Dr Andrew Tresidder, NHS Practitioner Health SW Clinical Lead and GP Appraiser, looks at what lies behind the risks to wellbeing.
It’s a privilege to practise medicine. Doctors serve, care for and support others. Yet how much do we care for ourselves? “You cannot draw water from an empty well,” says the proverb. If an ambulance ran out of fuel on a call-out, the consequences would be dire. Yet do we as doctors, as human beings, ensure that our own fuel tanks stay full, refreshed and re-energised on a regular basis?
The barriers to doing this are knowledge, skills and attitudes. Parker Palmer said: “Self-care is never a selfish act, it is simply good stewardship of the only gift we have – the gift we were put on earth to give to others.”
As doctors, we learn about car crashes – not how to avoid them. Strangely perhaps, the general public might assume that ‘health’ professionals understand all about health – yet doctors are taught much more about illness than health, and little about self-care. To avoid car crashes we need to learn about sensible driving, vehicle maintenance, good navigation and wise road design. Ironically, when it comes to our own health, health professionals often spend much effort looking after others, but not themselves.
Once we have the knowledge, we need to apply it! Yet knowledge of health is given little weight compared to pathology, pharmacology, medicine, surgery and all the other under- and postgraduate topics. Health skills could include applying knowledge about the autonomic nervous system (ANS), addressing our hardware (bodies’) needs of sleep, hydration, high quality food and movement, and our software (beings’) needs for social connection, fulfilment, taking notice, learning and giving (and receiving – not something most doctors are good at!). The Five Ways to Wellbeing are worth researching for personal benefit and would be considered worthwhile CPD points.
The two main attitudinal problems are generally deeply ingrained. First, Denial and Displacement of our own needs. Ask a hundred people how they are and the answer is often Fine – which might stand for Fearful, Insecure, Neurotic or Emotionally Imbalanced – or Feelings Inside Not Expressed – Denial. Ask a hundred doctors, managers, mothers, nurses or others with responsibilities how they are – and they cannot answer. They are too busy thinking about others – and about their to-do list – to consider the question; this is Displacement. These two Ds, Denial and Displacement, often lead to other Ds – distress, despair, disillusionment, exhaustion, drink, drugs and depression, and maybe debt, discipline or death (it is well known medics have an increased suicide rate compared to many other professions).
The second problem is that we all take our health for granted until it seeps away, or is taken dramatically. For me, it was catching mumps (from a child on the ward whilst a paediatric SHO) and post-viral fatigue that encouraged me to learn about health and apply it to myself. It’s fascinating how we can assume that we are invincible, and that illness can only happen to others (medical invincibility) – yet if we fail to pay attention to our own health, then inevitably, like a bank account with outgoings and little income, we end up with a zero balance, and then in debt. Many doctors mortgage their own health in looking after others. It gets worse, as we will now see.
Looking at the ANS, we remember that all mammals have an alert mechanism to deal with threat – the Sympathetic Nervous System (SNS) – and a maintenance mechanism, the Parasympathetic (PNS). When we feel safe, the SNS brings curiosity and drive, and when unsafe fight and flight. When we feel safe, the PNS supports belonging, rest, digest, tend and befriend, whilst when unsafe, we freeze. SNS uses adrenaline and cortisol – a little adrenaline brings excitement, more makes us irritable, and even more brings fear and anxiety. This is the reality of mammalian biology.
Yet many of us humans try to pretend that it doesn’t apply to us, and there is no such thing as the stress performance curve. The stress performance curve shows that some stimulus makes us achieve, more stimulus brings more achievement – but that there is not only a maximum performance, any further stimulus (threat) brings irritability, anxiety and then exhaustion – with a reduction in performance and efficiency, as we try to keep going whilst the fuel tank is empty.
When we’re on adrenaline, our blood pressure rises, our mouths go dry, palms sweaty, we lose both peripheral vision and situational awareness, are focused on tasks, and our breathing becomes shallow and rapid.
We can end up task driven Human Doings, rather than calm fulfilled Human Beings. One of the simplest things we can do is to move to ensure we burn off surface adrenaline (just a few moments of activity is enough), and then take several slow, regular, calming diaphragmatic breaths – this takes us back onto Parasympathetic Calm – blood pressure lowers, situational awareness returns, anxiety settles. Which is better for us long term? Inspired Healthy Human Being, or Exhausted Human Doing?
The principles of health are simple. Own oxygen mask on first. Look after the hardware (body). Strengthen self and retune when out of balance. Repair and heal when wounded. Get the environment right. Nourish the software (being).
Applied to the needs of the hardware (body), these principles mean: good sleep, rest, good hydration, food and high quality nutrition, attention to the breath, and an understanding of mammalian physiology.
Applied to software (being), the principles imply an understanding of retuning and resonance of our being, through connection to nature, to other people, to all aspects of life itself, to patterns of harmony from music, landscape, plants, animals, trees and connection to our own individual purpose in life. The physics principles of harmony, resonance and entrainment relate to software being.
Healthy Human Being, or Exhausted Human Doing? The difference lies in knowledge, skills and attitudes – and healthy habits! www.healthandself.care pp35- 42 provides useful CPD.
The Five Ways to Wellbeing remind us to Connect (with others), Be Active, Take Notice, Keep Learning and Give – all much easier when we feel calmer! https://www.nhs.uk/mental-health/self-help/guides-tools-and-activities/five-steps-to-mental-wellbeing/
Take care and go well!