Intended for healthcare professionals

Career Focus

The ABC of change: S, T, U

BMJ 2004; 329 doi: (Published 16 October 2004) Cite this as: BMJ 2004;329:s164
  1. Susan E Kersley, retired doctor, life coach
  1. susan{at}


Susan Kersley covers S, T, and U in our series and explains how trying to understand someone is better than undermining them


Like many doctors you probably want to be successful. But have you ever stopped and asked yourself what success means, to you personally? Is your definition of success imposed on you by others?

Have you ever asked yourself:

  • What you want to achieve in your life?

  • What is really important to you?

  • Whether what you do is congruent with your values?

  • What has to happen to align your values with what you are actually doing with your life?

The answer may be very simple. It could be as simple as saying “no” to something, so that you can leave work at a reasonable time, to have time with your friends or family, or to do some exercise or read a book.

You may believe that nothing can alter unless something is changed by those who control “the system.” You may consider that you, as an individual, are powerless to have any influence. If that is what you think, then that will be your experience.

However, big changes can happen by something started by you. If one thing alters other things have to adjust too. Life is like a spreadsheet: when you change one thing, everything else changes too.

What small thing could you do? What small step could you take towards living the life you want?

  • Don't wait for someone else to start—be proactive yourself

  • Don't make assumptions about the effect you will have on others—talk to them about what you intend to do.

In order to be efficient and capable of initiating change you must look after yourself as well as you possibly can. Self care is vitally important. When you look after your own needs as much as you look after those of others you become much better able to do your work.

What does self care entail1? It means:

  • Valuing and fulfilling yourself and your own needs

  • Recognising that you are important too, instead of only caring for others and fulfilling your role in relation to them

  • It is vital for your personal health and wellbeing that you allot time and energy to your own needs.

If you find that you are overwhelmed with fulfilling tasks that others expect of you, so that you have little energy left for your own needs, then look at how well you deal with yourself.

To look after yourself more, start with noting in your diary what you plan to do for yourself. Recognise that this is as necessary as a meeting or a clinic. Make time for it all by managing your day more effectively.

T is for TIME, TECHNOLOGY, and TRUST (the process)

You have 24 hours each day. What varies from person to person is how you decide to spend your time. Putting into practice whatever you've learnt from courses or books about time management will be useful, so that you are better able to plan your day and make good use of your time. Using technology may help, for example using your computer diary with reminders of appointments. Perhaps you could note your personal time in your diary too. Appointments with yourself are as important as any other commitment. If you decide to do something (for example, go swimming) at the same time and day each week it's easy to insert in your electronic diary.

Above all it's helpful to develop a sense of trust. A sense that you are willing to trust the process. That whatever happens is best for you at this time in your life. That there is always a lesson to be learnt when things seem to be going wrong, as much as when things are going the way you want them to go. Ask yourself:

  • What went well?

  • What could I do differently next time?

  • What have I learnt?


When you feel impatient about someone else's lack of understanding or if they have their own agenda, take a moment to consider their point of view. Try to really understand where they are coming from. “Seek first to understand then be understood.”2 Imagine what it would be like to be in their shoes, with their values. A common cause of misunderstanding or conflict is because the other person and you have a completely dissimilar motivation. Their desired outcome is likely to be very different from yours. As you begin to think about what it might be like to be that person talking to you (and how you appear to them) this may help you understand and realise why they are so resistant to you.

Ask questions about their aims; find out more about their ideas; show interest and understanding. Congratulate them on the bits that you appreciate. Then, when you have recognised better what drives them, you can tell them about your ideas. At that stage you may find they are more receptive to further discussion.

Don't be too quick to undermine another person's ideas without understanding the background to them. Even if you have to reject the new idea it helps both of you when this is done with respect, with an attempt to understand and even a word or two of encouragement. You could say, “That's an excellent idea and it's been useful to hear more about it,” or “I will certainly keep it in mind for the future. However at this time with the budget we have it won't be possible to implement it yet.” How much better might you feel if this was said to you rather than, “What a load of rubbish.”

Even if you think that your behaviour may be perceived as something unusual it could be better than continuing as you've always done (because then you will get what you've always got).