Dr Claire Davies considers wellbeing and fulfilment in the medical profession, giving nine top tips on regaining a passion for medicine
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Medical careers have been exceptionally challenging in recent years. Burnout, moral injury, the COVID-19 pandemic, wage stagnation, and unprecedented levels of staff sickness have caused many doctors to consider exiting the profession or the NHS.1–4
But what about clinicians whose heart is still in providing healthcare services in the state-run system? What about those who want to help patients unable to access private healthcare? In these times, clinicians who are planning to keep working in medicine and the NHS—without burning out and with the aim of enjoying their job—need to become very intentional in their plans to continue.
This article offers nine top tips for healthcare professionals wanting to rediscover their purpose and look after themselves while working in medicine.
1. Consider What Led to a Career in Medicine
Many clinicians may have never stopped to consider why they went into medicine, and why they are still in medicine right now. When clinicians are asked about this topic, ‘wanting to help people’ is the expected answer,5 but a recent Twitter thread that I initiated revealed a wider range of answers, both positive and negative.6 Some doctors felt that they had received poor careers advice at school, or had been channelled into medicine by their parents.6 Being good at science subjects was a contributing factor, as was the desire for a steady, well-paying job.6 The impact of witnessing serious illness in a close relative was another common theme.6
People’s lives change, and what gives them meaning can also change. Clinicians may therefore benefit from asking themselves why they are still in medicine and what has sustained them. It may be those exciting moments when they felt a deeper sense of fulfilment. Alternatively, it may be a lack of imagination to do something else, or it may even be as simple as needing to pay the bills. Regardless, this may be a useful exercise to help clinicians understand their personal motivation and consider their career choices.
2. Identify the Components of Job Fulfilment
Life can be very focused on getting and accomplishing things: an exam grade, a car, a house, and so on. However, there is a difference between achievement and self-fulfilment (or self-actualisation)—self-fulfilment tends to come from experiencing what is going on in the moment and engaging with what is meaningful to the individual rather than from materialistic achievements and comfort.7–10 As emphasised in Kimsey-House et al’s Co-active coaching, ‘Living a life of purpose, mission, or service can be intense, sometimes heartbreaking and exhausting, and at the same time enormously fulfilling. The paradox of fulfillment is that it is possible both to have a sense of inner peace and to experience an outer struggle at the same time.’7
Different things about the medical profession excite different clinicians, from developing relationships with patients to performing high-risk, highly skilled procedures. When a clinician takes the time to delve deeper into what makes them feel fulfilled, they will be better informed about themselves and able make plans to incorporate more of this into their work. It may be useful to think of a few career moments that were particularly energising—what was so important about those moments?
3. Appreciate the Role of Personal Values
Closely related to fulfilment is the appreciation of one’s own values, as they provide a blueprint by which to live and develop self-expression. Individuals who have clear, holistic career values tend to choose to do more of what makes them feel fulfilled and little of what they consider less important or relevant to them.11 Common values among healthcare professionals include altruism, capability, intellectual stimulation, self-direction, and equality.12
Developing an understanding of personal values can take time, and it may be beneficial to work with another person when considering them. Performing an exercise designed to help an individual to identify their values can also be useful—an example can be found on this webpage: brenebrown.com/resources/living-into-our-values.13
4. Know and Work With Individual Strengths
In medicine, much is made of what a clinician is going to do next to improve, whether it relates to their procedural skills, continuing professional development, reflection on patient feedback, or their own feelings of anxiety, imposter syndrome, or perfectionism, or indeed to any other difficulties common in the medical profession.14–16 Externally, there is constant pressure to implement best practice and follow clinical guidance, and there are numerous NHS initiatives that emphasise both individual and larger-scale service improvement, such as in the NHS long term plan17or the Interim NHS people plan.18 It is all too easy to end up on a continual journey of correcting professional shortcomings.
Less attention is given to what is actually beneficial for the individual clinician, yet there is evidence that understanding and playing to one’s strengths has a significant positive impact on people’s mental health, wellbeing, and performance,8,19,20 indicating that clinicians would likely be happier and perform better at work when working to their strengths. Here are three possible ways in which anyone can get to know their positive qualities:
- ask a trusted friend or family member what they think their strengths are
- spend a moment at the end of each day reflecting on what they did well—what were they expressing or doing at the time?
- undertake a strengths-based questionnaire, such as the VIA Character Strengths Survey21 (a free online tool developed by Professor Martin Seligman and Professor Christopher Peterson, which is based on their influential work in the field of positive psychology22).
5. Be Clear About FinancesAnecdotally, I have heard many clinicians say that they are disillusioned in medicine, but feel trapped because of their financial commitments. Therefore, it is essential for clinicians to spend time getting to know their finances properly, particularly their outgoing expenses and what is needed to maintain them. For this, a full financial audit of a year’s spending can be revealing.
There are various options to consider if finances are a concern, such as extending a mortgage, discussing the possibility of a spouse putting in more hours to accommodate work changes, or cutting back on certain expenses while settling into another career or role. Such changes require time, careful thought, and sometimes difficult conversations, but can be an important step to take.
Even a relatively small change, such as making the decision to reduce workload by one session per week and do something else with that time, can make a huge difference. When looking to understand one’s own skillset and financially viable options, it can be extremely helpful to engage with an experienced careers coach.22
6. Exert Control Over Working Life with Job Crafting
‘Job crafting’ is a process through which an individual alters their job to tailor it to their unique needs and make it more engaging and meaningful for them.23 Studies have shown that job crafting improves individuals’ wellbeing, motivation, and performance when used in healthcare settings.24–26
Not everyone can have control over their working environment, and most people’s jobs are influenced by external forces or circumstances, such as when working for a large institution or in a training position. However, some clinicians will be able to make beneficial changes, and even small changes can make a difference.
Job crafting is generally separated into three areas, as outlined in Box 1.25–27 One example of job crafting in a general practice setting would be to alter the emphasis of one session per week—this could be by changing it to a more specialised, lower-pressure clinic with longer appointments, or by swapping it for a teaching session.
|Box 1: Types of Job Crafting25–27|
7. Recognise and Deal With BurnoutHealthcare professionals are at high risk of burnout,3,28 but the very nature of burnout means that people are often poor at spotting the signs and, paradoxically, some people may work even harder as a way of combatting it. Signs of burnout include fatigue, poor concentration, detachment, disengagement, and irritability.28–31 The British Medical Association offers a self-assessment questionnaire for clinicians who think they may have symptoms of burnout.32
Reflecting its prevalence, burnout was first defined in 2019 by the World Health Organization in its International Classification of Diseases (see Box 2).29,30 According to this definition, burnout is an occupational phenomenon characterised by feelings of exhaustion, increased mental distance from one’s job, and reduced effectiveness at work.29,30,33
|Box 2: ICD-11 Definition of Burnout29,30|
Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:
ICD-11=International Classification of Diseases 11th revision.
© World Health Organization. International Classification of Diseases eleventh revision (ICD-11). Geneva: World Health Organization, 2022. License: CC BY-ND 3.0 IGO.
Support for Burnout
Some possible sources of information and support for clinicians experiencing burnout are detailed in Box 3. Coaching has also been shown to help clinicians with burnout.34
|Box 3: Sources of Support and Information for Clinicians Experiencing Burnout|
8. Understand the Psychology Underlying Self-Care
Many doctors report difficulty in implementing self-care. These difficulties include the practical challenges of time or energy constraints, but there is also a tendency for doctors not to prioritise themselves.35
Seligman’s theory of wellbeing uses the PERMA (positive emotion, engagement, relationships, meaning, accomplishment) model as a way of understanding what makes humans flourish.8,36 Within this conceptualisation, people need elements of each category on a regular basis.8,36
Self-care means different things to different people, and self-care, mental health, and relationships with work all go beyond this framework. However, it is an excellent starting block for reviewing the different areas of one’s life and considering what may be missing. See Table 1 for examples of how it could be applied.8,36
Table 1: Some Life Strategies Based Around the PERMA Model8,36
|Emotions involved||Pleasure |
|Being ‘in flow’|
Losing track of time
Learning new things
Sense of belonging
|Engagement in important and worthwhile pursuits|
Serving something you believe is bigger than yourself
|Sense of achievement|
|Ways of cultivation||Time spent with loved ones|
Planning and doing enjoyable activities
|Playing an instrument|
Practising yoga or meditation
Engaging in hobbies
|Interacting with friends or family|
Time spent with loved ones
Showing appreciation for people
Having positive interactions with strangers or coworkers
Giving to charity
Sharing learning on something important to you
|Mastery of a skill|
Setting and achieving goals
Following a regular exercise regime
Using a planner to get organised
Taking on new responsibilities
|PERMA=positive emotions, engagement, relationships, meaning, accomplishment|
9. Apply Decision-Making Skills to Life ChoicesDoctors are constantly making good decisions about patients, but how often are they ensuring that they make great decisions about themselves? Potential decisions relate to staying in a particular job, working in the NHS or private sector, staying in the UK or moving abroad—these are all common dilemmas.
There are numerous tools intended to help with decision making. When making key decisions, it is important to talk to people who will listen, but who will not necessarily prescribe what to do. After all, it is not their decision to make.
One useful method for assisting decision making is to create and fill out a grid detailing potential actions and consequences.37 These grids can be relatively complex or can be very simple—see Figure 1 for an example. Filling out this grid, or doing something similar in a different format that considers potential actions and their consequences, is a good way to develop a new perspective on a familiar problem.
Figure 1: Example of an Action–Consequence Matrix
In my experience, clinicians—and people in general—are often told that they need to say ‘no’ more or be more assertive, but rarely does anyone explain how to do so. The line between assertiveness and overconfidence can be a fine one, particularly in medicine,38 and being assertive can be very difficult in hierarchical structures.
Nevertheless, being assertive and holding one’s professional boundaries is likely to be more effective, and potentially kinder, for both a clinician and their patients.38,39 Healthy boundaries allow us to support patients without unintentionally over-helping them when there may be some issues that patients are best placed to manage themselves. Assertiveness can also be beneficial in many other areas of life, not just at work.
Assertiveness, particularly when saying no to someone, is actually an act that has many components. This is demonstrated by the existence of assertiveness training, an evidence-based type of therapy that is designed to help people to become more assertive.40 ‘Just say no’ is common advice, but being assertive has many components. When trying to be more assertive, it may be worth considering that:
- knowing why they are saying no to someone can help a person feel empowered to do so
- body language is an important factor—approximately 80% of communication comes from body language41
- being prepared for the potential pushback that comes with saying no is an important part of the process.
Regaining enjoyment of medicine is a journey in itself, and the process of self-evaluation and change can be difficult. It may be the case that starting small and developing regular habits is more productive than trying to make big changes that are harder to maintain. Choosing and implementing one or two actions inspired by this article will have more of an effect than trying to make many changes all at once.