Facing Difficulties (Part 1)

Welcome back to Serenity. We’ve talked here about looking after ourselves, finding out identity and last time some simple rules to help get us through life. Today I’d like to talk about facing difficulties. Throughout our lives – personal and working, we will face difficulties and challenges to our happiness and balance of well being. How should we deal with these challenges? You might think that this is just common sense but there are some things to consider and ways to approach these situations that might make life a little easier.

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Don’t Panic – when things start to overwhelm us, and we face a difficult , one of the most important things is not to panic. As a general rule doctors are fairly good at this. We are trained not to panic, we learn and practice not to panic and to deal with emergency situations. We have algorithms and flow charts, we have contingencies and protocols, we are usually the ones patient’s and other people turn to in an emergency situation. Unfortunately that very training and long list of protocols which make us good to deal with those scenarios can make it daunting to deal with things we don’t expect, or to deal with things that have to do with us rather then a patient.

WWBD ->

What would Batman Do?

What would Batman do? An amusing line that comic book fans say, has some relevance here. First take a deep breath and exhale slowly. Now think what would Batman do? He would grab the problem with his hands, choke the resistance out of it, and beat it into submission! Now does that image appeal to you regarding your current problem? If you’re sitting there with a half smile and some of that tension and anger or fear has leaked out good!  Fear and anger can paralyse and stop you thinking, so what ever you need to do to clear that head and kick-start that smart brain that has got you this far in life, do it!

The quip about Batman is to suggest that you need to view the problem or difficulty with an outside perspective and approach it in a calm and intelligent manner. Besides Batman or Yoda, you as the doctor or GP are often a source of sage advice and guidance to patients. I know I’ve been asked many times by a patient facing a difficult situation or time in their life what to do, and how to face those problems.  I’m sure most of you would have as well. So what would you advice a patient coming in with the problem or difficulty you face?

Start with slow deep breaths, and pushing that fear aside, getting that cognitive part of your brain working again, and start dealing with the issues in front of you.

Identify what the actual problem or difficulty is, and how and why it’s there in the first place. Are there any immediate things you can do? Are there immediate things you should not do?

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Get Help – beyond not giving in to panic, the second most important thing to do is to get help. This is one of the areas that we tend to not do too well. We are taught through our training as doctors to know when to ask for help. However, at the same time I think there is an underlying implication that we should be able to deal with things, and often there is a perceived sense that we can be seen as failures if we do have to ask for help.

Why is this?

Basically I think it comes down to pride. We have to learn to put aside that pride, and reach out to others. To admit that we are fallible and that we need help. So start with people close to you who love you and care for you, because they probably already know something is wrong, and not having to hide that from them will ease off some of that burden. From there look at mentors or senior colleagues, there are services like the Australian Doctors Health Network (adhn.org.au) which I mentioned in an earlier post. There are groups like Share GP and GPDU where you can get some advice on certain things (though do have caution on posting certain things online). Family and friends, can provide, insight and support. RACGP and other college bodies, and MDOs often have some support services. Reach out, don’t shut yourself in, and falsely believe that you are alone.

So what now? You’ve quelled the initial panic, you’ve started to formulate a strategy and plan, you’ve reached out for help. Now what? Now comes the hard part…

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Acceptance – having done what you can, the hardest thing to do is to accept the new situation you’re in. Whatever happened, the world you live in now is fundamentally different from the one you were in before. Its easy to loose yourself in ‘what ifs’, ‘this shouldn’t be happening to me’, and the old ‘its not fair!’. Whatever the situation, whatever has happened, and however unfair or undeserved it is, it has happened. Now you need to accept and own your situation. Until you can do that you can’t move forward.

Think that’s enough for today’s post, I’ll continue the – dealing with difficulties, in part 2. Apologies if the above seem blatantly obvious… It is… But sometimes when you are in that hole and things are overwhelming you, the blatantly obvious isn’t so obvious or easy.

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7 Rules to put on your wall

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For today’s Serenity post, something a little different, not as long winded as my usual posts .Not sure where the below quote/rules came from, not my own, but they do provide a great set to keep on your wall and to remind yourself now an then…

  1. Make peace with the past so it doesn’t spoil your present

  2. What others think of you, is none of your business.

  3. Time heals almost everything, give the time, some time.

  4. No one is the reason of your happiness except yourself.

  5. Don’t compare your life with others, you have no idea what their journey is all about.

  6. Stop thinking too much, its alright not to know all the answers.

  7. Smile, you don’t own all the problems in the world.

 

Hope you find the above useful, and have a great day ahead of you.

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Finding our identity

masks

\Welcome back to Serenity for the 2nd post, if you read the first post I talked about some of the difficulties that we as GPs face in looking after ourselves and why we are so bad at it. One of the main things is that we find if difficult to separate the identity of ourselves as a doctor from ourselves as a person – I thought I’d explore that a bit more on todays post.

In “Julius Caesar” , Shakespeare talks about the masks that we wear in our public and private lives. The idea that throughout our lives we wear different masks to face different situations and people, and rarely if ever do we take off the masks and show our true selves. We as GPs and doctors have many different masks that we wear, most people do in our modern world. Why then do we, compared to others, seem to find it so hard to take off theses masks? I’m not sure, but there is a difference, there’s an expectation by others and importantly ourselves, to maintain that mask of the “good GP”.

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In Caesar’s time the above quote – ‘I love the name of honour, more than I fear death’ drove him through his endeavours. Something similar can be seen in doctors – we are seen to have ‘honour’ and we are expected to uphold this and we fear the loss of this honour. This fear, of loss of honour, permeates a lot of what we do and how we react to things. I’m not saying that this is the main thing that we fear. I think its more about doing the best for our patients, and doing no harm. We’ve all had that night you go home worrying if you’ve done the right thing? Started the right medication? If you should have done that other test? What if you missed something? These thoughts, and doubts are part and parcel of being a doctor and indeed, I believe, a good doctor. At the same time these self doubts shouldn’t paralyse us, this balance usually comes with experience and knowledge (except surgeons… they’re wired slightly differently).

So going back to the point of honour why is that important in this discussion? Lets replace that word with ‘respect’ – now think of how we as doctors need ‘respect’ in our work and private lives. Most of what we do as GPs and doctors is done with a relationship with the patient where they respect our decision and advice. They may not always understand all that we tell them or why, but they respect us, and that we are there to help them. Same with our dealings with other specialists, allied health, administration, and regulatory bodies. I believe that we get used to that respect and do whatever we can to maintain it, that we go out of our way to do things to maintain that respect, even to the extent that it takes our work and public life/mask over into our personal or private life.

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One of the current trends in medicine and especially General Practice, is the growing dissatisfaction and disillusion we have with our work. There is growing angst, depression, early retirement, searching for alternative careers, substance abuse, and sadly increased suicide. Why?

I think it comes back to the ‘respect’ we spoke about earlier. That respect that the profession received has been whittled down over the last 40-50 years or so. Litigation, government policies and cut backs to health spending, patients perceptions and expectations, medical boards, increasing shift from clinical judgement, to ever growing paperwork and algorithm based decision making, have played their part. So what do we do ?

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For one we need to change how we perceive ourselves, there are issues in our work life we can address, and how we go forward as a profession, but we need to start with ourselves. We need to separate that idea of ourselves as a doctor and always a doctor, from our private and personal self. That identity of a doctor has been taking a lot of hits over the last few years, and we’re taking those hits and transmitting to our identity of ourselves as a person. Yes we’re doctors and usually very good ones who do more then we have to, but we’re also more. Once we find value in ourselves outside the profession we can approach the work itself with more confidence and belief.

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So start with yourself, in that person you see in the mirror, find worth in who you are. For you have worth, you have strength, you are smart, you are good at what you do, you have a purpose, and you are loved. Don’t be afraid of who you are, who you can be, and what you can achieve. Once you see worth in yourself as a person and not worth just in you as a doctor, then you can start making steps forward in other areas. Its difficult especially when we are at a low point, when people judge you, when you face challenges in your work. But you need to remember you aren’t alone. There are always people around you – loved ones, family, friends, colleagues, sometimes religion. So talk, don’t bottle things up, talk to those around you, and in doing so you might find that they see a lot in you that you didn’t realise, and that will help with that image we see in the mirror.

“Never forget what you are, for surely the world will not. Make it your strength. Then it can never be your weakness. Armour yourself in it, and it will never be used to hurt you.” – Tyrion Lannister, A Game of Thrones

 

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‘Medice, cura te ipsum’ – Physician, heal thyself

 

serenity

Welcome to Serenity – the idea came from a sci-fi show, but the word “Serenity” is defined as:

Noun : the state of being calm, peaceful, and untroubled.

Reading that I thought it would be an interesting name and idea for a blog here. I hope to discuss some things that pertain to the above state of being calm, peaceful and untroubled, as well as some other random thoughts and musings in my head. To start off the blog, I thought I’d lay out some thoughts on the way we look after ourselves.

As GPs we are naturally very good at or learn to become good at telling people how to live their lives, how to make adjustments, and what is good for them. Rather then being judgmental ‘know it alls’ this comes from a want, a need, and a duty, to care for and help others. We base these words of advice on evidence based studies, and recommendations from experts, yet how often do we apply this same advice to ourselves, and how well do we take advice dished out by others?

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Recently I’ve gone through some difficult situations in my personal life that have put a lot of pressure on me, and though stressful, have helped me find some clarity and insight into some of the things that I often tell patients.

As I explored mindfullness, CBT, and meditation I found that though I saw myself as very organised, calm and untroubled I was far from that – my life was far from serene. As I examined and continue to reflect on myself and what I do and who I am, I have found that a lot of the characteristics which I thought made me a good GP could have a detrimental effect on my own health and well being.

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Doctors in general tend to be driven, analytical, self critical, independent, and intelligent. They are encouraged to be empathetic with their patients, but not cross the patient doctor boundary, so that they learn not to take the worries and concerns of a patient home with them. So you have this package of an analytical, self critical person who is often fairly independent and who is told to listen to people and understand what they’re feeling but not feel too much, and at the end of the day remember to see them as patients and not take their concerns home with you – does that sound like a good mix? What would you say to a patient (let’s say a high level executive) who came to you with that lifestyle – adding in long hours, insomnia, a lot of bureaucracy, demands from regulatory boards, expectations from customers/clients, and high risk decision making multiple times a day?

With the above patient we would have a strategy in place, we would give them advice on lifestyle changes, on behavioural adjustments, we would go over the risks of that sort of lifestyle, work pressure and work life balance. We would talk about exercise, diet, mindfullness, taking breaks, general health assessment etc….

But do we apply these things to ourselves? I’m lucky in that I have a very supportive and understanding wife who often calls me out and tells me to pull my head out when I’m getting too stressed about something at work, and I have some close friends that are also doctors who help remind me to look after my own health. So recently I have tried to be a little bit more proactive in that department of looking after myself.

I found a GP for myself – the Victorian Doctors Health Program is a great service for Doctors which you can call up (03 9495 6011) to find a GP near you who takes on other doctors as patients. Australasian Doctors’ Health Network | Doctors’ Health Advisory Services in Australia and New Zealand – has lots of useful information, and support services for each region. I called up, found a GP, made an appointment, saw him, and started ticking off a few things that I would have expected any of my patients to have already done including general screening bloods, evaluating weight and lifestyle, stress and BP.

adhn-logo

There is a sort of relief in doing this, those concerns or worries you had about yourself- that you shelved to be done another day is cleared, and you pass them onto someone else. I often get that same feeling when I see my accountant and am assured that he’ll look after my taxes and finances. It’s true that he may berate me for not putting more away in my super or not claiming a certain deduction on tax, but I acknowledge that he’s there to look after my financial well being. There’s a release and de-stress in handing over that baton. So why are we so bad at doing this? Why do we feel that we are invincible and that our health doesn’t matter that much, or that we will be fine and this or that issue won’t affect us?

The answers are varied and complicated, but I think one of the key things is that we as doctors see our identity entrenched in that very image or ideal of being “the good doctor”. I think we can’t extract ourselves from this concept or identity as a doctor. This is perpetuated by our regulatory bodies, public expectation, government , media, and of course ourselves. I think one of the first steps to heal ourselves, is to start with a separation of that identity of ourselves as a person from that of the ‘Doctor’. We need to see ourselves as a person, with wants, needs, failings and weaknesses. We need to accept that we are fallible and that it’s ok to be so. When we are “off-duty” we need to remind ourselves of that fact, and be constantly aware that there shouldn’t just be small compartmentalised and scheduled time for family given we have a family all the time. In the end when we look to describe ourselves to someone else, being a doctor shouldn’t be the first thing that comes into our head.

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That I think is a good a place as any to leave this conversation for now, I’ll leave you with a quote from the very wise Douglas Adams –

“Well the hours are good…’ … ‘but now you come to mention it, most of the actual minutes are pretty lousy.”

Douglas Adams, The Hitchhiker’s Guide to the Galaxy

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