It's drilled into us from childhood. You should never talk to strangers. Other than a “hello” as you pass, strangers shouldn't really talk back to you either.

Doctors are required to overcome that suspicion of strangers on a daily basis. We go from “hello” to physical contact in moments. We are a stranger asking strange things. We can only break those societal norms because people trust us, they allow us into their world.

 ‘The contact we have, the ways we touch, the words we use, the way we talk, they all follow a set of unwritten rules. It's like a dance.’

The contact we have, the ways we touch, the words we use, the way we talk, they all follow a set of unwritten rules. It's like a dance. There is a way to do it, where to stand, what to say, where to put your hands. It has a beginning, a middle and an end. You get good at it, it is what you are trained to do.

Medicine depends so much on that dance, that relationship and your empathy. We rely on words, on descriptions of difficult feelings and sensations. It is not just about the tests, conversations matter, you must understand and be involved.

‘Put me in a room full of strangers and I will struggle to start meaningful conversations. But put me in a room with a patient and I am off - at ease striking up proper conversations.’

Can I make a confession though? Put me in a room full of strangers and I will struggle to start meaningful conversations. Follow me on my weekend dog walks and watch how I pick the route to avoid people. But put me in a room with a patient and I am off - at ease striking up proper conversations. Never have quite worked out why it is like this for me, I don't know if many other medics share this experience or not. I hope people will tell me it's not just me.

Is it just introversion? Is it rudeness? Am I just lazy in not wanting to talk to strangers? Sometimes I think it's just that I have run out of conversation, other times I just seem to need the silence. Maybe it is because those conversations at work come with so much else other than small talk, that I need some recovery time. Patients share burden, emotions, pain and frightening uncertainty with us. It's a lot to take in. I spend the weekends and my time off switching off by not talking to strangers.

I have to forget.

It's a skill we don't talk about, protecting yourself from the dangers of empathy and I think the key is literally - to forget. Put aside all that training we must remember everything and drop it all into a metaphorical oubliette while you are away from the castle.

You must protect yourself from the burden being put on you. It is too easy to become over-involved, to take on every issue, to lose the ability to think of other things or even yourself. I have seen this too often. Doctors phoning the ward in the middle of the night when they are not on call to check on a patient. Doctors worrying excessively about a decision, when there was no right answer. Doctors trying to solve every single issue for every patient themselves.

We are trained to never forget.

I try to, appropriately, forget patients and what is going on for them, until the time is right, so that I or someone else can deal with the issue at the right time and place. I think this is how I do it:

• Handover. Trust your handover when you go home, passing the buck is absolutely fine. That is what the on call team is for, they will do the same to you. Trust your colleagues like they trust you.
• Write it down. You don't have to remember things when they are written down. I keep telling people to buy nice notebooks. I have a Kindle Scribe now, gigabytes of notebook, all in searchable sections, I lose nothing.
• Use your team. I work with fantastic people, they are all better than me at something. Know who does what and how to pass things on. They will use you just the same.
• Use your MDT. Making a diagnosis and deciding on management is a process best shared. Makes for less time stewing on difficult decisions.
• Realise your boundaries. You can not do everything, don't even try. You also can't be perfect, good enough is just fine. I can do haematology well. I'm not good at antidepressants, finances or skin amongst many many other things. Know someone who can fix things, the equivalent of a good plumber, electrician or builder when you own an old house. You need contacts and colleagues in every specialty. You should foster these relationships, they will need you just as much.
• Put yourself back in the equation. Always make time for yourself at some point in the day, it can be as simple as a coffee, ten minutes reading a book and always have lunch or whatever meal you need.

Maybe you can even take a walk outside while you are on shift and try to forget, but whatever you do, don't talk to strangers.