Bradford VTS Online Resources:
Looking After Ourselves - resilience & preventing burnout
DOWNLOADS
path: LOOKING AFTER OURSELVES
BY DOCTORS FOR DOCTORS
SUPPORT SERVICES
- Practitioner Health Website
- BMA Wellbeing Website
- Full BMA list of support services (alcohol, drugs, finance, mental health, relationships, legal, bereavement etc)
- Full GMC list of support services
- Medical Protection Well-Being Hub (MPS)
- e-Care app by ICAS : Google Play (android) or iOS (apple)
- Enfys – addiction (including alcohol, drugs, gambling, sex, eating disorders and other dependency/harmful behaviour)
- Free wellbeing apps for NHS staff
ARTICLES
- Breaking the Burnout Cycle by MPS (very good)
- Emily shares her experience of burnout
- Why We Put Ourselves Last & Why Self-Care Should Be a Priority
- How to look after your patients by looking after yourself by Raj Persaud
- Wellbeing for GPs by Jennifer Napier
- An apple a day keeps the doctor away
- The importance of being hydrated and fed
PERSONAL DEVELOPMENT
Who cares about perfection?
Even the moon is not perfect, it is full of craters
The sea is incredibly beautiful, but salty and dark in the depths
The sky is always infinite, but often cloudy
So, everything that is beautiful isn’t perfect, but it’s still special
Therefore, every person is special to someone
Stop being “perfect”, but try to be free and live
Do what you love, and stop trying to impress others.
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
Questionnaire - Are you burning out?
7 quick questions. Answer them honestly. Step back and then reflect. Are you burning out? These 7 questions should give you some good idea.
1. Is your work emotionally exhausting?
- To a very high degree
- To a high degree
- Somewhat
- To a low degree
- To a very low degree
2. Do you feel burnt out because of your work?
- To a very high degree
- To a high degree
- Somewhat
- To a low degree
- To a very low degree
3. Does your work frustrate you?
- To a very high degree
- To a high degree
- Somewhat
- To a low degree
- To a very low degree
4. Do you feel worn out at the end of the working day?
- Always
- Often
- Sometimes
- Seldom
- Never/almost never
5. Are you exhausted in the morning at the thought of another day at work?
- Always
- Often
- Sometimes
- Seldom
- Never/almost never
6. Do you feel that every working hour is tiring for you?
- Always
- Often
- Sometimes
- Seldom
- Never/almost never
7. Do you have enough energy for family and friends during leisure time?
- Always
- Often
- Sometimes
- Seldom
- Never/almost never
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.
- Sleep well. About 7-8 hours a day.
- Eat well. Avoid junk food and sugar-laden foods. Try lowering your simple carbs.
- 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.
- 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.
- 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.
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.
Sign up with the BMA
We strongly urge you to become a member of the BMA. They’re amazing at supporting you when things go wrong. And often, the people who need the BMA are often the people who think it’s not important. You’ll regret it if things go wrong – because they will not help you with an issue if you were not a BMA member at the time. In the big court cases in the UK, the BMA have been absolutely amazing. You may be thinking that you dont feel you get much for your subscription costs – but nothing could be further from the truth. They supply the BMJ, lots of wonderful educational modules online and they if you ever need their counsel – be it for sickness in yourself or litigation – they are simply amazing. Trust us – join them! Personally, I feel they offer me “peace of mind” should something unpredictable go wrong in the future. And they say that chaos is less likely to be chaos if you prepare for it. You CAN reduce the effect of the cycles of chaos that inevitably come to us all – HAVE A PLAN. Don’t be terrified of the future. Don’t bury your head in the sand hoping it will all go away or blindly trusting “things will sort them out”. Instead, PLAN – and one way to do that is join the BMA. They’re well versed in most difficult doctor matters and they will hold your hand through whatever happens in the future.
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.
Suicide rates in doctors
The suicide rate for doctors has been estimated at 2-5 times that of the general population.
- According to the Office of National Statistics the suicide rate in 2018 was roughly 11 per 100 000 population.
- So in doctors, it is roughly 22-55 per 100 000 population
- And there are roughly 200 000 doctors in the UK
- So this means roughly 45-100 deaths per year!
- And the evidence suggests that GPs are at greater risk of suicide that most other specialties.
We cannot accept that it is just a side-effect of choosing to be in the doctoring game. It is changeable. It doesn’t have to be this way. And with the right support and help, doctors CAN change their lives around. So, please don’t add to this statistic. Doctors often just battle on, and that’s just a slippery slope. Self-care doesnt come easy to most of us doctors. So, if you feel you’re not yourself, reach out. There are people who can help. Call Practitioner Health – run by doctors for doctors. It’s an amazing service. Call them even if you’re not feeling suicidal. Call them if you’re struggling, feel stressed out, finding things difficult.
Practitioner Health
- https://www.practitionerhealth.nhs.uk/
- Telephone: 0300 0303 300
- Email: prac.health@nhs.net
Also, BMA Wellbeing Support Services
- Available 24/7 – for doctors and medical students, as well as their partners and dependents
- https://www.bma.org.uk/advice-and-support/your-wellbeing
- wellbeingsupport@bma.org.uk
- 0330 123 1245
If you notice you're struggling or not yourself... PLEASE Call Practititioner Health or BMA Wellbeing Services ASAP
Please don’t hum and hesitate about it. Just pick up that phone, or write an email if you prefer. Just do it… please. They are waiting FOR YOU.
Practitioner Health
- https://www.practitionerhealth.nhs.uk/
- Telephone: 0300 0303 300
- Email: prac.health@nhs.net
Also, BMA Wellbeing Support Services
- Available 24/7 – for doctors and medical students, as well as their partners and dependents
- https://www.bma.org.uk/advice-and-support/your-wellbeing
- wellbeingsupport@bma.org.uk
- 0330 123 1245
Where do I start to help myself?
First and foremost….
- It’s fine not to be fine.
- Many people are struggling to cope, and experiencing a wide range of emotions is extremely usual and understandable during this time.
Here are a few things you can do to help:
- You’re never on your own. Tell a trusted friend or family member how you’re feeling. If no one is available, you can phone a helpline (listed below) for a friendly talk.
- Concentrate on the fundamentals. Eat well, get plenty of sleep and exercise, spend time with yourself, spend time with loved ones, and try to see the positive aspects of life.
- Seek expert assistance. Talk to your GP or health provider about possible assistance, such as counselling or talking therapy. There are helplines available 24 hours a day, 7 days a week. There are helplines you can call at any time for a friendly chat with a volunteer, such as Samaritans in the UK or other similar crisis lines wherever you are in the world.
Professional Services
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 😊
Positive Self-Affirming Statements Before Surgeries, On-Call and OOH
On-call, OOH and surgeries, in general, can get rather busy. After a while, it can start taking its toll on you, especially when it is flooded with what you might consider trivial or non-urgent problems. You can end up getting irate with patients, who then get angry with you. You only need one altercation to make the whole session feel horrible, and you’ll end up taking that home with you. Then you start resenting future sessions, and that subconsciously affects the clinical care you provide. It also has a detrimental effect on patient safety – as you end up overlooking important things in a patient who superficially looks well. So, here is my positively self-affirming statements that I say just before I start my on-call and actually, it almost always works! But of course, for it to work, you have to believe in it. I will sometimes repeat some of these statements until I feel I have internalised them and made them part of me.
Ram’s Positive Self-Affirming Statements before surgeries…
- I am okay
- I am going to have a good happy day today
- I am going to be nice and kind to all patients and staff, irrespective of how they are.
- I am going to dance with patients and staff
- Today is going to be a good day
- And you know it’s going to fly by, so let’s go….
this work is really good and it’s a rally helpfull