Abstract
It is no secret that in the UK junior doctors are dissatisfied. In August 2023, the British Medical Association (BMA) successfully balloted for a second round of industrial action, and the General Medical Council (GMC) annual survey has found an increasing number of medical trainees experiencing burnout (BMA, 2023; Wise, 2022). Similar issues exist in general practice as part of a wider GP workforce crisis (Jefferson and Holmes, 2022).
While being a doctor is never easy, working conditions for these young professionals have worsened over the last decade. Expressed emotions include ‘not feeling valued, lacking autonomy, having a poor work–life balance, and providing compromised patient care’ (Lock and Carrieri, 2022). These circumstances - in particular, doctor burnout - have wider implications for patients, colleagues and the NHS as an institution. This has led directly to the current junior doctor retention crisis, in which many young doctors are deciding to complete their training abroad or leave the profession altogether. Inevitably it has a knock-on effect on consultant vacancies, waiting list times and staff morale.
Reflection 1: Luke Read
I have experienced this stress myself as a junior doctor and, previously, as a medical student. I have seen the effect this stress has on my colleagues including a significantly higher rate of anxiety and depression when compared with the general public (Mirza et al., 2021). This highlights the importance of students and doctors developing and maintaining effective strategies for managing wellbeing and preventing burnout. Additionally, the diversity of medical professionals indicates that no one strategy is likely to be effective or applicable to everyone, highlighting the importance of developing new and innovative strategies to address stress and burnout among this group. One strategy I have found helpful is knitting (Figs 1 and 2).
A knitted dinosaur named Nigel made by Dr Luke Read.
A knitted no-eyed, no-named elephant made by Dr Luke Read.
Knitting and wellbeing: Evidence
There is self-reported evidence that handicrafts are an effective means for improving wellbeing. Two popular forms of handicraft are knitting and crochet. Both techniques interlace wool according to repeated patterns, the former using long needles and the latter a single hook (in this article both will be referred to as knitting unless otherwise specified). These, and related skills, have been performed and shared in communities throughout the world for thousands of years. However, the industrial revolution mechanised many of these processes, possibly resulting in a waning of their popularity.
Burns and Van Der Meer (2021) surveyed 8391 crocheters regarding their crochet habits and the self-reported benefits of the handicraft. The participants responded overwhelmingly positively suggesting that crochet can improve wellbeing. These participants highlighted a sense of community, creativity and achievement as being important factors contributing to this effect. There are fewer experimental studies looking at its potential benefits, however.
One of these experimental studies investigated inpatients admitted to hospital with eating disorders (Clave-Brule et al., 2009). It explored whether knitting lessons alongside usual treatment could improve outcomes. The researchers found that knitting reduced stress and improved relaxation in this group. Other studies have found that knitting can help with sleep, anxiety and stress (Zhang and Gast, 2023). For instance, a study on patients in a drug and alcohol rehabilitation centre concluded that knitting could help patients regulate their emotions and reduce impulsivity (Duffy, 2008).
Several overlapping mechanisms could explain these proposed benefits. Both knitting and crochet are repetitive, predictable processes that may be able to elicit the ‘relaxation response’ (Zhang and Gast, 2023). This describes the response to repetitive actions, thought processes or speech that can decrease the heart rate, lower blood pressure and reduce muscle tension. Knitting also allows users to gradually develop at their own pace providing a sense of accomplishment and achievement. When knitters are able to match the difficulty of their pattern to their own state they may be able to enter a flow state becoming fully immersed in their project (Riley et al., 2013). This may be beneficial as it could act as a distraction to aid with agitation, anxiety and overthinking. Knitting can also bring social benefits as communities often form around the hobby.
Knitting and doctors
Even fewer papers explore the impact of knitting among doctors and after a literature review, we found no studies investigating this group. However, by applying an understanding of the effects of knitting to the specific stressors and context of medical careers we can extrapolate likely benefits.
As stated earlier, the wellbeing of doctors in the UK is impacted by providing ‘inadequate care’ due to limitations in funding, staffing and training (Lock and Carrieri, 2022). Although knitting cannot fix this, it could help doctors feel a sense of productivity or progression that they may not acquire from their clinical tasks. Knitting may also allow doctors to ‘turn off’ in their non-working hours by helping them enter a ‘flow state’ where they are, for a short time, no longer able to think about work. As healthcare is an emotionally taxing and draining career, the development of skills, such as knitting, that facilitate this downtime and aid in emotional regulation is vital.
In addition to the other benefits, knitting may have some transferable skills applicable to medicine, or more specifically, surgery. The level of dexterity, concentration and fine motor skills required for knitting are the same as those required for surgical procedures. Furthermore, knitting often requires an element of sewing, which is just a hair’s breath away from suturing. By knitting, surgeons may be able to continue to develop their surgical skills in a non-clinical context.
While knitting may be beneficial, some may find it frustrating, especially when first learning the skill. Mistakes are common, due to the repetitive and very precise movements required to knit effectively and these mistakes often require the reversal of several minutes of work. However, mistakes can be corrected and may help doctors challenge their own perfectionism, a trait associated with burnout.
The skills and challenges of knitting may not be suited to all people and may exclude those with certain disabilities. Even then, there are several strategies to overcome these challenges like those shared by Corkhill (2014). Additionally, the use of sharp objects may also be prohibited in certain workplace settings (e.g. psychiatric wards) making it less suitable for some professionals. However, other similar hobbies, such as spoon carving, may provide equivalent benefits to knitting but with different drawbacks and skill requirements (Hillman, 2023).
Reflection 2: Penny Geer
At the end of 2019, I burned out. After spending a month on the sofa doing cross stitch and watching Modern Family (the only way to stop crying was to laugh), I forced myself to go to a crochet course I had booked earlier in the year. Being surrounded by women learning, chatting and making mistakes together with a kind teacher made me feel a little better about myself. Over the next week, I practised every day to build up muscle memory. Successfully learning a new skill and making a granny square cushion gave me hope that I would get better, and I crocheted my way back to health.
Since I have been back at work, I have offered a student-selected component in crochet to year 1 undergraduate medical students at Brighton and Sussex Medical School. The themes coming from their feedback showed that although they initially found it frustrating, in the end they found it relaxing. It taught them patience, the value of practice and to be kind to themselves when they made mistakes. Most students planned to continue crochet in the future.
Conclusion
While the literature is limited, there is a consistent message coming from researchers and knitters alike: knitting (and other handicrafts) is beneficial in a number of areas, most of which we believe to be applicable to doctors in training. This may be especially true for GPs in the UK where doctors are facing high levels of stress, burnout and poor retention. Likewise, implementing stress reduction strategies for junior doctors, such as knitting, may be a cheap, but effective, way of providing support. It must be noted that expecting knitting alone to fix these problems is unrealistic. However, as part of a combined wellbeing initiative knitting could play an important role.
Implementing knitting into already established wellbeing seminars and initiatives could be effective; however, knitting could also be implemented in a range of areas of work. As highlighted by Dittrich (2001) knitting can also be used in the workplace during quiet shifts or during the downtime between patients. It can be picked up and put down quickly, requires little equipment and can be more beneficial than staring at a phone screen (Fig. 3). It can also be easily carried from place to place, for example, between the doctor’s home and their GP surgery. Knitting, like many other hobbies, provides several psychological and social benefits. The NHS should invest in rebuilding the communities that can foster these self-sustaining practices to maintain the wellbeing of its staff.
The equipment required to knit on the go: your project (the scarf), two knitting needles and a ball of wool. Image by Dr Luke Read.
