This is an article based on a short talk I gave at the Ninewells FY1 induction in August 2014. I had asked for a couple of minutes to let the new doctors know about the existence of the Doctors’ Support Network and was offered a slot for a whole talk about doctors’ mental health! I’m used to having to plead and negotiate to get what I want so I was delighted that the induction organisers had already recognised the need for us to think about looking after ourselves. You will be advised time and time again to look after yourself so that you can provide better care for your patients. This is absolutely right but you should be looking after yourself because you deserve it too. There are a lot of good articles out there on how to be a good doctor for your patients. This article, though, is not about your patients- it’s for you. The original title was, “Surviving as an FY1 and beyond,” but I’ve changed it to, “Enjoying life as an FY1 and beyond.” Although there will be times in your career when surviving is all you feel able to do, most of the time it should be better than that. The foundation programme can be particularly difficult as some of your jobs will in specialties that are, “not your thing.” Although it was good to get experience in different areas, I found that work improved a lot when I started core training in the specialty of my choice, then improved again when I had settled into higher training in the subspecialty that is right for me. I’m nine years into practicing medicine and can’t imagine doing anything else. I hope you have a wonderful time working as a doctor.
When preparing my talk and writing this article I asked for advice from local colleagues and those on the Couch forum on doctors.net.uk (a useful resource!) on what they thought is most important for new FY1s (and the rest of us) to know about looking after yourself. Some of the tips below are from them and their input is very much appreciated (thanks guys!).
Eat regularly- get out of the ward and go to the canteen or WRVS if you can, but even a quick sandwich in the doctors’ room is better than nothing. Make sure you get enough fluids as well. Hospitals are hot! While we’re on the topic of fluid balance, it seems to be considered cool or macho or something to boast about how you were so busy you didn’t even have time to go to the toilet during your whole shift. There’s always time to go to the toilet. Quite apart from the fact that you need to attend to your own basic needs for the sake of your wellbeing, you’ll take much longer to do things and will be more likely to make mistakes if you’re distracted by being hungry, thirsty or needing a pee. I once worked with an A+E doctor who checked his own blood sugar (he didn’t have diabetes- just felt lightheaded and checked it out of interest) ten hours into a busy resus shift; he hadn’t eaten since before he started work. It was 2.5. You can imagine the effect that this could have on your concentration and productivity, as well as general wellbeing.
Tea, coffee and Coke are wonderful things and it’s tempting to use caffeine to keep you going through a long shift but it causes anxiety and insomnia (and cardiac problems in some really hardcore users). Research evidence that caffeine improves performance is overall unconvincing but it is clear that caffeine withdrawal in those who are dependent on it does impede performance, so I’d suggest that using large amounts of caffeine daily isn’t helpful.
Alcohol is great in moderation but please watch how much you’re drinking. Alcohol problems, along with drug misuse (including legal highs…) affect a lot of doctors. If you’re running into problems with alcohol and/or drugs the Sick Doctors Trust can help.
Make sure you get enough sleep.
Take regular exercise to keep you physically and mentally well, although remember that exercise is not a treatment for major depressive disorder and should not be used as an alternative to antidepressants or seeking help.
Take all your annual leave, whether you’re planning holidays or just spending time at home. Always make sure you know when your next set of leave is.
For most of you your first month’s pay will be a lot more than your student income. Enjoy it but keep an eye on your bank balance- it’s easy to lose track of how much you’re spending and a surprising number of doctors have stressful levels of debt.
Work-life balance is hard, especially if you enjoy your job and have burdensome responsibilities outside work. We all had exciting interests and hobbies on our UCAS personal statements when we applied for medical school, and most of us were members of university societies as students. You may not have as much free time as you did as a medical student but think about what you really enjoy doing and anything that you have given up that you wish you hadn’t. Make time, even if it’s ten minute piano practice when you get home from a long shift or swapping an on call so you can get to five a side football.
Don’t self-diagnose or self-treat. Like your own patients, you deserve an objective assessment of your health. See your GP if you think you might be unwell, rather than putting it off until you’ve decided if you definitely are unwell. You’re a doctor, but you’re not YOUR doctor. If you don’t have a GP, register with one as soon as possible. It’s possible to be seen as a temporary resident on the day if you become unwell but you don’t need the extra stress and it’s better to see a GP who has access to your notes.
If you have mental health problems already, or have had in the past, think about the support that has helped you and consider how you can continue to access this, especially if you’ve moved to a different area from where you were at medical school. Make sure you take the time to get to appointments with your GP, psychiatrist, CPN or psychotherapist. The Doctors’ Support Network is a peer-support organisation, run by doctors with mental health problems, for doctors with mental health problems. It has local branches throughout the UK and many areas have regular meetings. DSN Scotland have 4-5 meetings per year, usually held in members’ homes. New members are very welcome. Please contact DSN via the website if you would like to be put in touch with us about local meetings.
Keeping a mood diary is a great way of monitoring your mental health and picking up any deterioration before you become severely unwell. There are a range of websites and apps that will let you do this. I tend to recommend the mood tracker on Medhelp.org, as they let you track a range of symptoms as well as rating your mood daily but you may want to look at different ones to see what would suit you.
If you’re on medication, think about the practicalities of taking it when working shifts. Use a pill-reminder app (there are lots to choose from in the Apple Store, Play Store, etc) to make sure you remember to take it- especially important if you’re on something that needs taken at the same time each day (e.g. lithium or the progesterone only contraceptive) or involves several doses per day. If you’re on medication that causes sedation, sit down with whoever prescribes it and work out when you’re going to take it when you’re on nights- well before you start your first set of nights. If you have a mood/anxiety disorder, keep a mood diary as discussed above to help you pick up on patterns of mood change related to shifts.
Basic life support
One in ten new doctors feel suicidal in their first year of work. If this applies to you, you’re not the only one and you need to ask for help. There is so much pressure to look ok at work and get on with looking after the patients. Some people are very good at this and it works as a coping mechanism to some extent, but when you’re having thoughts of taking your own life you need to speak to someone. Talk to your GP (or psychiatrist if you have one). Take time off work. If you feel you need to speak to someone now, the following phone lines are available:
The Samaritans: 08457 90 90 90 (available 24/7, UK wide)
Breathing Space: 0800 83 85 87 (hours on the website, Scotland only)
BMA Counselling and Doctor Advisory Service: 0330 123 1245 (available 24/7, BMA members only, BMA Counselling is staffed by BACP members and the Doctor Advisory Service allows you to speak to another doctor)
“Being a doctor does not exclude you from being a human being”
Dr Eleanor James, a consultant oncologist, contributed this advice which I think sums up the message I’m trying to get across:
“1. Eat, drink, wee, take time off. Being a doctor does not exclude you from being a human being.
2. You will not be able to be perfect 100% of the time. Being a doctor does not exclude you from being a human being.
3. Sometimes your colleagues will be nasty. Being a doctor does not exclude you from being a human being.
4. You will make mistakes. Being a doctor does not exclude you from being a human being.
5. You can’t prioritise everything as most important, some things just won’t get done or won’t get done very well. being a doctor does not exclude you from being a human being.
6. You won’t know how to do some things, or will be doing things you have never done before. This is scary but most of it’s not that hard. You may just need to do it, but remember- being a doctor does not exclude you from being a human being.”