don’t you think that number is incredibly worrying?
  • What makes you think you’re immune?

What makes our profession so prone?

  • Factors related to the job such as workload, time pressures, shift patterns related to the European Working Time Directive, etc.
  • Role-related stress, including the notion of the level of responsibility and the concept of having responsibility without any control
  • Conflict between home life and work pressures
  • Relationship difficulties with colleagues at work and/ or partner/family at home
  • Career development factors – achieving too much too quickly, trying to be the best rather than being good, trying to everything.
  • Factors related to the organisation you work in and the teams in which you work – meeting the demands of a forever changing and demanding NHS, the pressures, strategic responsibilities

First things first... 5 easy things

At different points in our lives we will experience varying levels of stress.  Sometimes life will be nice and easy and other times rough.   Whilst we don’t want too many unnecessary waves (and some of them are preventable), others are natural and we need to learn how to ride with them.

So, no matter how stressed you are, there are FOUR things we can do to lessen the impact of stressful waves.

  1. Sleep well.  About 7-8 hours a day.
  2. Eat well.  Avoid junk food and sugar-laden foods.  Try lowering your simple carbs.  
  3. Drink well.  Keep hydrated.  About 6 glasses of water a day.  Stay away from coffee and alcohol (and of course drugs – including ProPlus!).  If you must have coffee – just the ONE a day.
  4. Exercise – get out and go for a fast paced walk for 30 mins.   Even if you don’t feel like doing it, just do it!  You will be shocked at how immediate an effect this has on you.  Take a friend or your loved one with you.  Wrap up warm if it is cold.  Walk 5 times a week.  Or go to the gym.  Or some active activity.
  5. Make these things into a habit.  By starting off consciously doing them regularly everyday, they soon turn into an effortless habit.  Then you can build in other habits like daily Mindfulness practice.   The great thing about habits is that they are effortless and things no longer feel like a chore!   But these things keep you centred, grounded and well-balanced.   When you’re in this state, you can then cope with life’s natural ups and downs.
So, when you’re stressed and say that stress is like a 7 out of 10, if you DON’T do any of these four things, your stress levels will feel more like 15 out of 10 rather than 7!   Which do you think you can cope with better – stress that is 7/10 or 15/10?

It's good to talk...

When things get tough, it’s good to talk.   You will feel an instant release of pressure, just from the very act of talking.   Every one needs to vent now and again.  So please talk to others.  Here are some people you can talk to

  • Your partner
  • Your family 
  • Your friends
  • Your work colleagues -fellow trainees, fellow GPs, GP trainer, Educational Supervisor, Clinical Supervisor, Training Programme Director, Appraiser
  • Your GP – yes, your GP.   That’s why all of us need to be registered with a GP
  • The GP Health Service for GPs
  • The BMA Well-being Service
  • All GP trainees can access their local counselling service available from their Deanery (see local deanery website)

Please register with a GP

Most GPs are wonderful, kind, caring people.   And they know how difficult being a doctor is!   They will be understanding and compassionate and will not look down at you.   Your GP will probably feel honoured that you came to discuss this with them as they know it’s sensitive territory.

A UK study found that although 96% of doctors are registered with a GP, little use was made of their services, and a quarter of consultants would bypass their GP to obtain consultant advice (this is a bad way to do things!).  A GP is more likely to be balanced in their thinking compared to a work colleague who you know and seek for specialist advice.

  • Make sure you are registered with a GP.
  • If you are unwell, seek the advice of your GP.
  • Avoid prescribing medication for yourself or your family members.
  • If for any reason you feel that you cannot see your GP, you may need to consider changing your GP.
  • If secondary care is needed, talk to your GP about a referral, but remember to be guided by them.

Look out for the signs of stress and burnout

Some of the most common signs of stress you may notice in yourself quite early are

  • low energy,
  • headaches,
  • feeling agitated, feeling overwhelmed, having trouble sleeping. 
  • Noticing that you’re no longer engaging in your hobbies, interests or noursihing activities (e.g. perhaps you have stopped going to gym because no time)
  • Noticing that you’re spending less time with family (or perhaps your family have made comments on this to you)
  • Noticing that you’re no longer socialising or seeing your friends much anymore.
  • Not looking after yourself – eating chaotically, weight gain, drinking too much coffee
  • Engaging in dangerous actitivies – gambling, alcohol, drugs

Regularly keep an eye on yourself, and when you notice any of these things, PAUSE and TAKE A MOMENT TO REFLECT.   And be brave and talk to someone about it before it eats you up and takes control.

 

Resilience

  • Resilience is: “The capacity to prepare for, recover from and adapt in the face of stress, challenge or adversity.”
  • Practice being flexible through mindfulness; journaling, talking (i.e. being flexible is at the heart (and head) of good mental and physical health AND resilience).
  • Emotions create habits (wanted and unwanted) so now is the time to create positive habits via connecting with positive feelings – be compassionate, smile more, practice, say gratitudes etc.
  • Start a new tiny wanted habit today: After I (e.g. have a coffee) I will (e.g. relax for 3 seconds) and when you have done that – big smile 😊

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource.
And of course, if you have developed a resource of your own, please email it to me to share with others.

'Make GP Training Better Together'

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