Emily Fulleylove Ex-doctor, Joyful Doctor coach, wellbeing facilitator and pilates instructor

Caroline Walker, Founder of The Joyful Doctor, NHS psychiatrist and specialist in doctors’ wellbeing

Published in JHH18.1 – Flourishing in Medical Education

I started my career as a medical doctor and soon found that I was destined for a different path. I experienced the power of coaching through The Joyful Doctor, and now work with them to help physicians and other professionals navigate difficult life decisions and challenges. Having experienced the high-pressure medical system, I became passionate about working with people to develop healthy coping skills and cultivate a full and thriving life.

I became interested in doctors’ wellbeing after struggling with my own mental health as a junior doctor. After specialising in psychiatry and psychotherapy for a while, and a couple of interesting career breaks, I transitioned into working full-time in the emerging field of doctors’ wellbeing. I currently hold an active caseload of doctors for NHS Practitioner Health in the UK and I founded The Joyful Doctor which you can read more about below. www.joyfuldoctor.com

Introduction

The practice of medicine, although a noble profession, comes with many personal sacrifices. In a world increasingly driven by guidelines and checklists, there is little room for creativity and imagination to flourish. As two doctors who specialise in the wellbeing of healthcare professionals, we believe that encouraging our innate human creativity is vital to regaining balance in the working lives of doctors, and we find it a compelling antidote to the rising levels of burnout and mental health problems endemic in the medical profession today.

At The Joyful Doctor, all of our activities are geared towards improving the wellbeing of doctors and other professionals in high-stress roles. Here we describe some of the more creative ways in which we do this and explore the importance of fostering creativity in medicine. We hope that our examples, of working creatively with doctors as individuals and in groups, will bring you inspiration and permission to try similar ideas for yourself and any doctors you support.

The Joyful Doctor – creation

I (CW) founded The Joyful Doctor in 2017 after a long battle with my own mental health problems and stifled creativity in medicine. Through my own experiences with bipolar disorder, addictions, PTSD and an eating disorder, I became interested in why doctors in particular struggle with their mental health, and why we struggle to access support when we need it most. I also became increasingly frustrated by the lack of autonomy and freedom to create that the standard medical career path afforded me.

So, as I approached my final year of training in psychiatry and psychotherapy, I chose to step off the traditional medical career ladder and I founded The Joyful Doctor. Over the past four years we have grown organically into a team of more than 60 heart-centred individuals, known internally as Team Joy, many of whom are also creative doctors, and all of whom are passionate about supporting healthcare professionals to find more joy in their working lives. We provide individual coaching and wellbeing-based group trainings to thousands of health professionals each year. We also directly signpost hundreds of doctors a year to appropriate support services that can help with anything ranging from mental health problems to financial difficulties. And all of our profits are reinvested back into supporting doctors to look after themselves as carefully as they look after others.

Impact

The Joyful Doctor is run entirely organically and creatively, with a team made up of volunteers and some paid members. We function as a not-for-profit with all profits going back into supporting doctors. We have some standard fees, but we also offer pro bono or reduced fee services across the board on request.

We reach tens of thousands of doctors with our message of hope and support each year. Many attend our talks, events, webinars, workshops, away days and trainings, and at any one time, dozens of doctors are receiving free individual coaching and therapeutic support funded solely by our work, including the sale of art created by our talented Joyful Doctor artists. Over the last 12 months, for example, more than 2,500 people have attended our workshops or webinars and worked 1 to 1 with our coaches (a fast-growing facet of The Joyful Doctor). The Joyful Doctor podcast and appearances on other podcasts have attracted several thousand listens, and views of our social media posts have ranged from 5 to 12,000 per post. The most popular video over the past 12 months (with more than 12,000 views) has been ‘Doctors feeling guilty’ during the coronavirus pandemic.

Creativity in medicine

Why is it so important to foster creativity in healthcare professionals?

Medicine is a scientific discipline, underpinned by research and study. However, it is also an intrinsically creative process, often referred to as an ‘art’. It resists every attempt to reduce it down to simple tick-boxes and flowcharts alone. It remains, and always will be, a fundamentally fluid human practice.

Of course, ticking boxes and meeting the strict requirements of professional bodies to ensure the best patient care is beneficial when it comes to safety and consistency of medical treatments. However, this constant focus on achieving results can actually be detrimental to our learning and innovation. The scientific journalist Daniel Kahneman, in his best-selling book Thinking Fast and Slow (2007) describes beautifully how the wandering mind allows us to arrive at new insights and ideas. We believe such skills are essential for a doctor. At The Joyful Doctor we have certainly observed that healthcare professionals who bring an element of creativity to their working lives appear to be more resilient and content in their work.

How we foster creativity in our team and our clients

Team Joy

At The Joyful Doctor we strongly believe that we must live our own messages of wellbeing at work – so creative working starts with us. We have several initiatives to support a creative approach to working life at Team Joy. We have numerous joyful interest groups (JIGs) which meet around various topics including two separate writing JIGs, a creativity and arts JIG, and a thriving book club. We encourage our team members to support one another in their own individual creative endeavours (for example, creating a unique workshop for their own colleagues) or sharing their artistic endeavours via The Joyful Doctor platforms (for example, writing a blog piece for our website or selling their artwork as one of our Joyful Doctor artists). Our whole approach to working with one another is creative, and we co-create our joyful policies (eg our diversity and equality policy), our joyful events and initiatives as we go along. Our annual joyful away day always includes a creative element too, ranging from an improvisation workshop to a karaoke dance-along.

Joyful doctor coaching

The majority of Team Joy are enthusiastic coaches – helping individual doctors to make improvements across their life, career, relationships and health. During Joyful Doctor coaching sessions, many of our coaches intentionally use music, drawing, movement and improvisation to help clients explore ways to become unstuck and to move forwards in their careers. For example, one might ask a client to draw their desired new reality, adding as much colour and vibrancy as possible to bring their vision to life. Or one might ask a client to take part in an improvisation game where they pretend to open up the acceptance email for their dream job. Or one could collect together songs from a client’s life that help them to enter into a more positive, optimistic frame of mind, when considering career change options. The creative options are limitless and simply driven by the individual client’s preferences.

Coaching sessions can also take place outdoors, allowing for the imaginative use of nature in sessions, to help ideas to spark and flow more freely. For example, when working with a client who finds it difficult to tune into their natural intuition to make decisions, one could stand in a field with them and ask them ‘which direction would you like to walk in?’ The natural world is also full of useful metaphor. This is something I (EF) discovered in one of my own coaching sessions before joining Team Joy as a coach myself. During one of my own coaching sessions, my coach and I started reflecting on how I enjoyed moving from project to project in my working life, and how this could be represented by a bee, hopping from flower to flower. Since that moment the metaphor of a bee has been so poignant for me in making decisions about my next career moves – reframing movement as a necessary part of my purpose and working life. It helps me to let go of the ‘right way’ and embrace ‘my way’ of making career decisions.

Coaching sessions can also take place outdoors, allowing for the imaginative use of nature in sessions

Creativity-based coaching exercises also work really well with groups of healthcare professionals. At The Joyful Doctor we often use appreciative enquiry, for example, as a way of co-creating a plan with a team. Ideas are generated within small groups of attendees and then drawn together as a larger group to create a vision of what helps, often drawn on a whiteboard or equivalent for visual effect. Other examples of creative group work are illustrated below in the work of our events and training departments.

Joyful doctor events

The idea of creativity really drew me to today’s session. Something we know is good for us, but how do we allow ourselves to start something like that?’ ‘Your speakers showed us that it is just a case of diving in, one toe at a time, however messy, fast or slow it can seem at first. Then just keep going.’ Anon, Doctor

Our regular Joyful Doctor events always have a creative twist. For example, at our pre-pandemic Joyful Doctor LIVE! event in London we gave each attendee a handmade ‘Bag of Joy’ filled with little creative surprises such as a ‘Pill of Joy’ – a pill capsule containing a handwritten affirmation that the attendee could open and read when they felt most in need of inspiration. The day went on to include a creative wheel-of-life exercise to help attendees prioritise their wellbeing goals, and an inspirational reading and discussion led by author and ex-doctor Adam Kay.

At our most recent Joyful Doctor LIVE! event in December 2020 the whole event was themed around art for wellbeing. We had a series of ‘real-life’ doctors, each with different creative outlets, speaking and sharing their creative work with the attendees online – from song[1]writing, to spoken word and poetry, to making our own gratitude jars and drawing our own rivers of life. In March 2021 we took this creative approach further and applied it to career change for our next doctors’ online development day, ‘Create a Career You Love’. Once again we used art, music and poetry to inspire those looking to make a change in their medical career. In this way, creativity can be used to both improve an existing working situation for a doctor, or to help them make the necessary changes to move onto the next phase of their career journey.

So much of the creative side of life has been buried for so long, so it feels like an excavation is in process now, rekindling much of where I have come from. I am determinedly going to dust off a few pencils, art brushes, sculpture tools and already feel better!’

Barney, Doctor

Joyful doctor training

The event was a real success, it was great fun, thought provoking and brought everyone together. Everyone was buzzing at the end of the day.’ Organiser for arts-based departmental away day

• Through Joyful Doctor training we deliver a wide range of talks, webinars, workshops, away days and more. We try to bring creativity into our work as often as we can.
• When delivering a half-day department away day, for example, small groups rotated around four different art[1]based activity workshops as follows:
• An open group discussion of a piece of art, with and without background information, illustrating the power of preconceptions, assumptions and personal interpretations within a group.
• A facilitated group discussion, where each person chooses from four different pieces of art, which most represents how they feel about their workplace, thus allowing for more indirect discussion of workplace challenges and successes.
• A communication and drawing exercise in pairs, in which one person has to describe a picture to their partner to draw, answering only ‘Yes’ or ‘No’, then later answering more open questions.
• Small group discussions of the hierarchies represented by different individuals in a particular painting representing different social groups, opening up reflection on the inherent hierarchies existing in most workplaces.

Really enjoyable and allowed people to open up and share ideas, in a fun, non-judgemental, abstract way. Thank you!

Workshop participant

All of our joyful presentations, in-person or online, deliberately involve very few written words. We rely primarily on imagery, sound and interaction to enhance reflection and learning. At The Joyful Doctor we are aligned with the old adage ‘a picture holds a thousand words’ and Maya Angelou’s words ‘people will forget what you did, people will forget what you said, but people will never forget how you made them feel’.

We also offer a number of wellbeing-based online courses for doctors, that can be completed in the comfort of your own home, using creative coaching exercises to draw out your individual reflections and goals.

Joyful Doctor art

Perhaps the most obviously creative branch of the work we do at The Joyful Doctor is Joyful Doctor art, where we showcase the work of doctor-artists. We encourage doctors to heal through creativity, and to sell their artwork (paintings, music, sculptures, photographs) to help struggling doctors to access support when they need it most. We also enjoy networking with other like-minded creative individuals and organisations within the field of medicine (for example CRxeate www.crxeate.com) to encourage and benefit from one another’s enthusiasm and experience.

I want to reduce stigma around mental health issues in doctors…I express quirky ideas with miniature railway figures – using humour and perspective to change minds.’

 Julia Baxendine-Jones, head of Joyful Doctor Art

Why creativity?

Why is creativity so important to our wellbeing as healthcare professionals?

There is often an expectation from patients, the general public and also from doctors themselves to be superhuman, even robotic, in order to put patients first. Self-stigma is endemic in medicine and may present as working for long periods of time without rest or believing that our own bodies don’t need care and attention, that work must come first above all else.

We may believe we can only show certain appropriate and regulated emotions in the face of unimaginable trauma and death. Using creativity in our work with doctors allows them to loosen the grip on the ‘right way’ to be, and instead embrace a more fluid approach to expectations of how we ‘should’ think, feel and act as doctors.

Creativity also fosters more self-compassion and acceptance. Allowing the mind to wander and explore and letting go of the – often habitual – self-judgement, opens the doors to connection and dreaming and hope.

Creativity can be an antidote to perfectionism, a common trait among high achieving professionals such as doctors. It welcomes trial and error, and a chance to blur the lines between good and bad, right and wrong – something that can be uncomfortable at first, but which does get easier with practise.

It is not only beneficial for doctors themselves to allow room for exploration and discovery, but incredibly important for them to role model this to their patients and colleagues too. When you normalise doing things differently, it gives a powerful message or permission to others to do the same. So, look after your own creative needs as a doctor, and other doctors will do the same.

If you need any more evidence that it is ok to look after your own needs and wellbeing in modern medicine – look no further than the Declaration of Geneva, our ‘modern Hippocratic oath’, which states the following

I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard.

When we manage our stress levels and nourish ourselves with the space to be creative, we can offer up a calmer, more compassionate service to others. Owning, demonstrating and celebrating our shared creative humanity also allows for a much richer connection to those we serve, our colleagues and to our own joyful souls.

Conclusions

In today’s society of instant responses, increased expecta[1]tions and heightened productivity, it may seem frivolous to take time away from the to do list, to simply connect to your natural creative self. But we believe it is essential for our wellbeing as healthcare professionals. Periods of creativity invite an open mind, and reinvigorate our thinking, resulting in new ideas and enhanced productivity. At The Joyful Doctor, we believe that creativity is not just for extra-curricular activities, but can and should be folded into medical education and practice at its very core.

As the coronavirus pandemic continues to take an enormous toll on the wellbeing of healthcare workers across the world, it is more important than ever to lean into our natural state of creativity. We hope the work we are doing at The Joyful Doctor serves to demonstrate that creativity can, with a little imagination, be fostered within healthcare professionals and teams.

If you are struggling to harness your inner creativity as a healthcare professional, or you would like to join us as a Joyful Doctor artist, join an event or simply need a safe place to land for support – please contact us teamjoy@joyfuldoctor.com. We would love to welcome you!

REFERENCE

Kahneman D (2011) Thinking, fast and slow. Farrar, Straus and Giroux.