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Five minute guides

Retirement

Retirement is a career phase that most doctors find challenging. Medicine has usually been an integral part of finding meaning in life for the previous 40 plus years. For some retirement can become a huge financial stress and for some it can trigger a relationship crisis. Unsuccessful retirement occurs when one of the four existential needs is not met: love, hope, meaning and control.

What you can do

  • Discuss financial plans as early as possible
  • Build up non-work meaningful hobbies or volunteer work that you have something to look forward to and are continuing to impact people’s lives; eg, music, writing, teaching English to migrants, travel
  • Nurture your relationships so that you have someone to love and be loved by.

Further Reading

Closing your medical practice and transitioning into retirement:
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Older doctors and retirement:
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Exams

Exams are a necessary part of medicine. They can take over your life and fill every waking minute if you let them. Studying for exams means staying organised, staying healthy and staying motivated. Ensuring that you continue your self-care and nurturing your relationships means that these need to be factored into your plans – not as an added extra, but as an important part of each day.

What you can do

  • A long-term study plan with accountability to another person or something enjoyable is a must
  • Remember that nutritious food, laughter with friends and at least 7 hours sleep are not options – they are essential brain food
  • The motivation fair doesn’t exist – motivation is a decision, not a feeling

Further Reading

Surviving a clinical exam: a guide for candidates:
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Waiting for the motivation fairy:
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Bullying

The traditional hierarchy of medicine can make it ripe for bullying. This is repeated unreasonable behaviour that creates a risk to health and safety. It can include verbal abuse, exclusion, spreading rumours or constant criticism. This is not a one-off bad day, a debate that can become a bit heated, feedback as part of training or just being uncivil. Workplaces should have bullying legislation in place.

What you can do

  • Ask yourself if this is repeated and unreasonable and if you think it is, discuss with a trusted work colleague
  • Ensure that you are safe
  • Tell yourself that this person’s opinion of you is not the truth and continue to behave true to your own values.

Further Reading

Bullying, discrimination and sexual harasement fact sheet:
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When doctors are bullied, all of society is harmed:
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Compassion fatigue

Compassion fatigue arises in the setting of unrelieved and excessive demands on doctors who are expected to offer care and compassion in a stressful working environment over which the individual has little or no control. It’s like having an empty emotional bank account. If not addressed it can lead to burnout.

What you can do

  • Make sure you are taking care of your own emotional needs 
  • Ensuring you are “filling” your emotional bank account with care from other people
  • Build up strong relationships with other people by being understanding and appreciative, and then if you need a “deposit” into your emotional bank account they will be there for you.

Further Reading

The Emotional Bank Account:
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The doctor and the importance of self-care:
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Exercise for doctors

We know that exercise is good for all mental health problems as well as physical health such as cardiovascular health, weight, diabetes, dementia and sleep. We recommend 150 minutes to our patients but finding 150 minutes will seem impossible in our busy lives. Often we have given up competition sport as our work hours do not fit in with games or practices.

What you can do

  • Doing small amounts of exercise regularly is as good as doing it all at once – parking the car further away, using the stairs rather than the lift, walking around the grounds at lunchtime (having a lunchtime!!)
  • Buy a fitbit or keep track of your exercise on a smartphone
  • Find a non-competitive team of the sport you used to play where you can just turn up if you’re free

Further Reading

Coping with failure

Many medical students and doctors-in-training have never ‘failed’ anything before and the rigours of training requirements and environments can stretch usual resources. Internal and external expectations can be high and failure to meet these can be problems throughout a medical career.

What you can do

  • Have a ‘growth mindset’ and realize that ‘failure’ is part of learning
  • Discuss what has happened with a wise and kind friend
  • Build resources to learn from the experience and face the future as a challenge and adventure rather than pass or fail

Further Reading

Mindset works:
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The impostor syndrome:
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Depression

The rate of depression in medical students and doctors is higher than the rest of the population. Health professionals also have a higher alcohol problem and suicide rate than the rest of the community. The stigma associated with depression and fear of being reported can stop many asking for help.  However if a doctor follows the advice of their treating doctor and the public is not at risk, AHPRA does not need to be notified.

What you can do

  • Talk to someone you trust about how you are feeling so that they can look out for you. 
  • If you are depressed, seek help from the Doctors health service or a GP
  • It is important that you seek help before you lose touch with your friends, struggle with concentrating or begin to make mistakes at work

Further Reading

Crazy Socks 4 Docs:
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Sharing stories:
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Anxiety

The rate of anxiety in medical students and doctors, particularly in women is higher than the rest of the population. Anxiety is common at times of transition with an increase or change in clinical responsibility, workload and bureaucracy. Predisposing factors such as perfectionism and neuroticism can increase the risk of anxiety. Anxiety becomes an ‘anxiety disorder’ when it begins to affect a person’s work, relationships and self-esteem.

What you can do

  • Ensure you are getting enough exercise and spending enough time with your friends and family
  • Self-help CBT can be of assistance 
  • If you have anxiety disorder, seek help from the Doctors health service or a GP

Further Reading

Moodgym, an interactive self-help book:
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Night shifts

Working night shifts usually means that you are not only not getting enough sleep but also ‘jet lag’ type symptoms of irritability, fatigue and difficulty concentrating. Ensuring you have having 6-7 hours sleep each day is still essential. Finding a dark, quiet place where you will be undisturbed is essential.

What you can do

  • No coffee for 5-7 hours before sleep
  • No screen time for 1/2 hour before sleeping
  • Mindfulness meditation before sleep
  • Having a warm bath or winding down before sleep
  • Taking melatonin can help some people 

Further Reading

Top 10 Tips on Surviving Nightshift:
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Calm, a sleeping app:
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Burnout

Burnout is generally seen in caring doctors who are overloaded and have insufficient time to properly care for themselves. It has 3 domains – physical and mental exhaustion, cynicism or depersonalization, and a low sense of professional accomplishment or achievement. Symptoms might be irritability, disengagement, loss of concern for patients and the ‘imposter syndrome’. The impact can be significant eg medical errors, cynicism, decreased work effort.

What you can do

  • Organisational strategies addressing long hours, inadequate staff or overwhelming bureaucracy
  • Improving networks of friends and family who can support and encourage laughter and relaxation
  • Taking time for non-work activities
  • Psychological help and/or mindfulness, self-help websites etc. 

Further Reading

Sharing Knowledge to Combat Clinician Burnout: 
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Balancing Parenthood and medicine

Balancing the full-time job of parenting with the full-time (even if the hours are only part-time) job of medicine can be exhausting. Parents may be overly controlling, permissive, absent, distracted or irritable. Making sure there is enough time and energy for children and partner is difficult but should be priority. Patients are not really more important than family, but can be more urgent, demanding and time-consuming.

What you can do

  • Talk to other medical parents about how they are managing
  • Do your best to be attentive, caring, respectful, nurturing and firm
  • Don’t overwhelm yourself with guilt if you’re not always perfect
  • Some ideas – Get a nanny, go part-time, encourage your partner to be a stay-at-home parent….

Further Reading

10 truths of physician parents: 
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Work-life balance: tips for your family: 
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Annual health check with your GP

Seeing a GP for a full physical assessment annually offers the opportunity to screen for a number of physical and mental health risk factors, build rapport, advocate for them in the health system and connect them to additional supports in a timely way.

Make a long (30-45 minute) appointment and prepare a vaccination history, family history and past history. Be honest, even if you are feeling a slight sense of shame that you have not looked after yourself optimally, having some risky behaviours (eg, alcohol, weight) or have been disregarding red flags.

The RACGP red book discusses guidelines for preventive activities with a chart showing preventive activities over the life cycle as guidance Lifecycle Chart

For doctors, this will also include mental health screening as well as screening of BMI, BP, cervical screening, diabetes, cardiovascular risk, faecal occult blood, osteoporosis, mammogram, prostate, eyesight and hearing.

For older doctors, assessments of cognitive function, balance and tremor can be appropriate.

Leanne Rowe and Michael Kidd have written extensively on the important of preventive health and the annual health checks – Preventive Health Kindle



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