Tag Archives: stress

Physician Heal Thyself

Yet another doctor has committed suicide recently. The 3rd in the past year in the UK that I know about. There are probably more. It is so sad. On the face of it, many people might think what do doctors have to be so depressed about? The public still imagine that being a doctor comes with a good job, good income and the respect of the population in general. Those of us in the profession and our loved ones know better. For most doctors, the work is relentless. The NHS is no longer fit for purpose. There are too many patients with less resources to care for them. There is more and more paperwork borne out of the NHS having too many ‘managers’ who analyse medical errors and harm and feel that creating another form to fill in will prevent future incidents. They fail to realise that what is needed is more funding to employ enough staff for the numbers of patients we treat. They fail to realise that they need to invest in their staff and make them feel appreciated and valued for their hard work and for doing more than they are contracted to do. They need to examine the levels of sickness and absenteeism and realise that burnout is real and so is depression. Above all, they need to realise that without preventative measures, doctors will continue to work themselves until they simply can’t.

Although the UK rates highly in a lot of economic and living standards indices, being a rich developed 1st world nation, it doesn’t do so well with mental illness. The positive news is that the UK had made it into the top 20 of the world’s happiest countries in 2017 (it was previously 23rd and is now 19th) for the first time since 2012 when the world happiness report started being published annually.

In March 2017, the Mental Health Foundation commissioned a survey to look into prevalence of mental health in the UK and to identify the factors about individual that make them vulnerable to suffering from a mental illness. It found that 7 out of 10 women, those aged 18-34 and those living alone had a mental illness. Only 1 in 10 of the whole population are happy most of the time. Women are 3 times as likely as men to suffer a mental illness. Stress is a growing problem. Majority of people suffer from either a generalised anxiety disorder, depression or phobia. Self-harm and suicide are not classed as mental disorders but are a response to mental distress usually cause by mental illness that has not been recognised and treated.

With these statistics in mind, it is easy to see why young female doctors are at risk of mental illness. Couple that with the fact that medicine attracts people with a type A personality who are high achievers and do not like to admit they have a ‘weakness’ or that they need help. I have already described working conditions in today’s NHS. No wonder so many young female doctors are struggling and every year, we lose a few to suicide. What I find particularly difficult with this is that when colleagues pay tribute to those who have died, there is always a huge sense of shock. Unfortunately, these women hide their illness so well that often even their closest confidants have no idea how much despair they are in. Their friends often describe them as ‘superwoman’, someone who ‘has it all’, always helping others, taking on incredible amounts and managing to ‘juggle it all’ somehow. They give so much to others that they forget to give their selves.

Caring. Freedom. Generosity. Honesty. Health. Income. Good governance. These are the things that increase happiness and promote mental well-being according to the Mental Health Organisation. I would sum it up as friendship. I think human beings are social creatures (yes, even the introverts) and need to have at least one good nurturing relationship. This is intrinsically linked to self-worth. Many people who have attempted suicide and lived to tell their story say that depression and anxiety eroded their self-worth to such an extent that they felt useless and that the world would be better without them in it. Depression interferes with rational ordered thinking. When it is severe, it is like being in a deep dark hole, full of doubts and lacking in any hope. Far from being selfish, I believe people who contemplate suicide are (in their warped thinking) being selfless and believe in that moment that they are un-burdening those around them.

So is there anything we can do to turn the tide? Most experts agree that by the time a person has planned to commit suicide, it is probably too late to do anything. The depression has taken over and has them fully in its grasp. Where we can make a difference is at a much earlier stage. We need to prevent people with low mood going on to develop depression. We need to be that friend who validates their self-worth. The one who lets them know in words and action that their presence is very much appreciated in your life. We need to talk about mental health more so that someone at the early stages of depression feels able to confide in someone and seek help. If mental illness is so prevalent, why do we not talk about it more? Why are we ashamed to say, ‘I am depressed, I need time off work to get treatment/rest to get better’? Would any of us feel ashamed to call in sick at work if we developed appendicitis, had to have surgery and needed a few days to recover? Just because mental illness is invisible doesn’t make it less valid. I think this ultimately is what will turn the tide. Talking about it, admitting we have a problem and asking for help early, taking time out now to prevent getting to the point where all hope is lost and we feel like we have no other option other than suicide.

If you are reading this post and can identify with the desperation that mental illness can induce, please reach out to somebody. Ask for help and support. If you are in the UK, there are some very good resources. Your GP should be your first port of call. If you are feeling suicidal, call the Samaritans on the free phone 116 123. Mind has help pages online that can be accessed at https://www.mind.org.uk/information-support/types-of-mental-health-problems/suicidal-feelings/helping-yourself-now/#.WX8lFojyvIU as does Turn2Me at https://turn2me.org/?gclid=EAIaIQobChMIvKCtr8Sz1QIVT5PtCh2D7QnCEAAYAiAAEgKyyPD_BwE. The Mental Health Foundation has some great guides for promoting mental wellbeing which can be accessed on https://www.mentalhealth.org.uk/your-mental-health . The app Headspace comes very well recommended for dealing with stress, anxiety and depression.

If you are a medic, there is a wonderful Facebook group called Tea & Empathy for peer support for all those working in healthcare. It was founded after we lost another one of our young doctor colleagues a couple of years ago and is a brilliant space full of supportive caring people. The Wales Deanery has published a booklet specifically aimed at helping medics cope with the stress of the job. You can access it here: https://www.walesdeanery.org/sites/default/files/bakers_dozen_toolkit.pdf.

Finally, I want to say to you all: You matter. You are loved. You are not alone. Be kind to yourself x

 

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Don’t Sweat the Small Things

Sometimes in life, we allow small things which on their own are not significant to add up and turn into a massive problem. I speak from experience.  I am a creature of habit so I like things to be a certain way. To a degree, I do have obsessive compulsive traits. That is not unusual in a doctor. It takes a certain type of personality to go through medical school and then to work in hospitals and face all the horrors that can come with the territory. When I was living on my own, it was easy to use those OC traits for the good. Everything had its place in the little space I had. No mess was left where it was. Everything was clean and orderly. My personal life was organised to a T. In direct contrast, my professional life despite all my best intentions often felt out of control and at best, it was an organised chaos. Dealing with humans and ill-health is by its nature very unpredictable. You do all you can do and things get worse in some patients. In some patients, you barely have to do anything and everything gets better anyway. Which sometimes makes me question exactly how much we as doctors are able to influence and if it has more to do with patients than us.

Anyway…my lovely ordered life was turned on its head when I met and moved in with my husband. He is the spontaneous type who makes ad-hoc plans and also changes them (or should I say ‘forgets’) without warning. He is so full of energy that he cannot be neat. When he makes a mess, he would rather clean it up later. Later being in a few hours, days, weeks or even months in some extreme cases. I used to get really worked up about these things and ended up cleaning up after him because it was too much of a hassle to nag him into doing it. Then I started to resent having to come home after a long day’s work to organise everything again or use up my precious days off sorting. Now I have swung the other way. I have become an expert at turning a blind eye. I refuse to see the mess and I will generally not tidy up if it is not my mess. So whilst I complain less and I try to let him get to it in his own sweet time, it hasn’t lessened the stress it causes in my mind. I will literally obsess about the mess not being there.

Whilst I generally get on with my fellow doctors and nurses at work, there is inevitably one who is like a thorn in my side. In my most recent rotation, there was one such nurse. I will call her Nadine. She is a senior nurse with a lot of experience – this is usually an asset but in her case, she thought she could tell me how to do my job. I am usually quite laid back and approachable at work but I am certainly no pushover. I can’t be because as a registrar I have to take overall responsibility for patients out of hours. Well, Nadine decided because I was a new registrar that she had to question all my decisions, mostly indirectly. This really riled me because the decisions that I made were either straight forward or those which were more complicated were discussed with the consultant as per usual practice. I found that lack of respect very irritating and at the start of the job, I had to avoid any contact with Nadine until I could detach myself enough not to care. Once I realised by talking to the other nurses that it was not unusual for Nadine to give rotating doctors a hard time, I was able to maintain professionalism by communicating what was essential and just tuning out the negativity. What Nadine (and I) felt in the grand scheme of things was insignificant as long as I did the job I was there to do and I did it well. By the time I left, I think she had gained a grudging working respect for me.

I guess what I am saying is that I have come to realise some facts of life. Main fact being that most of life is not within my control. Fact is that there are many small imperfections and it is not always possible (or maybe even desirable) to make them perfect. I don’t always find it easy to let those little things go but when I do, it is less stressful. As long as I control those things I can control and make life as good as I can within my little bubble, I can live with the little things. Life is hard enough without sweating the small stuff.

When You Argue with a Fool

Have you ever had an argument that goes round and round in circles, never-ending with no point to be made? Where the person you are arguing with seems to be in a monologue? Where their comebacks are so off the mark that it feels like you are in a different time-zone? Where hitting your head hard against a concrete wall might be more productive?

I have and it used to annoy me so much that I’d get really upset and want to stamp my feet. And I used to try and reason with them and try to get them to see that the argument was entirely useless and was going nowhere. Now that I am older and wiser and my fuse less short, I deal with it in one of 2 ways. Either I say ‘look this argument is going nowhere and I don’t have the time for this’ or I just say ‘we will have to agree to disagree’.

I will confess something. I copied that 2nd response off somebody older who I admired when I was teenager. I remember the first time someone used it on me and back then, I couldn’t handle the maturity of it. Back then I thought everything was black or white. I thought every argument had to end with a winner and a loser. Now I know that there are many shades of grey in between (no, not 50 shades child!). Knowing that the world isn’t so binary makes arguments less upsetting for me.

I can now acknowledge what is fact for me is not necessarily fact for another because we are all shaped by different factors. We are shaped by our genes, our environment, our family, our friends, the media, our education, our beliefs, our religion, our culture and much more. Most important of the factors that shape how we view the world is our experiences. Hence, some of the things I would have argued successfully so passionately for 10 years ago, I am not so sure now are as I argued. Yes I enjoy a good debate but I am the sort that will not be dragged into an argument unless I have strong views on the subject and I have very solid reasons to back up my views. Fact is, I do not back away from an argument and I am often successful in getting my point accepted or at the very least acknowledged by my debating partner. But I choose what I will be sucked in by. And more importantly by who.

Which brings me neatly to the quote I have used as inspiration for this blog…‘don’t argue with fools, people passing by won’t be able to tell who is who’. It is my belief that arguing with someone who you know is arguing for all the wrong reasons is a complete waste of your life. This wrong reason might be that the arguer loves the sound of their voice and they are using you as a sounding board. Or they want to impose their beliefs on you because they do not think yours are important enough. Or they say things they don’t believe in order to shock or upset or entertain the passers-by. Or they want to score points. Or they are angry or upset or stressed about something or over someone and they want to take it out on a scapegoat. Or they are arguing for the sake of it, not because they believe in what they are trying to convince you is true.

These days, with my adult hat on if I spot the arguer with these wrong reasons and they ask an opinion so they can start a diatribe, I simply say: ‘oh good question but I am afraid I don’t know much about that. I’ll pass.’ Or ‘how about you tell me what you think’ or ‘I would be lying if I said I care about that matter’. Then I listen until my patience runs out and I find an excuse to not be in the same space anymore.

If it is a proper friend and they pick an argument over the littlest thing, I will usually get worried and ask if they are okay…really ok or if there is something they need to get off their chest? You know the saying ‘when you ask a woman what’s wrong and she says it’s nothing…’ Well fact is, when your sister/mother/husband/friend who you usually get on with great starts to conjure up arguments from the most innocuous conversation, then they are asking for help. Something is up and they want permission to spill. They want you to listen. So please, instead of entering into a slanging match, give them a hug and invite them to tell you what’s really bothering them. Chances are that they do not really think George Bush was a good president or Apartheid wasn’t all that bad.