In this personal account a junior doctor (now a post-CCT clinical fellow) spoke to me about deciding to take a year off work to focus on her mental health. She describes how she came to make this decision, how she spent her time off, what she learnt, and the impact this has had on her career.
I’m very grateful for her generosity and courage in sharing her story, and I hope it will be helpful to those who find themselves in a similar position.
How did you come to make the decision to take time out of work?
The decision to take time out was driven by an accumulation of factors. Having striven to achieve a well-regarded position in my higher speciality training I was increasingly feeling like a failure. Prior to starting the post one of my consultant colleagues told me that that department would either “make or break me” and this probably set the scene for me. I perceived the environment to be threatening and judgemental, and felt I received little encouragement or positive feedback. I increasingly compared myself to other junior doctors – people who appeared more confident, more able or more knowledgeable than me; and those who had chosen different speciality training routes or gained extra experience. I felt like an imposter in the workplace, and I was looking for faults in my performance before they even occurred. I was becoming increasingly deflated and anxious.
My confidence was then further knocked when I was asked to make a clinical report regarding a senior doctor. This experience added to the feelings of being scrutinised and judged when I had to have multiple meetings with various members of the department and deanery.
I recognised I was becoming increasingly stressed and anxious at work. Performance anxiety and imposter syndrome were also starting to have an impact on my happiness outside of work.
I distinctly remember on my run into work one day I found myself wondering if I accidently hurt myself how I would have time out of work. I imagined a broken wrist and 6 weeks off with no questions asked. This was really the trigger moment for me to seek some help and I arranged to have a meeting with the head of the deanery.
She was the first person to whom I properly expressed how I felt in the department and the culture of fear and judgement that I perceived to be pervasive. Comments like “these juniors don’t know anything” or publicly criticising others’ management of patients meant I could only imagine what they were saying behind closed doors. She acknowledged my experience and also validated it by stating that this was not the first time that this sentiment had been expressed about this particular department, which thrived on its “prestigious” reputation.
She asked what I wanted, and this is when I expressed that I needed a break, some time away from the department to reassess and reset. She suggested I seek support from the deanery’s mental health team that is set up specifically for medics, and I set up a block of therapy appointments with a clinical psychologist.
What was your experience of therapy like?
I found therapy a genuinely useful and insightful process. It really helped me to clarify my concerns and feelings about work. I discussed my performance anxiety and was asked to justify it: how many lines did you actually miss? how many right decisions did you make rather than wrong ones? It really helped to have to express things verbally to another person, and challenge my way of thinking.
How did you decide to take time out?
Through the therapy process we continued to talk about time out of training and needing a break. We talked about what I would do if I had a year off – maybe working in a hospital abroad. But one day I expressed that if I really had no ties or commitments, I would love to take a year to live in Europe, learn another language and attend art school.
During the therapy sessions we discussed what was holding me back from doing this. The pervading feeling was again one of judgement from outsiders or concerns that it would impact on my career and jeopardise the likelihood of me getting a post in future. In the end though, I reached the conclusion that continuing to work in the same field somewhere else may just perpetuate the issues in a new environment. I realised that in order to really reset, and identify what would keep me happy and balanced, I needed a true break and personal adventure – so off I went.
Where did you go? What did you do? Did it help?
I spent a year in Italy that felt like something out of “Eat, Pray, Love”. I learnt Italian, surrounded myself with beautiful art work, wonderful food, culture and scenery. More importantly, I met great people and established new friendships with people from all over the world, many of whom were embarking on similar emotional journeys, taking career breaks and pursuing their dreams.
The experience was fantastic – I could not recommend it enough. It was really important to spend time on myself, and pursue a hobby that is not related to medicine in any way. Exploring how I responded to the completely different stress of learning new skills and living in another culture helped me realised that I was my own worst critic. Prior to leaving my job, various people in the department had given me really positive feedback, saying I was suited to the speciality and they thought it was a shame or a waste that I was going. This was a real shock as I had sincerely felt that I wasn’t good enough for the department.
What did you learn through this time?
Following the year off – a year of no night shifts, eating and sleeping at normal times and meeting lots of new people, learning new skills and a new language – I felt so much more like me. I reset the balance of priorities. Medicine can define you as a person and it is demanding. It takes so much more from you than the hours you are physically present in the hospital both emotionally and physically. It is filled with as many highs as it is lows but fundamentally it is still just a job.
At one point I remember reading some of the obituaries in the back of the BMJ, reading about these prestigious doctors who had these amazing careers but one day retired, got ill, or died at work. I wondered how long their colleagues at work missed them for, or if they noticed they weren’t there, whether they really mattered to the people they worked with, and how replaceable we are as cogs in the machine.
No matter how much satisfaction we get from work it is never our sole source of pleasure. The things outside of work actually matter more. They are the things that keep us balanced. We have to nurture these interests and aspects of ourselves, protecting them from the steam-roller of medicine that wants to take over all of who we are.
What came next for you?
Perhaps my response to the situation I found myself in was extreme but I felt it was better to have time out and then feel that it was a conscious decision to return to work. It was my choice to return. I was clearer about my personal tendencies to self-doubt and I had certainly shifted my attitude towards making more time for other hobbies and interests.
After my career break, I came back to medicine and the speciality, albeit in a different institution. I now feel more self-assured and secure in my career choice. Although perhaps I do not yet have the confidence to walk away from the last 20 years of work. Fundamentally I recognise that there is still something about being a Doctor that is too intrinsic to my being that I am not prepared to let go of completely. I know I am never going to be the best doctor in the department, but I can do a good job and remain balanced instead of destroying myself in chasing an impossible standard.
Many people worry that having a career break on your CV might damage their career prospects – has this been your experience?
The majority of my peers have been positive about it, a few are jealous or wish they had done something similar, but there is still the question about whether it has impacted my career prospects. Honestly, I think that it has. People ask about it in interviews – it was recent enough that people note it on your CV and ask about the reasons I took time out. Some respond well to my explanation and others probably think I wasn’t tough enough, should have stuck it out etc.
This does create some worry and anxiety about the future and whether this has hampered my career, but at the time I felt I had no choice. I needed to do something, and this was the path I chose. Others could perhaps have taken a shorter break that wouldn’t be noticed on a CV but this would still come with challenges of explaining sick leave or absenteeism to seniors. Perhaps for others reducing their hours at work would have been enough.
Personally, I think if I was back in the same situation, I would still make the same decision even knowing how it is impacting on me now. I would hope that having gone through my experience means that I would be able to help others and support them through similar crises of confidence in the future.
What changes would you like to see happening in the NHS to meaningfully support staff wellbeing?
I think we are making progress in medicine to remove some of the public judgement of others. People can choose to work part-time now in certain specialities without citing a reason and this should be universal. Why should we have to explain our lives outside of work and life choices to our employer?
Some are advocating having optional sabbatical time built into training, which I think would be a fantastic step in allowing people to spend time on themselves. I also think the physician support system (Practitioner Health) was brilliant and I would highly recommend it. Being aware and seeking counselling before you hit crisis point is so helpful. I wish I had known about it and done it sooner.
Perhaps we as medics are a bit wary of seeking outside help – we like to believe we are indestructible and somehow different from our patients. We can see counselling as a sign of weakness when instead it should be seen as a strength – being brave enough to undergo self-analysis to unpick our fears and relationship with work.
Personally, I feel that actual psychological support should be readily available for all NHS workers. It is not about having a few posters in the staff-room about self-care or providing access to mindfulness apps. The onus shouldn’t be placed back on the individual – we need to think about how we can create a workplace that is supportive, allowing people to ask for help or support flexible working patterns without fear or judgement.
Next Steps
If this has resonated with you and you want to reach out to talk to someone about your own struggles check out the free mental health support services available for health professionals, or book a free therapy consultation with me.
The author of this story has kindly said that she is happy to be in touch with readers who may be contemplating taking time out and want to find out more about her experiences. If you would like to get in contact please do so via email to hello@drpaularedmond.com
