You didn’t want to take time off in the first place. Even though you knew you needed it. Taking time off sick for your mental health can feel uncomfortable. Thoughts that you’re not that bad, that you’re letting people down, that you should be able to cope. It can make you feel like you should be going back to work as soon as possible.
But if nothing’s changed, then nothing will change. You’ll go back and the same cycle will repeat itself. Before you return to work, it’s important that how you approach things has shifted, that how your feeling has improved, and that you have strategies to help you cope differently.
This article is all about how to achieve a realistic and sustainable return to work, and the aspects that need to be considered.
Coming up in this article I’ll cover:
- Why doctors are off work
- How long is long enough
- How to know you’re ready
- Utilising Occupational Health
- Phased return & Workplace adjustments
- Maintaining your return to work
- How therapy can help
- Working with me & next steps
Topics explored in more depth
Some issues deserve more detail and their own space.
Therefore I’ve written 5 additional articles on some more specific topics relating to Therapy for Doctors.
Links for these are at the end of this article.
- Therapy for Doctors
- Burnout in Doctors
- Therapy for Junior Doctors
- Decision-Making Anxiety and Managing Uncertainty
- PTSD in Doctors
1. Why doctors are off work
When we think of mental health difficulties, we often imagine the stereotype versions – withdrawn from life, struggling day to day, visibly unwell, something noticeable.
Yet for doctors, this doesn’t fit. Because for many the battle will be over-functioning, not under-functioning. On the outside you look the same, a little more tired maybe, but that’s it. Others might be completely unaware, and you’ve mostly managed to keep juggling everything without stopping. Because the reality is, this isn’t a new thing, it’s being gradually building for some time.
Emotionally, physically, and in your thoughts – you’re not coping.
Doctors are not all one type of person. But as most are high achievers, and have chosen a care industry, there is a lot of common ground for mental health issues that will come up in therapy for doctors.
Here’s a bit of a summary of the most common mental health reasons that doctors take time off work.
Burnout
Burnout is one of the most common reasons for sickness absence for doctors. It doesn’t arrive suddenly. It builds through months or years of working beyond your capacity, ignoring your own warning signs, and carrying more than is sustainable. At first, you might just feel tired and a bit fed up. Then the tiredness becomes constant. Your motivation dips. You start to feel disconnected from work, from people, and from yourself.
Many doctors stay in work long after burnout has set in, functioning on autopilot and collapsing at home. Eventually, something gives and your body simply refuses to keep going.
Therapy for burnout needs to work on understanding what your root cause is, what patterns lead to getting to this point, and how to resolve them for now and prevent them for the future.
Read more about Burnout here: http://hannahpaskintherapy.co.uk/burnout-in-doctors
Anxiety
Anxiety is something that many doctors report, particularly high-functioning anxiety. This includes difficulties such as constant overthinking, setting yourself impossible standards, worrying about worst-case scenarios, feeling like an imposter, getting stuck in procrastination, struggling with boundaries and more.
Perhaps you are worried about making mistakes, questioning your own clinical decisions or needing reassurance from others. Worries of course aren’t just about work. You could be worrying about being late, upsetting people, forgetting something, getting sick, having a car accident and many others. Your anxiety can impact your sleep, appetite, concentration, ability to switch off and can sometimes lead to panic symptoms. Regardless of what you’re anxious about, therapy can work on learning new coping strategies to break the cycle.
PTSD
When work involves dealing with life and death, there’s always the possibility that within your career you will witness a patient event which will stay with you, that will leave you particularly distressed afterwards. PTSD is when our memory gets stuck, and it doesn’t process what’s happened correctly. You get stuck thinking it’s your fault, and feeling always on alert.
Read more about PTSD here – http://hannahpaskintherapy.co.uk/doctors-with-ptsd
I’d like to find out more
Chat to Hannah – http://hannahpaskintherapy.co.uk/book-now/
2. How long is long enough
Most doctors want to take as little time off as possible. One or two weeks feels manageable. Longer starts to feel uncomfortable. Guilt about colleagues, patients, and waiting lists kicks in.
But the reality is that for most, one or two weeks won’t be sufficient.  If time off is only used as a short reset before returning to exactly the same patterns, the chances of ending up back in the same place are high.
For many doctors, sustainable recovery takes longer than they expect. Often we’re talking about several weeks to several months, depending on what you’re working through in therapy and what needs to change.
Taking time off allows you to focus on your therapy, and put changes in place so that when you go back to work, there’s been a shift.
3. How to know you’re ready to return to work
The aim of therapy when you’re off work is to ensure that you return having made changes, and that your return is sustainable. What needs to change will be different for everyone, depending on your reasons for taking time off and seeking therapy in the first place. Before you return to work, everything else in life should be back in place first – your social life, hobbies, daily structure and routines etc. Work should be the last piece of the puzzle.
There’s no perfect moment where you suddenly feel 100% ready to return. But there are some signs that suggest you’re moving towards readiness rather than just emerging from crisis.
Before returning, it’s usually helpful to see some improvement in:
- Sleep – you’re getting more consistent, restorative sleep
- Switching off – you’re able to switch off from unhelpful thoughts and be present
- Mood and interest – you’re starting to enjoy things again, even in small ways
- Anxiety levels – you feel less on edge, more able to relax
- Confidence – you feel more able to trust yourself and believe in yourself
- Capacity – your emotional and physical capacity is restored, and your empathy has returned
Therapy can help with all of these areas, so that when you go back to work, you feel in a much better place.
4. Utilising Occupational Health
Occupational Health (OH) can be a useful part of return-to-work planning.
Start the process early
In many trusts, OH appointments take time to come through. If you’re considering time off work, or are already off work, it’s best to get the referral started ASAP to make sure you have appointments in place to support your return to work plan.
Go in with some ideas
OH often asks doctors what they think would help them return safely. They may not prompt you with suggestions, instead expecting you to come up with ideas. Therefore it can help to spend some time considering this before your return to work meetings. If you’re engaging in therapy, your therapist should be able to provide some advice on this.
Get things in writing
Written recommendations from OH can make conversations with managers or rota coordinators easier. They provide a structure to work within, rather than relying on you having to repeatedly ask for what you need.
5. Phased return & workplace adjustments
A phased return allows you to gradually add work back into the mix, whilst having opportunity to apply your new learning from therapy, and still to continue to engage in your therapy sessions.
A phased return includes
* A gradual increase of days/hours
* A gradual increase of duties (this should continue beyond the date of getting back to your full hours)
* An ongoing support plan – e.g. check-ins, time off for therapy, OH reviews, etc
The longer you’ve been off for, the longer the duration of this plan needs to be.
6. Maintaining your return to work
In order to help maintain your return to work, and avoid future relapse, it can help to put some guidelines in place for yourself. Some low level bits to stick to, no matter what.
Here are some examples:
- No matter what, I take a lunch break
- No matter what, I don’t check emails on days off
- No matter what, I don’t take overtime shifts for the next six months
- No matter what, I protect at least one evening a week for proper rest
It’s also important to watch out for early signs that you’re struggling to cope, or that how you’re feeling is impacting you again. Being aware of these early signs, and having a plan of how to get on track is an important part of the final part of therapy.
7. How therapy can help
CBT is particularly helpful around return to work because it focuses on patterns, not just symptoms.
Therapy can help you:
- Understand what led to difficulties
- Change the habits that keep you stuck
- Overcome anxiety, burnout & more
- Build your confidence
- Set boundaries without being consumed by guilt
& lots more
It’s not about pretending the job isn’t stressful. It’s about equipping you to do the job without it costing you your health.
Read more about therapy for doctors: http://hannahpaskintherapy.co.uk/therapy-for-doctors
8. Working with me
I have been providing therapy to doctors for several years. I understand the realities of working within NHS services. I have helped many doctors to successfully return to work.
I’m a CBT therapist by training, and am straight-talking by approach. I focus on improving self-insight, getting to the root of the problem, and equipping you with skills to find a new way forwards.
I offer private therapy for self-funding clients.
I also provide limited availability for funded therapy under the Practitioner Health scheme (via OneBright). Message me to find out more.
Next steps
1. Book a free discovery call (this is optional)
2. Book your therapy assessment appointment
http://hannahpaskintherapy.co.uk/book-now/
Links for 5 more articles in the series
- Therapy for Doctors – http://hannahpaskintherapy.co.uk/therapy-for-doctors
- Burnout in Doctors – http://hannahpaskintherapy.co.uk/burnout-in-doctors
- Therapy for Junior Doctors – http://hannahpaskintherapy.co.uk/therapy-for-junior-doctors
- Decision-making anxiety & managing uncertainty – http://hannahpaskintherapy.co.uk/doctors-with-anxiety
- PTSD in doctors – http://hannahpaskintherapy.co.uk/doctors-with-ptsd
