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Perfectionism and Self doubt.

14/1/2021

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This post was also published on Whole Hearted Medicine, an organisation run by doctors and offering self care retreats specifically for doctors.
Call it 'Imposter Syndrome', call it self doubt. It doesn't really matter what name you give it, most of us feel it to some extent at some point in our lives. 

Medicine is full of high achieving individuals often with perfectionistic traits. Why wouldn't it be? People's lives fall into our hands every day. This sort of precious cargo demands as close to perfection as possible.

As a patient, I completely get it. I want a 'perfect' doctor. Who doesn't??
As a patient, I also benefit from this collective of immense knowledge and dedication.
As a doctor, I demand 'perfection' from myself. 
Yet, as a human being, I understand that no one is perfect.

How can I reconcile these facts?

This tends to be where self doubt creeps in. 

We set the bar at perfection and berate ourselves if we ever fall even a millimetre short. 
We see our colleagues with more compassionate eyes than we see ourselves.
We put ourselves or our family members in our patients shoes and understand the need for attention to detail, for the constant striving for perfection.
Imposter Syndrome or pervasive self doubt is the natural consequence of this constant self flagellation.
Now I'm not saying that we should all stop striving for as close to perfection as humanly possible. 
Our profession and our patients, deserves it from us. 
What I am saying is that our striving must be balanced with compassion. 

Just as the scales of justice balance the concept of support and opposition- that even the truth has many interpretations of it. We too must balance the concept of perfection with self compassion.

It sounds so simple doesn't it?

At the risk of sounding trite, it actually is.
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Mindfulness teaches us that we can be an observer to our thoughts.
That we can watch that stream of berating thoughts and self doubt as they come to us just as we might watch a train pulling into a station. That we can choose to step back and not engage, to not 'hop on' the train as it takes us on a journey to Imposter Syndrome Station.

Self compassion comes when we gain this ability to disengage with our thoughts. 

Mindful self awareness is a state of mind in which the default mode of the brain is set to compassion. Compassion for ourselves and compassion for others. This comes from practice. Whether it be a daily meditation practice, regular prayer or even informal mindfulness cultivation. The key is consistency. 

When we begin to see the goal of perfection not as some unattainable star, always seemingly out of our reach but rather the balance to our own practice of self compassion- we can see that striving for perfection isn't in fact a linear path along a spectrum but rather a constant state of being.

​Sustainable, but only when in balance with our practice of self compassion.
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The 'Medical Treadmill'...

17/12/2020

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by Dr Emily Amos
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Burnout for me was essentially the brakes being slammed on in my life. I suffered a series of debilitating panic attacks (which I had never in my life experienced before) and just couldn't even get out my front door. Thinking back now, I can still remember the suffocating feelings of fear and overwhelm. There is almost something comforting to knowing those feelings now. I remember them so well that I know I will never let myself get back to that point again. 
This is an excerpt from a blog post that was originally published on my website about 18 months ago. ​
I am a good doctor, an empathetic doctor. The sort who listens intently to you and tries to reflect back what I've heard you say with a mixture of comprehension and gentle advice. I've spent the last 15 years either training towards or being a doctor. ​But right now, I am a doctor who feels jaded and empty. Like the 'doctor' light globe inside me has gone out. The weighty responsibility of trying to help people in their darkest hours finally causing my legs to buckle under me. An unfamiliar mixture of panic and despair stopping my whole being from even getting out the door to go into work. To a job I am good at. A job that helps people. A job that (outwardly at least) appears so fulfilling. So why do I feel like this? 

In the last three weeks that I've been hiding from the world since panic set in and stopped me in my tracks, I have come up with a variety of explanations. My amazing GP helpfully offered "Anxiety likely secondary to burnout" as a reason for taking some time off. Seems reasonable. Right now I am incapable of seeing a patient. One, because of what it evokes in me (the afore mentioned fear, dread and panic for the most part). And two, because it is not fair to patients for me to be seeing them right now. There is a certain amount of resilience and strength required to take the worries and ailments of others and help them carry this burden. Have you ever stopped to consider the health (both physical and mental) of your doctor the last time you went to see one? We are all human also. There is no special course at medical school that takes the fleshy vulnerability of humanity away from us. We, like you, sometimes struggle to sleep with worry (which in my case is often about you, my patients). We feel that sickening sense of overwhelm and fear that we may make a mistake while at work. Except in our cases, people lives are the fragile cargo we carry. We also deal with all the behind the scenes issues that everyone else is, family, money, life in general. 

I feel as though I am standing in a doorway. Three weeks ago, all I wanted to do was close the door and hide inside. In the last three weeks, I have found some satisfaction in the fact that I no longer want to do that (everyday at least). Some days I am quite content to remain standing in this open doorway, pondering the space in front of me. 

​
I write all this not to garner sympathy, but simply to muse and offer support to those walking a similar path. A silent call into the ether of the internet to encourage those reading to look outside themselves. Consider whether the job they're working, the life they're leading, is congruent with their values and self. And maybe, just maybe, as I stand here in what feels like a doorway of change, waiting to see what path there is in front of me, I may begin to contribute to the world in a way I had never imagined.
This was only a few short weeks after I had stopped work. Little did I know it then, but there was an immense journey ahead of me. A journey that in some ways I think I'll always be on. This path of life that we all walk, I now walk more intentionally. No longer swept just onto the 'treadmill'.

​Some people are fortunate to have the self awareness to have always been on this intentional path. Yet for many of us, this path is in fact a treadmill. A moving conveyer belt on which we feel sometimes passively shifted along. The 'Medical Treadmill' has such inertia from school, to medical school, to internship, residency, unaccredited positions, being a junior reg, senior registrar, fellowship and eventually consultant. Don't get me wrong, there are huge life decisions to be made in that time. 
"Which college do I want to join?"
"Will I have any say into where I go?"
"When will I have time to have a family?"
Ultimately however, this process does tend to move along in a fairly linear pattern. Unless we are forced to or choose to step off.
What do we say to our colleagues who express a desire to 'step off' the treadmill at any point? Whether for a short break or even forever?

I experienced a lot of well intentioned encouragement not to do that.
That I would have to work too hard to "get back". Or that I would "miss opportunities". That it would be a "waste of my skills".

The dialogue here is really important I think.
As it turned out, I ended up needing to 'step off' for a while anyway. Perhaps I could have done this in a more intentional way sooner? Perhaps not. 

For me personally, I am immensely grateful for the journey I have been on as a result of the last couple of years and my 'burning out'. That doorway I felt myself standing in all that time ago was in fact this doorway into working to support the wellness of the healthcare workforce. Healing the healers. Caring for the carers.

I am excited and hopeful for the future. 
If you are feeling swept up on the medical treadmill, passively shuttled through your professional life towards some seemingly far off goal, I'd encourage you to try and familiarise yourself with the concepts of mindfulness.
Of presence.
Of perception.
Of non-attachment. 
Of self compassion.

Self awareness comes as we take our consciousness inwards to become more familiar with our own internal environment rather than only focussing on those things outside of ourselves and our control. 

Sometimes it involves some time "off the treadmill" for self reflection. And that is OK. 
Sometimes it involves staying "on the treadmill" but building a support structure around you so that you can lean on that and just lift your feet up every now and again. 
Sometimes it involves the speed and incline being turned up so far that eventually you end up flying off the end of the treadmill, unable to keep up anymore (like I did...). Look, it's not ideal- but that too is manageable.

The most important thing to realise is that ultimately, you control the treadmill.
​Even at the times when you feel like you don't, you always have the choice to step off for a while. 
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Square Pegs...

9/10/2020

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By Dr Emily Amos
I'm a square peg.

I’m a square peg who only very recently realised that I had spent my life trying to squeeze myself into round holes.

​Since burning out, I’ve come to realise that in order to try and fit these round holes, what I had begun to do was shave off my corners. To take away small pieces of myself bit by bit, very slowly, imperceptibly over such a long time that I almost looked like a round peg on the outside by the time I burnt out. I certainly fit in the round hole I had created for myself.
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Yet, I was still a square peg.
An unhappy, in-authentic, now piecemeal, square peg.

What I’ve realised in the process of break down and re-build is that some of the best things about me exist in those ‘corners’. My creativity for one. My self awareness- that innate sense of who I am and what I need. My ability to connect with other humans in a really meaningful, two-sided kind of way. My unquenchable thirst for knowledge in the most obscure and broad ranging topics.
The things that made me ‘square’ were some of the things that were most valuable to me. My ‘square-ness’ was actually made up of some of the best things about me and it took my candle going out to realise that those were things I really didn’t want to lose.
Specialty training programs. Hospital jobs we have to apply for each year. The way "things have always been done". 

It's easy to think that we need to be 'round' to fit in and succeed in medicine. To some extent we do. The medical world has a way of doing things and there is always going to be round holes that we cannot change. What we can change is how we talk about this and how we support people who like I did, find the endless round holes of the medical world to be exhausting at times.
Since burning out I found that there are a lot of people with advice on how to avoid burning out. Usually, it’s people who themselves have burnt out. I’m no different really. I’ve been through an immense amount of pain, I’ve been exceedingly fortunate to have been well supported during that time and I have come out of the other side passionate about preventing someone else from also going through this experience.
Except this isn’t that kind of advice. This isn’t about burn out. This is about self-awareness. 
Because burn out comes from a constellation of events that litter the path away from self awareness.
My self awareness existed in one of those all important corners that I had shaved off on my path towards trying to “fit in”. I didn’t realise that I had lost it and therefore didn’t realise how much of myself I was compromising as I tried harder and harder to make myself happier or less stressed. I had jumped onto the "medical treadmill" (the seemingly unstoppable inertia that takes us through graduation from medical school, through internship, residency, specialty training and beyond) without ever giving myself permission to consider other paths until I was so burnt out I needed to step away for a while. The thing about losing your self awareness (or not having it to begin with) is that you don’t know why you feel awful. You can’t see what it is that is making you so unhappy and you begin to feel like you just have to "keep going" because you've lost sight of any other options.
​This isn’t about every square peg saying “well this is who I am the world just has to learn to like it”. If you’re a square peg like me and you’re unhappy or searching for meaning, I'd encourage you to explore the places you find yourself within this world and see whether perhaps that round hole you’re trying to fit into can maybe be adapted a bit? A reminder to question yourself (and the familiar foe of 'Imposter Syndrome') but also question the hole you're trying to fit into. To be willing to ask yourself the question if it is in fact truely a place you want to be or are you just "on the treadmill"?
So here I am telling other empathetic individuals it's not about simply "not caring as much" to avoid burning out (which I was told more than once in my career)  but rather about giving yourself the space and permission to really 'know' yourself, what is important to you and what you need. About having the courage to be introspective, even if it means you might find things about yourself that you wish were different (for me personally it was that medicine was perhaps never the "calling" that I thought it was for me) and holding strong and healthy boundaries based on that new found knowledge. 

This is a story from a square peg, about finding happiness in a world full of both round and square holes without compromising yourself or expecting others to change for you. It’s an encouragement to keep searching both within and outside of medicine until you find fulfilment in places you might not expect, without shaving off the best parts of you. The Creative Careers in Medicine website is an amazing place to check out if you end up finding yourself searching for other avenues within medicine. Or you could seek out mentors who might not be professionally where you aspire but personally they have a lot in common with you to seek their guidance in how they made their path work. But mostly, it's to let you know that you're not alone.

Because there really are enough stories from round pegs about how everyone just needs to be flexible and change to fit into round holes to avoid burning out. It’s not what I needed to hear. And it’s not my story.
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The 'Other Side'.

16/8/2020

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By Anonymous
I have always thought of myself as an empathetic person. I felt that as a physiotherapist I was considered in my approach, thoughtful in my words and understood as best I could what each individual I met may be experiencing. I saw myself as strong but kind, able to help others through their rehabilitation. ​
​My relationship with my patients was as a knowledgeable ‘healer’.
These beliefs all changed significantly when I found a lump in my breast and underwent a bilateral mastectomy. I felt as though I had been catapulted to the ‘other side’, having never appreciated there might be such a thing.

​My experiences as a patient had a profound impact on my practice thereafter. In sharing some of these experiences, I hope it may allow you to reflect on your own practice as a ‘healer’ or ‘therapist’ and how it shapes our identity as health professionals and humans.

Whilst in hospital I did not share that I was a physiotherapist.
In fact, I did not openly share with many that the surgery was happening. There is a mix of reasons why I didn’t share (and still don’t) but the overarching theme is of fear, of admitting a weakness. Medical professions can polarise the world into two very distinct groups.
 There are those who are sick or sore and therefore in need of help or healing, and those that ‘do the job’. ​
Having always been strong, fit and healthy and part of the ‘doing’ group, becoming a patient challenged my identity. I also had fears that others would no longer perceive me as strong, fit, and capable. Which ultimately I believe, is part of what led me to remain silent. 

I had assumed breast loss to be hard but had not fully thought through the impact this has on the whole self. It wasn’t that I was particularly proud of my breasts prior to surgery. I was small-busted and thanks to breastfeeding there was nothing I’d show off. But the tissue was my body, had served a practical function in feeding my babies, and was part of my sexual identity as well. Comments from well meaning nurses or therapists after the surgery (comments that I too had previously made) such as “the surgeon did a good job” or “your scar is so neat” were met by my own resistive thoughts like “there is nothing neat about this at all”. The truth for me is that, despite a “successful surgery”, my body will never be the same, and for that I feel grief and loss. What I longed for was for someone to acknowledge that loss, to recognise that none of this was wanted, and that change is difficult.

Having never previously had major surgery, I had no appreciation for the utter exhaustion that comes with recovering from surgery and anaesthesia. This exhaustion encompassed mind, body and my sense of self. I returned to work after four weeks, much to the bemusement of my surgeon. I remember his words clearly, "What makes you so different from anybody else that you would heal at a faster rate?"

For some reason as health professionals, we believe we are different, that somehow physical or mental health and healing would be different for us. But truthfully, it’s not. ​
​We are no different, and in fact this belief that we are somehow stronger, more capable of healing or better able to navigate health issues, leaves us vulnerable to poorer outcomes and isolation in our struggles.
I believe this professional facade can permeate our attitude to our own personal health challenges and risks ultimately causing greater anxiety and distress.
It has just marked two years since my surgery.  
As more time passes, I wish that I had spoken up at the time.
I wish that I had shared this significant health event with more family, friends and colleagues so that they could be part of my life, this journey and allow them the opportunity to take on the role of ‘healer’. I recognise now, that in not sharing at the time, it has denied those around me that chance to help me when it was needed most. Two years on, it feels a little foolish not to have shared more than I did. 
If you are in the midst of health challenges, whether physical or mental, my encouragement to you is to say so. To share and allow that breaking down of the ‘us and them’ mindset, which ultimately only hurts us. ​
Sometimes life is very hard, but it does also get better. Wounds heal, strength returns and life marches on. Kindness, compassion and understanding ourselves as health professionals along the way can make all the difference.
​
Peace.
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New beginnings and growth edges.

1/8/2020

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By Dr Emily Amos
Right now I'm meant to be feeling all the feels of a recent business set back as I re-build myself after burning out in clinical medicine. 'Wallowing' was the word I used when talking to a very dear friend who was coaching me through it.

Admittedly, I'm actually terrible at sitting still for long, but I did have every intention of letting this feeling wash over me and set up shop for as long as it needed to for me to honour it.

Then I had an idea.

What if I could build a resource to bring together health care professionals as we question our lives outside of work? What if I could help others negotiate the discomfort around our growth edges?

What is a 'growth edge' you might ask?

Well a growth edge is that point at the limit of our abilities. It's the imaginary line around us that delineates "success" from "failure". It's the line that most high achieving individuals are terrified of ever finding. It's the line I found when I needed a break from my work as a General Practitioner after burning out. It's the line I've found again as I've begun to realise that my life in clinical medicine isn't the right path for me right now. It's an uncomfortable place to be.

We're hard wired to avoid failure. The thing about doing our best to avoid ever failing though is that we never actually know how close we are to our limits. We stay in the 'safe zone', only taking on tasks that we know we can succeed at. We never grow.

I really don't know what will come from this endeavour. But I do know that the last 12 months of introspection I've done and growth I've had as I've worked my way around this growth edge of mine has allowed me to really begin to know myself. A 'Self' outside of my identity as a doctor. If I've learnt anything in the last 12 months it's that there are many, many people who feel exactly like I was feeling within the healthcare industry right now. Feeling lost in my profession, sometimes robotic in my work and not sure how to find meaning in my life that was independent of my ability to help others. And with the current COVID-19 pandemic, I know that even more of us are feeling overwhelmed and alone than ever before.

The Healers Health Collective is the product of my desire to help others, my affinity and utmost respect for my colleagues and my gratitude for the journey I've been on.

I hope that other healthcare professionals will find this page of service to them in their own journeys of rediscovery.
I hope that others who find catharsis in writing feel drawn to submitting anonymous blog posts for publication here.
I hope that from this humble beginning a wonderful resource may grow.

Because, even the healers need healing sometimes.

​Emily
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