One of the hardest things to deal with once you enter the work force is leaving work at work. As a doctor, it can often be difficult to separate your home life with your professional. During medical school we weren’t alerted about the fact that patient issues can haunt you, and that you may develop feelings of guilt. So I thought it was worth a post about.

For me, feeling guilty and thinking about patients during the late hours of the night have been one of the most difficult elements of being a doctor. I often obsess over whether I could have done things better, agonise about if I missed something or beat myself up over not being a ‘perfect doctor’.

I know many doctors experience this same problem, and have seen anonymous posts about how people can’t deal with the immense worry they experience after work.

The other day a doctor replied to an anonymous post with:

Most of the issues you describe won’t just follow you in medicine, they’ll follow you through any career. Things like feeling the need to study incessantly, stressing about not doing a perfect job, letting work follow you home are all things related to your perceptions of yourself rather than the type of work you are doing. They make you a better doctor/worker, but will burn you out wherever you go. Try looking into some imposter syndrome and growth mindset resources to help you start to combat those issues

‘helpful’ advisor

This response got me thinking. Is it really purely a fault in a doctor’s character if they stress about not doing a perfect job and let work follow them home? Or is it more than that?

Before we continue I have to say I completely disagree with the ‘helpful’ advisor’s response. I think it is completely unfeeling to dismiss someone’s worry in the medical field as purely a personality defect. But let’s break it down into the aspects of why doctors may bring work home, worry about not being perfect and where this guilt stems from.

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Perfectionism and overachieving

The ‘type A’ personality who was top of their class and became an overachieving doctor, that demands excellence. It’s the classic stereotype of who most medics are, think Christina Yang from Grey’s Anatomy.

They strive for perfection, and anything less is utter failure.

Maybe they had a mum like Abby Lee Miller who indoctrinated into them “second place is the first to lose”. Who knows.

Though it is definitely a cliche, most doctors have spent their lives achieving. Getting into medical school is tough and competitive. The selection process values individuals who are not only top in their grades, but talented in multiple aspects of their lives. Think an ex-Olympian, who also plays in an orchestra, and has time to get high distinctions in every subject.

Countless doctors spend their free time running marathons, or finishing off their masters. Some of their lives just make you feel exhausted hearing about it.

The fact is, medical schools find individuals like this. Passing medical school requires individuals like this. And getting into a specialty values doctors who are striving for perfection.

This need to be perfect can start off as a positive maybe, when you’re a teenager excelling in high school. However, how sustainable is it to live decades of flawlessness? The high rate of burnout in medicine is a testament to the impossibility of being without fault, and the very thing that is valued by employers is then turned into a personality flaw when someone begins to crack.

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The fact that medicine is a uniquely stressful career

The advisor overlooked one huge factor that is completely independent to any particular person. Medicine is a uniquely stressful career. Sure medicine may be full of individuals who try to be as perfect as possible but not every career is life or death.

In some jobs the worst mistake could be placing the wrong order for a customer. Annoying, yes, but forgetting to order a chicken schnitzel for someone is hardly as stressful as dealing with a resuscitation. (I worked as a waitress prior to medicine and I never brought work problems home).

Doctors deal with death, and dying people daily. You see things that deeply affect you. Someone’s beloved grandmother who fell and shattered her pelvis, who won’t recover. You then tell their family how they likely won’t survive this injury, and discuss that they shouldn’t be for CPR. You go home and think about the poor woman, and feel for the family who will soon lose their loved one. Maybe you wonder if you made the right decision, if you could have done something better.

How can anyone just walk out of the hospital’s doors and immediately forget this? Is it really so simple to leave ‘work at work’? The scenario I mentioned really happened, and there are countless more sad stories like this that I’ve been involved in.

I don’t believe remembering things like that is a reflection of someone’s self, but rather something unique to this job.

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The need to study ‘incessantly’ and imposter syndrome

The anonymous post complained about the constant need to study. They worried about the fact that not studying would cause a hole in their knowledge that would negatively affect patients. It was also something necessary to specialise successfully.

The reply was that feeling this need to study was equivalent to the imposter syndrome, and purely a personality trait.

I really disagree.

It is absolutely impossible to know everything in medicine. There is a reason why there are so many specialties, as knowing it all will make you an expert on nothing.

The worry that not knowing something will harm a patient is not imposter syndrome. It is a real possibility, with real world outcomes.

Medical specialties also require multiple written and oral exams. Once you graduate medical school you do need to continue studying. It isn’t a made up idea. It can be hard to work full time, and spend your spare time revising notes.

Can you really leave your work at work when you go home to study?

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Worry and guilt

Worry: feel or cause to feel anxious or troubled about actual or potential problems
Guilt: a feeling of having committed wrong or failed in an obligation

Ah, the dynamic duo of worry and guilt. Usually also accompanied by anxiety.

Worrying about actual or potential problems can become commonplace in medicine. Some people do worry more than others, and worrying is not a useful action. However, I want to say that it is completely normal and understandable.

Yes, all work places can create sources of worry and anxiety. It isn’t specific to medics, and maybe medics are more prone to worry due to higher levels of perfectionism. Yet, I really feel for every doctor who is struggling with feelings of worry and guilt.

It is an immense responsibility to care for a human being, and to have someone’s life balanced in front of you. Your decisions can positively or negatively affect a patient in a big way.

When things go bad, which they often do in medicine, it can be so difficult to separate from it. You may feel like you have committed wrong or failed in some way.

Living with guilt is not healthy, and is something that you should seek help for. But know that is isn’t purely due to your personality. This job is really tough, and most people don’t see death and dying as often as you do.

You’re not weak, or broken. You’re human, with feelings that make complete sense.

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How to combat guilt and stop bringing work home

For me, this is such an important thing as a doctor to think about. In medical school we never had a lesson on this, and probably had no idea that we would face issues like this so often.

I wish I had a quick fix, but it isn’t easy. Overcoming guilt and keeping your home life separate from your job is a slow process. It can be painful and emotionally charged, but ignoring it is not an option.

Some strategies that help

  1. Acknowledge how you feel

The first step in dealing with negative emotions surrounding work is to acknowledge what you’re feeling. Trying to ignore or push it out of your mind may work temporarily, but you’re essentially leaving it hanging there to fall down later.

So if you feel sad, accept it, your feelings are valid.

  1. Explore why you feel this way
    The next thing to do is ask yourself why you’re feeling this way. Where does the worry, the guilt, the anxiety stem from? Does it relate to all aspects of your life? Or just work? There’s no right or wrong answer, take some time to think about it.
  2. Speak about it to a trusted and supportive person
    When you have so many thoughts racing in your head it can be overwhelming. All the pressure and stresses of your job can get too much. Speaking about it to someone can remove the noise from your mind. They may have an outsider view that can help you too. Beware in speaking to someone who may dismiss your thoughts or react negatively, try to avoid opening up to these kinds of people.

4. Write it down
Speaking about your difficult emotions can be hard. Why else are there so many anonymous posts from doctors struggling? You may be worried about being perceived differently, or just not feel ready to say it aloud. Write it down.

Putting thoughts into writing can order your mind and also quieten it.

  1. Think of the learning point
    Thinking positively does not magically make things better, I know. Sometimes a shit situation is what it is, a shit situation. However, everything has something you can learn from. What can you learn from what is happening? How is it helping to develop and shape you?
  2. Have a hot shower and change those clothes
    Besides the mental work, you need to care for yourself physically. When you get home from work don’t sit down in your scrubs. Take them off, have a hot shower and let the water rinse off the day. Change into something comfortable. Even this small act can help separate your work from your home

7. Exercise and eat well
Like the above strategy, it’s important to physically look after yourself. Being so busy in your job can lead you to neglect your physical health. Maybe you’re eating pure fast food and not exercising, or eating nothing at all.

Try to nourish yourself with healthy food, maybe order pre-made meals if you don’t have the time or energy to cook . You don’t need to push yourself to run a marathon, but try to walk outside in the sun, even a short stroll can help clear your mind.

  1. Focus on love, not fear
    Easier said than done, I know. But try to focus on love. Especially love for yourself. Guilt, worry and anxiety all stem from fear, which doesn’t help anyone. Not you or the patients. Learning to not be so darn hard on yourself is a huge step in self-love, and really necessary. No one is perfect, and accept that you’re human.
  2. Get professional help
    If it’s all getting too hard, and you think it’s affecting your mood and life outside of work get help. Even the strongest person can become overcome with these negative emotions that can become detrimental to your health and relationships. The longer you let it spiral out of control, the harder it can be to recover. So catch the feelings and recognise them early. If you need help, reach out.

    Maybe find a good GP, or psychologist, and look after yourself.
happy

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In the end, you need to make sure you’re okay before you can really help others.

I hope these tips help. It’s not an overnight fix, and it is important to remain mindful. Remember, medicine is a hard job, and you’re not flawed for feeling like this.

It can be seen as what makes you a good doctor, but preserve yourself, you have a life and worth outside work.

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