Intended for healthcare professionals

Career Focus

Planning your life and career

BMJ 1999; 319 doi: (Published 10 July 1999) Cite this as: BMJ 1999;319:S2-7202

Getting the balance between work and the rest of your life is difficult for doctors. Nick Steel has some planning exercises that can help

  1. Nick Steel, specialist registrar in public health medicine
  1. Norfolk Health Authority, Norwich NR7 0HT

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    Few of us spend any time planning how we wish to lead our lives. Our next car or holiday maybe, but not life. It can seem too full of accidental results to waste time preparing for them. However, as 200 obstetric registrars who have recently caught the whangdepootenawah know very well, it is the uncertainties of life that we need to plan for (Ambrose Bierce defines whangdepootenawah as “an unexpected affliction that strikes hard”1). Knowing your priorities is an essential part of this preparation, or, as Louis Pasteur would say, “le hasard ne favorise que les esprits prÑparÑs” (chance favours only the prepared mind).2

    The balance of work and other activities for most doctors has changed in recent years. Doctors have traditionally viewed long hours and overwork as an essential badge of dedication and achievement. Taking the full whack of annual leave or getting home before the children are asleep can still be considered ungentlemanly. Such singleminded dedication seldom makes for happy doctors, and recognition is mounting that job satisfaction is a better predictor of work quality than long hours on site. Work and personal life can be mutually beneficial.3

    Taking control

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    It is important to take a systematic approach to increasing control over your career destiny so that opportunities can be seized and developed. I offer an example of such an approach to develop the necessary insight and strategy. After working through the exercise, you will have greater insight into your ambitions and potential, and a written plan for personal or professional change. You may be surprised - the first time I did a similar exercise I ended up with a career in public health (see figure).

    This approach to career planning was designed for use with groups of doctors, but most of the exercises can be used individually. Many people find structured discussion to be the most useful part of the exercise, and if time is available (perhaps one or more whole days rather than half a day) extra discussion is likely to be more helpful than lots of written exercises. Discussion groups can be formal arrangements with role models or even career guidance experts or informal conversations between friends or colleagues. A combination of both is ideal. Other tools that can be used include psychometric tests and computer software to help identify key career choices.4

    What are your important life events?

    Firstly, write down up to six important life events in the past or planned for the future, either related to work and not. Then ask yourself what this tells you about how you see the balance of work with other events in your past and your future? Secondly, think about some day in the distant future. The day is perfect in that it includes all those things that you would like to be a part of. Describe this day in some detail (Robert Byron thought he could settle at Maimena for good if he had some more detective stories instead of Thucydides and some claret instead of tepid whisky5). Thirdly, write your own obituary as you would like it to appear in theBMJ.

    Draw a line to represent your life from your birth to where you are today.6 Be creative in illustrating your life line, putting in the peaks, troughs, and plateaux (see figure). After you have completed this diagram, think about what the vertical axis represents for you (such as happiness, fulfilment, opportunity).

    Happiness defined

    This process of reflection should help you understand the events that really influence you and, hence, the aspects of your life that are important to you. For George Sand, the essential ingredients of happiness were simple tastes, a certain degree of courage, self denial to a point, love of work, and, above all, a clear conscience.7 What are they for you?


    Charles Handy coined the term “motivation calculus” to describe how we decide how much “E” to expend on any particular activity.8 By “E” he meant effort, energy, excitement, enthusiasm, emotion, and expenditure of time, money, and passion. He believed that motivation depends both on the strength of our need for a given result and on our belief that expending energy will lead to that result. He suggested that psychological maturity in an individual shows up as a more conscious awareness of needs and motivation, and in a lengthening time span for the pay-off of expenditure.

    Balancing time better

    Next, prepare a list of non-overlapping activities in your life. Some will be at work, others not. You should be able to think of at least 10. Attach a percentage to each activity, representing roughly the proportion of your life that you have spent on that activity over the past year (see box). Mark this list to show whether you would like to spend more, less, or the same amount of time on each activity in future, and consider what the blocks and opportunities there might be to achieving each of these changes. Spending more time on some activities means spending less on others. You may wish to stop some activities altogether or start a new one. Even the most successful people should be able to imagine some improvements to life.

    Example of a list of life activities

    View this table:

    Put it in writing

    By now you will have a better insight into your current priorities and, more importantly, the changes you wish to make to this balance. Turn this quantitative analysis of your time (and the desired changes) into a short written plan for achieving at least two key changes to improve your life. In order to achieve these changes, there will be both enabling and disabling influences, both from yourself and from others. People are one of your major resources for achieving your goals so include them in your plan. You may find it helpful to establish a written contract with another person to help you achieve a given strategic goal.


    Write down the single most important thing you have learnt about your career or life, and the single most important action that you will take as a result that you would not have taken before the exercise. Set review dates to monitor progress with your action plan, ideally with the person you established a contract with. Monitoring progress is important and is not likely to take more than 30 minutes every six months or so. At each review date, four questions need to be answered: What did you set out to achieve? Have you achieved it? What are you going to do next? How will you know if you have done it?


    Doctors traditionally lead reactive lives and rarely have the opportunity to plan their future, other than deciding which specialty and which job to choose. As the degree of control over our lives increases, we must find the tools to best manage these opportunities. This means having a structured approach to gain insight from our past and to apply this knowledge to our future.


    I thank David Pencheon for his help with writing this article.


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