How to know when you’re reaching your limit, and what to do to prevent you taking it out on someone else.

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I've said it before, but nobody goes to work to be a jerk.

Usually I say that slightly differently, but I really can't swear

in the first minute of an episode.

But what happens when you are the one behaving badly?

When you are having a bad day, you're being pushed to the limit

and you end up snapping at somebody.

You really don't want a reputation as a difficult colleague, but you also know

you have to maintain your own boundaries.

So what do you do?

This week i'm delighted to bring Dr. Chris Turner back onto the podcast.

Now, Chris is the co-founder of the Civility Saves Lives Movement and an ED

consultant, and last time we had him on the podcast to talk about how to challenge

difficult behavior in a colleague.

But this time we wanted to turn the tables and ask, well, what do you

do when you are the one behaving in a way that you wouldn't want

one of your colleagues to behave?

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

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

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

My name's Chris Turner.

I'm a consultant at emergency medicine at university also Coventry and Warwickshire.

And it must be eight or nine years ago now, um, I

co-founded Civility Saves Lives.

Civility Saves Lives as a grassroots organization dedicated

to raising awareness of the impact of behavior, individual

team, and organizational levels.

And people around the world have picked it up, use it, speak under the banner,

and the reason for that is because it resonates with people as a message.

And I never thought this would be where I'm, but it's been the

privilege of the second half of my pro professional career to be able to chat

with people like yourself about it.

Now, one of the reasons why I just love what you do and we keep asking you back

to do stuff is because obviously I help doctors beat stress and burnouts, and one

of the main causes of stress and burnout for doctors is this absolute fear of

conflict and this avoidance of conflict.

Because a lot of us working really toxic cultures, so actually.

Conflict needs to be avoided at all costs because it's actually

very, very dangerous to us.

But the, the requests we get so often is, yes, I'm, I'm feeling stressed.

I've gotta have this conversation, or I've gotta manage this team and

there's these two people falling out, or this and that, and the other.

And so we realize that you can't help people beat burnout unless you help them.

Get more comfortable with conflict.

And one of the reasons I think doctors make their overwhelm worse is because

they are avoiding the difficult conversations that they know they

need to have, which just comes back to bite them down the line that things

escalate, they get much, much worse.

So that's my personal opinion.

Would you agree with that or do you have slightly different take on

Uh, oh mean, I'm always gonna have a slightly different take.

That's why we love

what you did there was you gave me permission to have a different take or do

you have a, you said, do you agree or do you have a slightly different take in it?

And it is, it's actually a really skilled thing to do.

You invited my disagreement.

And we know that inviting a different perspective makes it much easier to hear

the perspective and it makes it much more likely you're going to get one.

And the reason for that is pretty simple.

We work in an incredibly messy environment.

Everybody's looking at it from a different perspective, with a different background.

Sometimes with slightly different values.

Sometimes they're trying to get something different outta the situation.

And what that means is if we're all looking at something from a a different

perspective, and I'm talking here about a clinical situation, sometimes I'm talking

about strategic situation, everyone's gonna see it wee bit differently.

And what we know is that the best decisions in those circumstances,

and it does not matter if we are talking about global multinational

board level here, or if we are talking about in a resuscitation.

It applies to both of these situations.

The best decisions are made when we have the best information.

Information is king.

A problem for a lot of us is that we've been brought up in an environment

where we have been led to believe we have to have the answer to everything.

It's a personal responsibility.

In fact, our exam system feeds this.

Pretty much every exam I've ever done has been about me proving how

smart I am, me knowing the answer.

I don't remember many exams, and there's a little bit of it, but I don't

remember many exams where I'm asked to take on board new information, i'm

asked to pivot in my decision making, and I'm asked to allow my thoughts

to evolve as more things happen.

So pretty much my entire educational life was about proving I was

right, which is grand if I'm just dealing with something alone.

But as soon as I'm dealing with something where other people have

a perspective, and it could be patients, but it's often, often other

healthcare professionals, they're gonna have a different perspective.

Once they start talking.

We are going to disagree if we're honest.

If we have a psychologically safe environment, we are going to disagree.

And the crucial question for me at that point becomes how do you deal with

the discomfort of that disagreement?

And we've all got a kinda default mode, and we've probably got a default mode

in our professional settings, and we've probably got a stress mode as well.

So we're, so we're dealing with it differently at different times.

Recognizing how we are dealing with the discomfort, disagreement,

can be incredibly powerful.

Certainly has been for me.

So there's basically, there's lots of ways of, of splitting this, but from the

reading I've done and the, the number of times I've been through different tests,

like the Thomas Kilmann conflict inventory really boils down to three things.

When faced with the discomfort of disagreement, the first mode that

people go into and lots of people go into this, is we fight to win.

So Rachel Morris, you disagree with me, bring it on, let's

see what you've got, because.

We love winning.

Winning's.

Brilliant.

Winning.

Winning gives me a big surge of dopamine, I feel like the big, I am a wee bit

more than my five foot, seven and a half, and I feel all right when I win.

And that's great.

And I've had an education system that tells me I have to win.

I have to be right.

Trouble is we conflate winning with doing the right thing, and they

are not necessarily the same thing.

And the reason for that is that winning isn't about doing the right thing per se.

Winning is about dominance.

And we can dominate each other through intellect.

We can dominate each other through hierarchy.

We can dominate each other through explicit threat.

We can dominate each other through implicit threat.

We can dominate each other lots of different ways.

So we can win.

But have we done the right thing?

So that's one mode that people go into, and that's the thing I see regularly at

work and something that I have done many, many times, I've gone into it to work.

Um, these are high friction individuals.

There are some people whose default is to be like that, but you just, you

know, you can be discussing anything and you know you're gonna have a fight.

They, they will find a fight in a conversation about

the most odine nonsense.

So that's one group of people.

Then the second group of people are a group of people that I really

like, and they're the group that you alluded to at the beginning,

and they're probably the majority.

And that is people who are accommodating or avoiding, they're

people who don't like a fight.

And when I did the Thomas Kilmann conflict inventory, I was sitting there and I was

sitting next to somebody that I really like, but we clashed a lot at work.

And I got my Thomas Kilmann conflict inventory back and I,

Rachel, um, accommodating avoidant.

It is the sappies of combinations that exists.

I have no idea.

Initially I thought, I have no idea why, why I do emergency medicine.

It seems like completely the wrong specialty for me.

But the truth is I look around.

I think it's really common.

And I like these guys.

I, I like people who are bringing a fight to every bloody conversation.

You know what?

So can we just agree to disagree with some stuff and just muddle along?

I'm cool with that.

The thing about this group of people is that I like them.

I think they're rather lovely, but they are not contributing information

to our complex problem, so they're not helping us get to a better decision.

So the first group of people are destructive and they're fighting.

It's all about dominance.

So they don't really bring information.

What they bring is dominance.

Now, you, you fighty folk, you might like it, you might think this is

how people should be interacting.

Us, the lovers, not the fighters, we, we struggle with that.

So they've got this fighty guys, right?

And that's the way that they've learned that.

And I think perhaps education, and exams reinforce that, that need to be right.

And when they get into conflict, it's a destructive process.

It, it is, or at least it feels destructive to a lot of people.

Now, that's one group.

Second group of people when they're in the discomfort of disagreement,

they don't like fighting.

They, they don't like where it leaves them.

They don't like what it does to them.

So what they have a tendency to do is to be avoidant or accommodating,

because they kind of just like life a bit more like that.

And I mean, and not everybody's, everything all the time,

uh, is always one way, okay?

So we, we flip.

And it, I'm accommodating avoidant, right?

And for people who fall into that category, they will flip into having

a fight with somebody eventually.

But a lot of the time they'll, what they'll do is they'll be.

Kinda smooth within the, within People disagreeing with each other.

They're not looking to win things.

Uh, for whatever reason.

It doesn't really matter what the reason is.

But the consequence is always the same.

Those guys nice to be around, but they're not contributing to

the overall sum of information.

They don't tell us what they know because they don't want what's coming afterwards.

And I, I really do like people who are accommodating.

I, I've got just a ton of time for them.

But the truth is they're not helping us and these complex decisions when

we're dependent upon having information.

So we've got those first two types.

We've got people who fight to win, then got people who are accommodating

avoidant, and then we have a third group.

And the third group do something completely different.

What they do is when they hear somebody presenting a perspective that they

don't share, they listen to understand.

They don't listen to fight.

They're listening to get where the other person is coming from.

And it's a fascinating space because there's evidence on this from the world

of politics that a lot of people will take a position on something, but they

won't actually have thought it through.

They think they have, they take an emotional position, they get a feeling

for something, and then you go, oh, I don't, I don't like X and I don't like Y.

And if you then give them time and space to talk it through, some of

those guys just change their mind.

It's a bit less than 10%, but that's an incredible return on

investment if you want people to change a position on something.

So giving people the chance to talk about where they're coming from does two things.

The first one is that sometimes they change their own mind in the

process of talking it through.

But the second one is if I'm trying to understand some messy situation, it

could be clinical nonclinical, it could be work or not at work, if I'm trying

to understand some messy situation and I seek to understand where somebody

else is coming from, then actually what I end up with is more tooled

up to understand and respond or not, depending on where I'm coming from.

So the only people that consistently get into a position for making

better choices are the people who listen to understand, because what's

happening is that they get the benefit of other people's perspectives.

And this works all the way down to if you're thinking about a resuscitation,

in some levels it's easier to think about in a resuscitation because if

you're standing at the head end of the, the patient and I'm standing

at the feet end of the patient, you actually get a different view.

You can see things that I can't see.

You might actually see the knife sticking out somebody's flank that I can't see.

And if you don't tell me, I, I'm not going to respond to that.

And it's the same for just about everything that people

have different perspectives on.

And it's seeking the space where we get into dialogue rather than the

space where we're getting into a fight or we're just running scared

of people disagreeing with us.

And it's been a really hard lesson for me because my natural space is to not

fight with people, but I have, I have denied people my perspective on something.

And sometimes my perspective's a different one to theirs and something, sometimes

it could be contributing to a better answer, but I've chosen to deny it to

people 'cause I just didn't wanna fight.

That makes a lot of sense.

I feel the need here to argue with you.

You

Well, I'm just listening to, I'm just listening to understand

Rachel, so you argue all you like

because I think these, the fighty people are a little bit misunderstood

because It, it's seen as they're so competitive, they just wanna fight to win.

Um, and I'm, I'm sure that in certain circumstances, I, I can be seen like that.

But it never feels to me like I'm fighting to win.

It feels like my nervous systems have been triggered probably because,

well, for all sorts of reasons.

Like, 'cause we know that behavior makes sense, entire sense to the

person who's behaving like that because of what they assume.

You know, If you are assuming that the building's on fire, when you

hear the fire alarm, you're gonna start shouting people to get out.

If you're assuming that it's not, that it's not burning at all, you're just gonna

sit there and carry on what you're doing.

So every behavior makes sense to the person at the time.

Um, I come from a family where there was quite a lot of disagreement.

We just all yelled at each other.

My other half comes from family where they never said anything and they

just, you know, they'd sulk with each other and, but no one would

ever raise their voice be like that.

And I found that incredibly difficult because I'm like, well,

just tell me if there's a problem.

But they found it equally difficult when I, I lost the plot.

I've come to believe that actually the losing the plot bit is more

destructive than the, than the soy thing, because you do say things in

anger that you don't mean, and it, and it hurts people's feelings and stuff.

So, so it's not good.

But I think that.

People who are avoiding or, or seeking to understand sometimes don't realize

that the, the way, the way people are coming out as fighty is because they're

scared and it's the way that their nervous system has been, um, just taught, taught

to respond as as they've been going on.

In fact, they're just as scared as a person that's avoiding,

but they'll, they'll actually, they'll actually voice it.

So I think the fighty people get a bit misunderstood and they're

their own worst enemies, right?

'cause they're making enemies by being that.

Does that make sense?

I, I would say that the people who are, the people who are fighting, that's just,

that's just the way they've grown up.

You know, you, you learn what you live.

And if you come from a, uh, one of those more demonstrative families,

you're gonna learn to fight like that.

But you'll also learn some ways of winning.

And there are ways of winning that are in no way constructive.

And you touched on one of them there, the ad hominin.

The ad hominin, when you attack somebody else in the process of the

fight and you see something that you maybe don't even mean, but you, the

reason you're saying it is 'cause you're angry and you want to win.

You're not saying it because you want to get the best decision.

You're saying it 'cause you want to dominate.

And that's 'cause winning is that important.

Now, I don't in any way think that because somebody's been, somebody responds like

that, that it makes them a bad person.

I, please don't misunderstand it.

Just, it's just a person.

It's a person.

It's people and how they're, how they're responding to a situation.

What's really difficult to do is to be evolved enough to be able to

respond to that in a constructive way if you really hate it.

So for me, there is, I mean, I wanna shout, I wanna shout and,

and you know what, sometimes I do and sometimes I am a tool, okay?

And, uh, Wednesday this week was new doctors, and the place was crazy.

We had 90 patients in Majors, Rob, that I was on with.

Went to recess, didn't come back for four hours.

When he came back, the man was a shell of himself, but I'd been standing in the

middle of the department and I'd discussed more than 70 patients, and we had a

brief break, and then we're back at it.

It's now three o'clock in the afternoon.

I am knackered.

We have 12 new doctors who don't know the systems, and I've been talking to

them and I really want them to feel valued and welcomed and into the team.

And then the psychiatric team come in with the, with an interpreter device that's

a sort of an interpreter on a stick.

Um, and they turn it on and it's crazy loud.

It is so loud, they're five or six meters away.

I can't hear the person next to me.

I wait 20 seconds, or at least I think I waited 20 seconds.

I probably didn't, it was probably less than that.

And then I just shout, can you please turn that down?

I, in no way helped the situation there because what happened was

that they were offended that I had shouted across the department at them.

I was knackered.

I was knackered, and my brain was gone to mush.

And I, and one of the guys came and he was quite hostile to me afterwards,

and I kind of don't blame him.

It's taken me two days to get his name, so I'll have to write to him

this afternoon, say, send him that.

I'm sorry I was a dick, um, email, which is what I will do.

And The thing is that when we do that, we're, we're not, we're not exploding

'cause we want to make things worse.

We're exploding 'cause we've kind of reached the end of our tether and then we.

And I think recognizing that that has a, a very significant impact on other people's

ability to perform is one of these bits that falls into leadership for me.

Now, it is, it is true for everybody.

But if I am the boss and I display these behaviors, I normalize

those 'cause nobody stopped me.

Nobody came and said Chris, you're being a dick.

They probably all recognize I was knackered.

They're nice, they like me.

I've worked there a long time.

Thing is there's people there who don't know me, you might think that's my mo.

That's how it works for me.

And I probably destroyed the ability of a bunch of people to

perform well at that moment in time.

The point of, kind of, one of the points of me telling that is that

there can't be many people who don't think about this more than I do.

And fighting is not my natural place, or, or being offensive

is not my natural place, and yet there I am, there I am screwing up.

Um, and that's because the job sometimes pushes us into a place

where we just end up promoting.

So I, I think the recognition has to be that we learn ways of interacting with

other people, but sometimes there are other ways that we can learn to interact

with people that result in better outcomes, and that one of the crucial

abilities that we all need to have is adaptability to situations and to changing

who we are at a given moment, and that the system will, when we're senior, the

system will let us, it will let us make.

A bit of an idiot of ourselves

. I was just thinking, Chris, in that moment when you just, after you

yelled, can you turn that thing down?

If they'd have come back at you and said, stop being so rude or whatever,

how would you have reacted and or felt?

So that is kind of what happened.

So I, what I actually said was, I shouted, please, can you turn that deck?

I'm well aware that my accent sounds hostile to a lot of people, and I

wasn't feeling hostile, but I I was absolutely, there was so much noise,

I was completely overwhelmed by it.

And I was knackered, and I was thirsty, and I was meant to be getting away

sharp from my shift because I needed to collect Tamarah to take her to something

and I wasn't gonna make her, and it was hot, and it was all the bad stuff.

And the guy came over to me, and this is the guy I'm gonna write to today.

He came over to me and basically said, you were really rude to me there.

And I thought, you know what?

You're, you're right.

I was, I didn't say that out loud.

What I said to him was, I'm sorry it wasn't about you.

It was about the noise.

The noise was so loud.

And sometimes being clear that this is not an attack on a person,

this is an attack on a thing that's happening, can be helpful.

Uh, not sure if it was or wasn't in that setting, but it was the best I could do

in the circumstances and I can do better now that I've had a night and a half sleep

and something to drink and you know, just a wee bit time away from that environment.

But our environments pushed us into positions where we are not

the best versions of ourselves.

Yeah.

And hearing that story, you know, I'm sure everybody's thinking,

yes, we absolutely on your side, we can see how you got to that point.

Obviously he hadn't seen all that, so he was just receiving it as, as it was.

And I know that if it was me, I'd have gone home and felt utter, utterly

awful about it and feel really like, oh God, how did, how did I do that?

When everyone else going, well, look, look what you were coping with there.

But I think that is the problem with being one of these fighty people is

we react in the moment because of the circumstances in the, in the system.

And then we feel absolutely awful about it.

And we get this overwhelming shame that you've responded like that and nobody

else was, and I've got to go and fix it.

And out of all that awful day that you had, that's the thing that you

remember when there was loads more stuff that was really, really bad.

And so I just think we, we take that second bullet all the time by feeling

that, then shame about the fact we have been fighting and then everyone else

also thinks we are the bad guys too.

And it completely detracts from the thing that actually was happening,

like this ridiculously loud interpreter on a stick or whatever it was.

And then the focus becomes off that and onto our behavior, and then

the, the stuff that actually needs changing never, never gets changed

'cause you then become the bad guy, all because of just how you reacted.

Because what you said in that circumstance was totally fine.

Please, can you turn it down?

It wasn't what you said it was how you said it, right?

Absolutely

said it.

And I guess it's, that's, that's the lesson for the avoidance and the fighters

that probably what you're saying is totally right and really important to say.

You've just gotta change the way that you say it.

And I don't think there could be many people who think about this more

than me and I still screwed it up.

And I was aware, oh, probably a nanosecond after it came out my mouth, what I

was doing, uh, but it had escaped.

It was gone.

And the thing about that is that once we do recognize it's happened, we, we

have a responsibility to make it better.

Um, I am somebody who can say, sorry.

And although I felt justified, now the problem is you can't, it's really

difficult to say, sorry, when you're feeling really justified in it.

You know, I was burning with the fires of self-righteousness.

I was wrong, but I was burning with the fires of self-righteous

righteousness nonetheless.

And it was just, it was just the, it was a microaggression on a day

that had been hurting me all day.

I mean, the other thing that was happening on that day was people

were not helping each other at work.

And I work in an organization where people help each other.

And we had got into this loop of people not helping each other to get, there

was a very specific thing we were trying to get done and we could not

get it done and everybody was just pushing the problem onto somebody

else when somebody could have fixed it for us, but we couldn't fix it.

Uh, and it was, it was truly, uh, a genuinely very difficult

day and a very unusual one for the organization that I work in.

and as you're talking, I'm thinking it's all very well in hindsight, isn't it?

With the retrospectoscope going, okay, this is what was happening, you know,

I shouldn't have done that and I'm gonna email and apologize and all that,

which is really, really important.

But how do we manage it in, in the moment?

Because like, like you said, you are someone that talks about this,

you know more about it than anybody.

And, and still it happens.

And all of us, it happens to all of us, whether we're avoidant or whether, whether

we are fighters, do we just acknowledge that these things happen rather and, and

just say, right, but, and when it happens, I am going to apologize afterwards,

i'm gonna admit that I mocked up and tell people, you know, this is what, I

guess that's vulnerability, isn't it?

Say that I made a mistake, I overreacted.

This was why I reacted.

It's not an excuse, but it's a reason.

yes, all of that with a caveat.

And the caveat is that we have a responsibility to control the, the act.

Being able to say, sorry is not an excuse to behave negatively towards other people,

just 'cause you can say sorry afterwards.

Um, we have a responsibility to accept the impact that our behavior will have upon

others, to moderate our behavior in as much as we can and to own the consequences

of it, whether we do it well or not well.

And when we do it not well, that means, that means owning it and saying,

sorry if, if that is appropriate.

Now, I, I think that on many levels my behavior was justified, but not

the person that I was doing it to.

And actually as a, as an individual tiny little moment in my day,

there's no way that person deserved the response they got from me.

Uh, and this is, this is like those microaggressions, the,

there were microaggressions that the, the organization was doing

to me all day, and then I snapped and some poor guy copped that.

And I could walk away from that going, well, the bloody organization

needs to make my job better.

And there's a bit of me that thinks that, but at the same time, there's a guy

who's been treated negatively by me in a way that would make no sense to him.

And I have to own that as well.

So, so the sides to this, and I don't think the act of saying sorry, allows

you to just behave as you feel.

I think there's still a need to self-regulate as much as possible.

I just reached the end of my tether.

I heard a, an interesting, uh, comment the other day that, a mistake

made more than once is a decision.

So, you know, if that happened again and you did it again, then actually

it's like, well, you probably know what you were doing 'cause you'd

realize that what happened last time.

And,

I don't think so.

Look at me coming back with an, I don't think so.

Straight in there with a fight.

Yeah.

Tell me why.

because I think there are environments within which we can be the best versions

of ourselves, and then there are things that we can do physiologically and

psychologically to people where we stretch them and stretch them and stretch

'em till it is impossible for them to be the best versions of themselves.

So, uh, you might snap at somebody when you have been kept awake for 26 hours.

If I keep you awake for another 26 hours and then you snap at somebody

again, I don't think that's a decision.

I think that that is a consequence of environmental factors.

And that we can do our absolute best to be the best versions of ourselves,

but when we are put under strain that reaches the level of being intolerable

to us, then pretty much everybody is going to snap at that moment in time.

And, there's just a couple of other silly wee things happened

that day after I left work.

The first was, uh, after I left work, I was driving home and I drove the wrong way

' cause my brain wasn't really functioning.

And then I got stuck in a queue of traffic and somebody let me

in, and I was very, very grateful.

We were doing about one mile an error, and I went to hit my hazard warning lights to

say thank you to them and sum my hand up.

I'm, I'm all about the gratitude.

Do you know what I did?

I pressed the bloody brake button on my dashboard, not my hazard warning

lights, and my car just went do, came to a complete hot, didn't hit anybody.

We're good.

It's Birmingham.

We're good.

So slowly it's almost impossibles to crash.

Um, but he must have thought, what the hell have I done?

You know, like this guy in front of me who just slammed his anchors on.

And it's because I was so tired that I, that I really wasn't able to do much.

And I'd gone to bed at nine o'clock the night before because I knew

it was gonna be a tough shift.

One day after work.

This is years ago, I drove out of work, um, and drove the wrong way

round and roundabout I was so tired.

Uh, and the, this is the extremes that people get to when, when they're

absolutely exhausted, when their brain is empty and crazy stuff that happens.

And we all know about people who crash their cars when, when they're

fatigued, but I think there's a decision making fatigue that happens as well.

And that this must happen in most jobs, but I imagine general practice has this

intensely that come the end of a day when you've made hundreds and hundreds

of decisions you get to the end of the day and you, you just can't think.

Some, somebody said to me the other day that they've

sometimes got home from a shift.

Uh, it was my mate Marius, he said to me, and, and his wife, Jude

would say, do you want a cup of tea?

And his response was, don't make me make a.

yes.

You know, do you want a cup of tea?

I dunno.

Uh, and, and, uh, that, that's a crazy place, but I think people get there.

Do you think then, Chris, it's a case of awareness, or do you think it's a case

of trying to change the environment?

Because I'm thinking to myself, it would be really nice to change

that environment for everybody.

And if you were a leader in charge of everything, then you could possibly.

But given that we work in a very complex stress environment, there's only a

little bit you can do about that.

And like you said, you had the awareness that the shift was gonna be difficult.

You went to bed early the previous day.

But I think that a lot of us just don't recognize how tired we

are, how much our brain doesn't work because we've been drilled.

Think, oh, we're doctors, we are literally superhuman.

It can go on for forever.

So it is almost like that, that.

Hazard, hazard lights going on thinking, okay, there's a warning, then there's

an accident up ahead that people have got their hazard lights on.

There's, it hasn't, you know, nothing's happened yet, but let's

just, let's just be careful here because I can feel I'm about to snap.

Yeah, so, so I think it's both, I think, I think it's both having the

awareness and then actually manipulating our environment so that we are able

to cope with whatever is coming.

One, one of the things that happens in emergency medicine is a lot of places have

six hour shifts for their, for the people who are in charge of the department.

'Cause it's recognized that the intensity of work is crazy.

We are still working eight hour shifts and, um, I think that's probably a

little bit on the, the long side.

We used to do 12 hour shifts and I, you know, by a couple of hours into the

12 hour shift, I was really concerned with my decision making sometimes

because there'd been so many decisions.

So I think the, the environmental part is important.

We, and we have to talk about it.

An awful lot of people listening to this podcast will be senior enough

that they have a little bit of, ability to self determine around their

environment or at least to influence it.

So there's that.

But the other part is, is the awareness that we are getting

towards the end of our tether.

And sometimes there's something we can do about that.

Sometimes there's not.

But recognizing that there is, uh, that we are getting towards the end, end of our

tether does mean that we can do whatever it is that that helps us in that time.

And that'll be different for everybody.

For me, um, one of the things that helps me is when I'm getting a bit

frazzled, um, it's often to drink.

A couple of pints of water quite quickly.

'cause I realized that what's happened is I've got a bit dehydrated.

And, and we know the evidence on dehydration is that, you know, once

you get to 1% dehydrated, you can start to measure statistically significant,

significant cognitive decline.

And, you know, it is just one of those things where we, we get dehydrated, we

don't think so well, and then we go and we go and drink something and I feel

like my brain comes back online a bit.

And that's a simple fix, isn't it?

You know?

So what can we do about environment?

Take a break.

It's like the busier you are, the probably the more you need,

the more you need those breaks.

And we think, yeah, it's counterintuitive.

We think we get less done.

If you take breaks, you actually get a lot, a lot more done if you take breaks.

So it's, but the more frazzled you get, the harder it is to recognize, I guess.

Yeah, she's doing The other thing that is an investment in efficiency, and nobody

talks about this, is that relationships are an investment in efficiency.

Getting to know people is an investment in efficiency because if you don't

know people, I mean, I realize I've sort of left, turned or right

turned in our conversation here, but if you don't know people, what we

tend to do is have a reductionist perspective of them in our head.

So, I don't know Rachel, so she asked me questions.

So she's just hostile and that's how I think about it.

And in my head, you're this two-dimensional, nasty,

Rachel, the hostile person.

And you probably think I am Chris, the blob of uselessness.

And what happens is if you don't know each other, you, you tend to fill our

understanding of each other's actions with, with the stereotype or whatever

we've decided to, whatever rule we have around who the other person is.

Once we start to get to know each other, it's much harder to think of if, if

I know a couple of things about you, if we've shared a bit of information,

then it's much harder for me to fight with you because I tend to see you as

a human being, not as a bad object.

History is littered with examples of the dehumanization of other people,

which is the thing that comes before treating them like they're not

humans and allowing ourselves to do terrible, terrible things to them.

We do it a national level, but we also do it at an individual level.

And the counter to it is to spend a little bit of time getting to know

people, asking people how they're doing.

Connecting That connection leads to understanding which leads

to people helping each other.

And if you wanna be efficient in a system, and being efficient in a system is a

function of, we can look at this lots ways, but it's a function of three things.

There's what I know, and I cart that around with me everywhere I go.

There's stuff I know and, but then there's, how do I get

something done in this system?

So understanding the particular system that I'm working in.

And I think people would recognize that.

It's like when you move from one job to another, you might be going

into the same job in a different place, but you feel like you've

caught stupidity along the way.

So there's what, you know, you carry that around there.

There's how you work within that system, which takes time.

And the third bit is relationships, because it's the, the thing that helps you

to learn how to work in a system quicker is somebody who helps you navigate it.

And getting to know people means that we tend to get into a position

where we help each other out and we show folk how to do something.

You're much more likely to show somebody how to do something if you

know them just a tiny little bit.

It's why the best teams check in.

They take a moment to see where everyone's at.

It doesn't mean you have to say that the particular thing that's going on in

your life, but over time that check-in becomes something that builds trust.

If it's authentic and people, you know, Rachel, stop seeing Chris as the useless

blob and start seeing Chris as, uh, somebody who has to go away and get

this done for one of his kids, he has to go away and do this because maybe

my mom's sick or something and there's other stuff going on in my life and

it's much harder to just think of me as a, a negative object in that setting.

Uh, and I've, you know, I've encountered this many times where I,

I do lots of appraisals for people and sometimes I'll, I will do appraisals

for people that I don't know that well, but they have a reputation

and their reputations not great.

And then I do the, um, appraisal with them, and at the end of it, I'm

like, dear God, you do well to get up in the morning and come to work.

Coming to work is a victory for you and I'm dead impressed

that you make it to work.

And that's, that's one of the privileges of, of the appraisal

process of, of getting to spend a bit of time with people and

understanding where they're coming from.

And I, I do lots of appraisals for really senior people.

I'll tell you something.

Not once, have I done an appraisal for somebody and at the end of it thought,

well, you're a nasty piece of work.

Not once.

And I've done hundreds of them.

At the end of them, I've walked away from 'em thinking, whoa, there

but for the grace of God, hey?

Other people's lives.

Yeah, well, it is back to every behavior makes sense to,

to that person that doing it.

If you knew what they were coping with and doing, behavior would make sense.

Even if it, even if it's not helpful behavior, it's not constructive behavior.

You, you know about it.

We are very bad at getting to know each other in healthcare.

You know, one of, one of my sort of mantras for general practice is have

some coffee breaks together and, uh oh, we haven't got time for coffee breaks.

Oh my goodness.

It's like the most important thing that you can possibly do in terms of team

Yes.

Sandy Pentland, Sandy Pentland's a researcher who looked at specifically

that he did it in telecoms, uh, centers.

And all you do is send people on their break together, just in twos.

You send them on their break together and people go, we can't

afford to have two people off the shop floor are not doing stuff.

Actually, they're going on their break anyway.

You're not giving them longer breaks.

You're not taking people out the system for longer.

They're just going on their break together.

And the bump in productivity was in the region of 20% because they've

had a bloody break together.

And all that's happened is they've bonded and they're now, well,

they're now in the trench together.

They're in the trench together.

It's us.

It's us.

We are together.

We're part of a team.

We know each other, and then we tend to work a wee bit harder.

We're socially facilitated, but we're working for each other as well.

I mean, breaking bread's a good thing for people to do full stop.

But just the act of going and sitting and having a chat with somebody else.

And yet sometimes that, you know, pretty much the last thing I want to

do sometimes on my break is, and this is maybe just grumpy old man time

here, but, um, sometimes the last thing I want to do is talk to anybody.

I kind of would like to sit in a sensory deprivation tank, uh, and,

and spend a period of time just floating and then having them being,

being able to go back to work, having turned my brain off for a bit.

But actually that talking to people and connecting with

folk is really good for us.

And it's probably more rejuvenating a lot of the time.

Do you think it would've been harder to yell, turn that thing down at the

psychiatric team if you'd have spent 10 minutes chatting with them a week before

and you knew who they were and where

oh yeah, yeah, yeah, yeah, yeah, yeah.

And also they wouldn't have thought it was such a dick when I did it.

They'd have thought, oh God, Chris, what's wrong with you?

You know?

Are you all right, Mary

yeah.

He's had a bad day.

Poor

Chris?

Yes.

But I think shouting is fascinating.

Because if you have somebody who shouts in your workplace, that doesn't mean that

you've necessarily got a toxic workplace.

It's not the act of shouting that determines the, the

sort of workplace you're in.

It's the response that people have afterwards.

So if I shout in the workplace and everyone goes, ah, it's just

Chris, just let him do his thing.

You've got a toxic workplace, you've normalized it.

If I shout in the workplace, and then people come up to me and go, are you okay?

What happened?

Then you don't have a toxic workplace.

And that's what happened to me.

I shouted, people checked in on me.

You don't have a toxic workplace then you have a compassionate workplace with human

beings who get pushed beyond the edge.

And it's, the problem is the system pushes us and a person, cops it.

And then you'll blame Not the system then it's bad, bad, Chris, that I, I've written

this down, the blob of uselessness, bad blob, not bad system, right?

Yes, yes.

to blame each other rather than actually put the problem

where it, where it should be.

Absolutely.

So when someone does behave in a way that they don't want to behave,

yeah, ask them what happened?

Are they okay?

But also go, well, okay, well what factors led up to that?

Let's not just look at what happened.

Let's look at like all it's like you say, and on like a macro level with the,

the people you do the appraisals with.

You know, let's look at their lives, like, what's, what's going on?

You know, actually they're doing really well considering what

they're having to cope with in their personal life or whatever.

But yeah, what happened today that led up to that?

And I have really been challenging myself to think about that

much, much more ahead of time.

You know, and I think I've talked about it, I talked about it in a recent

email where I sort of yelled at two complete, strangers on, you know,

within an hour just because I was late.

Um, I was pushed, I was trying to get somewhere.

I was worried about letting somebody down and, and then I

did it and I was like, what, what the frick happened there because.

That, that wasn't how I would normally choose to behave.

Um, so how can I then give myself a bit of a break and recognize that I

shouldn't have done it, but then also think, right, how can I avoid being in

being in that position in the future?

Yes.

And, and we all want that, that ability to change ourselves in terms of the future.

We all want to be able to not let that happen again.

Uh, I, I guess my word of caution there would be you're pretty driven.

I'm pretty driven.

People listening to this are pretty driven.

We are gonna drive ourselves.

When we get to the outer limits of how hard we can drive ourself, there's stuff

that's not going to respond so well.

And our interactions with other people, other people are not going

to be as good as they could be.

And there is a point at which we might still be trying to achieve, to achieve,

to achieve, but we are going to damage other people in the process of doing that.

And our drive to achieve may be actually getting in the way of

achieving and certainly in the longer term of achieving with other people.

'Cause we all know people who get what they want by being pretty

damn unpleasant in the moment.

And, and we know that that works for them.

But we also know that we avoid those people in the longer term

'cause we just don't want that kind of interaction with them.

And we could be those people.

We, we will be those people sometimes.

And you see this when people are really driven at work and they're desperately

trying to make things better, make things better, make things better, but sometimes

in their drive to make things better, there's a fair amount of damage caused

to other people who then respond to that by withdrawing discretionary effort,

who respond to it by doing the whole quiet, quitting thing and checking out.

And that's a disaster.

And what we want is a bunch of people who feel valued, respected, seen in

the workplace, um, who don't feel blamed for things not going well,

and, and who are then able to be the best versions of themselves in the

workplace be, because we're creating an environment for them that that makes

'em feel seen, valued, and respected.

When we're really pushed hard, it's pretty difficult to do that sometimes.

And there might occasionally be cause for it, but if it's our norm, if our

norm is to push and push and push and push and push, then we're gonna hurt

people at the edge of that, and that's probably not to the overall benefit

at the end of it some of the time.

Do you think that doctors recognize that in themselves, particularly readily?

Because I, I think the doctors, some of the most abrasive

people I know are doctors.

And that might just be because that's, that's how they think they should behave.

But genuinely, I think some of us don't realize how we come across to people.

And I think that's partly because of the culture, how we've been trained.

But it might also, partly because some of us are neurodivergent and perhaps

don't pick up on the cues that we're getting from other people perhaps,

or we're impulsive or, I don't know.

are you suggesting that people who get into a university degree on

the basis of get, of their ability to stay in their bedroom for three

years as adolescents and get three a stars might not then be brilliant to

understanding other people's emotions?

Right.

I mean,

I mean, when you put it like that, Chris, no, of course

no, of course not.

And, and they then, they then spend all this time working and, and

becoming incredibly knowledgeable about stuff by studying books a lot of the

time, or the internet now, I guess.

Um, and then we would be surprised that they, they're, they're deep in one

bit of intelligence and maybe not so deep in another piece of intelligence.

So they might have a high IQ bot with a. Less emotional intelligence.

I, listen, I mean, I think that's almost a given that

that's gonna happen for someone.

And then, and not for everybody.

I mean, the, the totally beautiful thing about emotional intelligence is the

evidence on this tells us that, you know, your emotional intelligence is not static.

IQ's relatively static emotional intelligence is not.

We can learn to be better and better and better at this.

And if you keep your marbles, people's emotional intelligence

improves into their eighties and nineties if they want to work on it.

So there's a chance here for us to be better, by thinking about

this stuff and working on it.

And if as you were talking about that and how we are and, and we're talking

about us as doctors at this point, um, how we can be really abrasive, I

think we are something else as well.

I think we can be highly judgmental.

And the judgmental thing that I see coming out most often when I'm

running workshops is people, when we're talking about other people,

what don't they like in other people?

What grinds your gears?

This is a question we will work, ask and really frequently, and it's

doctors who say it, almost always doctors who say it is laziness.

We hate laziness.

Laziness is a sin on par with all the very worst sins in the

workplace for a lot of people.

And we, when we decide that somebody else is lazy, we have made a

judgment about their character.

We have decided effectively that they are bad.

Now, if we decide that somebody else is bad, that gives us the moral authority

to punish them ' cause they're bad, lazy.

And what then happens is I perceive somebody to be lazy.

So I, I give them down the banks, I, I, I give them a really hard time

about it and I attack their character.

What's fascinating about laziness is we are quick to

point the finger at other people.

However, when we ask a group of people about, Hey, think about the last time

you didn't do something, there's a thing, it's a work thing, you've not done it.

What happened to make that thing not, not occur?

When you get into the conversation with people, it's fascinating.

They didn't do it because they didn't know how, they didn't do it 'cause

they didn't have the resources.

They didn't do it 'cause they were really scared of what would go, what would happen

if it went wrong and they wouldn't be able to live themselves if it went wrong.

They're really scared of what would happen if it went wrong and how

the organization and system would respond to them if they got it wrong.

There's loads of other reasons 'cause you go around the room and

everyone's going, I didn't do it.

This, I didn't do it that.

Do you know what's bottom of the list?

Laziness?

Yeah.

Yeah.

Why didn't you do it?

You know what couldn't be ours.

There you go.

Don't you think it's because of this resentment that we have?

So, I mean, doctors have had this success story that I've got to work hard and

my, the way I'm success is to work hard.

And so when there's more work, I work harder and harder and harder.

And we feel really over responsible for everything.

So the buck stops with us.

So I can't say I'm not gonna do it.

And then when we see someone else who's not doing something, we feel

a massive degree of resentment?

And something I learned recently, I think from reading some stuff by

Ben Brene Brown, is we think that resentment is part of the anger family.

It's not, it's part of the jealousy family.

So we are resentful, but we go, why can't I be like, why can't I just stop working?

I, it's not fair.

I've knackered.

I can't have a break.

And we're actually really jealous of these people we perceive as

being lazy, but we can't say that.

So we just like to, to judge them and say they're bad.

I sometimes wonder if that's what's going on.

I, I'm sure it is.

But also I, I think that we have a system that allow, has allowed

us to believe that if you work harder, you can achieve things.

All exams are based on this.

Every exam that people do, the the, we fundamentally don't

create exams that are impossible.

The exams that are set for people are exams that you can achieve.

However, they require an awful lot of investment and time to achieve them.

And what, what people learn is that you can achieve stuff if you keep investing

more and more and more time in them.

That's true for exams, but it is not true for the rest of life,

because things become impossible.

You cannot achieve certain things at work if you don't have the equipment or

the team or the, the resources, whatever resources you need, you can't achieve it.

Yet we allow ourselves to feel personally responsible for that.

And of course, around the corner there's always somebody

who says that they can do it.

And this is, this is the, the curse of the chief exec and I heard there's a

guy, Richard Beacon, really good guy.

He was the chief exec at City and Sandwell, and Richard Beacon was

talking about this at conference.

And what he, what he said was this, right?

So I'm running this great big organization, I've got the money and we

can't do everything we need to do, it's not possible with the resources we've got.

However, if I say this cannot be done, there are 10 people standing

in the, in the shadows going, I can do it, I can do it, I can do it.

And people listen to the person who say they can do it.

And, and these guys genuinely believe that they can do it.

They're wrong.

They can't.

But they genuinely believe they can do it because they have

a work as imagined version of whatever the chief exec is doing.

And they think they could come in and just make these sweeping

changes and, and sort it all.

And it's a really difficult place for somebody who's in that kind

of position 'cause turning around and say I can't do it, means that

there will be other people say, well that's 'cause you're not good enough.

I could do it.

And it stops us having honest conversations about the achievability,

what's actually realistic, for us to, to get through at a given point.

Out of all this, what was your main, you know, what would you say?

'Cause you've got this live example here.

What would your three top tips be?

And also for people that are witnessing this going on, I can imagine,

like you said, people came up to you and said, how are you doing?

Are you okay?

But if some, if one of your colleagues has stormed up and said, that was

totally inappropriate, you know, it probably would've, I mean, that

goodness knows how you'd have felt.

So

Firstly, I think that when you know people, or even if you don't

know people, see, I don't think this, nobody came up to me and said

that was totally inappropriate.

Even though it was.

They came up and checked out, it was all right.

Um, that's the response that lets people grow.

If somebody had come to me and told me it was totally inappropriate, I

was full of the self-righteous fires.

I wasn't gonna be able to hear that.

In fact, telling people that they're wrong, telling people

that they're inappropriate is like saying you're bad is useless.

It's, it is.

All you do is you take a person who's hurting and you hurt them

a bit more ' cause that's been proven to not work ever, basically.

It just doesn't work.

I realize I've used some sarcasm today.

I don't use sarcasm as a general rule, and they'll, and I'm rubbish at it.

So,

I obviously bring out the sarcastic in you, Chris.

Well, I don't, no, who knows.

But, but what, what we want to do when, when somebody's

abreacting is look after them.

The person who can't do that, unless you're like, something

very special, is the, the person on the receiving end of it.

That's just, that's too much to ask.

But we can be checking in on people and checking that they're all right.

And also checking in obviously on the, the person who's been the recipient of this.

Because actually these behaviors, if they're not normal to somebody, are a

warning sign that something isn't right.

And it's an opportunity.

It's an opportunity to reach out, look after somebody, perhaps

stop things getting worse.

And frankly, none of us want things to get worse for our colleagues who

are struggling because at a totally selfish level, they go off sick.

See, when your colleagues go off sick, the total amount of work to be done

doesn't go down, you just get more each.

The pie is sliced in a different way.

So for me.

the, the first bit is the, the reaching out to people, recognizing that.

That, there's a, the personal bit is recognizing that we're

getting to the end of our tether and doing something about that.

Um, it'd be nice if we could get to the end of our tether once or twice

and then start to recognize that on a regular basis and do something about it.

So much food for thought.

You know what i'm Gonna say, I'm gonna ask you to come back again at

some point 'cause we've got so much.

more to talk about.

You've been so generous with your time.

If people wanna get hold of you or find out more about Civility Saves

Lives, what's the best place to go to?

So civilitysaveslives.com is us.

Uh, what we do is we collate a lot of evidence on civility.

Not all of it, because the, it is exploding all the time, but

we collate a lot of evidence.

We, we try to make sense of it and we have a lot of resources there.

And, uh, you know what, uh, sometimes people want to chat to me about

stuff and if they write to the website, I, I pretty much chat to

everybody that wants to talk to me.

And it can take a long time to, to find a little slot, talk to 10, 15 people a week.

But, you know, if people want to talk, drop me a line.

Chris, thank you so much.

Hopefully speak again soon

excellent.

Later.

Have a lovely day.

Thanks for listening.

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