– A guide for the primary care workforce
A career in general practice is very intriguing and quite an adventure compared to other monolithic specialities. As a GP you are approaching illness from a person’s perspective. Family physicians are specialists at tackling undifferentiated problems in the context of the individual, family and community without being beholden to a disease or body system, regardless of age or gender.
It can be surprising to realise that the vocational training scheme for preparing doctors for a career in general practice in the UK, appears to leave out the psychological development required to navigate this daunting career path.
I hope that in this article will equipped you with tools to approach your career without fear and the readiness to face the challenges that may come with it especially when unexpected changes take place in your life or in your career.
As primary care professionals, we often envision our careers with clear milestones. We dream of completing our training, starting a family, and perhaps even specialising in a particular area of interest. Despite our inability to fully foresee every aspect of our professional and personal lives, we strive to move from one milestone to another, meticulously plotting our course.
These plans are not just whims; they are calculated steps towards our goals. But life, in its unpredictable nature, often throws unforeseen circumstances our way. How do we make the right choices when the future is so uncertain? How do we account for technological disruptions in our career, losing our health, our means of livelihood, or suddenly becoming a carer for a family member?
Unforeseen changes, such as personal health issues, family responsibilities, or shifts in the professional landscape, can create significant stress. This stress disrupts the carefully laid plans we have for both our career and personal life. For instance, an unexpected illness or the need to care for a special needs child, or family member can derail career progression or strain both personal and professional relationships.
A Psychological Perspective
Adapting to these unexpected changes involves several psychological processes:
Cognitive Flexibility:
Cognitive Flexibility is the mental skill that enables a person to switch their thinking between different concepts and consider multiple ideas simultaneously. This ability helps individuals adapt their thoughts and behaviours when encountering new, unexpected, or changing situations.
This involves being open to new ways of achieving our goals for day to day challenges like covering a duty session when you planned for routine clinic session and more existential consequences like considering alternative career paths or roles within primary care. For example, if a clinical role becomes untenable due to unforeseen circumstances, exploring opportunities in research, teaching, or health administration can provide new avenues for professional fulfilment.
We can enhance our cognitive flexibility by engaging in activities that challenge our thinking, such as learning new skills, reading, embracing diverse perspectives, and practicing mindfulness.
Resilience
Whether it’s dealing with a heavy workload, patient complaints, or the emotional toll of caring for those in distress, the ability to recover and grow from these challenges is vital for both personal and professional well-being.
Psychologist Ann Masten describes resilience as the capacity of a system to adapt successfully to significant challenges. In the face of unexpected life changes, resilience helps individuals bounce back from adversity, maintaining or quickly regaining their psychological well-being. It is an ordinary process that involves basic human adaptational systems rather than some extraordinary trait.
Developing resilience also involves recognising our emotional responses, and maintaining a positive outlook. In primary care, this could be achieved by actively engaging in peer support groups or professional networks ( in-person /online ) to share experiences and strategies for coping with uncertainties.
Identity and Role Confusion
During the early stages of our careers, particularly in young adulthood, this could coincide with Erik Erikson’s psychosocial stage of “Intimacy versus Isolation.” This stage, which spans roughly from age 19 to 40, revolves around forming close relationships and establishing a clear professional identity. At this point, significant planning occurs around career trajectories and family life, with aspirations such as getting married, having children, and advancing in one’s profession.
However, young professionals also deal with the residue of the previous stage, “Identity vs. Role Confusion.” Successfully navigating this stage involves developing a strong sense of self, which is essential for forming meaningful relationships. When plans are disrupted, for example physical disability or becoming a carer, it challenges our identity, prompting a reassessment of personal and professional goals.
Coping Mechanisms
According to Lazarus and Folkman’s Stress and Coping Theory, the way individuals respond to stress (such as disrupted plans) depends on their appraisal of the situation and the coping strategies they employ. Problem-focused coping might involve creating new plans or seeking solutions, while emotion-focused coping might involve managing the emotional distress caused by the change.
Prolonged working hours, poor sleep-wake work cycles and limited breaks in-between can cause chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis, flooding the body with cortisol and other stress hormones. This chronic stress response can impair cognitive functions, disrupt sleep, and lead to a sense of overwhelming fatigue.
General actions from these coping mechanisms could include delegating tasks, engaging in self-care activities such as taking breaks, eating and sleeping well, or using mental visualisations of positive outcomes. These practices can really help us handle change better. Read more about How to bounce back from stress.
Reframing Our Narrative
Dan P. McAdams’ narrative identity theory highlights the power of the stories we tell about our lives. By reframing our experiences and viewing disruptions as opportunities for growth, we can integrate these changes into a new, coherent life story. This reframing helps us to see setbacks not as failures, but as chapters in our ongoing journey. Each patient interaction, each difficult decision, and each moment of uncertainty contributes to the rich narrative of our career. Professional and personal /self reflections ( including journaling ) can help us hone our skills, refining our intuition, highlight our growth, underscore our dedication, and strengthen our confidence in future scenarios.
Balancing Career and Personal Life in the face of Changes
Balancing career and family/personal life is a common challenge during the various stages of our careers. When unforeseen changes occur, this balance can be significantly disrupted. Strategies to manage this include:
Communicating Effectively: Open and honest communication with partners, family members, and colleagues about our needs and challenges can foster understanding and support.
Setting Realistic Expectations: Adjusting our expectations and being realistic about what we can achieve can prevent burnout. This might involve renegotiating work responsibilities or seeking flexible working arrangements.
Prioritising Self-Care: Ensuring that we take care of our own physical and mental health is crucial. Regular exercise, mindfulness practices, and seeking professional support when needed can help maintain our well-being.
I’ll highly recommend these books for further reading.
The Science of Storytelling by Will Storr
Career Fear (and how to beat it) by Somi Arian
Thinking, Fast and Slow by Daniel Kahneman
Best wishes in your career!
