Why Emergency Medicine is my favourite specialty

As a 5th year (intercalating) medical student, who is nearing the end of his time at university, I am often asked by doctors, friends and family members what I am eventually going to specialise in. Frequently, when I respond excitedly with: ’emergency medicine (EM)’, I receive negative remarks or horror-stricken faces. The media portrayal of EM definitely doesn’t help. I often have to answer questions such as:

‘But won’t you just get burnt out?’

‘How will you balance the night shifts and unsocial hours with family life?’

‘Aren’t emergency physicians just gloried triage nurses?’


Doctors, especially those not in acute medicine, will sometimes try to persuade me to rethink my interests or career options. At first, this used to really make me upset and question if I truly was capable of succeeding in a career that is notorious for being brutal and stressful due to the sheer workload, lack of resources and unsocial hours. But now rather than getting upset, I feel confident in my choice of pursuing a career in EM and attempt to combat any myths people have regarding it.

The reasons I am so confident that EM is the career for me are numerous but include the following:

  • I’ve had placements in literally every other specialty

At my university, we get the opportunity to rotate through every single specialty from pathology and microbiology to neurosurgery and cardiothoracics. As such, I believe I am ideally-placed to comment on which specialties I am best suited to. Out of all the different departments, however, I have spent the longest time in the Emergency Department. By the end of this academic year, I will have spent a total of nearly 11 months in the ED – all as a medical student! This year has really highlighted my passion and love for EM. Why is that?

  • Variety

We all know variety is the spice of life and EM offers me that. In a single shift, I can go from seeing patients presenting with stroke-like symptoms or chest pain to those presenting with poly-trauma or full-blown cardiac arrest.  But at the same time, there is always periods of ‘down-time’ where the workload consists of less severe conditions such as a common cold! I could never see myself specialising in one area, e.g. cardiology, as I could not bear the thought of seeing the same conditions day in day out. Every day I learn and see something new in the ED. Cognitive stimulation is really important to me.

  • Teamwork

I have said this time and time again but there is no better team in a hospital than the ED team. Even as a medical student, I can walk around the department and nurses, porters, doctors and receptionists will say hello to me and ask me how I am. It’s this sense of family and support that makes EM such an amazing specialty. Everyone looks out for one another’s well-being. Period.

  • Opportunities

In EM, the priority is always ruling out any life-threatening conditions and making critical life-saving decisions and interventions accordingly. Being able to do this opens up many doors into other exciting ventures. For example, pre-hospital emergency medicine (PHEM) has recently been recognised as a formal sub-specialty and this is an area I hope to pursue as it involves taking life-saving care to the roadside. These skills can be used anywhere in the world, whether it be during humanitarian crises, on the front line in battle or even on a navy boat. I plan on taking full advantage of these opportunities!

Other opportunities include attending national and international EM/Trauma conferences where you can meet doctors at the forefront of EM and partake in high-fidelity simulations. This year I have attended several conferences and EM/PHEM courses, all of which have inspired me tremendously. EM is ever-improving and it’s very cool to see this change and be an active part of it.

  • Practical Skills

EM requires a great deal of thinking. As soon as the patient walks into the room, the assessment begins. You judge their gait, their facial expression, the strength of their grip during the handshake etc etc. Long story short – you have to be like Sherlock Holmes. Nonetheless, along with this, there are lots of practical skills involved that EM doctors must learn and perfect – a lot of which are really cool! The basics involve cannulations and ABGs but as your exposure to EM increases, other more intricate, invasive and adrenaline-stimulating procedures can be learnt such as thoracotomies, intubations and REBOA. It’s this perfect blend of knowledge and clinical skills that makes EM so attractive.

  • Shift Work

Although shift work has its obvious cons such as meaning ED doctors have to do some night shifts and weekends, it also means that once your shift finishes, somebody will be there take over for you so you can finish as close to the right time as possible. Furthermore, the 4 nights on, 4 days off work schedule is common too meaning you can use those 4 days off to go abroad without having to use your official holiday leave. This is definitely a big plus of shift work.


Conclusion:

This academic year has given the opportunity to spend almost an entire calendar year in the busiest major trauma centre in Europe. I have been involved in cardiac arrests, numerous stabbings, countless traumatic brain injuries and some drunk patients! All of this has confirmed for me that EM is for me and I am for it. I have some very exciting opportunities coming up in 2018 in Johannesburg’s ‘Bara’ hospital as well as an upcoming attachment with an air ambulance service. I cannot wait and aim to make full use of these INCREDIBLE opportunities. I am also currently organising a highly-anticipated two-day regional conference in EM, PHEM and Trauma.

By no means am I disillusioned, however. I am aware of the downsides of EM such as the scary burnout rates but believe as long as I keep up my hobbies outside of medicine, seek support from those around me and live a healthy lifestyle, these downsides can be mitigated.

I urge all medical students to find the specialty that really suits their character, interests and skill set and to pursue it no matter what the naysayers tell you.

What are your favourite specialties? Do you already know what you want to specialise in?

As always, thanks for reading and keep smiling! 🙂 

Advertisements

10 Keys to Happier Living

First of all, I want to express my sincere gratitude to Stilettos and Stethoscopes for her incredibly kind gift of a book entitled: ’10 Keys to Happier Living’ by Vanessa King from Action for Happiness. Please check out S&S’s amazing and well-written blog if you haven’t already – she writes about her awesome journey as a medical student!

Since receiving this wonderful book, I have slowly been working my way through its 10 chapters to unravel its keys to success (oh wait, that’s DJ Khaled) – I meant Keys to Happiness.

Usually, happiness refers to a state of being emotionally positive or joyful. Everyone has different things that they resort to for short-term ‘happiness’; whether that be desserts (like me!) or other vices. Although these may provide temporary delight, they do not result in long-term contentment.

This brings me on to my next point; I recently watched a video which made me think more clearly about the word ‘happiness’. These days, everyone wants to escape feelings of sadness and pain which may explain why hospital admissions with a primary diagnosis of drug-related mental and behavioural disorders are slowly on the rise in England. The video, created by School of Life, highlights that ‘fulfilment’ may be a more useful and healthy word than ‘happiness’. It is possible to be going through hardship and pain but still feel fulfilled yet you may not be happy. To illustrate this concept, think of the following example: a new mother/father may have sleepless and tiresome nights looking after their baby and it is likely that this physical and emotional stress doesn’t make them happy per se, but odds are they will look back at this and feel fulfilled. The same can be said regarding managing a home or a big project.

Personally, chasing fulfilment through hard work and struggle delivers more long-term contentment than chasing ‘happiness’ as the latter can lead people to think suffering or feeling pain isn’t normal – especially in the current ‘Instagram world’ we live in.


Now, onto the 10 Keys to Happier Living. This book uses a nice acronym for the 10 keys:

GREAT DREAM

  1. Giving

S&S beautifully illustrated this first key by gifting me this book. Giving to others doesn’t need to be a big gesture; in fact it’s better to give little and often. Random acts of kindness such as giving up your seat on the train or giving somebody way whilst driving are all forms of giving and bring joy to others and in return it gives you a sense of delight. Another easy form of giving is to ‘pay it forward’. This is when somebody does something kind for you and in return for that kindness, you show a similar kindness to a third person. Happier people give more, and giving to others can make us happier.

Something you could try right away – give someone a genuine compliment.

2. Relationships

The quality of relationships is a lot more important than quantity. This may mean getting rid of so-called toxic people and ensuring that you show your appreciation to your genuine and loyal friends and family. Relationships with others are built on listening and it’s important to be present when interacting with them, meaning leave your smartphone in your pocket! We all need friends for a healthy state of mind and well-being as they are not only there for the good times but also the hard times.

Something you could try now is to message somebody you’ve not spoken to in a while – try to rekindle the friendship.

3. Exercise

If ever there was a ‘magic pill’ for health and well-being, this would be it. There’s no need to labour this point but I will add that exercise comes in a variety of forms and what better way to build and maintain relationships than over a bit of exercise! One small change you could make is to walk instead of getting the lift/escalator. Over time, these small changes make a big difference! This third key also emphasises the key of a good night’s sleep. Sleep is crucial for restoration of the mind and body which is why sleep hygiene is so important.

Try this right now: do 10 press-ups or do 10 star jumps (or both!)

4. Awareness

Mindfulness is not about clearing your mind of thoughts but about re-focusing your thoughts to what you want to focus on in a non-judgemental and caring way. Focus on the present moment instead of going into auto-pilot. Think of the amount of times you’ve been out driving or on public transport and then before you know it, you’re at your destination? I’ve wasted so much time doing that when it would have been better to be aware of the present moment by looking out of the window, for example, and appreciating life and nature around me. SAVOUR every single moment of your life.

During your next meal, really focus on the scent, flavours, textures and sounds of the food.

5. Trying out

Variety is the spice of life. Trying new things and having new experiences is vital for injecting some necessary fun (and sometimes adrenaline) into your life! Recently, I was at a jump arena in London which happened to have a 30ft, 90-degree-drop super slide. Sitting at the edge of the slide was scary as hell and it took AGES and a lot of encouragement from bystanders for me to finally let go and plunge into the depths of hell. Turns out, it wasn’t actually that bad and it was over in the blink of an eye. Moral of the story: try something new or say ‘yes’ to things you normally wouldn’t – it probably won’t kill you.

This coming week, I want you to try something new or out of your comfort zone whether that be signing up for a new class, trying a new food or just going for a walk in a different place.

6. Direction

Having a positive outlook on life and being hopeful for the future can increase your happiness. Create goals that align with your strengths and values as these will inspire you to lead a life of purpose. For me, this means combining my love of science and helping others to pursue a career in Medicine. Every day I am inspired further by seeing the great work that health care professionals do and every so often, patients thank us immensely for the great work we do and I often get a ‘good luck’ from the patients I see. It’s important to not only visualise the end goal, but to also plan out the steps needed to get there.

Take a moment right now to ponder over your life purpose/goal.

7. Resilience

Don’t get stressed about being stressed. Take steps, however small, to try to remedy the situation. Seek help from others when needed and ask others if they need help if you can see they are going through a hard time. We can’t choose what happens to us, but we can choose how we respond to it. Try not to make decisions when under emotional stress. Instead, take a pause and analyse the situation. This is something I need to work on as I can often snap at those around me when I’m hungry, tired or stressed. Instead, I should take a moment and regulate my emotions.

The next time something bad happens, take a deep breath

8.  Emotions

Being able to recognise, understand and manage your emotions is known as ‘emotional intelligence‘. Positive emotions can help broaden our focus and balance out negative experiences. The human mind tends to focus more on the negatives than positives. But the question arises – how can we increase our positive emotions to shift this balance? One way to increase our inner focus on positivity is to practice daily gratitude. Something I have added to my own night routine is to think/write down one thing I am grateful for that happened/I did that day. This doesn’t have to be ‘big’ things but it’s more about reflecting on the day-to-day things that make your day better e.g. getting a seat on the train today or having your favourite food for dinner. Whenever you have a spare moment and want to reflect, reflect over all the milestones in your life and the people who helped you through them. I would never have got into medical school (or stayed in) without God, my Mum, Dad and my siblings who constantly support me alongside my closest friends who have always been pillars for me.

I want you to write down three things you are grateful for in your life. Do it. Now.

9. Acceptance

We need to accept ourselves for who we are. We are all imperfect beings. Developing self-compassion should be a priority and we can achieve this by treating ourselves as we would treat a valued friend. Often, when I make a mistake – no matter how big or small, I can be very self-deprecating whereas if a friend were to make the same mistake, I would be very understanding. We need to recognise when we are being unfair to ourselves and moderate our thoughts and feelings. This doesn’t mean we should wallow in self-pity; instead we need to recognise our strengths, such as our ability to show kindness or make others laugh, and hone them so that we may use them daily in order to live a more fulfilled life.

I want you to think of one of your strengths, e.g. your ability to forgive and use this strength in the coming week.

10. Meaning

This final key is linked to both my opening paragraphs about happiness Vs fulfilment and also to Direction (Key 6). What we find meaningful is very individual. For me, my relationships with God and my family bring a lot of meaning to my life. Moreover, my ambition to use my medical knowledge in developing countries as well as in my local community is a huge driving factor for me. One of the best ways to find meaning is by contributing to others and feeling like you belong to something ‘bigger’ than just yourself. Even in small tasks, we can find meaning. Doing something for others or finding hobbies that align with your values can be rich sources of meaning. Life is full of ups and downs. There will be times where we have to deal with pain and suffering. Meaning can help us come to terms with and deal with these difficulties.

Take a moment to reflect on your most important life priorities e.g. relationships, careers, helping others, religion. What will people say about you when you pass away? What would you like them to say about you? Do these two things match? If not, what can you do about it?

 


 

There we have it. A brief insight into the ’10 Keys to Happier Living’. It is not enough to merely know about these keys but we must act upon them. Happiness is not something ready made. It comes from our own actions. So I would like to encourage everyone reading this to take control of their own happiness and fulfilment by seizing the opportunity to implement the 10 keys above as best as you can.

Thank you very much for taking the time to read this. Until next time, keep smiling! 🙂

 

 

Kindness is the best medicine

It’s taken me many weeks of thought to decide what to write this blog post about. This is in stark contrast to when I wrote my first few posts. The inspiration to write them came naturally and whilst typing them the words flowed with ease. Even now, I am still undecided what the topic of this post is going to be, even though I am typing this introduction. I guess I am facing ‘writer’s block’, although I don’t regard myself as a writer by any stretch of the imagination.

Initially, I had thought about writing in reference to the following topics:

  • ‘How to get into a UK medical school’
  • ‘Best and Worst parts of Medical School’
  • ‘Simple ways to be happier’
  • Notable books I’ve read in 2017

But perhaps I’ll save those topics for later (or maybe you have a preferred topic I could write about?).

For now, I guess I’ll reflect and take a moment to ponder over recent experiences. I am a few days away from my 24th birthday and feel like I have a lot of wisdom to impart now (!)

In the emergency department, where I am based for a year, we are often filled to capacity with ambulance crews and patients queued up in the corridors waiting for spare beds to open up or for doctors and nurses to become available to assess them. This is not unique to my ED, rather this is the case all over the UK – especially at the moment.

Along with this added stress and burden, staff members can often feel overworked and under-appreciated. Most recently, I have seen healthcare staff in tears and others in fits of rage, unable to (understandably) cope any longer with such workloads. I have also seen patients in similar situations, some of whom can become quite angry at staff for not being seen as quickly as they would like.

Do not get me wrong – this all stems from the current government’s mishandling and dismantlement of the NHS and the best solution would be to vote them out at the next opportunity. However, there are other things we, as medical students and healthcare professionals, can do in the meantime to help mitigate some of this tension and boost morale amongst staff.

How to help:

  1. Smile. LOTS.

You’ll be amazed at how far a simple smile can go. Whenever I walk past someone, be they a doctor/nurse/porter/domestic/patient, in the ED, I try to smile at them as genuinely as I can. Inevitably, 10 times out of 10, they will smile back regardless of whether we know each other or not. I have seen how smiling at others can lift their mood almost immediately and spread a bit of joy in an otherwise very stressful and fast-paced environment. It’s these small wins that can make the biggest difference. One of the aforementioned nurses who was crying a few days earlier due to being over-worked, gave me one of the loveliest smiles in return to mine and I really felt our morale increase even though we have never actually spoken to each other. Personally, I feel over-the-moon when somebody smiles at me and it just makes me feel like ‘everything is going to be alright!’

     2.  Be Polite.

Ensuring we say ‘please’ and ‘thank you’ every time we engage with someone else or ask them for something is mandatory, in my opinion. It’s so basic, yet sometimes carelessly overlooked. Healthcare staff need to ensure we treat each other with the respect and dignity that we all deserve. It doesn’t matter whether it’s a senior doctor or a domestic worker, they deserve these effortless courtesies and this will ultimately lead to a better working environment. Recently, my medical student friend told me how one of his consultants was brought to tears by another consultant over the phone by being abusive and aggressive. Hearing this was absolutely appalling and should be a ‘never-event’.

3. Kind words cost nothing.

I was scrolling through Twitter earlier today and saw the above image: ‘Kind words cost nothing’. It was at that point I realised what I should write my next piece about. Yesterday I saw a nurse, who I have never previously interacted with but have seen working in the department, wearing a new uniform, indicating she had been promoted. I therefore commented on her ‘nice new uniform’ with no other intention but to spread some positivity.  She was absolutely chuffed and replied with a massive smile and a ‘thank you’. This was so easy yet so rewarding for the both of us and is an easy way to increase the team spirit.

4. Learn names.

One of the best ways to build rapport with a fellow staff member is to learn their name. Use whatever tactics you have to to do so! (Admittedly, I often have to surreptitiously read their ID card when I forget their name because I feel like it would be rude to ask again!) I first acknowledged the importance of learning other people’s names after reading the famous book by Dale Carnegie entitled: ‘How to Win Friends and Influence People’. Honestly, it helps so much and makes the other person feel important just as you feel important when somebody you may not know knows your name. This is vital for ensuring a positive team atmosphere (but also because in emergency situations, it’s crucial for closed loop communication that we know each other’s names!)

Putting all of this into practice:

One of the patients I clerked yesterday was a middle-aged alcoholic who had sustained a head injury from an alleged assault. This injury had left him with a big flap of scalp hanging off his head. I was the first person to see him and it was important that I built a good rapport. I ensured I called him by his preferred name and was polite all throughout the consultation. I felt him open up more and more as the consultation went on and he eventually talked about his suicidal thoughts and was crying at this point. I remember how awkward I felt the first time a patient cried during a consultation with me. However, now in my 5th year of medical school, I am a lot more confident in my ability to connect with and help patients. I was able to put my hand on his shoulder and reassure him that we would do whatever we can to help him and I then fetched him a cup of water after asking him if he’d like one. After a Head CT scan thankfully showed no intracranial abnormalities, I closed up the wound on his head with staples. By this point his children were there with him and I was able to build a rapport with them too by employing additional tools of rapport-building such as humour!

It may have been easier to not show this man compassion and write him off as ‘just another alcoholic’. But at this early stage in my career, I am trying my utmost best to not become cynical. I think becoming so can be dangerous and will lead to lower levels of job gratification. I felt happy that I was the first and last person who took care of this gentleman (there was a 5 hour wait for the CT head results before I could close his wound so he was seen by others in that time) and believe this has helped me develop as a future doctor.

Furthermore, the other day I had a middle-aged gentleman who was suffering domestic violence at the hands of his wife and again this was a situation where I had to display kindness and compassion as he, too, was in tears at one point in the consultation. We were able to put the appropriate care package into place for him which involved the input of Victim Support, Social Services and The Police. If you or somebody you know is suffering from domestic violence, please do not hesitate to ask for support and help as it is available here for men and here for women.

I feel like earlier on in my medical career, I would have been quite detached from such patients and actively tried not to empathise with them, lest I feel it burdensome in the long run. However, I am slowly getting the balance between getting too attached to patients and not caring enough about them and I feel a lot happier with my ability to build rapport with patients.

Be kind to yourself and those around you

My main take-home message from this post is to remind yourself regularly that everyone, whether in the hospital or not, deserves to be treated kindly. Kind words cost nothing but can buy you anything and everything. If there’s one thing you want to put into practice from today onward, I would say the easiest is to smile at those around you. We already have too much negativity and suffering in this world, let’s combat that with compassion and love.

“The best way to cheer yourself up is to try to cheer somebody else up.”

Thank you for reading and until next time, keep smiling! 🙂

Teaching by humiliation – a medical student’s perspective

‘You will never get into medical school’

‘You will fail all your exams!’

‘You are terrible!’

‘You will not become a good doctor!’

‘You are so far behind!’

‘Outrageous!’

‘Medicine might not be the career for you!’

‘Do you know anything?!’

These are just some of the remarks that I’ve had aimed at me over the past four and a quarter years since starting medical school. (Disclaimer: most of the above comments were made by a single doctor.)

For those in the medical field, teaching by humiliation (TBH) is, unfortunately, an all-too-familiar occurrence. In my third year of medical school, I suffered TBH throughout the year during my General Practice placements (a General Practitioner (GP) is a Family Doctor/Primary Care Physician).

Traditionally, GPs are known to be very friendly, caring and warm. So it came as a complete shock to my system when the GP I was attached to during third year was the complete opposite. She reminded me of an orc from Lord of the Rings (side note: LOTR is the greatest trilogy of all time!!) On my first day, I could sense that something was very odd about this GP as she failed to smile, even during initial introductions.

Within the first week she already humiliated me in front of patients by remarking on my inability to answer every clinical question correctly or to the standard of a first-year doctor! Also, in the first week she told me I won’t pass my final medical school exams (exams that I wouldn’t actually be sitting for another 18 months from that point!) She was also very patronising and had a very old-school mentality. I once accidentally referred to her GP colleague as ‘Mr so-and-so’, to which she snapped back with a mean look on her face and said ‘it’s Dr so-and-so!’

‘Bloody hell’, I thought, ‘chill out mate.’

She even had her GP colleagues spy on me during the times I wasn’t with her and they would report back to her via email. I once got told off by my GP for asking one of her GP colleagues, who I went on a home visit with, what she thought the differential diagnoses were for a particular patient. Apparently, I was meant to know it already. ‘Sorry, for not knowing everything about medicine in my first ever clinical year’ I thought. There were many other situations where I would get told off or made to feel stupid for no real reason.

I remember coming home after each day, feeling mentally and physically exhausted. I would comfort-eat and just binge on lots of TV shows (one particular show I was watching at the time was The Knick – INCREDIBLE show!). I used to take evening walks by the sea to try to unwind. I also discussed my GP placements with my housemates, who were also medical students. I remember for weeks on end I was contemplating dropping out of medical school at the end of the academic year. I thought that my life would be stressful and negative like this for another 50 years if were to stay in Medicine. Fortunately, my close friend was able to support me through this and explained that his elder brother also went through a similar phase at medical school and that it is not uncommon for medics to feel like this.

What made this whole ordeal even sadder was that becoming a GP was one of my top two career options. I spoke to the doctor in charge of GP placements/allocations at my medical school about the problems I was having. He explained that every year he gets the same complaints about the same doctor but there wasn’t much he could do about it since they didn’t have any other GPs available. On the one hand, it was a bit reassuring to know that this GP wasn’t just being a particular prick to me and that others had gone through this trauma before and lived to tell the tale. On the other hand, I just felt sorry for all those who had gone through this before me – I could totally empathise with them.

I was extremely glad when my third year GP placements ended. I knew in year four, I would be allocated a different general practice which just in case you were wondering – was THE most incredible GP practice I have ever been a part of and probably will ever be a part of! The staff there were so positive, welcoming and taught me so much in the best way possible. It was like night and day compared to my previous year and my love for GP had once again been restored and increased.

Most recently in my 5th year of medical school, I was doing a night shift in the emergency department. A suicidal man had just been brought into resus as he had tried to kill himself via a car accident. He was stable but in a lot of pain. By this time, it was 4:30am and I was absolutely exhausted and finding it difficult to focus. I had never done a night shift in a hospital before. I was tasked with inserting a large-bore cannula into this man who was of a large body habitus and had difficult-to-find veins. Moments before this, this man had been refusing all treatment and monitoring  equipment until I was able to persuade him otherwise (even the consultant failed to persuade him). He also handed me the knife he was carrying because I was able to get through to him when others had failed.

Now came the moment to insert the cannula. I missed. I turned around to tell to consultant in charge and he, in front of a few other doctors and nurses, just said: ‘that’s outrageous!’.

I felt so deflated and just walked out of the resus room with my head down. The junior doctors on shift that night were very comforting and reassuring when I told them what had happened. However, for the proceeding week after this incident, I missed pretty much every single cannula, including the easy ones, because every time I went to insert it I pictured that consultant’s face and his words and it just really took my confidence away.

It’s been about three weeks since that shift, and thankfully I am now getting back to my normal baseline ability whilst slowly getting my confidence back. I (somehow!) didn’t miss a single cannula this whole week!

To summarise, teaching-by-humiliation still, sadly, exists in the medical field. But things are slowly improving, I believe. The current junior doctors were taught by humiliation a lot more than my generation of students and collectively, they made a vow not to teach us in the same way they were taught and it’s with this mindset and culture change that things are becoming more positive and constructive rather than negative and humiliating.

It brings me joy to say that 99% of the doctors, especially those working in the NHS, treat students with dignity, respect and understanding. I believe that my experiences with the ‘old-school’ doctors, particularly that GP, have made me more aware of the type of doctor I DON’T want to be in the future and I will ensure I treat my future students with the compassion, understanding and positivity that I wish that I had been treated with by all doctors. Countless studies have shown that TBH has a negative impact on students’ performance and mental well-being and it’s something that we all need to work together to eradicate.

In this current climate, no matter which walk of life you are in or from, we need to help build each other up and ensure that we only inject good vibes into each other’s day. This past week, I’ve been lucky enough to have been taught by a myriad of junior doctors, all of whom have been so patient with me and made me feel like a valuable part of the team. On Friday, the consultant, who was in charge of the emergency department that shift, was so incredibly positive and humble. He kept smiling and thanking me and made me feel like I was doing a whole load of good even though all I was doing was taking bloods/inserting cannulas/taking histories.

It’s doctors like that who I aspire to be similar to and it’s the reason why I am still in medicine and love it more than ever. This is a massive thank you to all the doctors, nurses and other allied health care professionals who teach students with compassion, kindness and patience. You guys are the real MVPs!

Have any of you reading this post ever seen or experienced teaching-by-humiliation? How did it affect you? What did you learn from it? I would love to hear from you.

As always, thank you for reading this and until next time, keep smiling! 🙂

 

 

 

 

 

 

 

How self-care is helping me become a better future doctor

What is ‘self-care’?

We have all heard the term “self-care” recently. But what does it actually mean? For me, it refers to the deliberate actions one can take in order to maintain or improve their health, happiness and well-being.

Why is this important? We all lead lives which are full of time constraints, deadlines and work. We are constantly on the run from one task to another and are repeatedly encouraged to be productive and seize every moment of the day. We see people posting pictures of their laptop and a coffee on social media in an attempt to be perceived as doing important work. This can put unnecessary pressure and stress on us. Why aren’t we sat in Costa with a MacBook?! Are we wasting time by not always working?

In healthcare, and especially in emergency medicine (which happens to be my favourite speciality and the one I’ve spent the most time in), the culture of being “hardcore” and always working not only seems to be accepted but it is often also praised as a marker of dedication. A lot of us may even take pride in working 10-12 hours straight without any breaks or food.

But is this really healthy? And is it what a fulfilled and well-rounded life looks like? In the last couple of years, we have seen the constant bombardment that the NHS (UK’s National Health Service) has taken in terms of budget cuts and lack of staff and beds. With this, NHS staff have had to work in overdrive in order to stop the system collapsing.

The only reason the NHS is still alive today is because of the sheer hardwork and dedication of every single NHS employee. Unfortunately, with this immense burden, comes a hefty price. A recent survey has shown that 2 in 3 young doctors are incredibly stressed to the point it is affecting their mental and/or physical health.

So how can self-care help mitigate some of the consequences of all the pressures on healthcare staff?

First we need to look at why self-care is important. The bottom line is: if you can’t look after your own health and well-being, then how can you look after that of others’? This is all the more pertinent as in recent times, more and more healthcare staff are becoming burnt out, resulting in them becoming apathetic towards their patients.

What do I do for self-care?

I have realised that, in order to make the most out of ‘self-care’, it can’t be something that happens only once we’re stressed out or tired. It needs to be an integrated part of our lifestyle that helps prevent poor health. This, for me, meant building daily habits that can help both my mental and physical health. Below are some of my daily activities that help me slow down the busy pace of life and divert attention towards my health.

  1.  Morning routine: This has been an incredible addition to my day-to-day life. I ensure I wake up at least an hour before I have to be out of the door. I thank God upon waking up for giving me another day and then whisper a one-sentence positive affirmation to myself. I then do some light stretches whilst focusing on my breathing and being in the moment. Nothing else matters during these several minutes. I am not yet thinking about the busy day ahead. I then shower and get myself ready. Breakfast is usually muesli and coffee and I watch a productivity/self-help related YouTube video (message me for channel recommendations!). I have a rule where I don’t check my social media accounts for at least at hour after waking up. By ensuring I wake up with ample time, none of my morning needs to be rushed. Instead, I am in complete control. I have found that by controlling my mornings, I can then go onto control the rest of my day. This sense of control is vital for inner peace, I have found.
  2. Regular breaks: Taking regular breaks is crucial. The Pomodoro technique has become popular recently as it involves taking a 5 minute break every 25 minutes. This can help you feel refreshed and ready to tackle your next task. I ensure I take breaks every 45 minutes or so and physically take myself out of the room I am working in. I usually grab a cup of water or a snack and update myself on the news and answer any messages.
  3. Diet: Firstly, I aim to consume at least 3 litres of water a day. I find that this is the amount I need in order to feel hydrated, which in turns helps me focus better. In terms of food, I try to maintain a fairly healthy diet, but with the flexibility of takeaway/restaurant meals. I absolutely love desserts, so after a long day, I see no harm in eating some ice cream – all in the name of self-care right! A few years ago, I used to have binge-eating syndrome whereby I’d pretty much starve myself for days-weeks and then all of a sudden I’d binge on lots of unhealthy food. I’d then try to counter-act the binge by drastically cutting my calories for the next couple of days. This vicious cycle continued for nearly a year. Since then, I have learnt that moderation and flexibility is key. We shouldn’t attach too much power to food and let it dictate our thoughts and feelings.
  4. Exercise: I try to do some form of activity every single day. This can include going to the gym, playing football, racket sports or going for a walk. The main objective is to get your body moving and your heart rate to increase for 20-30 minutes. If you find this difficult in the beginning, then split it up into 10-15 minutes in the morning and then the same again the evening. Exercise releases a lot of endorphin which is our natural painkiller and feel-good hormone. So this is definitely important for self-care!
  5. Reading: I read at least 15-20 minutes a day, usually during my daily commute. I find that reading allows me to forget about the distractions and stress of life, and focuses my energy and brainpower on something completely different. This again helps me keep my sanity and inner peace. I have never read as many books in my whole life compared to the amount I have read in 2017! The sense of achievement and fulfilment that comes with completing a book, and then being able to use the new knowledge gained, is remarkable and really does help you feel good and happy. I mainly read self-help books and am happy to recommend some for those who are interested.
  6. Family and Friends: Being able to rely on those closest to me has been instrumental in my happiness and well-being. They are always there to help, support and guide me as well as offer advice and a helping help for any problems or stresses I am going through. So I urge you to hold onto the important people around you. I also ensure I go out with the family and friends as often as I can as a way to de-stress and strengthen bonds with them. This has helped me so much.
  7. Gratitude: Practising gratitude is incredibly important. One way to do this is by giving back or paying a favour forward. This is commonly done in the form of teaching or supporting others, in the same way someone else had once taught or supported you. Another simple thing I do is to think of one thing I am grateful for in my life when I get into bed at night. I think of something different every night and thank God for such a blessed life.
  8. Enjoy the outdoors: Over these past couple of years, I have made great strides in my aim to visit at least 30 countries by the time I am 30. I usually only travel to areas with great natural landscapes as I find an amazing sense of peace and joy by just sitting and contemplating about the complexities and sheer wizardry of nature. On a more day-to-day basis, I focus on the nature around me e.g. the trees, farms  and animals I see on my daily commute. It brings a smile to my face every day.
  9. Television and memes: I watch a multitude of high-quality TV shows and love the fact that they offer an escape from, the sometimes stressful, realities of life. Furthermore, memes are life! I absolutely love a top-notch meme and enjoy being tagged in them, on Facebook, for example. Put simply, they offer a quick rush of dopamine, which can help overcome the task at hand!
  10. Sleep: Everyone knows getting enough sleep is important but still we, myself included, resist the urge to go to bed at a suitable time and then later regret it in the morning. To overcome this, I try to have a night-time routine where I ensure I reduce any bright lights, e.g. on my phone and try to slowly unwind. I aim for 7-8 hours of sleep. Sleep hygiene is vital and I would urge you to get familiar with it.

Conclusion

By doing all of the above things (none of which are innovative or new concepts but are simple to apply), as an integrated part of my life, I feel well-rested, enthusiastic and healthy enough to tackle each day as it comes. Thus, I am able to focus when I am in hospital and can give my full care and empathy to the patients I see and treat. Self-care ultimately allows me to care for others.

Until next time, keep smiling! 🙂

How to keep motivated as someone in healthcare – a fresh perspective

Classically, I have always been motivated by the desire to do well. All throughout my academic life, I have striven to achieve A and A* grades. Obtaining the results I wanted was always enough motivation for me to be studious and hard-working. Moreover, another important factor in keeping me driven was (friendly) competition from my peers. I vividly recall my elder brother’s advice before I started my GCSE years (year 9-11). He told me: ‘become friends with the smartest people in your class/year and then work hard to beat them!’ This was brilliant advice, I must admit, since we are the average of the five closest people around us. So as a side note: keeping good company is always crucial for self-development.

But now in medical school, although I have still been able to achieve consistent results in the top 10-15% of the year (ALL praise is for God), I felt my motivation being questioned. For some reason, these results started to feel quite empty and didn’t give me the joy or incentive as they had once done.

In my third year, my first result of the year (in October) was outside of this top 15% that I was normally getting. Previously, I had imagined that such a situation would cause me a massive amount of distress and anxiety but guess what? The world kept spinning and I actually breathed a relief of sigh and thanked God. I felt a huge pressure being lifted off my shoulders and I look back at this event as a significant turning point in my academic career.

This epiphany made me realise that striving for perfection is an admirable quest, but falling short of it is mere proof that we are only human. It may sound like I’m being melodramatic but that exam result demonstrated to me that, ultimately, it was not great results that motivated me and nor will they be the deciding factor in me becoming a good, competent doctor.

As you may recall in my previous blog, it was also around this time when I was battling burnout. My priorities started to change and I was more focused on becoming a well-rounded doctor.

So what do I use as a source of motivation now? Recently, I heard an amazing piece of advice; one that has changed the whole way I think and approach my learning and placements. We should not study incredibly hard, put the hours in and make sacrifices merely because we have exams at the end of each semester. Rather, we should do so because of the fact that the knowledge and skills we build now, as healthcare students, may ultimately be able to save someone’s life one day. Now, every time I am in class or in hospital, I bear this thought in mind and it focuses and encourages me to pay closer attention to the information in the books and the things I learn on the job.

The fact that we can directly impact somebody’s health is an amazing privilege that healthcare professionals have. There’s not many professions out there that have such a responsibility or opportunity. By regularly reminding ourselves of this fact, it ensures that we remain motivated to learn new information and practice new skills as they could be the difference between life and death for a future patient of ours.

Imagine, being the only doctor in the renal unit at 3am on a night-shift. You get bleeped to a patient who’s recent blood test has shown dangerously high potassium levels. This could soon stop their heart from beating. What will you do? It is precisely situations like this, which are not uncommon, that motivate me not to be lazy and skip important lectures, placements or learning opportunities. I want to be well-prepared for any life/death situations where the knowledge and skills I *should* have can come into use.

As students, we have the advantage of being able to learn and make mistakes in a relatively low-risk setting as we are constantly supervised and don’t make the ultimate decisions regarding a patient’s management. We should therefore make the most out of this to further our learning. Finally, loving the process and the journey itself is crucial to staying motivated. But I admit, (many) moments of procrastination and laziness still do creep in!

I’m interested to hear what keeps you motivated (whether you are in healthcare or not!). Any additional thoughts? Also, what would readers want me to write about next?

Until next time, thank you for reading and keep smiling! 🙂

 

 

Medical School and Burnout

5:30am. My alarm goes off. Time to get out of bed, sip some water and sit at the desk in my bedroom. There’s still about three hours or so until lectures start but I’m up and wiping sleep away from my eyes and stifling my yawns.

Why am I up so early? To do some studying of course! This is the perfect opportunity to get ahead. My peers/competition are sleeping but I’m up getting the work done and putting in the hours. “I’ll sleep when I’m dead” I tell myself.

This continued for weeks and then months. It resulted in me becoming super productive and organised. I started the year trailing behind the rest of my year fellows but ended the year ahead of everyone. I ensured I used the gaps between lectures/group work to go to the gym so that I was utilising my time as efficiently as possible. After a day of university sessions, I’d do more studying and aim to be in bed by 10pm. Somehow, I even managed to maintain a healthy diet and ended up with the lowest body fat percentage I’d ever had!

This all occurred in my second year of medical school. At the end of the year, I won an award for coming first. It felt great to see how happy my parents and siblings were.

Now it was time for 3rd year (the first of the clinical years) and I had the aim of continuing in the same way as 2nd year. I was waking up when it was still dark – two or three hours before I actually had to be in the hospital. I was learning about weird and wonderful conditions and answering practice questions.

Slowly, and without realising, my diet started to consist of frozen pizzas and doughnuts on a daily basis. I was starting to gain considerable weight. I also made excuses to skip gym sessions by blaming my ‘long’ hospital placements. I even became withdrawn from my close friends and started cancelling plans with them. 

And then one day it happened. I just crashed, tumbled and couldn’t get back up. I was COMPLETELY exhausted. I had stopped caring about the patients I was seeing, stopped caring about my studying and stopped caring about my diet and social life completely. I just wanted to stay in bed all day everyday and watch TV shows and films for 12hours+. 

What had led me to this painful destination known as “burnout”? On reflection, it was my poor coping mechanisms and lack of appreciation of a healthy work-life balance. Studies have shown that medical students and junior doctors have a staggering burnout rate of up to 60%. Unfortunately, I was just another part of this shocking statistic.

I had lost all the motivation and drive that I previously had. This made me feel guilty and rubbish about myself so I would end up comfort-eating. I would then feel guilty about eating lots of junk food, so would eat some more. This viscous cycle continued.

I knew I had to break out of this cycle somehow and restore some balance and productivity in my life. If I didn’t, I may well have ended up failing my assignments and exams. So what did I do? 

I started opening up to my close friends, who were also studying medicine. I told them how I was feeling so exhausted and lacking motivation. I explained how I was so fatigued and too tired to make it into hospital placements. Just by opening up and talking about what I was going through, I felt some therapeutic value. It was nice to no longer bottle up those thoughts and feelings. 

I began to read forums online about other medical students who had experienced burnout and was glad to know I was not the only one. My next steps, ironically, involved me taking a step back, paying attention to self-care and re-evaluating my priorities. I came to realise that there is more to life than getting good grades.

I researched ways to ensure a better work-life balance. This would involve taking breaks from studying, getting enough rest, engaging with those around me and ensuring regular contact with my family. I trialled new ways of keeping active too such as climbing and tennis and found that they were brilliant ways to de-stress and relax. 

Several weeks later, I felt re-energised and back to my normal self. I was no longer prioritising my studying, rather I was prioritising my work-life balance and happiness. I now realise there will never be a patient who asks me whether or not I graduated medical school in the top 10%. Rather, patients just need a well-rounded and competent doctor. So this was and is my new aim.

Now I am in my 5th year (intercalation year) and I have not experienced burnout since my episode in 3rd year, despite having just finished my finals. I credit this to my better coping mechanisms for stress and putting less pressure on myself. 

I remember speaking to a consultant plastic surgeon. I asked him what his work-life balance was like. He explained that in his earlier years as a doctor he was working a lot of over-time and doing private work and was able to make a nice amount of money doing so. But he went on to say that he wasn’t happy during this period. He had to move around the country a lot and sacrifice time with his family. He ended our little discussion by saying something that I have lived by ever since: “When I’m on my death bed, I will not regret not seeing more patients or working harder, I will instead regret time away from my family”. 

Nearly two years since speaking to him, I still remind myself and others of this ethos as it truly puts into perspective the important things in life. I no longer put unnecessary pressure on myself to achieve incredible results. Good enough is now good enough. This is not to say I have become lazy. I am still very motivated and hardworking towards my career but I have become more mature and have learnt an awful lot from being burnt out. A doctor cannot look after others if he/she cannot look after themselves first.

For those who have experienced similar, I would love to hear from you. Thank you for reading this long post. I welcome any and all comments. Until next time, keep smiling! 🙂