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Ask one hundred people how they are. What do they say? ‘Fine’ – fearful, insecure, neurotic and emotionally imbalanced. So, everyone uses denial.
Ask one hundred doctors and they don’t answer – they’re too busy with their concerns. This is displacement.
Doctors are heavily defended against looking after their own health (own oxygen mask), and fall into chronic oxygen starvation; into patterns of disharmony and imbalance. These two Ds of denial and displacement may lead into the three classic doctors’ Ds of drink, drugs and depression – on the way visiting distress, despair, disillusionment, divorce, debt and discipline.
Training compounds this. Doctors are intelligent, highly trained (metaphorically) in dealing with the results of car crashes and disasters (illness) – not in sensible driving, vehicle maintenance, good navigation or road design (health).
Self-care comprises of ‘habits based upon knowledge’ – we rise from bed, wash ourselves, clean our teeth, choose and put on our clothes, eat and drink, keep our rooms tidy, do the washing-up and the washing. All important.
When we are busy looking after others, especially in high-tech or glamorous ways, we put off fulfilling our own needs. We miss meals, we ignore the calls of our bladders, we go short on sleep. OK for a while, but if you fail to refuel your vehicle at some point you will run out.
The principles of self-care are simple. Calm the autonomic nervous system and attend to the needs of the body, mind and spirit. Consider the whole of your life, keep it in balance.
Many doctors work hard for too long. Physiologically they end up on the wrong side of the stress-performance curve, tolerate a high level of distress and think this is normal. On sympathetic nervous system overdrive, their levels of adrenaline and cortisol are raised – with resultant somatic, emotional, mental and behavioural symptoms. (Headaches, fatigue, muddled thinking, worrying, low mood, anxiety, insomnia and others). Adrenaline causes loss of insight into our own needs.
So what are the answers? Simple – put fuel in the tank, check the tyres, plan the journey, drive sensibly, avoid a breakdown or car crash.
Nourish your body – get sleep, exercise, fresh air, sunlight and good food. High-quality nutrition is key. Avoiding maintenance is an unhealthy choice, like avoiding the washing-up. This quick exercise can reset the system to parasympathetic chill, rest and digest, away from sympathetic fight or flight. Just stop for a few moments, put your feet flat on the floor, allow your spine to be comfortable, then take three slow regular rhythmic, diaphragmatic breaths.
Learn how to still your mind and use it carefully. The overactive, clever mind drives us into difficulties. Learn mindfulness, reflection or anything else that works for you. Connect to beauty and nature, don’t just watch electronic screens. Dance, sing or laugh often! Have a safety plan for difficulties. We use safety belts in cars in case of emergency – let’s plan for our own psychological health, too.
Staying Safe guides us in safety planning, so we can quickly access our resources if times get tough.
Nourish your being. Spirituality is everyone’s natural connection to the wonder and energy of life. It includes the instinct to explore that experience and its meaning. It’s connecting to our purpose and philosophy, with faith and confidence in life. Take time to think about what really matters to you in life: your ‘core values’. If you use these to guide you, harmony flows.
Apply the principles of health and self-care to the whole of your life, including the areas of work, home, relationships, spirituality, family and friends, health, fun and finance.
Think about self-care as making deposits into the Bank of Health. So many people in life take health for granted, until illness strikes. Doctors see this often – and they realise they are not invincible. So perhaps we should learn to take health seriously, care for ourselves, keep our own vitality high – then we can give oxygen to others from a state of personal health. Let’s abolish long-term chronic oxygen deficiency for doctors.
The whole topic of self-care and health deserves attention – the free resource Health and Self-Care for Health Professionals supports this.
NHS Practitioner Health Programme
BMA Wellbeing Services
Read more about the BMA patient liaison group resources and self-care
Good luck and keep up the great work.
Andrew Tresidder is practitioner health south-west clinical lead, a GP educator, Somerset clinical commissioning group GP patient safety lead and GP appraiser
Fantastic piece, Thankyou for writing this Andrew.
Thank you Andrew. Please keep up your good work