Are you OK, Doc? : Mental Health Support For A Struggling Doctor

In the spirit of the 2021 World Mental Health Day campaign, we call for better awareness and support for the mental health of our doctors. Here is an extensive list of ways doctors can take care of themselves better.

Here’s the thing. Everyone is wired differently, and a lot of that has to do with the environment we’re brought up in on top of inherent personality traits. A lot of traumatic experiences and defence mechanisms stem from a very young age. That is why many seemingly usual things at work can be triggers to some and just another day at work for most others. If you’re a doctor who’s finding it difficult to hold on to sanity, here is my list of things that can help you look after your mental health. Take this is from someone who has experienced the depths of a depressing pit and has managed to come out stronger.

FIRST AID

Recognise the pattern.

When you start recognising a change in your mood, behaviour, and daily habits, alarm bells should ring. Your body is usually in tune with its needs and will show signs if they’re not being met. 

These include sleep patterns or your period cycles. Mood swings are very telling too. A loss of interest in what usually excites you, feeling lonely, intentionally avoiding people, and wanting to sit in the dark signals a warning. You don’t have to wait for a meltdown to know your body requires attention. 

Binge eating, not eating at all, harming yourself by either physically injuring yourself or by misusing drugs and substances ought to be a distress signal. Be aware of thought patterns that lead to ruminating or fearing the worst. Know that those are signs that perhaps your mental health is not doing well. The first step is recognising what your body is telling you and to respect that. 

Take a step back. 

There really is no use saving up your rest days or fearing an extension. They are meant to be used on days when you’re not doing too well. Being mentally unwell, especially, is exactly when you need them.

You should not be compromising your health for career advancement whichever job you do. Breaks help you to reorient and re-prioritise. I’ve known of those who’ve taken a week or two off only to come back stronger and power through training. I’ve also known those who need intermittent breaks to be able to perform well at work. Breaks are necessary for growth and mental health. Of course, I  know those who’ve needed breaks to figure out a plan B as well, and that’s totally okay. 

Speak to your team, and arrange for breaks should you need them. It provides room for communication and support that way. I’d caution against not showing up out of the blue. It spells poor work ethics with no team accountability, and you don’t want that for yourself. 

Plan something to look forward to – treat yourself.

All work and no play makes Jack a dull boy. You don’t have to go for an extroverted night out. It’s just that it’s easy to feel like your life revolves around work and nothing else, especially when it’s work that’s currently making you unhappy. 

Plan something ahead of time, like meeting your friends after work for cake or scheduling an ayurvedic abhyanga. Plan to go to the beach or a forest trail on your day off. Make sure you block your time for yourself. Download a fitness app that makes you excited to clock in a 5-minute workout. 

Get yourself a plant, maybe a room full of plants (quite trendy these days). Treat yourself to a good meal, bring yourself to the movies. Buy a good outfit you could wear to work. As Tom and Donna would say –

Had a good day? – Treat yourself.

A bad day? – Treat yourself.

Can’t figure it out? – Treat yourself.

For showing up, for existing, for making it through another day. Waking up and getting yourself to a job you’re struggling with deserves applause. 

Tell people you could use some extra support.

Reaching out can be hard, especially when mental health debilitates you. I do wish you have it in you to say this at least –

I haven’t been doing too well mentally, would it be okay if I spoke to you about it?

Will it be okay if I sit down with you for a bit?

Say it to a family member, friend, or co-worker. Whether they’re in a position to offer help may not be up to you, but asking for support brings you halfway there. It also helps to have a safe word and an accountability partner. Identify one person who’d be there for you and discuss a mental health safe word for you to use should you need help. It’s a simple way to signal you’re not doing well, sparing an explanation. Examples include – 

Black clouds.

I can’t breathe.

Or they could be unassuming words that come from an inside joke, like “dinosaurs” or “chocolate chip and mint”. Feel free to use your creativity to your advantage. 

Sometimes we tend to feel more comfortable talking to strangers. In that case, reach out to the Malaysian Medical Association’s Helpdoc at 03-4041-1140. They’ve set up a hotline with the welfare and well-being of doctors in mind. 

CHEAT SHEETS 

Ask how someone else is doing.

It’s interesting that I should suggest asking how someone else is doing when you’re struggling. It’s a mental cheat that helps you widen your point of view. 

Call someone up and ask how their day went. Ask them about something interesting that has recently happened, or how work is going for them. This way, you explore the various other narratives there are to life and not assume the bubble of what life looks like to you 

Listening to a friend who is scrambling to meet project deadlines, for example, can offer an alternative perspective of what work is like for those not working as a doctor. You are in no way diminishing your struggle, but perspective matters. At least you can share a conversation about how both of you need a break and should schedule coffee sometime soon. 

Practice mental tricks. 

You can learn a lot through therapy, mind tricks that act as first aid to a spiralling mind. There are a couple of pretty neat tricks I have learned that helped me get my mental health back on track.

When you notice yourself going down a predictable pattern of intrusive thoughts, know that nothing good comes out of it. It exaggerates the situation and is a train wreck waiting to happen. When you’re mindlessly going down that track, do something unpredictable. Something your brain did not see coming. I would love to tell you to break into a song or dance, but here are some practical suggestions – 

Sing ‘If you’re happy and you know it’ in your head and clap out loud. Yes, in the middle of that speeding train of thoughts in your head. 

If you’re walking with your right foot forward, switch it up. Watch your brain concentrate on coordination. 

Bite into a slice of lemon. 

The age-old grounding trick – look around you and acknowledge 5 things you see, 4 things you can touch, 3 things you can hear, 2 things you smell, and 1 thing you taste. It doesn’t work for me because it clutters my mind. I like focusing on one thing at a time. Do what suits you. The key is to distract not just yourself, but the thought process in your mind. 

The second mental trick is using the word ‘stop’. Our brains are so familiar with the word “stop” that it immediately associates the word with stopping, be it something you’re doing, or a thought process. Mindfully say stop to yourself every time you catch yourself going haywire. Say it again if you’re a little more stubborn. 

Check this Cognitive Behavioural Therapy (CBT) Skills Workbook out to understand thought processes better.

SUPPORT AND SOLUTIONS

Get yourself referred to a psychiatrist.

First aid and neat tricks don’t cut it at times. That is why it’s important to seek professional help regardless. You don’t have to wait for a mental breakdown to seek help. The sooner you do, the more manageable it becomes.  

Get yourself a referral to the psychiatry clinic from the person who manages you at your department. If you’re uncomfortable, get help from someone else who can write you a referral. Take a friend with you if going to the clinic feels daunting. 

Psychiatrists are really kind people who’ve mastered the art of listening and validating your experiences. Not only do psychiatrists help identify your triggers, they offer therapy and medication to help you heal, whichever you may need. They can also offer you a short break to recharge, realign your priorities and come back stronger. 

It may not be a popular opinion, but different psychiatrists have different approaches. It’s important that you make known your goals during your sessions. For some, it is to heal and go back to work as soon as possible. For others, it may be to foster a long term relationship and tackle deep-rooted issues like childhood trauma. Work becoming secondary. Know that it is okay to find yourself the best fit. Find the right therapist and make your goals known.

Know the kind of support you need.

Self-love Languages (click to enlarge)

They say you work best with good colleagues and that is as true as it can get. Good colleagues make work fun. Not only won’t you feel the overwhelming workload, but you’d also remember to have a snack and take that loo break. That being said, you need to know the kind of mental health support that works best for you. 

For some, being around family offers support and living ease. On the other hand, for some, living away from family is bigger support, affording them independence, including emotional independence. 

There are people whose biggest support is a good partner, or an adopted pet. Some find great support in that compulsory after work get together. The bottom line is, the right kind of support is what makes or breaks you. It won’t be the same for everyone, so know yourself well. 

If you are your greatest support, it’ll help to understand what your love language is. Yes, it works for self-love too. The five love languages include words of affirmation, quality time, physical touch, receiving gifts, and acts of service. Click and check our self-love languages poster out!

Mistakes happen. 

I once saw a child fall. Instead of rushing to attend to him like I was, his mother stopped me and allowed him to get up himself. 

We’re too careful, often afraid to make mistakes and feel pain. We’re afraid to fail in exams and afraid to admit we don’t know something. Honest feedback terrifies us. These temporary inconveniences are uncomfortable but they offer tremendous opportunities. 

Admitting you don’t know something, gives you the opportunity to identify the gaps in your knowledge and the opportunity to seek that information out. “I don’t know” is empowering. It’s so rooted in our culture to punish instead of celebrating failures. Somewhat radical. 

It’s usually the ones with straight As who enter medicine. Those who so rarely see failure. Those for whom failure is unacceptable. The gold medallist, the star student. There is resilience in this, no doubt, but there is far greater resilience in those who allow themselves to get Bs. Those who let the gaps in their knowledge inspire and get them further. Those who know that it’s okay to not know, or to fail because tomorrow presents with another opportunity. 

Some of the best doctors I know now are not the ones who got straight As. They are also not the ones who went for every lecture and studied all night for exams. They’re the ones who let life be their greatest teachers and take on each day with grace and good nature. 

Medicine obviously is no place for errors, but they can be prevented not by policing or punishing yourself, but by good communication, an effective team, and a safe learning space. Allow yourself to be a novice.

Learn your career options. 

Your career doesn’t have to be a one-way track. Medicine isn’t even a one-way track. Healthcare is expansive and far-reaching. You could be interested in clinical medicine, or you could be interested in being of service to the community. Maybe you’re technically inclined. You could be creative and have an eye for design and the written word. Maybe you’re a fierce advocate, or maybe you close deals like a professional. There is a place for you in health. 

You see, just because the usual path is graduating from medical school and going into housemanship, it doesn’t mean you’re stuck on that path forever. You can branch out right out of medical school or you could acquire a few years of experience before you go into something you’re more in tune with. 

“Tell a fish to climb a tree and it fails, falls dead even, but put that fish into the ocean, and it’ll never drown, in fact, it thrives.”

Be wise to leverage your years of medical education and training. It helps to know what your options are with or without a full practising license. Try finding inspiration from the numerous success stories here on Medic Footprints and speak to those who have something to share. 

It’s okay if clinical practice doesn’t work out.

Every decision you make is not a life sentence. As an adult, you have to make choices. There is never a right or wrong one and you’re allowed to change your mind if something isn’t serving you well. You don’t have to abide by the conventional. Bend the rules. Be in control of how things go. Make radical decisions. Stand out. Leave medicine. Come back into medicine. Do something else that’s just as interesting and fulfilling. You see, the world is anything you make of it. Take accountability for the life you live. 

Here is a story I find empowering. Hannah’s story of weighing her options out, and deciding what’s best for her. You can spend years so certain of something, but life is all about growing and doing better for yourself. Know what you want your life to look like. 

I suppose it’s because we’ve never been trained to be rebellious, to be empowered to make decisions for ourselves. We’ve never been able to say – look, here’s what I want, and this is how I want my life to look like. Maybe that’s medicine, maybe that’s something else, maybe a bit of both or a design of your choosing. You get to decide. 

There never really is a right time to do anything. The right time is exactly when you make a decision for yourself. Please don’t be afraid of making decisions. If it’s the right one, then off you go! If it’s the wrong one, then you’re that much wiser in making the next decision, which means you’re halfway there already. 

Voice out and advocate for change. 

Leaving medicine won’t change the fact that it does a disservice to mental health. 

You’ve got to speak up and you’ve got to be loud if you want it to reach the tables of decision-makers. Join advocacy platforms like the numerous medical organisations. Collectively, we make a greater impact.

Mental health isn’t someone else’s problem. Pardon me, but it’s not right to let others advocate for the cause while you watch to see if something comes out of it. It’s not right to not be bothered because you’re strong enough to deal with mental health on your own. 

Your voice and your needs matter. It’s important that you’re heard and it’s important that your needs are met. That is why we vote and have those we trust represent us in governments. The welfare of the medical community matters just as much. Mental illness doesn’t have to mute or diminish you. 

Your story is unique.

Our stories are all unique. We may have similar experiences but we view them through the lens of our personal struggles. Your struggles are valid and cannot be discounted. Mental illness should not cost the rest of your life. Know that you’ve come very far and every decision you’ve made up to this point has made you that much wiser and braver – and there is strength in that. I’d love to hear your stories if you’re feeling a little chatty. If it’s anything, I just know there is so much to be inspired by. 

Interested in finding out more about alternative careers for doctors? Check out our career guides and find inspiration from our case studies. For those based in Malaysia, you can sign up for updates here, and follow our MF Malaysia Instagram and Facebook pages to stay updated on our events, webinars, job vacancies and more.

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Victoria Navina

Victoria Navina is driven towards policy and practice-changing public health interventions, and is a strong advocate for mental health, aiming to make the conversation surrounding it louder and unrestrained.

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