Dr Hilton Koppe is a general practitioner in Lennox Heads, NSW, and a medical educator with NCGPT. His own health and personal care struggles as a doctor led him to developing a checklist to help doctors to establish good habits early on, and have a successful and fulfilling career and life.
Hilton’s personal story: from self abuse, to self care
When I graduated from medical school, I was hopelessly ill-equipped to deal with the personal demands of working as a doctor. As with many of my colleagues, I relied on an over indulgence in alcohol and multiple short-term pathological relationships as a means of coping with my sense of dis-ease arising from my work. Luckily I was still young enough (and therefore still arrogant enough to believe in my 'immortality') to survive this period of my life without too many scars.
Part of me enjoyed the release in alcohol and the intensity of frequent new relationships, but there was a larger part which felt empty and unsatisfied.
During my GP training, I did a rural term in Coffs Harbour. I was fortunate enough to meet some people who were interested in yoga, and they invited me to join their class. This was quite a challenge for me for two reasons. Firstly, I was totally sceptical and ignorant about Eastern practices such as yoga, and secondly, my toes and fingers had until this point never met (i.e. I was extremely inflexible). I warned the teacher on my first visit that I would be unable to do most of the poses, and she said, “You can’t touch your toes because you think too much.” These turned out to be quite prophetic words.
Through this contact with people who had significantly different views on life from anything I had come into contact with during my time at university or in the hospitals, I began to reflect on my values and the way in which I wanted to live my life. It was the start of a journey that continues to this day, and hopefully has a long way to run yet.
I would like to share a few of my insights with you and offer some ideas of how I have tried to take better care of myself in my work as a doctor.
1. Be true to yourself in your work
The myth of professional distance doesn’t ring true for me, especially in general practice. We spend so much of our time at work, it just does not make sense to try to be someone other than oneself during this time. The doctor-patient relationship is just that – a relationship. It relies on both parties being open and honest within the boundaries of the relationship. This means being clear about what I will do and what I won’t do. It means giving up trying to be all things to all people. It means being proud to work part-time in the practice, knowing that the other doctors are fully capable of attending to the patients when I am not there.
2. Get down, be silly and play with kids
Even if you do not have children of your own, spending time playing with young people is one of the best ways I know to forget all the seriousness of our work, and to have a good laugh. And as we all know, 'laughter is the best medicine'.
3. Resist the temptation to get rich
True wealth comes from the quality of one’s relationships and life experiences, not from the size of one’s bank balance. As doctors, we will always be able to earn a comfortable living, and will usually be significantly better off than the majority of the population. Many doctors I know seem to have lost sight of this fact.
4. Resist the temptation to work too hard
From my perspective, 6 or 7 sessions per week in general practice is full time work. I find the work so intense that if I do more than this, then I am a pretty poor doctor to those unsuspecting patients who come in at the end of the week. I have only been able to achieve this goal by first resisting the temptation to get rich. It was an excellent decision.
5. Develop a regular practice of physical exercise
I have found the benefits of this to be enormous. While it is easy to do 30 minutes of light exercise at least three times per week, unfortunately it is even easier not to do it! Like many of these things, it requires commitment.
6. Develop a regular practice of mental quiet time
I find that I need at least 20 minutes per day of mental quiet time. It may involve sitting focusing on my breath, or listening to music. It can be combined with physical exercise such as tai chi, or focusing on the breath while walking, swimming, showering or even doing the washing up.
7. Develop a regular practice of awareness of spirituality
The word spirituality means different things to different people. I like the concept used in Alcoholics Anonymous of it meaning a force greater than ourselves influencing our lives. An awareness of spirituality helps to give greater meaning to life, with its consequent improvement in sense of wellbeing.
8. Develop a network of personal support
Most of us spend all day supporting others in ourr lives, but fail to gain the same level of support for ourselves. We need to have the opportunity to de-brief some of the difficult situations we face in our work, as well as to celebrate our successes. (The successes always outnumber the difficulties. It’s just that we are not very good at putting our attention on the successes, and we certainly were never taught to celebrate them!)
9. Develop your creativity
Allow time, effort and energy for 'right brain' activities to help balance the intense thinking nature of our work. My creative outlet is cooking. (I’m a hopeless artist, and besides, you can’t eat a painting.)
10. Take a break, preferably a long one, regularly
I know many doctors who have not ever had more that 1 or 2 weeks off at a time. While frequent short holidays have their value, it is just not long enough to get work right out of the system. In the 20 years since I graduated, I have had four long breaks away from work – one for 9 months backpacking around Europe in my 20s, one for 3 months for my honeymoon, one for 12 months traveling around Australia, and most recently for 6 months when our second child was born. They were the most valuable times of my life. In summary, treat your wellbeing with at least as much respect as you treat others. This probably means enlisting the support of a medical colleague in deciding upon any medical treatments you may require. It may also mean making a commitment to some of the ideas outlined above.
Dr Hilton Koppe, Senior Medical Educator, North Coast GP Training.