The mind is a wonderful and a terrible thing. It can store away an astounding number of facts, conjure up images from decades ago and completely change our perception of the world around us. Unfortunately, that can sometimes also be damaging.

The power of the mind is nothing new in healthcare. The chances are you find yourself using carefully worded sentences with a patient, for example saying “discomfort” not “pain”. You’re subtly tweaking your patient’s thought patterns to help improve their outlook.

Well, maybe it’s time to change your own outlook. The current research tells us that stress, burn out and self-esteem issues are plaguing an ever-increasing number of doctors and whilst systemic changes are needed, they take time.

Whether you think your glass is half-full or half-empty,  these three simple steps can help to reduce doctors stress.

What is cognitive reframing?

If you are familiar with psychotherapy, then you’ve probably come across cognitive reframing. It is the process of using subtle adjustments in thought processes to produce a more positive, optimistic mental outlook. The effects can be profound, as demonstrated by its central role in cognitive behavioural therapy.

There are many damaging thought processes that we develop, and they are usually entangled, accentuating the downstream effects on our mood and health. The good news is that you can reframe them for your own benefit.

The beauty of cognitive reframing is it is something you can do now, for free and can be a a foundation upon which to build more robust mental health. As you progress, you’ll start to develop your own techniques for introspection, resilience and empathy, all of which can benefit you and your patients. Let’s look at three common cognitive distortions that contribute to doctors stress and how to reframe them.

Tip 1: As one door closes, your mind opens

One common cognitive distortion is placing far too much emphasis on problems. The resulting rumination and personalisation “this is my fault, I am not good” adds a mix of negativity to the bubbling cauldron between your ears.

A problem can take many forms, and if you find yourself worrying about even the smallest setbacks then this is probably a good place to start applying the three steps of cognitive reframing; identify, challenge and replace. I give an example of this below.

Identify

• A problem or setback causes me to ruminate, blame myself or feel low
• I will identify when I do this

Challenge

• Problems can be due to many reasons, everyone has them
• They are part of life.

Replace

• Problems will occur, so reframing them as opportunities will enable me to approach them positively and learn from them

Of course, some problems are genuinely large but for the frequent small issues that crop up, seeing them as opportunities can transform your outlook and remove significant mental burden. Examples include:

• A cancelled meeting, becomes more time for personal development
• You promise to complete a task for someone but don’t deliver, becomes an opportunity to potentially review your workload
• A patient complains about something that wasn’t your fault, becomes an opportunity to improve systems

Tip 2: Invest in yourself

The most pressing problem for doctors right now is burnout. It is occurring earlier in careers, more frequently and shows no signs of slowing down. Of course, being overworked in a system stretched to breaking point will whittle away some of the strongest minds, so it goes without saying that systemic changes are needed.

However, one pre-emptive step you can take now to reduce mental fatigue is allowing yourself time off and not feeling guilty for it. If you don’t allow yourself genuine physical and mental breaks, your stress will remain high and you will find it hard to switch off. Constantly saying to yourself “I’m not working, should I be reading up on the latest drug developments?” or “Should I respond to the stack of unread emails?”

Let’s look at how you might reframe that:

Identify

• When I am not working I am still thinking about work
• Not doing something productive makes me feel guilty

Challenge

• It is not expected of me to always work outside of work hours except for vital or pressing matters
• Team members can help me

Replace

• Having time off will benefit me in the future
• By recharging, I will be a better doctor and reduce the risk of burnout

Setting boundaries, such as not accessing emails and messages at certain hours, can facilitate the reframing. Of course, sick patients don’t stick to the nine to five plan and it may not always be easy to set time aside for yourself but developing the inner voice of “I can feel myself getting fatigued” is vital for ensuring you don’t burnout.

Tip 3: Thumbs up, chin up!

One of the most common mental health issues in doctors is low self-esteem. As scientists, we are taught to examine data under a microscope and pick out key themes to develop pattern recognition.

Unfortunately, if your brain is calibrated to “negative mode”, you will over-emphasise the negative aspects that occur in your life and minimise the positive aspects. Every scenario, problem and event will add to this via confirmation bias to the point where you’re unable to accept a simple compliment and everything you do feels subpar.

This can be a tricky one to reframe but here’s what I suggest:

Identify

• I focus on the negatives and minimise the positives
• I don't think I am a good doctor, partner or friend

Challenge

• Everyone has positive and negative aspects
• I have objective achievements that show I am good
• I am loved

Replace

• I can celebrate the positives which will improve my outlook
• The negatives are opportunities for growth

This can be supplemented by techniques such as keeping a gratitude journal. This involves listing the positive experiences and gratitudes once each day. Such repetition enables your brain to focus on even the most minor positives that happen in a day to improve your mood.

Final thoughts

These techniques may seem simple, but they represent an immediate action plan that can work pro-actively to improve your outlook and perspective. Of course, if you find yourself struggling and need further support, it is essential that you speak to colleagues and access mental health treatments. One of the main barriers to doctor’s mental health is the associated stigma, which will take time to change.

In the meantime, don’t let yourself become another cautionary tale. If you take away just one learning point, let it be this: you are your most important patient. Try implementing just one of these tips today and you’ll quickly find how frequently you fall into damaging thought patterns, and how potentially life-changing cognitive reframing can be for you, your loved ones and your patients.

Good luck.

Hardeep Lotay
5^th year student doctor
University of Cambridge

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