As a busy doctor working hard, trying to have more balance in your life, you must avoid ‘emotional blackmail.’
There are two opposing forces inside you: the part of you that wants to have a happy and balanced life and the other that doesn’t want to let colleagues down.
Here is a typical scenario: a colleague is away, perhaps through illness yet there is a clinic to finish, a ward round and emergency patients to admit. You are already overwhelmed with work yet you are asked:
‘Can you just see these extra few patients?’ ‘It won’t take long, can you speak to someone on the phone?’ ‘Please, will you check Mrs So and So, she’s not feeling too good?’
You know that it will take more than the few minutes and you sigh as you realise your other plans will have to be cancelled again. You know that a doctor you must be willing to drop everything in the case of emergency and so you will need to make a rapid assessment of each request. Have you the confidence to say an assertive ‘no’ to all except those extremely urgent and important scenarios?
Similarly, when you are asked to do extra clinic sessions and you had planned to do things at those times. You find yourself saying ‘yes I’ll be able to do that,’ because you don’t want to upset the person asking you. Instead, you could try: ‘I’m sorry I can’t help you out this time.’ Doing that may seem difficult but do you know what the likely response will be? It could be, ‘OK. That’s fine. I’ll ask someone else. It’s not a problem, don’t worry.’
It’s important to look after yourself as well as you look after your patients.
Create boundaries and do your very best to keep to them. However hard you try you can’t be perfect you can only be as good as you can be. That means learning when to stop and when to say ‘no’ if you are being asked to do something which you know either isn’t your job or you really don’t have the time or the skills to do it.
Decide how long you will spend worrying about a particular patient and when you reach your limit seek advice from colleagues. You learn by watching others and talking about what you find difficult. So stop worrying, identify the person who knows how to deal with the situation and ask for help and advice from them.
You don’t have to deal with every problem entirely alone. Talk to someone else about the parts of the job you find difficult and if necessary put aside time to learn the extra skills you need. This is better than struggling on for ages not really having much idea about what you are doing.
It’s OK to say ‘I don’t know what to do’ or ‘ I can’t deal with this situation, I need to talk to someone else about it.’ This is how you will learn what to do next time and it is the time-honoured way you can learn what to do.
Decide what can and can’t be achieved in the time available and set realistic goals. Plan to go home at the end of the day. The routine work will be there for you to continue next day. Learn to differentiate between the urgent and important, and urgent but not important (and who else could deal with those things) from that which is neither urgent nor important.
Place importance on your out of work life so that you don’t neglect it. There is a life outside of Medicine, even though your work takes a huge amount of time and energy, plan social events and don’t neglect your partner, friends and family. Be aware that life is more than Medicine and make sure you set aside some time each week to connect with friends and family and take part in activities completely unrelated to your work.
When you discover more balance between work and the rest of life you will feel better, have more energy, enjoy life more and get things into proportion.
We thrive on positive feedback. When someone says, as in ‘Alice in Wonderland,’ when Alice was asked to recite ‘You are old, Father William.’ she duly does so, and is then told by the caterpillar: ‘That was wrong from beginning to end…..’
How awful to be undermined in that way!
It’s a common experience amongst doctors to be ‘put down’ by their superiors, for example: how badly they have carried out a procedure or how wrong is their suggested diagnosis.
Have you ever experienced being humiliated in that way? Or have you done that to your juniors?
Even if it’s true that there are ways to improve your practice, it is so much better to praise whatever what is correct before suggesting ways to do better next time.
I remember as a medical student being the only female student around the bed of a patient (when I was studying medicine there was a strict quota of female medical students) I was picked on to present the patient’s history and examination and remember wanting to disappear into a hole in the floor that wouldn’t open up for me. The Prof. of Medicine looked over his spectacles and tut-tut as I didn’t say what was expected. ‘Come , come’, he said disapprovingly, ‘surely you know what this might be due to?’
I heard no word of praise for what I had answered correctly only putting me down for what I had not known. No offer of kind explanation for what I hadn’t understood. On reflection many of those medical student ward round memories were about being able to regurgitate facts and figures rather than demonstrating any ability to demonstrate understanding of the situation.
So, when you reflect on your experience of feedback from superiors and/or feedback you give to those you are teaching, aim to give more positive strokes and less undermining.
Please share your experience of this in the ‘Please leave a reply’ box at the very bottom of this page. Thank you.
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Although you may believe that you are indispensable, you might, one day, become unable to work. Perhaps you develop an illness which means you must take time away from work to recover fully either physically, emotionally or both.
You may not want to take this time away from work although you are told that it is vital you do, or circumstances may mean you have no choice becauseof the type of work you do or the type of treatment you have to undergo.
Doctors, like you, are particularly bad at taking necessary time away from work to fully recover. You feel guilty at letting yourpatients down and even more, you realise yourcolleagues will have to do much more work to cover for yourabsence until you return or how quickly a locum is found.
You know that even with good locum cover there will be a considerable number of their patients who would rather wait to see their ‘own’ doctor when you return.
All these factors can result in you not taking enough time to fully recover from your illness and so you may return and be less able to cope with the work load, take more time to do simple tasks and are not able to work as efficiently or even as competently as before.
What is the alternative? If you are a doctor who is or becomes ill then what you must do is tobe more ‘selfish’. The word ‘selfish’ may have bad connotations for you.
Think about it meaning ‘self-care’.
When you take more care of yourself and your own needs, you will cope much more effortlessly with those of your patients.
Don’t wait to find solace in drink or drugs, or until you reach crisis point. Find someone to encourage and support you unconditionally.Don’t wait until you become so exhausted that you become ‘burnt out’ and have to take early retirement on health grounds.
Instead put yourself first for a change. Listen to what you are advised to do and decide whether you can do that. Put your own needs to recover fully at the top of your agenda and don’t let guilty feelings about letting people down get in the way of your personal needs to recovery time.
It’s a hard lesson to realise that you are dispensable but it’s true.So do the best for you and then you will be in the best state to get on with whatever you want.
What is on the top of your agenda when you are ill or becoming burnt out? Please add your comments by clicking the ‘leave a comment button at the top of this post.
PS If you haven’t already got your free copy of Lifestyle coaching for doctors please complete the form in the sidebar —>>> and get yours before I take it down!
Are you a Doctor who needs CPR?(Confidential Personal Readjustment)
Life as a doctor can be very stressful. Sometimes both you and others may wonder how you keep going with so much to do and so little time to do it. How many of the following challenge you?
lack of work-life balance
keeping up to date
excessive demands on your time
insufficient funding to get the work done
unreasonable demands made of you
too little time with family or friends
unable to ‘switch off’ when on holiday
taking work home
lack of self-care
If any or all of the above resonate with you then you are not alone.
Doctors who have too much to do in too little time – organise your time more effectively
Doctors who worry about whether they have made the correct diagnosis and prescribed the right treatment – let go of the need for perfection.
Doctors who wonder if they made the right career choice – step back and consider all of your options.
Doctors who don’t feel valued as no-one seems to care for them – start to care more about yourself others value you more.
Doctors who don’t look after their own needs – define what these are and make time to address them each week.
Doctors who self-medicate or turn to drugs or alcohol to cope with the day-to-day stress – recognise when you need support and ask for it.
If you are demoralised, overwhelmed, tired, stressed, undervalued and wonder if this is the way life as a doctor has to be, and wonder how you might be able to change things for the better, read on, Consider what you could do now to start to have the life you really want, before it all gets too much. It IS possible to have a life and be a doctor.A recent client wrote: Susan helped me look for the inside me. The person who wonders and enjoys rather than the one who is worried and stressed. She taught me about the journey of life, of taking control over my own journey, and recognising the choices that are there. It was most helpful that she had worked as a doctor, because she understood how ingrained we are. When I signed on for life coaching I was ready to take the enormous step of giving up my job as a GP. That is what I wanted to do but didn’t know how it could be possible. Susan helped me realise that this was just the first step of an exciting journey. I cannot know where it will take me, but I am now looking forward to it!Susan’s warm and straightforward approach was just what I needed from a life coach. She manages to balance professionalism with humour and good sense. She has masses of insight and is refreshingly optimistic. I wonder if my life would have turned out differently if I had found out about Susan and her telephone coaching sooner.FR General Practitioner What can YOU do? If you want tools, ways to change, and questions to make you think, you will find the following resources useful.
There are three massive mistakes that doctors make that keep them feeling tired, stressed and frustrated.
Many doctors believe that overwork is part of being a doctor. They complain of a constant feeling of pressure and of frustration of not getting things done. not having enough time to do the things they really want to do. They neglect their lives outside of work because Medicine takes over their lives. The three mistakes the make are:
3. Neglecting your own health and well-being. This means looking after your body, mind and spirit so you can be happy and fulfilled. You can do this by eating healthily, taking regular exercise and connecting with spirituality, by connecting with nature, meditation, or in formal religious practice.
You cannot expect to be fit and well while eating junk food, never taking exercise, taking excessive alcohol and smoking and never taking time to watch a beautiful sunset or waves crashing on the shore.
This is important because when you are look after yourself you can better look after your patients. When you don’t care about yourself how can you give the best care to your patients? You could start by taking a walk each day; eating regular meals and avoiding unhealthy food and doing something outside to connect with nature.
2. Not finding the time to keep in contact with friends and family Relationships with people outside of your work environment are important because throughout your life there is a bond between family and friends that is very different from that between you and patients or colleagues at work. Usually friends and family are there for you, whatever the ‘ups and downs’ in your professional life, so don’t neglect these relationships. Even if separated by distance you can do this by meeting regularly or speaking on the telephone or via the internet.
1. Not taking ‘time out’ for rest, relaxation and re-charging your personal batteries. Even doctors are not mechanical machines and you need time doing something else apart from work. When you do this you return to work feeling refreshed and enthusiastic once again. Taking ‘time out’ means rest or recreation away from your work. This can be achieved in various ways: You could:
Take a few minutes between patients to close your eyes, concentrating on slow breathing in and out . You may want to think about breathing in relaxation and breathing out tension as you do this, or simply count slowly as you breathe in and out.
Get away from your clinic, ward or office for at least twenty minutes for a break during the day. Take the opportunity to take a walk outside especially if you can walk by a river or in a park. At the very least take a walk around the block.
Make a regular commitment to see a film each week or go to a concert or theatre : on your own can be as refreshing as with company.
Have a few days away, for a complete change of scene and a chance to really get away from it all.
Take several months away from work as a ‘sabbatical’
I have a colleague who is writing a self-help book on burnout. She would be very interested in talking to any doctors or nurses who have experienced burnout or traumatic stress. If you, or anyone you know would be happy to share your experience, please email Sarah Kuipers on firstname.lastname@example.org and she will contact you to arrange a mutually convenient time to call you.
: ‘The patient’s treatment begins with the doctor, so to speak. Only if the doctor knows how to cope with himself and his own problems will he be able to teach the patient to do the same.’ (C. G. Jung in Memories Dreams and Reflections)
Who do you turn to when you begin to wonder how you’ll get through the next few years? Do you believe seeking help and support will be seen as a sign of weakness? Do you make it impossible or very difficult for people to connect with you? Can you make connections? Do you feel vulnerable? Are you frightened about seeking assistance for yourself? Do you believe you have to cope on your own? Do you have to know all the answers? Do you hate to admit that you don’t know? Do you consider that others will think less of you if you admit ignorance?
Do you put obstacles between you and other people? Do you put up barriers to communication? Is it easy to enable a patient to tell you their most intimate thoughts and feelings but difficult for you to do the same to your Do you dread the phone ringing because you don’t want to speak to a patient? Are you going to wait until you are at crisis point? Who can support you now? Who can be there for you and accept who you are?
Is now is the moment to make changes to improve the quality of your life so that you can have time for family as well as patients, more time for your friends as well as your colleagues. You could have more time to enjoy being away from work doing things you haven’t done for years, such as going for a walk, a cycle ride, reading a book, painting, writing, any other almost forgotten hobby, whatever you’ve been saying to yourself ‘One day I’ll have time for such and such’ Now is the time to get more balance between your medical work and the rest of your life, the part of you that may have been submerged for years.
Don’t wait until you’re ‘burnt out’. Re-discover who you are. Start to make small changes right now. Be clear about what you have to do against what you ‘should ‘do. Do what you love to do. Teach others your skills so that you can delegate more to them to do some or all of the boring things you are doing now.
Do you think that you are indispensable and no-one else can do what you do? Suppose you are unable to do your work for some reason or another, what then? Someone else will take over. They may not do it the same way you do. They may not even do it as efficiently as you did. But they will do it their way and hopefully it will get done.
It’s OK to be ‘selfish.’ The word ‘selfish’ may have bad connotations. Start to look after yourself, physically and emotionally. Think about it meaning ‘self-care’ If you take more care of yourself and your own needs you will cope more effortlessly with the needs of your patients. Don’t wait until you have to find solace in drink or drugs. Don’t wait until you reach crisis point. Start now. Find someone who will encourage and support you unconditionally. Someone who won’t have any expectations of you but will encourage you to achieve whatever you want.
Who can you talk to about your frustrations and difficulties of overwork as a doctor in an environment of being undervalued and endless demands? Do you have a mentor who understands?
When you experience the power of support and encouragement rather than demands and intimidation you will be able to coach your patients to do whatever they need to do, rather than reaching for the prescription pad again to write up yet more tablets destined to be put in the back of the bathroom cabinet with the others. When someone listens to your concerns and acknowledges them as legitimate, you will become a better listener to your patients and hear more of their underlying issues and so be able to give them the help they need. You will be able to convey to them that they can make a difference to their own lives when they take responsibility for it.
Every small change you as an individual make will eventually help to change the system. Take courage, start to care for yourself , much more. What will you do differently today?
“We deceive ourselves when we fancy that only weakness needs support. Strength needs it far more.” -Madame Swetchine,
PS if you want to care for yourself treat yourself to a few days away in April 2014 at Connect and Change (but hurry only limited places remain!)
I remember many years ago asking a patient if she had experienced any abnormal bleeding. ‘No, no, doctor,’ she replied. ‘ No bleeding. But I have been haemorrhaging badly.’ !!
We used to avoid saying the word ‘cancer’ to patients. Instead we talked about them having a ‘lump’ or a ‘tumour’ or a ‘growth’ anything so long as the dreaded C word wasn’t said out loud. Nowadays it seems to be the fashion to say it even with little definite evidence. An elderly lady in her 90s told me she had bowel cancer, and she was desperately upset by this. She was told by her GP before any definitive investigations had taken place.
I’ve used a word recently – the word: ‘retreat’ which I realise might have very different meaning to some people who read it. I meant it as an opportunity to be away from your usual surroundings and by doing new and creative things you could experience being able to ‘sort things out’ come to conclusions about ways to improve your life, work life balance, self- care or decisions you need to make.
I didn’t mean a shutting away in silence as in ‘religious retreat’ Instead an opportunity to have a few days connecting and discovering new ways to change the way you think about a situation you may be stuck about.
Anyway from now on I will truly make every attempt to use words without ambiguous meanings!
Many doctors tell me that they want to have better work life balance, but they struggle to find a way to achieve it.
Working as a doctor can have it’s ups and downs. There ail be many days when you feel excited and exhilarated yet others when you are exhausted and overwhelmed. Both of these states can affect your life and relationships outside of Medicine.
Yet if you don’t improve the balance in your life you may become more and more stressed and both your work and your personal life will suffer.
How do some doctors cope?
1. They realise that work and life outside work is a matter of finding ways to be effective in both though not necessarily in relation to time actually spent in each role. Stop trying to keep all aspects of your life in separate compartments. Sometimes your best ideas might come to you while playing with your children or engaging in sport.
2. Define for yourself what you want in your life and realise that your definition of success may be different from others. Decide to follow your own path in being successful in your various roles.
3. Set your own boundaries in relation to what you will or won’t do in all aspects of your life.When you do this you will be able to define what are your personal priorities so that you designate time for friends and family and for your own self-care of body mind and spirit.
It’s not uncommon for doctors just like you to feel dissatisfied with their life.
You like them may think there is little you could do to improve the situation and may be blaming ‘the system’ for most of your frustrations at work.
Yet you are becoming increasingly aware of how these spill over into your home life and social life too. You find that Medicine takes so much of your waking hours that you have little energy left for the few hours left each day when you are supposed to be living the rest of life. The whole concept of work-life balance may seem an impossible dream.
You know you want something to be different but are not quite sure what you really want, when you would like the change to happen, why you want to change, who might be able to help you or how to make the changes you want to make.
So there’s the challenge. Can you make the shift from thinking about how frustrated and unhappy you are to changing your life to be more in line with the way you want it to be.?
Is this just a pipe-dream or could it actually be possible to make changes which would improve your life in some ways so at least some of the frustrating parts wouldn’t overwhelm you so much and more of your time could be spent following more enjoyable pursuits with people you want to spend the time of day with?
Having a more balanced life and finding time to do more of what you want to do is possible. When you start to examine what’s happening and the reasons for it you can begin to find that there are things that can be changed quite simply.
The easiest first step is to pick just one thing that annoys you. Ask yourself what could happen instead for things to improve for you. Then challenge your assumptions about the situation. Ask if it really has to be that way and what small thing has to change to make a difference to you. Which of your boundaries have to change? Who will you tell that you will no longer so such and such?
As you tease out the situation in this way you are very likely to find a very simple change that would make a difference to your working practice.
You have to take courage in your hands and talk to the person involved. For example tell the person who makes the appointments you are not prepared to see any extra. Doing this will enable you to leave earlier, have time for a swim or meet your children from school or whatever else you want to do if you went home earlier than you do now.