Dread and motivation

Dread and motivation have something in common - they look to the future, something I do do and don't do respectively.

Confused? Let me explain.

Every morning I am woken up by my mother. Even at 40 years old, I've still need somebody to wake me up and force me out of bed, like an unruly teenager who doesn't want to go to school. I dread the day ahead. I hate being stuck in traffic for an hour, I hate being consulted by patients, I hate eating my packed lunch nowadays and I hate being consulted by more patients. It's worse when I wake up and my depressed part of me keeps saying don't go to work, take a sick day or resign. Unfortunately that part of me has been increasing steadily. People say it is the anticipation of a dreaded event is worse than the dreaded event itself. Everybody has anxiety before taking examinations but the actual test itself maybe not so bad. For me that is not the case. "Why won't it be 13:00/17:00?" is what I'm constantly feeling. Yes I know everybody have these thoughts. So why am I different? I should buckle down and get on with it but... I don't know, 

On the flip side I don't look to the future regarding motivating myself. I know I should study medical topics but I don't. I know I should clean up my paperwork but I don't. Even the obsessive compulsive things I do, like back up my podcasts, tidy up my Lego parts or watch movies I haven't seen that are on my Netflix "My List", I don't have the motivation for. I keep repeat old episodes of QI / The Bugle. Or try to refine my designs on my Lego MOCs (My Own Creations) on the Lego designer program. 

I wish I had less dread and motivation in life, rather than vice versa.

The lack of drive

I touched upon the subject of my lack of drive in a previous post back in August 2015. I thought the situation would change but the lack of drive continues to persist. Even trying to sum up the will to write this post took several months. Only because I want to write about another subject that I have to write about the lack of drive so that the next post makes any sense.

I looked back at my previous post and found nothing has really changed. My reasons for the lack of drive is the same. I still haven't done what I am supposed to do for my higher training: my consultation videos, my notes for the practice assessment, my clinical audit. Even the fear of being left behind, having fellow doctor friends or doctors who are younger than me being resident specialists, associate consultants or consultants, doesn't motivate me into trying. Here I am, still pondering about emigrating to another country or planning my epic months-long holiday (I've added a cross country trip of Japan into the lexicon, either as a rail journey or a road trip). I've excluded my ambition to join MSF as I know my depression will get in the way. When I'm really unmotivated to do anything, I become very obsessive-compulsive about doing meaningless tasks, i.e. planning my epic North American / European / Japanese trips, despite them being at least 2.5 years away. I watch / listen to TV/radio programmes I have watched / listened to before, instead of engaging into new stuff.

I've tried to find other reasons why I'm not motivated. Is it the fear of the stress that will be entailed if I do my Exit Examination? I've seen other doctors go through the endeavour and the whole process frightens me. I fear of relapsing into a major depressive state, something I never want to happen again. There have been many senior colleagues who have said the Exit Examination isn't hard but they didn't rule out the process will be stressful. I have learned I cannot handle stress well (hence why I won't be apply for MSF). One recent event has made me quite sombre lately (which I will write about later).

So what am I doing to help my motivation. I've agreed to participate in a clinical trial, to see if repetitive transcranial magnetic stimulation will help. Basically it is using a device to produce magnetic waves so it will stimulate my brain into being happier and more motivated. I'm in week 3 of 4 into the treatment and I don't think anything has changed. I know with this method of treatment that the results may not be seen immediately.

However in the end I know most of the motivation has to come within. But how do I motivate myself to become motivated?

Professional procrastination

One of the traits which has been going away from me has been my motivation. For particular things -  especially regarding my family medicine higher training - they have been put off so many times. Even this blog entry has been put off for several weeks, maybe even months. It has come to the stage that my psychiatrist had to add bupropion (Wellbutrin), an anti-depressant usually used to help people quit smoking, to improve my motivation. Although this has helped a little, there is still stuff left to do.

So why am I so unmotivated to do anything about my family medicine higher training? Probably it is the lack of drive which is a factor. My family medicine higher training is not compulsory to be completed. I can still practise in Hong Kong without it. My level of pay won't be as much as doctors who have completed the family medicine higher training and passed the exit examination but the money is still nothing to scoff at. It is comfortable to live on, I have no debts and no-one that financially depends on me. My chances of promotion within the department will be zero without the resident specialist title but I'm not worried about that - I would hate the added responsibility and doing stuff such as seeing patients in specialist clinics and attending meetings.

Even getting up in the morning, knowing I have to go to work and see patients, requires serious willpower and motivation. There are many times I lie in bed thinking if I can pull a sickie today and then I realise the reason I have gone part time is so I don't want to do this.

To be honest I fulfilled most of adult ambitions in becoming a doctor. When I was a teenager, I was naive to think I could fulfil most of my goals: 16 A*'s at GCSEs, 6 A's at A Levels, get into the University of Cambridge to study medicine, get married at 25 years old, have children by 28 years old and win the Nobel Prize for Medicine and Physiology by 40 years old. During my depression years, when I was deferring studying and repeating years, all I wanted to do is graduate and become any doctor. Now that I've achieved that, what is left to do in terms of big goals? I don't expect even to have sex, let alone hook up, get married or have kids.

There are other goals which I want to do, which strangely I am more motivated to prepare for: take a 3 month European trip, get a Diploma in Tropical Medicine and Hygiene so I can volunteer for Medicins San Frontieres and, finally, do the research so I can emigrate to Australia or go back to UK. But even then the motivation is not immediate.

For my family medicine higher training, I have still got to record my consultation videos. This is the part I am most dreading, since it requires me to converse in Cantonese at length, something I'm not comfortable doing. I have to enter 600+ patients' data for my clinical audit and I've only done 100+ patients. I have still got to prepare for my practice management assessment, which I haven't even started. This requires me having to fix any problems with my clinic settings, such as making sure the cardiopulmonary resuscitation drills and fire drills paperwork is in order, which it isn't and I have been sitting on this for the past year. The lack of drive goes in hand with the lack of consequences - there is no punishment if I don't fulfil my higher training.

I think it is an effort related matter regarding my motivation. There are some things I don't want to do. Going out to gatherings on Meetup such as "British Born Chinese and Friends" and "Social Scrabble Club" requires me to hop on to public transport for one hour or more, which I find hard to do. Yet going to volunteer for Hong Kong Dog Rescue is something I do regularly, probably because it is only a 15 minute drive from home and I can park for free.

Probably I should give in and say, "Look, I don't envisage me staying in Hong Kong in the near future. Completing my higher training and taking the exit examination, which I will probably fail, will be pointless."