Why saying no could lead to better outcomes for your patients, your colleagues, and you.

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FrogFest Virtual – The Boundary Hunters
Tuesday 25th November

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I coached a doctor a while ago who could never manage to leave when

she was finishing her shift as duty doctor, because every time she went

to check on a patient or just go to the loo, she'd come back and find a

new prescription she needed to sign.

Now, it turned out there was a pharmacist who came in and process

the prescriptions in the evening because it suited their schedule.

And in reality, these prescriptions didn't need to be signed straight

away, and it wouldn't have made a difference to the practice if

she'd left it for the next doctor.

But she felt that if she didn't do it now, it wasn't going to get done,

and she was worried that somehow colleagues would think that she hadn't

done her job if there were loads of prescriptions left in the morning.

So this week I'm bringing Corrina Gordon-Barnes back on the podcast

to talk about this mindset of if I don't do it, who else will?

We look at some real life scenarios where even the thought of saying no

would be unthinkable, and Corrina offers us a thought exercise that

you can try to get a grip on the real consequences of setting your boundaries.

Often they're not as life and death as we think.

Now, Corrina will be speaking at our next FrogFest Virtual event in November,

so follow the link in the show notes to book your ticket or catch the replay.

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

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

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

I'm Corrina Gordon-Barnes.

I am a trainer for Shapes Toolkit and I am an executive coach.

Work with lots of different executive senior leaders, uh, on

resilience, wellbeing, productivity.

And all sorts relationships.

relationships.

Oh my God.

It's good to have you back.

Corrina.

I've lost count of how many times you've been on the podcast.

You're a, a very favorite FrogFest guest as well.

You're coming to our next FrogFest virtual, and um, you are the

person that I turn to when I have tricky questions, right?

So I'm gonna just dive straight into the tricky question if that's okay, because we

do lots of training, obviously, on how to set boundaries, say no deal with pushback,

'cause in my opinion, this is the only way that we can protect our time, manage

our energy, and embrace our capacity and actually stay performing well.

So I'm not gonna use the R word, I'm now talking about protecting your time.

But of course when we talk about this, we get pushback.

We get pushback from people.

And one of the most common bits of pushback, either live in the room

or questions in the chat we get is something along the lines of, but

if I don't do it who else will?

Someone's got to do it.

Surely I'm just passing stress onto the rest of my team.

That's all very well, but you know, I can't dump on my colleagues.

So we have some sort of version of the question, well, if I don't

do it, no one will, or who else will or someone else has got to.

And so you're assuming that what's happening is you are not doing it,

therefore somebody else has to you passing on stress to everybody else.

And for doctors and healthcare professionals, who, let's face

it, a lot of their raison d'être is to help people, to serve, that

is just far too uncomfortable.

And that is where the boundaries crumble and they can't then protect

their time and their energy.

So how would you approach that question?

Uh, can we just have the first, the very simple answer?

One line.

One line answer that we can all go home, right?

Yeah, it's done.

Uh, it, it was interesting the way when you were kind of embodying someone asking

that question, I got a sense of the panic that can be behind this question.

Because we are actually talking about survival situations.

You know, with healthcare, with medicine, the stakes are truly high.

I work with all different industries and sometimes it's not a life or death

situation, but in medicine, in healthcare, it is life and death situation,

uh, often that we're dealing with.

So I think that's the first thing to acknowledge, just how much you

are carrying to even be asking the question and how natural and

understandable the panic, the fear response is given those stakes.

And I think that's really important, 'cause we don't wanna bypass the reality

of what we're actually talking about.

These are, these are patient lives.

And you know, as a patient, I would love for all doctors to say yes all the

time to everything and all healthcare professionals to say yes all the time to

everything so that we have this completely 24/7 service where everyone's health

is being taken care of all the time.

And healthcare professionals are humans and they have limits.

And actually, I don't want a depleted, burnt out healthcare

professional in front of me.

That's not good either.

So I think it's really important to see that inaction can cause life and

death situations, but also burnout can cause life and death situations.

So by people over functioning and being over responsible,

there is also a danger in that.

So I think that's really important.

I think it's also really important that we acknowledge how much people are caring

about their colleagues, that people are not selfish, uh, isolated, like, islands.

They're thinking about, wow, we as a collective, how on earth are we surviving

this ridiculous, impossible system?

I'm, you know, I care about my colleagues, so well, I'm just gonna

put myself kind of down the bottom of the list and, and do the thing so

that other people are gonna be okay.

And it's an overused metaphor, but of course, we're not then

putting on our own life mask.

And I absolutely acknowledge a lot of these are life and death

situations, but most of them aren't.

Yeah,

of them are, most of them aren't.

I think in healthcare, we like to think we are so important.

We are so important that everything we do has a potential consequence.

But it doesn't.

And I, you know, I can talk about the poll I've done, I mean, know a

thousand times in different talks and things like that is, you know.

What, what will the consequences be of not saying no, you know, what's stopping you?

And when I've asked them, and we can talk about some of the other things

that stop us in a minute, but less than 20% of people have said it's because

it would cause severe harm to patients.

And when you think about all the, the decisions and the times, you're gonna

say no in a, in a routine day, I, I would think it's definitely less than 20% of

those would cause direct patient harm.

Now, almost any decision in healthcare you could probably

extrapolate to have dreadful causes.

So, you know what, if you, um, I dunno, don't answer the phone at the right

time, then someone could be really ill and they can't been able to access

the surgery and then they might die.

Or what happens if, the on-call list accidentally forgets to phone

somebody back then this, then this.

So you can sort of, everything in healthcare you can extrapolate to, and

that could have a dreadful consequence.

But the ones that actually have the immediate consequences, very few.

And connected to that is the fact that because we evolutionarily,

have these instincts around the tribe, the group, the community.

It can feel like life and death when it's actually that someone's

gonna be a bit pissed off with us.

And so that does still feel like life and death, because it feels like

we're gonna be disapproved of, we're gonna be disliked, we're not gonna

feel part of the community, we're not gonna feel full part of the team.

And so we do overextend and over function in order to get people's approval.

And that's, that is such a beautiful area to work on within ourself,

within our own personal growth.

Can I sit with the discomfort of that person's really annoyed with me?

That person thinks I'm not pulling my weight.

When in reality what's happening is I'm just checking in with myself, finding

that I don't have the resources to do the thing, and just naming that.

You know, it's like I've gone to my car, I know that I've

got a journey to Manchester.

I've gone to my car.

There's not the petrol in the tank, and I know there's no petrol

station between here and there.

So I'm simply reporting, i've checked in.

I don't have the availability for that.

It's not personal.

I just don't have that right now.

So I'm gonna say no because that's the honest answer based on my

availability and my capacity.

I think that is one of the underlying problems actually, and it's this, this

question has got so many layers in it.

Is it, doesn't it?

Because yeah, that's really logical.

I've checked in.

I don't have the capacity.

If only we were like a car.

If only, if only we did actually have like on our foreheads a little

thing going full empty, full empty.

Then not only would we know, but everyone else would know as well.

I think the problem is in healthcare, a lot of us don't know when we're empty

and we are so used to running on empty that it, it feels, it feels normal.

So then we are, fool ourselves into thinking that I'm running

on empty, but actually no, I do have feeling in the tank.

Therefore, I'm just saying no on a whim and that feels really selfish.

And so in that then it would be a matter of, um, developing more inner

awareness of what does feel like full and what does feel like empty.

We in the Shapes Toolkit have that lovely exercise where we have participants

actually rate different aspects.

And we do use a, like a, a petrol gauge, don't we?

Like a, a fuel tank full?

A fuel tank empty.

And it could be that, that becomes a really important practice for

people just to have a snapshot now and again of, hang on, where am I

with my, you know, my compassion.

Like for a lot of people, that's how they know that they're depleted

is when they don't have compassion.

They have that empathy, that compassion fatigue where they just

don't actually care anymore, which feels so horrendous to someone whose

whole profession is around caring.

I don't actually give a shit really, because I'm so depleted.

So that can be a real red flag for people when they start to feel that going down.

And then just, yeah, energy level, you know, brain power capacity.

There's a, to develop ways of self-analyzing and self-assessing.

Do I actually have anything left in the tank?

But that is so alien to us because our training and everything in

us says, it just actually doesn't matter how you are feeling.

This is your job, this is your role, and yet it might not even be your role.

But we've actually been trained to feel that if no one else is

gonna do it, we've got to do it.

Yeah, I remember when I was a junior doctor, I was on coronary care and all

the nurses suddenly decided that their phlebotomy certificates had run out.

So who's gonna do the blood round?

Well, they didn't go well.

It's, we've got to sort out the problem.

It's like, ble the junior doctor, Rachel, you are doing it.

And that is literally how most doctors have then grown up.

And then you become more senior.

And of course the buck sorts are the senior person, you have to do it.

So you've always felt that the buck sorts with you.

So even if it's not your role, you end up feeling like, well, I, I ought to,

or I'm the partner in this practice, so I ought to, I'm the clinical lead here.

There's gonna be dreadful consequences.

No one else is gonna do it.

I, I've got to, or other people could do it.

I can't possibly ask them to take on stress that I'm not happy to take on.

And I think that's much more of a motivator than thinking,

well, I'm out of fuel.

I, I can't,

Yeah, so there's something about being res that our responsibility

is to be a sustainable instrument for our craft, whatever it is.

You know, I, me as a coach, um, people as, as doctors or, or nurses or, or

professionals in, in other healthcare settings, that my responsibility

then, my part of my ethics is to be asking myself that question

of do I actually have capacity?

Am I nearing burnout?

Am I beyond burnout?

And I think there's a very important belief to question.

We have the assumption that it's bad to say no to something.

if I say no then, and like what's gonna happen after that?

That, how would we finish that sentence?

And it can be very helpful to question that.

Can I really know that it is gonna be bad if I say no?

Could it be that there is another way of looking at it, which is that

we have this very broken system.

I think everyone can agree with that.

I'd love to hear if any, any listeners or viewers don't

No Corina NHS are working brilliantly at the moment.

Yeah,

you know it's all fine.

Yet to meet a person who, uh, who even thinks that, so I think

we all agree it's dysfunctional.

And there's this kind of belief that somehow dysfunctional systems, if we

all just kind of silently suffer and kind of shuffle things around, then

we'll all kind kind of muddle through.

And, you know, we see this in dysfunctional family systems, even

that it, it might be just that someone needs to be that canary in the, shaft.

You know, the person that is like, I'm not gonna silently suffer anymore.

I'm gonna name something, or I'm gonna pull back from saying yes

so that there's even more chaos to start with, but that, that actually

maybe could lead to something more functional, having to arise as a result.

So that, like that question of could it be, could it be that me

saying no is part of helping this system to become more functional?

totally agree with that.

And, and absolutely in, in the workshops and when we do the Shapes Toolkit,

you know, we have people saying, you know, what am I choosing to do so that?

You know, and.

People know that if they keep saying yes in the system and they keep

absorbing the stu absorbing the thing, no one's gonna sort it out.

Um, and that's partly why we're in this problem, because I think, you know, if

you can imagine a big sink and demand, patient demand being like a tap, which

is filling up the sink, and you've got a few outlets in the tap, you've got

secondary care, you've got like your overflow thing, you've got primary

care who's, which is basically your over primary care does most things.

In fact, um, it, you know, it has, I think something like 90% of the patient contacts

in, in the UK are in primary care.

It gets 8% of the budget, 8% of the budget is shocking.

Anyway, primary care by people, overworking has absorbed the

stuff, but they are at capacity.

They're still at capacity that now the water's now going over the

sink and it's, it is overflowing.

And so while the, while the water wasn't overflowing, no one was doing anything.

Now it's overflowing.

It's almost a little bit late.

There are things going on trying to, trying to happen.

So I think, I don't think anybody disagrees that we can't

just keep absorbing it because then the system won't change.

And at our best we can believe that and and say no.

The problem is the system's out here, isn't it?

But the patients are here and our colleagues are here, and they're also

working in the stressed out system.

So if I say no, then my assumption is, well, that means work gets done straight

on my colleague who's as stresses me, who's gonna find it as stressful as

me to do that work and that it has to be done Now those are all assumptions,

which I guess we could challenge.

Mm-hmm.

Yep.

We could definitely question the assumption that they, they will

take it on or have to take it on because they are also an autonomous

being who gets to make choices.

Hard choices.

We're talking about very, very hard choices.

And you know, when we, whenever we do these podcasts, there's

always just the, like, it's the impossibility of the situation that

always needs to be acknowledged.

That there's no like glib response or like, da da da dah.

Like, I'm not coming onto this podcast saying, by the way, guys,

I figured it all out and you all been doing it wrong with this time.

It's like the opposite of that.

It's like, what the, you know, what is all of this?

And I am responsible for myself.

I am responsible as an independent human being for my choices,

as uncomfortable as they are.

My colleagues are also responsible for their choices,

as uncomfortable as they are.

And when my colleague makes a choice that has an impact on me, I feel that

impact, but it's still their choice.

And then I have a choice about how I respond to the impact on me.

So I think that is very important that we, we only own what is ours to own.

And we sit in the discomfort of what is not our own.

And, and I'm, I think I've used this word discomfort quite a bit

already today, 'cause I feel like that's really key, that there is

just going to be a lot of discomfort.

And if we can grow our tolerance with discomfort, that will serve us well.

and I think this is key to it, isn't it?

I think there are two different ours to own though, and two

different types of discomfort.

because there are things that I'm not in control of and I talk about these

control responsibility mismatches.

And if we talk about the zone of power, so what am I in control of?

What am I not in control of?

And you just draw a circle on a piece of paper, say what I'm in control

of is in the middle, what I'm not in control of is on the outside.

I think we can often feel incredibly guilty for stuff

that is outside of our control.

Now, the traditional teachings, we feel stressed and frustrated and,

and, and and stuff, but actually the healthcare professionals sit more senior

they are, the more guilty they feel.

So Corrina, I'm actually incredibly guilty that you can't get that appointment

you've been waiting for at the hospital.

I have absolutely no control over that, but I just feel, feel guilty.

And then if a patient presents with this extra problem and I'm not on duty

and someone's just asked me for to see them as a favor, I'm not in control

of that person coming, I can decide if I, you know, I could say yes or no.

And I would still feel guilty for saying no, but it would be a little bit

easier 'cause I'm sort of not in control of when the patient came in and I'm

always, you know, doing them a favor.

So there's that stuff outside our zone of power that we, that we sort of

overreach on and feel over responsible.

My issue, Corrina, is the stuff that's inside our zone of power.

So I was doing a, a training session recently and we were talking

about, you know, the fact that you can really care about that stuff

that's outside your zone of power.

You can't carry it though if you can't do anything about it.

But then this chap put his hand up and said, well, I get that,

and so I'm really focusing on what I can control and what I can do.

So I'm sitting on this committee, I'm doing this, I'm running this

service, I'm doing this, like six or seven different things all at once.

This was outside of the day job.

And I just said, how's that going for you?

Not very well 'cause he was so overscheduled.

So I've begun to realize I'd be really interested in the thoughts of

this, that there is so much stuff we could do within our zone of power.

We can't do it all.

And that's where you actually need a smaller circle within your zone

of power, which is your capacity.

And I think this is what healthcare professionals find really hard to

do is say no to things that they could do that's within their zone

of power, that is in their control, but it's not within their capacity.

And, and, and that where's your capacity?

It's a, it's a bit of a blurred line or whatever.

But if you then, you know, you can go way over capacity and end up

saying, you know, yes to everything.

And that, that's what feels really, really hard is actually, I, I

could do that little extra thing.

I could do it, but I really don't have capacity to, but it

is in my zone of power, therefore I, I feel that I ought to.

And that feels really, really uncomfortable, particularly when that

other person also has a finite capacity.

Now, again, I think that is, that is an assumption.

And I think one of the issues, I think that with this question is

that we are, we are looking at it in a very black and white binary way.

You know, if I don't do it, someone else has got to do it.

There's either I do it or I don't, or, or someone else does it.

Actually, I think what I'm trying to find out is, is there a third way?

Is there a third way that isn't, isn't this binary black and white and I've taken

control over that and have my capacity 'cause it really does affect somebody

else who's got the similar capacity.

That just feels too awkward because it was in my zone of power

and I could have done something.

Hard enough, it's hard enough letting stuff go that I couldn't

have done anything about yet alone stuff I could do something about.

So that was a bit of a long rant, but does that make sense?

Well it does because it's about, again, I'm gonna keep, I think

pulling us back to like checking in with myself, doing that, developing

a practice around self assessment.

Because if you've got those items on your zone of power list,

all of the things I could do.

But you are checking in with yourself, not with anyone else, not with what's needed,

but with yourself, is this something that I am actually, I have capacity for?

I have availability for, I have choice around, because that then is our come

from not guilt or fear or panic even.

But we have to keep developing this.

It's not a normal practice, but to develop the practice of self check-in.

Is this within my capacity?

Is this sustainable for me?

is this a choice, an intentional choice that I'm going to make?

Because when we make choices, then we don't have resentment

because we've chosen it.

I think people think that they don't have any choice because I can, the, the doctor

in me is going, yeah, I know that's all very good, but it just feels so selfish

to keep going, i'm checking in with myself and no, I'm checking with myself and no.

'Cause actually, if everyone just checked in with themselves all the

time and said, no, literally you wouldn't have a health service.

And maybe that's the point.

That's the point about what if, what if saying no was important

to fully break the system?

We are all, we're all quite scared, aren't we?

Of systems falling apart.

I can really see that if we look at education system, even though

we know it's dysfunctional, family systems, even though we know they're

dysfunctional, uh, political systems, you know, how bad do things need to get?

I mean, we're seeing that played out in the political stage at the moment.

But maybe things do have to get that bad before they can get better.

And so me saying yes isn't actually necessarily helping the bigger picture.

But then it's the bigger picture versus the smaller picture, isn't it?

And it's the it it's the people and yeah.

I, I think people are accepting of the fact that the system, yeah, it, it's

gonna, it something drastic needs to happen for, for anything to happen.

But it's these people.

It's these people in front of you.

And I think, I think one thing you said was really interesting, Corrina, which

is that the assumptions that we're making that, that saying no is bad.

And I think, I wonder whether we could dig into that a little bit

more and think about even maybe using the work or some of those amazing

questions that you asked to help.

How can we challenge our assumptions and look at things the other way?

Rather than make the immediate assumption, which I think our amygdala makes us think,

like you said, threat, threat, threat.

We're scanning for threat constantly, if I say no here, then it's going to

absolutely ruin my relationship ship with everybody else, or it's gonna

cause other people inconvenience, it's gonna be, it's gonna be awful.

So, yeah, would that be a good way to try and tease this out?

Yeah.

Great.

And just, and, and before we go into the work with it.

seeing how in so many situations we have that like saying, Hmm is bad, right?

Saying Hmm to my intimate partner or my, you know, my, uh, child or my friend,

or just so many places where we have the assumption that saying our truth, which

is what it is, speaking our truth is bad.

And so let's go into it.

So, so the work of Byron Katie is what you're inviting us to use,

which is a way of questioning assumptions, questioning beliefs.

So we hold this thought saying no is bad, and we just have it

like a, it's just a default.

It's an assumed like, yeah, saying no is bad.

So the first thing we do is we test the truth of it.

It's like we put it under, under the pressure of our

questioning saying No is bad.

Is that true?

Okay, so this situation actually happened to me.

I was, a GP quite a few years ago.

Somebody, a mum came in for her twins, immunizations.

There wasn't a nurse on that day.

The, the receptionist had mucked up and there wasn't, there wasn't a nurse on.

And I was the duty doctor and the request came to me, please, can you

do the ims for this, this patient?

And I, I wasn't trained to do the ims or whatever, you know, obviously I

know how to do injections, but I wasn't up to date with it all, whatever.

And I was expected to do these, to do these, IM immunizations.

The mum was really distraught, 'cause you know, it's really hard with twins,

it's hard with one, maybe let alone two.

So she's knackered, she'd struggled through the traffic to get in.

It was a really big deal.

I think it, the, the ims had already been delayed and I was under a lot of

pressure to, to fit this patient into a busy thing and to do these immunizations.

That's a great example.

And I, I felt as soon as you said mom, as a mom myself, as soon as you

literally said the word mom, I was like.

Because we have that.

It's so inbuilt, like you can't say no to a mother with children who

need something for her children.

That's the most emotive thing.

Great.

So saying no is bad.

So we have to meditate on this.

We can't just answer from our, our fast brain.

We have to sink in.

We have to visualize the moment.

You can actually visualize it, but we can all imagine whatever we,

you know, we're gonna make it up.

So saying no to that mother, to immunize her children in that moment is bad.

And maybe I would even say it's wrong, like that's the kind

of like our thinking will go.

Like, no, you just can't do it.

It's bad.

It's wrong.

Is that true?

And we sink in and we are asking like a deeper part within

ourself, not just our brain.

We are asking our whole system like head, heart, gut, all of our

body is that saying no is bad.

Is that true?

And we just wait until we have a sense of a yes or a no.

when it was immediately presented to me, I think it was a, it would've been a yes.

And now if you, if you step into that observer position within

yourself, might still be yes.

But just give yourself a moment to question it.

Well, no, in the observer position, it's a no.

Okay.

And I found a no when I sat with it.

Now, if we found a yes, this is that everyone can do it at home.

You know, if you found a yes and you may have found a screaming

yes, like Rachel whatcha talking about, of course it's a yes.

These poor, right?

Okay.

Then you say, can you absolutely know that it's true?

Which isn't a trick question, it's a chance to go deeper again

and just say like, can you know the biggest picture of all of it?

Can you know these, these children's full lives, this mother's full life,

can you know, basically, can you know better than whatever you perceive

as God, the universe higher power?

Can you know better than all of it?

Can you, you individual person, know that it is true, that saying no is bad?

Categorically?

No.

No, 'cause you can never categorically really know anything.

Because I've had that many situations in my life where I was

sure something was bad or wrong and it should never have happened.

And then after the event, like even maybe years after the event, realizing, oh, like

that's why that was perfect as it was.

That's why that happened as it did, because here this situation is now.

So we test the truth first.

And again, you might get a really clear yes for the second question.

That's fine.

This is just giving you a chance to question.

And whatever you find as the truth for you, you look at how do you react, what

happens when you believe the thought.

So for you, Rachel, how did you react in that situation when you really

believed I can't say no saying no is bad?

Oh, well you felt pressurized into doing it.

Well, I have to, I ought to like a bit of panic a bit like this is gonna take ages.

Um, and also a bit of.

Speaking myself up about, oh, for goodness sake, you're such a cow even

thinking you shouldn't, you know, you know, there's this whole, of course you

should, you know, uh, this poor woman.

So the panic I'm really interested in.

So just notice, you know, when I believe saying no is bad,

i'm in my amygdala, right?

I'm in my fear-based response, i'm in, I mean, panic, you know, thinking about

me as a prac, if I'm thinking about myself as a practitioner, wow, this

thought has put me into a panic state and I'm about to pick up a needle like

that does, they don't seem compatible.

So how do I react when I believe saying no is bad?

I might get flustered, I might get hot, I might get panicked.

Like, what else might happen in our physiology when we

Gosh.

Well, we make, we make bad decisions.

We rush things.

We don't think things through, uh, we make massive mistakes.

We are rude.

All that sort of stuff.

yes.

Yeah.

So this is for each person listening or watching to assess that for yourself.

What is the cost, what is the impact when you believe I

can't say no, saying no is bad.

Because it will have you sharp a certain way.

And then to assess whether that way of showing up is actually

in anyone's best interests.

And then when we've really fully looked at that, then we look at who would

I be in that exact same situation without the thought saying no is bad.

So imagine you just, for some reason Rachel, someone's just

deleted that thought from your mind.

You see the mother in front of you, you maybe see the twins crying, the

mother's distraught, but you, you know your capacity and you can't

believe that saying no is bad.

Who would you then be?

Well, I'd be much more kind and compassionate, so I would be

more kind and compassionate.

I would be behaving in a way that I maybe thought was less kind.

Well, no, I wouldn't be thinking that anymore because that, that,

that's a thought I'd been a out of my head, but I would be being

much more kind and compassionate.

Um, because I wouldn't be feeling pressurized that I should have done

something differently or, you know, so I'd probably just be very matter of fact

in that I'm afraid we, we literally, the, the fact of matter is there is not

a space for you to have the vaccination.

You know, there's no personal, it's not personal.

Yes.

Yes.

It's not like we are, I'm choosing not to do it.

It's like it's, it's not, it's not happening.

There is not an, there's not an appointment.

Um, can I just break this and tell you the story of my

beautician waxing story, Corrina?

As long as you keep it in the recording, yes.

Oh yeah.

Alright.

So I was at Birdie the other day, having some waxing done before I went away.

I won't tell you every tiny detail of it, but I was, I built my nails, you

know, various different things and I just had my nails done and I was just

about to move through to the waxing room.

And, um, this woman came in floods, it was a Friday afternoon, right?

She was in floods of tears, like, absolutely distraught.

I was like, this is interesting.

Like beautician emergency, what could it be?

She's like, sobbing.

I'm getting married tomorrow she said.

And my, my waxer hasn't turned up to my house.

Anyway, so.

You know, the, the, the beautician is doing my nails and stuff.

It was so lovely.

She walks over to her desk, she said, oh, I'm so sorry,

let me just see what we can do.

She, let me just check our schedule.

So she looked at it and she looked at it again, and she looked at it again and she

said, I'm so sorry, we're fully booked.

And, and this woman, oh, can't you fit me?

And she, and she went, hang on.

No, I'm so sorry.

She said, but I can give you the name of someone down the road.

And I thought, wow, look at that.

Look at that.

It's, I, no one's gonna die right here.

The worst that can happen.

She's got a bit of hair somewhere.

She didn't want it.

Certainly no one's gonna die.

That's just a side note, but it just made me think, oh my goodness.

You know, when patients come in for, I can, I just say much less of an emergency.

I'm not talking about these kids with the vaccinations, but you know, just

like, I need a holiday medical done.

I need this.

I forgot my prescription.

Like, no one is really gonna die if they just, it's just convenient for

them, they want it, they kick up a fuss.

Most, most gps just fit them in.

Even they, they don't have any capacity, they don't literally

have capacity in their diary.

It's not like, do I need to check into myself?

Do I have time?

It's like, no, we literally don't have time.

And that will put all the rest of the patients back.

But partly it's people pleasing.

Partly there's that niggle of, what if I miss something and it was really, really,

really, really, really urgent, you know?

But we had this amazing capability of pre reliving stuff.

So I was in a, a training session, a Shapes training

session, Corrina, the other day.

And, um, I love, I love in the zone of power when we're talking about

what you in control of what you not.

And I always pop in what time I leave work.

And you can see people go, Ooh.

I'm not in control of that.

And I've seen you deal with that before and it's brilliant.

But, um, it was, I think it was a load of, um, new first five gps

and it's like, okay, I said, you in charge of what time you leave work.

And every, they were not happy.

And someone said, no, I'm sorry that I am not in charge of what time you leave work.

I said, oh, that's interesting, tell me.

Well, she said, well, if I'm on call and even when the phones go

there, if a child comes in, I can't just leave them and not see them.

Well, who, who is in charge of when you literally get up and leave your desk?

Well, I said if I'm, I just can't leave a child if they come in, you know, late in

the evening because 111 is rubbish in our area, they won't deal with them properly.

It's too risky to leave a child.

And I was like, Hmm, that's interesting.

And someone else said sort of, he said, what do you do on a Sunday

afternoon when there's a sick child?

And what about at midnight when there's a sick child?

Or on Saturday lunchtime when you're not at the practice and there's a sick child.

So there's something about when I'm there and someone wants something, we

can't cope, 'cause there's just so much need, you know, that sick child on a

Sunday goes to 111, so how come they can't do it on a, on a Friday night?

But we, it's like, well if they turned up at the surgery and they are really, really

sick and 111 doesn't work, what happens?

And so we're, we can find, we can escalate any small situation to a potentially

lethal, life threatening situation.

It's quite interesting how we do that.

And whether it, and I think a lot of it is really, really genuinely,

we, we genuinely feel this over responsibility that we are responsible

for everything a patient says or does.

And if a patient, you know, we don't give patients enough

responsibility for their own health,

we'll get to the turnaround in a minute, but what you're pointing to there

is that when she said no, when the beautician said no, the system arranged

itself better actually around it.

Oh, and interesting.

What would've really pissed me off is if she'd have fit this

woman in quickly and made me late.

Ooh.

And I would've sat there going, well, I'm waiting and made them, you know?

Whereas actually I'm much, I was much happier just to say, oh, you, you have the

slot and vol. 'cause it was choice, right?

It's choice.

So who would you be without that thought?

You're there with the mom, with the twins.

What I see in you, if I imagine myself in that situation is I would be able

to be more with that mother from a clear place of like, I really get

how distraught you are and how much this means, and how scared you are or

whatever it is that you wanna say in terms of empathy, compassion, presence.

And this kind of idea that we can have both.

Right?

I hear all that.

I see all that.

I can actually be present with you for all that and I'm not

able to do that right now, or nobody's able to do that right now.

Here's the alternative.

And then we look at the turnaround, right?

So we've questioned the thought.

Is it true?

We've looked at the cost of believing it, who we'd be without it, and

then we look at whether the opposite could be just as true or even

truer than the original thought.

So saying no is bad.

We flip it, saying no is not bad, or saying no could actually be good.

Do you see any examples in your situation where actually it

would've been good to say no?

Oh, yes, several, because number one, the nurse does vaccinations much better than

me, because they do them every day so they can, they know all the complications,

they give much better counseling, you know, all that sort of thing.

So it's much better to have someone who's fully trained and able to do it.

So that's a first thing, actually, from patient safety point of

view, much better to say no.

So that's, that's a no brainer.

Second say no is good.

Um, well, it protects me, protects my time for a start.

and then you were then available for other patients.

May, maybe you were then more present if you, you know, if you'd said no,

maybe you would've been then present more cognitively with another patient

and you may have then picked up on something that you just wouldn't

have been able to pick up on if you were so frantic and so panicked.

We just can't think clearly like that.

Who would I want as a doctor, someone fully present and available?

Who would I want vaccinating my child?

Someone fully present and available and who was trained to do so, right?

And so, yes, it might be inconvenient, but again, we sit with the discomfort of that

inconvenience and someone not being happy.

Yeah.

And the inconvenience was, you know, I, I would've felt really

bad and really responsible.

Not my responsibility.

I can't even remember.

It would've been a patient's diary, mal malfunctional, or a receptionist

are in malfunction or something.

None of my, not my problem or not my responsibility.

And even if I was a partner in that practice, and this is part of the problem

that we get, and I know this being a business owner myself, and you're a

business owner, you know, if something goes wrong in your organization,

you feel totally responsible for it.

Even if you couldn't stop it happening.

And I see this with the, do lots of training with GP trainers, GP

trainers groups and things like that.

And I start up by saying in terms of your trainees, what

do you feel responsible for?

And they're like, well, we are responsible for if they pass their exams, how

happy they are, their wellbeing, what training they get in our practice.

And I'm like, is there any of that you've got control of that?

Well, we're a trainer.

We have to be, we're like, okay, so how are you responsible

for if they pass their exams?

Literally, are you there holding their pen, writing their exams for them?

Are you there every weekend saying, are you revising?

You know, like I should have been with my son, you know.

So even if you do own the organization or own the business, yes there are

things you can do like train receptionist properly or have the protocols that

are right and run the thing properly.

Day to day, what happens in your business, how somebody answers the

phone or behaves, or the interpersonal relationships you can't control.

And it's, I think, you know, so it's this double whammy of being a doctor

and then being responsible as a partner or as clinical lead or something

that, that really, you know, so I think at the time I was a salaried

doctor, I still felt bad enough.

I think if I was a partner, it would've been even worse because

I'd have felt always my practice, I am ultimately responsible.

But you, it, that's the problem with this control, responsibility, mismatch.

And instantly all the, um, research and burnout recently has been that

the, the people who have the highest incidences of burnouts, the people

in high stakes jobs with low control.

That's healthcare.

Um, there was another subset of people in high stakes jobs who had high control.

They had really low levels of burnout, so that was really, really interesting to me.

So, yeah, so I think there is this something about doctors take that extra

level of responsibility either because they genuinely own the practice, their

business, or they're respons, they're the clinical lead or the director,

and think the more responsible they are, the harder they find to say no.

And it's, that's where it comes down to questioning, does this actually lead

to more safety or does it just make me feel a little bit like a hero or

a, you know, the one who's gonna save the day, or the one who's gonna, even,

even that kind of like, just, I'm the one who's really responsible, but is

it actually leading to more safety?

Like, in that example, is it more safe for those twins to be immunized

by you or to wait a day or a week

Much more safer than to wait for the work for the nurse, yes.

And we can also turn it around saying, no is bad.

We can look at saying no is good, or saying no is not bad.

We can also look at saying yes is bad as the other turnaround.

So saying yes is bad.

Maybe then something more systemic gets missed, right?

Maybe there is a diary training issue or there's uh, I don't know, like

a re if it's a, if it's a patient diary, mishap, there's a different

reminder system to put in place.

But we don't see, we don't see clearly the problems to be solved

if we keep papering them over.

And I think that saying yes is bad, that's a really important turnaround for lots

of doctors because another thing that we teach, which gets a lot of teeth sucking.

I wonder if you've had the same experiences talking about delegation.

When we teach the prioritization grid and like anything that's not

important to below the line, but you feel you need to do, eliminate,

renegotiate, automate or delegate?

And everyone's always got, oh no, I can't delegate.

I can't delegate nobody to delegate to.

That's what they say, which is just another version of, if I

don't do it, no one will, I think.

Yeah.

And that, and the turnaround for that one is that, not always, but

in some situations, delegating is by far the kind of thing for the other

person because they get to have an experience, they get to have a level

of responsibility that they wouldn't have otherwise, they get to step up to

something, get exposure to something.

So actually by holding everything that like I have to do it

mentality is not good for anyone.

Yeah, exactly.

And I've found that in my own organization, sometimes I've just got

on with something and done it just because it, I want it done quickly

or I just thought it was helping out it as quickly if I did it and it's

totally disempowered somebody else.

Um, and it's shown them I don't trust them or it's given them all, all

these sorts of unspoken messages.

Um, I think in healthcare, genuinely, often there isn't anybody to delegate

to, but I think we do use that as an excuse, 'cause actually we could find

people, we need to train them up.

And then the problem is I don't have the time, time to train them or

the fear of the loss of control or that, well, I can't really let them

do that because what if they miss this and then this dreadful thing.

But again, that's where checks and measures come in and processes come in.

But you know, I think this, that's, that's just what that whole question about if

saying yes is bad question got me to the actual, if I'm saying yes and not

delegating or giving it to someone else, quite often that can, that can be bad.

And you know, my daughter had an operation recently on her foot.

I would've been really hacked off if the surgeon who was operating

on her foot had also had to get all the operating instruments ready and

sterilize the operating tables, 'cause I'd be like, hang on a sec. No, no.

Can you do the op, the actual operation?

But a lot of the time in healthcare, the doctors doctors, the nurses, the, the

practice managers are doing a load of administrative tasks that other people

could be trained up to and could do with just a bit of thought and attention.

And it's completely distracting them from their one main really important job, which

for me was that that was being on call that day triaging really sick patients.

Yeah, so I got a bit of a bee in my bonnet.

You know, we always say, you know, if you are paid really well and you

are doing something that someone else in your organization who's paid less

could do, then you are wasting money.

You are quite literally wasting money, let alone not giving them the

opportunities to grow and develop and grow in their role and things like that.

But we do it because we think we are helping out and we think they

would be disappointed if we left it for them and, and, and, and, and.

So, yes.

So that, so saying yes is bad.

Yes.

I think that could be very true.

Any other example for that specific immunization example?

Any other reasons?

If you think about everyone, the practice manager, whoever, you know,

whoever or the receptionist, whoever booked her in, the twins, the mom, your

colleagues, the other patients, anyone else for whom saying yes is bad, that

would be true when you think about them?

There's something about respecting the receptionists

and the diary booking system.

You know, if you're just gonna say yes to any patient that comes

in at any point for anything.

There's something about fairness.

I felt particularly inclined to say yes to that mum.

What if it was a. A patient who had another problem that wasn't quite

emotive, but actually whose need was more?

Well, that's not, I would say, no, I'm not seeing that person now.

That's not very fair.

And also it could cause problems in the future because you say yes to

that mum, then anytime it is just convenient for her, she shows up and

it's like, well, you did it last time, so what's, what's changed this time?

So you do create a real rod for your own back if you don't have clear

boundaries and that sort of thing.

So I think we keep coming back to the bigger picture, don't we, of like this

system, and as you say, it's like the system versus the patient in front of

you, but it doesn't need to be either or.

We can hold, both is important, but we're, we are being truthful about

our capacity for the sake of the whole system, and we're being compassionate to

the patient who's right in front of us.

What are the things that have bothered me as a patient most probably have

been like rudeness or lack of respect or lack of, you know, the way people

have maybe interacted, not so much the, actually you have to wait this

much time to have your appointment.

It's those human interactions which can leave people feeling, yeah, not

seen, not respected, not cared for.

And that's really true.

And actually what this has made me think of, Corrina, I hadn't really thought

of much before, is I thought about the whole long term benefit of saying no.

and we often talk about, you know, the power language mantras, the

power mantras of I'm choosing to say no, so that, you know, I can be

on time for the rest of my patients and triage the urgent ones better.

Even if the mum is upset.

But actually, I haven't ever really thought about the benefits

of saying no in the short term.

And what are now seeing?

Well I'm now seeing that you are right.

If you don't say no, then you are doing it in a muddled way.

You are, you know, even the patient in front of you might not be

benefiting so much from this sort of knackered doctor just fitting them

in on a WHI 'cause they feel guilty.

So even short term, it's not that great for the patient in front of me.

In fact, the only reason I'm saying yes is for my own self-soothing of my amygdala.

And I'm just wondering though, how this works when it's not the patient you

are letting down, it's your colleagues.

Because that seems even harder.

Like if you had, you know, 20 test results to file and you have to

be somewhere, you have to leave.

'cause you've got, I know parents' evening to get to and there's these test results

and literally someone else does have to do it, and you feel dreadful about

dumping on other people, but they need filing and it's a question of either I

send you that or I go to parents evening, or I set really late tonight, but by then

I've sort of missed the on-call labs or I, I've missed being able to admit that

patient if I haven't checked the results.

You know, it's, it's, it's the, the dumping tasks on colleagues

that seems to be the cardinal sin and people absolutely fear.

So how would we deal with that one?

My guess, I mean, you the, please push back immediately

on this if this is not true.

Um, but my guess is in that kind of scenario, there's a give and a take

where sometimes people are gonna have a harder stop at this time.

Other people are gonna have a harder stop at this time.

And again, the system kind of organizes itself where it doesn't always fall to

one person unless that person is kind of unconsciously over-functioning.

And that, that's interesting.

You are absolutely right.

'cause actually no one would mind someone poking their head and

going, I caught parents evening.

Would you mind?

I would mind if one of my colleagues just left it and didn't ask me.

So they weren't seen.

That's less likely to happen and someone just races through it really,

really quickly, doesn't feel they can ask and make loads of mistakes or

whatever, or causes extra problems.

I'd have been like, why didn't you just ask me to do it?

And I think what we then confuse is, 'cause nobody minds being

asked wants to do something.

Well, we like helping our colleagues out.

It's when it's assumed you're gonna do it all the time.

And so when the system is chronically over capacity, so it's like, well, if

I say no, I'll literally be saying no every single day that I go to work.

But then that is probably a completely different kettle official together.

You are not saying, well, if I say no, who's gonna do it,

and no one's gonna do it.

You know, in this acute circumstance, it's actually a chronic, there's all this

work, there's this much work, there's this many people, you can't fit that much

time into that much space or, or whatever.

It's like trying to squash a balloon into a box that, that doesn't fit.

And then absolutely.

It, it's probably a, a different question altogether.

Where have we got to Corrina if we were to summarize our discussions?

Well, what have you noticed in everything that I've been saying, what do you

think the real core of the issue is?

I think it is questioning our assumptions, which may be shared

assumptions across our profession.

So they feel very much just like facts, almost like religion facts, you know,

like you just, thou shalt not kill.

Like thou shalt not say no, thou shalt not dump stuff on colleagues.

Like we need to question assumptions always.

Then we may question things and come to believe the thoughts, but we have

at least questioned them and so we're consciously believing the thoughts, then.

We need to have that level of honesty with ourselves.

We need to not make ourselves gods and assume that everything's

gonna fall apart without us.

Because actually if we overextend, then we will fall apart ourselves and then

we're in the same situation that we were kind of fearing in the first place.

So, not doing things we fear is gonna lead to bad outcomes, but doing things

can lead to bad outcomes and not doing them can lead to good outcomes.

So it all like, can go, can flip from what we originally thought.

And then I think tolerating discomfort just across the board.

This is kind of my big, like my own personal journey and just across the

board, how much discomfort can we tolerate, can we sit in, can we stay in?

Like, ooh, it feels like being in a fire when that person's not happy with me or

that patient's distraught or, or like this feeling of guilt I feel like is

gonna actually consume my entire body.

I actually can I just literally count, like, can I count to 10 and

see that I haven't burst into flames from feeling guilty or you know, from

whatever I've just done or from wherever someone else is feeling towards me.

I love that.

And I think where it's landed for me is we just need to stop

attaching such meaning to yes or no.

And like, it makes us a, a certain kind of person, like good people.

Again, you could finish that sentence.

Good people say, yes, good people or good doctors or good

nurses don't do this or do this.

And we have this kind of, um, a credo, a credo, I think

is the word i'm looking for.

Yeah, when actually it's just like, it's like, if I could not believe

that thought, I like that question.

If I could no longer believe that that saying no was maybe a selfish person, what

would I be doing and where would I be?

I think that's a nice way to look at it.

And I think this tolerating of discomfort is, is something maybe

I'll get you back to talk about.

And I think that's one of the things you're gonna talk to us

about, about FrogFest, how to, how to set impeccable boundaries and

deal with everyone else not liking.

Oh,

Yeah.

Being out of favor with other people.

Like, oh, even just saying the words, I can feel it in my body, like my

solar plexus goes, oh, and I'm sure people listening or watching are

just like, no, that's not tolerable.

And so if something feels intolerable, we take all kinds of not great

actions to try and avoid that feeling.

That's intolerable.

Yeah, And we are just kidding ourselves that we can actually

avoid, not people pleasing, that we can please everybody all the time.

It's a complete myth.

Even people that are incredibly nice and never do anything to upset anything and

bend everyone else's wills will they end up not pleasing somebody at some point.

Yes, Completely inevitable that someone's gonna not be happy with us.

well that's a depressing way to end it.

But, but because we are two type sevens on the Enneagram, we will always

want to end with a silver lining.

Go on then.

What's your silver lining?

that there is a part of us that is beyond all of this, a part of us that sits behind

and beyond that need for approval, that need for security, control, all of that,

that is a part of us that is beyond that.

And if we can more and more live into that part of us and come from that part

of us, then we are just so much wiser and we make such wiser decisions for everyone.

The system as a whole, the patients in front of us, our

colleagues, and ourselves.

Yeah.

I love that.

I know Tara Brack talks about her sort of rain therapy, self-compassion, and

I guess that that wise part of you, when you notice this intolerable,

ugh, I've upset them, whatever.

You just sit there and you go, of course you're feeling like that, Lou, you just

have to put up with or do or whatever.

Yeah, anyone will be feeling like that right now.

Doesn't mean it's wrong.

So yeah, there's that lovely quote from Rumi and I'll just finish with that.

Out beyond ideas of wrongdoing and right doing, there is a

field, I'll meet you there.

Thanks Corrina.

If anyone wants to get in touch with you, how can they do that?

Yeah, so they can go to my website, corrinagordonbarnes.com.

Corina spelled C-O-R-R-I-N-A, Gordon, G-O-R-D-O-N, Barnes,

B-A-R-N-E-S .com and just drop me a line in the contact section there.

You can also connect with me on LinkedIn,

That's wonderful.

And uh, come and see, um, Corrina talking and pick her brains

at our next FrogFest Virtual.

All the links and details will be in the show notes.

So Corrina, thank you so much.

I've really enjoyed our chat as ever and we'll chat again soon.

Thanks for listening.

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