Intended for healthcare professionals

Career Focus

The ABC of change: M, N, O

BMJ 2004; 329 doi: (Published 03 July 2004) Cite this as: BMJ 2004;329:s7
  1. Susan E Kersley, retired doctor, life coach
  1. susan{at},


Susan Kersley covers M, N, and O in her series that helps you to change your life at your own pace


A powerful way to illustrate a concept is by using something with similar attributes to the subject being considered. For example, the metaphor of the seasons of the year to relate to how you feel about certain aspects of your life can help you realise that a process for change happens internally.1 If you are considering leaving something you may be like autumn becoming winter. You may experience a point in time when outwardly things are dormant. Others may comment about your lack of energy or drive. However, inwardly things are happening. When your spring arrives you will go through new hope, a period for growth and anticipation. Quite suddenly, so it seems, you are be filled with ideas and energy. You are ready to take the first steps for change. Finally, in the cycle, comes summer, when your life is in full bloom again.

During such time of change it's important to find a mentor. It's useful to have someone there for you during the time of transition and reassure you that how you feel is part of the process. Having a mentor is considered a good way to relieve the feeling of being overwhelmed that many doctors experience, whether or not you call yourself a “doctor in difficulty.” Perhaps you, yourself, are a mentor part of one of the many mentoring schemes.2 If so, make sure you work with a mentor too. Everyone benefits: your patients, your mentees, and most of all yourself.

A first rate tool for initiating and planning change is the mind map. It is a superb way to discover what to do in a challenging situation. Devised by Tony Buzan,3 mind maps are an effective technique to use even at a most simple level: with the subject of your challenge or deliberation written in the centre of your paper, draw radiating lines with the topics which arise from them. The mind map is a snapshot of your thoughts and gets you away from the usual listing, which leads to prioritising in a linear way. You will have a representation of your reflection on the subject on one piece of paper. The method gets you to think “outside of the box.”

N is for NEEDS, NO, and NEW

Has your life has been taken over by the demands of your work so much so that and you find it really difficult to set boundaries and say no? If so, maybe many of your important needs are met by your “busy-ness” as a doctor. Perhaps your wish for status and your self esteem is fed by your lifestyle. Needs are compelling and have to be met one way or another. How else could they be met? How about addressing your personal needs too? Discover who you are behind the stethoscope. Revisit hobbies and things that made your heart sing in the past. Doing this is as important as having oxygen to breathe or enough food to eat. If you want to change but find it difficult ask yourself: what needs are being met by staying put. You can decide to get these met in another way. Use a mind map to discover how to do this.

Do you work long and hard as a way to avoid being with your family, friends and community? Or as an excuse not to look after yourself as well as you could?

Do you blame the system, conveniently forgetting that the system eventually changes because of individuals who make a difference.

You decide to try something new: to consider other ways of doing what has to be done. You could question some of the ways things are, if they aren't working well. The challenge for you is differentiating what truly cannot be changed and what can be, then taking the action that has to be taken. There are other ways of doing things. You can make a difference.


Look out for opportunities. When you start to be open to possibilities you will find there are more than you ever imagined. Stop assuming that because you don't know the alternatives right now, that there aren't any. There is more than one way to go about what you want to achieve. Jot down, as a mind map, all your options, however unlikely some may be. Don't dismiss anything. Consider the pros and cons. You may be giving reasons why you can't do something. Sometimes the opportunities aren't obvious when you decide to make the change you want. However once you take the first step you will find that opportunities come your way. Sometimes you have to take a leap into the relatively unknown. Be brave. Take a risk. Unless you try something new how do you know whether it will work or not? You may feel it's rather like jumping off a cliff. However when you make the decision to act you find that many of the obstacles are in your head rather than the reality, and they fade away, so that you find that you can fly (metaphorically). Instead of thinking why you can't do something, start to find ways you can do it. Don't make assumptions about what someone will say or how they might react to you. You are not responsible for their reaction anyway. Take a reality check. The change you want may be easier than you could envisage.


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