Being a medical student and junior doctor is tough. With each transition you can be thrown into new uncomfortable experiences and challenges. As you go through your training your responsibility increases. Sometimes it can all feel too overwhelming.

How can we best look after ourselves and prevent the all too common burnout?

Skip to here if you want to go straight to the tips! Or keep reading if you want my own personal experiences for context.

In the thick of it: part one

I myself struggled to achieve sustainability. In medical school I found the first two years relatively ‘easy’, similar to high school in that you studied and sat exams. My transition to third year was very difficult.

Third year was clinical full time, so I spent every day at the hospital, almost like an intern. I did ward round notes, discharges, collected blood, inserted cannulas and more. Always an overachiever, I wanted to do well and tried to impress my supervisors.

It was tough because I’m introverted, and every few months you change and need to make new first impressions. Plus you’re so fresh that every clinical skill is completely new to you, it can be scary to mess up and fail.

Personally, I’m not good at failing or making mistakes.

After time off between third and fourth year I came back refreshed and more confident. I found my last two years a lot better, and felt more capable. The time off was essential for this, and for me was the right choice.

Photo by Gustav Gullstrand on Unsplash

In the thick of it: part two

Internship and residency was a whole new world to me. Though I had been an almost intern for three years during medical school, there was nothing to prepare me for actually being responsible.

Relief terms where you cover the whole hospital were brutal and anxiety stricken. It was impossible to see every patient that needed to be seen, let alone do the thorough job that I wanted.

Mixed with COVID-19, I often found myself working overtime and being understaffed. It was rare to have a full team, and I was in the deepest stage of burnout.

At the time I knew I was burnt-out, but I didn’t really realise how bad it was. Now that I have been able to step back and have time off I can see the severity.

Reading my previous posts showed me what a dark space I was in. All I could think at work was how I just wanted to not be there. My memory was poor, I was distracted at home and it began to affect my personal relationships.

I didn’t feel in control of my life, and I had lost sight of why I was doing what I was doing. The only thing spurring me along at work was the desire to give the best patient care that I could, and the fear of patients having a bad outcome.

Photo by Edward Howell on Unsplash

How to be a sustainable doctor (or try to be)

The above passages were to highlight how sometimes self-help posts can be way easier said than done. Certain tips for doctors can be completely unrealistic, especially as a junior in the public hospital system.

I know it isn’t easy, I’ve been there and not done the best job at being sustainable myself. However, I can agree on the pitfalls and on what has helped. Plus how I combatted my own burnout to feel recuperated again.

Now to the tips!

1. Maintain good lifestyle habits

It sounds obvious, but being busy, stressed and preoccupied can cause you to forget to look after yourself.

The earlier you start these habits the better.

Avoid smoking, optimise nutrition, minimise alcohol intake, keep physically active and practice good sleep hygiene.

Tips for nutrition, activity and sleep during internship

  • Buy ready made healthy meals or boxes like Hello Fresh
  • Reach out to family or friends who like to cook and can send over a meal
  • Take a moment to eat and drink water while at work, if there’s no life threatening emergency it can usually wait!
  • Before or after work try to stretch or go for a walk
  • On days off see if you can do a workout that you find fun, like team sports, the gym, swimming or dancing
  • SLEEP – quarantine your bedroom from electronic devices, keep it dark and quiet, no excess of alcohol, no caffeine after 12pm
  • Sleeping during night shifts – quiet, dark room, ‘sleepy time’ teas, no phone
Photo by Luemen Rutkowski on Unsplash

2. Meet your physical needs daily

Extending on from the previous tip, you need to meet your physical needs daily to look after your wellbeing and prevent burnout. This means adequate sleep, water, food, exercise, sunlight and quiet creative time.

It’s common to see a tired, dehydrated, hungry, vitamin-D deficient, unfit doctor with poor home relationships. They’re trying to achieve at work but it’s close to impossible to do this in that state. This isn’t sustainable practice.

If you can identify yourself in this sentence what can you do to change it? You have a right to these basic needs.

3. Meet your existential needs every day

For me this was difficult as a junior doctor. The main needs are love, hope, meaning and control. I had no scarcity of love, but I had definitely struggled on finding hope, meaning and control.

It can be easy to feel victimised by medicine, a lot of it seems so out of your control. You ‘have to’ finish med school, you ‘have to’ get general registration and so on. For myself, I turned the corner when I accepted responsibility for my life and my choices.

The next to follow were hope and meaning. Nearing the end of residency hope began to come back, mainly because I could see myself almost being done with that stage of my life. Meaning was the last to follow, which really improved my hope.

For me, one of the most difficult things to deal with during internship is not having meaning behind your work.

I was without direction, and didn’t know what to do. Now I’m excited to work at creating a community of doctors who care about wellbeing. One where we pick each other up, and dismiss that myth of a doctor who is infallible. It’s a cause I’m passionate about and has me looking forward to work again.

What’s your meaning?

Photo by Etienne Girardet on Unsplash

4. Fulfil non-medical roles in life + non-medical interests

Medicine is a demanding career and can really take over your life if you let it. Some surgeons proudly say “knives before wives” and female surgeons have their own version that they can strictly adhere to.

I think this is outdated, and as a group we can work towards dismissing this old adage.

What did you do before you were a doctor or medical student? What brought or brings you joy?

Let’s celebrate non-medical roles and fulfil them. Your identity isn’t purely being a doctor, we are all complex multi-faceted beings and that’s what makes the world beautiful.

Photo by Helena Lopes on Unsplash

5. Diverse network of personal supports – and re-engage with non-medical friends

“No man is an island”, as John Donne eloquently penned. Who are your supports?

It can be easy to neglect important relationships during medical training, due to time, fatigue and burnout.

These very people can be your greatest strengths, especially when times get tough.

Cultivate your relationships and diversify your network of personal supports.

Non-medical friends are great as they can ground you. They remind you that there is a whole universe outside medicine!

6. Have an annual check up with a GP

As doctors it can be very tempting to self-prescribe and avoid other doctors.

Being a patient as a doctor can feel embarrassing or time-consuming.

Having a good GP is essential, for age appropriate screening, acute issues, annual check ups and mental wellbeing.

It can take a bit of time to find the right one, but it’s worth it.

Photo by Amy Hirschi on Unsplash

7. Get good advice from supportive professionals

Medics are smart, but leave certain things to the professionals! We can’t do it all. So look at finding an accountant, a psychologist, personal trainer, physiotherapist, beautician or relationship counsellor…whatever it is you’re needing.

Research your local doctors’ helpline to become familiar with the resources available.

Australia

8. Spend your working time doing what you truly enjoy

This is not as applicable to junior doctors and medical students. It’s more for people who have completed specialty training and can gear their career towards what they’re interested in.

Maybe a mix of clinical, study, teaching and research is ideal for some, or more clinical is better for others.

As a junior doctor it can be worthwhile writing down what your ideal week would be, and remember this as you go through your training.

If your ideal week has no medicine in it whatsoever, maybe re-evaluate what you’re doing and what you should do to get on the path you need to be.

Photo by Randy Tarampi on Unsplash

9. Develop ways to reduce stress during the day

Again, this can be challenging in the hospital. Especially on those days when you haven’t urinated for 12 hours or drank a drop of water.

If it’s one of those days, I advise you to try meet your basic needs first!

If it’s not one of those days, how can we best relieve stress?

Music, laughter, mindfulness, meditation, coffee breaks, lunch with colleagues and sitting outside for meal breaks when possible.

As a junior doctor, I found coordinating meal breaks, when we could, to be super rewarding. Coffee breaks were life saving sometimes, and as a group we would organise ‘Fat Fridays’ where we’d order meals every Friday for all the interns to share.

If a friend was having a difficult time at work I’d hold their phone/or pager for them while they had a moment and vice versa. Lifting each other up and being a team was what worked.

I hope these tips helped. I’ll be writing more posts on other common things such as burnout and imposter syndrome. Let’s improve things and the earlier you start the better!

Photo by Lina Trochez on Unsplash