Rumination, automation or facilitation?

How do you really feel about reflective writing? It’s frequently demanded and is an expectation of being a good doctor. You know: “You have now completed this course. Please complete your Reflective Learning Statement.” And you have to keep your e-portfolio up to date for your appraisal or ARCP meeting. Many doctors report feelings of irritation. “Here we go again.” “What’s the point?” “I could be doing something useful instead.” Such thoughts often lead to procrastination. But you know that you still have to do it eventually.


There are a lot of things in life that we do on auto-pilot. It happens when we’ve completed a task over and over again without negative consequence. So, we default to ingrained, habitual behaviour. We do it quickly and efficiently without really thinking about it.

This is a common approach to reflective writing. It’s the chore that has to be done. Going through the motions. Ticking the box. If this is the case, then it genuinely has become a time-wasting activity. If there’s no benefit then what really is the point? You would definitely be better off doing something else. But what’s the alternative?


Things can and do go wrong. Sometimes we say the wrong thing in the wrong way at the wrong time. Sometimes, no-one has done anything wrong – yet we are still exposed to events and circumstances which are upsetting or confusing.

It’s easy to fall into rumination, where repetitive thoughts go round and round in circles. We can become victims of our own thinking. Problematic ideas undergo fermentation. This can lead to pre-occupation and to poisonous fixation. Anxiety, depression and burnout are all-too-familiar results of un-managed rumination. So, we need an alternative to that too.


“Keep a lid on it.” “Dissociate yourself from the situation. Concentrate on the task.” “Move on, there’s another patient here to be cared for.” “Keep your work at work and your private life private.”

On a personal level, tucking our toughest experiences away in our darkest corners can seem like a logical, attractive solution. But what to do when thoughts start to resurface? Drown them out with some form of distraction? This can lead to problematic ‘coping’ mechanisms and even fragmentation of character.

And what about the impact on others? Does ablation of our memories and experiences go hand in hand with abdication of responsibility over our behaviour and actions? If so, then does this lead to constriction of self-awareness? Does it close the door on learning, meaning there is stagnation rather than progress? This is one clear reason for empathy to measurably decrease over the course of a doctor’s training. So this doesn’t seem like the right way forward either.


What’s really required is a method which enables facilitation of strong foundations for stability and growth. Different people prefer to do this in different ways. Silent introspection, discussion with a mentor or reflective writing are good examples of this. When done well, they utilise awareness of the past to inform a better future. But none of these methods should be taken for granted.

Silent introspection can work well for those who have learned and practised a disciplined approach. Otherwise rumination and lack of conclusion may be just a small step away.

Discussions with an experienced coach, mentor or colleagues offer the benefits of externalising thoughts. When we do this, we are more likely to channel our mental processes into something constructive.

The same can be said of reflective writing when it is conducted for the right reasons and using effective methods.

Unfortunately, many doctors have never been taught how to do this well. The ability has been taken for granted. Or if they have learned in the past, they have fallen out of love with the practice through over-familiarity. That’s why we’ve now launched our new course Reflective Writing Skills for Appraisal & CPD.

So, rumination, automation, dislocation or facilitation. What’s your current approach to reflective practice?

Stephen McGuire – Managing Director