Self-care. Where do I start?!

Daffodils adjThere is a growing buzz word on the streets that is ‘self-care’. We as doctors now need to ‘self-care’. But what exactly does that mean?!

When I speak to most people, they like me years ago don’t have a clear understanding on what it is to take care of ourselves.

When I speak with people about self-care their responses are usually, after a prolonged pause and thinking along the lines of:

‘Pampering yourself from time to time’

‘Making sure you eat healthy’

‘Knowing when your mental health is bad’

‘Having hobbies outside of medicine’

All those things are part of self-care, but they are not the all of what self-care is.

Most of us know that when we are ill, we need to take care of ourselves and get rest.

But what if we took care of ourselves all of the time?

Might that change the quality of life that we daily live in?

True self-care is not just about what we do to rescue ourselves when we are blue and down and out, but it is about taking care of ourselves in all aspects of our lives so that we lead amazing lives, feeling truly well.

In Medicine, our concept of life is that we survive life, that we survive the day, that we survive the week, and thus it makes sense that when we consider self-care that it is something that we do the bare minimum to make it through the day, the week and the year without dying.

But if we shift our focus and consider that we are here to live truly well in life, to thrive instead of survive, then that shifts our focus on the way we take care of ourselves.

The way that we feel comes from the way that we live life, in all areas of our life.

There is no one area of our lives that we can compartmentalise as being separate from any other aspect of life. We are the same body, literally, in all of life. We all know how stress at work can feed into and affect our home life, and vice versa. Thus self-care is about taking care of ourselves in all areas of life.

Self-care is not just doing the things that function, it is about the way that we do things with and for ourselves.

Self-care begins with a quality. Continue reading

Health Care Reform. When do we need it, and how?!

Burnout matchesFirst published in the European Medical Journal October 18 2017 I re-publish it here:

The buzz on the streets across the world is the need for healthcare reform. The costs of healthcare are exponentially skyrocketing globally and the rates of illness and disease are increasing, with mental health and chronic pain being in the top 5 causes of disease burden globally. Of the world’s population, 95% have some form of illness during the year; furthermore 81% of people with 5 or more health conditions are below the age of 65.1 The rising rates of chronic, non-communicable diseases across the planet are so rampant that the World Health Organisation (WHO) has labelled this as an epidemic.2

Globally, healthcare systems are struggling to cope with the burden of illness and disease they are faced with; the costs are expensive for healthcare organisations, governments, as well as consumers.

In today’s constrained financial times, the focus of healthcare reform has been on cost (including the cost of personnel) and how the cost will be sustained.

In the NHS, systems are stretched, with large numbers of staff leaving to work in lesser skilled roles for the same level of pay.3 The remaining staff are left in the tricky situation of coping with the high patient load with reduced numbers of colleagues.

In the USA, managed care has rationalised the delivery of healthcare with a focus on electronic health records for billable items, patient satisfaction, and business outcomes. This focus means professional autonomy has never been lower for healthcare professionals.

At the same time, the health and well-being of the medical professionals has reached an all-time low with burnout rates of more than 50%,rates of anxiety and high psychological distress greater than that of the general public,5 and suicide rates and suicidal ideation far higher than the general public.

The combination of these statistics highlights the potential difficulties associated with mental health faced by those in the medical profession and perhaps represents the tip of a growing iceberg.6 Continue reading

Self-care – who needs it?!

IMG_0093When I spoke with a group of medical students recently, I asked them what their understanding of self-care is and what it is in their lives. Their responses were as follows:

After a long period of consideration….

‘umm…..knowing when to take a break?’

‘….making sure you notice when your mental health is getting worse?’

‘…making sure you have hobbies outside of medicine to balance the stress so you don’t get too stressed?’

And their answers were phrased as questions more than direct confirmed answers. Like so many of us, they had no true concept of what it is to take care of ourselves.

Yet, looking after ourselves is a foundation in life. If we are not taking care of ourselves then how are we treating ourselves and why?

If we had a beautiful car, lets say a Lamborghini, or, a Maserati, we would treat it with care and pride.

We would make sure that we got it serviced frequently.

We would make sure it was cleaned and polished, and sparkling, regularly.

We would drive it with care, and enjoy the power in its manner of driving.

We would put the correct fuel in it, and regularly so.

We would make sure we didn’t do anything to injure it, a. because we loved it and b. because it would cost a lot to fix it if anything did happen to it!

But why don’t we have the same approach to our bodies?

How we treat our bodies has a big impact on the health and well-being of our bodies.

I find it interesting that in the health care profession in particular, that we are even less likely to take care of our bodies than in other professions.

In Medicine the culture is around studying until you drop, sleep deprivation as a sign of dedication to your studies and determination, and having food only on the go and only when you have to, or as a relief from the stress and tension of it all.

But in Medicine in particular we are here to be the leaders in health care, and health and well-being. Continue reading

What actually is personalised medicine?

doctor baby adj

The latest buzz word in health care is to make it ‘personalised’. This word I have noticed is used interchangeably with ‘precision’ medicine. Precision medicine is where drugs are ideally chosen to be used dependent on the genetic profile of each person. But this is hardly personalised! It may be precise, but it is definitely not the definition of personal.

When I consider the term ‘personal’, I consider the person and what it is to be a person.

There is far more to our make up as people than our genetic makeup! We are whole people with feelings, thoughts, sensitivities, dreams, aspirations, relationships, jobs, families, children and a whole host of assorted issues and personalities. There is far more to being a person than our genetics, our gender, and our anatomic arrangements!

Making something personal, means that we are cared for as a whole, that our uniqueness is taken into consideration, and that treatments are tailored for us as a person. As a whole person, not just a set of genes, organs and blood tests.

The notion of personalised means that things become exactly that. Personal. Where you connect with and develop a relationship with your doctor or other health care provider. Where you and your practitioner are seen and respected for the people that you are. Continue reading

What are we training medical students for?

depressed young doctor adjWhen young people go to medical school they are called medical students. They know that they are to learn about medicine. Everything about medical school is about learning about medicine. In fact, every waking moment is about learning about medicine.

We learn about anatomy, physiology, statistics, how to read a research paper, how to do a research project, we learn about diseases, pathology, histology, how to examine patients. We learn the right questions to ask in the right way to get the information that is needed.

We endlessly learn about rare diseases, treatment protocols and how to do various procedures and operations.

Our whole lives are consumed with medical information.

But is this all that there is to medical school?

Of what value is all the medical knowledge in the world if the person holding that knowledge is miserable and unwell themselves, struggling to work and struggling to cope with people?

Of what purpose is it learning everything that there is to learn about ‘medical knowledge’ if we are not preparing our students to be well in life? Continue reading

Who took the Fun. out of Medicine?!

Alex funny doctor adj

If you go to any health care conference all around you, you will see a bunch of very serious professionals. Dedicated to their cause, they are taking it very seriously. It is rare to see anyone laughing, and conversations about health care and research matters are taken very seriously. People get upset about things, and they express their hurts, and sometimes, people storm out of meetings. It can be intense!

It is the same on hospital wards and in consulting rooms. Doctors as a rule are a very serious group of people. We are trained to be that way. You need to look serious to be taken seriously, or so we learn.

But what kind of a way is this to live life?

In all seriousness (yes, yes, pun intended ;)) why can we not have fun at work?

Why can we not have fun and enjoy ourselves when we discuss things?

Does it all have to be SO serious and intense?

Do we have to look serious and intense to show that we are paying serious attention to things? To show that we care?!

I wonder,

What might happen if we kept things light?

What might happen if we saw the lighter side of things when things didn’t seem quite right to us in a discussion about a certain matter?

And what if we kept things light when somebody dared to disagree with our point of view, in public of all things! As everyone knows in academia, differing opinions can be the start of a very intense exchange…

Yet, when we are born and we are small, we know how to enjoy life. We know how to laugh, and how to enjoy ourselves. It’s usually not a disaster if we fall over and make our bottom a little bit wet……. Small children naturally laugh with each other, unless they have been traumatised…

Is this perhaps what happens to us in the medical profession?

I wonder, do we perhaps become traumatised through the way that we are educated and trained, and through our professional experiences and use being ‘serious’ as a coping mechanism?

Is this perhaps one of our modes of defence and protection from trauma, our serious faces projecting out against the traumas of the world, both actual and perceived?

And what do we think our professional seriousness will prevent… Continue reading

What is our True Power as Physicians?

super flying dog

In Medicine we spend a lot of time learning about facts figures and statistics. We learn about guidelines, the Krebs cycle, the different types of renal tubular acidosis and the right drugs to prescribe under the right circumstances. We learn about the correct procedures and how to do good operations.

All of these things are vital and important in medicine, as if we do not get this stuff right, things go wrong for people.

But, are these things where our true power lies as physicians?

Much of what we learn is about function. It is about getting protocols right and following procedures. But these are all impersonal things.

What about the personal? Is that important?

After all, Medicine is fundamentally about people. It has care for people at its heart.

And as people, what is it that we seek when we are ill?

We naturally seek a true care. And not only care, we actually want to feel loved. Continue reading

Do we really need our doctors to be ‘resilient’?

haddock fight tough

When we think of the word ‘resilience’ it conjures up certain meanings. ie that no matter what is thrown at you, you can ‘handle it’. That you are tough enough to take it all on, and carry on.

Increasingly there are moves to train our doctors to be more ‘resilient’ to life, but is this really what is needed?

Burnout rates in the profession are utterly staggering. Over half of the medical profession. That is correct, over half of the medical profession are burnt out. 25% of the profession have thought of killing themselves at any one point in life. That’s right. A quarter of health care professionals, those trained to be our experts in health care have found life so miserable that their only way out has been to contemplate suicide.

Our suicide rates are far higher than any other section of society, the irony not being lost here as we are health care professionals.

The levels of bullying and harassment in our profession are rife, and increasingly doctors are beginning to speak up about the stresses and strains that they are under, and in the UK in particular, they are walking off the job to move to other countries where they feel more valued.

It is clear that as a profession our health and well-being is suffering. But is aiming for increased ‘resilience’ really the answer?

The sort of people who do medical school are by nature pretty ‘resilient’. They push themselves, deny themselves all sorts of things, in order to not only get the marks required for medical school but increasingly the vast array of extra-curricular activities that are required to demonstrate and prove that one is a suitably exceptional candidate.

Circumstances in medicine are certainly arduous.…..long hours of work, study for years on end, seeing people at their worst, a well established culture of bullying and harassment….Nobody ‘survives’ unless they have a degree of ‘resilience’ to human suffering, both their own, and others 😉

As doctors, we care deeply about people and innately and through our programming in medical school we want to take away human suffering. We see it as being a bad thing. Yet we quickly realise that the time that we have and the tools that we have in our medical armamentarium are not sufficient, and are woefully inadequate in comparison to the immensity of the human suffering that we are confronted with.

There is much to process in day to day life, in conjunction with the multitude of pressures, to do with time management, clinic hours, paperwork, and on top of that our life and family demands.

Many of us burnout and there are many things that people are pointing the finger to that are causing burnout.

Some people say its long hours, but its clearly not that, as many people work long hours with no burnout. There are clearly other factors at play and we are certainly affected by and react to the toxicity of the environments that we find ourselves in.

But is ‘resilience’ really what we need and what we truly want our doctor to be? Continue reading

‘Resilient’ doctors, or, Doctors on Fire?!

GIrl with daisies adj

There is a lot of talk in recent times about doctors needing to be resilient to be able to handle the stresses and strains of the job better, rather than getting depressed or suicidal.

I welcome the attention that is being brought to these important issues. It is vital that we discuss the health issues of the health care profession itself, but it seems to me that we are stopping short of the true potential that is available to us all here.

The notion of resilience means that we toughen ourselves up even more to deal with the stresses and strains of the job. The notion of resilience is still about survival.

Resilience is about doctors surviving the stresses and strains of both the job and the system.

Resilience is not about true health and well-being. It is about a better state of function.

We don’t need doctors who are surviving. We need doctors who are thriving.

Why are we as a health care profession focussing on helping doctors to survive, rather than focussing our attentions on  helping them to thrive?! Continue reading

Checking in – how well do you feel?

Ask a doctor adj

Most of us on a day to day basis just get through the day with The Big C –  That’s right: c.o.f.f.e.e.!!. The line up at the hospital café first thing in the morning before ward rounds is worse than peak hour traffic. There are mobile latte vans that visit our surgeries in private practice. We need our coffee. When we have breaks in the day, we have more coffee, and yes, we like the taste, and the smell, because its amazing!!! But, how well do we feel without our coffee? And that’s a telling point…..

If we are needing sugar and caffeine to get through the day, then there is something not quite right. Apart from its taste, it is a stimulant, it heightens the nervous system, and then it drops us again.

Animals don’t need stimulant drugs to make it through their days. Dogs do great without it. They’re pretty happy too. So, as an interesting note, why do we?!

Can we really say that we are living well and truly vital if we are needing stimulants to get through the day?!

The history of doctors and their association with stimulants is well known. Not, that it is something to aspire to, just something to be aware of 🙂 I once read that one of the founders of a famous US teaching hospital was addicted to cocaine having to give himself a dose each day just to function….I do not know for sure if that story is true, but as we know in medicine our rates of addiction are high, and they are not even measuring our addiction to caffeine… 🙂

Most of us are so used to feeling tired that we think it is normal. But, whilst it might be the norm in our profession, its actually is not natural to feel so tired and exhausted that you can’t get through a day without a stimulant! That is a sure sign that we are not as well as we could be. We’ve just become used to this way of living that it is ordinary for us, and its become a collective team activity at morning tea time, or post ward round….

As health care experts, why do we accept being so tired as our normal? Why are we tired only a few short hours after waking up when sleep is supposed to regenerate us and give us energy?

Can we say it is something of being truly well to need a drug like caffeine (as tasty as it is!) to keep us going?

Lets face it, as doctors, we are so used to dealing with the most horrendous diseases, that we consider that if we don’t have a disease that we must be well!

But being chronically tired, is not part of a state of well-being.

Being well is more than the absence of diagnosed disease.

To me, a state of well-being is feeling fully energized, joyful, vitalized on waking and during the day, having a sustained zest for life. It is a wonderful feeling on the inside, not just the absence of cancer.

Most of us feel grateful that we don’t have a horrible disease. But what if there was more to well-being than just not having disease! Continue reading