Self-Care During Changeover & Beyond

It will come as no great surprise that the change brought by transition periods can be a significant stressor affecting mental health. This is no less true for doctors – whether the transition period is from one grade to the next, from one job or hospital to the next (termed changeover in the UK) or perhaps most significant of all, the transition from medical student to doctor. Having a self-care practice can help alleviate some of this stress. 

“Self-Care” 

What comes to mind when you think about self-care? 

More importantly, how do you react or feel when you read those two words? 

It’s worth thinking about about your emotional, mental and physical reaction to the concept of self-care and what this might reflect. 

Did you feel overwhelmed? Did you sigh?

Did you baulk? Did you scoff?

Did you roll your eyes?

Reactions to Self-Care 

If you felt overwhelmed and immediately thought to yourself “I don’t have time for that stuff, I’m in my 10th day on call in a row!” you certainly wouldn’t be alone. Looking at infographics like the one below which list all the different types of self-care and how to employ these to improve your life can feel impossible for a doctor – especially when many of us are in rotas that leave us with barely enough time to recover from one shift to the next. That doesn’t mean that these techniques are ineffective by any means. It’s just that so much of what we traditionally consider to be self-care activities play out in the realm outside of work, which can be hard to achieve for most doctors who are typically time-poor individuals. Not to mention how overwhelming it can be to try and build a self-care routine if you wait till the moment when you need it.  Building a self-care practice is something that is best done in times of wellness and will serve you well in challenging times such as times of change and transition. 

If you baulked a little at the sight of those words, I wouldn’t be too surprised. The term “self-care” is bandied about a lot by self-proclaimed wellness experts trying to sell any manner of products and services – from gym memberships to bath bombs, miracle cures and spa getaways. Such is the nature of capitalism – anything can be packaged and sold – including the concepts of wellness and self-care. 

Self-Care Myth-Busting 

This commercialisation of self-care can be a massive turn off for many people for a number of reasons. 

1. Money in return for self-care

It can feel extremely disingenuous when people try to extract cash from you in return for wellness. Doing so in the name of “self-care” casts a shadow over the whole idea of self-care. In truth, self-care is NOT a commodity that can be bought and sold. In fact you don’t need to spend any money at all on a self-care practice, although you can choose to do so if you wish. 

2. Narrow conceptualisation of self-care

An additional unfortunate side effect is that we often fall into the trap of thinking of self-care in terms of things that can be sold – usually either: 

A. Tangible products (e.g. bath bombs, face masks, questionable scented candles) OR

B. Time=constrained activities (e.g. luxury holiday, appointment at the nail salon, yoga) 

This has obvious drawbacks for people who are financially-poor as well as time-poor. Although a long luxury holiday might make you feel fantastic, you might not have the financial resources to go and even if you did, it can be really hard to get that much-needed time off when working a rota. 

3. One size fits all

Being constantly bombarded with specific images about what self-care involves can promote the idea that this is all that self-care is or could be – and that if these products or activities don’t work for us, then self-care itself will not work for us. That is not to say that these things do not comprise self-care. They absolutely do for many people. For example I find yoga and meditation particularly helpful in my own self-care practice. But it’s important to realise that not every practice will work for every person. 

What is Self-Care, Really?

If we could erase all our pre-conceived notions or pre-programmed responses regarding what self-care is and what it means, what are left with?

Self-Care = Caring for yourself 

Doctors can be highly driven, ambitious people who are really committed to their career path and progress. Many of us are so busy that we can let our lives slip through our fingers whilst we focus on jumping through hoops and juggling everything we have going on. Many of us are so tired that we don’t have the energy to step back and ask ourselves if we are taking care of ourselves throughout this process.

Caring for ourselves requires that we know ourselves and what keeps us well – both inside and outside of work. It requires us to step back, reflect on what wellness looks like for us and how we can achieve it and to commit to living and working in ways that support this. 

Self-Care in Times of Transition 

Most us know that physical forms of self-care (e.g. eating well, sleeping well, exercising), personal forms of self-care (e.g. making time for meaningful hobbies) and spiritual self-care (both religious and secular) can be helpful at times of transition like changeover. We tell our patients to do these kinds of things all the time – even if we sometimes struggle to do them ourselves – either because we are too busy prioritising other things we consider more essential and productive or because we are just too tired to do them properly. Maintaining such self-care practices during the relative turbulence of changeover might feel hard, especially when we are throwing one routine out of the window in favour of a new one. But finding even a small amount of time for such forms of self-care can restore a sense of balance that is often lost otherwise. And if you don’t practice these forms of self-care yet but you really want to? Ask yourself what small step you can take towards that goal and start slowly.

Other areas of self-care like emotional, social and work self-care are more likely to be neglected by doctors, especially at times of transition. 

Emotional Self-Care 

How do doctors best practise emotional self-care during times of transition?

“Keep Calm and Carry On”?

We as doctors are pretty good at compartmentalising our experiences. We use techniques like suppression and repression to respectively push down feelings for us to deal with at a more appropriate time (suppression) or – perhaps in vain –  push away difficult feelings in the hopes they completely disappear (repression). It’s natural to develop these kind of psychological responses when faced with stress – such as the inherent stress of medical work. In fact these could be considered essential skills which allow us to guard ourselves against the potential trauma of our work. It wouldn’t do if every medical emergency sent us spiralling and made us unable to perform. There are obviously shortcomings to these kinds of responses especially when applied to other areas like dealing with the feelings caused by transition. Whilst suppression may allow us to continue to perform until we are able to reflect on our experience, repression of our feelings can be particularly unhelpful, especially in those cases where we fail to adapt fast enough to our new situation.

“Fake It Till You Make It”?

During times of transition it can be really tempting to “fake it till you make it” – a  piece of advice that is particularly ubiquitous during the first year of medical practice. Leaving aside the fact that this piece of advice might make less experienced clinicians feel like they have to act outside their limitations (with the obvious risks this entails), it encourages doctors to mask their vulnerabilities and suppress their anxieties in favour of maintaining a facade of professionalism. Not only does this do very little to allay any personal anxieties we as doctors may have about our change in situation, it also axes any chance we may have taken to discuss our fears with our colleagues, peers and loved ones – a practice which could actually help by contextualising our experiences.

Lean In 

It’s not commonplace in medical culture for doctors to admit to their vulnerability, but we could all benefit from a little leaning in to our vulnerability. Simply put, this is the acceptance that we are humans rather than Superhumans or Superdoctors and that it’s natural for us to feel apprehension around times of change – regardless of our age or level of medical expertise. This is particularly important advice for foundation years who may not have any yardstick to compare their feelings against. If you think you’re alone in feeling disconcerted at times of transition or at any other time for that matter – let me be the first to tell you, this is far from uncommon. We are human, after all. Once we accept that it’s natural to feel worried, anxious, scared or to have any other feelings about transition, we can start to move forward. Rather than suppressing or repressing our anxieties in order to “keep calm and carry on” or project a false sense of confidence by “faking it”, it can be far better to lean into our vulnerability, allowing us to foster greater self-awareness of our own feelings and needs so that we can address these as soon as possible.

“Stiff Upper Lip”?

You get the idea by now. If it’s a British slogan, it’s probably not a great coping mechanism! Too many of us doctors are afraid to express our vulnerability out loud. We worry about what this would mean for our respectability, our professionalism and what repercussions this could have on our progression through training. Shame and stigma about emotional and mental health struggle are unfortunately not absent from the medical profession. 

Social Self-Care 

There is no shame in asking for help, whether practical or emotional. We all have social support systems available to us that we can lean on during challenging times. It’s ok to ask others in your life if they can help with some of your responsibilities as you adjust to change. This might include things like asking someone else to do the cooking or laundry or asking for help with childcare.

Sharing your vulnerability out loud with a trusted person can be a huge source of relief, whether it’s with a loved one, a friend or even a professional like a coach, therapist or mentor. Even if no solutions are found, sometimes just being heard can be so therapeutic. In fact, simply naming our emotions out loud instead of bottling them up has been shown to lessen their intensity. Finding a mentor at work can also be a form of work self-care. Making such connections can create a safe space for discussion of any issues around the added responsibility of progression or new duties that come with transition into a new job or workplace. 

Self-Care at Work During Changeover 

So much of what we typically consider to be self-care plays out in an arena far removed from the workplace. Ironic isn’t it, considering how much time we actually spend at work? Breaking away from the idea of self-care as tangible products or time-constrained activities allows us to start thinking about how to practice self-care at work. You might not be able to have a bubble bath in the middle of the staff room, but there are still lots of ways to care for yourself. 

Arguably self-care at work should be considered as its own entity, with all the same categories of self-care outside of work including physical, social, emotional and so forth. 

Physical Self-Care at Work 

On the physical side of things, obvious acts of self-care include having the confidence to ask for and take breaks, including breaks to eat a nutritious meal, hydrate and go to the toilet. It’s amazing how many of us don’t manage to do even these basic things. What other small physical acts of self-care could you bring into your workplace? A couple of mine include bringing my favourite caramel as a sweet treat for when I have lots of paperwork to do and my favourite herbal tea for when I work evening shifts. 

Emotional Self-Care at Work

Perfectionism is a common attribute of doctors. Our desire to perform perfectly can really interfere with our ability to act with self-compassion. At times of transition into a new role it’s natural that we will struggle initially. Even though we logically know that we will gradually adjust to the new situation and our practice will improve, it can be really hard to accept this and to act with self-compassion. Times of transition are also times to check your perfectionism at the door. Adopting a growth mindset instead of a fixed mindset can help with this.

A growth mindset is the belief that you can improve your skills and abilities with effort, as these are not set in stone. We all have areas we can improve upon and we would do well to recognise these, accept they exist and rather than beat ourselves over the head about our perceived failings, exercise self-compassion and make concrete steps towards improving ourselves through more learning and practice. 

Social Self-Care at Work 

Remember that you are not an island. If you find yourself struggling at work – ask for help. Knowing your limitations (both knowledge wise and emotionally) is one of the hallmarks of a good doctor.

Make an effort to befriend work colleagues. This not only makes our time at work more enjoyable but fosters better teamwork.

Encourage others to practice self-care for themselves by helping each other to take breaks (physical), and making sure to debrief properly after tragic events like failed resuscitations (emotional). Be there for your colleagues and they will be there for you. By supporting each other in practicing self-care, we can create cultural change in the workplace. 

Reflection as a Tool for Self-Care

What’s the best way to start thinking about your own self-care?

Reflection, reflection, reflection. 

*Groan*

Yes I know. All doctors are reminded all the time about the importance of reflection in their portfolios. We all know the irritating feeling of searching our minds for some interaction or experience worthy of a strained and stilted reflection. Genuine reflection however, in contrast to the aforementioned artificial exercise, is truly is an important skill that can allow us to design and evaluate a self-care practice. 

Designing a Self-Care Practice 

Designing a self-care practice may take a little initial thought and is probably best done on paper or on a computer. Choose a category of self-care where you think you could do better and commit to one small way in which you could improve it. Over time you can address other areas, but it’s best to take things slowly. Some people like to track their commitment to self-care activities with a calendar or an app in order to remind themselves that these are as important as anything else on their to-do-list.

Evaluating our Self-Care

There are many different ways to do this. Some people like to journal, or keep a mood diary where they name their emotions first, before analysing the events of the day that led to them. Others reflect best out loud, in conversation with a friend, coach or therapist. This can help identify areas of self-care which we could improve on. The important thing is to create some space in our busy lives where we can confront our own experience. This can be done on a daily, weekly or monthly basis. 

Reflection during Changeover 

Times of transition like changeover are also a good time to reflect back on where we came from, what we have achieved, where we are now and where we are going. If we are struggling with changeover or transition, it’s worth asking ourselves why this is. It’s worth asking ourselves if we are happy on the path we are on, whether we are working in ways that serve us and our self-care and whether we want to change things. There are many different ways to work in medicine and not everything has to follow the prescribed path laid out before us. You can consider bank staff work, locuming, working abroad, working part time etc etc.

This exercise be extremely scary for those of us who have perhaps been buoyed along by sunk cost fallacy i.e. those of us who felt we had committed so much time to medicine we “might as well just finish the medical degree” or “get through FY1” or “just finish FY2”. Times of transition should be viewed as forks in the road. Whichever road you take, asking the hard questions that lead to that decision can affirm our sense of agency and autonomy. Sometimes, when you walk the straight and narrow path that medical training can be, it can feel like change is happening to you, rather than being caused by you. Remember that you always have a choice and can always re-evaluate your priorities. Reflection can be the antidote to feeling trapped on a hamster wheel – that of medical training or of our own thoughts and emotions. 

Self-Care: A philosophy for Life 

Self-care can seem deceptively simple, even trite when viewed through a commercial lens. It may indeed be a simple concept at heart. But it’s far from a simplistic achievement. 

Take it from a doctor who had to learn it the hard way. At the point of my own transition from first to second foundation year, I had the unfortunate but far from uncommon experience of working in a particularly unsupported work environment. I worked night shifts with no senior support on site and at times I had to manage emergencies alone for over an hour whilst I waited for my seniors to arrive from home. This, combined with personal circumstances including unwell family members and crumbling relationships led me to experience severe anxiety, depression and burnout. I ended up taking 6 months out of training to recover. During this time, I had a lot of time to reflect on the various parts of my life and to think analytically about what it would mean to feel well. 

Creating an effective self-care practice was front and centre in my path to wellness. In case you’re wondering, I still struggle from time to time. But having a self-care practice means I have tools to fall back on when this happens. If I could share only one piece of advice about self-care, it would be that starting to think about this early can save you a lot of suffering down the line

My experiences have taught me that self-care is not just buying a bathbomb. It is a pervasive philosophy for life. It is anything and everything that helps us care for ourselves, at times of changeover and beyond. It is a tool that can help us design lives that safeguard our own happiness and wellness.