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Working as a GP can be draining and exhausting, yet very rewarding, work. You know that you’re supposed to be looking after yourself to enable you to do your job well. You want to approach your life and work with energy, empathy, and care but sometimes it feels like you are scraping the bottom of the barrel. You are not alone.  You probably have a good idea about managing your physical and mental health – you probably educate your patients about it every day. But how often do you actually practice what you preach?

I’m here to offer you a reminder and some practical tips about how to actually fit this into your real everyday life. It can be hard, seem near impossible to ‘find the time’ to take care of your own physical and mental health as a doctor. You are busy seeing patients all day, catching up on notes, following up results, going to seminars and conferences, keeping up to date, and you may be responsible for after-hours on-call for your local hospital or nursing home, you may have families of your own you need to care for, or you might be studying for fellowship exams. The problem is, to be able to do all of those things, you actually need to be at your best – so it’s important to prioritise self-care to enable you to bring energy and results to the rest of what you do. Relegating it to your leftover time at the end of the day means it will never happen. Think about each aspect of what I am about to say and think about a time in your day when you can actually do this, schedule it in and give it a go. Morning usually works best in my experience but everyone is different, so find what and when works best for you.

 

1.     Mindfulness

Mindfulness can make a big difference to your life. Several practices can cultivate mindfulness such as yoga and tai chi but most of the literature has focused on meditation. Mindfulness is really about awareness without judgement, an acceptance of your moment-to moment thoughts and experiences.

Evidence from correlational research suggests that mindfulness is positively associated with a variety of indicators of psychological health, such as higher levels of positive affect, life satisfaction, vitality, and adaptive emotion regulation, and lower levels of negative affect and psychopathological symptoms (1).

You don’t have to create a perfect environment or have large amounts of free time to sit down and meditate. All you need is a 10-minute time slot prioritised into your day; I suggest scheduling it into your calendar. First thing in the morning works best for me before anyone knows I’m up! There might be a bit of background noise in the house, dogs barking, someone screaming at their sibling in the kitchen, it just doesn’t matter. There’s no perfect time so just sit down and do it. Here’s one approach to meditating:

Sit down comfortably, take a few moments listen to the sounds in your environment (just an awareness with no judgement attached), take a few moments to focus on your breath, close your eyes, conduct a slow body scan top to toe to check in and notice each area of your physical body, just allowing it to be, as it is, not trying to judge or change anything. Then spend a few more minutes focusing on your breath. You can count your breaths if that helps. Remember its normal for your mind to wonder off – again do not judge yourself on this, just be aware your mind has wandered and gently bring your focus back to your breath.

Some people like to use a mantra to focus on however I find that focusing on my breath (inhale… exhale) works best. It is interesting the types of thoughts that pop into your mind when you do this. Whatever the thoughts are, remember they aren’t good or bad, they just are. Notice them with curiosity and acceptance.

I also highly recommend using this technique during your work day – stop, take 3-5 deep breaths. Stay calm. When we are running behind and it all feels a bit stressful you can return to this. You can ground yourself with your breath. Initially it may feel strange but once you get used to it, it becomes second nature. I suggest an app like Headspace or Smiling Mind if you haven’t ever done this before[SP1] .

 

2.     Exercise

We know you know this. But it actually helps. Exercise is an effective evidence-based intervention for osteoarthritis, back pain, tendinopathy, depression, diabetes and cardiovascular diseases (2). I suggest doing some activity on most days of the week to keep you in a routine. Accumulate 2.5–5 hours of moderate intensity physical activity, 1.25–2.5 hours of vigorous intensity physical activity, or a combination of these per week. The ‘how’ will vary from person to person but if you aren’t exercising currently then I suggest the cheapest, simplest, least time-consuming method to start with – walking! Put your sneakers on and go for a brisk walk. In my opinion this one, like meditation, is all about routine. If it becomes a habit it’s not even a thing you need to ‘try to remember’ anymore. If it’s all planned for and routine-based then those around you begin to get used to it too. You do not need to apologise to anyone for looking after yourself. You just do it and it becomes a staple in your life – like showering in the morning or brushing your teeth.

 

3.     Healthy diet

This can be a little trickier. You are probably time-poor, if you have a family to feed its even trickier again. Planning ahead is the cornerstone of healthy eating in my life. I like to sit down once per week and plan all of our dinners. I then order my groceries online according to this plan and I don’t even have to leave my house.  This does not take long. I am not so specific with lunch but I always try to pack my lunch and snacks from home as it makes it easier to eat well at work.

If your dinners are all planned in advance and you have all of your ingredients in the house it is very easy to have a healthy, vegetable-filled meal each day. I am probably going to sound crazy now but I have a basic rhythm to the meal plan that stays the same each week so there’s even LESS THINKING involved. I make enough decisions all day long I don’t want to have to think about this ANY more than I have to, and the meal is always easy to prepare. So here it goes – the basic meal plan is –

  • Meatless’ Monday – (vegetarian dish for example Mexican beans, ratatouille, quiche, baked potatoes, lentils, tofu stir-fry, fried rice)
  • Tuesday – ‘slow cooker day’ (for example casseroles, soups, chilli, curry – always make an extra serve to freeze)
  • Wednesday – ‘fresh cooked’ meal (fish, salads, grilled meat and veg, BBQ etc)
  • Thursday – ‘freezer meal’ (night off cooking)
  • Friday – ‘fake-away’ (home-made pizza, burgers, home-made sweet potato chips, hot chicken, fried rice)
  • Weekends is usually an outing or take away and then a roast.

See how little thinking there is when it follows the same simple pattern but still with lots of flexibility and variety. Veggies are key –all of our meals have loads and loads of extra veg thrown in. Lunch can be leftovers or salads or soup from the freezer, snacks are salad sticks, hummus, fruit, peanut butter on crackers. For me it’s all in the planning – makes healthy eating very simple and stress-free.

 

4.     Time for leisure

Life is for living. Don’t forget to have fun. Fun for you is different than fun for me. Whatever it is for you – book it in, do it and enjoy it! Woohoo!

 

5.     Sleep

We are all guilty of not getting enough at some point in our lives. It might not even be our fault if we have small children in the house. Adults should be aiming for around 8 hours per night although there will be some individual variation.  I don’t need to preach to you about sleep hygiene but as a gentle reminder sleep hygiene recommendations include: having regular bed and wake-up times (including weekends), limiting caffeine and alcohol intake, regular exercise (preferably not too close to sleep onset), and to avoid napping too much in the day (3). If you’re studying for your fellowship exams, sleep is even more important as there’s a clear link between sleep, learning and memory – see the Harvard Sleep Centre website for their research findings at: http://healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/learning-memory

 

6.     The importance of connection

I recall feeling as though I had already ‘emptied my cup’ at work and didn’t have enough left over for my kids, friends, husband and self. This was a big challenge for me and for many others in our profession. In the end, reducing my clinical workload and increasing the above self-care strategies was my solution. At the end of the day, it is connection with other humans that matters the most in our lives. I don’t want to come home every night and hope that everyone just leaves me alone so I can have some quiet time!! I want to come home and have capacity to cook and sit down to a family meal together, to chat and reconnect, to play, to exercise and have fun. If you come home every day feeling completely depleted this will impact those around you. If you find it hard to carve out time for meditating, exercise, sleep, healthy eating and leisure because it feels selfish then please remember this will not just benefit you. This will benefit you, your family, your friends and your patients.

If you are not doing any of the above right now then I suggest you make one change at a time, get used to having that as part of your weekly routine for a few weeks and then change another thing. Making gradual sustained changes is more likely to be successful than a sudden overhaul of your whole life.

 

Good luck!

 

References:

  • Keng SL, Smoski M, Robins C. Effects of Mindfulness on Psychological health: A Review of Empirical Studies. Clin Psychol Rev. 2011;31(6): 1041-1056
  • Orchard J. Prescribing and dosing exercise in primary care. Aust J Gen Pract 2020;49(4):182–86
  • Liotta M. How does sleep affect health? News GP. 2019. Available from: https://www1.racgp.org.au/newsgp/clinical/how-does-sleep-effect-health