Tips for New Doctors: Self-Care at Home & at Work

The basics are basic but they bear repeating. If you don’t nourish your body it’s highly unlikely that your brain and by extension your mind – which most definitely resides in your body – will function at its best. You need to attend to the 4 Pillars of Health and you need to know your rights so that you can safeguard these pillars. These pillars apply to everyone and are just as important when considering mental health in doctors.

The 4 Pillars of Health:

1. Move Your Body
2. Eat Well & Hydrate
3. Sleep Well & Take Breaks
4. Attend to Psychologically Nourishing Activities 

Move Your Body

I have never met anyone who has done exercise and said it made them feel worse psychologically. Some tips for exercise: Don’t do a type of exercise that you hate just because you think it “works”. Take it slow – if you’re quite sedentary just try going for a walk every day after dinner to begin with. Add in small achievable goals over time. Find your motivation – for me a large part of my motivation is maintaining good mental health. I suffer with anxiety and exercise always makes this better. I have come to think of exercise as “medicine for my mind”. Try to steer clear of motivations based around negative self talk or vanity goals like “I want to fit into that dress this summer” or (presumably if you’re a man but hey, you do you) “I want to feel confident topless at the beach” (Also what beach? We’re in the middle of a pandemic 😂 – but you catch my drift). 

Eat Well & Hydrate

The food served in hospitals isn’t usually particularly nutritious and can be really expensive. Try cooking nourishing meals at home. You can meal prep in advance. Bring lunch as well as dinner if you’re on a late shift. Carry water with you always. If you run on caffeine like I do, consider also carrying a travel mug. Consider what other small “niceties” or acts of self-care might soften your working day. A butterscotch candy for when you’re busy with admin work? Or perhaps keeping a box of your favourite herbal tea at work? Using part of your break to pray or meditate in the multi-faith chapel? The possibilities are endless.

Sleep well & Take Breaks

Prioritise sleep. According to the ‘HALT campaign‘, which aims to raise awareness of the dangers of working long hours without taking a break, if you’re awake for more than 16 hours your reactions are similar to being over the drink-driving limit and you’re more likely to make a mistake. On night shifts, take a power nap of about 15-20 minutes during your break and make use of eye masks and ear plugs. Try to avoid revenge bedtime procrastination. This is the decision to sacrifice sleep in favour of leisure time/ getting a few extra hours of entertainment. It’s associated with a delay in going to sleep that results in reduced total hours of sleep. The person knows that delaying sleep time will have negative consequences, and there is no valid reason for staying up such as an external event/ underlying illness. It often affects people in high stress jobs, including doctors and is thought to be a way of clawing back personal time at night when we have no time for ourselves during the day. So now you know why you’re scrolling at 2am all the time!

A few things that might help to overcome this include: 

⏰ Consistent wake up time and bedtime, even when not working 

☕️ Avoid caffeine and alcohol in the late afternoon/ evening

📱 Avoid using electronic devices before bed – at least for 30 mins but ideally longer

📚 Develop a relaxing night time routine e.g. read a book, meditate, gentle stretching before bed 

🛌 Make you bedroom inviting e.g. black out blinds, comfortable mattress, keep the temperature at 18 degrees celsius 

To learn more about the importance of sleep, consider reading the excellent book ‘Why we sleep’ by Matthew Walker. If nothing else, it’ll scare you to sleep when you learn that sleep deprivation increases your risk of Alzheimer’s disease, heart attack and cancer!

So many of us doctors are really good at noticing our hunger / tiredness / that point in the day when our concentration dips because we haven’t had a break yet – only to swiftly ignore it and get on with what we consider to be “urgent business”.  Here’s the thing – all work in hospital feels urgent. If everyone is breathing and no clinically unstable patients need review, develop the confidence of telling your team you need to take a break. How long? 10-15 mins is a short break. 30 mins is a good break. How often? According to the Working Time Regulations in the UK you are entitled to a 20 minute rest break when the working day is longer than 6 hours. The HALT campaign advocates for a 20 minute break every 5 hours. Try to help others take their breaks too by carrying each other’s bleeps so that everyone has time for a break during the day.

“If you are Hungry, Angry, Late or Tired you are less productive and it is difficult to make decisions effectively. Think HALT and take a break.”

HALT CAMPAIGN

Attend to Psychologically Nourishing Activities

Try to figure out what activities, things and people you need to stay happy and well. Guard these psychologically nourishing activities zealously. Be mindful of the gradual attrition in activities that maintain your well-being that most doctors experience. This is an insidious process that starts with you being too tired after work or feeling you don’t have enough time to do the things you want. Plan ahead, organise your leave early and have things to look forward to. Don’t let the things you love and the things that make you, you fall by the wayside.

Know your Rights

Self-care is as much about looking after yourself as it is being mindful of your environment – in this case the environment you’re working in. Knowing your rights is important if you’re going to safeguard the 4 Pillars of Health. You can think of your Rights as the foundation that the pillars are anchored in.

The Working Time Regulations, which implement the EU Working Time Directive in law, confer the following protections for junior doctors, consultants and career grade staff in the UK: 

• a limit of an average of 48 hours worked per week, over a reference period
• a limit of 8 hours worked in every 24-hour period for night work
• a weekly rest period of 24 hours every week
• an entitlement to 11 hours consecutive rest per day
• an entitlement to a minimum 20-minute rest break where the working day is longer than 6 hours

Note: According to the British Medical Association (BMA), working time doesn’t just include time spent actively carrying out duties. It also includes the undertaking of relevant training, travel time (when this has to be undertaken as part of the job), and periods of inactive time such as time spent asleep on site when on-call. 

Get your rota checked by the BMA to make sure your hours are compliant. Aim to leave work on time and exception report any overtime (for remuneration in pay or time off in lieu). Don’t let anyone convince you of doing otherwise.

Just remember – attend to the 4 pillars (move your body, eat well, sleep well, attend to psychologically nourishing activities) & don’t forget your rights!