1 00:00:00,000 --> 00:00:02,560 >> Rachel Morris: You may think you're fine, you may still be 2 00:00:02,560 --> 00:00:05,320 performing really well at work and you're still 3 00:00:05,320 --> 00:00:07,760 the one that people rely on, yet you know that 4 00:00:07,760 --> 00:00:10,840 something's off. And maybe you've stopped doing 5 00:00:10,840 --> 00:00:13,320 the things that you used to enjoy. Maybe things 6 00:00:13,320 --> 00:00:15,640 are suffering at home and you've told yourself 7 00:00:15,640 --> 00:00:19,000 it's just a busy patch and you may be closer to 8 00:00:19,000 --> 00:00:21,560 burnout than you think. That's what this episode 9 00:00:21,560 --> 00:00:23,320 is about. Um, and this is why I'm bringing it back 10 00:00:23,320 --> 00:00:25,640 as a replay whilst I write my book, how to say no 11 00:00:25,640 --> 00:00:27,920 When Someone Might Die. About a year ago, I spoke 12 00:00:27,920 --> 00:00:30,560 with Dr. Richard Duggins, NHS psychiatrist, 13 00:00:30,640 --> 00:00:33,180 consultant psychotherapist and author of Burnout 14 00:00:33,180 --> 00:00:34,900 Free Working. And halfway through our 15 00:00:34,900 --> 00:00:37,140 conversation, he said something about the way that 16 00:00:37,140 --> 00:00:39,460 burnout shows up in High Achievers. And it really 17 00:00:39,460 --> 00:00:42,180 clicked for me because for years I've wondered m 18 00:00:42,860 --> 00:00:45,540 how so many of us just keep on working when we're 19 00:00:45,540 --> 00:00:48,300 really close to burnout. Because all the theory 20 00:00:48,300 --> 00:00:50,740 says your performance should actually drop. But 21 00:00:50,740 --> 00:00:53,020 Richard explained it really well. He said that we 22 00:00:53,020 --> 00:00:56,500 protect our work, we borrow our energy from the 23 00:00:56,500 --> 00:01:00,140 rest of our life to do it. So we stop doing the 24 00:01:00,140 --> 00:01:02,300 exercise, we stop seeing friends, and eventually 25 00:01:02,300 --> 00:01:04,700 we lose the joy as well. And so from the outside 26 00:01:05,020 --> 00:01:09,180 we look totally fine, but inside we feel a bit 27 00:01:09,180 --> 00:01:12,180 like one of those burnt out buildings that Richard 28 00:01:12,180 --> 00:01:14,300 talks about in this episode. The walls are 29 00:01:14,300 --> 00:01:17,780 standing but there's nothing left inside. And then 30 00:01:17,780 --> 00:01:19,980 often what happens is that something really small 31 00:01:19,980 --> 00:01:22,660 happens, so, say a complaint or a colleague going 32 00:01:22,660 --> 00:01:25,140 off sick and then we go straight over what Richard 33 00:01:25,140 --> 00:01:27,980 calls the burnout cliff. And it really takes us by 34 00:01:27,980 --> 00:01:30,020 surprise and probably takes our colleagues by 35 00:01:30,020 --> 00:01:32,280 surpr as well. So there's one theme that I'm 36 00:01:32,280 --> 00:01:35,440 noticing time and time again. If you're feeling 37 00:01:35,440 --> 00:01:37,400 overwhelmed, if you feel that you might be close 38 00:01:37,400 --> 00:01:40,840 to burnout, if nothing changes, then nothing will 39 00:01:40,840 --> 00:01:43,320 change. Now, rest will help a bit, time off will 40 00:01:43,320 --> 00:01:45,960 help. But if we just go back into that, uh, same 41 00:01:45,960 --> 00:01:49,040 way of working, carrying exactly the same load in 42 00:01:49,040 --> 00:01:51,160 the same way, we'll end up back on the edge of 43 00:01:51,160 --> 00:01:54,240 that cliff. So whether you're a doctor, a nurse, a 44 00:01:54,240 --> 00:01:57,080 lawyer, teacher, or just anybody in a high stakes 45 00:01:57,080 --> 00:01:59,120 job who's ever thought, if I don't do it, who else 46 00:01:59,120 --> 00:02:02,120 will? Then listen to this episode with one 47 00:02:02,120 --> 00:02:06,400 question in mind. Not am I burnt out? But what am 48 00:02:06,400 --> 00:02:10,080 I borrowing from my life to keep my work looking 49 00:02:10,240 --> 00:02:12,160 fine? Here's the episode. 50 00:02:14,960 --> 00:02:18,200 >> Dr. Richard Duggins: I'm Dr. Richard Duggins. I'm an NHS psychiatrist 51 00:02:18,200 --> 00:02:22,400 and consultant psychotherapist and I work for and 52 00:02:22,400 --> 00:02:24,960 lead our regional north east and North Cumbria 53 00:02:24,960 --> 00:02:27,550 staff mental health and wellbeing hub. And I also 54 00:02:27,550 --> 00:02:30,630 work as a psychiatrist in the outstanding NHS 55 00:02:30,630 --> 00:02:32,870 Practitioner Health. I'm also the author of a new 56 00:02:32,870 --> 00:02:35,510 book, Burnout Free Working and I'm really pleased 57 00:02:35,510 --> 00:02:36,150 to be here today. 58 00:02:36,230 --> 00:02:38,350 >> Rachel Morris: The book is really great and I would encourage any 59 00:02:38,350 --> 00:02:40,470 listener to check it out and it's absolutely 60 00:02:40,470 --> 00:02:42,669 packed with such useful information. The thing I 61 00:02:42,669 --> 00:02:45,110 really liked about your book is it is talking 62 00:02:45,110 --> 00:02:48,030 about the workplace and also stuff you can do as 63 00:02:48,030 --> 00:02:51,830 well. Because the biggest issue with burnout and 64 00:02:51,830 --> 00:02:54,110 with resilience training, with wellbeing and stuff 65 00:02:54,110 --> 00:02:55,990 is people feel like they're being blamed. 66 00:02:56,220 --> 00:02:57,940 Resilience, victim blaming. And that's something 67 00:02:57,940 --> 00:03:01,700 you talk about in your book. How do you see 68 00:03:01,700 --> 00:03:03,980 resilience victim blaming showing up? 69 00:03:04,300 --> 00:03:05,900 >> Dr. Richard Duggins: It's one of the motivations for writing 70 00:03:05,900 --> 00:03:09,740 >> Dr. Richard Duggins: the book because the people coming to see me often 71 00:03:09,900 --> 00:03:13,100 feel it's a personal weakness, that it's some 72 00:03:13,100 --> 00:03:15,860 strength, they're letting their team down. And 73 00:03:15,860 --> 00:03:19,060 actually that's not what we see. And when we speak 74 00:03:19,060 --> 00:03:20,860 to people and they tell their histories and they 75 00:03:20,860 --> 00:03:23,860 can start to see it, what we really see is what's 76 00:03:23,860 --> 00:03:26,690 going on is something in the system. It's, it's a 77 00:03:26,690 --> 00:03:29,530 change or some change in the balance of what's 78 00:03:29,530 --> 00:03:31,770 going on around people rather than what's going on 79 00:03:31,770 --> 00:03:34,890 inside people. So I often talk about radiators and 80 00:03:34,890 --> 00:03:38,050 drains. So what are the things that are radiating 81 00:03:38,370 --> 00:03:41,370 energy and keeping people resilient, but also what 82 00:03:41,370 --> 00:03:44,050 are the things that are draining their energy and 83 00:03:44,270 --> 00:03:46,890 um, making them more likely to burn out? And what 84 00:03:46,890 --> 00:03:50,130 we see clinically is a tip in these radiators and 85 00:03:50,130 --> 00:03:50,610 drains. 86 00:03:50,850 --> 00:03:52,850 >> Rachel Morris: And I did laugh in the book because you talked 87 00:03:52,850 --> 00:03:54,610 about the fact when you talk about this and you 88 00:03:54,610 --> 00:03:56,650 show people the stress curve which we use all the 89 00:03:56,650 --> 00:03:58,110 time, which simply plots you, your performance 90 00:03:58,590 --> 00:04:01,430 against pressure, uh, and as the pressure 91 00:04:01,430 --> 00:04:03,430 increases initially you get this good stress, 92 00:04:03,430 --> 00:04:05,230 don't you, where you perform well, but then as the 93 00:04:05,230 --> 00:04:08,190 pressure increases, you tip off the top of the 94 00:04:08,190 --> 00:04:10,310 curve and your performance starts to decrease. And 95 00:04:10,310 --> 00:04:12,550 you said you often hear sort of audible gasps when 96 00:04:12,550 --> 00:04:14,470 you talk about this. As people realise that 97 00:04:14,470 --> 00:04:17,320 happened to me in a training session, a woman, um, 98 00:04:17,320 --> 00:04:19,310 it was a non medical training session actually, 99 00:04:19,310 --> 00:04:22,390 but a woman ran out of the room, um, really in 100 00:04:22,390 --> 00:04:24,670 distress and I caught up with her at the break 101 00:04:24,670 --> 00:04:27,030 time, said I'm so sorry. Okay, is that something I 102 00:04:27,030 --> 00:04:30,330 said? She said she'd recently been offset with 103 00:04:30,330 --> 00:04:33,090 burnout and it was such a relief for her to know 104 00:04:33,330 --> 00:04:36,130 it wasn't her fault. And There wasn't anything 105 00:04:36,210 --> 00:04:40,930 wrong with her. So why, why is it that we do blame 106 00:04:40,930 --> 00:04:44,289 ourselves? And do you think people in health care 107 00:04:44,530 --> 00:04:47,490 blame themselves more readily than other people? 108 00:04:48,050 --> 00:04:50,800 >> Dr. Richard Duggins: I think it's a narrative throughout many, um, 109 00:04:51,410 --> 00:04:54,170 professions in high stress. I think it's certainly 110 00:04:54,170 --> 00:04:56,210 there within healthcare, but I think it's there 111 00:04:56,210 --> 00:04:58,170 within teaching, I think it's there within social 112 00:04:58,170 --> 00:05:01,310 work. It's there within. I've done some work with 113 00:05:01,310 --> 00:05:02,870 the police. It's certainly there within the 114 00:05:02,870 --> 00:05:06,870 police. So, um, I think it's a misunderstanding. I 115 00:05:06,870 --> 00:05:09,550 don't think resilience and burnout are understood 116 00:05:09,550 --> 00:05:12,110 very well. So I think it's a misunderstanding and 117 00:05:12,590 --> 00:05:15,990 that's why your podcast and things like that are 118 00:05:15,990 --> 00:05:18,990 so important, because they correct these 119 00:05:18,990 --> 00:05:22,430 misunderstandings. But I also think organisations 120 00:05:22,430 --> 00:05:25,510 at times have found it more convenient, when 121 00:05:25,510 --> 00:05:27,870 people are struggling with burnout in their mental 122 00:05:27,870 --> 00:05:31,320 health to say, actually it's that individual, and 123 00:05:31,320 --> 00:05:33,640 to scapegoat them rather than to ask the harder 124 00:05:33,640 --> 00:05:35,560 questions, which is, what are we doing that's 125 00:05:35,560 --> 00:05:38,960 burning out our staff? What could we change? It is 126 00:05:38,960 --> 00:05:41,280 easier to blame the individual, I think. 127 00:05:41,440 --> 00:05:44,560 >> Rachel Morris: Yeah. And as medics, I mean, we have been used to 128 00:05:44,560 --> 00:05:46,440 pretty high pressure for most of our careers, 129 00:05:46,440 --> 00:05:48,400 haven't we? You know, starting with doing A 130 00:05:48,400 --> 00:05:50,120 levels, quite frankly, and then med school with 131 00:05:50,120 --> 00:05:52,320 all those exams and working much harder than it 132 00:05:52,320 --> 00:05:54,680 seemed like, than anybody else who only had, you 133 00:05:54,680 --> 00:05:56,720 know, my husband only had, like, three lectures a 134 00:05:56,720 --> 00:05:59,280 week at uni. We were there nine to five every 135 00:05:59,280 --> 00:06:01,280 single day. And then you go straight into house, 136 00:06:01,660 --> 00:06:04,860 which were incredibly pressurised. So do you think 137 00:06:04,860 --> 00:06:08,100 we have a. That our normal pressure gauge is just 138 00:06:08,100 --> 00:06:10,940 set a bit higher than everybody else's, perhaps? 139 00:06:11,340 --> 00:06:14,180 >> Dr. Richard Duggins: Well, it's certainly the case that, um, 140 00:06:14,300 --> 00:06:17,659 >> Dr. Richard Duggins: the medics I meet in my clinic are incredibly 141 00:06:17,659 --> 00:06:18,620 resilient people. 142 00:06:18,700 --> 00:06:23,820 >> Dr. Richard Duggins: They can manage a lot of stress, but we are all 143 00:06:23,820 --> 00:06:28,810 human and we can all only take so much. And at 144 00:06:28,810 --> 00:06:32,730 times there will be too much stress at work, often 145 00:06:32,730 --> 00:06:35,330 combined with too much stress at home, combined 146 00:06:35,330 --> 00:06:38,250 with too little support or a change in support, 147 00:06:39,050 --> 00:06:41,930 and we all reach our limits. And at that stage 148 00:06:41,930 --> 00:06:45,210 we'll start to develop problem stress or burnout, 149 00:06:45,210 --> 00:06:48,530 and may even progress to anxiety, depression or 150 00:06:48,530 --> 00:06:52,650 some physical complications. So, um, I agree we 151 00:06:52,650 --> 00:06:55,930 are used to and trained to manage high stress, but 152 00:06:56,210 --> 00:06:59,410 too much for too long will burn us all out. 153 00:06:59,890 --> 00:07:02,770 >> Rachel Morris: And do you think in the people that you've seen, 154 00:07:03,010 --> 00:07:06,730 it's a problem with the drains have increased, or 155 00:07:06,730 --> 00:07:09,250 is it a problem that the radiators have decreased? 156 00:07:09,250 --> 00:07:10,970 And actually, it might be quite helpful for you to 157 00:07:10,970 --> 00:07:12,850 just tell us what you think the drains and 158 00:07:12,850 --> 00:07:15,090 radiators are, particularly in healthcare? 159 00:07:15,170 --> 00:07:18,530 >> Dr. Richard Duggins: Yeah, absolutely. So the drains are. There's three 160 00:07:18,530 --> 00:07:22,860 drains. Um, typically they are, um, work stress, 161 00:07:23,020 --> 00:07:25,740 both the hours worked and the intensities of those 162 00:07:25,740 --> 00:07:29,220 hours worked, their home pressures. So that's 163 00:07:29,220 --> 00:07:31,900 also, you know, what's going on at home. Are there 164 00:07:32,140 --> 00:07:35,580 changes? Are there disputes? Have we suffered a 165 00:07:35,580 --> 00:07:39,180 bereavement? All sorts of pressures that are at 166 00:07:39,180 --> 00:07:42,260 home, caring responsibilities. And then the other 167 00:07:42,260 --> 00:07:44,780 drain, which is a really interesting one, is 168 00:07:45,100 --> 00:07:48,140 negative experiences about work. So this is about 169 00:07:48,140 --> 00:07:50,900 how we feel about work and this is very much the 170 00:07:50,900 --> 00:07:55,230 culture of work. This is our support at work, how 171 00:07:55,230 --> 00:07:57,390 we're treated at work, how investigations are 172 00:07:57,390 --> 00:08:00,590 handled at work, uh, how we feel valued at work. 173 00:08:00,910 --> 00:08:03,230 >> Rachel Morris: When you talk about negative experiences of work, 174 00:08:03,230 --> 00:08:06,270 are you talking about what the HR department would 175 00:08:06,270 --> 00:08:07,870 call employee engagement? 176 00:08:08,110 --> 00:08:11,030 >> Dr. Richard Duggins: It's related, but in my mind is slightly 177 00:08:11,030 --> 00:08:13,550 different. So certainly negative experiences at 178 00:08:13,550 --> 00:08:16,950 work do stop employee engagement. But no, I'm 179 00:08:16,950 --> 00:08:19,750 talking more about the way we feel, our work 180 00:08:19,750 --> 00:08:22,590 treats us, so how we feel treated by our 181 00:08:22,590 --> 00:08:25,340 organisation, our line management, our, uh, 182 00:08:25,430 --> 00:08:28,830 colleagues, how fair work is. So it's more of a 183 00:08:28,830 --> 00:08:31,830 cultural thing about work. If we're exposed to 184 00:08:31,830 --> 00:08:34,629 moral injury, those sort of things that affect our 185 00:08:34,950 --> 00:08:36,310 relationship with work. 186 00:08:36,630 --> 00:08:39,750 >> Rachel Morris: So it's not just about the hours in the workload, 187 00:08:39,830 --> 00:08:42,790 it's not just about the pressures at home. It's 188 00:08:42,790 --> 00:08:47,030 actually about how we're treated by people if we 189 00:08:47,110 --> 00:08:51,190 feel the culture is supporting us and is fair. So 190 00:08:51,190 --> 00:08:52,950 you can have a high load of hours and high 191 00:08:52,950 --> 00:08:56,910 workload, high load of home pressures, and be just 192 00:08:56,910 --> 00:08:59,550 about coping. But then suddenly you start to get 193 00:08:59,550 --> 00:09:02,270 these negative experiences at work and that can 194 00:09:02,270 --> 00:09:04,230 then tip you over into burnout. 195 00:09:04,470 --> 00:09:06,470 >> Dr. Richard Duggins: Yeah, that's. That's what we see. 196 00:09:06,550 --> 00:09:08,350 >> Rachel Morris: That's interesting. So do you get patients coming 197 00:09:08,350 --> 00:09:10,430 in, going, well, um. Um, the workload hasn't 198 00:09:10,430 --> 00:09:12,070 changed, you know, so I don't quite understand 199 00:09:12,070 --> 00:09:14,070 what's going on here. You know, we've sort of got 200 00:09:14,070 --> 00:09:16,310 the same workload, but for some reason, things 201 00:09:16,690 --> 00:09:17,650 much, much harder. 202 00:09:17,810 --> 00:09:21,330 >> Dr. Richard Duggins: Absolutely. Yeah, absolutely. And, uh, people tend 203 00:09:21,330 --> 00:09:23,330 to just look at the workload, they don't tend to 204 00:09:23,330 --> 00:09:27,930 look at the other drains. So the radiators are how 205 00:09:27,930 --> 00:09:30,530 much support we've got. Um, and we're doubly 206 00:09:30,530 --> 00:09:33,810 blessed if we've got support at work and at home. 207 00:09:34,690 --> 00:09:37,210 So this, again, is the culture of work line 208 00:09:37,210 --> 00:09:40,450 management, but also our colleagues. Have we got a 209 00:09:40,450 --> 00:09:43,530 buddy at work, but also have we got support at 210 00:09:43,530 --> 00:09:47,990 home? The second one is, um, whether we've got any 211 00:09:48,070 --> 00:09:51,800 opportunity for fun and social Time. So, um, 212 00:09:52,150 --> 00:09:55,350 that's often done outside work. But to be honest, 213 00:09:55,350 --> 00:09:58,390 why can't work be fun? It should be fun at times. 214 00:09:59,140 --> 00:10:02,750 Um, but these are our hobbies and activities. And 215 00:10:02,750 --> 00:10:04,630 then the third one, which I think is really 216 00:10:05,030 --> 00:10:08,150 helpful for medics to think about particularly is, 217 00:10:08,310 --> 00:10:10,350 is there some intellectual stimulation in our 218 00:10:10,350 --> 00:10:13,670 working week? So this is, do we feel stretched and 219 00:10:13,670 --> 00:10:16,590 developed within our working week? And some people 220 00:10:16,590 --> 00:10:19,150 can have extremely busy jobs, but there's 221 00:10:19,150 --> 00:10:21,310 something in that week where they really look 222 00:10:21,310 --> 00:10:24,150 forward to, they really enjoy a particular clinic, 223 00:10:24,150 --> 00:10:26,790 a particular role, an education role or something 224 00:10:26,790 --> 00:10:29,270 like that, and that really helps us keep going. So 225 00:10:29,270 --> 00:10:30,350 that can be a radiator. 226 00:10:30,430 --> 00:10:34,270 >> Rachel Morris: I love that. I remember in one of my GP jobs I was 227 00:10:34,270 --> 00:10:36,510 incredibly stressed but incredibly bored at the 228 00:10:36,510 --> 00:10:38,790 same time and I was like, how can that, how could 229 00:10:38,790 --> 00:10:40,750 those two coexist? But you've hit the nail on the 230 00:10:40,750 --> 00:10:43,350 head. Yeah, there was a lot of the workload was 231 00:10:43,350 --> 00:10:45,640 really, really high, but there was really at that 232 00:10:45,640 --> 00:10:48,040 point no intellectual stimulation. And actually I 233 00:10:48,040 --> 00:10:50,560 fixed that, not by changing jobs or changing the 234 00:10:50,560 --> 00:10:52,760 workload because I actually, I think started to 235 00:10:52,760 --> 00:10:55,480 doing, uh, a master's or doing some more training. 236 00:10:55,480 --> 00:10:57,400 So that was something that suddenly started to 237 00:10:57,400 --> 00:10:59,920 intellectually stimulate a bit more. So we don't 238 00:10:59,920 --> 00:11:01,360 often think about that, do we? 239 00:11:01,520 --> 00:11:03,680 >> Dr. Richard Duggins: No, absolutely. And it's important to think about. 240 00:11:04,080 --> 00:11:06,880 It's also one of the things when people get busy 241 00:11:06,880 --> 00:11:10,120 at work and they start to burn out, the thing they 242 00:11:10,120 --> 00:11:13,060 often drop is that what they see as the optional 243 00:11:13,060 --> 00:11:15,220 extra, which might be the most intellectually 244 00:11:15,220 --> 00:11:17,940 stimulating bit of their week. So they might stop 245 00:11:18,500 --> 00:11:21,100 the teaching or the additional clinic they offer 246 00:11:21,100 --> 00:11:23,940 or the minor surgery or something like that. And 247 00:11:23,940 --> 00:11:26,700 actually that's a real mistake because you're 248 00:11:26,700 --> 00:11:29,060 dropping the thing that's keeping you going. But 249 00:11:29,060 --> 00:11:31,540 you see it quite often because people retreat back 250 00:11:31,540 --> 00:11:34,820 to doing the core, often the bit that isn't that 251 00:11:34,820 --> 00:11:36,180 stimulating and enjoyable. 252 00:11:36,340 --> 00:11:38,220 >> Rachel Morris: And you talk about that in the book, don't you, 253 00:11:38,220 --> 00:11:40,220 with the, uh, funnel of exhaustion by I think, 254 00:11:40,220 --> 00:11:43,720 Mary Asberg, where yes, you just give up doing 255 00:11:43,720 --> 00:11:46,520 everything that you need to survive mentally and 256 00:11:46,520 --> 00:11:49,240 physically. And yes, I certainly talk about that a 257 00:11:49,240 --> 00:11:52,280 lot, but more relation to the well being factors. 258 00:11:52,280 --> 00:11:54,600 But actually learning and growing, that is a well 259 00:11:54,600 --> 00:11:57,640 being factor. So, um, often I think about, well, 260 00:11:57,640 --> 00:11:59,520 we just give up exercising, don't we? And we give 261 00:11:59,520 --> 00:12:02,320 up the yoga class and resting. But you're right 262 00:12:02,320 --> 00:12:05,120 often because the learning and the developing 263 00:12:05,280 --> 00:12:08,520 feels like an optional extra that is just put on 264 00:12:08,520 --> 00:12:10,120 the back burner. And I have lost count of the 265 00:12:10,120 --> 00:12:12,280 amount of doctors who said to Me? Well, I just 266 00:12:12,280 --> 00:12:14,560 haven't got time to do that Masters or do that 267 00:12:14,560 --> 00:12:16,620 course that I wrote, really want to do, when 268 00:12:16,620 --> 00:12:18,420 actually what you're saying is that could actually 269 00:12:18,420 --> 00:12:20,420 be the thing that saves them from burnout, 270 00:12:20,420 --> 00:12:23,270 weirdly. But how do you do that, though, uh, 271 00:12:23,270 --> 00:12:25,180 without it just becoming one extra thing to do, 272 00:12:25,180 --> 00:12:27,460 one extra pressure on workload and time? Because 273 00:12:27,460 --> 00:12:29,180 that is the real crux of it, isn't it? 274 00:12:29,340 --> 00:12:32,020 >> Dr. Richard Duggins: Yeah, well, avoiding burnout and then managing 275 00:12:32,020 --> 00:12:35,580 burnout, well, I don't need to tell you, is really 276 00:12:35,580 --> 00:12:39,660 hard. I mean, I run, um, a therapy group for 277 00:12:39,820 --> 00:12:42,820 professionals who've burnt out. And these are 278 00:12:42,820 --> 00:12:46,060 great professionals, very creative, and they'd 279 00:12:46,060 --> 00:12:47,760 have solved their problems on their own if they 280 00:12:47,760 --> 00:12:49,840 could have done. But these problems are really 281 00:12:49,840 --> 00:12:52,200 difficult to solve, and that's why the group's so 282 00:12:52,200 --> 00:12:54,400 helpful, because people get to think together and 283 00:12:54,400 --> 00:12:58,000 sometimes it requires really difficult decisions 284 00:12:58,000 --> 00:13:02,080 and courageous conversations and to try and get 285 00:13:02,080 --> 00:13:05,080 that balance back, um, the balance between the 286 00:13:05,080 --> 00:13:09,300 radiators and the drains back. And I think one, 287 00:13:09,300 --> 00:13:12,560 um, thing I certainly see with the patients, uh, 288 00:13:12,560 --> 00:13:15,520 and the professionals I'm working with is that 289 00:13:15,520 --> 00:13:18,730 that often requires not them having to solve it 290 00:13:18,730 --> 00:13:20,890 all on their own, because they would have done 291 00:13:21,130 --> 00:13:23,050 that already if they could have done, but having 292 00:13:23,050 --> 00:13:25,370 to reach out and have those conversations about 293 00:13:25,530 --> 00:13:28,650 how do I get this balance back, you know, who can 294 00:13:28,650 --> 00:13:32,210 support me with this, who can help that balance in 295 00:13:32,210 --> 00:13:35,450 my work? So I'm not just burning myself out doing 296 00:13:35,450 --> 00:13:38,170 lots and lots of hours of unstimulating work, uh, 297 00:13:38,170 --> 00:13:41,210 when I know I can contribute in other ways too. 298 00:13:41,450 --> 00:13:43,210 >> Rachel Morris: Then we've got another problem, haven't we? And I 299 00:13:43,210 --> 00:13:45,820 know all throughout the whole of your book, I've 300 00:13:45,820 --> 00:13:48,300 noticed the theme is reach out, reach out, get 301 00:13:48,300 --> 00:13:52,140 support, connect, which I totally agree with. But 302 00:13:52,140 --> 00:13:55,460 the problem I see is that in healthcare, often the 303 00:13:55,460 --> 00:13:57,700 people that you reach out to are your colleagues 304 00:13:57,700 --> 00:14:00,860 who are in the same boat. And often they have a 305 00:14:00,860 --> 00:14:04,620 vested interest in you keeping on churning through 306 00:14:04,620 --> 00:14:06,860 the workload that might not be stimulating to you, 307 00:14:07,020 --> 00:14:09,260 to keeping you going. So you can do the service 308 00:14:09,340 --> 00:14:12,700 delivery, you can reach out to your manager, who 309 00:14:12,990 --> 00:14:15,070 is probably even more stressed and burnt out than 310 00:14:15,070 --> 00:14:18,070 you. Um, so that's another problem for them to 311 00:14:18,070 --> 00:14:21,030 deal with. So I'm not sure you're going to get the 312 00:14:21,030 --> 00:14:23,950 best support and unbiased support from people at 313 00:14:23,950 --> 00:14:26,030 work. So then the question is, well, yeah, you can 314 00:14:26,030 --> 00:14:27,510 reach out to your friends and family, but they 315 00:14:27,510 --> 00:14:29,430 don't really understand the workplace and what 316 00:14:29,430 --> 00:14:31,230 you're going through, particularly if they're not 317 00:14:31,230 --> 00:14:35,990 in a health care context. So who do you reach out 318 00:14:35,990 --> 00:14:36,750 to for this support? 319 00:14:37,230 --> 00:14:41,230 >> Dr. Richard Duggins: Yeah, and it's. There are, there aren't simple, 320 00:14:41,230 --> 00:14:44,820 easy answers. And I think it's requires quite a 321 00:14:44,820 --> 00:14:49,180 lot of courage, assertiveness, persistence. I 322 00:14:49,180 --> 00:14:52,460 think a key thing that people start to accept when 323 00:14:52,460 --> 00:14:54,660 they come forward for support and help is 324 00:14:55,380 --> 00:14:57,700 actually, this is really serious what's going on. 325 00:14:57,860 --> 00:15:02,500 Burnout is horrible. It's a terrible feeling and 326 00:15:02,500 --> 00:15:05,380 it can lead, if you don't manage it, to anxiety, 327 00:15:05,380 --> 00:15:07,780 depression, physical health problems like high 328 00:15:07,780 --> 00:15:11,610 blood pressure. So it needs managing. And as good 329 00:15:11,610 --> 00:15:14,360 work is good for us, bad work is bad for us and, 330 00:15:14,360 --> 00:15:18,370 uh, I think it requires us in a way to take a 331 00:15:18,370 --> 00:15:20,970 stance where we're saying, actually, I can't 332 00:15:20,970 --> 00:15:24,650 sustain this. I, uh, need changes to happen. And 333 00:15:24,650 --> 00:15:28,490 that can feel very difficult. But actually you 334 00:15:28,490 --> 00:15:31,450 burning yourself out, having to take time off work 335 00:15:31,850 --> 00:15:35,890 or performing poorly because you're burnt out and 336 00:15:35,890 --> 00:15:38,650 making errors or mistakes or having poor 337 00:15:38,650 --> 00:15:42,000 conversations with patients or colleagues isn't 338 00:15:42,000 --> 00:15:46,240 worth it. It's not helping anyone. And, uh, it's 339 00:15:46,240 --> 00:15:47,840 not really, it's not helping your colleagues, 340 00:15:47,840 --> 00:15:50,400 although it may feel like it. So although 341 00:15:50,960 --> 00:15:53,160 organisations and colleagues might want to turn a 342 00:15:53,160 --> 00:15:56,440 blind eye at times, they might want to just keep 343 00:15:56,440 --> 00:16:00,720 us going until we burn out. We really aren't doing 344 00:16:01,040 --> 00:16:03,880 us any favours in that, but we're also not doing 345 00:16:03,880 --> 00:16:05,560 them any favours for, uh, that we're not doing our 346 00:16:05,560 --> 00:16:06,760 patients any favours. 347 00:16:07,550 --> 00:16:11,350 >> Rachel Morris: I totally agree. And it's this sort of weird cycle 348 00:16:11,350 --> 00:16:13,670 of people saying, well, I haven't got time to do 349 00:16:13,670 --> 00:16:15,910 anything about this because there's so many 350 00:16:15,910 --> 00:16:17,870 patients I've got to see. Or I can't say no 351 00:16:18,190 --> 00:16:20,750 because it will let people down and it'll pass the 352 00:16:20,750 --> 00:16:23,710 stress on. Or I'll get a complaint and then I'll 353 00:16:23,710 --> 00:16:25,670 say, okay, fine, well, you may get a complaint if 354 00:16:25,670 --> 00:16:28,030 you say no, but what's going to be worse? A 355 00:16:28,030 --> 00:16:29,310 complaint when you've said a, uh, well thought 356 00:16:29,310 --> 00:16:32,590 through. No. Or your colleagues may be thinking 357 00:16:32,590 --> 00:16:34,070 you're letting them down. We don't have any 358 00:16:34,070 --> 00:16:37,470 control over that. Or properly letting them down 359 00:16:37,630 --> 00:16:39,970 when you're off the six months. I mean, I'm not 360 00:16:39,970 --> 00:16:41,890 saying, you know, um, that's not a judgement, but 361 00:16:41,890 --> 00:16:44,770 you won't be there to do the work. Or getting an 362 00:16:44,770 --> 00:16:46,690 even worse complaint because your judgement's 363 00:16:46,690 --> 00:16:49,010 gone. And we know that doctors that are near a 364 00:16:49,010 --> 00:16:52,570 burnout make many more mistakes than people who 365 00:16:52,570 --> 00:16:54,769 aren't. So then you're going to get that complaint 366 00:16:54,769 --> 00:16:56,290 and let people down anyway. It would have been 367 00:16:56,290 --> 00:16:58,050 better to have that difficult conversation in the 368 00:16:58,050 --> 00:17:01,050 first place. So that's one whole thing about, you 369 00:17:01,050 --> 00:17:02,610 know, setting boundary, saying, no, having those 370 00:17:02,610 --> 00:17:04,850 conversations. And as you were talking, I was 371 00:17:04,850 --> 00:17:07,170 thinking about the difficulty of finding people to 372 00:17:07,170 --> 00:17:09,850 reach out to. But I've had this situation, not 373 00:17:09,850 --> 00:17:11,570 about stress, but there's been a situation where I 374 00:17:11,570 --> 00:17:13,490 want to find out about something and I'm really 375 00:17:13,490 --> 00:17:15,810 not sure about who to contact. I'm thinking, oh, 376 00:17:15,970 --> 00:17:19,130 oh, gosh. And my other half said, rachel, you 377 00:17:19,130 --> 00:17:20,850 know, lots of people you could contact. And I 378 00:17:20,850 --> 00:17:22,970 thought, okay. And I just sat down and I wrote a 379 00:17:22,970 --> 00:17:25,410 list. So it turns out, having said, oh, I don't 380 00:17:25,410 --> 00:17:27,570 know what to do, I don't know who to ask advice 381 00:17:27,570 --> 00:17:29,570 from. There are at least 10 people I could 382 00:17:29,570 --> 00:17:32,050 literally email and ask some advice from. But it 383 00:17:32,050 --> 00:17:34,970 takes a bit of thinking, a bit of putting my neck 384 00:17:34,970 --> 00:17:37,120 out there and a bit of being ready for people to 385 00:17:37,120 --> 00:17:39,120 say, actually, no, I can't help you, type thing. 386 00:17:39,120 --> 00:17:42,080 So, uh, yeah, it probably isn't that we don't know 387 00:17:42,080 --> 00:17:43,720 anyone who can support us. 388 00:17:43,720 --> 00:17:46,480 >> Dr. Richard Duggins: Right, well, absolutely. And for me it's one of 389 00:17:46,480 --> 00:17:48,960 the joys of being a doctor, um, and m. Being in 390 00:17:48,960 --> 00:17:53,400 the nhs. And for me, one of the key values and why 391 00:17:53,400 --> 00:17:56,440 I do this work really for being a doctor and in 392 00:17:56,440 --> 00:17:59,320 the NHS is we help our colleagues. We are there 393 00:17:59,320 --> 00:18:02,640 for our colleagues. And I increasingly believe 394 00:18:03,100 --> 00:18:05,700 that actually helping our colleagues stay well is 395 00:18:05,700 --> 00:18:08,100 for all of us, whatever our roles, is the best way 396 00:18:08,100 --> 00:18:10,780 we help patients because healthy, thriving 397 00:18:10,860 --> 00:18:14,380 colleagues deliver great services. So I almost 398 00:18:14,380 --> 00:18:18,060 think it should be our priority. The other thing I 399 00:18:18,060 --> 00:18:22,340 was reminded of when you were talking was, um, how 400 00:18:22,340 --> 00:18:25,380 we change culture. And I think we have an 401 00:18:25,380 --> 00:18:27,780 opportunity sometimes, especially if we're 402 00:18:27,780 --> 00:18:30,730 reasonably senior, to do that. And I was thinking 403 00:18:30,730 --> 00:18:33,570 about, there was a service I worked in about 10 404 00:18:33,570 --> 00:18:36,850 years ago and we used to see all sorts of doctors. 405 00:18:36,850 --> 00:18:39,170 It was a self referral service. Lots of doctors 406 00:18:39,170 --> 00:18:42,330 came to us. Really popular, but no surgeons came 407 00:18:42,330 --> 00:18:44,530 to us. So I was like, well, these surgeons are 408 00:18:44,530 --> 00:18:45,970 under a lot of pressure. I know that. I've got 409 00:18:45,970 --> 00:18:48,330 friends who are surgeons, but they never came to 410 00:18:48,330 --> 00:18:51,530 us. And then one day a very senior surgeon came to 411 00:18:51,530 --> 00:18:54,610 us. He was burnt out, he'd become depressed. He 412 00:18:54,610 --> 00:18:56,980 referred into our service. He did very well 413 00:18:56,980 --> 00:19:00,220 because most people do. And then he went back and 414 00:19:00,220 --> 00:19:03,660 this was the remarkable thing he did. He talked to 415 00:19:03,900 --> 00:19:06,060 all the other surgeons in the region and says, 416 00:19:06,220 --> 00:19:08,900 look, this happened to me. I was overworking. 417 00:19:08,900 --> 00:19:11,020 There was a lot going on at home. I went through 418 00:19:11,020 --> 00:19:13,580 to this service, I'm much better, you can see, I'm 419 00:19:13,580 --> 00:19:16,500 much better. And Then the floodgates opened and we 420 00:19:16,500 --> 00:19:19,420 never, ever had any problems with surgeons coming 421 00:19:19,420 --> 00:19:22,830 through to our service. So that person, I'm sure 422 00:19:22,830 --> 00:19:26,430 he doesn't know it, but probably saved a lot of 423 00:19:26,430 --> 00:19:29,430 people's careers, will have benefited patients and 424 00:19:29,430 --> 00:19:32,310 maybe saved some people's lives. So I do think 425 00:19:32,310 --> 00:19:35,310 there's something else about just battling on and 426 00:19:35,310 --> 00:19:37,950 waiting for burnout to hit us. And doing it 427 00:19:37,950 --> 00:19:40,070 silently doesn't help our colleagues either. 428 00:19:40,310 --> 00:19:42,550 >> Rachel Morris: No, it really doesn't. And the minute you share 429 00:19:42,710 --> 00:19:45,990 something, the shame dissipates, doesn't it? And 430 00:19:46,150 --> 00:19:48,150 let's face it, we still all feel shame when we 431 00:19:48,150 --> 00:19:49,750 think we're not coping because we feel I'm not 432 00:19:49,750 --> 00:19:51,550 good enough as a doctor, I should be able to cope 433 00:19:51,550 --> 00:19:53,700 with everything, which is totally bonkers 434 00:19:53,700 --> 00:19:56,940 thinking. It's this superhero thinking that is so 435 00:19:56,940 --> 00:19:59,340 unhelpful for us. But the minute someone senior 436 00:19:59,340 --> 00:20:02,100 tells their story, it's like, okay, yeah, we can 437 00:20:02,100 --> 00:20:03,820 do it. And we've been involved in coaching 438 00:20:03,820 --> 00:20:06,780 programmes for new to GP fellowships, and there's 439 00:20:06,780 --> 00:20:09,580 coaching programmes around the country that are 440 00:20:09,580 --> 00:20:12,940 fully funded for doctors and not being used by 441 00:20:12,940 --> 00:20:16,220 anybody, which is total madness. Now, either 442 00:20:16,220 --> 00:20:18,300 people just don't know about them, that could be 443 00:20:18,300 --> 00:20:21,540 one thing. But I think people firstly feel they 444 00:20:21,540 --> 00:20:24,420 haven't got time, which is, again, total madness. 445 00:20:24,420 --> 00:20:27,860 We'll talk about that in a minute. Or people maybe 446 00:20:27,860 --> 00:20:31,940 don't want to admit how bad things have got. Why 447 00:20:31,940 --> 00:20:34,500 do you think people aren't using these services 448 00:20:34,740 --> 00:20:37,140 that are available to them? They're out there. 449 00:20:37,300 --> 00:20:39,380 >> Dr. Richard Duggins: I, um, mean, there's a lot of talk about how far 450 00:20:39,380 --> 00:20:42,260 we've come on about mental health and 451 00:20:42,260 --> 00:20:46,220 destigmatizing it, and yet a lot of professionals 452 00:20:46,220 --> 00:20:48,460 I still meet with, a lot of doctors I still meet 453 00:20:48,460 --> 00:20:51,460 with, they're really ashamed to be meeting with 454 00:20:51,460 --> 00:20:54,940 me. They're, you know, the line usually is, I'm, 455 00:20:54,940 --> 00:20:56,620 you know, I'm sorry to be wasting your time. I'm 456 00:20:56,620 --> 00:20:59,220 sure you see people a lot worse than me and a 457 00:20:59,220 --> 00:21:01,540 sense of a weakness, a failure, letting their 458 00:21:01,540 --> 00:21:05,140 colleagues down. And it's still there. And, um, 459 00:21:05,180 --> 00:21:07,140 it's a miss, you know, as I said earlier, it's a 460 00:21:07,140 --> 00:21:10,860 misunderstanding of what burnout is. It's not true 461 00:21:10,860 --> 00:21:12,780 what they're saying. And when they tell their 462 00:21:12,780 --> 00:21:14,990 stories, they can see it's not true, but that's 463 00:21:14,990 --> 00:21:18,270 there. The other thing is, I think people need to 464 00:21:18,270 --> 00:21:20,510 trust these services. They need to trust that the 465 00:21:20,510 --> 00:21:23,710 services will be for them, that they'll be rapid 466 00:21:23,710 --> 00:21:26,950 to access, that they'll be confidential, and the 467 00:21:26,950 --> 00:21:29,990 outcomes are really good. I mean, NHS practitioner 468 00:21:29,990 --> 00:21:30,629 Health is a 469 00:21:30,710 --> 00:21:34,710 >> Dr. Richard Duggins: fantastic example of that in the uk. So when Clare 470 00:21:34,710 --> 00:21:37,270 Gerard set it up, she said, if we build this, 471 00:21:37,270 --> 00:21:39,910 people will come. And I'm not sure people were 472 00:21:39,910 --> 00:21:42,350 sure about that, uh, at the beginning, but it was 473 00:21:42,350 --> 00:21:45,030 built. People come to NHS Practitioner Health, 474 00:21:45,190 --> 00:21:47,830 they get really, really well, they start thriving, 475 00:21:47,910 --> 00:21:50,270 they then go back and tell their teams about their 476 00:21:50,270 --> 00:21:53,430 positive experiences and the service has grown 477 00:21:53,430 --> 00:21:55,990 into the kind of, you know, massive trusted 478 00:21:55,990 --> 00:21:59,630 services at the moment. So I think, uh, it does 479 00:21:59,630 --> 00:22:02,470 take a little bit of time to make people trust 480 00:22:02,470 --> 00:22:05,110 things. I think people can worry that if they come 481 00:22:05,110 --> 00:22:08,030 through to help, that it will be opening a kind of 482 00:22:08,030 --> 00:22:10,790 Pandora's box and that they'll suddenly be off 483 00:22:10,790 --> 00:22:13,810 work and they won't be able to get back to. That's 484 00:22:13,810 --> 00:22:16,410 not true at all. You come through to help, you'll 485 00:22:16,410 --> 00:22:18,330 do really, really well. It's when you don't come 486 00:22:18,330 --> 00:22:18,730 through to 487 00:22:18,730 --> 00:22:20,930 >> Rachel Morris: help that the problems can come, I think, as well. 488 00:22:20,930 --> 00:22:24,160 When some of these services were first set up, I'm 489 00:22:24,160 --> 00:22:27,530 m thinking of a particular coaching service. It 490 00:22:27,530 --> 00:22:29,529 was like, oh, yeah, come and see us. And they'd 491 00:22:29,529 --> 00:22:31,890 give like one day of training to people and then 492 00:22:31,890 --> 00:22:33,370 so people would use it and think, well, actually, 493 00:22:33,370 --> 00:22:36,930 that wasn't very helpful because actually they saw 494 00:22:36,930 --> 00:22:39,090 someone that wasn't very experienced and also 495 00:22:39,730 --> 00:22:41,770 almost felt like they were just trying to persuade 496 00:22:41,770 --> 00:22:44,450 them to stay working rather than. Or they were 497 00:22:44,450 --> 00:22:46,930 doing mentoring, which is great, but probably what 498 00:22:46,930 --> 00:22:49,410 wasn't needed at the time. And so they're put off. 499 00:22:49,410 --> 00:22:52,130 But I think things have very much developed and 500 00:22:52,450 --> 00:22:55,250 improved since then. I think one of the reasons 501 00:22:55,489 --> 00:22:59,370 why people do put off getting help is they don't 502 00:22:59,370 --> 00:23:03,210 recognise it. And you talk about this in your book 503 00:23:03,210 --> 00:23:05,930 that, uh, the burnout cliff that people go along, 504 00:23:05,930 --> 00:23:08,650 along, along, think, well, I can't be. I can't be 505 00:23:08,650 --> 00:23:11,010 burnt out. But I've spoken to someone who's 506 00:23:11,390 --> 00:23:13,150 director of Medical Director of Wellbeing at a 507 00:23:13,150 --> 00:23:15,470 local hospital trust. They surveyed their doctors 508 00:23:15,470 --> 00:23:18,430 recently using, I think it's a Maslach inventory. 509 00:23:18,670 --> 00:23:22,670 50% of their doctors are working in burnout. And 510 00:23:23,390 --> 00:23:26,190 we are led to believe that actually burnout is so 511 00:23:26,190 --> 00:23:28,830 severe you'd know when you're in it. Uh, you can't 512 00:23:28,830 --> 00:23:30,590 carry on when you're in it. But actually a lot of 513 00:23:30,590 --> 00:23:32,870 people actually working in it, so. Absolutely. And 514 00:23:32,870 --> 00:23:34,390 I've had those thoughts just the same as your 515 00:23:34,390 --> 00:23:36,190 patients. Well, I think I might be wasting your 516 00:23:36,190 --> 00:23:37,790 time because I don't think I'm actually that bad. 517 00:23:38,750 --> 00:23:42,180 But you actually are. But, uh, almost you felt 518 00:23:42,180 --> 00:23:45,060 like that for such a Long time, or even, dare I 519 00:23:45,060 --> 00:23:47,580 say it, for most of your career, it's become 520 00:23:47,660 --> 00:23:51,300 normal to you. So is it true that we've almost 521 00:23:51,300 --> 00:23:53,380 normalised burnout and a lot of it are working in 522 00:23:53,380 --> 00:23:55,260 burnout without even knowing it? 523 00:23:55,820 --> 00:23:59,660 >> Dr. Richard Duggins: Yes, I think that's right. And, um, I think I talk 524 00:23:59,660 --> 00:24:02,700 about a culture in high stress professions, 525 00:24:02,940 --> 00:24:05,460 particularly in the nhs, where we keep calm and 526 00:24:05,460 --> 00:24:09,900 carry on. We listen to, uh, Dorian finding Nemo, 527 00:24:10,220 --> 00:24:13,500 we just keep swimming. That's what we do. And that 528 00:24:13,500 --> 00:24:16,700 is terrible burnout advice. It's a way to get 529 00:24:16,700 --> 00:24:20,380 through a difficult night shift, but it's like 530 00:24:20,380 --> 00:24:21,780 trying to run a marathon in the way that you 531 00:24:21,780 --> 00:24:24,900 handle a sprint. So keeping calm and carrying on 532 00:24:24,900 --> 00:24:27,580 doesn't work, but it's the way that it's our go 533 00:24:27,580 --> 00:24:31,460 to, I think, in high stress professions. So we 534 00:24:31,460 --> 00:24:34,290 keep our heads down despite, you know, feeling a 535 00:24:34,290 --> 00:24:36,770 lot of problems, stress, early signs of burnout, 536 00:24:36,770 --> 00:24:39,730 even, even quite severe burnout, and we just try 537 00:24:39,730 --> 00:24:42,610 and keep going. What we do is we try and protect 538 00:24:42,610 --> 00:24:46,490 our work and the core work and often other things 539 00:24:46,490 --> 00:24:48,650 are, uh, you know, we're neglecting home life, 540 00:24:48,650 --> 00:24:51,410 we're neglecting, uh, social activities, we're 541 00:24:51,410 --> 00:24:53,490 becoming quite isolated from our, uh, community. 542 00:24:54,290 --> 00:24:56,930 But we do try and keep calm and carry on. 543 00:24:57,010 --> 00:24:58,450 >> Dr. Richard Duggins: And some of that, I think, is 544 00:24:58,450 --> 00:25:01,680 >> Dr. Richard Duggins: because doctors and I see this all the time, are 545 00:25:01,680 --> 00:25:04,560 really quite hopeful, optimistic people and they 546 00:25:04,560 --> 00:25:07,760 say to me, it will get better. It's just a really 547 00:25:07,760 --> 00:25:08,600 busy spell. 548 00:25:08,600 --> 00:25:10,720 >> Rachel Morris: Yeah. Next year, when I get my new colleague, 549 00:25:10,720 --> 00:25:11,440 it'll be fine. 550 00:25:11,440 --> 00:25:15,360 >> Dr. Richard Duggins: Yeah, absolutely. So you hear a lot of that and, 551 00:25:15,360 --> 00:25:17,400 you know, and hopefulness is wonderful. We need 552 00:25:17,400 --> 00:25:20,080 that when we work with our patients. But it can 553 00:25:20,240 --> 00:25:24,270 get to the point where it's fooling yourself. Um, 554 00:25:24,270 --> 00:25:27,780 and the danger with the, um, that stage is what I 555 00:25:27,780 --> 00:25:29,380 call the plateau, where people are just putting 556 00:25:29,380 --> 00:25:32,140 their heads down, hoping it will get better. But 557 00:25:32,140 --> 00:25:34,300 the danger with the plateau is you end up sleep 558 00:25:34,300 --> 00:25:37,500 walking towards the burnout cliff. So it comes to 559 00:25:37,500 --> 00:25:40,300 a point where things go. There's too much for too 560 00:25:40,300 --> 00:25:43,020 long and then there's one thing, the straw that 561 00:25:43,020 --> 00:25:46,100 breaks the camel's back. And that will potentially 562 00:25:46,100 --> 00:25:50,060 take you off work or, um, you'll have to then, um, 563 00:25:50,060 --> 00:25:52,580 reduce your commitments and that's where we really 564 00:25:52,580 --> 00:25:55,050 don't want to get to. So it's much better for 565 00:25:55,050 --> 00:25:57,450 people to act early, to try and recognise things. 566 00:25:58,090 --> 00:25:59,810 >> Dr. Richard Duggins: I also think you're right that people don't 567 00:25:59,810 --> 00:26:00,970 necessarily look out for them. 568 00:26:00,970 --> 00:26:03,050 >> Dr. Richard Duggins: So one of the things I do when I'm lucky enough to 569 00:26:03,050 --> 00:26:05,570 be able to do some workshops with people is spend 570 00:26:05,570 --> 00:26:07,570 a bit of time saying, you know, what are your 571 00:26:07,570 --> 00:26:09,850 signs of problem stress? Do you know them? Do you 572 00:26:09,850 --> 00:26:12,130 know them as a tick list? And often people don't 573 00:26:12,130 --> 00:26:15,330 know them, but really they should be on our 574 00:26:15,330 --> 00:26:18,050 dashboard. We should be monitoring them. And uh, 575 00:26:18,050 --> 00:26:20,050 you know, we should be watching out when we're not 576 00:26:20,050 --> 00:26:22,850 sleeping as well, when we're withdrawing, whether 577 00:26:22,850 --> 00:26:24,970 we're, when we're becoming irritable, when we're 578 00:26:24,970 --> 00:26:27,470 getting muscle tension. But I'm not sure people 579 00:26:27,470 --> 00:26:30,030 are monitoring those and, or if they do recognise 580 00:26:30,030 --> 00:26:31,430 them, sometimes they're ignoring them. 581 00:26:31,510 --> 00:26:33,990 >> Rachel Morris: And I've just had this real realisation as I've 582 00:26:33,990 --> 00:26:36,190 been talking to you because this burnout cliff is 583 00:26:36,190 --> 00:26:38,030 really interesting and you have it in the Burke as 584 00:26:38,030 --> 00:26:39,670 you know, you're this wiggly line you go along and 585 00:26:39,670 --> 00:26:42,510 then suddenly you go into burnout. Because the 586 00:26:42,510 --> 00:26:44,910 question I've had for a long time is, okay, why 587 00:26:44,910 --> 00:26:48,270 are so many doctors able to work in burnout when 588 00:26:48,270 --> 00:26:50,350 the traditional advice is their performance will 589 00:26:50,350 --> 00:26:54,420 go down? You know, so you can't perform if you're 590 00:26:54,420 --> 00:26:57,140 in burnout, yet they are still just about 591 00:26:57,140 --> 00:26:57,740 performing. 592 00:26:57,980 --> 00:27:00,500 >> Dr. Richard Duggins: That's right. And I think it's um. There's two 593 00:27:00,500 --> 00:27:02,500 people I think of in the kind of history of 594 00:27:02,500 --> 00:27:05,140 burnout that I often go back to. And the first one 595 00:27:05,140 --> 00:27:07,820 is he's got a wonderful name. It's Dr. Herbert 596 00:27:07,820 --> 00:27:10,580 Freudenberger. And he was a psychoanalyst in New 597 00:27:10,580 --> 00:27:14,620 York in the 1960s and he burnt out. Um, and then 598 00:27:14,620 --> 00:27:17,010 he coined the phrase to describe his burnout. And 599 00:27:17,010 --> 00:27:20,540 um, and he, he was doing a public addictions 600 00:27:20,540 --> 00:27:22,260 clinic during the day and doing a private clinic 601 00:27:22,260 --> 00:27:24,460 at night and too much for too long with too little 602 00:27:24,460 --> 00:27:29,020 support. And he coined the word burnout because it 603 00:27:29,020 --> 00:27:31,340 reminded him of what he was seeing in New York at 604 00:27:31,340 --> 00:27:33,980 that time, which was the uh, burnt out buildings. 605 00:27:34,220 --> 00:27:36,220 And he said if you look at a burnt out building, 606 00:27:36,220 --> 00:27:39,180 it looks okay from the outside, but inside there's 607 00:27:39,180 --> 00:27:41,980 a kind of desolation and emptiness. And he said 608 00:27:42,060 --> 00:27:45,500 that's what I feel like. People look at me, they 609 00:27:45,820 --> 00:27:50,380 think I'm fine, but inside feel terrible. Uh, and 610 00:27:50,380 --> 00:27:53,420 that is, I think the burnt out clinician at work. 611 00:27:54,140 --> 00:27:57,020 They're protecting their work, they look okay, but 612 00:27:57,020 --> 00:27:59,580 inside something really quite serious is going on. 613 00:27:59,820 --> 00:28:02,940 But when the straw that breaks the commands back 614 00:28:02,940 --> 00:28:04,820 and they need to take time off work, it sometimes 615 00:28:04,820 --> 00:28:07,020 takes them by surprise, but almost always takes 616 00:28:07,020 --> 00:28:08,660 their colleagues by surprise. They don't see it 617 00:28:08,660 --> 00:28:11,220 coming. The other key name is the name you've 618 00:28:11,220 --> 00:28:13,460 already mentioned, Professor Christina Mashlak, 619 00:28:13,460 --> 00:28:15,940 who Did the Mashlak inventory. And she described 620 00:28:15,940 --> 00:28:19,540 burnout as three things. So I think at that stage 621 00:28:19,540 --> 00:28:22,140 she didn't talk about performance, but what she 622 00:28:22,140 --> 00:28:25,780 talked about is emotional exhaustion. So that kind 623 00:28:25,780 --> 00:28:28,260 of absolutely exhaust. At the end of the day all 624 00:28:28,260 --> 00:28:30,140 you can do is sit on the sofa and have a glass of 625 00:28:30,140 --> 00:28:33,460 wine and fall asleep. Emotional detachment. So 626 00:28:33,460 --> 00:28:36,420 that kind of robotic kind of compassion fatigue 627 00:28:36,420 --> 00:28:38,100 feel not there for your colleagues and your 628 00:28:38,100 --> 00:28:40,540 patients. And then the third thing she said was a 629 00:28:40,540 --> 00:28:43,340 loss of joy in work. So that kind of where you 630 00:28:43,340 --> 00:28:47,460 don't feel that joy that brought us into medicine 631 00:28:47,460 --> 00:28:49,260 or these high stress professions, you don't feel 632 00:28:49,260 --> 00:28:51,980 those small wins anymore. And lots of people have 633 00:28:51,980 --> 00:28:54,580 those three symptoms and are still at work and 634 00:28:54,580 --> 00:28:57,420 manage it. And it's only, I think much later in 635 00:28:57,420 --> 00:29:00,660 the burnout kind of well worn path that you get 636 00:29:00,660 --> 00:29:03,500 the drop in work performance. But because people 637 00:29:03,500 --> 00:29:06,300 stay off so long, you get a sudden drop, you get 638 00:29:06,300 --> 00:29:09,220 this kind of slow burnout and then a very quick 639 00:29:09,220 --> 00:29:09,770 burnout. 640 00:29:10,080 --> 00:29:11,760 >> Rachel Morris: And this is diagramming in your book that you've 641 00:29:11,760 --> 00:29:14,440 got this plateau, um, which is slowly going down, 642 00:29:14,440 --> 00:29:15,880 which is your performance and then suddenly the 643 00:29:15,880 --> 00:29:18,360 burnout cliff where it suddenly drops down. But 644 00:29:18,360 --> 00:29:20,000 what really struck me about what you said, 645 00:29:20,000 --> 00:29:22,880 Richard, is that actually your performance isn't 646 00:29:22,960 --> 00:29:25,759 carrying on well. Your performance at work is. So 647 00:29:25,759 --> 00:29:28,240 you protect your work. But if you look at your 648 00:29:28,240 --> 00:29:30,160 performance at home, so I've drawn another wiggly 649 00:29:30,160 --> 00:29:33,360 line underneath and that is your relationships, 650 00:29:33,760 --> 00:29:36,240 that's your thriving in life, that's your family 651 00:29:36,320 --> 00:29:39,520 life, that's any friendships, your exercise, your 652 00:29:39,520 --> 00:29:41,860 well being, all that, your performance in, of 653 00:29:41,860 --> 00:29:43,580 thriving in life, well that is starting to go 654 00:29:43,580 --> 00:29:46,460 down. And you'll, you'll drop all of those. As 655 00:29:46,460 --> 00:29:49,380 long as you are protecting your work. Well, 656 00:29:49,380 --> 00:29:50,980 thinking well, I can't be burnt out because I'm 657 00:29:50,980 --> 00:29:53,700 still performing fine even though like you said, 658 00:29:53,780 --> 00:29:55,900 joy has completely gone. You're this hollow empty 659 00:29:55,900 --> 00:29:58,020 shell with nothing in your life but work. Because 660 00:29:58,020 --> 00:29:59,900 you've given up doing anything that brings you 661 00:29:59,900 --> 00:30:02,020 happiness, joy or whatever so that you can protect 662 00:30:02,020 --> 00:30:04,340 your performance at work. And then something 663 00:30:04,500 --> 00:30:06,780 happens, the straw that breaks the camel's back, 664 00:30:06,780 --> 00:30:10,460 be it a complaint or a tricky patient or a 665 00:30:10,460 --> 00:30:11,980 colleague going off sick or maybe something 666 00:30:11,980 --> 00:30:14,680 happening at home and then sudd oomph, your 667 00:30:14,680 --> 00:30:16,880 performance everywhere plummets. Is that a good 668 00:30:17,120 --> 00:30:19,760 interpretation of what you've said? 669 00:30:19,840 --> 00:30:22,360 >> Dr. Richard Duggins: Yeah, I mean it's exactly right. And that's what 670 00:30:22,360 --> 00:30:25,880 we see. We see people protecting work at ah, far 671 00:30:25,880 --> 00:30:29,799 too heavy a cost to them personally, um, and to 672 00:30:29,799 --> 00:30:33,000 their families and ultimately to work. So you 673 00:30:33,000 --> 00:30:35,720 might see somebody. In fact, um, I'm thinking 674 00:30:35,720 --> 00:30:39,160 about somebody who example of somebody who's just 675 00:30:39,160 --> 00:30:41,100 had a baby, but they've also just had a promotion. 676 00:30:41,570 --> 00:30:44,210 So that's great. These are great things. But 677 00:30:44,210 --> 00:30:47,810 massive increase in home and work stress because 678 00:30:47,810 --> 00:30:50,610 they've had a promotion. They've also changed line 679 00:30:50,610 --> 00:30:52,730 manager, and the new line manager isn't very 680 00:30:52,730 --> 00:30:54,730 supportive. They're expecting them to get on with 681 00:30:54,730 --> 00:30:58,850 it. So there's been a decrease in support. But the 682 00:30:58,850 --> 00:31:01,850 way they manage that is focusing on work, so 683 00:31:01,850 --> 00:31:04,850 working really hard, focusing at home, but 684 00:31:05,090 --> 00:31:07,930 absolutely no time anymore for themselves. So 685 00:31:07,930 --> 00:31:10,930 they've stopped running, they've stopped seeing 686 00:31:10,930 --> 00:31:14,140 their friends. Um, they become more isolated. They 687 00:31:14,140 --> 00:31:15,780 don't come out of their office much, so they're 688 00:31:15,780 --> 00:31:17,480 not talking to their colleagues unless it's in, 689 00:31:17,480 --> 00:31:19,780 uh, a teams meeting. And they're not doing 690 00:31:19,780 --> 00:31:22,260 anything fun at work or enjoyable or stimulating. 691 00:31:22,420 --> 00:31:26,100 And that's where it tips. So you get a change, and 692 00:31:26,100 --> 00:31:28,940 then the way people manage that change gets things 693 00:31:28,940 --> 00:31:30,260 even more out of balance. 694 00:31:30,660 --> 00:31:33,020 >> Rachel Morris: That makes a lot of sense. And the problem is that 695 00:31:33,020 --> 00:31:35,100 just the time where you are being promoted, where 696 00:31:35,100 --> 00:31:36,580 you are taking on leadership experience, often 697 00:31:36,580 --> 00:31:39,610 coincides with, with life stuff going on. Babies, 698 00:31:39,850 --> 00:31:43,570 kids, teenagers, elderly, parents, all that, all 699 00:31:43,570 --> 00:31:45,250 that sort of stuff. So you can see there's a lot 700 00:31:45,250 --> 00:31:47,850 of things that are going to break the camel's 701 00:31:47,850 --> 00:31:49,690 back, as it were. And you also talk about 702 00:31:49,690 --> 00:31:51,490 curveballs in the book. Are these things that will 703 00:31:51,490 --> 00:31:53,850 also, like, plummet you down that cliff quicker? 704 00:31:53,930 --> 00:31:56,970 >> Dr. Richard Duggins: Yeah, absolutely. And I talk about these because a 705 00:31:56,970 --> 00:31:59,330 lot of people who come m and see me in these 706 00:31:59,330 --> 00:32:01,570 conversations, the conversation initially is all 707 00:32:01,570 --> 00:32:04,490 about work, and work is really important. And they 708 00:32:04,490 --> 00:32:07,840 probably wouldn't be seeing me unless things were 709 00:32:07,840 --> 00:32:10,840 very demanding at work. But there's also often 710 00:32:10,840 --> 00:32:13,880 things at home. And it's only home only comes in 711 00:32:13,880 --> 00:32:15,680 when I often ask about it. Well, you know what's 712 00:32:15,680 --> 00:32:18,800 happening at home. And I talk about curveballs 713 00:32:18,800 --> 00:32:21,320 because there's typically kind of four home 714 00:32:21,320 --> 00:32:24,440 curveballs that are important, but also we can 715 00:32:24,440 --> 00:32:27,440 have strategies to manage. And, um, these 716 00:32:27,440 --> 00:32:30,800 curveballs come from interpersonal therapy, a type 717 00:32:30,800 --> 00:32:33,560 of therapy that, um, I'm trained in. But the big 718 00:32:33,560 --> 00:32:36,850 curveballs to watch out for are, uh, changes. So 719 00:32:36,850 --> 00:32:39,090 has something changed at home? So the example I 720 00:32:39,090 --> 00:32:41,890 gave there, new baby, big change at home, moving 721 00:32:41,890 --> 00:32:42,810 house would be one. 722 00:32:42,810 --> 00:32:44,570 >> Rachel Morris: Even though it's a positive change, it's 723 00:32:44,570 --> 00:32:46,010 emotionally very draining, right? 724 00:32:46,010 --> 00:32:49,530 >> Dr. Richard Duggins: Yeah, absolutely, yes. So lots and lots of changes 725 00:32:49,530 --> 00:32:51,969 happen in people's lives. Um, caring, 726 00:32:51,969 --> 00:32:54,650 responsibilities, as you've said, um, the 727 00:32:54,650 --> 00:32:56,930 menopause is a Massive, massive physical change. 728 00:32:57,250 --> 00:32:59,250 So the other things going on is maybe 729 00:32:59,250 --> 00:33:02,450 disagreements at work, but disagreements at home. 730 00:33:02,690 --> 00:33:04,850 So, you know, if you're working very hard, very 731 00:33:04,850 --> 00:33:07,130 long hours, things can often be a bit difficult at 732 00:33:07,130 --> 00:33:10,070 home. How do you manage those disagreements at 733 00:33:10,070 --> 00:33:12,710 home? With a partner or sometimes with parents or 734 00:33:12,710 --> 00:33:14,670 sometimes with children. They're very stressful. 735 00:33:14,670 --> 00:33:17,630 >> Rachel Morris: Yeah, just say that. I had some friends who, 736 00:33:17,710 --> 00:33:19,430 there's a massive dispute going on with their 737 00:33:19,430 --> 00:33:22,070 neighbours and that, uh, I, uh, couldn't quite 738 00:33:22,070 --> 00:33:24,110 work out why it was affecting them so much. I 739 00:33:24,110 --> 00:33:25,790 mean, it's not very nice thing to happen, but it 740 00:33:25,790 --> 00:33:27,590 absolutely knocked them sideways for six months. 741 00:33:27,590 --> 00:33:30,270 They couldn't think or talk about anything else. 742 00:33:30,350 --> 00:33:32,830 So it's a big thing, isn't it? Whether it's with 743 00:33:32,910 --> 00:33:36,310 parents, families, partners or neighbours or 744 00:33:36,310 --> 00:33:37,550 anything else, really, and. 745 00:33:37,550 --> 00:33:40,210 >> Dr. Richard Duggins: Absolutely. And you throw that in along a very 746 00:33:40,210 --> 00:33:42,370 busy job or a job where you're not particularly 747 00:33:42,370 --> 00:33:44,450 supportive of, that will be the thing that will 748 00:33:44,450 --> 00:33:47,250 tip it. So we've got change disputes. The third 749 00:33:47,250 --> 00:33:51,290 one is bereavement and natural process losing 750 00:33:51,290 --> 00:33:54,010 people. Natural process grief. But do we ever 751 00:33:54,010 --> 00:33:56,450 allow any time for it in healthcare? Sometimes you 752 00:33:56,450 --> 00:33:58,330 might get five days off or something like that. 753 00:33:58,410 --> 00:34:01,450 And people are expected to work just the same 754 00:34:01,450 --> 00:34:05,450 alongside being bereaved. And that is a very big 755 00:34:05,450 --> 00:34:10,240 ask and often not very possible. And then, um, the 756 00:34:10,240 --> 00:34:13,480 fourth curveball I put in is loneliness. 757 00:34:13,880 --> 00:34:16,000 >> Dr. Richard Duggins: And this is something we don't talk 758 00:34:16,000 --> 00:34:18,520 >> Dr. Richard Duggins: about a great deal within high stress professions. 759 00:34:18,760 --> 00:34:21,800 >> Dr. Richard Duggins: But we do see people can become quite isolated 760 00:34:21,879 --> 00:34:23,240 because of how many hours 761 00:34:23,240 --> 00:34:25,240 >> Dr. Richard Duggins: they're working and how intense they're working. 762 00:34:25,560 --> 00:34:28,600 >> Dr. Richard Duggins: But a group that I particularly think about here 763 00:34:28,600 --> 00:34:31,200 are, uh, international healthcare graduates who 764 00:34:31,200 --> 00:34:33,579 are coming over to the uk. It's a wonderful 765 00:34:33,579 --> 00:34:36,379 opportunity to come over here and develop their 766 00:34:36,379 --> 00:34:39,259 career. But they're quite isolated and expecting 767 00:34:39,259 --> 00:34:42,219 to do really difficult work without the normal 768 00:34:42,219 --> 00:34:45,259 support. So isolation can be really important. We 769 00:34:45,259 --> 00:34:48,419 can really feel it when we've got a good friend we 770 00:34:48,419 --> 00:34:52,179 rely on. Um, a good buddy moves away, you know, 771 00:34:52,179 --> 00:34:55,459 that can be the difference. Um, so isolation is a 772 00:34:55,459 --> 00:34:57,459 really important curveball to think about as well. 773 00:34:57,539 --> 00:34:59,269 >> Rachel Morris: If you can tell someone's heading towards that, 774 00:34:59,420 --> 00:35:02,780 that, that burnout cliff. How do we get people to, 775 00:35:02,780 --> 00:35:06,860 to take action? Because I'm presuming most people 776 00:35:06,860 --> 00:35:08,380 leave it till it's too late. 777 00:35:08,620 --> 00:35:09,900 >> Dr. Richard Duggins: They do. They do. 778 00:35:09,900 --> 00:35:12,180 >> Rachel Morris: Or leave it too late. Not till it's too late. 779 00:35:12,180 --> 00:35:13,020 Nothing's ever too late. 780 00:35:13,020 --> 00:35:14,500 >> Dr. Richard Duggins: No, nothing's. No. And, And. 781 00:35:14,500 --> 00:35:14,980 >> Dr. Richard Duggins: Absolutely. 782 00:35:14,980 --> 00:35:18,500 >> Dr. Richard Duggins: And people, people come forward to services for 783 00:35:18,500 --> 00:35:20,980 support when they're very burnt out. They're, you 784 00:35:20,980 --> 00:35:22,900 know, they're anxious, they're depressed and they 785 00:35:22,900 --> 00:35:24,900 still do really well, you know, I mean, it's 786 00:35:24,900 --> 00:35:28,220 important message here. But yes, we can avoid an 787 00:35:28,220 --> 00:35:32,320 awful lot of distress for our colleagues, our 788 00:35:32,320 --> 00:35:35,600 organisation, if we come forward earlier. The 789 00:35:35,600 --> 00:35:38,360 group that are really good at coming forward 790 00:35:38,360 --> 00:35:40,200 earlier are the people who've burnt out 791 00:35:40,440 --> 00:35:44,520 previously. And, um, I love seeing people who've 792 00:35:44,520 --> 00:35:48,960 burnt out earlier in my clinic because they say, 793 00:35:48,960 --> 00:35:51,360 I'm coming forward because I'm starting to feel 794 00:35:51,360 --> 00:35:53,320 these symptoms of, uh, problem stress. They've 795 00:35:53,320 --> 00:35:55,680 been with me for a few weeks now. I'm, um, a bit 796 00:35:55,680 --> 00:35:57,480 worried because I'm not kind of caring quite as 797 00:35:57,480 --> 00:35:59,880 much my patients. I used to feel a bit robotic. 798 00:36:00,270 --> 00:36:02,310 I'm not going down the route to burnout again. I'm 799 00:36:02,310 --> 00:36:04,990 coming forward for some support and that's exactly 800 00:36:05,070 --> 00:36:07,630 the great thing to do. So what would be wonderful 801 00:36:07,630 --> 00:36:09,550 and one of the motivations for writing the book 802 00:36:09,790 --> 00:36:14,030 was can people do that? Can people learn from all 803 00:36:14,030 --> 00:36:17,110 of the people who come forward later to come 804 00:36:17,110 --> 00:36:18,870 forward earlier? Because if you come forward 805 00:36:18,870 --> 00:36:19,670 earlier, it's 806 00:36:19,670 --> 00:36:22,950 >> Dr. Richard Duggins: much easier to get things back in balance, to 807 00:36:22,950 --> 00:36:25,070 balance out, uh, your radiators and drains, to 808 00:36:25,390 --> 00:36:29,080 make changes that protect you from burnout. It's 809 00:36:29,080 --> 00:36:30,880 much easier, it's much more effective, it's much 810 00:36:30,880 --> 00:36:33,280 quicker and it's much less disruptive to everyone. 811 00:36:33,520 --> 00:36:37,600 But it's something about self monitoring, uh, it's 812 00:36:37,600 --> 00:36:40,240 about recognising those symptoms. But m equally 813 00:36:40,240 --> 00:36:42,800 important, it's about taking those symptoms 814 00:36:42,800 --> 00:36:46,600 seriously. Don't just ignore them and keep calm 815 00:36:46,600 --> 00:36:49,040 and carry on. Don't just keep swimming, stop, 816 00:36:49,360 --> 00:36:52,400 reflect, but also act, do something about it. 817 00:36:52,720 --> 00:36:55,600 >> Rachel Morris: I think people put off coming A because they're 818 00:36:55,600 --> 00:36:58,070 not recognising it and because everyone is in the 819 00:36:58,070 --> 00:36:59,990 same boat as them, everyone's working in burnout. 820 00:37:00,230 --> 00:37:03,110 B, they think they're only deserving of treatment 821 00:37:03,110 --> 00:37:06,590 when they are in full burnout. Actually, no one 822 00:37:06,590 --> 00:37:08,710 wants to see me now. And to be honest, there have 823 00:37:08,710 --> 00:37:11,150 been anecdotal reports from people that written 824 00:37:11,150 --> 00:37:13,870 in, um, the podcast saying, well, I was feeling 825 00:37:13,870 --> 00:37:15,390 really stressed and overwhelmed. I went to see 826 00:37:15,390 --> 00:37:16,870 occupational health. They said, the only thing we 827 00:37:16,870 --> 00:37:18,750 can do is sign you off. That was it. Or they said 828 00:37:18,750 --> 00:37:21,550 the GP goes. And to be honest, with most GPT, 829 00:37:21,550 --> 00:37:23,270 anything they can do is say, well, do you want to 830 00:37:23,270 --> 00:37:25,510 take time off? They can point people towards, 831 00:37:25,510 --> 00:37:27,640 well, there's practitioner health and there's some 832 00:37:27,640 --> 00:37:30,080 other services, but they themselves, that is the 833 00:37:30,080 --> 00:37:32,800 only. They don't have time in 10 minutes to go 834 00:37:32,800 --> 00:37:34,640 through, okay, let's look at your radiators and 835 00:37:34,640 --> 00:37:37,400 drains and Coping mechanisms and all that sort of 836 00:37:37,400 --> 00:37:39,600 stuff. So people are very fearful that they're 837 00:37:39,600 --> 00:37:41,200 told, they're just going to be told to take time 838 00:37:41,200 --> 00:37:42,800 off and then they'll be going about against 839 00:37:42,800 --> 00:37:45,480 medical advice. And I think it's a real conundrum 840 00:37:45,480 --> 00:37:46,880 because we've seen, if you look at the stress 841 00:37:46,880 --> 00:37:49,320 curve, I think if you're going to get some help 842 00:37:49,320 --> 00:37:51,920 when you're at stress and just before overwhelm 843 00:37:52,000 --> 00:37:54,560 and someone tells you to take time off, then 844 00:37:54,560 --> 00:37:57,560 actually sometimes, sometimes it's absolutely what 845 00:37:57,560 --> 00:37:59,600 they need to do, but sometimes it's like the last 846 00:37:59,600 --> 00:38:01,840 thing you want to do and it'll make things a lot 847 00:38:01,840 --> 00:38:04,560 worse for you. Yes, you need to rest and make some 848 00:38:04,560 --> 00:38:07,040 changes. But this prolonged time time off that 849 00:38:07,040 --> 00:38:08,880 most people are just told to do as a sort of 850 00:38:08,880 --> 00:38:11,680 panacea for burnout management, that's just like, 851 00:38:11,760 --> 00:38:13,960 that's not going to work for me. Right. Right now. 852 00:38:13,960 --> 00:38:17,240 And so let's wait until I 100% can't actually go 853 00:38:17,240 --> 00:38:19,520 into work just to be told to take time off. Now, I 854 00:38:19,520 --> 00:38:21,000 know I'm being a little bit harsh, but I think 855 00:38:21,000 --> 00:38:23,040 that's genuinely some of the experiences of our 856 00:38:23,040 --> 00:38:23,370 listeners. 857 00:38:23,920 --> 00:38:27,840 >> Dr. Richard Duggins: Yeah, And I've heard people report that to me as 858 00:38:27,840 --> 00:38:32,240 well. And um, who've gone to other services and 859 00:38:32,250 --> 00:38:35,800 um, other services are limited. They haven't got 860 00:38:35,800 --> 00:38:39,640 the knowledge. I mean, we're still quite early 861 00:38:39,640 --> 00:38:41,840 with our understanding of burnout, I think, and 862 00:38:41,840 --> 00:38:44,800 it's not, you know, it's not greatly understood. 863 00:38:45,130 --> 00:38:47,160 Um, it's still not considered a medical condition. 864 00:38:47,160 --> 00:38:50,720 I don't really understand that. But it isn't. So I 865 00:38:50,720 --> 00:38:51,440 think you're right. 866 00:38:51,520 --> 00:38:54,520 >> Dr. Richard Duggins: But what I would say is that if you can come 867 00:38:54,520 --> 00:38:57,460 forward early, it is much easier. It's what you 868 00:38:57,460 --> 00:39:00,260 should be doing. To take examples of us as 869 00:39:00,260 --> 00:39:03,180 doctors, we don't really say to our patients, 870 00:39:03,500 --> 00:39:06,620 let's not sort this out early on while it's mild. 871 00:39:06,700 --> 00:39:08,940 Let's just come back when it's really, really bad 872 00:39:08,940 --> 00:39:11,620 and then we'll tackle it. Because it's much easier 873 00:39:11,620 --> 00:39:15,300 to sort things out when they are mild and you'll 874 00:39:15,300 --> 00:39:18,500 need much less input and there's a greater range 875 00:39:18,500 --> 00:39:20,660 of people who can help you when it's mild. And, 876 00:39:20,660 --> 00:39:23,380 uh, it may not be that you want to come through to 877 00:39:23,380 --> 00:39:26,940 service. You might want to do some coaching or you 878 00:39:27,320 --> 00:39:29,440 have some peer support or things like that. There 879 00:39:29,440 --> 00:39:32,320 can be other things. So it is, you know, I would 880 00:39:32,320 --> 00:39:33,640 say it's really important people. 881 00:39:33,800 --> 00:39:36,280 >> Rachel Morris: I mean, this is why we have our Shapes toolkit 882 00:39:36,280 --> 00:39:38,440 system, because we think there is nothing between 883 00:39:38,520 --> 00:39:41,440 stress and burnout for people, often even to help 884 00:39:41,440 --> 00:39:44,120 themselves. Because with the best in the world, 885 00:39:44,120 --> 00:39:46,080 getting an appointment to talk to people, that 886 00:39:46,080 --> 00:39:48,280 might be a few, few days away or even a few weeks 887 00:39:48,280 --> 00:39:50,840 away. But there are things that we know help, like 888 00:39:51,160 --> 00:39:53,120 staying in your zone of control, your zone of 889 00:39:53,120 --> 00:39:54,600 power, working out what you're in control of, what 890 00:39:54,600 --> 00:39:57,240 you're not, actually facing reality, having 891 00:39:57,240 --> 00:39:59,070 conversations, learning to put some boundaries 892 00:39:59,140 --> 00:40:01,540 around your time and workload, things like that, 893 00:40:01,940 --> 00:40:03,780 which are really, really helpful and can just pull 894 00:40:03,780 --> 00:40:05,780 you back up that curve and away from the burnout 895 00:40:05,780 --> 00:40:06,980 cliff. Yeah. 896 00:40:07,060 --> 00:40:09,140 >> Dr. Richard Duggins: And if you act early, I don't know where this 897 00:40:09,140 --> 00:40:10,740 metaphor worked, but sometimes I think of it a bit 898 00:40:10,740 --> 00:40:13,660 like driving a car, that if you steer a little bit 899 00:40:13,660 --> 00:40:15,820 and use your brake a little bit, that's how you 900 00:40:15,820 --> 00:40:17,900 drive. What you don't drive is wait until you hit 901 00:40:17,900 --> 00:40:21,060 the corner and then just go like that and slam 902 00:40:21,060 --> 00:40:25,060 your brake on. So actually, if you do, if you do 903 00:40:25,060 --> 00:40:26,940 take things seriously and you do monitor things 904 00:40:26,940 --> 00:40:29,250 and you do come forward and make the sort of 905 00:40:29,250 --> 00:40:31,130 changes that you're suggesting, they often don't 906 00:40:31,130 --> 00:40:33,290 need to be massive changes. What you want to be 907 00:40:33,290 --> 00:40:35,770 doing is self correcting and making these small 908 00:40:35,770 --> 00:40:38,450 changes and learning these small, these ways of 909 00:40:38,450 --> 00:40:40,090 doing it, um, early on. 910 00:40:40,330 --> 00:40:43,010 >> Rachel Morris: So what do you wish your patients had done or been 911 00:40:43,010 --> 00:40:45,530 able to do or had support to do to self correct 912 00:40:45,690 --> 00:40:46,090 early? 913 00:40:46,410 --> 00:40:50,530 >> Dr. Richard Duggins: Well, what I see people doing, uh, when they 914 00:40:50,530 --> 00:40:54,040 recover, I mean, it's individual and it's. But I 915 00:40:54,040 --> 00:40:57,040 think there's five key things that I see people 916 00:40:57,040 --> 00:41:01,000 do. The first one is that if their 917 00:41:01,000 --> 00:41:04,800 >> Dr. Richard Duggins: basic needs are out of whack, they do something 918 00:41:04,800 --> 00:41:08,040 to, uh, attend to it. So that is, if they are 919 00:41:08,040 --> 00:41:11,040 working massive hours, intense hours, they're not 920 00:41:11,040 --> 00:41:13,240 getting any time to talk to their colleagues, not 921 00:41:13,240 --> 00:41:16,480 taking their annual leave, or if it's something at 922 00:41:16,480 --> 00:41:18,600 home that is out of whack, they try and address 923 00:41:18,600 --> 00:41:21,690 it. Because the danger is if you take time off and 924 00:41:21,690 --> 00:41:24,130 you come forward for help, you will get better. 925 00:41:24,130 --> 00:41:27,930 But if you go back to the same problems, it only 926 00:41:27,930 --> 00:41:30,650 lasts so long. And there's good research evidence 927 00:41:30,650 --> 00:41:34,210 that shows that too. So I think if it is about 928 00:41:34,210 --> 00:41:36,850 basic needs that are making you become unwell, 929 00:41:37,010 --> 00:41:39,370 then you need to address it. The second one is 930 00:41:39,370 --> 00:41:41,690 decompression activities. So this is the idea that 931 00:41:41,690 --> 00:41:44,290 stress builds upon us every day. So we need to do 932 00:41:44,290 --> 00:41:47,520 something regularly to manage that stress. And 933 00:41:47,760 --> 00:41:50,840 that could be something that's active, like 934 00:41:50,840 --> 00:41:54,120 running, joining a choir, or it could be something 935 00:41:54,120 --> 00:41:57,680 that's quieter, a restorative niche, like, um, you 936 00:41:57,680 --> 00:42:00,240 Know, might be reading, might be mindfulness. I've 937 00:42:00,240 --> 00:42:02,000 heard you speak to Paula Redmond. She talks about 938 00:42:02,000 --> 00:42:04,720 knitting. You know, these are all really important 939 00:42:04,800 --> 00:42:06,480 things and they're different for different people. 940 00:42:06,880 --> 00:42:08,680 So you know, don't listen to somebody who says, 941 00:42:08,680 --> 00:42:10,320 oh, you should go running if that's not what you 942 00:42:10,320 --> 00:42:10,800 want to do. 943 00:42:10,960 --> 00:42:12,160 >> Rachel Morris: My m. Idea of hell. 944 00:42:13,710 --> 00:42:17,040 >> Dr. Richard Duggins: But do do something that you like to do that. Now, 945 00:42:17,040 --> 00:42:20,430 um, Matt Morgan is an ICU consultant. I love the 946 00:42:20,430 --> 00:42:22,390 way Matt Morgan talks about this. So he talks 947 00:42:22,390 --> 00:42:25,030 about early on in his consultant career he was 948 00:42:25,030 --> 00:42:28,710 sort of soaking up this stress and he, and he 949 00:42:28,710 --> 00:42:30,990 found himself perhaps drinking a little bit too 950 00:42:30,990 --> 00:42:34,310 much or more than he wanted to and uh, also being 951 00:42:34,310 --> 00:42:37,310 a bit irritable. And he talks about the idea of 952 00:42:37,310 --> 00:42:39,590 what he discovered, which a kind of brainwave came 953 00:42:39,590 --> 00:42:42,300 to him when he had his. He was kind of um, bathing 954 00:42:42,300 --> 00:42:44,940 his young children. Uh, and he talked about 955 00:42:44,940 --> 00:42:47,580 squeezing the sponge. And he said the idea that 956 00:42:47,580 --> 00:42:51,220 came to him was that um, at work he was like a 957 00:42:51,220 --> 00:42:54,380 sponge for stress and he was filling up and 958 00:42:54,380 --> 00:42:57,220 filling up with stress and because he was 959 00:42:57,220 --> 00:42:59,900 >> Dr. Richard Duggins: over full, that he wasn't coping very well. He was 960 00:43:00,140 --> 00:43:02,660 taking out on other people sometimes. But he said 961 00:43:02,660 --> 00:43:06,300 what he learned was that to be a consultant and 962 00:43:06,300 --> 00:43:09,020 sustain his career, he needed to regularly squeeze 963 00:43:09,020 --> 00:43:11,700 the sponge. He needed to do something to get the 964 00:43:11,700 --> 00:43:15,880 stress out of him. Uh, he talks about the various 965 00:43:16,040 --> 00:43:18,600 kind of activities that he made routine within his 966 00:43:18,600 --> 00:43:20,960 week, um, to manage his career. That's a really 967 00:43:20,960 --> 00:43:21,400 good one. 968 00:43:21,640 --> 00:43:25,420 >> Dr. Richard Duggins: The other thing is, um, social support. So, um, 969 00:43:25,420 --> 00:43:28,480 having your support team, knowing who's there for 970 00:43:28,480 --> 00:43:32,160 you at work and home and uh, really reaching out 971 00:43:32,160 --> 00:43:34,600 for people. And it's not just about a shoulder to 972 00:43:34,600 --> 00:43:38,120 cry on, just those normal kind of everyday social 973 00:43:38,120 --> 00:43:41,400 activities alongside people. Those chats before 974 00:43:41,400 --> 00:43:43,720 and after meetings, those chats in the coffee 975 00:43:43,720 --> 00:43:46,620 room, or those just those chats down the pub or in 976 00:43:46,620 --> 00:43:49,420 a coffee room are really, really important for our 977 00:43:49,420 --> 00:43:53,300 health. The fourth thing is a don't do, which is 978 00:43:53,940 --> 00:43:58,780 to avoid false cures, to avoid um, things that are 979 00:43:58,780 --> 00:44:02,660 unhelpful, like drinking too much. Um, you know, 980 00:44:02,660 --> 00:44:05,260 I'm seeing effect. Some professionals are using 981 00:44:05,260 --> 00:44:07,780 gambling. And this is a way of kind of taking you 982 00:44:07,780 --> 00:44:10,580 out of things, but it doesn't solve the underlying 983 00:44:10,580 --> 00:44:13,540 problem and can become in time a bigger problem 984 00:44:13,780 --> 00:44:16,980 than the underlying problem. And then the fifth 985 00:44:16,980 --> 00:44:20,220 thing is what I see people do, and I've mentioned 986 00:44:20,220 --> 00:44:23,180 this already, is they keep calm but they nip 987 00:44:23,180 --> 00:44:26,620 things in the bud. So people get really good at 988 00:44:26,620 --> 00:44:30,660 taking their well being and their mental health 989 00:44:30,740 --> 00:44:34,740 seriously. And they look out for symptoms and 990 00:44:34,740 --> 00:44:36,780 signs in themselves of when things are getting out 991 00:44:36,780 --> 00:44:39,500 of balance and they act quickly to do something 992 00:44:39,500 --> 00:44:42,300 about it. So they don't keep calm and carry on. 993 00:44:42,540 --> 00:44:44,780 They keep calm, nip it in the bud, do something 994 00:44:44,780 --> 00:44:47,700 about it. And, and that is a really rewarding 995 00:44:47,700 --> 00:44:49,100 change to see people make. 996 00:44:49,420 --> 00:44:51,780 >> Rachel Morris: I think we're quite bad at doing that. I'm 997 00:44:51,780 --> 00:44:54,020 thinking of people, friends that I've had in the 998 00:44:54,020 --> 00:44:57,300 past who um, have been quite flaky. Like they 999 00:44:57,300 --> 00:44:59,340 haven't been doctors. Doctors always, you know, 1000 00:44:59,340 --> 00:45:01,060 doctors turn up when they say we will, we'll go 1001 00:45:01,060 --> 00:45:03,470 out when we do it, you know. But some, some non 1002 00:45:03,470 --> 00:45:05,430 doctor friends have been like, I can't come out 1003 00:45:05,430 --> 00:45:07,550 this evening, I'm just feeling a bit tired. And 1004 00:45:07,550 --> 00:45:09,750 I'm like gosh, I would never cancel anything, just 1005 00:45:09,750 --> 00:45:11,910 I'm feeling tired, you know, because like we've 1006 00:45:11,910 --> 00:45:13,590 been programmed that uh, like tired is just 1007 00:45:13,590 --> 00:45:15,430 normal. So you wouldn't, you know. But actually 1008 00:45:15,670 --> 00:45:18,030 looking back, they were nipping it in the bud. 1009 00:45:18,030 --> 00:45:20,990 They're like actually I can't do that tonight 1010 00:45:20,990 --> 00:45:23,390 because I know I don't have the emotional capacity 1011 00:45:23,390 --> 00:45:24,950 for it. I've just cancelled that. I'm not going to 1012 00:45:24,950 --> 00:45:27,710 do that. And yeah, they, they recognise it and 1013 00:45:27,710 --> 00:45:30,170 they do it. But I think in medicine we're like oh 1014 00:45:30,170 --> 00:45:32,770 well I can keep going because I always had and 1015 00:45:32,770 --> 00:45:34,530 when I was younger I did 120 hours a week, 1016 00:45:34,530 --> 00:45:36,970 therefore I can manage that now. And yet it's a 1017 00:45:36,970 --> 00:45:38,410 weird mindset we have, isn't it? 1018 00:45:38,890 --> 00:45:41,210 >> Dr. Richard Duggins: It's interesting, isn't it? Because the other 1019 00:45:41,210 --> 00:45:42,730 thing that we are 1020 00:45:42,730 --> 00:45:44,809 >> Dr. Richard Duggins: quite good at, uh, uh, medics, especially for our 1021 00:45:44,809 --> 00:45:50,370 patients, is taking control and advocating and 1022 00:45:50,370 --> 00:45:53,130 acting. But when it comes to our own wellbeing 1023 00:45:53,290 --> 00:45:54,650 we're not very good at it. 1024 00:45:55,110 --> 00:45:59,030 >> Dr. Richard Duggins: Um, but we have got those medical skills to, you 1025 00:45:59,030 --> 00:46:02,390 know, we're not normally afraid of acting, we make 1026 00:46:02,390 --> 00:46:04,750 difficult decisions but we need to start doing 1027 00:46:04,750 --> 00:46:07,270 that for ourselves. So I think a lot of high 1028 00:46:07,350 --> 00:46:10,110 professionals in high profile jobs have got these 1029 00:46:10,110 --> 00:46:12,910 skills that just haven't yet harboured them for 1030 00:46:12,910 --> 00:46:13,750 their own well being. 1031 00:46:13,830 --> 00:46:15,470 >> Rachel Morris: The other thing, it's just come to me, it's a bit 1032 00:46:15,470 --> 00:46:18,030 of a play on the word acting. Um, we like to get 1033 00:46:18,030 --> 00:46:19,470 into action. We're very good at getting into 1034 00:46:19,470 --> 00:46:21,710 action and solving problems but actually sometimes 1035 00:46:21,710 --> 00:46:25,360 the action that we need is to subtract. So I'm 1036 00:46:25,360 --> 00:46:27,960 just thinking, you know, it's actually very hard 1037 00:46:27,960 --> 00:46:31,080 for me to go, I actually need to sit in my hanging 1038 00:46:31,080 --> 00:46:33,800 pot in the garden for an hour and read and read A 1039 00:46:33,800 --> 00:46:36,040 magazine, that's what I need. I'd be much more, 1040 00:46:36,040 --> 00:46:38,640 but I need to do this, this and the other. So if 1041 00:46:38,640 --> 00:46:41,280 we can change resting and subtraction into an 1042 00:46:41,280 --> 00:46:44,000 action that we know is good for us, maybe we'd be 1043 00:46:44,080 --> 00:46:46,880 more keen to do that. I mean, it's interesting 1044 00:46:46,880 --> 00:46:48,800 you've talked about those five things and actually 1045 00:46:48,880 --> 00:46:52,040 nowhere there have you talked about, about therapy 1046 00:46:52,040 --> 00:46:54,240 and counselling and psychotherapy and stuff. So 1047 00:46:54,240 --> 00:46:56,720 where does that all come in in any of this? 1048 00:46:57,360 --> 00:47:00,920 >> Dr. Richard Duggins: Yeah, no, it's a really good point. So people who 1049 00:47:00,920 --> 00:47:04,360 are coming through are making these changes. Um, 1050 00:47:04,360 --> 00:47:07,160 and I don't think you have to be in therapy or in 1051 00:47:07,160 --> 00:47:09,040 a therapeutic relationship to make these changes, 1052 00:47:09,040 --> 00:47:09,440 but 1053 00:47:09,520 --> 00:47:12,200 >> Dr. Richard Duggins: people are doing that within a therapeutic 1054 00:47:12,200 --> 00:47:14,560 relationship. And I think there is something about 1055 00:47:14,640 --> 00:47:17,640 coming through to a support service or a wellbeing 1056 00:47:17,640 --> 00:47:20,760 service that allows you to stop and reflect and 1057 00:47:20,760 --> 00:47:23,440 think actually things are out of balance. What do 1058 00:47:23,440 --> 00:47:27,080 I need to do to kind of correct this? So that sort 1059 00:47:27,080 --> 00:47:30,080 of therapeutic support can be really helpful in 1060 00:47:30,080 --> 00:47:32,920 helping people reflect, take things seriously, but 1061 00:47:32,920 --> 00:47:35,920 start to make a plan and uh, making those steps 1062 00:47:35,920 --> 00:47:37,320 and goals and focus. 1063 00:47:37,960 --> 00:47:40,520 >> Dr. Richard Duggins: And I don't think that, you know, if you're coming 1064 00:47:40,520 --> 00:47:42,920 through early enough or with burnout, it doesn't 1065 00:47:42,920 --> 00:47:45,880 have to be a long time. You know, you can do that 1066 00:47:45,880 --> 00:47:49,080 within a relatively brief therapy, six to 12 1067 00:47:49,080 --> 00:47:51,940 sessions, uh, you know, maybe even lesser. So 1068 00:47:51,940 --> 00:47:54,860 that's important. Where therapy does come in I 1069 00:47:54,860 --> 00:47:57,900 think is if your burnout's gone on for a long 1070 00:47:57,900 --> 00:48:01,380 time. So if so, some people will be on the 1071 00:48:01,380 --> 00:48:04,500 plateau, will be prioritising their work. They 1072 00:48:04,500 --> 00:48:08,060 become really quite severely burnt out. And if 1073 00:48:08,060 --> 00:48:09,780 you're still at work and you're still under a lot 1074 00:48:09,780 --> 00:48:12,340 of stress, it's reasonably easy for that burnout 1075 00:48:12,340 --> 00:48:15,780 to turn into a, uh, medical condition like anxiety 1076 00:48:15,780 --> 00:48:20,660 or depression. So I'd see it as rather a continuum 1077 00:48:20,660 --> 00:48:23,560 of kind of problem stress to different levels of 1078 00:48:23,560 --> 00:48:26,400 burnout. And then if it's still not managed, you 1079 00:48:26,400 --> 00:48:29,000 run a quite a high risk of developing anxiety or 1080 00:48:29,000 --> 00:48:31,400 depression or physical health complications like 1081 00:48:31,400 --> 00:48:32,320 high blood pressure. 1082 00:48:32,640 --> 00:48:35,280 >> Dr. Richard Duggins: And I think if you're moving into that anxiety 1083 00:48:35,360 --> 00:48:38,480 depression area, then that's where therapy comes 1084 00:48:38,480 --> 00:48:41,720 in. And an evidence based therapy comes in. It may 1085 00:48:41,720 --> 00:48:44,040 also be, and professionals tend to be a bit 1086 00:48:44,040 --> 00:48:46,600 resistant to this. It may also be a conversation 1087 00:48:46,600 --> 00:48:48,560 about, actually if I've got anxiety and 1088 00:48:48,560 --> 00:48:51,480 depression, do I need to consider, um, some 1089 00:48:51,480 --> 00:48:53,830 medication here to treat this? But most anxiety 1090 00:48:54,140 --> 00:48:56,940 depression, the first step would be therapy and it 1091 00:48:56,940 --> 00:49:00,540 would be an evidence based therapy like um, CBT 1092 00:49:00,780 --> 00:49:04,020 >> Dr. Richard Duggins: or IPT would be the top, the top ones in the 1093 00:49:04,020 --> 00:49:04,820 evidence base to. 1094 00:49:04,820 --> 00:49:07,860 >> Rachel Morris: Do most of us know what CBT is? Can you just 1095 00:49:07,860 --> 00:49:09,340 explain what IPP is? 1096 00:49:09,420 --> 00:49:09,900 >> Dr. Richard Duggins: Yeah. 1097 00:49:10,060 --> 00:49:13,220 >> Dr. Richard Duggins: So IPT is, um, a type of 1098 00:49:13,220 --> 00:49:16,300 >> Dr. Richard Duggins: therapy, um, developed for depression. 1099 00:49:16,460 --> 00:49:19,780 >> Dr. Richard Duggins: It is available in the uk. It's available, um, in 1100 00:49:19,780 --> 00:49:20,780 most primary care, 1101 00:49:21,030 --> 00:49:23,860 >> Dr. Richard Duggins: uh, services for anxiety and depression. Um, it's 1102 00:49:23,860 --> 00:49:25,730 also developed in some secondary care. 1103 00:49:26,440 --> 00:49:29,440 >> Dr. Richard Duggins: We have got, uh, IPT specialists within NHS 1104 00:49:29,440 --> 00:49:31,760 Practitioner Health and M within the 1105 00:49:31,760 --> 00:49:33,240 >> Dr. Richard Duggins: service I work in regionally. 1106 00:49:33,400 --> 00:49:36,200 >> Dr. Richard Duggins: It's an interesting, um, therapy because it was 1107 00:49:36,200 --> 00:49:39,760 developed by somebody, um, asking therapists if 1108 00:49:39,760 --> 00:49:42,160 you're treating somebody for depression, what do 1109 00:49:42,160 --> 00:49:44,480 we need to have in this therapy? What's it need to 1110 00:49:44,480 --> 00:49:47,360 look like? And they all wrote a big list. And the 1111 00:49:47,360 --> 00:49:49,560 therapy of IPT was designed upon that. 1112 00:49:50,040 --> 00:49:53,790 >> Dr. Richard Duggins: And, um, CBT tends to be about modifying your 1113 00:49:53,790 --> 00:49:56,990 thoughts, distorted thoughts, um, and then that 1114 00:49:56,990 --> 00:49:57,990 leading to a change in 1115 00:49:57,990 --> 00:49:59,510 >> Dr. Richard Duggins: your feelings and behaviour. 1116 00:49:59,910 --> 00:50:04,150 >> Dr. Richard Duggins: IPT is, um, much more about looking at your social 1117 00:50:04,150 --> 00:50:07,270 support and your relationships and who's there for 1118 00:50:07,270 --> 00:50:12,310 you. And also, um, we talk about, um, in ipt, the 1119 00:50:12,310 --> 00:50:14,070 idea of antidepressant activities. 1120 00:50:14,550 --> 00:50:17,990 >> Dr. Richard Duggins: So often when people become depressed, they stop 1121 00:50:17,990 --> 00:50:20,390 doing the things that are good for them. So they 1122 00:50:20,390 --> 00:50:21,910 become very tired, they think 1123 00:50:21,910 --> 00:50:23,510 >> Dr. Richard Duggins: they're no good, they're not good company 1124 00:50:23,510 --> 00:50:26,030 >> Dr. Richard Duggins: anymore, so they stop seeing friends. They stop 1125 00:50:26,030 --> 00:50:27,750 doing those nice things because they're too 1126 00:50:27,750 --> 00:50:30,270 exhausted to do it. So we focus on people getting 1127 00:50:30,270 --> 00:50:32,030 those things back into their life as well. 1128 00:50:32,350 --> 00:50:35,150 >> Rachel Morris: Okay, that makes a lot of sense. And can I quickly 1129 00:50:35,150 --> 00:50:37,710 ask you about the relationship between anxiety, 1130 00:50:37,870 --> 00:50:40,990 depression and burnout? Do you think that all 1131 00:50:40,990 --> 00:50:43,470 burnout, uh, if it gets severe enough, turns into 1132 00:50:43,710 --> 00:50:44,990 anxiety and depression? 1133 00:50:45,470 --> 00:50:48,860 >> Dr. Richard Duggins: No, I don't think all burnout does. Um, I think 1134 00:50:49,490 --> 00:50:52,570 all problems stress does. So if we start off with 1135 00:50:52,570 --> 00:50:54,490 problem stress, if we're in problem stress for too 1136 00:50:54,490 --> 00:50:57,250 long, we'll become burnt out. And then if we stay 1137 00:50:57,250 --> 00:50:59,410 in burnout too long, we'll become increasingly 1138 00:50:59,410 --> 00:51:03,250 burnt out? Burnout is a spectrum. But some people 1139 00:51:03,490 --> 00:51:06,490 will then, if they're severely burnt out, will 1140 00:51:06,490 --> 00:51:08,970 have a high risk of developing anxiety and 1141 00:51:08,970 --> 00:51:12,250 depression. But not everyone will, but quite a lot 1142 00:51:12,250 --> 00:51:15,370 will. And the longer you are burnt out, the higher 1143 00:51:15,370 --> 00:51:17,450 your risk of developing anxiety and depression. 1144 00:51:18,470 --> 00:51:21,120 >> Rachel Morris: Um, and is the other way round true that if you 1145 00:51:21,120 --> 00:51:24,600 suffer with anxiety and depression anyway, are you 1146 00:51:24,600 --> 00:51:25,920 at high risk of burning out? 1147 00:51:26,240 --> 00:51:29,680 >> Dr. Richard Duggins: I wouldn't say necessarily so, because what 1148 00:51:29,680 --> 00:51:32,360 determines whether you're at risk of burnout is 1149 00:51:32,360 --> 00:51:36,120 what's going on around you. So we burn out because 1150 00:51:36,120 --> 00:51:39,240 of those balances between our radius and the 1151 00:51:39,240 --> 00:51:42,200 drains. Um, you know, when the drains are high and 1152 00:51:42,200 --> 00:51:45,410 the support is low. Our and that is the same for 1153 00:51:45,490 --> 00:51:48,170 everyone. So whether you've got a history of 1154 00:51:48,170 --> 00:51:50,290 anxiety or depression or whether you haven't, 1155 00:51:50,610 --> 00:51:52,690 whether you're going to become burnt out or not is 1156 00:51:52,690 --> 00:51:54,130 because of what's going on around you. 1157 00:51:54,290 --> 00:51:56,770 >> Rachel Morris: And um, what for you would be the red flags that 1158 00:51:56,770 --> 00:51:59,450 someone in burnout is tipping also over into 1159 00:51:59,450 --> 00:52:00,690 anxiety and depression. 1160 00:52:01,090 --> 00:52:04,850 >> Dr. Richard Duggins: So it's the diagnostic factors for um, anxiety and 1161 00:52:04,850 --> 00:52:09,410 depression. So for anxiety it would be feeling 1162 00:52:09,410 --> 00:52:14,690 worry and anxiety over most days for several 1163 00:52:14,690 --> 00:52:18,550 weeks. Know probably over you know to a couple of 1164 00:52:18,550 --> 00:52:21,270 months really. That's kind of. There often goes 1165 00:52:21,270 --> 00:52:24,590 alongside um, physical symptoms such as heart 1166 00:52:24,590 --> 00:52:29,190 racing, sweaty palms, those kind of things. Um, so 1167 00:52:29,190 --> 00:52:32,310 that, that kind of feeling, that protracted 1168 00:52:32,310 --> 00:52:35,030 constant feeling and along alongside those 1169 00:52:35,030 --> 00:52:39,390 physical feelings as well. Depression is a feeling 1170 00:52:39,390 --> 00:52:43,620 of being low or a feeling of not really being able 1171 00:52:43,620 --> 00:52:47,260 to enjoy things most days for at least two weeks. 1172 00:52:48,060 --> 00:52:51,780 Um, and often depression also affects both the way 1173 00:52:51,780 --> 00:52:54,060 that we see the world. So we tend to see the world 1174 00:52:54,060 --> 00:52:57,300 through the opposite of rose tinted glasses. So we 1175 00:52:57,300 --> 00:53:00,460 tend to see the world as viewing us as worthless. 1176 00:53:00,460 --> 00:53:03,220 We might feel guilty, uh, we might lose our 1177 00:53:03,220 --> 00:53:06,620 optimism, um, we might feel hopeless, you know, 1178 00:53:06,640 --> 00:53:10,930 um, thoughts that um, actually I might better the 1179 00:53:10,930 --> 00:53:12,650 world might be better off if I wasn't here or I 1180 00:53:12,650 --> 00:53:14,370 might be better off I wasn't here. Quite common 1181 00:53:14,370 --> 00:53:17,570 within depression. So they're the feelings. But 1182 00:53:17,810 --> 00:53:20,530 the other kind of hard signs to uh, look out for 1183 00:53:20,530 --> 00:53:23,410 are physical signs. So people's sleep goes off, 1184 00:53:23,650 --> 00:53:26,129 there's a change in their appetite either reducing 1185 00:53:26,210 --> 00:53:28,970 or increasing. People often feel worse in the 1186 00:53:28,970 --> 00:53:33,930 mornings, there's a lack of energy. So those are 1187 00:53:33,930 --> 00:53:37,930 kind of key signs to look for for depression. As I 1188 00:53:37,930 --> 00:53:40,450 say you only really need those signs for most days 1189 00:53:40,450 --> 00:53:44,910 for a few and at that stage I would start to 1190 00:53:44,910 --> 00:53:48,750 wonder if I'm depressed and um, might seek further 1191 00:53:48,750 --> 00:53:51,110 advice and treatment for that. It doesn't help to 1192 00:53:51,110 --> 00:53:54,510 ignore those for too long. And if talking therapy 1193 00:53:54,510 --> 00:53:57,310 was the first step, there are some screening tools 1194 00:53:57,310 --> 00:54:01,150 available free um on the web, um and I link to 1195 00:54:01,150 --> 00:54:02,790 them in the book as well. But anyone can find 1196 00:54:02,790 --> 00:54:06,070 them. The PHQ9 for depression, really good 1197 00:54:06,070 --> 00:54:09,264 screening tool, very simple to use and the Gad 6. 1198 00:54:09,316 --> 00:54:12,590 7 is for anxiety. So if you are thinking oh am I 1199 00:54:12,590 --> 00:54:14,950 tipping into anxiety or depression? Just do one of 1200 00:54:14,950 --> 00:54:15,670 those and you'll 1201 00:54:15,670 --> 00:54:17,790 >> Dr. Richard Duggins: get a score and that score will 1202 00:54:17,790 --> 00:54:20,350 >> Dr. Richard Duggins: give you some advice about what to do next. 1203 00:54:20,750 --> 00:54:22,910 >> Rachel Morris: That's really really helpful. We also provide a 1204 00:54:22,910 --> 00:54:24,910 free toolkit called am I stressed, overwhelmed or 1205 00:54:24,910 --> 00:54:27,240 burnt out. And it Contains all the burnout, uh, 1206 00:54:27,240 --> 00:54:29,230 free inventories as well. But what I might do is 1207 00:54:29,230 --> 00:54:33,270 add into that the Gad7 and the PhQ9 that people 1208 00:54:33,270 --> 00:54:35,260 can access just to make sure. And obviously 1209 00:54:35,730 --> 00:54:38,010 getting your book would be really good. But as you 1210 00:54:38,010 --> 00:54:39,650 said that, uh, I'm thinking, well, gosh, it's 1211 00:54:39,650 --> 00:54:41,290 actually very difficult to tell because you get 1212 00:54:41,290 --> 00:54:42,890 fatigue in burnout. You get fatigue and 1213 00:54:42,890 --> 00:54:45,810 depression. You get this sort of cynicism, don't 1214 00:54:45,810 --> 00:54:47,970 you? An emotional detachment in burnout. And then 1215 00:54:47,970 --> 00:54:50,330 you get this hopelessness in depression, which is 1216 00:54:50,330 --> 00:54:52,370 probably why it's so important to actually seek 1217 00:54:52,370 --> 00:54:54,530 professional help. Because they'd be able to sort 1218 00:54:54,530 --> 00:54:56,490 of tease it out and work out what's really going 1219 00:54:56,490 --> 00:54:57,010 on for you. 1220 00:54:57,010 --> 00:54:58,930 >> Dr. Richard Duggins: Yes, and it is important it's teased 1221 00:54:58,930 --> 00:55:02,770 >> Dr. Richard Duggins: out because burnout is different from, um, from 1222 00:55:02,770 --> 00:55:05,330 anxiety and depression. And we'd use a different 1223 00:55:05,330 --> 00:55:08,810 approach. So, for example, I wouldn't consider 1224 00:55:08,810 --> 00:55:11,530 antidepressants in burnout, but if a, uh, talking 1225 00:55:11,530 --> 00:55:13,930 therapy hasn't resolved a depression or anxiety or 1226 00:55:13,930 --> 00:55:16,730 it's very severe, then it's worth considering, I 1227 00:55:16,730 --> 00:55:19,290 think if you're wondering if you're depressed and 1228 00:55:19,290 --> 00:55:21,050 you're getting those physical symptoms, so your 1229 00:55:21,050 --> 00:55:22,690 sleep's going off, your appetite's going off, you 1230 00:55:22,690 --> 00:55:26,690 might be losing weight, you've got an awful lot of 1231 00:55:26,690 --> 00:55:29,050 kind of fatigue, especially in the mornings, it 1232 00:55:29,050 --> 00:55:31,800 might push you a little bit more to, to thinking, 1233 00:55:31,860 --> 00:55:33,840 um, this might have tipped into depression. But 1234 00:55:33,840 --> 00:55:36,440 once again, depression, anxiety, really easily 1235 00:55:36,440 --> 00:55:39,920 treated. So don't worry, just come through for 1236 00:55:39,920 --> 00:55:40,200 help. 1237 00:55:40,360 --> 00:55:41,880 >> Rachel Morris: And a lot of the treatments are very similar to 1238 00:55:41,880 --> 00:55:44,080 the treatments of burnout, aren't they? Which is 1239 00:55:44,080 --> 00:55:46,159 good news, which is really good news, which shows 1240 00:55:46,159 --> 00:55:48,840 why it's so important. This might be, again, 1241 00:55:49,320 --> 00:55:51,400 talking about some of these talking therapies. But 1242 00:55:51,400 --> 00:55:54,680 there's a chapter in your book all about what we 1243 00:55:54,680 --> 00:55:57,690 bring to the table, which I found fascinating 1244 00:55:57,690 --> 00:55:59,970 because we know that not all burnout is the same, 1245 00:56:00,000 --> 00:56:02,450 um, as Paula Redmond said, that there's different 1246 00:56:02,770 --> 00:56:05,410 causes. It might be due to moral injury, or it 1247 00:56:05,410 --> 00:56:07,570 might be due to just pure work overload, or it 1248 00:56:07,570 --> 00:56:10,010 might be due to sort of under confidence in 1249 00:56:10,010 --> 00:56:13,010 ourselves and things like that. So what other 1250 00:56:13,250 --> 00:56:15,810 things are these? Sort of could be some of the 1251 00:56:15,810 --> 00:56:19,250 underlying causes. I know you mentioned attachment 1252 00:56:19,250 --> 00:56:21,730 theory, and then there's moral injury and things 1253 00:56:21,730 --> 00:56:24,020 like that. But what do you typically see in some 1254 00:56:24,020 --> 00:56:24,780 of your patients? 1255 00:56:24,940 --> 00:56:27,900 >> Dr. Richard Duggins: So I'm going to start this with a kind of warning, 1256 00:56:27,900 --> 00:56:29,060 which is I 1257 00:56:29,060 --> 00:56:31,620 >> Dr. Richard Duggins: firmly believe when I'm meeting people in my 1258 00:56:31,620 --> 00:56:33,820 clinic that they've burnt out because of some 1259 00:56:33,820 --> 00:56:37,620 change in the system. So, you know, whatever their 1260 00:56:37,620 --> 00:56:40,700 personalities or coping systems are, they've often 1261 00:56:40,780 --> 00:56:44,620 been doing perfectly fine for many years and then 1262 00:56:44,620 --> 00:56:48,020 something's changed. So it's not the cause of 1263 00:56:48,020 --> 00:56:51,790 burn, burnout. So I want to be that. But we do see 1264 00:56:51,790 --> 00:56:52,550 some, some things. 1265 00:56:52,870 --> 00:56:55,510 >> Dr. Richard Duggins: So Herbert Freudenberger, who I mentioned, who was 1266 00:56:55,510 --> 00:56:58,630 the wonderful psychoanalyst who first coined the 1267 00:56:58,630 --> 00:57:02,030 term burnout, one of the first terms he toyed with 1268 00:57:02,030 --> 00:57:04,549 around burnout was Super Achiever Syndrome. And 1269 00:57:04,550 --> 00:57:07,150 the reason he did that is because he said there 1270 00:57:07,150 --> 00:57:10,310 are some people who are really dedicated, work 1271 00:57:10,310 --> 00:57:13,190 really hard, really want to make a difference and 1272 00:57:13,190 --> 00:57:16,460 for them they work, they will work very hard, 1273 00:57:16,460 --> 00:57:18,940 they'll try and do a lot at home. They won't 1274 00:57:18,940 --> 00:57:21,580 necessarily reach out for support. And that is a 1275 00:57:21,580 --> 00:57:23,700 group that are vulnerable for burnout and the 1276 00:57:23,700 --> 00:57:25,620 group that are vulnerable for burnout in the nhs, 1277 00:57:25,620 --> 00:57:27,940 I think, because I think our organisations take 1278 00:57:27,940 --> 00:57:31,460 advantage of those super achievers. So I'm utterly 1279 00:57:31,460 --> 00:57:34,660 amazed when I meet healthcare professionals who 1280 00:57:34,660 --> 00:57:37,540 are allowed to work ridiculous hours, allowed to 1281 00:57:37,540 --> 00:57:40,740 wear too many hats. These are super achievers and 1282 00:57:40,740 --> 00:57:43,220 they've been allowed by their organisation to burn 1283 00:57:43,220 --> 00:57:45,220 out. And I kind of, of think, you know, how did 1284 00:57:45,220 --> 00:57:46,940 the organisation think this was going to turn out? 1285 00:57:47,660 --> 00:57:50,650 What did they think was going to happen here? Um, 1286 00:57:50,780 --> 00:57:53,660 but that happened. So there is this idea. The 1287 00:57:53,660 --> 00:57:55,260 other thing I think is really interesting, and 1288 00:57:55,260 --> 00:57:57,220 then I'll move on to attachment is there's a 1289 00:57:57,220 --> 00:58:00,060 double edged sword in um, high performing 1290 00:58:00,060 --> 00:58:02,940 professionals. So high performing professionals 1291 00:58:02,940 --> 00:58:03,660 tend to be 1292 00:58:03,660 --> 00:58:07,380 >> Dr. Richard Duggins: conscientious, they tend to be determined and they 1293 00:58:07,380 --> 00:58:09,860 tend to be quite outgoing. Not always, but they 1294 00:58:09,860 --> 00:58:12,360 tend to, to be. Now that's good. You know that, 1295 00:58:12,360 --> 00:58:14,240 that they're the sort of people you want to 1296 00:58:14,240 --> 00:58:17,800 recruit often. But under pressure those same 1297 00:58:17,800 --> 00:58:20,640 characteristics can become a kind of Achilles 1298 00:58:20,640 --> 00:58:23,760 heel. So your conscientiousness can become 1299 00:58:23,760 --> 00:58:26,920 perfectionism, your determination can become 1300 00:58:26,920 --> 00:58:30,880 obsessionality and your um, outgoingness can 1301 00:58:30,880 --> 00:58:34,080 become kind of a little bit of narcissism. So you 1302 00:58:34,080 --> 00:58:36,320 stop listening to people, stop taking advice. 1303 00:58:36,960 --> 00:58:39,800 >> Dr. Richard Duggins: So, so it, it's interesting that the things that 1304 00:58:39,800 --> 00:58:43,780 make us really good at our job can also get in the 1305 00:58:43,780 --> 00:58:46,540 way of us doing our job really well. And then the 1306 00:58:46,540 --> 00:58:48,300 final thing I'll talk about is attachment theory, 1307 00:58:48,630 --> 00:58:51,380 um, which is um, something I'm interested in for 1308 00:58:51,380 --> 00:58:55,460 various reasons. But uh, one thing that I tend to 1309 00:58:55,460 --> 00:58:58,700 see in doctors particularly, but other, you know, 1310 00:58:58,700 --> 00:59:01,060 other high level professions, you know, m. I've 1311 00:59:01,060 --> 00:59:03,700 seen lawyers like this is a couple of typical 1312 00:59:03,700 --> 00:59:06,180 attachment patterns. One is a dismissive 1313 00:59:06,180 --> 00:59:10,260 attachment pattern where we play down our emotions 1314 00:59:10,260 --> 00:59:13,580 and our Relationships. So this is the doctor who 1315 00:59:13,580 --> 00:59:16,760 just kind of keeps a stiff of a lip and just gets 1316 00:59:16,760 --> 00:59:20,040 on with it. Just kind of um, uh, manages things 1317 00:59:20,200 --> 00:59:23,720 often very effective. But the problem is with this 1318 00:59:23,800 --> 00:59:27,200 is this doctor isn't necessarily processing their 1319 00:59:27,200 --> 00:59:29,800 emotions. So there's an emotional impact of work 1320 00:59:29,959 --> 00:59:31,880 but they're just getting on with it, going from 1321 00:59:31,880 --> 00:59:34,360 one thing to another, dismissing their emotions 1322 00:59:34,440 --> 00:59:37,000 and eventually that can catch up with you. The 1323 00:59:37,000 --> 00:59:39,160 other attachment style I tend to see in medics, 1324 00:59:39,320 --> 00:59:41,160 but less common than dismissive one, but it's 1325 00:59:41,160 --> 00:59:43,620 there, it's a preoccupied attachment style style 1326 00:59:43,620 --> 00:59:45,860 which are these medics who are the opposite of 1327 00:59:45,860 --> 00:59:48,780 dismissive. They really, really prioritise 1328 00:59:48,780 --> 00:59:52,800 emotions and they prioritise relationships. So uh, 1329 00:59:52,800 --> 00:59:55,060 a typical warning sign for a medic that I meet 1330 00:59:55,060 --> 00:59:57,220 with this is they tell me they've never had a 1331 00:59:57,220 --> 01:00:01,020 complaint. So these are these wonderful medics who 1332 01:00:01,020 --> 01:00:02,380 keep everyone happy. 1333 01:00:02,620 --> 01:00:06,660 >> Dr. Richard Duggins: And that is great, that's great. But it takes a 1334 01:00:06,660 --> 01:00:09,300 big emotional toll doing that and keeping everyone 1335 01:00:09,300 --> 01:00:13,300 happy. And what these medics can do is they tend 1336 01:00:13,300 --> 01:00:15,900 to neglect their own needs in the ear by 1337 01:00:15,900 --> 01:00:18,300 prioritising the other. So attachment is very 1338 01:00:18,300 --> 01:00:21,220 interesting. Um, um, I also think it's interesting 1339 01:00:21,220 --> 01:00:23,540 because um, if we recognise we're in one of those 1340 01:00:23,540 --> 01:00:26,019 attachment styles it might inform what sort of 1341 01:00:26,019 --> 01:00:29,420 therapy we want. So if we're dismissive, um, don't 1342 01:00:29,420 --> 01:00:31,820 really do emotions, we might be attracted to cbt. 1343 01:00:32,060 --> 01:00:34,460 Let's get our thinking right. But what we might 1344 01:00:34,540 --> 01:00:36,940 more benefit from is a relational type therapy 1345 01:00:36,940 --> 01:00:38,500 where we can actually, actually look at our 1346 01:00:38,500 --> 01:00:40,180 relationships and things like that and how we 1347 01:00:40,180 --> 01:00:43,220 process emotions. And similarly, um, people who 1348 01:00:43,220 --> 01:00:45,420 are preoccupied, really in touch with emotions 1349 01:00:45,980 --> 01:00:48,220 often think, well, I want a relationship therapy. 1350 01:00:48,220 --> 01:00:50,460 I want to do something where I can think about my 1351 01:00:50,460 --> 01:00:53,060 emotions. Whereas actually they might be, might be 1352 01:00:53,060 --> 01:00:55,420 more beneficial from CBT because what they might 1353 01:00:55,420 --> 01:00:58,660 benefit is a more structured approach that helps 1354 01:00:58,660 --> 01:01:01,500 them kind of prioritise their self care and helps 1355 01:01:01,500 --> 01:01:04,100 them kind of order their thinking and their 1356 01:01:04,100 --> 01:01:06,270 relationships. So I think it's really important. 1357 01:01:06,420 --> 01:01:08,020 >> Rachel Morris: Interesting. That is really interesting. I 1358 01:01:08,260 --> 01:01:10,500 remember reading about that in your book actually 1359 01:01:10,500 --> 01:01:13,820 and thinking, gosh, I'm the sort of person, I'm an 1360 01:01:13,820 --> 01:01:16,580 enneagram7. So I'm like, I like, don't like to 1361 01:01:16,580 --> 01:01:18,660 feel difficult but I just like to move on and have 1362 01:01:18,660 --> 01:01:20,740 fun. And actually what I've been thinking for a 1363 01:01:20,740 --> 01:01:22,459 while actually some therapy where you are really 1364 01:01:22,459 --> 01:01:24,460 looking, you can inter, you know, emotions, 1365 01:01:24,460 --> 01:01:27,300 feelings, somatic, you know, where, where am I 1366 01:01:27,300 --> 01:01:29,500 feeling that would be, would be really helpful 1367 01:01:29,500 --> 01:01:31,140 rather than, yeah, just staying in your head and 1368 01:01:31,140 --> 01:01:32,900 thinking it through thinking it through just 1369 01:01:32,900 --> 01:01:35,510 really quickly, what caused, what would have been 1370 01:01:35,510 --> 01:01:37,590 the underlying cause of those two attachment 1371 01:01:37,590 --> 01:01:38,150 styles? 1372 01:01:38,470 --> 01:01:42,210 >> Dr. Richard Duggins: Yeah, well, attachment tends to be, um. 1373 01:01:42,550 --> 01:01:45,190 >> Dr. Richard Duggins: They tend to be styles that will develop from. 1374 01:01:45,590 --> 01:01:49,230 That will start to develop from childhood. So most 1375 01:01:49,230 --> 01:01:53,470 of us are securely attached and most of the people 1376 01:01:53,470 --> 01:01:56,310 I meet in my clinic are securely attached. But you 1377 01:01:56,310 --> 01:01:59,430 might become dismissive of, uh, emotions and 1378 01:01:59,430 --> 01:02:02,630 relationships if you're the sort of, uh. If from a 1379 01:02:02,630 --> 01:02:05,070 young age you're kind of expected just to get on 1380 01:02:05,070 --> 01:02:07,450 with it, perhaps not talk about emotions and 1381 01:02:07,450 --> 01:02:09,690 perhaps look after someone else. There's quite a 1382 01:02:09,690 --> 01:02:12,050 lot of medics who've kind of been in a carer role 1383 01:02:12,050 --> 01:02:15,530 from quite a young age. And so they might need to 1384 01:02:15,530 --> 01:02:19,370 have put their needs to one side, uh, and just get 1385 01:02:19,370 --> 01:02:22,330 on with it and manage things. And that could lead 1386 01:02:22,330 --> 01:02:25,330 to a dismissive attachment style. We also train 1387 01:02:25,330 --> 01:02:28,370 people. You talked about what we're doing in A 1388 01:02:28,370 --> 01:02:31,250 levels and, uh, med school and things. 1389 01:02:31,650 --> 01:02:34,490 Unfortunately, we can sometimes train people to be 1390 01:02:34,490 --> 01:02:36,940 disabled, dismissive, so we can train them just to 1391 01:02:36,940 --> 01:02:38,900 get on with the next thing. You know, don't think 1392 01:02:38,900 --> 01:02:41,020 about how you're feeling, just do the next exam or 1393 01:02:41,020 --> 01:02:43,260 the next case and things like that. So we can 1394 01:02:43,260 --> 01:02:46,620 encourage that. Unfortunately, preoccupied people 1395 01:02:47,020 --> 01:02:50,700 tend to be the children who, um, perhaps have been 1396 01:02:50,860 --> 01:02:53,540 very sensitive, very caring for others. They, 1397 01:02:53,540 --> 01:02:55,420 again, might have been in a caring role, but in a 1398 01:02:55,420 --> 01:02:57,780 different way. They might need to be particularly 1399 01:02:57,780 --> 01:02:59,900 attuned to someone in their family and look after 1400 01:02:59,900 --> 01:03:04,020 them in that way. So that might create, um, uh, 1401 01:03:04,020 --> 01:03:06,400 preoccupied attachment style. But it's complicated 1402 01:03:07,190 --> 01:03:09,510 and some people might have features of both. So, 1403 01:03:09,620 --> 01:03:12,190 uh, it's not always a straightforward thing. 1404 01:03:12,190 --> 01:03:13,990 >> Rachel Morris: And that's probably where a skilled therapist 1405 01:03:13,990 --> 01:03:15,910 would be really, really helpful to help you 1406 01:03:16,070 --> 01:03:18,590 identify those underlying things and what you can 1407 01:03:18,590 --> 01:03:22,750 do about it. Right. What would your top three tips 1408 01:03:22,750 --> 01:03:24,910 be for someone who can recognise themselves on 1409 01:03:24,910 --> 01:03:28,510 that plateau and thinks, oh, crumbs, okay, maybe I 1410 01:03:28,510 --> 01:03:30,550 want to do something right now before I get to 1411 01:03:30,550 --> 01:03:32,310 that burnout cliff. Just the three. Well, let's 1412 01:03:32,310 --> 01:03:34,030 say rather than three top tips, because all your 1413 01:03:34,030 --> 01:03:36,340 top tips are in the book. Your three next action. 1414 01:03:37,290 --> 01:03:39,370 >> Dr. Richard Duggins: First thing is fantastic. 1415 01:03:39,610 --> 01:03:42,450 >> Dr. Richard Duggins: They are thinking about what's going on, you know, 1416 01:03:42,450 --> 01:03:44,450 have I got problem stress? Have I got burnout? So 1417 01:03:44,450 --> 01:03:47,450 they've stopped. Fantastic. And they've reflected. 1418 01:03:48,090 --> 01:03:50,490 The next thing they should do is reach out for 1419 01:03:50,490 --> 01:03:53,920 help, nip it in the bud. That could be to a, uh, 1420 01:03:54,090 --> 01:03:56,210 support organisation, you know, like NHS 1421 01:03:56,210 --> 01:03:57,650 Practitioner Health, if you're a healthcare 1422 01:03:57,650 --> 01:04:01,170 professional. Or it could be to a coach or it 1423 01:04:01,170 --> 01:04:03,130 could be just to friends and family, let people 1424 01:04:03,130 --> 01:04:06,080 know how you're feeling. You know, people often 1425 01:04:06,080 --> 01:04:09,600 carry this alone and in silence. You know, don't 1426 01:04:09,600 --> 01:04:13,000 do that. So stop and reflect, reach out for help. 1427 01:04:13,000 --> 01:04:15,920 And the next thing is be hopeful and positive 1428 01:04:16,000 --> 01:04:18,400 because actually by reaching out for help, you 1429 01:04:18,400 --> 01:04:22,120 will do incredibly well. People do incredibly 1430 01:04:22,120 --> 01:04:24,960 well. They make amazing recoveries. And in fact, 1431 01:04:24,960 --> 01:04:27,480 some people, quite a lot of people, if they have 1432 01:04:27,480 --> 01:04:30,480 time to stop and reflect and recover, recover, 1433 01:04:30,960 --> 01:04:33,520 say. Actually, I've developed through this. I feel 1434 01:04:33,520 --> 01:04:35,720 different. I've made important changes and 1435 01:04:35,720 --> 01:04:39,480 decisions and my life feels more aligned now. So 1436 01:04:39,480 --> 01:04:41,800 be really hopeful. Coming through to help is a 1437 01:04:41,800 --> 01:04:42,640 positive thing. 1438 01:04:42,880 --> 01:04:46,199 >> Rachel Morris: Yeah, and that was another great chapter, uh, your 1439 01:04:46,199 --> 01:04:48,680 book on sort of post burnout growth. Post 1440 01:04:48,680 --> 01:04:51,360 traumatic growth. So actually often, yeah, the 1441 01:04:51,360 --> 01:04:53,360 good news is that after a burnout, people can 1442 01:04:53,360 --> 01:04:55,680 actually be a lot better, um, or feel a lot 1443 01:04:55,680 --> 01:04:57,910 better, better than before. But you don't actually 1444 01:04:57,910 --> 01:05:00,030 have to go through the whole massive burnout thing 1445 01:05:00,030 --> 01:05:01,670 to get that. You can actually nip it in the bud 1446 01:05:01,670 --> 01:05:03,590 and then be better. Right, so let's avoid that 1447 01:05:03,590 --> 01:05:04,670 massive dip, shall we? 1448 01:05:04,670 --> 01:05:05,750 >> Dr. Richard Duggins: Yeah, yeah, that's right. 1449 01:05:06,390 --> 01:05:08,110 >> Rachel Morris: Thank you so much, Richard. We'll have to get you 1450 01:05:08,110 --> 01:05:10,430 back because no doubt we'll, we'll have lots more 1451 01:05:10,430 --> 01:05:12,190 to talk about. And if anyone's listening to this, 1452 01:05:12,190 --> 01:05:13,550 you've got questions for Richard, please, just, 1453 01:05:13,550 --> 01:05:15,390 just uh, email them in. And Richard, if we get 1454 01:05:15,390 --> 01:05:17,710 some questions, when you come back to answer them. 1455 01:05:17,710 --> 01:05:18,630 >> Dr. Richard Duggins: Oh, I'd love to. 1456 01:05:18,630 --> 01:05:20,390 >> Rachel Morris: That would be wonderful. And yeah, we'd love to 1457 01:05:20,390 --> 01:05:22,120 have you back and to talk about this more, because 1458 01:05:22,120 --> 01:05:25,640 it is such a big, big thing for doctors. Well, 50% 1459 01:05:25,640 --> 01:05:28,080 of doctors working in burnout. So whether you're a 1460 01:05:28,080 --> 01:05:30,080 doctor, dentist, nurse, other healthcare 1461 01:05:30,080 --> 01:05:31,600 professional, we have accountants, lawyers and 1462 01:05:31,600 --> 01:05:33,920 teachers as well. And I would think that their 1463 01:05:33,920 --> 01:05:36,240 levels are pretty similar. But for me, the big 1464 01:05:36,240 --> 01:05:39,000 revelation has been you might be in burnout, but 1465 01:05:39,000 --> 01:05:41,360 your performance is still okay at work because you 1466 01:05:41,360 --> 01:05:43,200 protected that, but the performance everywhere 1467 01:05:43,200 --> 01:05:44,800 else is down and then suddenly you're going to 1468 01:05:44,800 --> 01:05:47,280 crash. So thank you so much for being here. If 1469 01:05:47,280 --> 01:05:49,880 people want to get hold of you or find out more 1470 01:05:49,880 --> 01:05:51,960 about the book, about you, about your work, where 1471 01:05:51,960 --> 01:05:52,610 can you they go? 1472 01:05:52,770 --> 01:05:54,530 >> Dr. Richard Duggins: So, yeah, well, I haven't got a 1473 01:05:54,530 --> 01:05:55,850 >> Dr. Richard Duggins: webpage, but I'm on LinkedIn. 1474 01:05:55,850 --> 01:05:57,650 >> Dr. Richard Duggins: Always really happy to hear from people. 1475 01:05:57,810 --> 01:05:59,090 >> Dr. Richard Duggins: So, Richard Duggins. 1476 01:05:59,090 --> 01:06:00,890 >> Dr. Richard Duggins: And, um, if people want to know about the book or 1477 01:06:00,890 --> 01:06:03,490 the audiobook, all good bookshops, it's on Amazon 1478 01:06:03,490 --> 01:06:03,810 too. 1479 01:06:03,810 --> 01:06:06,970 >> Rachel Morris: And of course, if you are working in the NHS and 1480 01:06:06,970 --> 01:06:09,010 you are eligible for practitioner health, it's a 1481 01:06:09,010 --> 01:06:10,930 fantastic organisation, Rich. Can you just remind 1482 01:06:10,930 --> 01:06:12,070 us who. Who it serves? 1483 01:06:12,070 --> 01:06:15,570 >> Dr. Richard Duggins: Uh, so it serves any healthcare professional who 1484 01:06:15,570 --> 01:06:17,850 finds it is finding it difficult to get 1485 01:06:17,850 --> 01:06:21,760 confidential local support support. So that's 1486 01:06:21,760 --> 01:06:25,480 every doctor and every dentist in the NHS can come 1487 01:06:25,480 --> 01:06:28,320 through, or it's any health professional who 1488 01:06:28,320 --> 01:06:30,720 hasn't got local confidential support. 1489 01:06:31,200 --> 01:06:34,280 >> Rachel Morris: So do get in touch with Practitioner Health. And 1490 01:06:34,280 --> 01:06:37,800 if you're not in the uk, or you can't access that, 1491 01:06:37,800 --> 01:06:41,040 there will be other ways for you to get help. It 1492 01:06:41,040 --> 01:06:43,120 might just take five minutes of digging around and 1493 01:06:43,120 --> 01:06:46,080 googling. So, employee assistance programme, your 1494 01:06:46,080 --> 01:06:48,800 own gp, your family practitioner. Please, please 1495 01:06:48,800 --> 01:06:51,460 don't struggle on an alone, even if it's just 1496 01:06:51,460 --> 01:06:53,740 telling a colleague about it. So, thank you, 1497 01:06:53,740 --> 01:06:55,940 Richard. Um, and hopefully speak again soon. 1498 01:06:56,020 --> 01:06:57,540 >> Dr. Richard Duggins: Great. Thanks so much, Rachel.