“When men are easy in themselves, they let others remain so.”

- Lord Shaftesbury

(quote taken from pg 211, Housekeeping, The Inner Consultation 2nd Ed - Roger Neighbour)

This summer, I attended a reunion that celebrated 20 years since I graduated from medical school. I reconnected with old friends and peers, many of whom are now also GPs.

Lately, as I think about the struggling workforce in my beloved profession and my own plan for a career break after some 20 years (maybe I’ll share more on that later this year!) I find myself wondering how to stay present and true to this emotionally challenging work, maybe for another 20 years to come.

Perhaps it's these ponderings, September back-to-school energy, or the anticipation of the annual winter pressures, but I found myself reaching for Roger Neighbour’s seminal guide for trainees, The Inner Consultation, first published in 1987. Even though this book is considered something of a Bible on Consultation Skills, I confess (shhh 🤫, my trainer would be horrified) that I never really read it until now.

Housekeeping

The book is helping me return to the fundamentals—the core skills needed to work well and be effective. One chapter - Housekeeping - particularly caught my attention with its timely relevance.

Neighbour’s consultation model involves a journey of checkpoints: Connecting, Summarising, Handover, and Safety-netting. Housekeeping is the final checkpoint of the framework, marking the end of one consultation before another begins.

This last checkpoint recognises this a step as important as any other in the consultation cycle—the doctor must look after themselves and their physical and emotional needs to remain effective, which is to say dispassionate, neutral and focused.

House of Yoga

Neighbour encourages this housekeeping process by suggesting a form of considered mindfulness: stopping and becoming aware.

He invites us to discover ourselves well, learn our micro-cues of stress and tension, raise in consciousness any rising frustration or fluster, feelings of flattery, ego, and satisfaction, and clock any regret from the last interaction or dread of the next.

“Am I in good condition for the next patient? What, if anything, do I need to do to prepare myself? What emotion is beginning to arise? Are there any early warning signs of stress..?” - RN

Beyond awareness, he also gives practical advice about how to clear the emotional arisings in preparation for the next interaction.

In a section entitled ‘Here and Now’ he describes a state of present-centredness and offers methods that focus on the sensations of breathing, intentional body awareness, and muscle tone release. He also gives an anchoring technique using visualisation and imagination.

If this isn’t yoga, I don’t know what it is!

Keep House and Carry On

Reading about housekeeping suddenly makes me realise that the more I need it, the more I tend to neglect it. It’s often the only step of the consultation that gets omitted consistently.

And more often than not, I haven’t been doing it in the mindful, measured way Neighbour recommends - the yogic way, no less!

In real life, my daily housekeeping looks a bit like this: a pause, a deep breath, a symbolic and mental reset when I close and open the consulting room door. If I’m lucky, a longer spell of housekeeping might involve a warm cup of tea, getting some fresh air or having an animated rant with a colleague (I had such a three-way rant only last night, after work!)

“minute by minute, patient by patient…like housework…a regular dusting of the emotional state.” - RN

When I neglect more regular dusting, my housekeeping has unfortunately turned rather extreme at times—sobbing in the toilet, screaming into a jumper… screaming at the receptionist… screaming at the next patient.

What I love about Neighbour’s advice is that not only does housekeeping practically help us ‘Keep Calm and Carry on’ when faced with a conveyor belt of challenges, but it also helps us recognise our needs with curiosity, with a vulnerable reframe that we are human, too.

I find comforting affirmation in the acceptance that the doctor is just as needy and dysfunctional as any patient in front of them who needs care and attention. But I can only remind myself of this.

Perhaps a coaster might help. I think I need a new one for my desk that says,

‘Stop, Keep House, and Carry on.’

Your House

Of course, my work allows me to think about housekeeping in a specific context and share it with you. It also gives me ample opportunity to practise it… all the time. Lucky me!

Have you ever stopped to consider the state of your ‘house’ after the small everyday interactions that grace daily life? How much stress do you recognise in your body? When and how often? And what do you then do about it, if anything?

It’s such an interesting exercise to stop and keep one’s house in mind and in order. How about trying it today?

Let’s practise.