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Why is it that in healthcare we
so often blame ourselves if we

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are burning out or we minimize our
feelings, telling ourselves we just

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need to keep calm and carry on?

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More often than not, it's a system
that causes burnout and blaming

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ourselves is just gonna drive us further
into feeling anxious or depressed.

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This week I'm joined by Dr. Richard
Duggins,, who's just written a book

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specifically to help healthcare
professionals avoid burnout.

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This episode is jam packed with
insights to help you figure out whether

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you are in danger of burnout or if
you're simply working through it to

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the detriment of other vital parts of
your life, like your relationships,

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or frankly, your own happiness

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Burnout doesn't always
look like a dramatic event.

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Stress and moral injury
can build up over time.

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So if you find yourself irritable or
you've noticed a change in empathy for

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your patients, this episode has got some
really practical steps for you to follow.

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There's loads more information in the show
notes, which you can find on our website.

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If you're in a high stress, high stakes,
still blank medicine, and you're feeling

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stressed or overwhelmed, burning out or
getting out are not your only options.

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I'm Dr. Rachel Morris, and
welcome to You Are Not a Frog.

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I'm Dr. Richard Duggins.

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I'm an NHS Psychiatrist and Consultant
psychotherapist, and I work for and lead

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our regional north east and North Cumbia
staff mental health and wellbeing hub.

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And I also work as a psychiatrist in
the outstanding NHS Practitioner Health.

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I'm also the author of a new book,
Burnout Free Working, and I'm

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really pleased to be here today.

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the book is really great, and I
would encourage any listener to

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check it out, and it's absolutely
packed with such useful information.

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And the thing I really liked about your
book is it is talking about the workplace

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and also stuff you can do as well.

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Because the biggest issue with burnout and
with resilience training with wellbeing

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and stuff is people feel like they're
being blamed, resilience, victim blaming.

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And that's something you talk
about in your, in your book.

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How, how do you see resilience,
victim blaming, showing up?

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It's one of the motivations for writing
the book because the people coming

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to see me often feel it's a personal
weakness, that it's some strength,

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they're letting their team down.

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And actually that's not what we see.

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And when we speak to people and they
tell their histories and they can start

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to see it, what we really see is what's
going on is something in the system.

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It's a change or some change in the
balance of what's going on around people

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rather than what's going on inside people.

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So I often talk about
radiators and drains.

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So what are the things that are radiating
energy and keeping people resilient,

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but also what are the things that
are draining their energy and, um,

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making them more likely to burn out?

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And what we see clinically is a
tip in these radiators and drains.

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And I, I did laugh in the book 'cause
you talked about the fact when you

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talk about this and you show people
the stress curve, which we use all

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the time, which simply plots your
performance against, uh, pressure and

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as the pressure increases initially.

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,You get this good stress, don't
you, where you perform well.

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But then as the pressure increases, you
tip off the, uh, the top of the curve

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and your performance starts to decrease.

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And you said you often hear sort
of audible gasps when you talk

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about this as people realize.

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That happened to me in a training session.

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We, I, a woman, um, it was a
non-medical training session actually,

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but a woman ran out of the room,
um, really in distress, and I caught

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up with her at the break time.

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I said, I'm, I'm so sorry, ar you okay?

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Is that something I said?

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She said she'd recently, recently been
off upset with burnout, and it was such a

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relief for her to know it wasn't her fault
and there wasn't anything wrong with her.

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So why, why is it that
we do blame ourselves?

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And do you think people in
healthcare blame themselves

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more readily than other people?

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I think it's a narrative throughout
many professions in high stress.

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I think it's certainly there
within healthcare, but I think

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it's there within teaching.

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I think it's there within social work.

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It's there within law.

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I've done some work with the police.

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It's certainly there within the police.

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So it's, um, I think
it's a misunderstanding.

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I don't think resilience and burnout are
understood very well, so I think it's a

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misunderstanding and, you know, that's why
your podcast and, and things like that are

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so important, 'cause they, you know, they,
they correct these misunderstandings.

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But I also think organizations at
times have found it more convenient

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when people are struggling with
burnout in their mental health to say,

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actually it's that individual and to
scapegoat them rather than to ask the

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harder questions, which is what are
we doing that's burning out our staff?

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What, what could we change?

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It's, it is easier to blame
the individual, I think.

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Yeah.

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And as medics, I mean, we have been
used to pretty high pressure for

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most of our careers, haven't we?

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You know, starting with doing a Levels,
quite frankly, and then med school with

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all those exams and working much harder
than it seemed like, than anybody else

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who only had, you know, my husband only
had like three lectures a week at uni.

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He was there nine to
five every single day.

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And then you go straight into house
jobs, which were incredibly pressurized.

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So do you think we have a, that our
normal pressure gauge is just set a bit

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higher than everybody else's perhaps?

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It's certainly the case that, um,
the medics I meet in my clinic

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are incredibly resilient people.

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They can manage a lot of stress,
but we are all human and we

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can all only take so much.

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And at times there will be too much
stress at work, often combined with

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too much stress at home, combined
with too little support or a change in

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support, and we all reach our limits
and at that stage we'll start to develop

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problem stress or, or burnout and may
even progress to anxiety, depression,

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or some physical complications.

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So it's, um, I agree we are used to and
trained to manage high stress, but too

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much for too long will burn us all out.

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And do you think in the people
that you've seen, it's a problem

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with the drains have increased?

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Or is it a problem that the
radiators have de decreased?

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And actually it might be quite
helpful for you to just tell us what

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you think the drains and radiators
are, particularly in healthcare.

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Yeah, absolutely.

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So the drains are, there's three
drains, um, typically they are, um,

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work stress, both the hours worked and
the intensities of those hours worked.

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They're home pressures.

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So that's also, you know,
what's going on at home.

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Are there changes?

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Are there disputes?

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Have we suffered a bereavement?

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All sorts.

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Pressures that are at home,
caring responsibilities.

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And then the other drain, which
is a really interesting one, is

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negative experiences about work.

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So this is about how we feel about work,
and this is very much the culture of work.

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This is our support at work,
how we're treated at work, how

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investigations are handled at
work, how we feel valued at work.

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when you talk about negative
experiences of work, are you talking

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about what, what the HR department
would call employee engagement?

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It's related, but.

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In my mind is slightly different.

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So certainly negative experiences
at work do stop employee engagement.

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But, but no, I'm talking more about
the way we feel our work treats us.

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So how we feel treated by our
organization, our line management,

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our colleagues, how fair work is.

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So it's more of a cultural thing about,
about work if we're exposed to moral

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injury, those sort of things that
affect our relationship with work.

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so it's not just about the
hours and the workload.

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It's not just about the pressures
at home, it's actually about how we

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are treated by people if we feel the
culture is supporting us and is fair.

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So you can have a high load of hours
and high workload, high load of home

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pressures, and be just about coping,
but then suddenly you start to get these

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negative experiences at work and that
can then tip you over into burnout.

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Yeah, that's, that's what we see.

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that's interesting.

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So do you get patients coming in,
going, well, the workload hasn't

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changed, you know, so I don't quite
understand what's going on here.

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You know, we've sort of got the
same workload, but for some reason

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things are much, much harder.

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absolutely.

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Yeah.

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Absolutely.

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And, uh, and people tend to
just look at the workload.

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They don't tend to look
at the other drains.

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So the, the radiators are, are
how much support we've got.

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Um, and we're doubly blessed if we've
got support at work and at home.

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So this again, is the culture of work,
line management, but also our colleagues,

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you know, have we got a buddy at work,
but also have we got support at home.

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The, the second one is,
um, whether we've got any.

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Opportunity for fun and social time.

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So, um, that, that's
often done outside work.

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But, but you know, to be
honest, why can't work be fun?

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It should be fun at times, but,
um, but, you know, the, these

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are our hobbies and activities.

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And then the third one, which
I think is really helpful for

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medics to think about particularly
is, is there some intellectual

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stimulation in our working week?

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So this is, do we feel stretched and
developed within our working week?

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And some people can have extremely
busy jobs, but there's something

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in that week where they really look
forward to, they really enjoy a

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particular clinic, a particular role, an
education role, or something like that.

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And that really helps us keep going.

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So that can be a radiator.

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I love that.

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I remember in one of my, uh, GP
jobs, I was incredibly stressed but

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incredibly bored at the same time.

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And I was like, how can that,
how could those two coexist?

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But you fit the nail on the head.

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Yeah, the, there was a lot of,
the workload was really, really

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high, but there was really, at that
point, no intellectual stimulation.

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And actually I fixed that not by changing
jobs or changing the workload, 'cause I

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actually, I think started to doing a, a,
a master's or doing some more training.

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So that was something that
suddenly started to intellectually

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stimulate a bit more.

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So we, we don't often
think about that, do we?

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No, absolutely.

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And it's important to think about.

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It's also one of the things when people
get busy at work and they start to burn

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out, the thing they often drop is that
what they see is that optional extra,

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which might be the most intellectually
stimulating bit of their week.

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So they might stop the teaching or the
additional clinic they offer or the

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minor surgery or something like that.

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And actually, that's a real mistake
because you are, you're dropping

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the thing that's keeping you going.

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But, but you see it quite often
'cause people retreat back to doing

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the core, often the bit that isn't
that stimulating and enjoyable.

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And you talk about that in the book, don't
you, with the, uh, funnel of exhaustion.

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I think Mary Asberg, um, uh.

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Where yes, you just give up
doing everything that you need to

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survive mentally and physically.

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And yes, I certainly talk about that a
lot, but more in relation to the, the

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wellbeing factors, but actually learning
and growing that is a wellbeing factor.

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So, um, often I think about, well,
we just give up exercising, don't we?

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We give up the yoga class and
resting, but, but you are right.

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Often because the learning and the
developing feels like an optional extra,

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that is just put on the back burner.

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And I have lost count of the amount of
doctors who've said to me, well, I just

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haven't got time to do that masters or
do that course that I really want to

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do when actually what you are saying
is that could actually be the thing

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that saves them from burnout weirdly.

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But how do you do that though?

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Without, without it just
becoming one extra thing to do?

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One extra pressure on workload
and time, because that is the

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real crux of it, isn't it?

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Yeah.

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Well, avoiding burnout and then managing
burnout, well, I don't need to tell you.

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It's, it's really hard.

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I mean I, I run a, um, a therapy group
for, professionals who've, burnt out.

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And, these are great professionals,
very creative, and they'd have solved

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their problem on their own if they could
have done, but it's, these problems

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are really difficult to solve, and
that's what were the group's so helpful

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'cause people get to think together.

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And sometimes it requires really difficult
decisions and courageous conversations

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and to try and get that balance back.

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Um, the balance between the
radiators and the drains back.

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And I think, um, one thing I certainly
see with the patients, uh, and the

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professionals I'm working with is, is
that that often requires not them having

225
00:12:18,768 --> 00:12:22,428
to solve it all on their own, because
they would've done all that already

226
00:12:22,428 --> 00:12:25,608
if they could have done, but having to
reach out and have those conversations

227
00:12:25,608 --> 00:12:27,768
about how do I get this balance back?

228
00:12:27,978 --> 00:12:30,498
Uh, you know, who can
support me with this?

229
00:12:30,671 --> 00:12:33,311
Who, who can help that balance in my work.

230
00:12:33,311 --> 00:12:37,188
So I'm, I'm not just burning myself
out doing lots and lots of hours of

231
00:12:37,188 --> 00:12:41,778
unstimulating work, um, when I know
I can contribute in other ways too?

232
00:12:41,920 --> 00:12:43,512
But then we've got another
problem, haven't we?

233
00:12:43,512 --> 00:12:47,052
And I know all throughout the whole
of your book, I've noticed the theme

234
00:12:47,052 --> 00:12:51,852
is reach out, reach out, get support
connects, which I, I totally agree with.

235
00:12:52,542 --> 00:12:56,562
But the problem I see is that in
healthcare, often the people that you

236
00:12:56,562 --> 00:13:01,152
reach out to are your colleagues who
are in the same boat, and often they

237
00:13:01,152 --> 00:13:05,922
have a vested interest in you keeping
on, churning through the workload

238
00:13:05,922 --> 00:13:08,802
that might not be simulating to you
to, you know, to keeping you going

239
00:13:08,802 --> 00:13:10,752
so you can do the service delivery.

240
00:13:11,202 --> 00:13:14,322
You can reach out, reach out to your
manager, who is probably even more

241
00:13:14,322 --> 00:13:16,092
stress and burnout than, than you.

242
00:13:16,392 --> 00:13:19,002
Um, so that's another problem
for them to deal with.

243
00:13:19,002 --> 00:13:22,962
So I'm not sure you're going to
get the best support and unbiased

244
00:13:22,962 --> 00:13:24,833
support from people at work.

245
00:13:24,833 --> 00:13:27,383
So then the question is, well, yeah,
you can reach out to your friends

246
00:13:27,383 --> 00:13:29,963
and family, but they don't really
understand the workplace and what, what

247
00:13:29,963 --> 00:13:33,503
you're going through, particularly if
they're not in a healthcare context.

248
00:13:33,833 --> 00:13:37,583
So, so who wanna do you reach
out to for this support?

249
00:13:37,783 --> 00:13:42,607
Yeah, and it's, yeah, there, there
are, there aren't simple, easy answers

250
00:13:42,607 --> 00:13:46,597
and, and I think it requires quite
a lot of courage, assertiveness.

251
00:13:47,152 --> 00:13:48,172
Persistence.

252
00:13:48,892 --> 00:13:53,414
I think a, I think a key thing that
people start to accept when they come

253
00:13:53,414 --> 00:13:58,214
forward for support and help is actually,
this is really serious, what's going on.

254
00:13:58,424 --> 00:14:00,284
Burnout is horrible.

255
00:14:00,344 --> 00:14:05,334
It's a terrible feeling and it
can lead if you don't manage it to

256
00:14:05,334 --> 00:14:08,964
anxiety, depression, physical health
problems, like high blood pressure.

257
00:14:09,491 --> 00:14:10,721
So it needs managing.

258
00:14:10,948 --> 00:14:14,518
And as good work is good for
us, bad work is bad for us.

259
00:14:14,618 --> 00:14:19,748
And, uh, I think it requires us in
a way to take a stance where we're

260
00:14:19,748 --> 00:14:22,418
saying, actually, I can't sustain this.

261
00:14:22,478 --> 00:14:26,728
I need changes to happen.. And,
and that can feel very difficult.

262
00:14:26,758 --> 00:14:33,088
But actually you burning yourself
out, having to take time off work or.

263
00:14:33,643 --> 00:14:37,993
Performing poorly because you're burnt
out and making errors or mistakes

264
00:14:37,993 --> 00:14:43,123
or having poor conversations with
patients or colleagues isn't worth it.

265
00:14:43,363 --> 00:14:47,983
It's not helping anyone, and, uh,
it's not really, it's not helping your

266
00:14:47,983 --> 00:14:49,723
colleagues, although it may feel like it.

267
00:14:49,723 --> 00:14:55,333
So although organizations and colleagues
might want to turn a blind eye at times,

268
00:14:55,603 --> 00:15:00,953
they might want to just keep us going
until we burn out, we, we really aren't

269
00:15:00,953 --> 00:15:05,513
doing us any favors in that, but we're
also not doing them any favors for that.

270
00:15:05,513 --> 00:15:06,983
We're not doing our patients any favors.

271
00:15:07,820 --> 00:15:09,080
I, I totally agree.

272
00:15:09,080 --> 00:15:13,591
And, and it's this sort of weird cycle
of people saying, well, I haven't got

273
00:15:13,591 --> 00:15:17,431
time to do anything about this because
there's so many patients I've got to see,

274
00:15:17,431 --> 00:15:22,021
or I can't say no because it will let
people down and it pass the stress on.

275
00:15:22,381 --> 00:15:26,101
Or I'll get a complaint and then I'll say,
okay, fine, well you may get a complaint

276
00:15:26,101 --> 00:15:28,231
if you say no, but what's gonna be worse?

277
00:15:28,441 --> 00:15:32,261
The complaint when you've said a well
thought through, no, or your colleagues

278
00:15:32,261 --> 00:15:34,061
may be thinking you are letting them down.

279
00:15:34,061 --> 00:15:38,231
We don't have any control over
that, or properly letting them down

280
00:15:38,281 --> 00:15:39,931
when you are off for six months.

281
00:15:39,931 --> 00:15:42,961
I mean, I'm not saying, you know, and
that's not a judgment, but you won't be

282
00:15:42,961 --> 00:15:47,176
there to do the work, or getting an even
worse complaint because your judgment's

283
00:15:47,176 --> 00:15:51,526
gone and, and we know that doctors that
are near a burnout get, make many more

284
00:15:51,526 --> 00:15:53,656
mistakes than than people who aren't.

285
00:15:54,046 --> 00:15:56,476
So then you're gonna get that
complaint and let people down anyway.

286
00:15:56,476 --> 00:15:59,356
It would be better to have that difficult
conversation in the first place.

287
00:16:00,046 --> 00:16:02,536
So that's one whole thing about,
you know, setting boundaries, saying

288
00:16:02,536 --> 00:16:03,916
no, having those conversations.

289
00:16:03,916 --> 00:16:06,836
And as you were talking, I was
thinking about the difficulty of

290
00:16:06,836 --> 00:16:08,426
finding people to reach out to.

291
00:16:08,426 --> 00:16:12,003
But I've had this, a situation, not about
stress, but there's been a situation where

292
00:16:12,003 --> 00:16:15,603
I want to find out about something and
I'm really not sure about who to contact.

293
00:16:15,603 --> 00:16:17,223
I'm thinking, oh, oh gosh.

294
00:16:17,223 --> 00:16:21,153
And my other half said, Rachel, you
know, lots of people you could contact.

295
00:16:21,153 --> 00:16:22,203
And I thought, okay.

296
00:16:22,203 --> 00:16:23,763
And I just sat down and I wrote a list.

297
00:16:23,763 --> 00:16:27,393
So it turns out having said, oh, I
don't know what to do, I don't know

298
00:16:27,393 --> 00:16:30,633
who to buy advice from, there are
at least 10 people I could literally

299
00:16:30,663 --> 00:16:32,403
email and ask some advice from.

300
00:16:32,403 --> 00:16:36,003
But it takes a bit of thinking, a bit
of putting my neck out there and a

301
00:16:36,003 --> 00:16:39,603
bit of being ready for people to say,
actually no, I can't help you type thing.

302
00:16:39,603 --> 00:16:43,083
So yeah, I don't, it probably
isn't that We don't know anyone

303
00:16:43,083 --> 00:16:44,613
who can support us, right?

304
00:16:44,853 --> 00:16:45,843
Well, absolutely.

305
00:16:45,843 --> 00:16:50,208
And for me, it's one of the joys of
being a doctor, uh, and being in the NHS.

306
00:16:50,688 --> 00:16:56,658
And for me, one of the key values and why
I do this work, really for being a doctor

307
00:16:56,658 --> 00:16:59,208
and in the NHS is we help our colleagues.

308
00:16:59,268 --> 00:17:00,768
We are there for our colleagues.

309
00:17:01,298 --> 00:17:05,234
And I increasingly believe that
actually helping our colleagues stay

310
00:17:05,234 --> 00:17:09,002
well is, for all of us, whatever
our roles is, the best way we help

311
00:17:09,002 --> 00:17:13,832
patients because healthy, thriving
colleagues deliver great services.

312
00:17:14,162 --> 00:17:16,802
So I, I almost think it
should be our priority.

313
00:17:17,402 --> 00:17:21,182
The, the, the other thing I was
reminded of when you were talking

314
00:17:21,182 --> 00:17:24,173
was, um, how we change culture.

315
00:17:24,173 --> 00:17:28,103
And I think we have an op we have an
opportunity sometimes, especially if

316
00:17:28,103 --> 00:17:29,993
we're reasonably senior to do that.

317
00:17:30,623 --> 00:17:34,733
And I was thinking about, there was a
service I worked in about 10 years ago,

318
00:17:35,483 --> 00:17:37,463
and we used to see all sorts of doctors.

319
00:17:37,463 --> 00:17:38,753
It was a self-referral service.

320
00:17:38,843 --> 00:17:43,253
Lots of doctors came to us, really
popular, but no surgeons came to us.

321
00:17:43,624 --> 00:17:45,844
So, and I was like, well, these
surgeons are under a lot of pressure.

322
00:17:45,844 --> 00:17:49,126
I know that I've got friends who are
surgeons, but they never came to us.

323
00:17:49,343 --> 00:17:52,397
And then one day a very
senior surgeon came to us.

324
00:17:52,547 --> 00:17:54,767
He was burnt out, he'd become depressed.

325
00:17:55,067 --> 00:17:56,537
He referred into our service.

326
00:17:56,747 --> 00:17:58,427
He did very well, 'cause most people do.

327
00:17:58,997 --> 00:18:02,567
And then he went back and this
was the remarkable thing he did.

328
00:18:02,880 --> 00:18:07,590
He talked to all the other surgeons
in the region and says, look, this

329
00:18:07,590 --> 00:18:09,540
happened to me, I was overworking.

330
00:18:09,540 --> 00:18:12,487
There was a lot going on at home,
I went through to this service.

331
00:18:12,600 --> 00:18:14,610
I'm much better, you
can see I'm much better.

332
00:18:14,917 --> 00:18:19,057
And then the flood gates opened, and
we never, ever had any problems with

333
00:18:19,267 --> 00:18:20,947
surgeons coming through to our service.

334
00:18:21,367 --> 00:18:27,577
So that person, I'm sure he doesn't know
it, but probably saved a lot of people's

335
00:18:27,967 --> 00:18:31,567
careers, will have benefited patients
and maybe saved some people's lives.

336
00:18:31,957 --> 00:18:36,367
So I, I do think there's something else
about just battling on and waiting for

337
00:18:36,367 --> 00:18:40,597
burnout to hit us, and doing it silently
doesn't help our colleagues either.

338
00:18:41,007 --> 00:18:41,847
No, it really doesn't.

339
00:18:41,852 --> 00:18:46,182
And, and the minute you share something,
the shame dissipates, doesn't it?

340
00:18:46,317 --> 00:18:49,797
And let's face it, we still all feel shame
when we think we're not coping because we

341
00:18:49,797 --> 00:18:52,527
feel I'm not good enough as a doctor, I
should be able to cope with everything,

342
00:18:52,527 --> 00:18:54,567
which is totally bonkers thinking.

343
00:18:54,567 --> 00:18:59,451
It's a superhero thinking that it is so
unhelpful for us, but the minute someone's

344
00:18:59,451 --> 00:19:01,611
senior tells their story, it's like, okay.

345
00:19:02,181 --> 00:19:02,901
Yeah, we can do it.

346
00:19:02,901 --> 00:19:06,756
And we've been involved in coaching
programs for new to GP fellowships

347
00:19:06,756 --> 00:19:11,092
and there's coaching programs around
the country that are fully funded

348
00:19:11,122 --> 00:19:15,902
for doctors and not being used by
anybody, which is total madness.

349
00:19:15,902 --> 00:19:19,889
Now either people just don't know about
them, that could be one thing, but I

350
00:19:19,889 --> 00:19:24,894
think people firstly feel they haven't
got time, which is again, total madness,

351
00:19:25,004 --> 00:19:26,264
we'll talk about that in a minute.

352
00:19:26,264 --> 00:19:31,904
Or, or people maybe don't want
to admit how bad things have got.

353
00:19:32,264 --> 00:19:35,744
Why do you think people aren't
using these services that are

354
00:19:35,744 --> 00:19:37,339
available to them that are out there?

355
00:19:38,084 --> 00:19:42,194
I mean, there's a lot of talk about
how far we've come on about mental

356
00:19:42,194 --> 00:19:44,084
health and de-stigmatizing it.

357
00:19:44,534 --> 00:19:48,014
And yet a lot of, the lot of
professionals I still meet with, a lot

358
00:19:48,014 --> 00:19:52,205
of doctors I still meet with, they're
really ashamed to be meeting with me.

359
00:19:52,205 --> 00:19:55,805
They're, you know, the, the, the
line usually is, I'm, you know,

360
00:19:55,805 --> 00:19:57,005
I'm sorry to be wasting your time.

361
00:19:57,005 --> 00:20:00,900
I'm sure you see people a lot worse
than me, and a sense of a weakness, a

362
00:20:00,900 --> 00:20:02,910
failure, letting their colleagues down.

363
00:20:03,480 --> 00:20:04,500
And it's still there.

364
00:20:04,590 --> 00:20:07,620
And, um, and it's a miss, you
know, as I said earlier, it's a

365
00:20:07,620 --> 00:20:09,810
misunderstanding of what burnout is.

366
00:20:09,815 --> 00:20:12,330
It's a, you know, it's not
true what they're saying.

367
00:20:12,330 --> 00:20:15,910
And when they tell their stories, they
can see it's not true, but that's there.

368
00:20:16,570 --> 00:20:19,975
The other thing is I think people
need to trust these services.

369
00:20:20,005 --> 00:20:24,265
They need to trust that the services will
be, be for them, that they'll be rapid

370
00:20:24,265 --> 00:20:28,755
to access, that they'll be confidential,
and the outcomes are really good.

371
00:20:29,305 --> 00:20:33,545
I mean, NHS Practitioner Health is a
fantastic example of that in the UK.

372
00:20:33,885 --> 00:20:38,702
So I, when Clare Gerada set it up, she
said, if we build this, people will come.

373
00:20:38,959 --> 00:20:43,489
And I'm not sure people were sure about
that at the beginning, but it was built.

374
00:20:43,615 --> 00:20:47,723
People come to NHS Practitioner Health,
they get really, really well, they

375
00:20:47,723 --> 00:20:51,203
start thriving, they then go back and
tell their teams about their positive

376
00:20:51,278 --> 00:20:56,159
experiences, and the service has grown
into the kind of, you know, massive

377
00:20:56,159 --> 00:20:57,899
trusted services at the moment.

378
00:20:58,379 --> 00:21:03,569
So I, I, I think it, it does take a little
bit of time to make people trust things.

379
00:21:03,689 --> 00:21:07,318
I think people can worry that if they
come through to help that it will be

380
00:21:07,318 --> 00:21:11,998
opening a kind of Pandora's box and
that they'll suddenly be off work and

381
00:21:11,998 --> 00:21:13,648
they won't be able to get back to work.

382
00:21:13,948 --> 00:21:15,178
And that's not true at all.

383
00:21:15,358 --> 00:21:18,088
You come through to help,
you'll do really, really well.

384
00:21:18,118 --> 00:21:20,548
It's when you don't come through
to help that the problems can come.

385
00:21:20,851 --> 00:21:24,961
I think as well, when some of these
services were first set up, um, I'm

386
00:21:25,016 --> 00:21:29,311
thinking of a, a particular coaching
service, it was like, oh yeah, come

387
00:21:29,311 --> 00:21:32,564
and see us, and they'd give like one
day of training to people and then so

388
00:21:32,564 --> 00:21:35,474
people would use it and think, well,
actually that wasn't very helpful

389
00:21:35,474 --> 00:21:40,544
because actually they saw someone that
wasn't very experienced and also almost

390
00:21:40,544 --> 00:21:43,784
felt like they were just trying to
persuade them to stay working rather

391
00:21:43,784 --> 00:21:47,174
than, or, or they were doing mentoring,
which is great, but probably what,

392
00:21:47,174 --> 00:21:49,154
what wasn't needed at, at the time.

393
00:21:49,154 --> 00:21:49,994
And so they're put off.

394
00:21:49,994 --> 00:21:53,924
But I think things have very much
developed and, and improved since then.

395
00:21:54,134 --> 00:21:59,204
I think one of the reasons why
people do put off getting help

396
00:21:59,204 --> 00:22:01,004
is they don't recognize it.

397
00:22:01,769 --> 00:22:06,029
And you talk about this in your book,
that the burnout cliff, that people

398
00:22:06,029 --> 00:22:09,749
go along, along, along think, well,
I, I can't be, I can't be burnt out.

399
00:22:09,749 --> 00:22:12,899
But you know, I've spoken to someone
who's a director of medical, director of

400
00:22:12,899 --> 00:22:14,579
wellbeing and a, a local hospital trust.

401
00:22:14,579 --> 00:22:17,499
They surveyed their doctors
recently, using, I think

402
00:22:17,499 --> 00:22:18,993
there's a Maslach inventory.

403
00:22:19,233 --> 00:22:22,773
50% of their doctors
are working in burnout.

404
00:22:22,983 --> 00:22:27,353
And we are led to believe that
actually burnout is so severe, you'd

405
00:22:27,353 --> 00:22:30,323
know when you're in it, uh, you
can't carry on when you're in it.

406
00:22:30,323 --> 00:22:33,324
But actually a lot of people are
actually working in it, so, absolutely.

407
00:22:33,324 --> 00:22:35,364
And I've had those sorts just
the same as your patients.

408
00:22:35,364 --> 00:22:37,764
Well, I think I might be wasting your
time because I don't think I'm actually

409
00:22:37,764 --> 00:22:43,780
that bad, but you actually are, but
almost you felt like that for such a long

410
00:22:43,780 --> 00:22:49,394
time, or even, dare I say it, for most of
your career, it's become normal to you.

411
00:22:49,715 --> 00:22:50,364
So.

412
00:22:50,433 --> 00:22:53,823
is it true that we've almost normalized
burnout and a lot of it are working

413
00:22:53,823 --> 00:22:55,863
in burnout without even knowing it?

414
00:22:56,375 --> 00:22:56,885
Yes.

415
00:22:57,155 --> 00:22:58,385
I, I think that's right.

416
00:22:58,385 --> 00:23:02,651
And I think, um, I think I talk
about a culture, in high stress

417
00:23:02,651 --> 00:23:06,401
professions, particularly in the
NHS where we keep calm and carry on.

418
00:23:06,611 --> 00:23:10,331
We, we listen to, uh,
Dory in Finding Nemo.

419
00:23:10,331 --> 00:23:13,121
We, we just keep swimming
that that's what we do.

420
00:23:13,556 --> 00:23:16,286
And that is terrible burnout advice.

421
00:23:16,406 --> 00:23:20,496
It's a way to get through a difficult
night shift, but, you know, it's like,

422
00:23:20,534 --> 00:23:23,204
it's like trying to run a marathon
in the way that you handle a sprint.

423
00:23:23,204 --> 00:23:26,504
So, so keeping calm and carrying
on doesn't work, but it's the

424
00:23:26,504 --> 00:23:30,464
way that it's our go-to, I think
in high stress professions.

425
00:23:30,764 --> 00:23:35,384
So we keep our heads down despite,
you know, feeling a lot of problem,

426
00:23:35,384 --> 00:23:39,284
stress, early signs of burnout,
even even quite severe burnout,

427
00:23:39,584 --> 00:23:41,174
and we just try and keep going.

428
00:23:41,714 --> 00:23:45,434
What we do is we try and protect
our work and the core work.

429
00:23:45,674 --> 00:23:49,274
And often other things are, are, you
know, we're neglecting home life.

430
00:23:49,274 --> 00:23:52,514
We're neglecting, uh, social
activities, we're becoming quite

431
00:23:52,514 --> 00:23:57,434
isolated from our community, but, but
we do try and keep calm and carry on.

432
00:23:57,794 --> 00:24:02,155
And some of that I think is because
doctors and I see this all the time, are

433
00:24:02,155 --> 00:24:04,615
really quite hopeful, optimistic people.

434
00:24:04,765 --> 00:24:06,895
And they say to me, it will get better.

435
00:24:07,255 --> 00:24:08,695
It's just a really busy

436
00:24:09,140 --> 00:24:09,700
yeah.

437
00:24:09,790 --> 00:24:11,530
Next year when I get my
new colleague, it'll be

438
00:24:11,965 --> 00:24:13,495
Yeah, absolutely.

439
00:24:13,525 --> 00:24:17,605
So you, you hear a lot of that and you
know, and hopefulness is wonderful.

440
00:24:17,605 --> 00:24:21,395
We need that when we work with our
patients, but it can get to the

441
00:24:21,395 --> 00:24:23,585
point where it's fooling yourself.

442
00:24:23,675 --> 00:24:29,075
And, um, and the danger with the, um,
that stage is what I call the plateau,

443
00:24:29,105 --> 00:24:31,895
where people are just putting their
heads down hoping it'll get better.

444
00:24:32,555 --> 00:24:35,375
But the danger with the plateau
is you end up sleep walking

445
00:24:35,375 --> 00:24:36,605
towards the burnout cliff.

446
00:24:37,055 --> 00:24:41,295
So it comes to a point where things
go, there's too much for too long,

447
00:24:41,655 --> 00:24:45,465
and then there's one thing, the straw
that breaks the camel's back and that

448
00:24:45,765 --> 00:24:49,605
will potentially take you off work
or you'll have to, um, you'll have

449
00:24:49,605 --> 00:24:51,915
to then, um, reduce your commitments.

450
00:24:52,095 --> 00:24:54,045
And that's where we really
don't want to get to.

451
00:24:54,105 --> 00:24:58,125
So it's much better for people to act
early to try and recognize things.

452
00:24:58,570 --> 00:25:01,540
I, I also think you're right that people
don't necessarily look out for them.

453
00:25:01,540 --> 00:25:04,117
So one of the things I do when I'm
lucky enough to be able to do some

454
00:25:04,117 --> 00:25:07,784
workshops with people is spend a
bit of time saying, you know, what

455
00:25:07,784 --> 00:25:09,284
are your signs of problem stress?

456
00:25:09,444 --> 00:25:10,257
Do you know them?

457
00:25:10,257 --> 00:25:11,307
Do you know them as a tick list?

458
00:25:11,312 --> 00:25:14,990
And, and often people don't know
them, but, but really, they,

459
00:25:14,990 --> 00:25:16,400
they should be on our dashboard.

460
00:25:16,400 --> 00:25:17,750
We should be monitoring them.

461
00:25:18,070 --> 00:25:21,520
And, uh, you know, we should be
watching out when we're not sleeping as

462
00:25:21,520 --> 00:25:25,270
well, when we're withdrawing, whether
we're, when we're becoming irritable,

463
00:25:25,300 --> 00:25:26,710
when we're getting muscle tension.

464
00:25:26,980 --> 00:25:30,666
But I, I'm not sure people are monitoring
those and, or if they do recognize

465
00:25:30,666 --> 00:25:31,866
them, sometimes they're ignoring them.

466
00:25:32,181 --> 00:25:35,792
and I've just had this real realization
as I've been talking to you, because

467
00:25:35,792 --> 00:25:37,382
this burnout cliff is really interesting.

468
00:25:37,382 --> 00:25:39,152
And you, you have it in the book
'cause you know, you have this

469
00:25:39,152 --> 00:25:42,092
wiggly line, you go along and
then suddenly you go into burnout.

470
00:25:42,092 --> 00:25:47,752
Because the question I've had for a long
time is, okay, why is so many doctors able

471
00:25:47,752 --> 00:25:51,442
to work in burnout when the traditional
advice is their performance will go down?

472
00:25:51,862 --> 00:25:56,572
You know, so you can't perform
if you're in burnout yet, they

473
00:25:56,572 --> 00:25:58,192
are still just about performing.

474
00:25:58,655 --> 00:25:59,165
That's right.

475
00:25:59,165 --> 00:26:02,985
And I, and I think it's, um, there's two
people I think of in the kind of history

476
00:26:02,985 --> 00:26:04,725
of burnout that I often go back to.

477
00:26:04,845 --> 00:26:07,215
And the first one is he's
got a wonderful name.

478
00:26:07,215 --> 00:26:09,315
He's Dr. Herbert Freudenberger.

479
00:26:09,705 --> 00:26:13,790
And he was a psychoanalyst in New
York in the 1960s, and he burnt

480
00:26:13,790 --> 00:26:17,047
out , um, and then he coined the
phrase to describe his burnout.

481
00:26:17,287 --> 00:26:22,087
And, um, and he, he was doing a public
addictions clinic during the day and doing

482
00:26:22,087 --> 00:26:25,387
a private clinic at ,night and too much
for too long with too little support.

483
00:26:26,123 --> 00:26:30,893
And he, he coined the word burnout
because it reminded him of what he was

484
00:26:30,893 --> 00:26:34,630
saying in New York at that time, which
was there were burnt out buildings.

485
00:26:34,904 --> 00:26:37,844
And he said, if you look at a burnt
out building, it looks okay from

486
00:26:37,844 --> 00:26:41,662
the outside, but inside there's a
kind of desolation and emptiness.

487
00:26:42,052 --> 00:26:43,882
And he said, that's what I feel like.

488
00:26:44,302 --> 00:26:47,092
People, people look at me,
they think, I think I'm fine,

489
00:26:47,092 --> 00:26:49,582
but inside I'm feel terrible.

490
00:26:49,912 --> 00:26:53,992
And, uh, and that is, I think
the burnt out clinician at work.

491
00:26:54,187 --> 00:26:58,402
They're, they're protecting their work,
they look okay, but inside something

492
00:26:58,402 --> 00:27:00,202
really quite serious is going on.

493
00:27:00,334 --> 00:27:03,844
But when they, when the straw that
breaks come off back and they need to

494
00:27:03,844 --> 00:27:07,114
take work time off work, it sometimes
takes them by surprise, but almost

495
00:27:07,114 --> 00:27:09,454
always takes their colleagues by
surprise, they don't see it coming.

496
00:27:09,819 --> 00:27:13,522
The other key name is the name you've
already mentioned, professor Christina

497
00:27:13,522 --> 00:27:18,723
Maslach, who did the Maslach Inventory
and she described burnout as three things.

498
00:27:18,933 --> 00:27:22,683
So I think at that stage she didn't
talk about performance, but what she

499
00:27:22,683 --> 00:27:25,683
talked about is emotional exhaustion.

500
00:27:25,773 --> 00:27:28,923
So that kind of absolutely exhausted
at the end of the day, all you

501
00:27:28,923 --> 00:27:31,833
can do is sit on the sofa and have
a glass of wine and fall asleep.

502
00:27:32,216 --> 00:27:36,515
Emotional detachment, so that kind
of robotic, kind of compassion

503
00:27:36,515 --> 00:27:39,095
fatigue, feel not there for your
colleagues and your patients.

504
00:27:39,515 --> 00:27:42,245
And then the third thing she
said was a loss of joy in work.

505
00:27:42,725 --> 00:27:47,465
So that kind of where you don't feel
those, that joy that brought us into

506
00:27:47,465 --> 00:27:51,185
medicine or these high stress professions,
you don't feel those small wins anymore.

507
00:27:51,478 --> 00:27:53,638
And lots of people have
those three symptoms and are

508
00:27:53,638 --> 00:27:55,828
still at work and manage it.

509
00:27:56,098 --> 00:28:00,028
And it's only, I think, much later
in the burnout kind of well warm

510
00:28:00,028 --> 00:28:04,342
path that you get the drop in work
performance, but because people stay

511
00:28:04,342 --> 00:28:08,422
off so long, you get a sudden drop,
you get this kind of slow burnout and

512
00:28:08,422 --> 00:28:10,372
they're then a very quick burnout.

513
00:28:10,625 --> 00:28:13,985
And this is diagrams in your book that
you've got this plateau, um, which

514
00:28:13,985 --> 00:28:16,410
is slowly going down, which is your
performance, and then suddenly the

515
00:28:16,410 --> 00:28:18,480
burnout cliff suddenly drops down.

516
00:28:18,780 --> 00:28:21,930
But what really struck me about what
you said, Richard, is that actually

517
00:28:22,140 --> 00:28:24,600
your performance isn't carrying on well.

518
00:28:24,660 --> 00:28:27,780
Your performance at work is
so you protect your work.

519
00:28:28,140 --> 00:28:30,300
But if you look at your performance
at home, so I've drawn another

520
00:28:30,300 --> 00:28:34,050
wiggly line underneath, and
that is your relationships,

521
00:28:34,350 --> 00:28:35,850
that's your thriving in life.

522
00:28:35,850 --> 00:28:37,380
That's your family life.

523
00:28:37,380 --> 00:28:41,100
That's any friendships, your exercise,
your wellbeing, all that, your

524
00:28:41,100 --> 00:28:44,490
performance in terms of thriving in
life, well that is starting to go down

525
00:28:44,490 --> 00:28:49,350
and you'll, you'll drop all of those as
long as you are protecting your work.

526
00:28:49,830 --> 00:28:53,190
Well, thinking, well, I can't be burnt
out 'cause I'm still performing fine even

527
00:28:53,190 --> 00:28:56,790
though, like you said, joy has completely
gone, you're this hollow, empty show with

528
00:28:56,790 --> 00:29:00,360
nothing in your life, but work because
you've given up doing anything that brings

529
00:29:00,360 --> 00:29:03,790
you happiness, joy, or whatever, so that
you can protect your performance at work.

530
00:29:04,056 --> 00:29:08,576
And then something happens, the straw that
breaks the camel's back, be it a complaint

531
00:29:08,606 --> 00:29:12,956
or a tricky patient or a colleague going
off sick or maybe something happening

532
00:29:12,956 --> 00:29:16,526
at home, and then suddenly boom,
your performance everywhere plummets.

533
00:29:16,526 --> 00:29:19,973
Is that a good interpretation
of, of, of what you've

534
00:29:20,313 --> 00:29:20,525
Yeah.

535
00:29:20,723 --> 00:29:23,375
I mean, it's, exactly right
and that's what we see.

536
00:29:23,585 --> 00:29:28,115
We see people protecting work
at far too heavy a cost to them

537
00:29:28,115 --> 00:29:32,585
personally, um, and, and to their
families and, and ultimately to work.

538
00:29:33,095 --> 00:29:37,475
So you might see somebody, in fact,
I'm, I'm thinking about somebody who,

539
00:29:37,964 --> 00:29:41,024
know, example of somebody who's just
had a baby, but they've also just

540
00:29:41,024 --> 00:29:42,914
had a promotion, so that's great.

541
00:29:42,974 --> 00:29:47,624
These, these are great things, but
massive increase in home and work stress.

542
00:29:48,104 --> 00:29:52,124
Because they've had a promotion, they've
also changed line manager and their

543
00:29:52,124 --> 00:29:55,544
new line manager isn't very supportive,
they're expecting them to get on with it.

544
00:29:56,204 --> 00:29:59,624
So there's been a decrease in
support, but the, the way they

545
00:29:59,624 --> 00:30:02,024
manage that is focusing on work.

546
00:30:02,084 --> 00:30:06,634
So working really hard, focusing
at home, but absolutely no

547
00:30:06,634 --> 00:30:08,134
time anymore for themselves.

548
00:30:08,164 --> 00:30:09,424
So they've stopped running.

549
00:30:09,874 --> 00:30:13,414
Uh, you know, they, they've stopped
seeing their friends, um, they become

550
00:30:13,414 --> 00:30:16,864
more isolated, they don't come outta their
office much, so they're not talking to

551
00:30:16,864 --> 00:30:20,567
their colleagues unless it's in a Teams
meeting, and they're not doing anything

552
00:30:20,567 --> 00:30:22,817
fun at work or enjoyable or stimulating.

553
00:30:23,057 --> 00:30:24,377
And that's where it tips.

554
00:30:24,587 --> 00:30:29,237
So, so you get a change and then the
way people manage that change gets

555
00:30:29,237 --> 00:30:30,887
things even more out of balance.

556
00:30:31,269 --> 00:30:32,379
That makes a lot of sense.

557
00:30:32,379 --> 00:30:35,679
And the problem is that just the time
where you are being promoted, where

558
00:30:35,679 --> 00:30:39,309
you are taking on leadership experience
often coincides with life stuff going

559
00:30:39,309 --> 00:30:44,949
on, babies, kids, teenagers, elderly
parents, all that, all that sort of stuff.

560
00:30:44,949 --> 00:30:47,859
So you can see there's a lot
of things that are gonna break

561
00:30:47,859 --> 00:30:49,179
the camels back, as it were.

562
00:30:49,329 --> 00:30:51,279
And you also talk about
curve balls in the book.

563
00:30:51,279 --> 00:30:54,339
Are these things that will also like
plummet you down that cliff quicker?

564
00:30:54,520 --> 00:30:55,570
Yeah, absolutely.

565
00:30:55,720 --> 00:30:59,714
And I, I talk about these cause a
lot of people who come and see me in

566
00:30:59,714 --> 00:31:02,763
these conversations, the conversation
initially is all about work.

567
00:31:03,076 --> 00:31:04,576
And work is really important.

568
00:31:04,666 --> 00:31:09,556
And they probably wouldn't be seeing me
unless things were very demanding at work.

569
00:31:10,039 --> 00:31:13,999
But there's also often things at home
and, and, and it's only at home, only

570
00:31:13,999 --> 00:31:15,499
comes in when I often ask about it.

571
00:31:15,499 --> 00:31:16,849
Well, you know, what's happening at home?

572
00:31:17,179 --> 00:31:21,299
And, and you, I talk about curve balls
'cause there's typically kind of four

573
00:31:21,539 --> 00:31:23,789
home curve balls that are important.

574
00:31:24,336 --> 00:31:26,946
also we can have strategies to, to manage.

575
00:31:27,134 --> 00:31:31,724
And, um, these curve balls come from
interpersonal therapy, a type of therapy

576
00:31:31,724 --> 00:31:35,813
that I'm trained in, but, but the, the
big curve balls to watch out for are

577
00:31:35,933 --> 00:31:38,783
change, so has something changed at home?

578
00:31:38,933 --> 00:31:40,733
So the example I gave there, new baby.

579
00:31:40,934 --> 00:31:41,954
Big change at home,

580
00:31:42,069 --> 00:31:43,479
moving house would be one.

581
00:31:43,509 --> 00:31:46,329
Even though it's a positive change,
it is emotionally very draining,

582
00:31:46,404 --> 00:31:47,484
Yeah, absolutely.

583
00:31:47,724 --> 00:31:51,714
And yeah, so  lots and lots of
changes happen in people's lives.

584
00:31:51,864 --> 00:31:54,054
Um, caring responsibilities,
as you've said.

585
00:31:54,294 --> 00:31:57,594
Um, the, the menopause is a
massive, massive physical change.

586
00:31:57,824 --> 00:32:00,674
So the other thing that's going
on is, is maybe disagreements at

587
00:32:00,674 --> 00:32:03,067
work, but disagreements at home.

588
00:32:03,097 --> 00:32:06,537
So, you know, if you're working very
hard, very long hours, things can

589
00:32:06,537 --> 00:32:08,007
often be a bit difficult at home.

590
00:32:08,012 --> 00:32:11,637
How, how do you manage those
disagreements at home with a partner

591
00:32:11,847 --> 00:32:15,297
or sometimes with parents or sometimes
with children, they're very stressful.

592
00:32:15,297 --> 00:32:15,597
Yeah.

593
00:32:15,597 --> 00:32:19,677
Just say that I, I had some friends
who there was a massive dispute going

594
00:32:19,677 --> 00:32:23,047
on with their neighbors and that,
i, I just couldn't quite work out

595
00:32:23,047 --> 00:32:24,577
why it was affecting them so much.

596
00:32:24,577 --> 00:32:26,947
I mean, it's not very nice thing
to happen, but it absolutely

597
00:32:26,947 --> 00:32:27,607
knocked them sideways.

598
00:32:27,607 --> 00:32:30,757
For six months they couldn't
think or talk about anything else.

599
00:32:30,757 --> 00:32:32,677
So it's, it's a big thing, isn't it?

600
00:32:32,677 --> 00:32:36,367
Whether it's with parents,
families, partners, or neighbors

601
00:32:36,372 --> 00:32:37,627
or, or anything else really.

602
00:32:37,882 --> 00:32:38,655
And absolutely.

603
00:32:38,655 --> 00:32:42,525
And you throw that in alongside a very
busy job or a job where you're not

604
00:32:42,525 --> 00:32:45,465
particularly supportive from, that,
that will be the thing that will tip it.

605
00:32:45,805 --> 00:32:47,545
So we've got change, disputes.

606
00:32:47,545 --> 00:32:48,895
The third one is bereavement.

607
00:32:49,345 --> 00:32:54,555
And natural process losing people,
natural process grief, but do we ever

608
00:32:54,555 --> 00:32:56,205
allow any time for it in healthcare?

609
00:32:56,470 --> 00:32:58,810
Sometimes you might get five
days off or something like that.

610
00:32:59,020 --> 00:33:04,080
And people are expected to work just
the same alongside being bereaved.

611
00:33:04,140 --> 00:33:08,210
And that is a very big ask
and often not very possible.

612
00:33:08,493 --> 00:33:14,128
And then the fourth, um, the fourth
curve ball I put in is, is loneliness.

613
00:33:14,308 --> 00:33:17,878
And, and this is, this is something we
don't talk about a great deal within

614
00:33:17,938 --> 00:33:22,498
high stress professions, but we, we do
see people can become quite isolated,

615
00:33:22,527 --> 00:33:25,947
because 'cause of how many hours they're
working and how intense they're working.

616
00:33:26,284 --> 00:33:29,654
But, uh, a, a group that I
particularly think about here are

617
00:33:29,714 --> 00:33:33,134
international healthcare graduates
who are coming over to the UK.

618
00:33:33,561 --> 00:33:36,891
it's a wonderful opportunity to come
over here and develop, develop their

619
00:33:36,891 --> 00:33:41,181
career, but they're quite isolated
and expecting to do really difficult

620
00:33:41,181 --> 00:33:43,251
work without the normal support.

621
00:33:43,251 --> 00:33:45,141
So isolation can be really important.

622
00:33:45,591 --> 00:33:49,681
We can really feel it when we've
got a good friend we rely on,

623
00:33:50,001 --> 00:33:52,070
um, a good buddy moves away.

624
00:33:52,460 --> 00:33:53,890
You know, that can be the difference.

625
00:33:54,040 --> 00:33:57,785
Um, so, so isolation's a really important
curve ball to think about as well.

626
00:33:58,263 --> 00:34:02,313
If you can tell someone's heading
toward that, that burnout cliff, how

627
00:34:02,313 --> 00:34:05,103
do we get people to, to take action?

628
00:34:05,103 --> 00:34:09,093
Because I'm presuming most people
leave it till it's too late

629
00:34:09,296 --> 00:34:10,504
They do, they do.

630
00:34:10,583 --> 00:34:11,663
Or leave it too late.

631
00:34:11,912 --> 00:34:12,752
Not till it's too late.

632
00:34:12,752 --> 00:34:13,442
Nothing's ever too

633
00:34:13,502 --> 00:34:14,642
No, nothing's no.

634
00:34:14,647 --> 00:34:15,602
And, and absolutely.

635
00:34:15,602 --> 00:34:19,622
And people, people come forward to
services for support when they're

636
00:34:19,622 --> 00:34:22,892
very burnt out, they're an, you know,
they're anxious, they're depressed,

637
00:34:23,162 --> 00:34:24,332
and they still do really well.

638
00:34:24,512 --> 00:34:26,642
You know, I mean, it's an
important message here.

639
00:34:26,642 --> 00:34:31,640
But, yes, we can avoid an awful lot of
distress of ourselves, our families,

640
00:34:31,640 --> 00:34:35,420
our colleagues, our organization,
if we come forward earlier.

641
00:34:35,953 --> 00:34:39,643
The group that are really good at
coming forward, forward earlier are

642
00:34:39,643 --> 00:34:41,593
the people who've burnt out previously.

643
00:34:42,606 --> 00:34:47,387
And I, um, I love seeing people have
burnt out earlier in my, in my clinic

644
00:34:47,417 --> 00:34:51,746
because they, they say, they say, I'm
coming forward because I'm starting to

645
00:34:51,746 --> 00:34:55,256
feel these symptoms of problem stress,
they've been with me for a few weeks now.

646
00:34:55,481 --> 00:34:58,736
I'm, I'm a bit worried 'cause I'm not
kind of caring quite as much for my PA

647
00:34:58,766 --> 00:35:00,386
patients, I used to feeling a bit robotic.

648
00:35:00,776 --> 00:35:02,576
I'm not going down the
roof to burnout again.

649
00:35:02,606 --> 00:35:04,286
I'm coming forward for some support.

650
00:35:04,436 --> 00:35:06,715
And that's exactly the great thing to do.

651
00:35:07,015 --> 00:35:09,655
So what, what would be wonderful, and
one of the motivations for writing

652
00:35:09,655 --> 00:35:12,408
the book was can people do that?

653
00:35:12,438 --> 00:35:16,068
Can people learn from all of
the people who come forward

654
00:35:16,368 --> 00:35:18,372
later to come forward earlier?

655
00:35:18,472 --> 00:35:22,612
Because if you come forward earlier,
it's much easier to get things back

656
00:35:22,612 --> 00:35:26,392
in balance, to balance out your
radiators and drains, to, to make

657
00:35:26,812 --> 00:35:29,092
changes that protect you from burnout.

658
00:35:29,452 --> 00:35:31,102
it's much easier, it's
much more effective.

659
00:35:31,102 --> 00:35:34,058
It's much quicker and it's much
less disruptive to everyone.

660
00:35:34,241 --> 00:35:36,491
But it's something about self-monitoring.

661
00:35:36,491 --> 00:35:41,566
It's about, it's about recognizing those
symptoms, but equally important, it's

662
00:35:41,566 --> 00:35:44,266
about taking those symptoms seriously.

663
00:35:44,446 --> 00:35:47,926
Don't just ignore them and
keep, keep calm and carry on.

664
00:35:47,926 --> 00:35:48,946
Don't just keep swimming.

665
00:35:49,106 --> 00:35:52,796
Stop, reflect, but also
act, do something about it.

666
00:35:53,325 --> 00:35:57,110
I think people put off coming A,
because they're not recognizing it and

667
00:35:57,260 --> 00:36:00,500
because everyone is in the same boat
as then everyone's working in burnout.

668
00:36:00,920 --> 00:36:05,360
B, they think they're only deserving of
treatment when they are in full burnout.

669
00:36:05,960 --> 00:36:08,030
They actually, no one wants to see me now.

670
00:36:08,030 --> 00:36:11,390
And to be honest, there have been
anecdotal reports from people that have

671
00:36:11,390 --> 00:36:14,990
written in, um, to the podcast saying,
well, I was feeling really stressed and

672
00:36:14,990 --> 00:36:17,450
overwhelmed, I went to see occupational
health, they said, the only thing we

673
00:36:17,450 --> 00:36:18,980
can do is sign you off, that was it.

674
00:36:18,980 --> 00:36:20,120
Or they see the GP, he goes.

675
00:36:20,840 --> 00:36:23,620
And to be honest, with most GPs, the only
thing they can do is say, well, do you

676
00:36:23,620 --> 00:36:26,465
wanna take time off with, you know, they
can point people towards, well there's

677
00:36:26,465 --> 00:36:30,395
Practitioner Health and there's some other
services, but they, they themselves, that

678
00:36:30,395 --> 00:36:34,325
is the only, they don't have time in 10
minutes to go through, okay, let's look

679
00:36:34,325 --> 00:36:38,255
at your radiators and drains and coping
mechanisms and all that sort of stuff.

680
00:36:38,255 --> 00:36:41,240
So people are very fearful that they're
told, they're just gonna be told to

681
00:36:41,240 --> 00:36:44,450
take time off and then they'll be
going about against medical advice.

682
00:36:44,678 --> 00:36:46,958
And I think it's a real conundrum
because we've seen, if you look at

683
00:36:46,958 --> 00:36:50,378
the stress curve, I think if you are
going to get some help when you are at

684
00:36:50,378 --> 00:36:54,788
stress and just before overwhelm and
someone takes, tells you to take time

685
00:36:54,788 --> 00:36:58,718
off, then actually sometimes, sometimes
it's absolutely what they need to do.

686
00:36:58,718 --> 00:37:01,688
But sometimes it's like the the
last thing you want to do and it'll

687
00:37:01,688 --> 00:37:02,978
make things a lot worse for you.

688
00:37:02,978 --> 00:37:07,388
Yes, you need to rest and make some
changes, but this prolonged time, time off

689
00:37:07,388 --> 00:37:11,018
that most people are just told to do as
a sort of panacea for burnout management.

690
00:37:11,410 --> 00:37:14,740
That's just like, that's not gonna
work for me right, right now, and

691
00:37:14,740 --> 00:37:18,340
so let's wait until I a hundred
percent can't actually go into work

692
00:37:18,400 --> 00:37:19,720
just to be told to take time off.

693
00:37:19,720 --> 00:37:22,510
Now, I know I'm being a little bit
harsh, but I think that's genuinely some

694
00:37:22,510 --> 00:37:24,190
of the experiences of our listeners.

695
00:37:24,347 --> 00:37:29,507
Yeah, and I, I, and I, I've heard people
report that to me as well, and, um,

696
00:37:29,867 --> 00:37:35,777
who've gone to other services and, um,
you know, and other services are limited.

697
00:37:35,807 --> 00:37:36,827
They haven't got the knowledge.

698
00:37:36,827 --> 00:37:40,607
I mean, you know, we we're
still quite early with our

699
00:37:40,607 --> 00:37:42,287
understanding of burnout, I think.

700
00:37:42,287 --> 00:37:45,347
And it's not, you know, it's
not, it's not greatly understood.

701
00:37:45,347 --> 00:37:47,777
It's, um, it's still not
considered a medical condition.

702
00:37:47,777 --> 00:37:52,097
I don't really understand that, but,
but it isn't, so I think you're right.

703
00:37:52,127 --> 00:37:56,117
But, what I would say is that,
if you can come forward early.

704
00:37:56,328 --> 00:37:57,468
it is much easier.

705
00:37:57,468 --> 00:37:58,878
It's what you should be doing.

706
00:37:59,242 --> 00:38:04,006
To take, uh, examples of us as doctors,
we don't really say to our patients,

707
00:38:04,126 --> 00:38:07,996
let's not sort this out early on
before, while it's mild, let's just

708
00:38:07,996 --> 00:38:10,906
come back when it's really, really
bad, and then, then we'll tackle it.

709
00:38:11,176 --> 00:38:13,966
'cause it's much easier to sort
things out when they are mild.

710
00:38:13,966 --> 00:38:18,221
It's mu you know, and you'll need
much less input and, you know, and

711
00:38:18,221 --> 00:38:21,221
there's a greater range of people
who can help you when it's mild and

712
00:38:21,221 --> 00:38:24,191
it, you know, it, it may not be that
you want to come through to service,

713
00:38:24,191 --> 00:38:26,119
you might want to do some,  coaching.

714
00:38:26,119 --> 00:38:29,479
Or you may, you may have some
peer support or things like that.

715
00:38:29,479 --> 00:38:32,867
The, there can be other things,
so it is, you know, I, I would

716
00:38:32,867 --> 00:38:34,307
say it's really important people

717
00:38:34,479 --> 00:38:38,379
I mean, this is why we have our Shapes
Toolkit system because we think there is

718
00:38:38,379 --> 00:38:42,819
nothing between stress and burnout for
people often even to help themselves.

719
00:38:42,989 --> 00:38:46,059
Because with the best will in the
world, getting an appointment to talk

720
00:38:46,059 --> 00:38:49,149
to people that might be a few, few
days away or even a few weeks away.

721
00:38:49,149 --> 00:38:53,199
But there are things that we know help,
like staying in your zone of control,

722
00:38:53,204 --> 00:38:55,869
you're of power working out what you
control, of what you're not actually

723
00:38:55,989 --> 00:38:59,829
facing reality, having conversations,
learning to put some boundaries around

724
00:38:59,829 --> 00:39:03,639
your time and, and workload, things like
that, which are really, really helpful

725
00:39:03,639 --> 00:39:06,564
and can just pull you back up that
curve and away from the burnout cliff.

726
00:39:07,026 --> 00:39:07,506
Yeah.

727
00:39:07,506 --> 00:39:10,956
And, and if you act early, I dunno whether
this metaphor work, but sometimes I think

728
00:39:10,956 --> 00:39:14,776
of it a bit like driving a car, that
if you steer a little bit and use your

729
00:39:14,776 --> 00:39:16,744
brake a little bit, that's how you drive.

730
00:39:16,864 --> 00:39:19,324
What you don't drive is wait until
you hit the corner and then just go

731
00:39:19,414 --> 00:39:22,264
like that and slam your brake on.

732
00:39:22,474 --> 00:39:26,704
So, so so actually if, if you do, if
you do take things seriously and you

733
00:39:26,704 --> 00:39:30,152
do monitor things and you do come
forward and make the sort of changes

734
00:39:30,152 --> 00:39:33,099
that you're suggesting, they often
don't need to be massive changes.

735
00:39:33,196 --> 00:39:36,266
What you want to be doing is
self-correcting and making these small

736
00:39:36,266 --> 00:39:40,643
changes and learning these small,
these ways of doing it, um, early on.

737
00:39:40,898 --> 00:39:44,528
So what do you wish your patients
had done or been able to do or had

738
00:39:44,528 --> 00:39:46,838
support to do to self-correct early?

739
00:39:47,080 --> 00:39:51,628
Well, what I see, I, what I see
people doing, uh, when they recover,

740
00:39:51,658 --> 00:39:55,348
I mean, it's, it's individual and
it, but, but I think there's five,

741
00:39:55,708 --> 00:39:57,868
five key things that I see people do.

742
00:39:58,678 --> 00:40:04,288
The first one is that if their
basic needs are out of whack,

743
00:40:04,498 --> 00:40:06,538
they do something to attend to it.

744
00:40:06,538 --> 00:40:11,428
So that is, if they are working
massive hours, intense hours, they're

745
00:40:11,428 --> 00:40:15,178
not getting any time to talk to their
colleagues, not taking their annual leave.

746
00:40:15,748 --> 00:40:19,474
Or if it's something at home that is
out of whack, they try and address it.

747
00:40:19,709 --> 00:40:23,174
Because the danger is if you take
time off and you come forward

748
00:40:23,174 --> 00:40:24,854
for help, you will get better.

749
00:40:24,854 --> 00:40:29,384
But if you go back to the same
problems, it only lasts so long.

750
00:40:29,474 --> 00:40:32,294
And there's good research
evidence that shows that too.

751
00:40:32,594 --> 00:40:36,894
So I, I think if it is about basic
needs that are making you become

752
00:40:36,894 --> 00:40:38,874
unwell, then you need to address it.

753
00:40:39,174 --> 00:40:41,244
The second one is
decompression activities.

754
00:40:41,407 --> 00:40:44,801
So this is the idea that stress builds
up on us every day, so we need to do

755
00:40:44,801 --> 00:40:47,301
something regularly to manage that stress.

756
00:40:47,631 --> 00:40:54,041
And that could be something that's active,
like running, joining a choir, or it

757
00:40:54,041 --> 00:40:58,327
could be something that's quieter,  a
restorative niche like, um, you know,

758
00:40:58,327 --> 00:41:00,307
might be reading, might be mindfulness.

759
00:41:00,567 --> 00:41:03,057
I've heard you speak to Paula
Redmond, she talks about knitting.

760
00:41:03,357 --> 00:41:05,937
You know, these are all really
important things and they're

761
00:41:05,937 --> 00:41:07,107
different for different people.

762
00:41:07,257 --> 00:41:10,176
So you know, Don't listen to somebody
who says, oh, you should go running

763
00:41:10,176 --> 00:41:11,316
if that's not what you wanna do.

764
00:41:11,612 --> 00:41:12,272
My idea of

765
00:41:12,722 --> 00:41:17,027
yeah, but, but, but do do something
that you like to do, that.

766
00:41:17,297 --> 00:41:21,107
Now, um, Matt Morgan is an ICU
consultant, and I love the way

767
00:41:21,107 --> 00:41:22,487
Matt Morgan talks about this.

768
00:41:22,487 --> 00:41:26,007
So he talks about early on in his
consultant career, he was sort of

769
00:41:26,007 --> 00:41:31,137
soaking up this stress and he, and he
found himself perhaps drinking a little

770
00:41:31,137 --> 00:41:35,637
bit too much or more than he wanted to,
and, uh, and also being a bit irritable.

771
00:41:36,267 --> 00:41:39,147
And, and he talks about the idea
of what he discovered, which he, a

772
00:41:39,147 --> 00:41:42,237
kind of brainwave came to him when
he had his, he was kind of, um,

773
00:41:42,473 --> 00:41:46,733
bathing his young children, uh, and
he talked about squeezing the sponge.

774
00:41:47,003 --> 00:41:51,387
And he said the idea that came to
him was that, um, at work he was

775
00:41:51,387 --> 00:41:56,127
like a sponge for stress and he was
filling up and filling up with stress.

776
00:41:56,611 --> 00:41:58,441
And, and, and because he was over full.

777
00:41:58,531 --> 00:42:00,031
that he wasn't coping very well.

778
00:42:00,031 --> 00:42:02,251
He was, uh, you know, taking
out on other people sometimes.

779
00:42:02,735 --> 00:42:07,827
But he said what, what he learned was that
to be a consultant and sustain his career,

780
00:42:07,887 --> 00:42:10,317
he needed to regularly squeeze the sponge.

781
00:42:10,497 --> 00:42:13,377
He needed to do something to
get the stress out of him.

782
00:42:13,647 --> 00:42:16,887
And, uh, and, you know, and need, he
took, he talks about the various kind

783
00:42:16,887 --> 00:42:20,507
of activities that he made routine
within his week, um, to manage his

784
00:42:20,507 --> 00:42:21,882
career, so that's a really good one.

785
00:42:22,265 --> 00:42:24,740
The other thing is, um, social support.

786
00:42:25,160 --> 00:42:29,510
So, um, having your support team, you
know, knowing who's there for you at

787
00:42:29,510 --> 00:42:33,293
work and home, and uh, and really,
really reaching out for people.

788
00:42:33,473 --> 00:42:35,573
And it's not just about
a shoulder to cry on.

789
00:42:35,847 --> 00:42:40,377
Just those normal kind of everyday
social activities alongside people,

790
00:42:40,377 --> 00:42:44,637
those chats, you know, before and after
meetings, those chats in the coffee room,

791
00:42:44,817 --> 00:42:48,267
or those, you know, just those chats
down the pool, but in a coffee room are

792
00:42:48,267 --> 00:42:50,217
really, really important for our health.

793
00:42:50,892 --> 00:42:56,322
The fourth thing is a don't do, which
is to evol to avoid false cures, to

794
00:42:56,322 --> 00:43:01,632
evolve, avoid, um, things that are
unhelpful, like drinking too much.

795
00:43:01,752 --> 00:43:05,862
Um, and you know, I'm seeing a fair,
some, some professionals are using

796
00:43:05,862 --> 00:43:10,002
gambling, and this is a way of kind
of taking you outta things, but it

797
00:43:10,002 --> 00:43:11,772
doesn't solve the underlying problems.

798
00:43:11,892 --> 00:43:16,092
And beca can become in time a bigger
problem than, than the underlying problem.

799
00:43:16,812 --> 00:43:20,742
And then the fifth thing is, what
I see people do, and I've mentioned

800
00:43:20,742 --> 00:43:24,582
this already, is they keep calm,
but they nip things in the bud.

801
00:43:24,972 --> 00:43:30,882
So people get really good at taking
their, their wellbeing and their mental

802
00:43:30,882 --> 00:43:36,582
health seriously, and they look out for
symptoms and signs in themselves of when

803
00:43:36,582 --> 00:43:40,658
things are getting out of balance, and
they act quickly to do something about it.

804
00:43:40,952 --> 00:43:42,872
So they don't keep calm and carry on.

805
00:43:43,232 --> 00:43:46,472
They keep calm, nip it in the
bud, do something about it, and,

806
00:43:46,472 --> 00:43:49,567
and that is a really rewarding
change to see people make.

807
00:43:50,022 --> 00:43:52,132
I think we are quite bad at doing that.

808
00:43:52,132 --> 00:43:55,944
I'm thinking of people, friends
that I've had in the past who,

809
00:43:56,214 --> 00:43:57,534
um, have been quite flaky.

810
00:43:57,534 --> 00:43:58,704
Like they haven't been doctors.

811
00:43:58,704 --> 00:44:01,674
Doctors always, you know, doctors turn
up when they say We will, we'll go

812
00:44:01,674 --> 00:44:05,514
out when we do it, you know, but some
non-doctor friends have been like, I

813
00:44:05,514 --> 00:44:08,484
can't come out this evening, i'm just
feeling a bit tired and I'm like,

814
00:44:08,600 --> 00:44:10,190
gosh, I would never cancel anything.

815
00:44:10,190 --> 00:44:13,850
Just I'm feeling tired, you know, because
like we've been programmed that like tide

816
00:44:13,850 --> 00:44:15,290
is just normal so you wouldn't, you know.

817
00:44:15,590 --> 00:44:18,650
But actually looking back, they
were nipping it in the bud.

818
00:44:18,650 --> 00:44:19,760
They're like, actually.

819
00:44:20,180 --> 00:44:24,230
I can't do that tonight, 'cause I know I
don't have the emotional capacity for it.

820
00:44:24,230 --> 00:44:25,040
I've just canceled that.

821
00:44:25,040 --> 00:44:25,790
I'm not gonna do that.

822
00:44:25,790 --> 00:44:28,700
And yeah, they, they
recognize it and they do it.

823
00:44:28,700 --> 00:44:32,120
But I think in medicine we're like,
oh, well that I, I can keep going

824
00:44:32,120 --> 00:44:35,060
'cause I, I always had, and when I
was younger I did 120 hours a week.

825
00:44:35,060 --> 00:44:36,620
Therefore I can manage that now.

826
00:44:36,620 --> 00:44:38,720
And yet this weird
mindset we have, isn't it?

827
00:44:39,084 --> 00:44:40,524
it's inter it's interesting, isn't it?

828
00:44:40,524 --> 00:44:44,754
Because the other thing that we
are quite good at, at medics,

829
00:44:44,754 --> 00:44:50,964
especially if our patients is taking
control and advocating and, and, and

830
00:44:50,994 --> 00:44:55,182
acting, but when it comes to our own
wellbeing, we are not very good at it.

831
00:44:55,632 --> 00:45:00,102
Um, but, but we have got those medical
skills to, you know, we are not,

832
00:45:00,102 --> 00:45:01,932
we're not normally afraid of acting.

833
00:45:02,052 --> 00:45:06,122
We, we, we make difficult decisions, but
we need to start doing that for ourselves.

834
00:45:06,122 --> 00:45:11,347
So I think a lot of high, professionals in
high profile jobs have got these skills.

835
00:45:11,437 --> 00:45:14,234
They just haven't yet harbored
them for their own wellbeing.

836
00:45:14,485 --> 00:45:17,215
The other thing, it's just come to me,
it's a bit of a play on the word acting.

837
00:45:17,485 --> 00:45:19,105
Um, we like to get into action.

838
00:45:19,105 --> 00:45:21,265
We're very good at getting into
actions and solving problems,

839
00:45:21,265 --> 00:45:24,715
but actually sometimes the action
that we need is to subtract.

840
00:45:25,495 --> 00:45:29,185
So I'm just thinking, you know,
it's actually very hard for me to

841
00:45:29,185 --> 00:45:32,755
go, I actually need to sit in my
hanging pod in the garden for an

842
00:45:32,755 --> 00:45:34,975
hour and read and read a magazine.

843
00:45:35,365 --> 00:45:36,115
That's what I need.

844
00:45:36,115 --> 00:45:38,155
I'd be much more, but I need to
do this, this, and the other.

845
00:45:38,155 --> 00:45:42,865
So if we can change resting and
subtraction into an action that

846
00:45:42,865 --> 00:45:46,042
we know is good for us, maybe
we'd be more keen to do that.

847
00:45:46,465 --> 00:45:49,015
I mean, it's interesting, you, you've
talked about those five things and

848
00:45:49,015 --> 00:45:53,425
actually nowhere there have, you
talked about therapy and counseling

849
00:45:53,425 --> 00:45:54,505
and psychotherapy and stuff.

850
00:45:54,505 --> 00:45:57,385
So where, where does that all
come in, in, in any of this?

851
00:45:57,993 --> 00:45:59,643
Yeah, no, it's a, it
is a really good point.

852
00:45:59,643 --> 00:46:03,908
So, so PE-people who are coming
through are making these changes.

853
00:46:04,493 --> 00:46:08,303
Um, and I don't think you have to
be in therapy or in a therapeutic

854
00:46:08,303 --> 00:46:11,813
relationship to make these changes,
but pe-people are, are doing that

855
00:46:11,813 --> 00:46:13,163
within a therapeutic relationship.

856
00:46:13,163 --> 00:46:17,603
And I think there is, there is something
about coming through to a support service

857
00:46:17,603 --> 00:46:21,593
or a wellbeing service that allows
you to stop and reflect and think,

858
00:46:22,013 --> 00:46:23,543
actually things are outta balance.

859
00:46:23,573 --> 00:46:26,243
What do I need to do to
kind of correct this?

860
00:46:26,483 --> 00:46:31,006
So that sort of therapeutic support
can be really helpful in helping

861
00:46:31,006 --> 00:46:35,356
people reflect, take things seriously,
but start to make a plan and making

862
00:46:35,356 --> 00:46:38,116
those, those steps and goals and focus.

863
00:46:38,676 --> 00:46:41,366
And I don't think that, you
know, if you're coming through

864
00:46:41,366 --> 00:46:44,426
early enough or with burnout, it
doesn't have to be a long time.

865
00:46:44,501 --> 00:46:48,206
You know, you can, you can do that
within, you know, a relatively

866
00:46:48,206 --> 00:46:52,046
brief therapy, six to 12 sessions,
you know, maybe even less actually.

867
00:46:52,240 --> 00:46:53,110
So that's important.

868
00:46:53,260 --> 00:46:58,882
Where therapy does come in, I think is
your burnout's gone on for a long time.

869
00:46:59,152 --> 00:47:04,762
So if so, some people will be on the
plateau, will be prioritizing their work,

870
00:47:04,882 --> 00:47:08,122
be become really quite severely burnt out.

871
00:47:08,316 --> 00:47:10,746
And if you're still at work and
you're still under a lot of stress,

872
00:47:11,033 --> 00:47:14,663
it's reasonably easy for that
burnout to turn into a medical

873
00:47:14,663 --> 00:47:17,333
condition like anxiety or depression.

874
00:47:17,933 --> 00:47:22,613
So it's, um, I'd see it as rather a
continuum of kind of problem stress

875
00:47:22,853 --> 00:47:24,653
to different levels of burnout.

876
00:47:24,893 --> 00:47:28,853
And then if it's still not managed, you
run a quite a high risk of developing

877
00:47:28,853 --> 00:47:32,753
anxiety or depression or physical health
complications like high blood pressure.

878
00:47:33,323 --> 00:47:37,489
And I think if you are moving into
that anxiety depression area, then

879
00:47:37,489 --> 00:47:41,584
that's where therapy comes in and
an evidence-based therapy comes in.

880
00:47:41,824 --> 00:47:45,223
It may also be, and professionals
tend to be a bit resistant to

881
00:47:45,223 --> 00:47:49,063
this, it may also be a conversation
about, actually I've got anxiety and

882
00:47:49,063 --> 00:47:53,388
depression, do I need to consider, um,
some medication here to treat this?

883
00:47:53,469 --> 00:47:57,519
But most anxiety and depression, the
first step would be therapy and it

884
00:47:57,519 --> 00:48:03,788
would be an evidence-based therapy like,
um, CBT or IPT would be the top, the

885
00:48:03,788 --> 00:48:05,558
top ones in the evidence base to do.

886
00:48:05,970 --> 00:48:07,560
most of us sort of know what CBT is.

887
00:48:07,560 --> 00:48:08,040
What, what?

888
00:48:08,070 --> 00:48:09,610
Can you just explain what IPT

889
00:48:09,785 --> 00:48:09,960
is?

890
00:48:09,987 --> 00:48:10,500
Yeah.

891
00:48:10,560 --> 00:48:12,720
So IIPT is, um.

892
00:48:13,349 --> 00:48:16,979
type of therapy, um,
developed for depression.

893
00:48:17,159 --> 00:48:18,479
It is available in the uk.

894
00:48:18,479 --> 00:48:22,403
It's available in, um, pri in
most primary care, uh, services

895
00:48:22,403 --> 00:48:23,573
for anxiety and depression.

896
00:48:23,903 --> 00:48:26,543
Um, it's also developed
in some secondary care.

897
00:48:26,633 --> 00:48:32,196
Um, we have got, uh, an IPT specialist
within NHS Practitioner health, and, and

898
00:48:32,196 --> 00:48:33,816
within the service I work in regionally,

899
00:48:34,146 --> 00:48:38,682
it's an interesting, um, therapy
because it was developed by somebody,

900
00:48:38,742 --> 00:48:42,642
um, asking therapists, if you're
treating somebody for depression, what

901
00:48:42,642 --> 00:48:44,352
do we need to have in this therapy?

902
00:48:44,352 --> 00:48:45,642
What's it need to look like?

903
00:48:45,882 --> 00:48:50,052
And they, they offer a big list, and the
therapy of IPT was designed upon that.

904
00:48:50,622 --> 00:48:55,375
And, um, CBT tends to be about
Modifying your thoughts, distorted

905
00:48:55,375 --> 00:48:59,995
thoughts, um, and then that leading to
a change in your feelings and behavior.

906
00:49:00,565 --> 00:49:05,785
IPT is, um, much more about looking
at your social support and your

907
00:49:05,785 --> 00:49:08,275
relationships and who's there for you.

908
00:49:08,665 --> 00:49:14,785
And also, um, we talk about, um, in IPT,
the idea of antidepressant activities.

909
00:49:14,935 --> 00:49:19,028
So often when people become
depressed, they stop doing the

910
00:49:19,028 --> 00:49:20,318
things that are good for them.

911
00:49:20,468 --> 00:49:22,028
So they become very tired.

912
00:49:22,028 --> 00:49:25,328
They think they're no good, they're not
good company anymore so they stop seeing

913
00:49:25,328 --> 00:49:29,228
friends, they stop doing those nice things
because they're too exhausted to do it.

914
00:49:29,233 --> 00:49:32,558
So we focus on people getting those
things back into their life as well.

915
00:49:32,938 --> 00:49:33,298
Okay.

916
00:49:33,298 --> 00:49:34,918
That makes, that makes a lot of sense.

917
00:49:34,918 --> 00:49:37,678
And can I quickly ask you
about the relationship between

918
00:49:37,678 --> 00:49:39,568
anxiety, depression, and burnout?

919
00:49:40,108 --> 00:49:43,768
Do you think that all burnout,
if it gets severe enough, turns

920
00:49:43,768 --> 00:49:45,628
into an anxiety and depression?

921
00:49:45,876 --> 00:49:48,576
No, I don't, I don't
think all burnout does.

922
00:49:48,636 --> 00:49:51,426
Um, I think all problem stressed us.

923
00:49:51,636 --> 00:49:54,666
So if, if we start off with problem
stress, if we're in problem stress

924
00:49:54,666 --> 00:49:56,565
for too long, we'll become burnt out.

925
00:49:56,769 --> 00:50:00,609
And then if we stay in burnout too long,
we'll become increasingly burnt out.

926
00:50:00,609 --> 00:50:01,029
Burnout.

927
00:50:01,029 --> 00:50:02,199
Burnout is a spectrum.

928
00:50:02,589 --> 00:50:06,909
But some people will then, if they're,
if they're severely burnt out,

929
00:50:06,909 --> 00:50:10,719
will have a high risk of developing
anxiety and depression, but not

930
00:50:10,719 --> 00:50:13,179
everyone will but quite a lot will.

931
00:50:13,179 --> 00:50:17,049
And the longer you are burnt out,
the higher your risk of developing

932
00:50:17,049 --> 00:50:18,309
anxiety and depression is.

933
00:50:18,991 --> 00:50:22,806
And is the other way round true
that if you suffer with anxiety

934
00:50:22,806 --> 00:50:26,461
and depression anyway, are you
at high risk of burning out?

935
00:50:26,868 --> 00:50:28,218
I wouldn't say necessarily.

936
00:50:28,218 --> 00:50:32,626
So, because, what determines
whether you're at risk of burnout

937
00:50:32,746 --> 00:50:34,276
is what's going on around you.

938
00:50:34,876 --> 00:50:40,386
So, so we burn out because of those
balances between our radiators and drains.

939
00:50:40,526 --> 00:50:44,418
Um, you know, when the drains are
high and the support is low, and

940
00:50:44,838 --> 00:50:46,608
that is the same for ev everyone.

941
00:50:46,748 --> 00:50:50,048
So we, you know, whether you've got
a history of anxiety or depression or

942
00:50:50,048 --> 00:50:53,188
whether you haven't, whether you're
gonna become burnt out or not is

943
00:50:53,208 --> 00:50:54,588
because of what's going on around you.

944
00:50:54,948 --> 00:50:59,058
And what for you would be the red flags
that someone in burnout is tipping

945
00:50:59,148 --> 00:51:01,218
also over into anxiety and depression?

946
00:51:01,707 --> 00:51:05,907
So it's the diagnostic factors
for, um, anxiety and depression.

947
00:51:05,907 --> 00:51:12,242
So, for, for anxiety it would be, you
know, feeling worry and anxiety over

948
00:51:12,812 --> 00:51:15,872
most days for, for several weeks.

949
00:51:15,902 --> 00:51:19,772
You know, probably over, uh, you
know, to a couple of months really.

950
00:51:20,072 --> 00:51:24,332
That's kind of, there often goes
alongside, um, physical symptoms

951
00:51:24,332 --> 00:51:28,592
such as heart racings, sweaty
palms, those kind of things.

952
00:51:28,952 --> 00:51:33,812
Um, so the, that kind of feeling,
that protracted, constant feeling.

953
00:51:33,992 --> 00:51:36,992
And along alongside those
physical feelings as well.

954
00:51:37,695 --> 00:51:44,739
Depression is a feeling of being low or a
feeling of not really being able to enjoy

955
00:51:44,769 --> 00:51:48,009
things most days for at least two weeks.

956
00:51:48,609 --> 00:51:53,299
Um, and often depression also affects
both the way that we see the world.

957
00:51:53,419 --> 00:51:57,139
So we tend to see the world through
the opposite of rose tinted glasses.

958
00:51:57,559 --> 00:52:02,360
So we tend to see the world as viewing
us as worthless, we might feel guilty,

959
00:52:02,780 --> 00:52:04,370
uh, we might lose our optimism.

960
00:52:04,970 --> 00:52:10,040
Uh, we might feel hopeless, you know,
um, thoughts that, um, actually I

961
00:52:10,040 --> 00:52:13,190
might better, the world might be
better off if I wasn't here, or I

962
00:52:13,190 --> 00:52:15,830
might be better if I wasn't here,
quite common within depression.

963
00:52:16,460 --> 00:52:17,720
Um, so they're the feelings.

964
00:52:17,900 --> 00:52:20,570
But the other, the other kind
of hard signs, uh, to look

965
00:52:20,570 --> 00:52:22,220
out for are physical signs.

966
00:52:22,490 --> 00:52:23,960
So people's sleep goes off.

967
00:52:24,350 --> 00:52:28,010
There's a change in their appetite
either reducing or increasing.

968
00:52:28,376 --> 00:52:30,146
People often feel worse in the mornings.

969
00:52:30,776 --> 00:52:32,756
Um, there's a lack, lack of energy.

970
00:52:32,996 --> 00:52:37,556
So there's the, the, those are kind of
key, key signs to look for for depression.

971
00:52:38,186 --> 00:52:42,843
As I say, you only really need those signs
for most days, for a few weeks and at

972
00:52:42,843 --> 00:52:48,933
that stage, I, I would start to wonder if
I'm depressed and, um, and I might seek

973
00:52:49,023 --> 00:52:50,583
further advice and treatment for that.

974
00:52:50,793 --> 00:52:53,283
It doesn't help to ignore
those for too long.

975
00:52:53,523 --> 00:52:55,863
And, and if talking
therapy was the first step.

976
00:52:56,253 --> 00:53:00,213
There are some screening tools
available free on the, um, on the web.

977
00:53:00,693 --> 00:53:03,603
Um, and I link to them in the book
as well, but anyone can find them.

978
00:53:03,873 --> 00:53:08,890
The PHQ9, for depression, really good
screening tool, very simple to use.

979
00:53:09,100 --> 00:53:11,230
And the GAD7 is for anxiety.

980
00:53:11,440 --> 00:53:14,590
So if you are thinking, oh, am I
tipping into anxiety or depression,

981
00:53:14,800 --> 00:53:18,970
just do one of those and you'll get
a score and that score will give you,

982
00:53:18,970 --> 00:53:21,010
um, some advice about what to do next.

983
00:53:21,331 --> 00:53:22,411
That's really, really helpful.

984
00:53:22,411 --> 00:53:25,951
We also provide a free toolkit called,
Am I Stressed, Overwhelmed or Burnt Out?

985
00:53:25,951 --> 00:53:28,801
And it contains all the burnout,
uh, free inventories as well.

986
00:53:28,801 --> 00:53:33,961
But what I might do is add into that
the GAD7 and the PHQ9 that people can

987
00:53:33,961 --> 00:53:37,471
access just to make sure, and obviously
getting your book would be really good.

988
00:53:38,266 --> 00:53:40,996
As you said that I'm thinking, well,
gosh, it's actually very difficult

989
00:53:40,996 --> 00:53:44,056
to tell because you get fatigue and
burnout, you get fatigue and depression.

990
00:53:44,356 --> 00:53:48,346
You get this sort of cynicism, don't
you, an emotional detachment in burnout,

991
00:53:48,346 --> 00:53:51,376
and then you get this hopelessness
in depression, which is probably why

992
00:53:51,376 --> 00:53:54,556
it's so important to actually seek
professional help because they'll be

993
00:53:54,556 --> 00:53:57,326
able to sort of tease it out and, and
work out what's really going on for you.

994
00:53:57,669 --> 00:54:02,310
Yes, and it is important, it's teased
out because, burnout is different from,

995
00:54:02,370 --> 00:54:06,505
um, from anxiety and depression, and,
and we'd use a different approach.

996
00:54:06,955 --> 00:54:10,915
So I, you know, for example, I wouldn't
consider antidepressants in burnout.

997
00:54:11,015 --> 00:54:14,615
But if, uh, a talking therapy hasn't
resolved a depression or anxiety, or it's

998
00:54:14,615 --> 00:54:16,623
very severe, then it's worth considering.

999
00:54:17,155 --> 00:54:19,945
I think if you're getting, if you're
wondering if you're depressed and you're

1000
00:54:19,945 --> 00:54:22,975
getting those physical symptoms, so your
sleep's going off, your appetite's going

1001
00:54:22,975 --> 00:54:28,121
off, you might be losing weight, you are
got a, an awful lot of kind of fatigue,

1002
00:54:28,121 --> 00:54:31,910
especially in the mornings, it might
push you a little bit more to, to, to

1003
00:54:31,910 --> 00:54:35,632
thinking I'm, this might have tipped into
depression, but once again, depression,

1004
00:54:35,632 --> 00:54:40,792
anxiety, really easily treated, so don't
worry, you know, just come fu for help.

1005
00:54:40,972 --> 00:54:42,952
And a lot of the treatments are
very similar to the treatments

1006
00:54:42,952 --> 00:54:43,642
of burnout, aren't they?

1007
00:54:43,642 --> 00:54:46,222
Which is which, which is good news,
which is really good news, which

1008
00:54:46,462 --> 00:54:47,662
shows why it's so important, go.

1009
00:54:48,009 --> 00:54:51,969
This might be again, talking about
some of these talking therapies, but

1010
00:54:51,969 --> 00:54:56,379
there's a chapter in your book all
about what we bring to the table,

1011
00:54:56,709 --> 00:55:00,549
which I, I found fascinating because we
know that not all burnout is the same.

1012
00:55:00,549 --> 00:55:04,209
Um, as Paula Redmond said
that there's different causes.

1013
00:55:04,209 --> 00:55:07,239
It might be due to moral injury
or it might be due to just pure

1014
00:55:07,239 --> 00:55:10,599
work overload, or it might be due
to sort of under confidence in

1015
00:55:10,599 --> 00:55:11,829
ourselves and things like that.

1016
00:55:11,829 --> 00:55:18,510
So what other things are these sort of,
could be some of the underlying causes?

1017
00:55:18,510 --> 00:55:21,120
I know you mentioned attachment
theory and then there's moral

1018
00:55:21,120 --> 00:55:22,620
injury and, and things like that.

1019
00:55:22,620 --> 00:55:25,440
But what do you typically see
in your, some of your patients?

1020
00:55:25,565 --> 00:55:30,259
so I'm, I'm gonna start this with a
kind of warning, which is I firmly

1021
00:55:30,259 --> 00:55:33,769
believe when I'm meeting people in
my clinic that they've burnt out

1022
00:55:33,769 --> 00:55:35,359
because of some change in the system.

1023
00:55:36,109 --> 00:55:41,396
So, you know, whatever their personalities
or coping systems are, they've often

1024
00:55:41,396 --> 00:55:46,166
been doing perfectly fine for many
years, and then something's changed.

1025
00:55:46,676 --> 00:55:48,771
So it's not the cause of burnout.

1026
00:55:49,496 --> 00:55:53,156
Um, so I want to be that, but
we do see some, some things.

1027
00:55:53,366 --> 00:55:56,841
So Herbert Freudenberger, who
I mentioned, who was the, the,

1028
00:55:56,846 --> 00:55:59,936
the wonderful psychoanalyst who
first coined the term burnout.

1029
00:56:00,286 --> 00:56:04,066
One of the first terms he toyed with
around burnout was super achiever

1030
00:56:04,066 --> 00:56:08,199
syndrome, and, and the reason he did
that is because he said there are some

1031
00:56:08,199 --> 00:56:12,549
people who are really dedicated, work
really hard, really want to make a

1032
00:56:12,549 --> 00:56:17,949
difference, and for them they will, they
will work very hard, they'll try and do

1033
00:56:17,949 --> 00:56:22,059
a lot at home, they won't necessarily
reach out for support, and that is a

1034
00:56:22,059 --> 00:56:23,679
group that are vulnerable for burnout.

1035
00:56:24,009 --> 00:56:26,859
And the group that are vulnerable
for burnout in the NHSI think because

1036
00:56:26,859 --> 00:56:30,399
I think our organizations take
advantage of those super achievers.

1037
00:56:30,879 --> 00:56:35,319
So I'm utterly amazed when I meet
healthcare professionals who are

1038
00:56:35,319 --> 00:56:39,219
allowed to work ridiculous hours,
allowed to wear too many hats.

1039
00:56:39,219 --> 00:56:42,680
These are super achievers and,
and they've been allowed by

1040
00:56:42,680 --> 00:56:44,090
their organization to burn out.

1041
00:56:44,090 --> 00:56:46,310
And I kind of think, you
know, how did the organization

1042
00:56:46,310 --> 00:56:47,510
think this was gonna turn out?

1043
00:56:48,410 --> 00:56:50,510
What did they think was gonna happen here?

1044
00:56:50,900 --> 00:56:52,400
Um, but, but that happened.

1045
00:56:52,400 --> 00:56:53,990
So, so there is this idea.

1046
00:56:53,990 --> 00:56:56,390
The other thing I think is really
interesting, and then I'll move on to

1047
00:56:56,390 --> 00:57:01,273
attachment is there's a double edged sword
in, um, high performing professionals.

1048
00:57:01,663 --> 00:57:05,689
So, high performing professionals
tend to be conscientious, they

1049
00:57:05,689 --> 00:57:09,409
tend to be determined, and
they tend to be quite outgoing.

1050
00:57:09,559 --> 00:57:11,029
Not always, but they tend to be.

1051
00:57:11,569 --> 00:57:14,239
Now that's good, you know,
that, that they're the sort of

1052
00:57:14,239 --> 00:57:15,559
people you wanna accrue often.

1053
00:57:15,815 --> 00:57:20,349
But under pressure, those same
characteristics can become

1054
00:57:20,349 --> 00:57:21,549
a kind of achilles heel.

1055
00:57:21,879 --> 00:57:25,149
So your conscientiousness
can become perfectionism.

1056
00:57:25,959 --> 00:57:30,399
Your determination can become
obsessionality and your, um,

1057
00:57:30,427 --> 00:57:34,891
outgoingness can become kind of a
little bit of narcissism, so you stop

1058
00:57:34,891 --> 00:57:36,966
listening to people stop taking advice.

1059
00:57:37,386 --> 00:57:41,466
So, so it, it's interesting that the
things that make us really good at our

1060
00:57:41,466 --> 00:57:45,846
job under stress can also get in the
way of us doing our job really well.

1061
00:57:46,464 --> 00:57:48,894
And, and then the final thing I'll
talk about is attachment theory,

1062
00:57:49,164 --> 00:57:53,004
um, which is, um, something I'm
interested in for various reasons.

1063
00:57:53,528 --> 00:57:59,058
But, uh, one things that I tend to see in
doctors particularly, but other, uh, you

1064
00:57:59,058 --> 00:58:03,138
know, other high level professions, uh,
you know, I've seen lawyers like this is

1065
00:58:03,138 --> 00:58:05,418
a couple of typical attachment patterns.

1066
00:58:05,628 --> 00:58:10,218
One is a dismissive attachment
pattern where we play down our

1067
00:58:10,218 --> 00:58:12,228
emotions and our relationships.

1068
00:58:12,378 --> 00:58:16,369
So this is the, the doctor who
just kind of, keeps a, stiff upper

1069
00:58:16,389 --> 00:58:20,709
lip and just gets on with it, just
kind of, um, uh, manages things.

1070
00:58:20,782 --> 00:58:25,702
Often very effective, but the problem
is with this, is this doctor isn't

1071
00:58:25,702 --> 00:58:28,342
necessarily processing their emotions.

1072
00:58:28,492 --> 00:58:31,642
So there's an emotional impact of
work, but they're just getting on

1073
00:58:31,642 --> 00:58:35,272
with it, going from one thing to
another, dismissing their emotions, and

1074
00:58:35,272 --> 00:58:37,042
eventually that can catch up with you.

1075
00:58:37,481 --> 00:58:41,261
The other attachment style I tend to see
in medics, but less common than dismissive

1076
00:58:41,261 --> 00:58:45,485
one, but it's there, it's a preoccupied
attachment style, which are these medics

1077
00:58:45,485 --> 00:58:50,075
who are the opposite of dismissive,
they really, really prioritize emotions

1078
00:58:50,165 --> 00:58:52,115
and they prioritize relationships.

1079
00:58:52,655 --> 00:58:56,615
So, uh, a typical warning sign for a
medic that I meet with this is they

1080
00:58:56,615 --> 00:58:58,295
tell me they've never had a complaint.

1081
00:58:58,865 --> 00:59:02,885
So these are the, these are these
wonderful medics who keep everyone happy.

1082
00:59:03,286 --> 00:59:08,416
And that is, that is great, that's
great, but it takes a big emotional toll

1083
00:59:08,416 --> 00:59:10,456
doing that and keeping everyone happy.

1084
00:59:10,966 --> 00:59:15,406
And what these medics can do is they
tend to neglect their own needs in

1085
00:59:15,406 --> 00:59:17,416
the ear by prioritizing the other.

1086
00:59:17,626 --> 00:59:19,486
So attachment's very interesting.

1087
00:59:19,576 --> 00:59:19,666
Um.

1088
00:59:20,411 --> 00:59:23,891
Um, I also think it's interesting
because, um, if we recognize we're one

1089
00:59:23,891 --> 00:59:27,581
of those attachment styles, it might
inform what sort of therapy we want.

1090
00:59:28,061 --> 00:59:31,713
So if we're dismissive, um, don't really
do emotions, we might be attracted to

1091
00:59:31,713 --> 00:59:33,903
CBT, let's, let's get our thinking right.

1092
00:59:34,173 --> 00:59:37,553
But what we might more benefit
from is a relational type therapy

1093
00:59:37,553 --> 00:59:40,193
where we can actually look at
our relationships and things like

1094
00:59:40,193 --> 00:59:41,693
that and how we process emotions.

1095
00:59:41,913 --> 00:59:45,550
And similarly, um, people who are
preoccupied really in touch with

1096
00:59:45,550 --> 00:59:49,510
emotions often think, well, I want
a relationship therapy, I want to do

1097
00:59:49,720 --> 00:59:52,960
something where I can think about my
emotions, whereas actually, they might

1098
00:59:52,960 --> 00:59:56,890
be, might be more beneficial from CBT
because what they might benefit is

1099
00:59:56,890 --> 01:00:00,700
a more structured approach that that
helps them kind of prioritize their

1100
01:00:00,700 --> 01:00:05,530
self-care and helps them kind of order
their thinking and their relationships.

1101
01:00:05,530 --> 01:00:07,300
So i, I think it's really interesting.

1102
01:00:07,410 --> 01:00:08,280
That is really interesting.

1103
01:00:08,325 --> 01:00:11,880
I, I re remember reading about that
in your book actually, and thinking,

1104
01:00:12,030 --> 01:00:16,560
gosh, I'm the sort of person, I'm an
Enneagram seven, so I'm like, I like,

1105
01:00:16,620 --> 01:00:19,680
don't like to feel difficult, but
just like to move on and have fun.

1106
01:00:19,980 --> 01:00:22,350
And actually, what I've been thinking
for a while, actually, some therapy where

1107
01:00:22,350 --> 01:00:26,880
you, I'm really looking, you can inter,
you know, emotions, feelings, somatic,

1108
01:00:26,880 --> 01:00:30,300
you know, where, where am I feeling that
would be, would be really helpful rather

1109
01:00:30,300 --> 01:00:33,030
than, yeah, just staying in your head and
thinking it through, thinking it through.

1110
01:00:33,210 --> 01:00:36,630
Just really quickly what, cause,
what would have been the underlying

1111
01:00:36,630 --> 01:00:38,910
cause of those two attachment styles?

1112
01:00:39,011 --> 01:00:44,334
Yeah, well, a attachment tends to be, um,
they, they, they tend to be styles that

1113
01:00:44,334 --> 01:00:48,827
will develop from, um, that will, will
start to develop from, from childhood.

1114
01:00:48,987 --> 01:00:51,809
So most of us are securely attached.

1115
01:00:51,869 --> 01:00:54,449
So, and, and most, most of
most of the people I meet in my

1116
01:00:54,449 --> 01:00:55,559
clinic are securely attached.

1117
01:00:55,889 --> 01:01:01,139
But you might become dismissive of, uh,
emotions and relationships if you are

1118
01:01:01,139 --> 01:01:05,639
the sort of, uh, if from a young age
you're kind of expected just to get on

1119
01:01:05,639 --> 01:01:09,629
with it, perhaps not talk about emotions,
and perhaps look after someone else.

1120
01:01:09,659 --> 01:01:12,239
There's quite a lot of medics
who've kind of been in a care

1121
01:01:12,239 --> 01:01:13,829
role from quite a young age.

1122
01:01:14,219 --> 01:01:17,399
And, and so they might need to,
to have put their needs to one

1123
01:01:17,399 --> 01:01:21,719
side, uh, and just get on, get on
with it and, and manage things.

1124
01:01:21,929 --> 01:01:24,239
And, and that could lead to a
dismissive attachment style.

1125
01:01:24,599 --> 01:01:29,489
We also train people, you talked about,
you know, what we're doing in A levels

1126
01:01:29,489 --> 01:01:31,829
and, uh, and, and med school and things.

1127
01:01:32,254 --> 01:01:35,674
Unfortunately, we can sometimes
train people to be dismissive.

1128
01:01:36,199 --> 01:01:39,019
So we can train them just to get
on with the next thing, you know,

1129
01:01:39,019 --> 01:01:41,569
don't think about how you are
feeling, just do the next exam or

1130
01:01:41,569 --> 01:01:42,829
the next case, and things like that.

1131
01:01:43,009 --> 01:01:45,229
So we, we can encourage
that, unfortunately.

1132
01:01:45,889 --> 01:01:51,469
Um, preoccupied people tend to be the
children who, um, perhaps have been

1133
01:01:51,516 --> 01:01:53,616
very sensitive, very caring for others.

1134
01:01:53,616 --> 01:01:56,406
They, they again might have been in a
caring role, but in a different way,

1135
01:01:56,406 --> 01:01:59,886
they might need it to be particularly
attuned to someone in their family

1136
01:01:59,886 --> 01:02:03,816
and look after them in that way,
so that, that might, might create,

1137
01:02:03,876 --> 01:02:05,736
um, a preoccupied attachment style.

1138
01:02:05,916 --> 01:02:09,642
But it's complicated, and some
people might have features of both.

1139
01:02:09,672 --> 01:02:12,702
So it's, uh, it, it's not, it's
not always a straightforward thing.

1140
01:02:12,844 --> 01:02:15,454
And that's probably where a skilled
therapist would be really, really

1141
01:02:15,454 --> 01:02:18,574
helpful to help you identify
those underlying things, then

1142
01:02:18,724 --> 01:02:19,954
what you can do about it, right?

1143
01:02:20,281 --> 01:02:25,291
What was your top three tips be for
someone who can recognize themselves

1144
01:02:25,291 --> 01:02:30,025
on that plateau and thinks, oh, crumbs,
okay, maybe I, I wanna do something right

1145
01:02:30,025 --> 01:02:31,765
now before I get to that burnout cliff.

1146
01:02:31,795 --> 01:02:34,075
Just the three, well, let's
say rather than three top tips.

1147
01:02:34,105 --> 01:02:37,495
'cause all your top tips are in
the book, your three next actions.

1148
01:02:37,758 --> 01:02:39,963
First thing is fantastic.

1149
01:02:40,233 --> 01:02:42,749
They are thinking about what's going on.

1150
01:02:42,809 --> 01:02:43,919
You know, have I got problem stress?

1151
01:02:43,919 --> 01:02:44,789
Have I got burnout?

1152
01:02:44,789 --> 01:02:47,939
So they've stopped fantastic
and they've reflected.

1153
01:02:48,773 --> 01:02:52,690
The next thing they should do is
reach out for help, nip it in the bud.

1154
01:02:52,806 --> 01:02:57,373
that could be to a support organization,
you know, like NHS Practitioner Health,

1155
01:02:57,373 --> 01:02:58,753
if you are a healthcare professional.

1156
01:02:58,943 --> 01:03:03,059
Or it could be to a coach, or it
could be just to friends and family.

1157
01:03:03,059 --> 01:03:04,889
Let people know how you're feeling.

1158
01:03:05,253 --> 01:03:10,563
You know, people often carry this alone
and in silence, you know, don't do that.

1159
01:03:10,953 --> 01:03:13,548
So stop and reflect, reach out for help.

1160
01:03:13,578 --> 01:03:16,589
And the next thing is
be hopeful and positive.

1161
01:03:16,619 --> 01:03:20,969
Because actually, by reaching out for
help, you will do incredibly well.

1162
01:03:21,569 --> 01:03:24,599
People do incredibly well,
they make amazing recoveries.

1163
01:03:24,899 --> 01:03:28,769
And in fact, some people, quite a
lot of people, if they have time to

1164
01:03:28,769 --> 01:03:33,539
stop and reflect and recover, say,
actually, I've developed through this.

1165
01:03:33,599 --> 01:03:34,649
I feel different.

1166
01:03:34,649 --> 01:03:38,969
I've made important changes and decisions,
and my life feels more aligned now.

1167
01:03:39,539 --> 01:03:41,041
So, be really hopeful.

1168
01:03:41,281 --> 01:03:43,171
Coming through to help
is a positive thing.

1169
01:03:43,382 --> 01:03:43,672
Yeah.

1170
01:03:43,807 --> 01:03:46,297
And that was another great chapter.

1171
01:03:46,537 --> 01:03:50,197
Your book on sort of post burnout
growth, posttraumatic growth.

1172
01:03:50,197 --> 01:03:53,737
So actually often, yeah, the good
news is that after a burnout, people

1173
01:03:53,813 --> 01:03:57,623
can actually be a lot better, um,
or feel a lot better than before.

1174
01:03:57,623 --> 01:03:59,903
But you don't actually have to
go through the whole massive

1175
01:03:59,903 --> 01:04:01,043
burnout thing to get there.

1176
01:04:01,043 --> 01:04:03,233
You can actually nip it in the
bud and then be better, right?

1177
01:04:03,233 --> 01:04:05,333
So let's avoid that massive dip, shall we?

1178
01:04:05,333 --> 01:04:05,693
Yeah.

1179
01:04:05,843 --> 01:04:06,353
that's right.

1180
01:04:07,054 --> 01:04:07,924
Thank you so much, Rich.

1181
01:04:07,924 --> 01:04:09,574
We'll have to get you
back 'cause No doubt.

1182
01:04:09,574 --> 01:04:12,574
We'll, we'll have lots more to talk
about and if anyone's listening to

1183
01:04:12,574 --> 01:04:15,184
this, you've Got questions for Richard,
please just, just uh, email them in.

1184
01:04:15,184 --> 01:04:18,274
And Richard, if we get some questions
when you come back to answer them?

1185
01:04:18,425 --> 01:04:19,205
Oh, I'd love to.

1186
01:04:19,222 --> 01:04:20,002
That would be wonderful.

1187
01:04:20,002 --> 01:04:22,642
And yeah, we would love to have you back
and to talk about this more, 'cause it

1188
01:04:22,697 --> 01:04:25,282
is, is such a big, big thing for doctors.

1189
01:04:25,282 --> 01:04:27,862
Well, 50% of doctors working in burnout.

1190
01:04:27,862 --> 01:04:30,982
So whether you're a doctor, dentist,
nurse, other healthcare professional,

1191
01:04:30,982 --> 01:04:34,132
we have accountants, lawyers and
teachers as well, and I would think

1192
01:04:34,132 --> 01:04:35,752
that their levels are pretty similar.

1193
01:04:35,752 --> 01:04:39,594
But for me, the big revelation has
been you might be in burnout but your

1194
01:04:39,594 --> 01:04:42,954
performance is still okay at work,
'cause you're protected that, but the

1195
01:04:42,984 --> 01:04:45,814
performance everywhere else is down
and then suddenly you're gonna crash.

1196
01:04:46,064 --> 01:04:47,624
So thank you so much for being here.

1197
01:04:47,774 --> 01:04:51,373
If people want to get a hold of you,
or find out more about the book, about

1198
01:04:51,373 --> 01:04:53,083
you, about your work, where can they go?

1199
01:04:53,272 --> 01:04:56,389
So yeah, well I haven't got a
webpage, but I'm on LinkedIn.

1200
01:04:56,449 --> 01:04:58,309
Always really happy to hear from people.

1201
01:04:58,339 --> 01:05:01,549
So Richard Duggins and if people
wanna know about the book or the

1202
01:05:01,549 --> 01:05:03,349
audio book, all good bookshops.

1203
01:05:03,349 --> 01:05:04,339
It's on Amazon too,

1204
01:05:04,434 --> 01:05:09,084
And of course, if you are working in the
NHS and you are eligible for Practitioner

1205
01:05:09,084 --> 01:05:10,554
Health, it's a fantastic organization.

1206
01:05:10,554 --> 01:05:13,194
Rich, can you just remind
us who, who it serves?

1207
01:05:13,309 --> 01:05:18,019
So it serves any healthcare professional
who finds it, is finding it difficult

1208
01:05:18,019 --> 01:05:20,629
to get confidential local support.

1209
01:05:21,229 --> 01:05:27,207
So that's every doctor and every dentist
in the NHS, can come through or it's

1210
01:05:27,207 --> 01:05:31,222
any health professional who's who
hasn't got local confidential support.

1211
01:05:31,761 --> 01:05:36,201
So do get in touch with Practitioner
Health and if you, you're not in the

1212
01:05:36,201 --> 01:05:41,211
UK or you can't access that, there will
be other ways for you to get h help.

1213
01:05:41,211 --> 01:05:44,151
It might just take five minutes of
digging around and, and Googling.

1214
01:05:44,151 --> 01:05:48,811
So employee assistance program, your
own GP, your family practitioner.

1215
01:05:48,871 --> 01:05:52,021
Please, please don't struggle
on alone, even if it's just

1216
01:05:52,021 --> 01:05:53,341
telling a colleague about it.

1217
01:05:53,431 --> 01:05:54,791
So, thank you Richard.

1218
01:05:54,881 --> 01:05:56,381
Um, and hopefully speak again soon.

1219
01:05:56,720 --> 01:05:56,817
Great.

1220
01:05:56,817 --> 01:05:57,657
Thanks so much, Rachel.

1221
01:05:59,299 --> 01:06:00,229
Thanks for listening.

1222
01:06:00,329 --> 01:06:04,789
Don't forget, you can get extra bonus
episodes and audio courses along with

1223
01:06:04,879 --> 01:06:09,709
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1224
01:06:09,789 --> 01:06:14,249
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1225
01:06:14,249 --> 01:06:17,219
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1226
01:06:17,592 --> 01:06:21,112
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