A few years ago, I was feeling really stressed and really bored at the same time
in a job that I didn't particularly like, but I trained for years and years to do.
I had fairly small children and life was full.
I've told the story several times, but I went on a retreat in the Alps, and as I
was there to sort of think about what did I wanna do with the rest of my life, I was
reading the poem by Mary Oliver, which is that wonderful poem called A Summer's Day.
And the final line in that poem is tell me what is it that you plan to do
with your one wild and precious life?
And that line jumped out at me, your one wild and precious life.
It didn't feel like at that time my life was particularly wild and it
certainly didn't feel that precious And I remember feeling trapped and
stuck in my work because my other half ran a business in Cambridge.
I had several jobs, one at the university, one in a busy practice, and I felt
that I had no choice but to stay there.
My kids were in school and I couldn't do anything about it.
And that got me thinking, well, actually I did have a choice.
I could choose to leave.
I could choose to move to the Alps, ditch the family.
I wasn't gonna do that though.
I didn't want to do it.
I was gonna choose to stay.
And then the question became, well, how can I have a world and
precious life in the life I'm already living on a Monday morning?
Because it must be possible to thrive, not just survive as a doctor in a busy job.
Where I am in the life I'm currently at, and that's what I became obsessed
with finding out how to do it.
But that was the first time I realized I had a choice about what I did and
that actually I was in control of a lot more than I thought I was.
But I had been pulled along on the wave of expectation.
This is just what you do.
And to be honest, the the person holding me back the most was myself.
But I would've given all sorts of excuses.
I would've said it's the pressure of work, the pressure of the family,
the fact that I had to earn a certain amount of money, the fact that I had
to do this, actually, I wanted to do half of it, but the way I was living
was at a huge personal cost, and that's what I want to talk about today.
The cost of stress, the cost of overwhelm, and the cost of burnout.
And in my mind, it's not a great equation.
Why are we paying a massive cost in order to feel terrible, in
order not to enjoy our lives?
There's so much stuff behind that, but today I want to explore
just what that cost is and why we are underestimating that cost.
This is a You Are Not a Frog quick dip, a tiny taster of the kinds of things we
talk about on our full podcast episodes.
I've chosen today's topic to give you a helpful boost in the time it
takes to have a cup of tea so you can return to whatever else you're
up to feeling energized and inspired.
For more tools, tips, and insights to help you thrive at work, don't
forget to subscribe to You Are Not a Frog wherever you get your podcasts.
Now, it's not often that I have a massive realization and I find a new idea which
I then start to get obsessed with.
Well, I say it's not very often.
I'm sure my friends and family and colleagues will tell me that I'm
coming up with them all the time, and their job is just to reign me in.
But I have been struggling with this conundrum.
You see, recently I met a colleague who had surveyed the doctors in his
workplace with the Maslach Burnout inventory, and on the survey, between
40 and 50% of them were burnt out according to the validated burnout survey.
So 40 to 50% of the doctors in his workplace were working in burnout.
And I'm sure that applies to nurses, physios, and managers, and many of
the other healthcare professionals working in the NHS right now.
So 40 to 50% of people working in burnout.
But that gives me a bit of a conundrum because we teach the stress curve.
And the stress curve is a really helpful way of understanding what happens to your
performance under increasing pressure.
So initially, as the pressure increases, your performance will go up.
We all need a few deadlines to perform well, but you'll reach a point where
you are at peak performance for a bit, and then as the pressure builds up,
your performance will start to go down.
And so we can see that under increasing pressure, a human being's
performance will go off the top of the curve and we'll start to slip
down the other side of the curve.
And this happens to everybody.
This is a human phenomenon.
And yes you can improve your mental fitness and your wellbeing,
which means that you can probably withstand a little bit more pressure
before you start to slip off the curve, but it happens to everybody.
There's well validated, important neuroscientific reasons for this.
Your prefrontal cortex gets overwhelmed.
You've got high circulating cortisol.
You literally can't think straight.
And side note, I'm really sick of doctors coming to me for coaching
and saying, what's wrong with me?
Why can't I cope?
So the first thing I do is show them the stress curve and say, you are normal.
You are having a physiologically normal response to too much
pressure, to too many demands on you.
And we were in a training session once, and I presented this so
somebody ran out of the room really upset and I caught up with them
at break and I said are you okay?
What's going on?
She said, oh, she said, I've been off with burnout.
And seeing that was such a relief, I realized it wasn't my fault.
No, it's not your fault.
It's the way you are built.
Under increasing pressure.
Your brain just doesn't work.
You start to perform badly.
But then that's the conundrum, isn't it?
Because the stress curve tells us that you are not performing when
you're in burnout, yet my colleague survey showed that 40 to 50% of his
doctors were working in burnout, and yet they were still performing.
Now the other day I also recorded a podcast with Dr. Richard Duggins.
He's a consultant psychiatrist and works with practitioner health, so he helps
diagnose, and he's also a psychotherapist, so he works with many, many doctors who
come through suffering with the effects of stress, overwhelm, and burnout.
And he's noticed the burnout cliff.
So he has noticed that particularly in healthcare professionals, they
go along and their performance is, is okay, probably wavering a little
bit, maybe dropping a little bit, but suddenly they reach a point of
burnout where it massively drops off.
So you have this burnout cliff.
And that's a little bit at odds with the stress curve where you
reach peak performance, and then gradually, as the pressure gets
higher, your performance decreases.
So I've been thinking, well, If you've got this burnout cliff and up to 50%
of doctors are working in burnout, how does that square with the stress curve?
And I asked Richard this, and his answer just really blew my mind.
He said, well, you might carry on performing well at work, but
everything else is suffering.
Essentially, you are borrowing your performance from other areas of your life.
You are borrowing your performance from your health, you are borrowing
your energy from your family and from your relationships, you are
borrowing your performance from any hobbies or any life outside of work.
And actually the chap who initially coined the term burnout, he
was referring to a building.
It was in one of the suburbs of New York.
I think it looked fine on the outside.
On the inside.
,It had completely burnt out.
There'd been arsonists who'd set a fire and there was nothing inside.
So outwardly it looked fine, inwardly, there was nothing.
So.
In healthcare, perhaps what is happening is that you will preserve
your performance in your work at the cost of everything else.
And this strikes me as being absolutely what goes on.
Because often I remember as a GP you'd get healthcare professionals coming
into you saying, gosh, my other half said I had to come and seek help.
You know, my friend said I really, really needed to come and see, but
they were performing really, really well, functioning as head of a, a unit
as clinical director, but everything else was crumbling around their ears.
So the commonly held view is that people know when they're burnt
out because their performance will be really, really suffering.
And we know that the hallmarks, their diagnostic criteria for burnout are
extreme fatigue, not relieved by rest, lack of empathy, increased
cynicism towards your work and.
A feeling of poor performance, which then really tips into poor performance.
Yet these doctors, they're still performing because what's happening is
that even though their overall performance is going down, they preserve their
work performance and everything else, their performance is at rock bottom.
So this stress curve looks a bit different for people in high stress jobs.
You've got two different types of performance, outside work and inside work.
Now, I'm a huge fan of the Apple TV show called Severance.
I don't wanna give you any spoilers and.
I haven't got to the end of it yet, but the premise of the show is that
people are going to work in a very difficult, toxic organization, but they
have given their consent to be severed.
So they essentially have two different minds.
They have a microchip planted in their heads, and that means that when they
enter the lift to go to work, they go down and the microchip activates one
part of their brain, which is called their innie, their in work persona.
They have no memories of anything.
They can only remember what happens inside work.
They have no memories of the outside world.
They don't know who they are in the outside world.
They don't know even if they're married, what they like doing.
And the only thing they know is their environment in the office.
So they're sort of kept in these very sort of sterile offices.
Now, at the end of the day, they get back into the elevator, they go up,
something happens to their brain, the microchip gets switched, and they're in
their outie, their outta work persona.
So they then, you know, put their stuff away, go off and have a life.
And the main character in the series, well, he decided to take a severed job
because his wife had died and he was struggling with the emotions so much.
He just wanted not to feel that pain for eight hours of the day.
Now it, the story expands and it's a really good watch, so I'd really suggest
you look at it, but I think in healthcare, we've probably got it the other way round.
You see in Severance, the innies suffer.
They work really, really hard.
They're doing a job they don't really understand.
They're treated really, really badly.
But as soon as they leave work, their outies are having a ball, they don't have
to think about work at all, they're having a really nice life, they're going out,
they're partying, and then they just have to turn up, go to the elevator, their
innie does the work for them, and then they can step out at the end of the day.
We've got it the other way round.
I think in healthcare what happens is that our innies work so hard that
the outies don't get a life at all.
We are miserable, because we are using our finite energy for work.
We are not using our energy on our hobbies, the things that we
enjoy doing outside of work, our opposite worlds, which is really
important to prevent burnout.
See the episode on, um, the opposite world and burnout with Nick Petri,
we'll put the link in the show notes.
Any free time we have outside of work, well, we spend catching up on work.
So all our outie time is spent doing any stuff.
We borrow performance from our future health.
Yeah, it might feel okay today, but what about in five years time where
you have a stress induced heart attack?
We don't look after ourselves, we don't eat properly, but most
importantly, we borrow our energy and our time from the most important
things in life, which are our relationships, our family, our friends.
We don't have time for them anymore.
And as for our partners, well, they become what's called the residual beneficiary.
Like if I have any energy left after work, after other obligations after
the kids, then my residual beneficiary can get that like five minutes at
the end of the day where my brain is so addled that the only thing I can
do is zoom scroll on social media.
So no wonder so many people end up in difficulty with relationships
because relationships take time.
And what's more, the message you are sending to your friends, to your family,
to your significant others, is that they don't matter, is that work is
much, much more important than them.
Now, the problem is in the moment.
You could always argue that it is, particularly in healthcare, we could
doing some really high stakes stuff.
Yes, saving that person's life, doing that operation, doing that clinic.
But in the long run, you are putting your patients first at the cost of
you, you relationships, and in the long run, the patients suffer because
you will become like that building.
You will just be performing at work.
But you'll be burnt out inside and eventually you'll drop off
the burnout cliff when you can't perform anymore because the
performance does not go on forever.
So we borrow from our time, from our energy, from our health outside of work.
And we use all sorts of excuses.
One excuse might be finance, you know, I need, I need to earn this amount of money.
Another excuse might be, well, you know, it's what I've trained
for all these years, but actually underneath it all, it's all about
not being thought of badly by other people, being seen to do good stuff.
And we have a conscience that we, we really, genuinely want to help.
But that can overreach and it can mean that we end up just not helping anybody.
So we have a choice here.
We can carry on borrowing our performance from our life outside of work.
If we carry on doing that, we will eventually hit the burnout
cliff where everything goes south.
Our job as well, not just our relationships.
Our health will get worse and slowly we will lose the support
that we have at home, the support that we have from our friends
because they're just not seeing us.
And life will feel really, really empty.
It'll be very busy, but it'll be empty.
I had a quote the other day that the busy life is the empty life.
If you wanna live a full life, you need to balance your energy
between work and between home.
That's hard, isn't it?
Let's look at how to do that.
Well, there's no quick, easy solution.
If there was, I wouldn't have a job, right?
But here are some thoughts I've had about it.
So often when I notice things in myself, my first reaction is to jump into action.
Right, what can I do about this?
What can I do about it?
But as I talked about in a previous podcast, the first action on the
action step ladder is not to do any action, it's to face reality and
work out what actually is going on.
So if you are not sure if you are stressed, overwhelmed, or burnout,
or you secretly worry that you might be working in burnout, then the first
thing you should do is download our free PDF Burnout Self-Assessment Toolkit.
This contains links to loads of burnout, self-assessments you can do.
It contains some reflection questions for you to ask yourself.
It contains some stuff around the difference between stress, overwhelm
and burnout, and it contains a stress curve, so you can actually
put yourself on the stress curve.
That will help you face reality and workout like.
Where am I on this stress curve?
How urgent is this situation?
But don't be misled by thinking, I only need to do something about
this when it gets to urgent.
Because it's much, much, much, much easier to do something about it when
you are starting to slip down the curve, when you're starting to feel really
stressed and going into overwhelm, rather than waiting till you are in
burnout when you've gone off that cliff.
'Cause often that takes a lot of time off work and some serious
work on yourself to recover.
So face reality.
Is that you, are you currently working in burnout?
Secondly, work out where am I borrowing my performance from right now?
What is suffering at home?
Think to yourself, is it my relationships?
And you can rate them on a scale of one to 10 if you want to.
Yeah, what is really important in your life?
If I was thinking about that right now, I would say my family a hundred percent.
But then I need to rate how much time am I actually spending with them.
You know, I might rate that 10 out of 10 in importance, but if
you were to look at my diary, what would someone else rate that as?
So if you were to look at my diary, I'm saying it's 10 out of 10 in
importance, probably you'd say, well, maybe it's only a five or six because
you spend a lot of your time, Rachel, at work or traveling, uh, doing
conferences and things like that.
So what does your diary tell you?
Rate how important those things are to you, and then rate what an external
observer would say if they looked at your actual diary and your actual schedule.
Think through to the last month, how much time have you spent on your hobbies?
How much time have you spent with your significant people?
How much time have you spent looking after yourself?
Because you might say that's important to you, but if you're not
doing it, there's a problem there.
And just by rating it, you can start to create some cognitive dissonance, and that
is the first step towards some change.
Recently I realized that I just wasn't seeing my friends as
much as I wanted to see them.
And we had a little routine when the kids were little.
Those of us who didn't work on a Monday morning, we would always
meet at a local coffee shop from nine till 10 after school drop off.
And we have continued this and it's really wonderful.
But in the last six months, I've just thought that I'd been too busy.
And I knew it took up an hour of my day just at a time where actually I could
be getting some really good work done.
So I stopped going.
And gradually I started to feel like I was missing out.
And some of the relationships suffered.
'Cause quite literally, I wasn't seeing some of these people
for six months, whereas before I'd been seeing them weekly.
So I decided not to borrow that time from my outie life just to serve
my innie work life, and I am going back there and it's been joyous in
the last few weeks that I have been.
Now obviously I have the luxury of being more in control of my diary than
than many people listening to this podcast, but have a look at your weekly
working schedule, and we provide the Thrive Week planner to help with this.
And if you haven't got that already, we'll put that link in the show notes
as well, and that just helps you plan what your ideal week should look like
or what you would like it to look like.
Now, you'll never get to that ideal week, but you can get as close as you can.
There will be some times free.
There will be some times where you are choosing to work when you
could be doing something else.
But that throws up another problem, doesn't it?
Because you're gonna have to start saying no and setting boundaries.
And when we work in healthcare, when everything seems like it's
important, it's very hard to think, well, what on earth could shift?
And this is where you might need to do a zone of power.
Simply draw a circle and work out what's in your control and
what's not in your control.
You know, if you are employed for a certain amount of surgeries
or clinics or operating theater lists or ward rounds, put in those
times that are non-negotiable.
But there will be negotiable times in your week, and there will be times
where you have that extra discretionary effort that you are putting in.
And it's this discretionary effort time, and it's this non-scheduled time that you
can start to choose what you do with it.
And part of it might be just becoming a little bit more efficient and focused
with the time that you do have, making sure that you are getting deep work
thinking time not being interrupted.
And if you wanna find out how to get some of that and avoid the urgency trap, then
do sign up for our urgency trap training.
Again, we'll put the link there in the show notes.
But sometimes it's choosing to perform less well at work so that
you can perform better at home with your friends and your family.
I'll say that again.
Sometimes you need to choose for your performance to go down.
One of the first people I was coaching while I was a trainee coach
really brought this home to me.
I asked him to fill in the performance diamond, which is a simple rating
tool where you rate your enjoyment of work, your learning that you
are doing, the purpose you have in work and your achievement at work.
Now, this guy was a really high flying medic and his ratings really
surprised me because he rated his achievement as like a nine.
He was on all sorts of college boards.
He was, you know, one of the clinical directors.
He was an amazing guy.
but his enjoyment.
Was sort of around four or five, and I then said to him, well,
where would you like that to be?
He said he'd like his enjoyment to be at eight, and he actually said he wanted
his achievement to be more like a seven.
That was the first time I'd come across that concept.
I was like, that's so interesting.
Tell me about it.
He said, well, there's a direct line between my achievement enjoyment.
As soon as I achieve more, I enjoy less in life, and as soon as I
achieve less, I enjoy my life more.
So we need to think about that.
How important is achievement for you?
And let's face it, we have been brought up to think that I am only as
good as what I do as the output that I produce, you know, as, as my exam
results and as the status that I've got.
And that is what other people think about me.
And to be honest, that's how I think about myself.
I need to achieve to be a valuable human being.
But what if that is just totally the wrong success story?
We know that it's happiness that leads to success.
It's not achievement that leads to success.
That's quite hard to get your head around.
the problem is, whilst we've had those success stories ingrained
in us all our lives, it's very difficult to get outta that.
And that is where you might need to do some work.
You might need to read some books.
You might need to go and see a therapist.
'Cause bottom line, if we don't think we can achieve as much as we
want to achieve, we start to think, well maybe I'm not good enough.
When we say no to doing those things on our to-do list, we go,
well, I might not be good enough.
When we have to give up that role, or is it because I'm not good enough?
And it's a quick hop, skip and a jump from I'm not good enough to, I am not enough.
And the underlying emotion there is shame.
Shame about ourselves.
But if you be our choosing that we are not gonna perform as well, we are not
gonna achieve as much at work so that we have more energy and time for the
things outside work that make life worth living, actually, we will be happier.
We might not achieve as much, but the main thing blocking us there is our
own internal mindset and the stories we are telling ourselves around shame.
So can I suggest you might wanna reduce your performance at work by
scrapping that discretionary stuff that you are doing, because achievement
seems to be the most important thing.
So just have a look, think where can you bring the achievement down a little
bit so that you can increase it at home?
The next thing you need to do is just start putting some recovery time in.
Use the ABC of wellbeing, stay active, take breaks, and connect with people.
If you get at least that in every day, you will start to rebuild
your performance and your energy.
So start to look after yourself.
Make sure that you put date night regularly in your diary.
You cancel stuff outside of work that's purely driving the achievement thing
rather than giving you proper rest.
We'd often pursue leisure, which means that we're sort of
having to perform really highly.
But what if we just focused on switching off type of rest rather than that sort
of driven rest that so many of us have?
Make sure you are able to turn off completely.
Doing nothing or even just sitting reading a book, that is a great way of resting.
I have started to make sure that I spend at least an hour at the weekend
sitting in my hanging pod, in the garden, reading the Week magazine.
I find that really restful.
But to be honest, there's so much stuff to do, uh, I have to force myself to do it,
and I'm always so glad when I've done it.
And you know what?
After that hour of just sitting still.
The other stuff, it just doesn't seem so important.
So when you've had time to rest, you start to get a little bit of perspective back.
You know, like when you go on a holiday and it seems like, gosh, I can't possibly
leave, there's so much I need to do, and then you're away for two weeks and
halfway through the second week you're thinking, gosh, that really wasn't so
important after all, I can't really remember what I was stressed about.
And then in the last couple of days of holiday, the stress starts building
back and you start to predict all those emails you've got to deal
with before you even get back.
So put some time into discover an opposite world, something that gives
you the opposite of the achievement and the drive that you have to do at work.
And finally, as part of facing reality.
Identify those stories in your head that you are telling yourself, how
are you making your overwhelm worse?
Why are you doing the extra stuff that you don't really need to do, that nobody
asked you to do, or maybe you could have said no to, that wasn't compulsory,
that's not in your job plan, that you're not gonna be sacked for not doing?
Why are you doing it?
And we have these six overwhelm amplifies.
I've noticed that senior leaders in healthcare have all the time,
that just means they're working so much harder than they needed to.
The first one is being stuck in the agency trap, responding to
everyone else's stuff all the time.
Learn how to leave it to other people.
Number two, being a rescuer, feeling that actually your job is to rescue and help
your team, and that's not your fault.
You've been built like that, but where are you rescuing your team and
doing their work for them and not leaving them to do their own job?
The next overwhelm amplifier is this superhero's delusion.
This delusion that we don't actually have limits, that we can operate without any
sleep, we can operate without any breaks.
I hate to break it to you, but that doesn't work for you.
Even if as a junior doctor you manage to do 120 hours a week, believe me, as you
get older, that is not gonna work for you.
You are human, you have limits.
These wellbeing factors are really important for your
mental and physical fitness.
And you know what?
They also make life worth living.
The fourth overwhelm amplifier is fear of conflict.
It means that we don't have the difficult conversations that we need to.
We don't say no, we don't challenge people when they are causing issues in the team.
And what happens is that the issues build up, build up, and they're far more
difficult to sort out down the line.
So we make life much, much harder for ourselves because we are so scared
of disrupting the relationship.
Another overwhelm.
Amplify is over responsibility.
This mindset that if I don't do it, who's going to?
I am responsible for everybody and everything.
And I see this time and time of day again when I do training with say, GP trainers
who are feeling totally responsible for everything about their trainee,
about if they hand in their portfolio.
So, so the trainers are giving up their annual leave to mark the late portfolios.
They feel responsible for whether their trainee passes the exams or not.
But they're so much that they can't possibly be responsible for, and
we feel guilty when stuff happens that's outside of our control.
That we can't be responsible for, but we still take responsibility for it.
And finally, biscuit boundaries.
We try and put these boundaries in.
We try and say no, but as soon as we get pushed back or somebody else
doesn't like it, the boundaries crumble.
We feel like terrible people and we think, oh no, I really, really ought to do that.
And so everything crumbles.
So all of these things are mindset shifts that we need to have in order to
really be able to protect our time and our energy, and protect our performance
outside work, not just inside work.
Because when the pressure builds up, what we tend to do in healthcare in
these high stress, high stakes jobs is to maintain our performance at
work, but our energy is taken up there and our performance suffers at home.
We borrow our performance from our home life, from our relationships,
from our kids, from our wider family, from our friends, from our
hobbies, from our leisure, from our spirituality, and life becomes empty.
We are in burnout, in this burnout shell of a person whilst
maintaining our performance at work.
But at some point we drop off that cliff.
It comes at a huge personal cost, but often we don't realize till
it's too late, till our relationship has gone wrong, or till we have
a really bad, bad health problem.
So please recognize the cost of what is going on.
Recognize what.
The cost of not doing anything about this is.
Recognize the cost of not understanding those toxic, difficult, overwhelm
amplifier mindsets that we get into, which mean we make it worse.
And this is something we can help with.
So if you wanna check out our Beat Stress and Thrive course, our Escape the
Urgency Trap training, and there's lots of other ways that we help you recognize
and beat the overwhelm amplifiers.
But start off with downloading the burnout self-assessment toolkit.
It's totally free, and it will just give you a snapshot of where you are now.
And I'll just finish with that really amazing challenge from that
wonderful poem by Mary Oliver.
Tell me what is it that you plan to do with your one wild and precious life?
You choose.