The worried doctor

I think I have always experienced anxiety. Not all the time, in that I’m not always anxious, but it has always lurked in the background, waiting to spoil things. I don’t know how much anxiety is normal though, and perhaps mine is a sensible and healthy amount. No anxiety at all would be quite a problem, potentially taking away both fear and motivation, a life without any experience of relief.

I’m less anxious now, and I don’t really know why, as I’m not sure that anxiety always abates with age. My childhood was anxious – I was able to be happy, but I never quite knew what to do to escape my thoughts. There were certain specific anxieties – I remember worrying for the entirety of a summer about a summer diary I had disposed of. I was nine, and every night I relived what might happen when the teacher found out. I tried to think of ways to amend this – not really because I cared about the book, but because the sensation of worry was intolerable. I can’t believe, looking back, that something so trivial caused me so much angst. It wasn’t pain, or fear, it was anxiety, pure and simple. I was also socially anxious, in the way that only a nerdy, bespectacled, yet also needy, young girl can be. I craved friends, but couldn’t think of anything to say. In fact that hasn’t changed much, but now I feel less pressure to bother. Working the room, for me a form of middle-class torture, has been abandoned.

Many anxious – and highly achieving – people become doctors, and it’s often most uncomfortable for them. If I could change one aspect of my personality, it would be a lowering of the natural anxiety levels, as I think it might have made my path through medical school and junior doctordom more gentle. You need to be anxious to be a doctor – you need to ask the right questions and draw the right conclusions, double check doses, make careful notes. But you also need to trust your mind that you do know things, as self-doubt can lead to tortuous triple checking and more, and long nights of wondering about patients, their survival and your role in any problems. There’s also sleep, or its lack, and this was a real problem for me. Even before I entered the realms of the mood disordered, I struggled to sleep, and nights on-call, when the threat of the bleep hung over one’s scattered dreams, were far worse. Previously I had coped with my anxiety – just – but this ability was gradually eroded by sleeplessness.

Pregnancy was probably the final straw. Again, normal and right for a pregnant woman to look after herself, to watch out for danger, but I was consumed by it. At this point it went beyond anxiety, to something else; but even when I was relatively well the worries remained. And worries about pregnancy were tipped into a new dimension when I lost a baby at twenty-two weeks of pregnancy, no cause found, just a little heart that had ceased to beat. The next pregnancy shimmered with fear – and yet there was another feeling, a feeling that I might be right to be anxious, that the worst could and did happen. And in a strange sort of way, I think that actually helped me to start to cope better with anxiety. No longer did I simply fear the unlikely, knowing that my thoughts would be disregarded, even ridiculed, but I was more able to acknowledge that bad things happen. This was quite liberating. Now, even when I’m on the other side of the conversation, I try to avoid the destructiveness of saying – it won’t happen.

I’m still anxious, but far more accepting of it. As a doctor, I worry about my patients, I do double check things – but I let it slip away when I go home. I’d rather stay late, to ensure I’m happy, than worry at night. And I do think, for me, that increasing anxiety is a trigger for relapse. More often increasing worry leads to a plummet in mood, as if I’m shutting down to escape the anxiety. But sometimes it escalates into irritability, which is hardly more helpful. Anxiety is recognised to be commonly comorbid with both bipolar disorder and depression, so maybe it’s hardly surprising. I have also noticed that I have significant problems with obsessional symptoms when unwell, or even when mildly depressed, that tend to lift as I get better. Again, these were particularly bad in the early years of my illness, and after I lost my baby. Interestingly, I developed adaptive methods to deal with some – for example I couldn’t bear to see labels when I folded clothes, so I cut them off everything. This became a habit, which I still have, even though the labels themselves no longer worry me.

Is there any point to these thoughts? I think so, because I discount anxiety most of the time, and I expect many others do. But it has caused me considerable distress, even at times when I have been apparently well, and has been something that I have sought to hide or dismiss. But I may well ignore it at my peril, given that worsening anxiety is a trigger to becoming unwell. Many doctors continue to experience considerable anxiety – not only about their patients, but also about managing an often-overwhelming workload, completing assessments, exams, appraisal – it can be never ending.  And this anxiety can get in the way of the real stuff of doctoring, of speaking to and hearing patients, of treating them and doing their best for them. 

The worried doctor is not a good thing, for them or for others. I am not a good example – I worried about too much for too long, and now I sometimes even worry when I’m not worried enough. But I think that probably I am. Simmering is what I seek, far better than bubble, toil and trouble. 

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