What can you do to quiet the inner critic voice that tells you you’re not good enough, or there’s more you could have done?

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We all have different names for that nagging voice in our head that tells us we should have done more for patient, we've mucked up or we should have really helped help that colleague.

But what can you do to quiet that voice which means you can get on with your day?

Who can you go to when you need some reassurance or just to have a moon?

And if you're leading a team, how can you spot when other people's inner critics have jumped into the driving seat?

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.

This week, I'm sharing with you a panel discussion, which I led at the Wounded Healer conference in London, which we recorded in June.

I was joined by Dotsa Helen Garr, Medical Director, and Simon Lyne who's a psychologist and therapist, both working at Practitioner Health.

In the second half, we take a couple of questions from the audience.

But I start by asking Simon about what people realize in therapy that they wished that addressed sooner.

So it's really helpful to look back and to think about, you know, what we can learn from the past.

I don't think it's helpful to think, well, if I'd done that, then I wouldn't be here today.

Because I think what's what's happened, I think it's really useful to just accept that what's happened has happened and it can only have happened the way it happened.

It's only later that with the retrospective scope you're able to say like, oh, we could have done that.

Well, you couldn't because you didn't, because for whatever reason it didn't happen like that and it wasn't available to you.

So first, first and foremost, what's happened has already happened and it can only have happened that way because it's already happened.

So let's learn from it and try and do something different moving forwards.

And part of that is gonna be looking at, you know, uncomfortable stuff maybe about yourself that, it's interesting when you were talking about, I'm going off a tangent, when you were asking about,

We love to be love tangents on this podcast.

Perfectionist that everyone you know, raised their hand really quickly, quite happy to identify, but actually behind that might be something that is, has been that you're constantly trying to run from, which is maybe an inherent sense of like, maybe I'm not actually

that good and I have to constantly get top marks and be better than everyone else or get the praise in order to feel that I'm okay.

There's a whole other imposter syndrome podcast there.

Um, I'd I'd add to what you just said though, about moving forward.

I, I hear that, however, I'd say every single practi healthcare worker who I've seen at Practitioner Health burnt out, pretty much every single one of them has said, looking back, the signs were there.

And I think, um, it can be helpful to look back actually.

And what were the signs, and I, I say this a lot.

What, what are your signs?

What are your red flags?

How will you know moving forward if you are struggling?

And I think what we do a lot in healthcare, we don't check in with ourselves and we just go, go, go, go, go.

We give, give, give, give, give, give until we crash.

And actually, it can be really helpful to take stock.

Um, and the airline industry do this.

They, they, the military do it.

They'll check in, um, every morning, how is everyone is, are you red?

Are you amber, are you green?

Is anyone not in the green?

What's going on?

And safety improved.

So I think getting into the habit of checking in with ourselves can be really helpful.

But also know what your signs are.

But also know what your colleague signs are.

So I know that, um, when, when I was in general practice, I said, it's really good to have a work wife at work.

So I think that's one of the big protective factors.

Having a friend at work, somebody you can you moan at or the session we had yesterday about the chimp, your chimp buddy.

So you need, everyone needs a work wife.

And my work wife in general practice was Rachel and my work husband, Zaid, and Practitioner Health.

Um, and I know when, when Rachel would close her door, she'd get quiet, um, she'd get in earlier every morning.

I know they were her signs and I'd check in with her.

And getting to know your own signs as well.

So mine are, um, definitely, I, I start to moan when I'm feeling stressed out.

In fact, somebody once put in my 360 degree appraisal, which if I was ever in a position of power, I'd get rid of those 360 degree anonymous feedbacks, but somebody put moan less, achieve more.

And I spent three years trying to find out who wrote that about me.

And then eventually I gained a bit of self-awareness and insight and thought, actually I do moan when I'm stressed and I do moan when I'm sort of feeling burnt out.

And I actually printed it off and put it in a little frame and carried it around with me.

So now I know actually if I start to moan, that's one of my signs.

And I catch myself and I actually, I'll name it.

Oh, I'm moaning now.

Actually, this is a sun.

I need to, I need to do something.

And it might even, I just need to go and stick my head out of the wind.

Did you find out who wrote it by the way?

I narrowed it down 'cause it's such a, such a.

Was it your work wife?

But it's also such a doctor thing to say, isn't it?

Moan less, achieve more.

Oh, yeah, yeah, yeah.

That, but it was true.

When I feel overwhelmed and I'm stressed, I moan and I become negative.

But now I'm able to see it.

So I, I catch myself.

I'm moaning.

Okay, I might just need to go and look at the clouds for 30 seconds or just go and have a cup of tea or whatever.

Um, or I might need to do something bigger, like make sure I've booked some annual leave.

But I think recognizing your own signs.

My other one is, um.

Sometimes it's okay to moan as well, though.

Well, it is okay to moan, but I

if it, I mean, just give yourself 30 seconds.

Moan, moan, moan, moan, moan.

And then.

I think I was moaning a lot.

Mega moaning.

But my other one is inequalities.

So that, and that's a key sign of when people are burning out.

So noticing inequalities.

And I'd start to look at other people's lists and gp, why have they got a break there?

Why have they got a double appointment?

Why aren't they seeing a patient?

And when I catch myself doing that, that's when I know, actually that's one of my other signs.

When I'm great, when I'm best Helen, I don't care what anyone else is doing.

I just get on with my own work.

So I think recognizing your signs and your colleagues' signs can be really helpful to just pull back before things get out of hand.

Yeah.

One of eye signs is the, my internal, you know, critical voice gets quite like, why did you do that?

That's really awful.

And but also combined with why is no one else doing what they should be doing?

Yeah.

And then you're really bad and how dare you think that about the team.

Yes.

And we were talking the other day about this, this inner critic.

Mm-Hmm.

And there's been, we talk a lot about how you try and get rid of it and beat it and stuff, but you came at it a, a really nice angle, which I thought would be really nice to talk about.

But you don't say, just switch a critic off, just get rid of it.

You have a slightly different approach about that.

Yeah.

I mean, I can't take credit from, uh, for this, this is from, um, internal family systems model, but, um, it's, it's basically about working with whatever is happening internally and the critic is that I think we probably will all recognize that we all have something like this, our own version of this.

And it's a major player in a lot of, or definitely a lot of doctors systems.

And working with it, understanding what it is, trying to help you with, what it's trying to protect you from, and then figuring out how to maybe if you want it to, if you want, it's not gonna stop criticizing, it's not gonna, it's not gonna be quiet if you try and get annoyed with it or try and switch it off or get rid of it, it's gonna relax.

If you validate it and try and understand what it's trying to help you with, then it might be amenable to toning down its language or, you know, not being so nasty, but we need to understand what, what is it trying to help with, what's it trying to protect you from?

And then you can also bring in some of the other parts that you mentioned that you are, you know, you recognize yours being nasty.

And then there's another part that comes in that kind of criticizes you for being nasty about being, being nasty.

So there are other parts as well that are gonna be able to communicate with those parts and, um, you know, be kinder in compassionate and more friendly.

I think connecting with a friend inside is a very important, uh, too.

And how much, how much does that contribute to the, the burnout that you see in, in doctors and other healthcare professionals?

You know, it, it is sort of befriending all those internal critical voices.

Is that quite a, a big thing?

Oh, it's a major thing.

I think it's really difficult.

Is it really difficult for people to get their head around their head around initially, but I think it's such a, such a, a hugely important skill.

I think that not only do doctors identify very much with their role and what they do and how they perform, they also identify with their internal critics.

They think that is me.

That is me.

I, that's, I kind of am going along with that.

That's who, that's who I am.

They don't, they're not able to separate themselves out and understand that there are lots of, you know, we're not a monolith, we're not just one thing.

We're lots of different things.

And so am I right in thinking then that when we talked about this culture, say if you were in the perfect practice or the perfect department where you had a manageable workload, where you got your lunch break every day, that you loved your colleagues, you're still gonna make mistakes and you still.

Yeah.

Might have this huge internal critic, so therefore it's perfectly easy to bend out.

'cause you are, you are your own tormentor.

We are never gonna be perfect.

Like, let's just forget that we are not, we are.

Really?

Speak for yourself, Zaid.

Sorry..

Sorry.

I, I I really hate to, you know, to breaking news everyone, you're not gonna be perfect.

Like, we, like, we bring with ourselves so much baggage from the past, the, even on a really good day, there's gonna be moments when, you know, you're, you judge yourself harshly or you compare yourself negatively to someone or, you know, you just, yeah.

It's just, that's kind of human nature.

It's okay.

We can still work on changing what we want to change and improving tomorrow, but right here, right now, we are 100% okay.

Now obviously therapy's really helpful for that, and you provide, you know.

Sometimes, can be.

Mostly if you engage with the right therapist.

What about people who, who aren't currently in therapy, who, you know, might be driving home listening to this after a really long day at the surgery.

That in the critics having a field day, they're really tired and knackered.

What, what can we start to do without having the luxury of, of being in, you know, in on the therapist couch as it were?

Do you use couches anymore?

I definitely have a couch, but no one's lying on it.

Okay.

No, I'm not sitting mad.

Unless it's a really boring session.

Um, I think, okay.

Because it's such a, you know, it's a, it is a lot to go into, but I think one, maybe the first step might be just being aware that you're having this experience that actually your inner critic has come online is saying like, oh, they're talking a letter of nonsense.

This doesn't apply to you, whatever.

And then see that if you're able to connect with a curiosity and turn towards it and be, oh, that's interesting.

I'm now I hear you.

I'm, I'm, I'm, you know, what is it you are, you know, what is it you need to say?

Let me, I want to kind of, I want, I want, I wanna know you.

You know, if you can't be friends with it yet, at least try and have that friendly approach.

Be curious what, you know, what is, what, what, what's going on here?

What do you have to say?

And, um, yeah, almost say thank you.

You know, extend some gratitude towards it.

Do you know, that's interesting.

Something, 'cause I have a completely different approach to my, I call them the NATs, negative automatic thoughts.

So I absolutely agree with you about recognizing them.

So it can be really helpful when it happens for me, um, and for some people to, to just recognize, okay, I am having a, I'm having a NAT, I'm having a negative automatic thought, like I'm not, I'm not very good at this, or everybody's better than me.

Actually, the approach I find really helpful, um, which I dunno what you think about this Simon, and I've read some evidence about it, is you write down your negative automatic thought and then you physically rip it up and put it in the bin.

And actually I, I think I told you about this.

Well, you are, you are turning it off.

So I told you about, um, Kirsty Woolley, who is our Scottish clinical lead.

I was with her once and I must have said something that was a little bit, oh, I'm not very good at this.

And she came up to me and she just tweaked my ear like this.

I said, whatcha doing?

She says, I'm turning off that little voice inside your mind and actually that physical act of just doing that.

So sometimes I'll find myself, actually, I'll just tweak my ear and it does when I've recognized I'm having a negative automatic thought and it allows me just to turn off.

'Cause I, they're not helpful to me.

How long did it last for?

So they come back.

I don't think you can turn them off forever, but I don't, I think in some situations it's not helpful to have them.

So you might need to be able to perform and, and you are competent, but you need, your confidence needs to match your competency in order to be able to perform.

And if you are having a negative automatic thought, being able to have the ability to recognize it and switch it off allows your competence to meet your co your confidence and move forward.

That approach seems to work for me.

I think you're right.

They, they always come back and I don't think anyone's necessarily got a solution to turn those off forever.

But there are some people who never have negative automatic thoughts, but they're called narcissist.

Narcissist, don't they?

I'm wondering if if this are two sides of the same coin.

Because I think if you're having a negative, critical thought and you just turn it off without investigating it or making friends with it, then that's gonna be very difficult.

Um, and I love the way you say, you know, what are you giving me?

What are you trying to protect me from here?

Yeah.

And you might not, you know, it might not be, if you're in the middle of doing something, it might not be that moment that you're gonna be able to stop and reflect.

So you might just kind of put it aside for later.

And there is definitely.

I hear you.

A benefit from, you know, kind of just think, okay, thanks, I'm gonna move on and carry on what, what I'm doing.

But I think over time you can definitely rewire, you know, how your brain works so, and.

Oh, a hundred percent.

And, and, and intervene so that it, you train it over time to come up with stuff that maybe might be more useful to you.

I think trying to get rid of like a negative, I don't even call it negative or unhelpful thoughts, they're just thoughts that feel uncomfortable.

Over time, I think that getting to understand, you know, what it is and not being afraid of them.

They're literally just thoughts.

I don't have to respond or I don't have to react using the, you know, Sarah's words from yesterday, I don't have to react the, the same way to them.

I can understand that actually it comes from a part of me that's trying to help me with something.

And lots of doctors are gonna have these thoughts because they, they think that the only way to really feel okay is to be the best of the best of the best.

And therapists say that a lot, don't you?

Your thoughts are just thoughts.

They just, thoughts, just notice them.

They're not facts.

Yeah, they're not facts, they're just thoughts.

I, I think it's so important to be able to work out what that thing is protecting you from.

I tried after having our conversation the other day, I, I tried it when I was having like a hole.

Oh, you're so bad.

I'm like, okay, don't wanna go.

Like, no, no, think bad, but okay, what am I trying to protect myself from?

Oh, you're trying to protect yourself from that person thinking badly of you.

Yeah.

Okay.

What's the worst thing?

Okay.

Thank, thank you, that part of me.

And then go underneath it and, and try and look after the vulnerable part of you that is, you know, that has been kind of, you know, sent away and, and, and banished.

So you're talking about self-compassion.

Compassion for ourselves?

I think that's, that's a huge thing, isn't it?

And it's certainly something I'd love to explore.

We are running out of time, but we are nearly out of time now.

Anyone got any comments or questions?

Okay, let's

Hi, I'm, I'm Matt Dom,, I'm an orthopedic surgeon and, uh, I and the clinical leave department of about 40 orthopedic surgeons who are, who all think they're Teflon.

And I've all got moats castles, rottweilers, and everything at their gates.

In this room you are sort of talking to the converter people who are here for a reason, who understand.

None of them have any insight at all, that they are at risk of burnout.

Yet, I see signs in many of my colleagues and I have had colleagues who've gone through the process, and when they do, they drop off a cliff and suicide rates and surgeons are through the roof, and multiple articles in, in the press about that.

What methods can you as a panel give me?

When I'm dealing with my colleagues and their appraisals, their job planning, when I see issues that I can help identify those issues for them, just to signposts in the right direction rather than dealing with my instant inner chimp that says, oh, shut up and get on with the job.

Actually, I want to take their complaints on board and try and sign, post 'em in the right direction.

I can give you two practical things to do.

Um, 'cause you we don't have a lot of time and it, I mean there's lots of system things we can do around enabling people to recognize signs of burnout and training, so we all are looking out for each other and cultural change.

But practical things you can do in those one-to-ones, um, where you are limited on time and there's a billion other things you have to cover.

Um, something we've brought in at Practitioner Health for everybody's yearly review.

We've brought in encouraging people to complete a wellbeing plan and actually there's some really great wellbeing plans out there.

Mind do a really good one, which asks you to recognize things, write down things you need to do every day to stay well, things you need to do less of.

Gets you to recognize your signs of when things are not going quite so well.

So it's a tangible, practical tool for you and your manager, your line manager to look at together.

And then another really great tool of the Health and Safety Executive, they've released a Talking Stress Toolkit for the NHS, which is again, for a line manager and an employee to look at together.

And they're actually really useful prompts and tools that you can do, um, in that meeting or they can take away that gets people just to start thinking about your signs.

Am I burning out?

What do I need to do?

If I am, what do I need my, my organization to do for me?

And they're written in such a good way that they're not fluffy, they're not patronizing.

So I think, um, even orthopedic surgeons might come on board, but they're just useful, practical tools to use.

But Simon will have much more, I'm sure.

And I was just thinking as you were, as you were saying, again, I think it's so difficult to, to come up with like, like the best top tips.

It's probably gonna be a bit, um, annoying to hear, but I think that being, different with those people, like showing them it, it's okay to, you know, to be a human.

And because I think it sounds like the way that you described them, they sound very defended, you know, like they have, they're Teflon because maybe inside they are scared of what's gonna happen if it all falls apart.

So you just gotta keep going, keep it perfect, keeping really, like I'm, nothing bothers me until eventually it does.

And then you're in trouble.

But you know, it, the way I think that the culture is gonna change is if we start to be real with people and say, and, and they might find it very, um, they might, their defenses might go up if you go in, if you highlight the fact that actually maybe there, there's something going on under the surface.

But you can be the, you can show them actually, you seem to be working a lot at the moment and you know, that's all great and everything, but you know, when I was doing that last year, actually I had to take a week off because I just was completely burnt out.

Or you know, just being vulnerable with them.

I think there's

a lot in that actually.

And we see a lot if we see surgeons and anesthetists come to practitioner health and if a surgeon or an anesthetist in particular self refers to practitioner health, we're immediately on alert.

And actually the surgeons I've seen have come in and they's, they're very clear I cannot let anybody know that I'm struggling.

I cannot let my colleagues know this is not acceptable in where I work yet, they are struggling inside.

And I think there's a whole lot about what Simon says about if you are a leader in an organizational or, and we're all leaders no matter what our role, modeling vulnerability, um, and saying actually how we talk a lot about how asking how you are.

So Neil Greenberg, um, who's amazing, amazing doctor, he's, he did a study on soldiers in Afghanistan and he found that soldiers in Afghanistan who had a line manager who checked in on them and who they felt cared about them, had one 10th of the poor mental health problems of the soldiers who felt their line manager didn't care.

So, checking in with your team and having what Neil Greenberg calls psychologically savvy conversations and the NHS runs React conversation training to give you the tools to have this, can be really great, but simple things like, how are you feeling?

Well, I'm fine.

Well, actually I'm glad you are feeling fine.

'Cause what I've heard is from the rest of the team, things are difficult.

Oh, actually, I'm glad you are feeling fine.

'cause I've had a really rough week.

Um, oh, I'm glad you are feeling fine because what I've noticed is x, x, x, and it just gives people that in to be able to share.

Um, one I use a lot is what's going on in your world.

How have you been since, since we last spoke?

How have things been?

So how are you, what you get?

I'm fine.

How have things been since I last saw you?

Just allows people to open up role,

Role modeling it.

Yeah.

Role model is, is really strong.

From my perspective.

It's really, really strong to be a leader who's, who is able to talk about being a real human being.

And, you know, it's not equating anxiety, for example, or stress with weakness.

I think that there is, it is just deeply ingrained in maybe our culture, but definitely in, in with medical professionals that it's somehow you are, you have to be, you know, kind of able to deal with like, everything that went on in the pandemic, you know, like we obviously saw what was going on.

Oh, of course.

With those people in real time.

But like, people going through some really, really extraordinary stuff and not having access to support around that.

Is that, what are you expecting to happen?

This is, this is, you know, this is.

Yeah, yeah.

Really traumatic.

We see a lot of trauma as healthcare workers that actually we just accept as normal.

And if somebody outside of healthcare were to go through that, that would not be accepted as normal.

We, we just, we just keep going as if it's just part of the job without.

It's normal to be traumatized when you go through something traumatic

mm.

Yeah.

But no, no, no.

But you, you push it down and you just get on and see the next patient straight away.

Yeah.

Many of those stories.

Yeah.

Yeah.

It's hard, isn't it?

And it's recognizing that I do think stuff about leadership.

There's something we use, um, when we train teams.

It's the Yerkes-Dodson curve, which is the stress.

As your, as the pressure increases, your performance increases is at the beginning.

Then you reach a plateau, and then your performance drops.

And sometimes just getting per, someone to put where they think they're on the curve is quite a, like, it's a unemotional thing.

Well I think I maybe just dropping down the curve, then you've got an in to talk about it and it's a bit less, how are you, you know, so that's maybe one way.

And it's, it's hard though, isn't it?

There's the patient safety aspect as well, isn't there?

That we know that people, doctors burning out 63% higher chance of making a medical error.

So there is that, particularly in surgery.

But it's a tough one, isn't it?

I'm Sam Antony.

I just wanted to mention two things.

So one is I think looking at the barriers that we have to sales permission, um, we are always looking for approval.

People to take a break,

to put a break in clinic list.

Yeah.

Who, whose mission, who waiting to tell.

Um, and the second thing which ties into that is career breaks because it's something I've had, it was opportunistic.

Um, and I actually, it came at a very good time because I was at the edge of burnout and I really wanted one, but I didn't know how to do it.

And opportunistic, my husband.

Nothing happened to my job or you know, I came straight back to, I was supported doing it.

Um, and I really fly the flag for career breaks.

No one tells you that you're entitled to them.

No one tells you how to do them.

They are in most of our contracts and some countries also do this as and free.

So every few years.

Why not?

Um, and um, I think the idea that that is in our very, you know, to keep longevity, we have long careers.

We hope, uh, there's no reason not to.

It's done very well for things like maternity leave.

It's very structured.

Why can't that be done?

The comment about, permissioning and whose Permission are we, are we looking for?

And I think that one of mistakes I've noticed that people make when they are heading towards burnout is expecting their colleagues to give them permission.

Like going to your colleagues and going, you know, what do you think?

Is it okay if I go off, like?

But if your colleagues are in the same boat as you, in the same department, the same practice, what are they gonna say?

Like, if it was me, I'd be going, well, you know, if, if you go off sick now, what's that gonna mean for me?

So I think trying to seek approval from your closest colleagues, that's a really difficult, because you're probably not gonna, they'll try and be sympathetic.

Of course, they will.

And unless they're like, you are said, Ben, we need, we need you out of here.

Yes, please.

You might get that.

I think even then, I think even then you won't get that.

No.

Um, because everybody's trying to keep the head above water.

And I say that a lot to the healthcare staff who come to Practitioner Health.

Nobody is gonna look out for you as much as you.

And we, you are absolutely right.

Your friends outside of work, he'll go flipping it.

You need, you need that.

You're absolutely right.

We're waiting often for somebody to just notice and say, go off.

That's not going to happen.

That's where practitioner health will come in.

Well, we're wearing, you know, we will advocate where a voice will give people the strength and the autonomy and the permission to do what they need to do to get better.

And sometimes you just, you need that person alongside you.

And it's very rare to get that at work.

I mean, I remember working in a practice and partner's, um, mum had died and she came in the very next day to work.

I said, why are you here?

Your mom has died and just hadn't occurred.

I was like, you need to go home.

And actually she did.

And she came back in and said, thank you for saying that to me.

It just hadn't occurred to me.

Why are we not all saying that to each other?

And it's not because anybody doesn't care, it's the culture that we work in.

We just crack on.

I mean, I remember times when my son was sick in hospital and I was working on a different ward, and I'd just go nip up and see him on my lunch break, you know?

And no one said, Helen, what are you doing?

Because the culture we work in is that we all just keep going.

And if one person goes off, that means more work for everyone else.

And everyone's either consciously or subconsciously so aware of that.

So, um, being able to give yourself permission, but that's incredibly hard.

Having someone else to advocate for you, um, which is what Practitioner Health we will do when it's needed, give you that strength and be that advocate can be really helpful.

The one word answer from both of you, in your experience, do people go off sick with burnout too early or too late?

Too late.

Too late.

Okay.

There you go.

Heard it here first.

And thank you so much everybody for being here.

Um, thank you to Practitioner Health for all the support you, you, you provide to, to colleagues, and, um, hope you enjoy the rest of the conference.

Thank you so much for being here.

Thanks for listening.

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