After experiencing burnout as a junior doctor, Dr Sebnem Selek is passionate about helping other doctors overcome it and changing the working conditions that are becoming medicine's status quo for junior doctors.
We caught up with her to find out about her experience with burnout, how she got through it, and get some advice for other doctors.
1. Tell me a bit about yourself, and why you wanted to become a doctor?
If I'm being honest, despite being in medical school for 3 years, I was still unsure if I wanted to be a doctor until my 4th year in university when our clinical rotations started.
I studied in one of the two top-ranking medical schools in Turkey, and despite all the hype, I found the first 3 years in medical school very isolating and exhausting as compared to some other majors. It felt like everyone I knew was either at the library or were feeling guilty that they weren't.
On my 4th year, however, on the very first day, I remember feeling this sense of belonging when I attended a surgical WR and went to theatres to observe, which then turned into assisting in skin closure when the consultant noticed my enthusiasm.
From then on, I just knew that I was in the right place.
It's a magical profession where with small touches and smiles you can change someone's day when they are going through very unfortunate things that a mind sometimes can't comprehend.
I just love working with humans, and it motivates me to be a better person every day.
2. Have you ever experienced burnout, if yes, can you tell me a bit about it and how you got through it?
I sadly have.
It happened in my first year in the NHS. I believe the snowball effect is the best way to describe this. I had very poor support at the beginning of my job, and coming from a different country with no UK bank account and permanent address, which most IMGs would agree is a terrible vicious cycle, was already stressful. On top of this, I started my job with no medical induction and got thrown into a very busy ward.
I remember staying late regularly and not having lunch breaks to learn the system quicker, which I did after a month or two.
Soon, I realised that the system was so dysfunctional that almost every junior, regardless of their background and familiarity to the system, was indeed asked to do way more than they are supposed to due to the immense workload and staff shortage.
I remember the environment in the department being very toxic, and junior doctors crying or lashing out in anger.
When they did exceptional reports for their long shifts, they would be told by their supervisors that they weren't good trainees if they can't commit to the job fully.
But the problem was that we had committed fully, and were all suffering from a lack of self-care, boundaries, and time for our personal lives.
I have so many stories but to give an example, one day my registrar called me on my mobile a few hours after my shift had ended. It must have been around 8 pm or 9 pm. I was at the gym, and, ignoring this, they asked me about a patient's blood test results which weren't reported before I handed them over, which is what I told them. Both the registrar and I lived close to the hospital, but my gym was away from the area, and they still asked me if I could 'quickly' go to the hospital to check the results. I remember feeling almost desperate and calmly telling them the obvious thing to do in this situation which is to contact the on-call team.
Events like this were happening very frequently where I was finding myself feeling guilty about the things that I was not even responsible for, and eventually on the second or third day of my on-calls 8 months into the job, I just remember feeling numb and sad.
I was getting teary during bathroom breaks and my body was just numb. It felt like I couldn't even feel the seat I was sitting on. I almost lost my will to live because I couldn't see where my job ended and where my life began.
That burnout was a wake-up call for me. I had time off from work and saw a therapist and occupational health specialist. They helped me reflect on what led me to burnout and made it clear that it wasn't my fault. I also had a new supervisor, who was brilliant in showing me how well I've done since starting the job, despite being undermined at work.
It also helped me see that not every team and every NHS hospital is the same and that we shouldn't be hopeless, or afraid of setting boundaries and raising our voices.
I know that it also helped to hear that the team I worked with back then had reflected on their behaviours, and I heard things have been improved since I left.
3. I see that you are a passionate advocate for mental health and wellbeing, was there a specific incident that motivated you to get involved in this field?
It started with my burnout. People started reaching out after they heard about me. They were being very honest and vulnerable about their struggles at work and were either sending support and advice or asking for my advice in handling their workplace problems.
Even people that I briefly met but didn't work closely with were visiting and messaging me.
The support was overwhelming, but it also made me realise that it should be provided before things go out of control.
The system is so pathological that it's almost designed to select efficient people and burn them out.
We should acknowledge that working in the NHS is unfortunately exhausting and stressful and should be vigilant about workplace toxic behaviour.
4. What do you do to look after yourself and your own mental health and wellbeing?
It's a work in progress, but I've been focusing on my boundaries and self-care, and it was fascinating to me how accepting most people are when I implemented them.
1. First of all, I try to work within my limits and contractual hours. There's this habit of what I call 'toxic encouragement' in the NHS, where juniors are asked to take on more prematurely by their seniors to offload senior workload or to cover an underperforming colleague. I don't believe the solution to these issues is to hand the responsibility over to another junior.
2. I try not to carry work home. It's almost impossible to achieve a pure, medicine-free life, but I try to limit the work I do at home to my projects, learning and portfolio.
3. I am very selective with what feedback I take in. I don't have a problem receiving negative feedback, but only if it is constructive. If I'm being criticised for having boundaries and knowing what I can and cannot do, I don't let it stick. In situations like this, I find it helpful to reflect on the incident with a trusted senior colleague to ensure that I've done the right thing.
4. I also realised that changing the system was not that difficult, and it starts with individuals taking action, which led to me being junior's representative for the 3rd year this year. I received good feedback on this, and it's very encouraging to make changes happen rather than waiting for someone else to do it for us.
5. Outdoors (running/walking) is my go-to after a bad shift to get my head back in a good place, and needless to say the support from my family and partner has been incredible.
Before I finish, I recommend everyone to read 'Also Human' by Caroline Elton to have a better understanding of the challenges that we face on a daily basis. It helped me understand my emotional reactions and motives at work much better.
Dr Sebnem encourages other doctors who are experiencing burnout to reach out if they need someone to talk too.