Are you wondering what more you can do to lead effectively and to take care of yourself during the Covid-19 pandemic?
After 20 years as a public health doctor, I now work as an Executive Coach and Career Counsellor for mid-career, senior and Executive level Doctors in Leeds and internationally by Skype. Building on my intercalated degree in psychology in 1993, and my masters in health promotion 1999 (specialising in emotional wellbeing), I’ve spent the last 30 years studying, teaching, using and researching the most effective evidence-based techniques and strategies in the field of self-help and self care.
In times of crisis we don’t rise to the occasion, rather we fall to the highest level of our training: I’ve created this page to share some of the ‘radical self care’ tools I use with my senior medical clients in the hope that there is something here which inspires and helps you to take care of yourselves during the challenging period ahead of us. I don’t include any HR negotiations, occupational health, financial or clinical advice but other sites such as Doctors Support Network or the BMA do. I’m also not focusing on some of the more obvious self care strategies such as exercise, sleep, hydration and nutrition.
Everything I include I have used myself, and this resource is not a substitute for medical or psychological care. Please feel free to share anything with your colleagues. I will keep updating and adding to this site. If you have any feedback or anything you’d like me to add I’d love to hear how this has helped you or any suggestions to make it more useful to you at firstname.lastname@example.org
Being human means living within multiple complex, adaptive systems which are both changing and becoming more complex all the time. This means living with high levels of ambiguity and not knowing, periods of relative calm and stasis, and periods of disruption whether a ‘big bang’ or a ‘rising tide’. As humans, we all know at some level that ‘Life is like stepping into a boat that is about to sail out to sea and (at some generally unknown and unknowable point to) sink’ (adapted from Shunryu Suzuki Roshi).
There are many things we can’t control or plan for in life, however it is possible to live skilfully with uncertainty and change, and to grow our capacity for what I call ‘radical self care’. This requires a conscious commitment to gaining insight into what is really happening both inside ourselves and in the world around us. In the face of the significant period of disruption and distress ahead of us, I wish you courage and every success in your clinical care, leadership and within your own lives and your families as you navigate the unknown and unknowable territory ahead. And remember that you are not on your own, rather we are all joined by our common humanity at this time.
Supporting you with expert Coaching and Mentoring for Doctors
Free 30 minute wellbeing and leadership support ‘speed coaching’ session for post CCT or other senior, UK based, clinicians, clinical or public health leaders, initially valid until 30.6.20. Limit of one free session per person. Book here: https://fionadayconsulting.as.me/consultation
Complementary 60 minute coaching session for all previous clients who are in clinical or public health leadership or frontline clinical roles; initially valid until 30.6.20. Book here: https://fionadayconsulting.as.me/onehouronline
Limited number of significant reduction on fees for all previous clients or new clients who are post CCT or other senior, UK based, clinicians, clinical or public health leaders – please contact me to arrange. New clients are required to have had a consultation first to ensure I am able to meet your needs – please use this link to book the consultation: https://fionadayconsulting.as.me/consultation
Participation in the FMLM ‘Safe Space Conversations’ Covid support programme – please contact me to discuss.
No prior notice required for you to rearrange a session – please just let me know asap to allow someone else to use your space until 30.6.20.
All sessions will be held on Skype, Teams, or Facetime or telephone until further notice.
Increase in evening and weekend appointments subject to my capacity.
Email support and free telephone check-ins for clients who are in a Coaching Programme with me (rather than standalone sessions).
It’s easy to be swamped with the difficulty around us, and especially as our brains are hardwired by evolution to be like velcro for things which activate our threat responses, and like teflon for anything good and positive. By noticing the tiny moments in your working day or home time which are good even when everything else seems challenging, you can learn how to really squeeze the goodness out of them and help your brain to rebalance both in the moment and over time. I spent a weekend training with Rick Hanson, one of the world’s leading psychologists in the field of positive neuroplasticity, 10 years ago. His ‘taking in the good’ practice has two steps and I’ve added a third:
Notice something small which is positive as it arises through your day – perhaps a smile from a colleague or patient, a flower on a desk, a child’s face, a hasty word of thanks.
Allow the fact that something positive has happened to really soak into you so that you are squeezing all the goodness out of it. Spend the next 20-30 seconds really holding onto the feeling that something good has happened as if savouring a warm cup of tea or a quilt surrounding your body.
When you have a quiet moment later on in your day, remember that moment again, perhaps share it with someone else so that you relive it and get even more goodness out of it. Keep looking out for moments to savour, like a treasure hunt.
Get on the Balcony
Our brain is hardwired to look for problems and difficulties around us all the time and to activate our ‘threat’ and ‘drive’ emotional systems. When we are faced with a long period of challenge ahead of us like we are at the moment, it is easy for the brain to only receive messages of ‘fear’ and ‘do more’ which drives up our sympathetic nervous system further.
Getting on the balcony means looking at the whole of your life with a sense of perspective. It’s important to notice where in your life are things going well, as well as being honest about the areas which are difficult or challenging. From your balcony, what can you see which nourishes and sustains you? Who do you feel supported by and grateful for? Find small things to feel gratitude for such as having clean water and clothes, somewhere safe to return to, colleagues and friends. Remember the resources you have inside yourself and how you have coped with difficulty in the past. Get up on the balcony at least once a day to purposefully remind you of the safety net you have in place already to support you.
Building ‘Team You’
As well as having ‘threat’ and ‘drive’ emotional systems, humans are also hardwired by evolution to connect with other people through a ‘soothe and connect’ (also called ‘rest and digest’, or ‘affiliative’/ ‘prosocial’) system which we can consciously learn how to activate. Now more than ever it is important to build your support network of your nearest and dearest outside of the work context, and to spend time connected with them as well as with your ‘work friends and family’. If you can’t see people in person due to time or travel limitations, it matters that you stay in touch with each other. Consciously choose the people who are in your team and let them know you would like to be able to count on each other now and in the immediate future.
Connect with your Values
Who are you at your core and what do you want to stand for in the face of this situation? Your values are like a compass which you freely and consciously choose for yourself to set the course of your life; they give you meaning, purpose and direction. You may have values for your work life and values for your personal life – or they may be the same. Two ways to access your values during covid-19 are: imagine a year from now and what people have said about you when you were at your best; who inspires you and why. Take time to find a small number of values you can really hold onto during the months ahead. And it’s not about knowing them intellectually, rather it is about knowing them and being them, bringing them to life in the world. What would I see you doing, saying, being if you were strongly connected to your values? There may be conflicts between values as a parent and as an employee, try to make space for this and to choose skilfully how to balance them on a day by day basis.
RAG Rate your Stress and Develop a Basic Action Plan
A certain amount of stress and activation of our ‘drive’ system enables us to be our best selves at work and at home. But we all know that too much for too long can become toxic. One way to keep track of your own stress levels is to learn how to track and rate it. The Red/ Amber/ Green (RAG) rating scale is an easy way to do this. By noticing when we are in Amber, we can take action early to prevent us going into Red. When in Red we know we have to institute urgent action to get back to Amber or ideally Green.
My Wellbeing Action Planwill help you to understand your own patterns better and to develop a personalised action plan. Take time now to plan ahead so that you have a ‘go-to’ resource to help you to go straight into action when your stress levels start to rise. Add as much detail as you see fit, and identify in advance key people you will turn to if you go into the red and can’t easily get out of it.
Poetry gives us a moment of reflection and pause, and, like music, a space to feel our feelings. Here is a beautiful poem, called ‘Hokusai Says’ by the academic Roger Keyes. It was read at the end of my 7 day Mindfulness Based Cognitive Therapy teacher training course many years ago, and I’ve loved it ever since. This version is read aloud on Youtube featuring images of the artist Hokusai’s beautiful woodcut prints.This version is a PDF. Take time out for 3 minutes to savour the beauty and wisdom in the words and to enjoy the images. Hokusai suffered enormously during his life, and I am always moved by people’s capacity for such wonderful creativity and beauty and especially in the face of hardship. If the poem touches you in some way, notice, pause and allow yourself to ‘let life live through you’.
Find Comfort in Inspiring Music and Songs of Solidarity
A friend sent me this beautiful songby Kate Thomas in Sheffield, a singing teacher and choir leader with the Natural Voice Network, link shared with permission. I found it very moving; the lyrics and tune have stayed with me as I’ve been writing this webpage and watching the world around me change at speed, as Covid-19 spreads across the world and my community. Music gives us space to feel our feelings and to process what is happening. Songs of solidarity can be an important part of building community, and music can reorientate us to hope, reigniting our determination to continue, helping us to garner our resources and to move forward.
I remember a few days after a beloved family member died a few years ago, I was listening to Bruce Springsteen’s latest album and one song really touched my grief. When we are moved by a piece of music, it happens ‘in the moment’, a particular set of circumstances come together and our brains integrate, it’s like wiping the slate clean. Allow yourself some time to listen to music which moves you to help you to process the situation around us and your own experiences, and to feel the sense of purpose and resolve afterwards. Stay with the feelings for as long as you can.
Make Life Easier for Yourself
It is easy to use a lot of brainpower in depleting activities, those which need a lot of willpower to get through something. A lot of us who are high on the ‘motivation’ personality domain (most doctors in my experience) use a lot of their energy reserves in willpower – forcing ourselves to do something such as getting through a crisis, keeping going on call, getting through exams. We humans seem to have a limited amount of willpower, it is rather like a battery which drains itself during the course of a day or a week. Are you trying to do too many things at once and using a lot of willpower in the process? The next few months are going to challenge all clinicians and medical leaders as never before.
Reduce your ‘willpower fatigue’ by making a few simple changes. Plan each day/ week in advance whenever you can – from the clothes you will wear, to the food you will eat, the people you will connect with, what caring responsibilities you will do when. Get your clothes ready before you go to bed, plan your travel, set yourself time limits when making decisions, especially low-risk ones such as online shopping, choosing holidays or flights (when that time comes around again). This will free up your willpower and emotional reserves to allow you to cope with unexpected challenges.
Connecting to our Values also helps to boost our willpower and recharge our batteries so that when we are feeling rundown and exhausted we can get access our additional reserves. But don’t be fooled, this is a temporary boost which needs to be balanced with downtime and proper rest and recovery.
Mindfulness Based Meditation
Many of you will have learned some basic or even advanced skills in mindfulness based meditation over the years. In the heat of an intense clinical situation we may feel that we can’t take a moment to pause. But if we just keep rushing from one crisis to another without taking a moment to ground ourselves then we are at higher risk of both burning out and making errors. Learning how to ground yourself in the face of a crisis is a critical skill to develop and mindfulness based approaches are used by high performance professionals around the world as one of the most evidence based ways to do this.
If you’re new to this form of mind training to help you to stay focused in the present moment while life is busy happening all around you, I suggest you start withthese informal practices.
Walking meditation practice can be done anywhere, in a corridor at work or even on the spot during a loo break. Try walking part of your journey to or from work in a slower way- walk at half your normal speed is a start, or even spend a couple of minutes at a really slow pace to help yourself centre and activate your parasympathetic nervous system.
There are a lot of apps, youtube audios of guided meditation practices, many of which are evidence based – and many which are more ‘esoteric’. The ones I have refer to and have recorded below are mainly based on Mindfulness Based Cognitive Therapy which has been in NICE guidelines since 2003. I’ve also added in some other guided practices which I have enjoyed or learned from over my own 28 years of meditation practice where I feel there is emerging evidence for their effectiveness.
The 3 Step Breathing Space. Use this to give you a 5 minute recharge when you need a tool to ground you in the moment. Once you’ve learned how to do it, you can do it in 30 seconds or over a longer period of time.
The Compassionate Hand Practice. Based on ACT, this 10 minute self compassion practice is an important tool for our wellbeing. The warmth of your touch activates the soothing (rest and digest, parasympathetic nervous system, ventral vagus nerve).
The Smile Meditation (Short Body Scan). This 10 minute body scan meditation based on Tara Brach’s practice creates a sense of space and openness.
Short Sitting Practice. Use this 10 minute practice to help you to develop some basic skills in sitting meditation.
Medium Sitting Practice. Use this 20 minute practice to help you to develop some basic skills in sitting meditation.
The Body Scan (Long). Use this 40 minute practice to recharge your batteries when you can lie down or sit on a chair undisturbed.