Looking after yourself : a survival guide
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 consultant posts. Trainees face particular challenges with membership exams, shift patterns and nighttime working, although many potential causes of stress exist for doctors at all levels.
There are many different causes and sources of stress at work, including:
- 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, including job security
- factors related to the organisation you work in and the teams in which you work; these factors might include problems with communication in teams and feeling that you're not able to participate in decisions.
The prevalence of depression in UK doctors is between 10% and 20%, and burnout affects variously between 25% and 76% of doctors. 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.
About 1 in 15 doctors have a history of drug or alcohol dependency. One study found that family practitioners (GPs) have the highest prevalence of substance misuse and another study found that psychiatrists have rates of substance misuse of 14.3%.
1. Monitor your own health and stress level
- Consider how you are coping with work – are you getting angry or feeling overwhelmed by the amount of work you have?
- Monitor your sleeping pattern. Ensure that you are getting eight hours of good rest every night.
2. Healthy living
- Although we are very good at talking to patients about the importance of diet and exercise, we are not always good at following our own advice.
- It is important to ensure that you have time to exercise for at least 30 minutes five times a week.
- It is important to have a balanced diet and ensure that you do not miss meals during the day because of work.
- Consider reducing your caffeine intake to one cup of coffee or equivalent daily.
3. Monitor your own stress-coping strategies
- At times of heightened or prolonged stress, it is important to be aware of and monitor the strategies we use to cope, particularly alcohol or substance use.
- Do you have time during the week to do things you enjoy?
- Are work stressors having an impact on your home life?
- How do you cope with stress?
- Are you able to find time during the day to relax?
- Have you found yourself drinking too much alcohol (or perhaps using substances/medications) because you are feeling stressed?
- •Do you need to keep an alcohol diary?
- Do you need to seek help for addictions?
4. Discuss your situation with friends and family
It is important to have a network of support outside work and, if possible, interests outside of work.
5. Informal discussions with colleagues
Try to reach out to your colleagues to have an informal chat about the difficulties you are facing, as they have probably experienced something similar and could help you to think about strategies for making a change. Such meetings can be arranged through local peer groups or mentoring relationships.
6. Formal discussion with colleagues
Formal discussions may be arranged with your clinical director or via mechanisms such as the job planning and appraisal processes to help tackle work-related issues leading to stress.
7. Make changes to your work/life balance
- Balance is important. Make sure you have a balance that works for you, your family and your patients.
- Consider reviewing your job plan with your clinical director. It may be possible to re-organise your work or reduce the number of hours you work.
- Give yourself time to do the things you enjoy. Do you have time for exercise, hobbies/interests?
8. Supervision/mentoring
- Would a supervisor or mentor be an appropriate source of support and advice?
- Does your trust or organisation have mechanisms to identify mentors for you?
- Would case supervision with a psychotherapist or other senior colleague be helpful on a regular basis?
- If you have a supervisor, have you discussed any difficulties with that person?
- For trainees, most deaneries have a training support unit. You can refer yourself to such a unit and they can see you to discuss any difficulties. They are able to support you in a variety of ways, including career guidance, counselling and tailored training to meet your needs.
9. Seek help for health problems
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.
- 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 secondary care is needed, talk to your GP about a referral. Contact one of the organisations listed on the PSS-Further help webpage for resources or advice.
10. Do not ignore the early warning signs of stress
Some of the most common signs of stress you may notice in yourself quite early are low energy, headaches, feeling agitated, feeling overwhelmed, and having trouble sleeping. If you notice them in yourself, it is important to take action to prevent more health problems from developing.
Some of the things you can do at an early stage are:
- Speak to colleagues, friends, and family.
- Analyse the cause of the stress.
- Initiate discussion with your clinical director and local colleagues to see whether changes could be made to your work.
- Seek appropriate medical help when needed.
For further advice and support, please refer to the list of organisations on the PSS website.
- Arnold J, Cooper C, Robertson I (1995) Work Psychology: Understanding Human Behaviour in the Workplace (2nd edn). Pitman.
- British Medical Association (1998) The Misuse of Alcohol and Other Drugs by Doctors. Report of a Working Group. BMA.
- Forsythe M, Calnan M, Wall B (1999) Doctors as patients: postal survey examining consultants’ and general practitioners’ adherence to guidelines. BMJ, 319, 605–608.
- Ghodse H (2000) Doctors and their health – who heals the healers? In Doctors and their Health (eds H Ghodse, S Mann & P Johnson), pp. 10–14. Reed Healthcare.
- Hughes PH, Brandenburg N, Baldwin Jr DWC, et al (1992) Prevalence of substance use among US physicians. JAMA, 267, 2333–2339.
- McGovern M, Angre D, Leon S (2000) Characteristics of physicians presenting for assessment at a behavioural health centre. Journal of Addictive Disorders, 19, 59–73.
- Pines A, Maslach C (1978) Characteristics of staff burnout in mental health settings. Hospital and Community Psychiatry, 29, 233–237.
Cox J, King J, Hutchinson A, et al. (eds) (2006) Understanding Doctors’ Performance. Radcliffe Publishing.
This webpage is available as a downloadable (PDF) PDF help sheet
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