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Returning to training after time taken off due to illness

Though sometimes it seems like both your patients and supervisors forget, doctors also get sick. Indeed, where else are you likelier to get sick than a hospital? If kids are petri-dishes, patients are probably more like fume-closets. It’s essential to give yourself the same compassion and space to recover as you would anyone under your charge, if not for your own wellbeing then to minimise risk of contagion for your own patients

It is your responsibility to take accountability for your own health and judge for yourself if illness has started to affect your ability to carry out your job. Although reluctant to take time off (research from Health and Social Care Information Centre shows that doctors take 1/3 less sick days than those in other professions), responding to illness early can prevent it from deteriorating into something far worse. Though never convenient, taking time away from training when you fall ill is both the responsible thing to do and the most likely to produce a speedy recovery.

Regardless of cause, coming into work after time away is never easy. However, it’s important to remember that your sickness will not affect your potential to be a great doctor, if anything it stands to strengthen your empathy for your own patients! That being said, returning to training after recovering from sickness will have some unique challenges you should be aware of:

The challenges that doctors identified on returning to training after sick leave are:

 

  1. Fear of relapse of condition
  2. Lower energy levels than colleagues, at least initially – may need to phase return
  3. Fear of encountering and treating the same illness
  4. New anxieties around the hospital environment and sickness in general
  5. Fear of judgment from colleagues – of appearing ‘weak’, for example
  6. New questions around whether you wish to continue training at all

 

Though this transition from being treated to being the one giving treatment is likely to take quite some adjusting to, resources exist to help you both during your time out of training during your return.

The Royal Medical Benevolent Fund

This organisation provides a variety of opportunities to obtain and provide support for doctors in training or currently practicing. This website specialises in both emotion-focused and problem-focused support, providing opportunities to receive psychological care, financial support and advice on a range of topics. This site is by far the most pragmatic available with resources on everything from how to handle a difficult landlord to considering whether an alternative career might be right for you. This site is helpful in good times and in bad, as useful in preventing emergencies as responding to them. Content here is produced by medical professionals from all specialisms and levels of seniority – you’re certain to find something relevant to you and your illness – click here.

Tea and Empathy

Social media has been taking on an increasingly pastoral role of late, with many preferring to self-disclose on these platforms than face-to-face. This is particularly true of experiences of physical and mental conditions that still remain surprisingly stigmatised amongst medical professionals. The Facebook group ‘Tea and Empathy’ is a national, peer-to-peer support network specifically designed for NHS practitioners, though is also accessible to any other medical practitioner. This site allows for anonymous posting via administrators and includes closed regional groups. Peer-to-peer support can be offered through private messenger and is completely confidential. This site has branched out internationally, especially valuable if you are currently on or are planning an Out Of Practice Experience. See Tea and Empathy for more information.

The British Association for Counselling and Psychotherapy

If you believe more regular, face-to-face support might be best for you in managing your condition, this site is best able to signpost you to counselling and psychotherapy professionals within your area. There really is no substitute for intensive, professional, one-to-one support. Taking time out of your training means you can dedicate yourself fully to your own recovery without fear of conflicting work demands. Click through to see if any services listed work for you.

The Doctors’ Support Network (DSN)

The DSN was set up in 1996 to provide physicians and medical students alike with peer-based support for any concerns with their own, or another’s, mental and physical wellbeing. This service is entirely confidential and provides an opportunity to find support within your own community. Only a doctor can appreciate the immense expectation that comes from training or practicing within the medical field. The benefit of sharing your experience and struggle with a like-mind is two-fold: it can provide a long-term source of support but also keep you feeling integrated, and up to speed, with your profession whilst away from training. Recovery and resilience need not be done alone; research shows peer support to be invaluable for both, with self-disclosure being a key part of lasting improvement. The DSN site provides resources, blog material and signposting to relevant events and meetings.

Headspace

Meditation isn’t something that may have crossed your mind, however the research supporting the efficacy of as little as 10 minutes of mindful breathing a day for pain management is staggering. This app (mostly free of charge though subscription options are available) provides detailed guides on how to make mindfulness work for you. Headspace has been demystifying mindfulness for millions of subscribers and for a price of just 10 minutes a day, you have so much to gain in terms of mental resilience and management over your condition the symptoms associated. If right for you, Headspace stands as an opportunity for you to explore your relationship with your condition both during and after your leave.

Beyond these resources, you may wish to consider the following options to tailor your returning to training to your needs:

Organising ‘top-up’ training and CPD-approved learning during time away and return

Though formal ‘Keep In Touch’ (KIT) days are primarily only available to those on paternity leave, opportunities do exist to ensure you feel prepared to return to the workplace after time spent away due to sickness. Online resources are incredibly valuable in this; see below some relevant examples taken from the British Medical Journal Learning Portal.

Contact your Deanery to enquire if any in-person learning is available (such as ‘bootcamps’ or accelerated learning schemes’) or if a KIT day could be arranged during your time away. Additionally, consider enrolling on London School of Medicine’s ‘Springboard’ Course. This is one-day course offered twice each year for those looking for both practical and pastoral support prior to returning to training. Details on this can be found here.

Arrange a supernumerary period or phased return

This refers to a period of intensive and supervised practice whilst coming back into training, including a variety of focused learning activities under direct observation. Contact your educational supervisor to see if any such opportunities exist, perhaps alongside other returners. Such support will be most beneficial on your first on-call rotas. It is important to be honest about your needs in this, particularly the level of intensity you need in this support. Asking for help saves your confidence and, in turn, helps you keep saving lives. It may also be worth considering Less Than Full Time Training – at least initially – upon returning after sickness-related leave.

Ensure first patient lists are as straightforward as possible, minimising risk of coming into contact with conditions associated with the bereavement.

The life if a junior doctor is notoriously changeable, with every patient seemingly more unpredictable than the next. However, if you feel comfortable doing so, make sure your educational supervisor is aware of the nature of your sickness-related leave and see whether your patient lists can be tailored to your needs at this time. At least in the beginning it may be useful to respond to routine cases to build your confidence back within the clinical setting. Make sure you treat yourself with compassion at this time – work up to more challenging cases rather than over-stretching yourself at the beginning.

Arrange for a designated mentor/coach

In 2016, The Advisory, Conciliation and Arbitration Service (ACAS) agreement within the Junior Doctors Contract committed the Secretary of State to fund mentorship for junior doctors when returning to training. Though this service is not yet universally accessible, it is worth contacting your Deanery as to whether a Senior Consultant with experience of sickness-related leave during training could be made available for advice and ongoing support. This may also be available in a group setting.

Arrange for counselling

If you find balancing your own recovery with the demands of the ward psychologically wearing, you may wish to consider counselling. It is possible your Deanery may fund counselling services for Junior Doctors directly. Remember, any concerns about confidentiality are unfounded – you will be treated like any other patient. Furthermore, the ability to have counselling nearby your own Trust shouldn’t be underrated – this will be an asset for ongoing support. Enquire with your educational supervisor if your Deanery funds such support.

Case study: Clare – Multiple Sclerosis diagnosis

‘I was off sick as I was diagnosed with MS, this experience has really made me re-think my priorities for my career and I think I am now much less willing to sacrifice my work-life balance. [I anticipate a] loss of confidence in clinical decision making [and am] worried about the impact of working on my health.

I’ve attended a deanery run event on supported return to training, which was a pilot day (after having gone back to work for approx. 7 weeks). This helped make me aware of the guidance in place but I was not aware of this previously.

[Having MS has] made me re-think if a career in paediatrics is for me, despite the senior team being very supportive of my return to work’

 

Though it’s never fun when the doctor becomes the patient, treat yourself with the same compassion. Sickness is part of the human condition and should be treated with respect and patience. So don’t be hypocritical with your Hippocratic oath – take the time you need and seek support from the resources that are available to you.

If you believe that life as a Junior Doctor doesn't need to be so full of frustration and admin and that as a profession we can achieve more when we come together then join more than 10,000 other Junior Doctors on Messly.
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