Things I Wish I’d Known From the Beginning: How to (really) keep a journal in medical school and residency

Most of us have the idea that keeping a journal involves a lot of time. For healers and healers in training that is one thing we don’t have… time. So here’s some realistic advice on how to approach journaling. Give it a try. I promise, it’s worth it. 

How

Here’s how to start. Download Day One on your phone and computer. Read the (very short) instructions. This app allows you to use your phone (and/or computer) to write or dictate on the fly, as well as when you have more time. It also lets you easily include photos, links, and audio files. I’m sure there are other apps that do similar things but this is one I know is fantastic (BTW I don’t have any connection to this company).

If you are worried about security, you won’t be honest in your journal - which is important. Make sure that, like this app, whatever technology you use has the security of face recognition and passwords. That being said - even though it should (and will) be very secure, keep HIPAA in mind. No names, photos, or anything that might directly identify a patient! 

Don’t worry about long entries. Use your journal as a “Captain’s log” - just a timestamp and a few words to jog your memory. Make an intentional effort to notice good things in addition to the things you struggle with. 

0845 OR crew dancing to YMCA before the patient arrived

1015 Boring rounds, but team is cool. Really bad dad joke from Joe. 

Similar to a “captain’s log”, your journal can also be a way to make “field notes” - as though you are an anthropologist studying yourself - it’s a remarkable way to sort out what is working for you and what needs to change. 

p.s. Save your journal as a password protected PDF on your computer and resave it frequently. #BackupsAreCritical

Why

Getting past deficit framing. Human beings “deficit frame” by default. Stated another way - we are programmed at a very primitive level to look for anything that might hurt us. As a result, we tend to remember bad things more than good things. Journaling helps keep the balance, and reminds us that we have the power to override our primitive responses to look for mystery, joy, and laughter in our days. It is also therapeutic - Journals let us look for patterns in things that distress us and give us the ability to “talk” these issues out. 

A diary for important events. As healers we learn constantly. There will only be one time something is a “first”…the first patient you examine as a medical student, the first murmur you hear, the first chest tube you put in. Write down what happened and how excited you were! Keeping a log/journal like this is also a wonderful way to realize how much progress you make as you advance in your training/practice.

Venting. As human beings, we need a (safe) place to vent. A password protected journal is perfect. Try freewriting - just let it rip without any editing or thought. Even better - vent on a separate piece of paper that you rip to shreds and throw away when you are done… then turn to your journal to describe what you said and did.

Some other thoughts

Gratitude. At the end of every day (or at 2am if you are awake on call), force yourself to write down three things from the day that gave you a sense of gratitude. There are good studies that show this is a powerful tool to ward off burnout and decrease depression and anxiety. It’s also a wonderful way to keep deficit framing at bay and remember why we do what we do. 

Mindfulness. This kind of journaling is also a great way to practice mindfulness. In addition to your “captain’s log”, look for moments where you are “between” things, and use these moments as a mindfulness tool. Just stop, take a couple of deep breaths and notice what’s around you. 

1620  In the airport, sitting in a food court.. There are a few families, a table with what I assume are work colleagues, an older gentleman with his hamburger (dinner?) who is taking a break from work. I wonder why someone his age is working? There must be a story. There are smiles everywhere. A TV behind me is discussing sports - specifically field kicks in football (which seems a little strange in basketball season?). 

Prompts. If you find yourself stuck, try using these questions. Consider writing them down in the morning and then set an intention to answer them at the end of the day. They will float in your subconscious during the day, leading you to look for stories, delight, surprises, and things that need healing.  

1. What story from the day warrants telling?

2. What delighted me today?

3. What surprised me today?

4. What needs healing today?

   

    

The world is bursting with wonder, and yet it’s the rare productivity guru who seems to have considered the possibility that the ultimate point of all our frenetic doing might be to experience more of that wonder. 

Allison Fallon, The Power of Writing it Down: A Simple Habit to Unlock Your Brain and Reimagine Your Life