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ss triple helix - Spring 2020,  Self-care as a Medic

Self-care as a Medic

juniors' forum
Sarah Wright looks at why we need to take more care of ourselves as carers and at some practical tips for doing so
It was some years ago now when I noticed that mental health support was almost non-existent in my medical school. I had gone through a rough patch of failing exams, and I was wondering if medicine was actually what God was calling me to. My medical school, unfortunately, didn't enquire as to whether I needed support and so I was left alone to prepare for resits. Blessedly my friends from church rallied round and helped me through. It was then that I realised the need for self-care for my mental health.

In October 2018, the BMA conducted a survey into doctor's mental health. They found that three in ten respondents had been diagnosed with a mental health condition and nine in ten stated that their working, training or study environments had contributed to their condition. [1] So as doctors, how do we look after ourselves? Since that time, I have been increasingly interested in the growing fascination with 'mindfulness' and 'self-care' in the medical world. It seems that every other post I see on Facebook or Instagram is about how to care for one's self. Mindfulness is 'knowing directly what is going on inside and outside ourselves, moment by moment' according to Professor Mark Williams, former director of the Oxford Mindfulness Centre. [2]

Many people advocate the use of mindfulness to combat mental health problems or just to keep a healthy mindset. The All-Party Parliamentary Group on Mindfulness wrote that they 'hoped that mindfulness will become as popular for improving mental health as jogging (only popularised in the 1970s) has become for improving physical health.' [3]

The evidence for mindfulness is at best similar to that of other relaxation techniques. James May in CMF Files 64 outlines the evidence for mindfulness, both its positive and its potential negative effects. [4] So while the world seems to take it for granted that it is an overwhelmingly positive activity, we should use it wisely. When we look at Scripture, we see that David advocated a type of mindfulness when he said 'Blessed is the one... whose delight is in the law of the Lord, and who meditates on his law day and night' (Psalm 1:1-2). Use of meditation is also found in Joshua 1:8, 'keep this Book of the Law always on your lips; meditate on it day and night, so that you may be careful to do everything written in it. Then you will be prosperous and successful'.

So what does Biblical mindfulness look like? James May in CMF Files 64 suggests that 'Meditation in this sense involves a type of awareness which is intentional' and can identify desires and thoughts that distract from our awareness of God. [5]

But it should not be taken as a distraction in itself from spending time one-to-one with our God. Meditating on Bible verses is a good thing, and David promotes 'ponder[ing] all your work and meditat[ing] on your mighty deeds,' in Psalm 77:11-13 and again in Psalm 119:14-16. However, it is not just reading the Bible, but spending time going into the deeper meaning of Scriptural passages and using them to focus on God. Mindfulness remains both a tool for self-discovery and a tool for self-destruction if misused. Where it can build up good thoughts and our awareness of God, it can also let us dwell on negativity and distract us from the one person who can help. In his CMF File, James May concludes that, 'The lack of robust evidence for the effectiveness of mindfulness, accumulating criticisms, and evidence of possible harms should make us doubly cautious.'[6]

Practical tips for looking after your mental health:

  • Above all, take time to spend with God - 'Be still, and know that I am God.' (Psalm 46:10)
  • Seek help - whether from your GP or from a friend, talk about what you're feeling and going through.
  • Read. CMF Files 64 on mindfulness is an excellent place to start. Living Life To The Full (llttf.com) is a website offering self-support for those going through mental illness, and Losing God by Matt Rogers (mattrogers.us/books/losing-god) is a book which really helped me through my most difficult times.
  • Meditate - pick one verse of the Bible to think about during the day, especially if you're feeling stressed.
  • Be yourself - whether that's as an extrovert being around people or an introvert needing time alone, make sure you take time to relax and refuel.
  • Be involved - make time to involve yourself in hobbies and interests outside of medicine.
  • Be honest - cultivate friendships where you can be authentic with people and share concerns and troubles.
  • Be healthy - eating a healthy, balanced diet and exercising has been shown to help with mental health conditions - even if it's taking one flight of stairs extra per day!
  • Observe - know your triggers for declining mental health and have a strategy for relieving them.
  • Learn to say no - I know rota co-ordinators can be scary people, but learn to say no to extra shifts/swaps if it will adversely affect your mental health.

Sarah Wright is a CT1 trainee in Internal Medicine & Medical Oncology
References
1. Caring for the mental health of the medical workforce. BMA, 2019. bit.ly/2vqgrz1
2. Mindfulness. NHS, 2019. bit.ly/2SjKmlq
3. Mindfulness All-Party Parliamentary Group. bit.ly/37gsJas
4. May J. Mindfulness. CMF File. 64; 2017. cmf.li/37AEsS25
5.Ibid.

6.Ibid.

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