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Why “Keep Calm and Carry On” Fuels Burnout
Episode 2879th September 2025 • You Are Not A Frog • Dr Rachel Morris
00:00:00 01:09:15

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Burnout happens when work stress and home pressures overrun our support structures. When we understand this balance, we can take steps to address burnout before we reach breaking point.

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Transcripts

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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

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to solve it all on their own, because they would've done all that already

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if they could have done, but having to reach out and have those conversations

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about how do I get this balance back?

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Uh, you know, who can support me with this?

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Who, who can help that balance in my work.

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So I'm, I'm not just burning myself out doing lots and lots of hours of

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unstimulating work, um, when I know I can contribute in other ways too?

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But then we've got another problem, haven't we?

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And I know all throughout the whole of your book, I've noticed the theme

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is reach out, reach out, get support connects, which I, I totally agree with.

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But the problem I see is that in healthcare, often the people that you

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reach out to are your colleagues who are in the same boat, and often they

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have a vested interest in you keeping on, churning through the workload

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that might not be simulating to you to, you know, to keeping you going

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so you can do the service delivery.

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You can reach out, reach out to your manager, who is probably even more

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stress and burnout than, than you.

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Um, so that's another problem for them to deal with.

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So I'm not sure you're going to get the best support and unbiased

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support from people at work.

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So then the question is, well, yeah, you can reach out to your friends

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and family, but they don't really understand the workplace and what, what

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you're going through, particularly if they're not in a healthcare context.

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So, so who wanna do you reach out to for this support?

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Yeah, and it's, yeah, there, there are, there aren't simple, easy answers

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and, and I think it requires quite a lot of courage, assertiveness.

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Persistence.

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I think a, I think a key thing that people start to accept when they come

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forward for support and help is actually, this is really serious, what's going on.

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Burnout is horrible.

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It's a terrible feeling and it can lead if you don't manage it to

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anxiety, depression, physical health problems, like high blood pressure.

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So it needs managing.

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And as good work is good for us, bad work is bad for us.

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And, uh, I think it requires us in a way to take a stance where we're

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saying, actually, I can't sustain this.

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I need changes to happen.. And, and that can feel very difficult.

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But actually you burning yourself out, having to take time off work or.

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Performing poorly because you're burnt out and making errors or mistakes

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or having poor conversations with patients or colleagues isn't worth it.

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It's not helping anyone, and, uh, it's not really, it's not helping your

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colleagues, although it may feel like it.

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So although organizations and colleagues might want to turn a blind eye at times,

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they might want to just keep us going until we burn out, we, we really aren't

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doing us any favors in that, but we're also not doing them any favors for that.

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We're not doing our patients any favors.

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I, I totally agree.

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And, and it's this sort of weird cycle of people saying, well, I haven't got

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time to do anything about this because there's so many patients I've got to see,

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or I can't say no because it will let people down and it pass the stress on.

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Or I'll get a complaint and then I'll say, okay, fine, well you may get a complaint

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if you say no, but what's gonna be worse?

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The complaint when you've said a well thought through, no, or your colleagues

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may be thinking you are letting them down.

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We don't have any control over that, or properly letting them down

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when you are off for six months.

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I mean, I'm not saying, you know, and that's not a judgment, but you won't be

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there to do the work, or getting an even worse complaint because your judgment's

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gone and, and we know that doctors that are near a burnout get, make many more

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mistakes than than people who aren't.

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So then you're gonna get that complaint and let people down anyway.

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It would be better to have that difficult conversation in the first place.

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So that's one whole thing about, you know, setting boundaries, saying

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no, having those conversations.

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And as you were talking, I was thinking about the difficulty of

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finding people to reach out to.

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But I've had this, a situation, not about stress, but there's been a situation where

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I want to find out about something and I'm really not sure about who to contact.

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I'm thinking, oh, oh gosh.

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And my other half said, Rachel, you know, lots of people you could contact.

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And I thought, okay.

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And I just sat down and I wrote a list.

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So it turns out having said, oh, I don't know what to do, I don't know

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who to buy advice from, there are at least 10 people I could literally

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email and ask some advice from.

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But it takes a bit of thinking, a bit of putting my neck out there and a

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bit of being ready for people to say, actually no, I can't help you type thing.

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So yeah, I don't, it probably isn't that We don't know anyone

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who can support us, right?

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Well, absolutely.

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And for me, it's one of the joys of being a doctor, uh, and being in the NHS.

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And for me, one of the key values and why I do this work, really for being a doctor

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and in the NHS is we help our colleagues.

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We are there for our colleagues.

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And I increasingly believe that actually helping our colleagues stay

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well is, for all of us, whatever our roles is, the best way we help

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patients because healthy, thriving colleagues deliver great services.

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So I, I almost think it should be our priority.

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The, the, the other thing I was reminded of when you were talking

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was, um, how we change culture.

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And I think we have an op we have an opportunity sometimes, especially if

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we're reasonably senior to do that.

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And I was thinking about, there was a service I worked in about 10 years ago,

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and we used to see all sorts of doctors.

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It was a self-referral service.

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Lots of doctors came to us, really popular, but no surgeons came to us.

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So, and I was like, well, these surgeons are under a lot of pressure.

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I know that I've got friends who are surgeons, but they never came to us.

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And then one day a very senior surgeon came to us.

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He was burnt out, he'd become depressed.

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He referred into our service.

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He did very well, 'cause most people do.

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And then he went back and this was the remarkable thing he did.

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He talked to all the other surgeons in the region and says, look, this

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happened to me, I was overworking.

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There was a lot going on at home, I went through to this service.

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I'm much better, you can see I'm much better.

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And then the flood gates opened, and we never, ever had any problems with

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surgeons coming through to our service.

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So that person, I'm sure he doesn't know it, but probably saved a lot of people's

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careers, will have benefited patients and maybe saved some people's lives.

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So I, I do think there's something else about just battling on and waiting for

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burnout to hit us, and doing it silently doesn't help our colleagues either.

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No, it really doesn't.

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And, and the minute you share something, the shame dissipates, doesn't it?

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And let's face it, we still all feel shame when we think we're not coping because we

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feel I'm not good enough as a doctor, I should be able to cope with everything,

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which is totally bonkers thinking.

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It's a superhero thinking that it is so unhelpful for us, but the minute someone's

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senior tells their story, it's like, okay.

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Yeah, we can do it.

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And we've been involved in coaching programs for new to GP fellowships

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and there's coaching programs around the country that are fully funded

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for doctors and not being used by anybody, which is total madness.

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Now either people just don't know about them, that could be one thing, but I

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think people firstly feel they haven't got time, which is again, total madness,

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we'll talk about that in a minute.

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Or, or people maybe don't want to admit how bad things have got.

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Why do you think people aren't using these services that are

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available to them that are out there?

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I mean, there's a lot of talk about how far we've come on about mental

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health and de-stigmatizing it.

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And yet a lot of, the lot of professionals I still meet with, a lot

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of doctors I still meet with, they're really ashamed to be meeting with me.

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They're, you know, the, the, the line usually is, I'm, you know,

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I'm sorry to be wasting your time.

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I'm sure you see people a lot worse than me, and a sense of a weakness, a

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failure, letting their colleagues down.

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And it's still there.

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And, um, and it's a miss, you know, as I said earlier, it's a

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misunderstanding of what burnout is.

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It's a, you know, it's not true what they're saying.

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And when they tell their stories, they can see it's not true, but that's there.

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The other thing is I think people need to trust these services.

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They need to trust that the services will be, be for them, that they'll be rapid

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to access, that they'll be confidential, and the outcomes are really good.

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I mean, NHS Practitioner Health is a fantastic example of that in the UK.

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So I, when Clare Gerada set it up, she said, if we build this, people will come.

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And I'm not sure people were sure about that at the beginning, but it was built.

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People come to NHS Practitioner Health, they get really, really well, they

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start thriving, they then go back and tell their teams about their positive

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experiences, and the service has grown into the kind of, you know, massive

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trusted services at the moment.

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So I, I, I think it, it does take a little bit of time to make people trust things.

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I think people can worry that if they come through to help that it will be

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opening a kind of Pandora's box and that they'll suddenly be off work and

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they won't be able to get back to work.

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And that's not true at all.

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You come through to help, you'll do really, really well.

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It's when you don't come through to help that the problems can come.

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I think as well, when some of these services were first set up, um, I'm

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thinking of a, a particular coaching service, it was like, oh yeah, come

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and see us, and they'd give like one day of training to people and then so

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people would use it and think, well, actually that wasn't very helpful

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because actually they saw someone that wasn't very experienced and also almost

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felt like they were just trying to persuade them to stay working rather

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than, or, or they were doing mentoring, which is great, but probably what,

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what wasn't needed at, at the time.

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And so they're put off.

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But I think things have very much developed and, and improved since then.

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I think one of the reasons why people do put off getting help

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is they don't recognize it.

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And you talk about this in your book, that the burnout cliff, that people

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go along, along, along think, well, I, I can't be, I can't be burnt out.

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But you know, I've spoken to someone who's a director of medical, director of

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wellbeing and a, a local hospital trust.

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They surveyed their doctors recently, using, I think

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there's a Maslach inventory.

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50% of their doctors are working in burnout.

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And we are led to believe that actually burnout is so severe, you'd

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know when you're in it, uh, you can't carry on when you're in it.

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But actually a lot of people are actually working in it, so, absolutely.

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And I've had those sorts just the same as your patients.

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Well, I think I might be wasting your time because I don't think I'm actually

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that bad, but you actually are, but almost you felt like that for such a long

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time, or even, dare I say it, for most of your career, it's become normal to you.

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So.

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is it true that we've almost normalized burnout and a lot of it are working

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in burnout without even knowing it?

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Yes.

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I, I think that's right.

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And I think, um, I think I talk about a culture, in high stress

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professions, particularly in the NHS where we keep calm and carry on.

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We, we listen to, uh, Dory in Finding Nemo.

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We, we just keep swimming that that's what we do.

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And that is terrible burnout advice.

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It's a way to get through a difficult night shift, but, you know, it's like,

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it's like trying to run a marathon in the way that you handle a sprint.

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So, so keeping calm and carrying on doesn't work, but it's the

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way that it's our go-to, I think in high stress professions.

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So we keep our heads down despite, you know, feeling a lot of problem,

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stress, early signs of burnout, even even quite severe burnout,

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and we just try and keep going.

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What we do is we try and protect our work and the core work.

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And often other things are, are, you know, we're neglecting home life.

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We're neglecting, uh, social activities, we're becoming quite

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isolated from our community, but, but we do try and keep calm and carry on.

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And some of that I think is because doctors and I see this all the time, are

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really quite hopeful, optimistic people.

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And they say to me, it will get better.

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It's just a really busy

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yeah.

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Next year when I get my new colleague, it'll be

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Yeah, absolutely.

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So you, you hear a lot of that and you know, and hopefulness is wonderful.

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We need that when we work with our patients, but it can get to the

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point where it's fooling yourself.

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And, um, and the danger with the, um, that stage is what I call the plateau,

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where people are just putting their heads down hoping it'll get better.

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But the danger with the plateau is you end up sleep walking

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towards the burnout cliff.

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So it comes to a point where things go, there's too much for too long,

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and then there's one thing, the straw that breaks the camel's back and that

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will potentially take you off work or you'll have to, um, you'll have

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to then, um, reduce your commitments.

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And that's where we really don't want to get to.

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So it's much better for people to act early to try and recognize things.

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I, I also think you're right that people don't necessarily look out for them.

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So one of the things I do when I'm lucky enough to be able to do some

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workshops with people is spend a bit of time saying, you know, what

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are your signs of problem stress?

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Do you know them?

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Do you know them as a tick list?

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And, and often people don't know them, but, but really, they,

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they should be on our dashboard.

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We should be monitoring them.

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And, uh, you know, we should be watching out when we're not sleeping as

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well, when we're withdrawing, whether we're, when we're becoming irritable,

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when we're getting muscle tension.

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But I, I'm not sure people are monitoring those and, or if they do recognize

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them, sometimes they're ignoring them.

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and I've just had this real realization as I've been talking to you, because

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this burnout cliff is really interesting.

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And you, you have it in the book 'cause you know, you have this

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wiggly line, you go along and then suddenly you go into burnout.

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Because the question I've had for a long time is, okay, why is so many doctors able

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to work in burnout when the traditional advice is their performance will go down?

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You know, so you can't perform if you're in burnout yet, they

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are still just about performing.

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That's right.

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And I, and I think it's, um, there's two people I think of in the kind of history

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of burnout that I often go back to.

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And the first one is he's got a wonderful name.

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He's Dr. Herbert Freudenberger.

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And he was a psychoanalyst in New York in the 1960s, and he burnt

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out , um, and then he coined the phrase to describe his burnout.

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And, um, and he, he was doing a public addictions clinic during the day and doing

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a private clinic at ,night and too much for too long with too little support.

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And he, he coined the word burnout because it reminded him of what he was

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saying in New York at that time, which was there were burnt out buildings.

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And he said, if you look at a burnt out building, it looks okay from

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the outside, but inside there's a kind of desolation and emptiness.

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And he said, that's what I feel like.

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People, people look at me, they think, I think I'm fine,

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but inside I'm feel terrible.

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And, uh, and that is, I think the burnt out clinician at work.

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They're, they're protecting their work, they look okay, but inside something

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really quite serious is going on.

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But when they, when the straw that breaks come off back and they need to

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take work time off work, it sometimes takes them by surprise, but almost

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always takes their colleagues by surprise, they don't see it coming.

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The other key name is the name you've already mentioned, professor Christina

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Maslach, who did the Maslach Inventory and she described burnout as three things.

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So I think at that stage she didn't talk about performance, but what she

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talked about is emotional exhaustion.

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So that kind of absolutely exhausted at the end of the day, all you

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can do is sit on the sofa and have a glass of wine and fall asleep.

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Emotional detachment, so that kind of robotic, kind of compassion

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fatigue, feel not there for your colleagues and your patients.

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And then the third thing she said was a loss of joy in work.

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So that kind of where you don't feel those, that joy that brought us into

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medicine or these high stress professions, you don't feel those small wins anymore.

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And lots of people have those three symptoms and are

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still at work and manage it.

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And it's only, I think, much later in the burnout kind of well warm

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path that you get the drop in work performance, but because people stay

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off so long, you get a sudden drop, you get this kind of slow burnout and

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they're then a very quick burnout.

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And this is diagrams in your book that you've got this plateau, um, which

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is slowly going down, which is your performance, and then suddenly the

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burnout cliff suddenly drops down.

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But what really struck me about what you said, Richard, is that actually

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your performance isn't carrying on well.

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Your performance at work is so you protect your work.

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But if you look at your performance at home, so I've drawn another

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wiggly line underneath, and that is your relationships,

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that's your thriving in life.

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That's your family life.

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That's any friendships, your exercise, your wellbeing, all that, your

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performance in terms of thriving in life, well that is starting to go down

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and you'll, you'll drop all of those as long as you are protecting your work.

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Well, thinking, well, I can't be burnt out 'cause I'm still performing fine even

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though, like you said, joy has completely gone, you're this hollow, empty show with

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nothing in your life, but work because you've given up doing anything that brings

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you happiness, joy, or whatever, so that you can protect your performance at work.

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And then something happens, the straw that breaks the camel's back, be it a complaint

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or a tricky patient or a colleague going off sick or maybe something happening

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at home, and then suddenly boom, your performance everywhere plummets.

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Is that a good interpretation of, of, of what you've

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Yeah.

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I mean, it's, exactly right and that's what we see.

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We see people protecting work at far too heavy a cost to them

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personally, um, and, and to their families and, and ultimately to work.

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So you might see somebody, in fact, I'm, I'm thinking about somebody who,

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know, example of somebody who's just had a baby, but they've also just

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had a promotion, so that's great.

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These, these are great things, but massive increase in home and work stress.

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Because they've had a promotion, they've also changed line manager and their

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new line manager isn't very supportive, they're expecting them to get on with it.

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So there's been a decrease in support, but the, the way they

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manage that is focusing on work.

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So working really hard, focusing at home, but absolutely no

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time anymore for themselves.

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So they've stopped running.

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Uh, you know, they, they've stopped seeing their friends, um, they become

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more isolated, they don't come outta their office much, so they're not talking to

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their colleagues unless it's in a Teams meeting, and they're not doing anything

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fun at work or enjoyable or stimulating.

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And that's where it tips.

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So, so you get a change and then the way people manage that change gets

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things even more out of balance.

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That makes a lot of sense.

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And the problem is that just the time where you are being promoted, where

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you are taking on leadership experience often coincides with life stuff going

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on, babies, kids, teenagers, elderly parents, all that, all that sort of stuff.

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So you can see there's a lot of things that are gonna break

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the camels back, as it were.

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And you also talk about curve balls in the book.

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Are these things that will also like plummet you down that cliff quicker?

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Yeah, absolutely.

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And I, I talk about these cause a lot of people who come and see me in

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these conversations, the conversation initially is all about work.

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And work is really important.

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And they probably wouldn't be seeing me unless things were very demanding at work.

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But there's also often things at home and, and, and it's only at home, only

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comes in when I often ask about it.

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Well, you know, what's happening at home?

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And, and you, I talk about curve balls 'cause there's typically kind of four

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home curve balls that are important.

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also we can have strategies to, to manage.

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And, um, these curve balls come from interpersonal therapy, a type of therapy

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that I'm trained in, but, but the, the big curve balls to watch out for are

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change, so has something changed at home?

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So the example I gave there, new baby.

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Big change at home,

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moving house would be one.

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Even though it's a positive change, it is emotionally very draining,

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Yeah, absolutely.

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And yeah, so lots and lots of changes happen in people's lives.

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Um, caring responsibilities, as you've said.

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Um, the, the menopause is a massive, massive physical change.

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So the other thing that's going on is, is maybe disagreements at

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work, but disagreements at home.

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So, you know, if you're working very hard, very long hours, things can

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often be a bit difficult at home.

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How, how do you manage those disagreements at home with a partner

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or sometimes with parents or sometimes with children, they're very stressful.

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Yeah.

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Just say that I, I had some friends who there was a massive dispute going

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on with their neighbors and that, i, I just couldn't quite work out

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why it was affecting them so much.

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I mean, it's not very nice thing to happen, but it absolutely

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knocked them sideways.

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For six months they couldn't think or talk about anything else.

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So it's, it's a big thing, isn't it?

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Whether it's with parents, families, partners, or neighbors

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or, or anything else really.

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And absolutely.

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And you throw that in alongside a very busy job or a job where you're not

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particularly supportive from, that, that will be the thing that will tip it.

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So we've got change, disputes.

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The third one is bereavement.

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And natural process losing people, natural process grief, but do we ever

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allow any time for it in healthcare?

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Sometimes you might get five days off or something like that.

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And people are expected to work just the same alongside being bereaved.

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And that is a very big ask and often not very possible.

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And then the fourth, um, the fourth curve ball I put in is, is loneliness.

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And, and this is, this is something we don't talk about a great deal within

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high stress professions, but we, we do see people can become quite isolated,

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because 'cause of how many hours they're working and how intense they're working.

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But, uh, a, a group that I particularly think about here are

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international healthcare graduates who are coming over to the UK.

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it's a wonderful opportunity to come over here and develop, develop their

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career, but they're quite isolated and expecting to do really difficult

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work without the normal support.

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So isolation can be really important.

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We can really feel it when we've got a good friend we rely on,

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um, a good buddy moves away.

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You know, that can be the difference.

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Um, so, so isolation's a really important curve ball to think about as well.

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If you can tell someone's heading toward that, that burnout cliff, how

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do we get people to, to take action?

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Because I'm presuming most people leave it till it's too late

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They do, they do.

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Or leave it too late.

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Not till it's too late.

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Nothing's ever too

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No, nothing's no.

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And, and absolutely.

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And people, people come forward to services for support when they're

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very burnt out, they're an, you know, they're anxious, they're depressed,

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and they still do really well.

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You know, I mean, it's an important message here.

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But, yes, we can avoid an awful lot of distress of ourselves, our families,

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our colleagues, our organization, if we come forward earlier.

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The group that are really good at coming forward, forward earlier are

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the people who've burnt out previously.

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And I, um, I love seeing people have burnt out earlier in my, in my clinic

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because they, they say, they say, I'm coming forward because I'm starting to

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feel these symptoms of problem stress, they've been with me for a few weeks now.

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I'm, I'm a bit worried 'cause I'm not kind of caring quite as much for my PA

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patients, I used to feeling a bit robotic.

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I'm not going down the roof to burnout again.

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I'm coming forward for some support.

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And that's exactly the great thing to do.

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So what, what would be wonderful, and one of the motivations for writing

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the book was can people do that?

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Can people learn from all of the people who come forward

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later to come forward earlier?

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Because if you come forward earlier, it's much easier to get things back

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in balance, to balance out your radiators and drains, to, to make

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changes that protect you from burnout.

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it's much easier, it's much more effective.

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It's much quicker and it's much less disruptive to everyone.

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But it's something about self-monitoring.

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It's about, it's about recognizing those symptoms, but equally important, it's

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about taking those symptoms seriously.

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Don't just ignore them and keep, keep calm and carry on.

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Don't just keep swimming.

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Stop, reflect, but also act, do something about it.

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I think people put off coming A, because they're not recognizing it and

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because everyone is in the same boat as then everyone's working in burnout.

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B, they think they're only deserving of treatment when they are in full burnout.

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They actually, no one wants to see me now.

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And to be honest, there have been anecdotal reports from people that have

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written in, um, to the podcast saying, well, I was feeling really stressed and

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overwhelmed, I went to see occupational health, they said, the only thing we

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can do is sign you off, that was it.

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Or they see the GP, he goes.

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And to be honest, with most GPs, the only thing they can do is say, well, do you

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wanna take time off with, you know, they can point people towards, well there's

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Practitioner Health and there's some other services, but they, they themselves, that

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is the only, they don't have time in 10 minutes to go through, okay, let's look

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at your radiators and drains and coping mechanisms and all that sort of stuff.

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So people are very fearful that they're told, they're just gonna be told to

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take time off and then they'll be going about against medical advice.

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And I think it's a real conundrum because we've seen, if you look at

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the stress curve, I think if you are going to get some help when you are at

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stress and just before overwhelm and someone takes, tells you to take time

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off, then actually sometimes, sometimes it's absolutely what they need to do.

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But sometimes it's like the the last thing you want to do and it'll

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make things a lot worse for you.

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Yes, you need to rest and make some changes, but this prolonged time, time off

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that most people are just told to do as a sort of panacea for burnout management.

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That's just like, that's not gonna work for me right, right now, and

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so let's wait until I a hundred percent can't actually go into work

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just to be told to take time off.

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Now, I know I'm being a little bit harsh, but I think that's genuinely some

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of the experiences of our listeners.

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Yeah, and I, I, and I, I've heard people report that to me as well, and, um,

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who've gone to other services and, um, you know, and other services are limited.

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They haven't got the knowledge.

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I mean, you know, we we're still quite early with our

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understanding of burnout, I think.

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And it's not, you know, it's not, it's not greatly understood.

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It's, um, it's still not considered a medical condition.

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I don't really understand that, but, but it isn't, so I think you're right.

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But, what I would say is that, if you can come forward early.

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it is much easier.

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It's what you should be doing.

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To take, uh, examples of us as doctors, we don't really say to our patients,

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let's not sort this out early on before, while it's mild, let's just

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come back when it's really, really bad, and then, then we'll tackle it.

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'cause it's much easier to sort things out when they are mild.

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It's mu you know, and you'll need much less input and, you know, and

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there's a greater range of people who can help you when it's mild and

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it, you know, it, it may not be that you want to come through to service,

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you might want to do some, coaching.

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Or you may, you may have some peer support or things like that.

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The, there can be other things, so it is, you know, I, I would

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say it's really important people

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I mean, this is why we have our Shapes Toolkit system because we think there is

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nothing between stress and burnout for people often even to help themselves.

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Because with the best will in the world, getting an appointment to talk

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to people that might be a few, few days away or even a few weeks away.

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But there are things that we know help, like staying in your zone of control,

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you're of power working out what you control, of what you're not actually

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facing reality, having conversations, learning to put some boundaries around

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your time and, and workload, things like that, which are really, really helpful

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and can just pull you back up that curve and away from the burnout cliff.

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Yeah.

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And, and if you act early, I dunno whether this metaphor work, but sometimes I think

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of it a bit like driving a car, that if you steer a little bit and use your

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brake a little bit, that's how you drive.

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What you don't drive is wait until you hit the corner and then just go

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like that and slam your brake on.

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So, so so actually if, if you do, if you do take things seriously and you

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do monitor things and you do come forward and make the sort of changes

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that you're suggesting, they often don't need to be massive changes.

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What you want to be doing is self-correcting and making these small

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changes and learning these small, these ways of doing it, um, early on.

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So what do you wish your patients had done or been able to do or had

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support to do to self-correct early?

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Well, what I see, I, what I see people doing, uh, when they recover,

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I mean, it's, it's individual and it, but, but I think there's five,

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five key things that I see people do.

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The first one is that if their basic needs are out of whack,

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they do something to attend to it.

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So that is, if they are working massive hours, intense hours, they're

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not getting any time to talk to their colleagues, not taking their annual leave.

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Or if it's something at home that is out of whack, they try and address it.

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Because the danger is if you take time off and you come forward

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for help, you will get better.

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But if you go back to the same problems, it only lasts so long.

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And there's good research evidence that shows that too.

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So I, I think if it is about basic needs that are making you become

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unwell, then you need to address it.

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The second one is decompression activities.

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So this is the idea that stress builds up on us every day, so we need to do

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something regularly to manage that stress.

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And that could be something that's active, like running, joining a choir, or it

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could be something that's quieter, a restorative niche like, um, you know,

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might be reading, might be mindfulness.

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I've heard you speak to Paula Redmond, she talks about knitting.

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You know, these are all really important things and they're

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different for different people.

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So you know, Don't listen to somebody who says, oh, you should go running

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if that's not what you wanna do.

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My idea of

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yeah, but, but, but do do something that you like to do, that.

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Now, um, Matt Morgan is an ICU consultant, and I love the way

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Matt Morgan talks about this.

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So he talks about early on in his consultant career, he was sort of

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soaking up this stress and he, and he found himself perhaps drinking a little

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bit too much or more than he wanted to, and, uh, and also being a bit irritable.

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And, and he talks about the idea of what he discovered, which he, a

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kind of brainwave came to him when he had his, he was kind of, um,

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bathing his young children, uh, and he talked about squeezing the sponge.

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And he said the idea that came to him was that, um, at work he was

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like a sponge for stress and he was filling up and filling up with stress.

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And, and, and because he was over full.

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that he wasn't coping very well.

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He was, uh, you know, taking out on other people sometimes.

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But he said what, what he learned was that to be a consultant and sustain his career,

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he needed to regularly squeeze the sponge.

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He needed to do something to get the stress out of him.

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And, uh, and, you know, and need, he took, he talks about the various kind

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of activities that he made routine within his week, um, to manage his

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career, so that's a really good one.

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The other thing is, um, social support.

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So, um, having your support team, you know, knowing who's there for you at

Speaker:

work and home, and uh, and really, really reaching out for people.

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And it's not just about a shoulder to cry on.

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Just those normal kind of everyday social activities alongside people,

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those chats, you know, before and after meetings, those chats in the coffee room,

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or those, you know, just those chats down the pool, but in a coffee room are

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really, really important for our health.

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The fourth thing is a don't do, which is to evol to avoid false cures, to

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evolve, avoid, um, things that are unhelpful, like drinking too much.

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Um, and you know, I'm seeing a fair, some, some professionals are using

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gambling, and this is a way of kind of taking you outta things, but it

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doesn't solve the underlying problems.

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And beca can become in time a bigger problem than, than the underlying problem.

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And then the fifth thing is, what I see people do, and I've mentioned

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this already, is they keep calm, but they nip things in the bud.

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So people get really good at taking their, their wellbeing and their mental

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health seriously, and they look out for symptoms and signs in themselves of when

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things are getting out of balance, and they act quickly to do something about it.

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So they don't keep calm and carry on.

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They keep calm, nip it in the bud, do something about it, and,

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and that is a really rewarding change to see people make.

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I think we are quite bad at doing that.

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I'm thinking of people, friends that I've had in the past who,

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um, have been quite flaky.

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Like they haven't been doctors.

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Doctors always, you know, doctors turn up when they say We will, we'll go

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out when we do it, you know, but some non-doctor friends have been like, I

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can't come out this evening, i'm just feeling a bit tired and I'm like,

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gosh, I would never cancel anything.

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Just I'm feeling tired, you know, because like we've been programmed that like tide

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is just normal so you wouldn't, you know.

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But actually looking back, they were nipping it in the bud.

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They're like, actually.

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I can't do that tonight, 'cause I know I don't have the emotional capacity for it.

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I've just canceled that.

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I'm not gonna do that.

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And yeah, they, they recognize it and they do it.

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But I think in medicine we're like, oh, well that I, I can keep going

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'cause I, I always had, and when I was younger I did 120 hours a week.

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Therefore I can manage that now.

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And yet this weird mindset we have, isn't it?

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it's inter it's interesting, isn't it?

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Because the other thing that we are quite good at, at medics,

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especially if our patients is taking control and advocating and, and, and

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acting, but when it comes to our own wellbeing, we are not very good at it.

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Um, but, but we have got those medical skills to, you know, we are not,

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we're not normally afraid of acting.

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We, we, we make difficult decisions, but we need to start doing that for ourselves.

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So I think a lot of high, professionals in high profile jobs have got these skills.

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They just haven't yet harbored them for their own wellbeing.

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The other thing, it's just come to me, it's a bit of a play on the word acting.

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Um, we like to get into action.

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We're very good at getting into actions and solving problems,

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but actually sometimes the action that we need is to subtract.

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So I'm just thinking, you know, it's actually very hard for me to

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go, I actually need to sit in my hanging pod in the garden for an

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hour and read and read a magazine.

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That's what I need.

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I'd be much more, but I need to do this, this, and the other.

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So if we can change resting and subtraction into an action that

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we know is good for us, maybe we'd be more keen to do that.

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I mean, it's interesting, you, you've talked about those five things and

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actually nowhere there have, you talked about therapy and counseling

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and psychotherapy and stuff.

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So where, where does that all come in, in, in any of this?

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Yeah, no, it's a, it is a really good point.

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So, so PE-people who are coming through are making these changes.

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Um, and I don't think you have to be in therapy or in a therapeutic

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relationship to make these changes, but pe-people are, are doing that

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within a therapeutic relationship.

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And I think there is, there is something about coming through to a support service

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or a wellbeing service that allows you to stop and reflect and think,

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actually things are outta balance.

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What do I need to do to kind of correct this?

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So that sort of therapeutic support can be really helpful in helping

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people reflect, take things seriously, but start to make a plan and making

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those, those steps and goals and focus.

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And I don't think that, you know, if you're coming through

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early enough or with burnout, it doesn't have to be a long time.

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You know, you can, you can do that within, you know, a relatively

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brief therapy, six to 12 sessions, you know, maybe even less actually.

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So that's important.

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Where therapy does come in, I think is your burnout's gone on for a long time.

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So if so, some people will be on the plateau, will be prioritizing their work,

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be become really quite severely burnt out.

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And if you're still at work and you're still under a lot of stress,

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it's reasonably easy for that burnout to turn into a medical

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condition like anxiety or depression.

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So it's, um, I'd see it as rather a continuum of kind of problem stress

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to different levels of burnout.

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And then if it's still not managed, you run a quite a high risk of developing

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anxiety or depression or physical health complications like high blood pressure.

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And I think if you are moving into that anxiety depression area, then

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that's where therapy comes in and an evidence-based therapy comes in.

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It may also be, and professionals tend to be a bit resistant to

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this, it may also be a conversation about, actually I've got anxiety and

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depression, do I need to consider, um, some medication here to treat this?

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But most anxiety and depression, the first step would be therapy and it

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would be an evidence-based therapy like, um, CBT or IPT would be the top, the

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top ones in the evidence base to do.

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most of us sort of know what CBT is.

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What, what?

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Can you just explain what IPT

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is?

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Yeah.

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So IIPT is, um.

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type of therapy, um, developed for depression.

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It is available in the uk.

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It's available in, um, pri in most primary care, uh, services

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for anxiety and depression.

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Um, it's also developed in some secondary care.

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Um, we have got, uh, an IPT specialist within NHS Practitioner health, and, and

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within the service I work in regionally,

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it's an interesting, um, therapy because it was developed by somebody,

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um, asking therapists, if you're treating somebody for depression, what

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do we need to have in this therapy?

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What's it need to look like?

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And they, they offer a big list, and the therapy of IPT was designed upon that.

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And, um, CBT tends to be about Modifying your thoughts, distorted

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thoughts, um, and then that leading to a change in your feelings and behavior.

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IPT is, um, much more about looking at your social support and your

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relationships and who's there for you.

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And also, um, we talk about, um, in IPT, the idea of antidepressant activities.

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So often when people become depressed, they stop doing the

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things that are good for them.

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So they become very tired.

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They think they're no good, they're not good company anymore so they stop seeing

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friends, they stop doing those nice things because they're too exhausted to do it.

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So we focus on people getting those things back into their life as well.

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Okay.

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That makes, that makes a lot of sense.

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And can I quickly ask you about the relationship between

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anxiety, depression, and burnout?

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Do you think that all burnout, if it gets severe enough, turns

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into an anxiety and depression?

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No, I don't, I don't think all burnout does.

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Um, I think all problem stressed us.

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So if, if we start off with problem stress, if we're in problem stress

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for too long, we'll become burnt out.

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And then if we stay in burnout too long, we'll become increasingly burnt out.

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Burnout.

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Burnout is a spectrum.

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But some people will then, if they're, if they're severely burnt out,

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will have a high risk of developing anxiety and depression, but not

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everyone will but quite a lot will.

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And the longer you are burnt out, the higher your risk of developing

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anxiety and depression is.

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And is the other way round true that if you suffer with anxiety

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and depression anyway, are you at high risk of burning out?

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I wouldn't say necessarily.

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So, because, what determines whether you're at risk of burnout

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is what's going on around you.

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So, so we burn out because of those balances between our radiators and drains.

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Um, you know, when the drains are high and the support is low, and

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that is the same for ev everyone.

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So we, you know, whether you've got a history of anxiety or depression or

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whether you haven't, whether you're gonna become burnt out or not is

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because of what's going on around you.

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And what for you would be the red flags that someone in burnout is tipping

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also over into anxiety and depression?

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So it's the diagnostic factors for, um, anxiety and depression.

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So, for, for anxiety it would be, you know, feeling worry and anxiety over

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most days for, for several weeks.

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You know, probably over, uh, you know, to a couple of months really.

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That's kind of, there often goes alongside, um, physical symptoms

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such as heart racings, sweaty palms, those kind of things.

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Um, so the, that kind of feeling, that protracted, constant feeling.

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And along alongside those physical feelings as well.

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Depression is a feeling of being low or a feeling of not really being able to enjoy

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things most days for at least two weeks.

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Um, and often depression also affects both the way that we see the world.

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So we tend to see the world through the opposite of rose tinted glasses.

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So we tend to see the world as viewing us as worthless, we might feel guilty,

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uh, we might lose our optimism.

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Uh, we might feel hopeless, you know, um, thoughts that, um, actually I

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might better, the world might be better off if I wasn't here, or I

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might be better if I wasn't here, quite common within depression.

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Um, so they're the feelings.

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But the other, the other kind of hard signs, uh, to look

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out for are physical signs.

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So people's sleep goes off.

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There's a change in their appetite either reducing or increasing.

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People often feel worse in the mornings.

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Um, there's a lack, lack of energy.

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So there's the, the, those are kind of key, key signs to look for for depression.

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As I say, you only really need those signs for most days, for a few weeks and at

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that stage, I, I would start to wonder if I'm depressed and, um, and I might seek

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further advice and treatment for that.

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It doesn't help to ignore those for too long.

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And, and if talking therapy was the first step.

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There are some screening tools available free on the, um, on the web.

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Um, and I link to them in the book as well, but anyone can find them.

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The PHQ9, for depression, really good screening tool, very simple to use.

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And the GAD7 is for anxiety.

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So if you are thinking, oh, am I tipping into anxiety or depression,

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just do one of those and you'll get a score and that score will give you,

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um, some advice about what to do next.

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That's really, really helpful.

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We also provide a free toolkit called, Am I Stressed, Overwhelmed or Burnt Out?

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And it contains all the burnout, uh, free inventories as well.

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But what I might do is add into that the GAD7 and the PHQ9 that people can

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access just to make sure, and obviously getting your book would be really good.

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As you said that I'm thinking, well, gosh, it's actually very difficult

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to tell because you get fatigue and burnout, you get fatigue and depression.

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You get this sort of cynicism, don't you, an emotional detachment in burnout,

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and then you get this hopelessness in depression, which is probably why

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it's so important to actually seek professional help because they'll be

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able to sort of tease it out and, and work out what's really going on for you.

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Yes, and it is important, it's teased out because, burnout is different from,

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um, from anxiety and depression, and, and we'd use a different approach.

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So I, you know, for example, I wouldn't consider antidepressants in burnout.

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But if, uh, a talking therapy hasn't resolved a depression or anxiety, or it's

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very severe, then it's worth considering.

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I think if you're getting, if you're wondering if you're depressed and you're

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getting those physical symptoms, so your sleep's going off, your appetite's going

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off, you might be losing weight, you are got a, an awful lot of kind of fatigue,

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especially in the mornings, it might push you a little bit more to, to, to

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thinking I'm, this might have tipped into depression, but once again, depression,

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anxiety, really easily treated, so don't worry, you know, just come fu for help.

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And a lot of the treatments are very similar to the treatments

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of burnout, aren't they?

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Which is which, which is good news, which is really good news, which

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shows why it's so important, go.

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This might be again, talking about some of these talking therapies, but

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there's a chapter in your book all about what we bring to the table,

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which I, I found fascinating because we know that not all burnout is the same.

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Um, as Paula Redmond said that there's different causes.

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It might be due to moral injury or it might be due to just pure

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work overload, or it might be due to sort of under confidence in

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ourselves and things like that.

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So what other things are these sort of, could be some of the underlying causes?

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I know you mentioned attachment theory and then there's moral

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injury and, and things like that.

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But what do you typically see in your, some of your patients?

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so I'm, I'm gonna start this with a kind of warning, which is I firmly

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believe when I'm meeting people in my clinic that they've burnt out

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because of some change in the system.

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So, you know, whatever their personalities or coping systems are, they've often

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been doing perfectly fine for many years, and then something's changed.

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So it's not the cause of burnout.

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Um, so I want to be that, but we do see some, some things.

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So Herbert Freudenberger, who I mentioned, who was the, the,

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the wonderful psychoanalyst who first coined the term burnout.

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One of the first terms he toyed with around burnout was super achiever

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syndrome, and, and the reason he did that is because he said there are some

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people who are really dedicated, work really hard, really want to make a

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difference, and for them they will, they will work very hard, they'll try and do

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a lot at home, they won't necessarily reach out for support, and that is a

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group that are vulnerable for burnout.

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And the group that are vulnerable for burnout in the NHSI think because

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I think our organizations take advantage of those super achievers.

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So I'm utterly amazed when I meet healthcare professionals who are

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allowed to work ridiculous hours, allowed to wear too many hats.

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These are super achievers and, and they've been allowed by

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their organization to burn out.

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And I kind of think, you know, how did the organization

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think this was gonna turn out?

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What did they think was gonna happen here?

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Um, but, but that happened.

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So, so there is this idea.

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The other thing I think is really interesting, and then I'll move on to

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attachment is there's a double edged sword in, um, high performing professionals.

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So, high performing professionals tend to be conscientious, they

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tend to be determined, and they tend to be quite outgoing.

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Not always, but they tend to be.

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Now that's good, you know, that, that they're the sort of

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people you wanna accrue often.

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But under pressure, those same characteristics can become

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a kind of achilles heel.

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So your conscientiousness can become perfectionism.

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Your determination can become obsessionality and your, um,

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outgoingness can become kind of a little bit of narcissism, so you stop

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listening to people stop taking advice.

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So, so it, it's interesting that the things that make us really good at our

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job under stress can also get in the way of us doing our job really well.

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And, and then the final thing I'll talk about is attachment theory,

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um, which is, um, something I'm interested in for various reasons.

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But, uh, one things that I tend to see in doctors particularly, but other, uh, you

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know, other high level professions, uh, you know, I've seen lawyers like this is

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a couple of typical attachment patterns.

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One is a dismissive attachment pattern where we play down our

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emotions and our relationships.

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So this is the, the doctor who just kind of, keeps a, stiff upper

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lip and just gets on with it, just kind of, um, uh, manages things.

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Often very effective, but the problem is with this, is this doctor isn't

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necessarily processing their emotions.

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So there's an emotional impact of work, but they're just getting on

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with it, going from one thing to another, dismissing their emotions, and

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eventually that can catch up with you.

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The other attachment style I tend to see in medics, but less common than dismissive

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one, but it's there, it's a preoccupied attachment style, which are these medics

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who are the opposite of dismissive, they really, really prioritize emotions

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and they prioritize relationships.

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So, uh, a typical warning sign for a medic that I meet with this is they

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tell me they've never had a complaint.

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So these are the, these are these wonderful medics who keep everyone happy.

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And that is, that is great, that's great, but it takes a big emotional toll

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doing that and keeping everyone happy.

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And what these medics can do is they tend to neglect their own needs in

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the ear by prioritizing the other.

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So attachment's very interesting.

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Um.

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Um, I also think it's interesting because, um, if we recognize we're one

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of those attachment styles, it might inform what sort of therapy we want.

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So if we're dismissive, um, don't really do emotions, we might be attracted to

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CBT, let's, let's get our thinking right.

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But what we might more benefit from is a relational type therapy

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where we can actually look at our relationships and things like

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that and how we process emotions.

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And similarly, um, people who are preoccupied really in touch with

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emotions often think, well, I want a relationship therapy, I want to do

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something where I can think about my emotions, whereas actually, they might

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be, might be more beneficial from CBT because what they might benefit is

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a more structured approach that that helps them kind of prioritize their

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self-care and helps them kind of order their thinking and their relationships.

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So i, I think it's really interesting.

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That is really interesting.

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I, I re remember reading about that in your book actually, and thinking,

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gosh, I'm the sort of person, I'm an Enneagram seven, so I'm like, I like,

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don't like to feel difficult, but just like to move on and have fun.

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And actually, what I've been thinking for a while, actually, some therapy where

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you, I'm really looking, you can inter, you know, emotions, feelings, somatic,

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you know, where, where am I feeling that would be, would be really helpful rather

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than, yeah, just staying in your head and thinking it through, thinking it through.

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Just really quickly what, cause, what would have been the underlying

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cause of those two attachment styles?

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Yeah, well, a attachment tends to be, um, they, they, they tend to be styles that

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will develop from, um, that will, will start to develop from, from childhood.

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So most of us are securely attached.

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So, and, and most, most of most of the people I meet in my

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clinic are securely attached.

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But you might become dismissive of, uh, emotions and relationships if you are

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the sort of, uh, if from a young age you're kind of expected just to get on

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with it, perhaps not talk about emotions, and perhaps look after someone else.

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There's quite a lot of medics who've kind of been in a care

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role from quite a young age.

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And, and so they might need to, to have put their needs to one

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side, uh, and just get on, get on with it and, and manage things.

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And, and that could lead to a dismissive attachment style.

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We also train people, you talked about, you know, what we're doing in A levels

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and, uh, and, and med school and things.

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Unfortunately, we can sometimes train people to be dismissive.

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So we can train them just to get on with the next thing, you know,

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don't think about how you are feeling, just do the next exam or

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the next case, and things like that.

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So we, we can encourage that, unfortunately.

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Um, preoccupied people tend to be the children who, um, perhaps have been

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very sensitive, very caring for others.

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They, they again might have been in a caring role, but in a different way,

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they might need it to be particularly attuned to someone in their family

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and look after them in that way, so that, that might, might create,

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um, a preoccupied attachment style.

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But it's complicated, and some people might have features of both.

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So it's, uh, it, it's not, it's not always a straightforward thing.

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And that's probably where a skilled therapist would be really, really

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helpful to help you identify those underlying things, then

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what you can do about it, right?

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What was your top three tips be for someone who can recognize themselves

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on that plateau and thinks, oh, crumbs, okay, maybe I, I wanna do something right

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now before I get to that burnout cliff.

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Just the three, well, let's say rather than three top tips.

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'cause all your top tips are in the book, your three next actions.

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First thing is fantastic.

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They are thinking about what's going on.

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You know, have I got problem stress?

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Have I got burnout?

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So they've stopped fantastic and they've reflected.

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The next thing they should do is reach out for help, nip it in the bud.

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that could be to a support organization, you know, like NHS Practitioner Health,

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if you are a healthcare professional.

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Or it could be to a coach, or it could be just to friends and family.

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Let people know how you're feeling.

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You know, people often carry this alone and in silence, you know, don't do that.

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So stop and reflect, reach out for help.

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And the next thing is be hopeful and positive.

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Because actually, by reaching out for help, you will do incredibly well.

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People do incredibly well, they make amazing recoveries.

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And in fact, some people, quite a lot of people, if they have time to

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stop and reflect and recover, say, actually, I've developed through this.

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I feel different.

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I've made important changes and decisions, and my life feels more aligned now.

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So, be really hopeful.

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Coming through to help is a positive thing.

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Yeah.

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And that was another great chapter.

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Your book on sort of post burnout growth, posttraumatic growth.

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So actually often, yeah, the good news is that after a burnout, people

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can actually be a lot better, um, or feel a lot better than before.

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But you don't actually have to go through the whole massive

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burnout thing to get there.

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You can actually nip it in the bud and then be better, right?

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So let's avoid that massive dip, shall we?

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Yeah.

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that's right.

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Thank you so much, Rich.

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We'll have to get you back 'cause No doubt.

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We'll, we'll have lots more to talk about and if anyone's listening to

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this, you've Got questions for Richard, please just, just uh, email them in.

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And Richard, if we get some questions when you come back to answer them?

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Oh, I'd love to.

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That would be wonderful.

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And yeah, we would love to have you back and to talk about this more, 'cause it

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is, is such a big, big thing for doctors.

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Well, 50% of doctors working in burnout.

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So whether you're a doctor, dentist, nurse, other healthcare professional,

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we have accountants, lawyers and teachers as well, and I would think

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that their levels are pretty similar.

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But for me, the big revelation has been you might be in burnout but your

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performance is still okay at work, 'cause you're protected that, but the

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performance everywhere else is down and then suddenly you're gonna crash.

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So thank you so much for being here.

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If people want to get a hold of you, or find out more about the book, about

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you, about your work, where can they go?

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So yeah, well I haven't got a webpage, but I'm on LinkedIn.

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Always really happy to hear from people.

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So Richard Duggins and if people wanna know about the book or the

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audio book, all good bookshops.

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It's on Amazon too,

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And of course, if you are working in the NHS and you are eligible for Practitioner

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Health, it's a fantastic organization.

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Rich, can you just remind us who, who it serves?

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So it serves any healthcare professional who finds it, is finding it difficult

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to get confidential local support.

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So that's every doctor and every dentist in the NHS, can come through or it's

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any health professional who's who hasn't got local confidential support.

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So do get in touch with Practitioner Health and if you, you're not in the

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UK or you can't access that, there will be other ways for you to get h help.

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It might just take five minutes of digging around and, and Googling.

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So employee assistance program, your own GP, your family practitioner.

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Please, please don't struggle on alone, even if it's just

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telling a colleague about it.

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So, thank you Richard.

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Um, and hopefully speak again soon.

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Great.

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Thanks so much, Rachel.

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Thanks for listening.

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Don't forget, you can get extra bonus episodes and audio courses along with

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unlimited access to our library of videos and CPD workbooks by joining

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FrogXtra and FrogXtra Gold, our memberships to help busy professionals

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like you beat burnout and work happier.

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Find out more at youarenotafrog.com/members.

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