Life is full of decision-making and there are many times in a doctor’s life when you have to stop and ask yourself: ‘Which direction shall I take now?’ in relation to your career path or to issues in your personal life. This is the doctor’s dilemma.
It may seem difficult to make that necessary decision because you are so engulfed in the ‘what will people think of me if I do this rather than that?’ mindset. There may be well-meaning senior colleagues who talk as if they know what sort of life is best for you and as they describe how they see your future you inwardly cringe and wonder how they could possibly believe that they know what you really want.
No-one can foretell what the future will bring for you, that is why making some decisions about your life is such a dilemma for many doctors: however when you find yourself saying or thinking along the lines of: ‘if I had my time over again I would definitely have made a different choice,’ then you have a strong clue about what you could or even should be doing with your life now. So think back to a time when you took a leap into the unknown or decided to do something a bit scary and recall what it was that gave you the push to do it. Maybe you took a deep breath and jumped or maybe you wanted to prove someone’s judgement about you as wrong, whatever it took you took that apprehension and just did it.
Since you have started to think about alternatives and other possibilities about your life, you have already started on a journey of change and even with your dilemma about which path to take it’s important to make a choice without endlessly procrastinating. Even if you decide to stay where you are things will be different because you have been considering other possibilities. That means that something will have changed in your present situation too. You may have discovered a way to improve it or may become more determined than ever to explore new ways. Project your thoughts into the future perhaps a year or several years ahead and imagine your life if you continue as you are or if you make the changes you are considering.
Can you imagine how the future you would look back to the today you and remember how great you felt afterwards and how pleased you were with yourself for being courageous enough to take that first step?
Doctor, you may feel stressed because of what you perceive as an excessive workload, so you work very long hours.
You’ve noticed how this pattern affects your home life, especially your relationships with your family and friends.
You’ve experienced the stress of keeping to government targets, especially when this means you have to persuade patients of the importance of having screening tests or examinations. Although this could result in discovering pathology it also means an increase in time spent with each patient, investigations and subsequent treatment.
Unrealistic demands from patients raise your level of stress too. These means time taken to explain why what the patient is requesting is not indicated. Sometimes you may give in and then feel the stress of doing something which may not be in the patient’s best interests.
There is, too, the ‘gremlin’ sitting on your shoulder, nudging you about possible litigation and asking you whether you’ve done the right thing, in case the patient decides to sue you.
When you feel well and unstressed you can deal with all of these things in a relaxed and professional way, but what can you do to move from stress to confidence and calmness?
Ways to reduce your stress levels are simple. The strategies listed below may
seem like common sense and some of them are just that. They are probably things you know already and may even be advising your stressed patients to do these already.
Stop caffeine: this has a huge effect on stress levels. Limit caffeine to one cup or less a day and notice how your stress decreases.
Learn to relax. Do this at least once a day. Arrange to have a gap, a 5- 10 minutes each day, when you can sit quietly. This could be when you take a break in the middle of the day, or in your office between patients. It’s fine to do this sitting in a comfortable chair. Close your eyes and start with your feet, think about each area of your body, and consciously tense the muscles and then relax them.Take relaxing breaths whenever you feel the stress rising. Take a slow breath in, to a count of five, as you think about breathing in relaxation, then a slow breath out as you think about breathing out any tension in your body.
Do some regular exercise: walking for 20-30 minutes each day either from your car, bus or train, to your place of work, or by going outside in your lunch hour not only to have something to eat away from your desk and patients but also to have a walk.
Eat more healthy foods, which means eating more complex carbohydrates and cutting down on sugar and other simple carbohydrates. Eat a Mediterranean type diet, with more fish and less saturated fats
However simple as they seem to be, they work. So take yourself in hand and resolve to try the five strategies until they become new automatic habits for you. To become automatic you may have to repeat something new for 21 days. So make a chart with these five habits listed and tick them each day you succeed in doing them.. You could also log your level of stress each day on a scale of 1 to 10 and notice the improvement.
So many doctors would like to have a different sort of life. Do you sometimes dream of a life, yes, as a doctor, but with the time to do the sort of work that inspires you and has a huge benefit for your patients? Yet instead you have to deal with the reality of busy clinics, demanding patients with not much wrong with them while others who you would dearly love to have the time and energy to treat and give the benefit of your expertise to, are side-tracked because you have to keep going to get the work done each day.
Perhaps at first you were so thrilled to have qualified after all those long years of study as a medical student, that you were even glad to suffer the lack of sleep and heavy work load of the time you spent as a junior doctor, yet always dreaming of when you would become a consultant and then at least you would have the life you dreamed of.
Yet perhaps it hasn’t quite worked out the way you hoped. You are the victim of your own success. Even though you are highly intelligent you just don’t seem to be able to make the changes you know you want to make. You succumb to the ‘emotional blackmail’ of colleagues asking you to do extra work, or the opportunity to do extra private work, because you know you can genuinely help people with your expertise and you hate the idea of letting people down by saying ‘no’.
You are juggling too many plates in the air and are becoming more and more stressed as a result.
There is an alternative: you could:
discover how to free up more time
start to put yourself first for a change
do the work you love, yet on your terms
change something in yourself
actually take the actions you know you have to take
become highly motivated
How can you achieve all of these?
Be highly self-motivated, make your plans and take action. You already know what you want to do so ‘just do it.’ But you’ve been like that for years so what would give you that push you need to actually make that difference and initiate the changes you want?
Find someone who is ‘on your side’, supporting your ideas, motivating you to take action, acting as a sounding board, challenging you to think through what you plan so you so you develop the strategy best for you.
Doctors contact me saying that one of their aims is to improve their work -life balance. They know what happens when this is too heavily weighted to their work activities, seeing patients, or doing the admin tasks of a busy medical practice and too little towards the rest of life, but feel they are unable to change anything.
One of the challenges of being a doctor is worrying so much about what’s happened during the day that you may find it very difficult to ‘let go’ when you go home.
Do you worry about whether you’ve made the correct diagnosis, arranged the appropriate investigations and explained the procedures in a clear and unambiguous way to your patient?
Is there a little ‘gremlin sitting on your shoulder nagging you about whether you’ve been a proficient doctor and done everything you have to do for that patient?
Don’t worry you are not alone! There are hundreds of other doctors who experience a similar sense of anxiety when they leave work and start to go over in their minds what happened during the day. And it’s not only worrying about one patient: those feelings you may have of not doing as much as you could do may be multiplied many times.
As a result you may begin to feel overwhelmed and exhausted. So what could you do?
You could develop a simple ritual to do before you go home so that you tell yourself that you are washing all that ‘stuff’ away.
You can do this simply by washing your hands and telling yourself that all your worries and anxieties are going down the drain with the dirty water. I used to do this and found it very effective.
When you do this or something which is relevant to you, then you will be better able to relax and enjoy your hours away from the patients and return next day feeling fully refreshed and ready to face up to the new challenges the new day will bring you.
Coaching is a way of enabling people to find their own solutions to their challenges and so it’s always useful improve your coaching skills and use them as much as possible.
As a doctor you may need to be prescriptive at certain times, yet there are instances when you could use coaching skills rather than just telling the patient what to do. When someone is involved in the decision-making process then there is likely to be greater compliance with the part of the procedure or treatment about which they have less choice. Here is a reminder of ways to use coaching within the medical consulation:
Ask the patient for their suggestions:
Rather than telling the patient with heart condition ‘ Lose weight and stop smoking,’ ask:
‘ what will you alter in your life in order to increase your chances of recovery from this illness?’
When they (hopefully) say they need to lose weight you could ask how they intend to do that, or what help they would like from you or the practice in order to achieve their goals.’
Encourage them to set achievable and specific goals:
If, for example, they have come up with their needed lifestyle change would involve weight loss find out how they intend t achieve this rather than plunging a diet sheet in their hand and saying: ‘just do what it says in the leaflet.‘
When the patient knows the goals they are working towards they are being forward thinking and outcome focussed and that in itself can be beneficial to someone who is feeling awful in the present time. It’s about encouraging them to think positively, take each step as it comes while keeping a desired outcome in their mind do they can move as close to it as they can do.
If you have useful information to share in the discussion then always ask:
‘ May I tell you what happened when other patients tried to do that?’ or ‘Can I tell you the options you have to cure this illness or to relieve your symptoms?’
When the patient asks for more information about their illness, ask first what they already know about it or if they have known someone with something similar and what they might be worried about in relation to that illness. In this way you can focus in on their worries and anxieties and discuss their options further, allaying fears and reassuring them about what they can do to help themselves in addition to what you can do too to help them.
If you’ve been through years of medical training, passed your exams and become a doctor, ask yourself whether you are a doctor for life and discover for yourself how much of you is now wrapped up in your identity as a doctor?
It’s important to remember that you are more than your profession, that you are more than your training and you deserve to have a life both in and out of Medicine.
Yet so many doctors forget this and as a result they neglect the important parts of themselves that existed before they became doctors and will be there when they have retired from Medicine.
If this applies to you too then consider this: your life as a doctor is more than your medical practice. You are allowed to have other interests apart from medicine and to have the time to spend with friends, family and community too.
What’s stopping you having your life as a doctor combined with a life away from that identity?
Perhaps there are overwhelming pressures on you to pass examinations, to do more research and to fulfill the expectations of your seniors. Maybe you put so much pressure onto your juniors in their pursuit of medical excellence and success that they daren’t question you nor realise that a doctor needs balance in his or her life.
Yet when you do create space for something away from your medical work you will find that you become more able to deal with the stresses of your day to day working life as a doctor.
Remind yourself that you became a doctor to diagnose and treat sick people, but you didn’t necessarily agree to give up every other aspect of your life. Recall what used to make your heart sing before you became overwhelmed with the doctor’s life. You may find that just remembering what it was that gave you an internal buzz that you realise you would love to re-visit that hobby or activity once more.
Don’t only think it, make the decision now, today, that something has to change and do one thing differently that will be the first step to changing your life to include things away from Medicine for a regular time set side each week just for you. The step you take could be simple and might be for example to book a ticket to go to a concert, see a film, join a class, bang a drum or go for a walk in the park.
I experienced a doctor’s life for many years, in spite of the heavy work load the frustration and the exhaustion which went along with it, I am grateful for certain aspects of the life of doctors.
I know now that it was truly a privilege to be able to communicate with people from all sorts of backgrounds, education, and in various emotional and physical states. It is special whereby as a doctor you are trusted with information not shared with anyone else. The patient trusts you with what they want to unburden and it is something which a doctor has to learn to accept and deal with.
Being a doctor goes beyond the conversation and the exchange of words: it also involves the physical examination, during which the patient may reveal more information that is helpful towards the diagnosis and treatment; and then there is the intellectual stimulation for the doctor of deciding what might be the reason for the symptoms, and initiating further investigations and treatment.
I’m grateful for:
Being able to listen to what people tell the doctor. Doctors must listen twice as much as speak and not jump to conclusions immediately. This was not always easy in medical consultation when limited by too little time per patient.
Knowing there is always the question: what do you want? Patients approach with a long list of symptoms and your heart goes into your boots but what they want is for you to sign something not turn their whole life around.
Noticing what isn’t being said People may use an excuse such as ‘I’ve got a cold’ as acceptable when they really want to say ‘I think I’ve got cancer.’
Being interested in people. People are all interesting and a doctor must try not to make judgements. Realising that people will only do what they are willing to do.
Patients will only do what they will do however strongly you tell them to change their lifestyle there will always be excuses if they don’t want to follow your advice.
So a doctor’s life taught me many things now used during coaching.
Listening rather than talking is important because by listening you can enable another person to discover their own solutions.
‘What do you want?’ is a vital question to get people to set their goal in life and what they want to achieve with coaching. People are fixated on what they don’t want.
During coaching, asking challenging questions helps to find out what isn’t being said.
Being interested in people is vital for a coach.
Coaching works when it enables people to decide for themselves what they will do rather than being prescriptive as a doctor must be, because even when you tell people to do this or that they decide for themselves.