The transition from medical student to doctor brings a mix of feelings; excitement, a sense of achievement, anticipation, apprehension, and maybe even fear.
This change can be difficult, because not only do you have adjust to the physical, emotional and mental demands of the job, you also need to cope with additional pressures and responsibilities.
However, long hours, heavy workloads, the threat of litigation, and patient demands can all combine to create a high-stress working environment with the potential to impact on a doctor's wellbeing. The General Medical Council's (GMC) national training survey found that a quarter of doctors in training said their job leaves them burnt out to a high or very high degree.
The GMC has previously recognised that work pressures impacting on doctors' wellbeing in turn can adversely affect patient safety, with chief executive Charlie Massey stating, 'We are concerned about how work pressures impact on the mental health and wellbeing of doctors, which could ultimately impact patient care.'
So while it's important to look after yourself throughout your career, it is particularly necessary at times of change or high stress - such as when starting your first job.
Focus on your successes
The qualities that drive many people into a career in medicine, such as being ambitious, dedicated and focused, unfortunately also puts these individuals at increased risk of burnout.
A contributory factor to burnout can be a feeling of isolation or not belonging. These feelings are more common than you might imagine, and it can help to discuss any concerns with trusted colleagues who will be able to reassure you.
Also consider the following ways of avoiding burnout:
- Recognise and celebrate your successes - keeping a record of positive feedback or appreciation from patients and colleagues can help.
- Don't constantly compare yourself to others, we all have different strengths and weaknesses.
- Reflect on incidents where things haven’t gone to plan but don’t be too hard on yourself. Reflection is a key part of clinical practice and an ethical duty. It can also help with your professional development. However, be conscious that everyone makes mistakes.
Deal with adverse incidents appropriately
Medicine can be a rewarding profession when things go according to plan and patients are happy. However, when things go wrong as a result of medical treatment it can be devastating - not only for the patient, but also for you.
A 2014 survey of fellows and members of the Royal College of Physicians demonstrated that of the 1,463 respondents who had been involved in an adverse event or near miss, 76% of them felt it had affected them personally and professionally.
It's important to realise there are sources of support to help you to cope in the event of an adverse incident, not least the MDU. We support thousands of members every year responding to complaints and investigations.
We have previously published advice about the support that is available to 'second victims' - a term sometimes used to describe clinicians coping with an adverse event. The website secondvictim.co.uk, launched in January 2019, also offers support for individual clinicians and their employers.
Know when to ask for help
The 2019 GMC national training survey also identified that many trainee doctors were unclear regarding the person within their organisation they should approach if they had concerns about their health or wellbeing.
Identifying who to contact for such concerns is only part of the problem. Often a much bigger obstacle is the fear of coming forward with health or wellbeing problems.
Research carried out by the Royal Medical Benevolent Fund (RMBF) found 78% of doctors believe that doctors are so busy looking after others that they neglect to look after themselves. The RMBF report found that, 'Doctors are expected to carry on and there is even a sense that needing support is a sign of weakness.'
However, there is nothing wrong with seeking help. In fact, getting help early can prevent a problem getting bigger and avoid time spent suffering in silence.
The following advice can help.
- Identify early on in your placement who to go to in your workplace or training scheme if you have wellbeing concerns.
- If you know or suspect your judgement or performance could be affected by your health, you must consult a suitably-qualified colleague (such as your GP, occupational health doctor or psychiatrist) and make any changes to your practice they advise.
- Don't be tempted to self-prescribe to alleviate symptoms such as exhaustion or anxiety, which could leave you vulnerable to a GMC complaint. Instead, seek objective medical advice - make sure you are registered with a GP.
- Speak to your colleagues and seek their support. They may be able to help reduce the pressures you face at work.
Look after yourself
It's not just your mental health that needs attention when you hit the wards, it's your physical wellbeing too. It's important to look after your basic needs like eating, taking breaks and getting proper rest, so you can cope with the rigours of the job.
Try to pay attention to the following points.
The 2019 GMC's national training survey reported that nearly two-thirds of respondents said they didn't have access to catering or a mess room while working out of hours.
Think about bringing in healthy snacks if you can, rather than relying on vending machines. Try not to be overly dependent on caffeine to get you through a night shift, as it might disturb your sleep when you finish work.
Working odd shifts or runs of nights can play havoc with your body clock. We've previously published an article in our journal about how to survive your first night shift, which includes advice on establishing good sleep habits.
Use your breaks wisely
Although it may be difficult at busy times, try to take your breaks and use them to get away from the wards or clinic. It can be tempting to cut breaks short or use them to catch up with other work such as chasing test results, but doing this won't give you the mental break you need.
If you can, use your break to take a walk, meet with peers or do something completely unrelated to work, even if you only have a short time.
Where else can doctors turn to for support?
Medicine is a rewarding career but it's important to be realistic about the highs and lows from the outset. Be kind to yourself, and to your colleagues as well. They may be going through the same emotions as you.
However you're feeling, remember that you are not alone and support is available - so ask for it early. The organisations and bodies below provide support for a range of health and wellbeing issues.
BMA wellbeing support services
Counselling and peer support available for all doctors and medical students. You don't need to be a BMA member.
British Doctors and Dentists Group (BDDG)
A mutual/self-help group for doctors and dentists recovering from chemical addictions (alcohol and/or drugs).
Doctors' Support Network
Peer support for doctors and medical students with mental health concerns, via mail forums and social events.
NHSE GP Health Service
Support for mental health and addiction. By self-referral only for any GP or GP trainee in England, or any wishing to return to practice.
NHS Practitioner Health Programme
An NHS service for doctors and dentists with health concerns/addictions especially where it may affect their work. Self-referral for doctors who live in London. Doctors in the rest of England can access the service via a referral from their GP.
Health for Health Professionals Wales
Funded by the Welsh government, a face-to-face counselling service for all doctors in Wales.
Support for doctors affected by addiction (including alcohol, drugs, gambling, sex, eating disorders and other dependency/harmful behaviour). Based in Wales.
Confidential psychotherapeutic consultation service for all qualified doctors (not medical students). Fees apply but financial assistance to cover fees is available if needed.
Confidential care and support for health professionals in Ireland with mental health issues such as stress, anxiety or burnout, or who may have a substance misuse problem. Free of charge at the point of care.
This guidance was correct at publication 30/07/2019. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.