What’s it like to work in a high-stress job with autism, ADHD, or another neurodivergence, and how do we support colleagues whose brains work differently?

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We're having a much needed break over the holiday season, but

whilst we were away, I wanted to offer some replays of some really significant

episodes that made a big impact on me.

first one is episode 1 78 released in the summer a couple of years ago.

and is all about how to thrive as a neurodivergent

person in a high stress job.

I didn't this conversation with Matthew Bellringer, we explore

some of the issues that twice exceptional neurodivergent people

may have Well, it's navigating a high stress, high stakes job.

This was particularly relevant to me as I am neurodivergent myself.

And over the last couple of years, I have lost count of the amount of

doctors and other senior professionals in healthcare that have also discovered

that they are neurodivergent.

And whilst many of us would say we would never have it any other way.

It does come with some challenges.

And I've reflected that this is possibly why I created the Shapes Toolkit and

this is why I am so interested in all this stuff around how to beat

stress and work happier, because over the years, I've had to find coping

strategies and navigate this myself.

I've also been told that this episode has been used by some

organizations for that training.

Around neurodiversity and neurodivergence.

And next year we're going to be running some Beat Stress and Thrive

live courses and some Shapes Toolkits for people who are neurodivergent or

supporting those who are neurodivergent.

So email us at youarenotafrog.com if that's something that

you might be interested in.

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

and you're feeling stressed or overwhelmed, burning out or getting

out are not your only options.

I'm Dr.

Rachel Morris, and welcome to You Are Not a Frog

I'm Matthew Baringer.

My work is all about exploring and sharing how everyone can

benefit from neurodiversity.

I'm particularly interested in the benefits that neurodiversity

can bring for individuals and for society and for organizations.

My focus is therefore a little bit different on the

normal deficit based stuff.

So it's all about actually what do we get with the way

that different brains work.

I have a, a kind of typical neurodivergent mixed background or, um,

tech research, innovation, psychology and communications, which has led me

to, to, to doing this particular work.

I'm also an autistic A DHD.

So much there to unpick Matthew.

Loads of stuff in your background, some sort of labels, well

labels, some diagnoses yourself.

And I really wanted to get you on the podcast today to talk to people

in high stress, high stakes jobs.

A lot of whom I think maybe neurodivergent themselves.

Uh, I know that in medicine we have a, a high incidence of what I think you

call twice exceptional people, so we'll.

Talk about that in a minute.

And what'd be really nice to know is a little bit about what people who

are twice exceptional particularly struggle with and how they might

approach not being stressed.

Not being burnt out in a bit of a different way to.

Other people perhaps I'd love to start off just by asking you,

Matthew, you do lots of work with people who are neurodivergent.

You are neurodivergent yourself.

And just before the podcast I said to you, well, did we say

neurodivergent or Neurodiverse?

So neurodiversity is, was, was coined by, uh, sociologist, Judy

Singer, um, in the late nineties to describe the normal variation

amongst the entire human population.

In the way that our neurology works.

So it, it's, it's that neurology varies quite a lot between different

people, between different and changes over, uh, as we age and

all of these different things.

And that's part of the, the normal diversity of human experience.

It's a way of questioning the approach that says anything that differs from a.

Very kind of strictly established standard is necessarily

disordered or dysfunctional.

That's not to say that it completely excludes that, and I, I think one of

the, you know, neurodiversity can, can sometimes be interpreted to mean

well then no one has any problems and absolutely not what we're talking about.

We should be kind of working with that normal variation of how we all think

and feel and experience the world.

And most people think and feel and experience the world mostly

the same, mostly similarly.

It's not that everyone experiences it exactly the same, but these things kind

of fall onto a normal distribution.

They form onto a fall, onto a bell curve, and if you sit.

Significantly outside of that vel curve, if you sit towards, towards the edges,

um, of various different traits, various different kind of experiences that can

introduce some specific problems, and we, uh, we've kind of started to use

the term neurodivergent to describe people who sit outside significantly

outside of that normal experiencing.

And I say normal in the sense of statistically.

Most common experiencing of the world.

So my kind of, my personal functional definition of, of

neurodivergent is someone who, who significantly and pervasively

experiences the world differently to most other people around them.

You don't necessarily need a diagnosis, though.

There are a lot of categories, diagnostic categories that are

associated with being neurodivergent.

Um, these are sometimes called neuro minorities, specific neuro minorities.

So for example.

Autism, A DHD or dyslexia.

Uh, the, the, these particular kind of ways of associated with a

certain neurology lead to a kind of cluster of common experience,

um, or more common experience.

That's really helpful.

So basically everybody is neurodiverse, but some people are further away

from the, the commonality than others, and that would be neuro.

Neurodivergent.

And then you've got these clusters of people that have fairly similar

neuro divergences, which are these sort of minorities, neuro

minorities that you talked about.

That's helpful.

And when we've chatted before, I know you've said to me that you

think there are quite high quantity of people who are in these neuro

minorities in some of these really high stress occupations such as medicine.

For instance is, is there a reason for that, do you think?

Absolutely.

I'd like to touch on, um, this idea of twice exceptional

that you mentioned as well.

That's, uh, that, that's, I think, is a really helpful one.

There is a cultural assumption that being neurodivergent comes

with intellectual disability.

That isn't true.

It just isn't true.

Sometimes some of the conditions come with intellectual

disability, sometimes they don't.

Being twice exceptional is to be.

Neurodivergent and or intell creatively and or intellectually gifted.

So it's to actually be kind of a higher level of certain ability than

we'd normally see in the population.

Until recently, that whole category has an even attracted diagnosis,

partly because the diagnostic criteria are entirely deficit based

and are relatively unsophisticated.

Um, as a, as a, as a really.

Differential diagnostic tool compared to a lot of other things.

And so we, we kind of overlooked a load of experiences and one of the big

experiences is, yeah, people who are, who are highly intellectually able,

extraordinarily sometimes and yet also have specific difficulties and, and

very often those abilities make people a really good fit for certain professions.

There are a range of different kind of things that come with neurodiversity

that lead people to being really able to cope in certain environments, being

really skilled in certain environments, wanting to work in certain environments

that perhaps most other people wouldn't.

I think the best example of this, you know, and, and it's not the

medicine as an entire body skews in one specific neurodivergent way.

But that within the practice of medicine, there are niches that suit the

ways of thinking and being and working that different neuro minorities possess.

I think the obvious example of this is emergency medicine and the chaos of

an a e department on a Friday night.

That takes a certain sort of skillset to just to be able to coach and navigate

and to actually kind of enjoy having spoken to people who work in, work

in, there's a kind of sometimes feels like a slightly perverse enjoyment,

but an enjoyment of that kind of, you know, the intensity of that.

And that's associated with a DHD traits in particular.

The, the ability to kind of cope with all of those things

happening at once and to enjoy and to actually seek it out.

But the flip side of that, if you think about someone kind of skewing

in that direction of a specialized neurology for being able to navigate

that kind of chaos, it comes with a relatively, potentially with a reduced

ability to do kind of procedural thing, particularly low unstimulating

procedural things like filling in forms.

And it's not to say that everyone who is in these practices certainly has a

clinically diagnosable condition, but might well share traits with people that

do, and people who do have the condition might well do well in those specialisms.

And it's not just medicine, is it?

There's all sorts of, you know, specialties where you have to use your

brain a lot for various things, or you have to respond quickly to emergencies,

or you have to really get into the detail of stuff and think it through.

Some things that you need to be able to interact with people a

lot more than than other people.

Is there something about, you know, people that are in these positions of

extreme responsibility for other people that predispose them to some types of

neuro divergence in the first place?

Well, I, I, I think there's, um, there isn't a generalized

blanket, but there are some trends.

One of the interesting things about.

A relatively understudied group of neurodivergent people is

neurodivergent people who are particularly interested in other people.

Now, that has been over partly because part of the diagnostic

criteria for a lot of neurodivergent conditions is a lack of empathy.

That criteria in itself is problematic.

It's actually that it's a lack of empathy for neurotypical people, for

people who experience the world kind of in like most other people do.

And those, um, those, those absences of empathy disappear when with other

people of their neuro type or their neuro minority or almost entirely.

So this whole situation of being interested in people can

often mask the stereotypical presentation of neurodiversity.

And I think a lot of people who, who end up professionally interested

in working with and for people.

Part of that drive comes from wanting to understand people on a

more profound level in some way.

A lot of neurodivergent people talk about missing a memo or not

getting an instruction manual that other people seem to have got.

And I think very often that desire to study and to understand if

we are intellectually capable, it's one way of being like, oh.

I can, I can, I can, I can figure it out.

Then I can look it up in a textbook.

I can understand it and then address that fundamental experiencing of

the world that I'm, I'm not sure I understand how people work.

Well, that, that's interesting.

Are there any specific, you know, superpowers that you would attribute to

some people with particular conditions?

For example, you know, I know that.

Often people with A DHD really struggle with executive

function, getting themselves organized, et cetera, et cetera.

Their superpower is connecting ideas and responding really quickly and just

being able to take things from over there and oh, that would work there.

And, you know, that is a real superpower.

But then another ways the A DHD can be a real hindrance in, you

know, actually getting stuff done.

So, I mean, that's a really obvious one.

What, what.

Superpowers.

Have you observed in people that aren't quite so obvious?

I tend to tend to avoid the word superpowers, um, partly because

it's not anything supernatural.

I think if we are using a metaphor, I.

It's closer to the, the kind of X-Men mutant powers that they

have this huge advantage, but they come with a cost and cent

power with a cost.

Love it.

Okay.

Because,

because they, they, they, you know, everything has

a, it's a plus and a minus.

Um, we don't really get like, abilities for free.

We are trading, you know, it's, it's a, a neurological trade of one thing

for another thing very often, um, or one strength for a relative weakness.

But having said that, I mean the, the, the kind of classic ones.

Yeah.

The ones around creativity for A DHD, uh, and, and, and it just a generalized

ability to cope with and often enjoy relatively chaotic environments that

can be overwhelming for other people.

I'm not entirely sure whether that's just down to practice and the fact

that we managed to generate quite a lot of chaotic environments.

But one of the other strengths actually I've noticed is also quite

a lot of project managers show a DHD traits, which seems counterintuitive.

And I think this is the, the, the, like, one of the other ways

that Neurodivergent strengths can manifest is when we develop

really good tools externally and ways of supporting everything.

So if you need to develop things, people tell me, I'm really, really organized.

I don't experience myself as organized.

I use a ton of tools around me and I'm pretty good at using them 'cause

I've used them for my entire life and if I don't, I don't do anything.

So, but that then means I've got this, this kind of organizational

skill set in the outside world so we can develop these skills that

are kind of mitigations really, and kept very, very good at them.

Thinking about autistic traits as well, which is the other, the other

really big one that's associated with visualization ability very often, often

sensory sensitivity in different ways.

So a real attunement to the senses as well as a kind of a real joy

in ordering things and having things in a certain arrangement.

And what's interesting is, for me, and the two combined lead

to a very intense curiosity and a desire to learn all the time.

And that itself can be a benefit, particularly for a generalist, um,

in a domain because it's that ability to go outside of the boundaries.

With neurodiversity, we often face quite significant challenges, social

challenges, um, life challenges, and if we're fortunate and we have

the developmental, um, context and.

The internal capacity to develop a skill that mitigates them, that

deals with it, we can end up with huge strengths in certain areas.

Well, I mentioned that difficulty and empathy between generally neurotypical

people and the neuro minorities.

If you have strong reason to overcome that, you can overcome that.

It's just a harder form of empathy.

For me, my quick test for anyone, if they're wondering if they're

hyper empathetic, hyper empathetic is, um, empathetic over spill,

which is when you have empathy for inanimate and non sentient objects.

So say for example, you see a mug that you haven't used for a while

and you think you feel sorry for that mug because it must be feeling like

it doesn't have a, you know, it, it, it's not living its purpose anymore.

Um.

That that's an example of empathetic overbuilt.

So it's, it's just as a quick idea, but it, it can manifest

all sorts of different ways.

And so you can see where these hyper adaptions develop and the hyper

adaptions can be huge strengths and huge superpowers, though only in

as much as they're not completely obligate trauma related responses.

'cause sometimes they develop as a result of trauma.

And if they are, then we, we, we struggle to moderate them.

We use them all the time and then we overuse them because

this is one of the huge things.

Any, any strength can be overused and very often the, the most normal

failure mode for anyone, neurotypical or neurodivergent is that, not that

we operate in a domain of weakness, but we operate in a domain of

strength long past its usefulness.

That is ringing really true because I know that I have.

The ability to connect ideas and share ideas, and see connections,

and see possibilities and all that 'cause of my own neurodiversity.

And I know that when I'm talking to someone about ideas, I often talk to

friends about new businesses that they want to set up and things like that.

It's really good for a bit.

And then I think I just overwhelm people with ideas, you know?

So it starts off really good.

It keeps going and it keeps going, and it keeps going and, and eventually

that person's like, oh my goodness.

I'm exhausted.

I can't listen anymore.

Does that make sense?

Absolutely.

And I, I think this, this, this links me really nicely to one of the other

things that I'd like to, to mention actually, which, um, which is this

concept of camouflaging or masking.

So when we're neurodivergent, most neurodivergent people, particularly

two E people choice, exceptional people, tend to pick up the habits of.

Getting by in, uh, normal society and behaving in ways that don't

mark them out is different.

And I think when people hear masking, it sounds like

striving to make up a deficit.

But particularly for this group, the largest part of the masking is

in inhibition, is in holding back.

So it becomes that.

Not telling everyone about, look, you know when, when you start

chatting to someone and you, you are ma incredibly interested in

something, you don't just give them all of the facts and the whole story.

Like you don't, or you don't Just tangent and tangent and tangent and

follow the, the threat of, because most people don't like that and it

so we learn to actually hold back.

And this also relates to the strengths 'cause it well deployed.

These things are huge strengths.

But when we've learned to mask them that way, we kind of associate

them with being problematic per se, rather than contextually just

something that's not always welcome.

And so we tend then, then we suppress them entirely and

we don't have access to them.

So I think that idea of unpicking and kind of developing the

strengths is, is about like working out, where am I inhibiting?

How could I use this thing?

Because it's about expressing yourself and expressing what you, what you

kind of are experiencing, but doing so skillfully, you know, in, in a medical

context, you might suddenly have a huge amount of medical information

at hand, but that's not something you necessarily want to, you know,

give a lecture to a patient on for a quarter of an hour if, if it comes up.

But it might be really useful in another context.

And so that like, being able to moderate that and knowing when it's a thing and

knowing how to work with it and how to express it well is, is a real part of

the, the kind of developing this skill.

I'm really interested in this thing about masking and camouflaging,

and I know Matthew, you work with a lot of high functioning professional

people who are having issues in their workplace, probably because of their.

Neuro diversions and because of the job as well.

I know you, you coach them a lot.

I know that people come to you with lots of different things.

Can you see any themes in the types of issues that people are

coming to you for help with?

Yeah, I, I think if I boil it down in, in, in these contexts,

like the, the core thing that most people I work with experience in

some way or another is a combination of frustration and anxiety.

That can manifest in all sorts of different ways, but very often it's

rooted in that, that common experience.

And that comes from seeing the world differently, seeing different things

in the world, seeing different opportunities and different threats.

And the difficulty with that is when you're working with others, that

means everyone ignoring opportunities that you, that are obvious to you.

And the frustration that comes with that, and equally blundering into

threats that are obvious to you and the anxiety that comes with that.

And so, yeah, that can, that can manifest in all sorts of different ways.

Some people experience a kind of gap between their, their level of

performance or their, what they think their level of performance.

However, um, how mu however much approval people get

in the outside world.

That can often feel hollow.

Um, it doesn't necessarily feel secure.

Um, and that's, that's partly um, a masking thing as well, is we

learn to kind of separate and show a very partial image of ourselves.

Then praise doesn't necessarily feel like it belongs to us when

we get it because we know we are presenting a partial image.

And, and so, uh, it can feel like a gap between in your potential

knowing that you are, says something else that you are, or a sense

that you are missing something.

It can lead to.

Quite often people have a kind of creative unconventional side

that doesn't get expressed.

Or feels like they can't get that out in the world and they can be incredibly

technically able, professionally able, but that there, that feels stifling.

It doesn't feel like self-expression in any sense of the word, and that

they can't express themselves it as a, as their professional identity.

And finally, it can also manifest as being torn between doing stuff

that's intrinsically rewarding.

That feels good.

That gives you energy that you enjoy and doing stuff that's materially rewarding,

that gets you paid and gets you praise, um, an external kind of, um, approval.

And that barrier, you know, the difficulty with those two things being

entirely separate is whenever you are doing one, you're not doing the

other because they're both needed.

That always feels like plate spinning.

And so this, this idea of constantly chasing reward, whether it's intrinsic

or extrinsic, is one of the other common experiences in this space.

And it it's because we've learned that this, our inner world, our

experiencing isn't really okay to share with others and isn't a value.

And in the long run, the work is integrating the two.

Um, is that more difficult for people?

Neurodivergence than it is for, um, air quotes, normal people.

I think, uh, mo a lot of people experience some not complete

overlap, I should say, between the, um, between intrinsic and extrinsic reward.

However, the system is set up to broadly direct people towards

professions where they will experience a reasonable degree of both.

If they're, if you're lucky enough to get a decent education and get all

of the support that, that, that comes with, you know, if you, if you are,

if you are fortunate enough to get to go to university, that's kind of

what that process is supposed to be delivering, accepting that there are

plenty of people who are marginalized and that path doesn't work, but that,

that is kind of what that's, that's so it, it gives you at least a.

Most people, a decent degree of overlap in that space.

There a lot of neurodivergent people.

It doesn't, you don't get so it, it's barely any overlap or no overlap at all.

And that starts very early.

You know that, that, that, that's often a, a, an early it, it

sometimes preschool, but definitely schooling upwards experience.

And if we are.

Again, it's an extra risk.

With the twice exceptionality, we learn to put all of our

approval, uh, we, we, we basically learn, okay, myself approval.

My self judgment is faulty clearly.

'cause it doesn't line up.

So we learn not to trust that all, and we learn just to

trust other people's approval.

And if we're bright, we can get a lot of it.

We never have the situation where we can't get good

grades, where we can't like.

We may not like, enjoy the process.

We may not intrinsically like want to do that, but extrinsically we

are rewarded for it and over time can separate us quite profoundly

from, from our intrinsic motivation.

So it is a particular risk.

It, it's, it's a, it's a risk for neurodiversity and it's a particular

risk for twice exceptionality.

So essentially you're just doing what everybody else

expects you to what you rewarded.

But actually you are not what you really love.

You are masking stuff and what you really love is over here and no one

really rewards or appreciates that.

And then that's quite a lot of dissonance then to, to live with, right?

It's a huge amount of dissonance to live with.

And I think, you know, we, we, we don't talk about the

mental health consequences.

Young and neurodivergence is quite significantly impactful

on a, on a life scale.

Uh, adult diagnosis of A DHD is associated with a 13 year

reduced life expectancy, which makes it more impactful than

smoking 20 cigarettes a day.

You know, and if we think about how we talk to people and

societally, we treat people who, who smoke 20 cigarettes a day.

According to the latest ONS survey, only 22% of autistic

adults are in work at all.

And that comes with its own set of.

The, the, the, the stress and all of these.

So this life expectancy reduction, it's partly in self-harm

and risk-taking quite, uh, extreme risk-taking behaviors.

It's partly in psychosocial stress and the ways of working with that, which

can manifest as compulsive behavior and addiction, they can manifest as

chronic physiological stress, which obviously, you know, increase risk

of all sorts of different things.

A big a, a chunk of it is not getting help for treatable conditions, and

that's because sometimes services are inaccessible or relatively inaccessible

to us in a variety of ways, partly because sometimes the presentation of

those conditions is un stereotypical.

When we are also neurodivergent might experience them differently

and therefore report them differently and therefore get them diagnosed.

So there's a whole raft of reasons for this impact.

None of them directly related to the neurology.

They're all kind of external, systemic reasons.

So this, this impact is, is something we kind of have

to work with and understand.

And I think, you know, both for you and I, it's a very interesting

position to be in, to be neurodivergent and understand this and be on

the pointy end of some of this.

And to be working with people around this and be talking to.

Professionals, medical professionals, about these kind of consequences

and trying to work with others to, to reduce the consequences,

the systemic consequences.

And again, thinking back to some of the stereotypes around how we cope,

how we manage, particularly in high stress roles and the maladaptive coping

mechanisms that people often adopt.

They can be significant doctors with.

Substance dependency is kind of a cliche at this point.

There's, there's a raft of other behaviors as well, and I think we

often overlook the, supposedly in inverted commas, good behaviors.

'cause we're very moral about what we think of as addiction.

It's all moralized, but actually compulsive behaviors of things that

we, that are, that are good to do, you know, that have some benefit.

If we overdo them, that can be just as harmful.

I know an awful lot of highly successful neurodivergent people who are.

Compulsive.

Well, compulsive workers were often, often addicted to work

that often a maladaptive way of coping with this stuff.

Though I should say maladaptive itself is judgmental.

I think I tend to prefer to think of these things as what they are is

coping with things in the moment, the least bad way possible that's

available to us at the moment with all the resources that we have.

Those might be.

Psychological resources, those might be knowledge resources, those

might be external environmental resources, but we choose the, we

always choose the least bad option.

What we actually have to do is move the situation so that there are

some good options, not just least bad options, because the, you know,

those least bad options can create a negative feedback loop and that's

what makes them so problematic.

But I wanna be clear when I say, you know that, that there is no judgment in.

Following these things very often we inherit these things from, from

authority figures, from parents, from mentors because they shared traits

with us and they learned to cope that way because they, that's what got them

through, and then you just carry that on and either it's not helpful anymore or

it was never that helpful in the first place, but we carry them on anyway.

I love the way that you said, you know, things aren't good or bad.

They're just helpful or not helpful, really.

You know, for example, lugging a bottle of wine every night, we've labeled

as bad, but I know lots of people use that to turn their brains off.

You know, that is, that is sometimes seems like the least bad option.

But other people just binge on chocolate or watch Netflix or go and do huge,

huge amounts of exercise for exercise.

That's a, that's a good thing.

So that's a Or or working hard.

Well, that's a good thing 'cause you're just committed, aren't you?

But actually all it is, is you trying to cope with stuff and, and

work things out as well as you can.

You know, I, I love what you said about the way that you have

adapted and then these things seem to be a, like a superpower

because you have to work on them.

And I can see that in myself being quite.

Chaotic at times, and I've to learn how to organize myself.

All of the work I do with this podcast is because I've struggled so much, um,

only just been diagnosed with a DHD and that makes a lot of sense because I

love these ideas and connecting stuff.

And also, you know, I have struggled in jobs where they have to be very,

very detail oriented and sit still for a long time and this and that as well.

But what I wanted to ask you, Matthew, what types of things are really,

really helpful coping mechanisms?

Because there are things that are more unhelpful, even without any judgment.

It it, in no one's world, is it helpful to drink a bottle of wine at night.

It's not helpful for your health.

It's not helpful for, for you.

So what have you found works for you and works for your clients that you.

Ultimately what we want to do is move towards being in a situation

where we, where we can play to our strengths primarily, and where our

weaknesses aren't a huge liability.

And that means creating a context where that's true,

which we can do multiple ways.

And there, there are various tools and various approaches we have available

at our disposal depending on, on, on what our particular needs are.

I, I don't actually take scheduled work until till midday.

So I do get up later than most people and I work later than

most people that has advantages.

'cause I'm based in the UK and it means I work with people in

the US So because I overlap quite significantly with their working hours.

So that whole kind of space is, is one of the, um, it it, you know, thinking

about like where, where is my difference and advantage because that's the

other area of this is, is actually.

We don't necessarily benefit from being exactly the same as everyone else.

There are advantages, indifference too, and figuring out a situation

that's like, oh, well, well this, where does this work?

But it's moving towards that point, understanding, you know, moving towards

a practice and a set of things that support us and play to our strengths.

I mean, that's great advice for anyone.

Like you don't even have to be neurodivergence.

Play to your strength is one of the.

Main pieces of advice I give when we talk about career

development and and resilience.

Because if you can get into a job where you are doing more of what

you love and you are good at, then actually you're gonna be much happier.

And what I loved about what you said was find your exceptionality and

then really, really play to that.

What if your exceptionality is just really left field of what is sort of.

Expected in the role that you've got.

I think this is really interesting.

This comes up a lot actually.

There are, there are, there are different ways to, to engage with this.

So one of the ways is to accept that, that you have a domain of practice

that's important to you but is not part of your professional work directly.

That can be incredibly rewarding and incredibly helpful.

The strong example for this is.

So one thing that predicts Nobel Prize winners more than anything

else is having a significantly developed practice of playing music.

And those aren't directly related.

That, and they kind of stay separate so you can have a practice.

So as long as you've got the space in your life to follow the practice,

keeping it separate can work.

And I think.

The other thing around this is, and this is where this crosses over with

my innovation work, is actually if you combine things together in an unexpected

way, you can meet a different need.

Anything in this space, choose something that feels more

exciting than it does scary.

Even if that means doing a really, really small thing and starting

with that, like actually this feels good to me, is a really good

way to start exploring that as.

As slowly as you need, because it can be incredibly challenging.

And I think all of this is great advice.

Like I said, just now, you know whether you are neurodivergent or not, because

there's never ever gonna be one job that hits all your needs for connection,

for this, for creativity, for that.

And if you can find that outside of your work, that's absolutely brilliant.

So if you are gonna look for the perfect job, you're never,

ever, ever gonna find it.

But perhaps it's, it's, it's harder to find that.

To get that, like you said, as much as, um, maybe other people would.

If you are neurodivergent the people that are listening to this, that

that would be, uh, quote normal.

How can they change what they do at work to really help their

colleagues who are neurodivergence?

Thank you.

I think that's a really important question actually.

We tend to assume with any difference that.

The person who's different then bears all of the cost

and, uh, of working with this.

And if we look through this lens of, oh, you get, well, you get something

exceptional now of working with this person, then maybe you can

put in, you know, there's, there's value in putting in some effort.

So, yeah, I think it's, it's a really important and under explored things.

So the primary things are really.

Building your own awareness and skills and understanding and finding

understanding with other people, reaching other people who experience

the word differently to you.

And that can be a really, really difficult thing if

you are not used to it.

One of the difficult things that we as neurodivergent people

have to understand is we, we are regularly crossing that bridge.

We're regularly encountering this, but not everyone is.

And so actually a lot of those skills, it's, it's hard to build and it's scary.

And so actually, you know, experiencing different perceptions, different ways

of seeing the world and working with integrating those and understanding

those and connecting with those and reflecting on your own position.

Your own understanding where is, where is your position actually?

'cause we all have one.

It's just that we tend not to notice it if it's the default.

And so, so you can then know where you are coming from in the

conversation as well is hugely helpful.

Another side of this is being willing to engage with some of

the work in bridging the gaps.

So the classic thing is like.

Is to say, well, what do you need?

And that's actually a really difficult question in a, in a,

in an organizational context, is because that me needs someone to

actually understand all of the stuff that you understand as well.

So being willing to try stuff out and also being willing to

be, to, to be wrong and to admit that you are operating in the

space of limited knowledge.

Because we all have limits to our knowledge and to our awareness.

If you work with someone who is a specific neuro minority, it can be

helpful to understand that condition, though with a big grain of salt.

The idea that we are, that the conditions predict very much

about us as individuals is and is, is kind of out there in broader

society, but it's not very true.

We don't tend to fit the stereotypes terribly well.

They're not that predictive.

So it can be helpful and maybe it's like, you know when you

come up with something it's like, oh, is this what it is?

Rather than this is what it is, is the really important thing.

Thank you.

Lots of helpful stuff there, Matthew.

As we just finish off, what would your three top tips be for anybody

who feels that, you know, with a diagnosis or without a diagnosis,

that it might be a little bit different from, from the norm?

And actually, I think that's possibly quite a lot of the listeners here

who've always felt, you know, I'm, I'm not exactly responding exactly

like, like other people here.

What would you, what would your main tips be for them for navigating.

World and the world of work with perhaps a little bit more ease.

I really like that focus on ease as well.

'cause that's very often what we, what we don't experience

if we're neuro divergent.

Mm.

We can do the performance, but it doesn't Fairly easy.

Yeah.

Ever.

I think the first tip is to get curious about yourself and

your experiencing of the wild.

You don't have to use the medicalized lens of specific diagnosis.

It can be very helpful.

Research suggests that the younger you are, you get a diagnosis,

the better your life outcomes.

If you're neurodivergent, it's a direct relationship.

Um, so whilst there are some drawbacks to diagnosis, it seems for most people,

it's mostly helpful, more helpful than it is, uh, uh, an impediment.

But that has to be a personal decision.

I think just doing the self-development work, doing

the, like self exploratory work.

Where are my strengths?

Where is my joy?

Where is my, you know, where is my interest?

Reconnecting with that, that's particularly important if we're

struggling with mental health issues, as many of us do, and I

think that connection with needs, what are my needs that aren't met?

And that can be a very difficult question to answer

if they've never been met.

I think if we have organizational authority, particularly the more

senior we are, the more important this is, is being open about it because

it makes it easier for other people.

There are a lot of people who are either don't know their neuro divergent or

are, um, kind of, who have a secret, who have their diagnosis a secret,

and that's perfectly valid, but.

If you have organization, you know you have authority.

It's worth considering whether you can use that authority to make your

life and other people's lives easier.

And so talking about the experiences of it, sharing those experiences

are really important and advocating for your own needs and other

people's needs from that experience.

One of the big reasons that it's so important that neurodivergent people

are given better access to work and to the profession is because when we are

fully represented, it actually makes those services much, much better for us.

Unfortunately, the history of psychiatry is not great

in terms of its treatment of.

Neurodivergent people.

And one of the big things that improves and has, has improved is making

sure that people are represented and that people understand and can

advocate for those experiences.

So being willing to advocate for, you know, the needs of people around us,

um, is, is another major part of this.

And I think there's just one more question I'd

like to ask you because.

First point about getting curious about yourself and if you think that

might be helpful, getting a diagnosis.

I think a lot of people get stuck on that.

Where can you go that's really helpful to get a diagnosis.

And I, you know, I'm asking this, you know, having worked as a GP

and it's not always really obvious where people can, can find this out

for themselves, even as doctors.

First of all, if you are female, if you are.

Twice exceptional.

If you are autistic and H-D-A-D-H-D, all of those are risk factors for not being

diagnosed because you don't present.

Stereotypically.

Also, as I mentioned, that having a particular interest in people

is a risk factor for not being diagnosed because you're not

supposed to be interested in people.

You're not supposed to be.

I might be making eye contact 'cause I'm interested in what's

going on in someone's head rather than 'cause I'm paying attention

to them in the convention.

But I'm, but that reads to another person as, oh, they're not, they're not

artistically, kind of like not making eye of a, of a averting eye contact.

So if we're uns stereotypical in our presentation, unfortunately we are

going to have to put together a case.

It's not gonna be spotted for us.

And I think working on that experience, like.

Where, where something is feels off, feels strange.

Following that, having a look at other people's experience and

seeing where you resonate with that strongly, it's like, are there any

people out there who you are like, Ooh, yeah, that, that, that's me.

And seeing who else resonates with that.

The other thing I'd say is following up any kind of mysteries

in your experience, do you have.

Pervasive, like low energy.

Do you have migraine stress, migraine when there isn't a a, a really

obvious external cause you're not going through a particularly high

number of life stresses at the moment.

You know?

Do you have any other differences in experience, anomaly in your experience

being like, well, okay, what.

What could explain though, and just that, that that's that curiosity.

I think also looking at the things that you really enjoy, like really

enjoy being like, okay, where do those point, what strengths do those point to?

And what situations are those potentially associated with as well?

And I think, you know, one of the things is.

If you are wondering about this and it's a regular wonder, it's

definitely worth following.

There is a saying in the community that neurotypical people

don't tend to go through life wondering if they're autistic.

So it is definitely worth following up.

And even if you don't, you know, it doesn't meet a specific

criteria or a specific diagnosis.

The, the experience of exploring it is worth it.

The knowledge about yourself is worth it.

The knowledge about how your experience and your, your, your kind of way of

being and the world differs from others.

Which can be incredibly useful in explaining and kind of triangulating

against all of this stuff.

And then having a, having a label kind of can help, but it, it's

really that journey of understanding that's the most valuable thing.

One, one of the challenges around this is actually there

are very few support options for neurodivergent professionals.

We are starting to see the emergence of neurodiversity groups within.

Um, various large organizations and professional bodies.

So if you're a member of a professional body, I, I'm chair

of neurodiverse it within BCS, the Charter Institute of it, for example.

So check out whatever professional accreditations you have and see whether

there's a community group run by and for neurodivergent people within that.

Similarly, if you work for an organization, there are an increasing

number of NHS trusts I know who have star neurodiversity groups.

So head along to that.

See whether it feels like you see, whether you meet people there who

you are like, oh yeah, okay, we are experiencing the world there.

There is something here.

There are a number of different tests online.

Don't take any single test seriously too seriously.

But if a lot of them point in a similar direction, it's

probably worth exploring.

One of the interesting things, a lot of neurodivergent people.

When they tell people close to them that they have the condition

is people go, yeah, you're like, I think, I think I've been like mask 8%.

I was like, I've got a DHD in autism.

People are like, yeah,

it can be quite a relief.

Can't I remember when I was diagnosed a couple of years ago?

Now with A DHD, it's a bit of a shock.

First of all, I had to go through a bit of a process with it, but actually

in terms of helping me understand what made me tick going, oh, that's why.

That's why it was actually absolutely brilliant and so, so helpful.

So I would encourage people, like you said, just start to explore it.

And I do know that there is a Facebook group for neurodivergent doctors,

and so that might be worth joining.

We'll have to dig out the link to that.

I guess then you can just say to people, well, I think I might

need to go and see a specialist.

Who would you recommend?

Do you know anyone?

And there are all types of coaches and psychologists and doctors out there who,

who do specialize in this sort of thing.

So it's, it's a matter of finding the right professional, but you

need to do a bit of research.

You.

Absolutely.

And I, I, I work with people around this navigating the, the, the

diagnosis process because there are so many pathways and so many options,

and it's not actually a necessarily a desirable thing for everyone.

So having, having someone who understands the, the world, if,

if it's helpful to you to kind of have someone to talk to.

Yeah.

There are people out there.

Myself included, who can, who can talk you through, so you can weigh

up all of the different stuff and work out whether it's worth what's

worth doing and in what priority.

And I think in the knowledge that what a diagnosis or what more

understanding is gonna mean is that just understand yourself a bit more.

It doesn't change who you are, it doesn't make you a different person.

All it does is just.

Connects you with other people that experience life in the same way and

give you some tools probably that other people have used that we know

work that you can then use just to, like I said before, move through

life with a bit more ease, hopefully.

Absolutely.

So, Matthew, you've already mentioned this, but I know that

you do a lot of work coaching and supporting people with Neurodivergency

who are, or who are exploring whether they have it or not.

If people want to get hold of you, how, how can they do that?

The main things.

Yeah.

Neurodiverse, I, I also run a community called Curious being,

which is intended as a space really for this discovery and exploration.

I do, uh, one-to-one work.

Yeah.

With people really around finding, navigating this whole process, getting

the support that, that you need, using the technology and the tools and the

knowledge that we have from psychology to be able to be, play to your strengths

some more, develop those capacities.

I work with organizations who want to be better places for

neurodivergent people and who want to really benefit from this.

If an organization is interested in improving its support for neurodivergent

people, then I'm always very happy to work with them, either in facilitation,

one-to-one with their staff, or, uh, do talks and Right as well.

So I should say I do one-to-one work with, um, with people who

are supporting neurodivergent people, whether they, they think of

themselves as neurodivergent or not.

People can go to, um, matthew bowinger.com/links to get all of that

stuff and other publications and.

Bits and bobs.

So, uh, anything that you'd like, you can find me on

LinkedIn as well on that link.

Thanks so much, Matthew.

We'll put all of those links in the show notes so people can get a hold of you.

Uh, thank you so much for being on the podcast and you know,

this was really in response.

I had a lot of, um, emails in saying, please, can we talk about it?

So if people have been listening, have got any specific questions or anything

else that they'd like to explore around this topic, please let us know.

And Matthew, would you come back again to talk to us in the future?

I'd love to come back and ask some, answer some questions.

The questions were always my favorite bit and he'd love to.

Okay.

There we

are.

Challenge if you guys listening, will email in with your q and a.

Then we'll get Matthew back on to answer them.

So thank you Matthew.

Have a good rest of day and we'll speak with you soon.

Thanks very much.

Thank you for having me on the show.

Thanks for listening.

Don't forget, we provide a self-coaching CPD workbook for every episode.

You can sign up for it via the link in the show notes, and if

this episode was helpful, then please share it with a friend.

Get in touch with any comments or suggestions at hello@unnotterfrog.com.

I love to hear from you.

And finally, if you are enjoying the podcast, please rate it and leave a

review wherever you are listening.

It really helps.

Bye for now.

Just a couple of things.

Firstly, I just get people's consent for podcasts on the cameras.

So rather than make you filler for, are you happy to consent to being

filmed and vi videoed and video and audio, which may go on YouTube clips,

social media, all that sort of thing?

Absolutely.

Just remind me what happens if I say something that I think, oh,

good grief, that was really stupid.

I did say, what do I do then?

you do is, well, A, we can cut it out afterwards.

So if you say something and you listen to it afterwards, you

think, no, I, I don't want that in.

Just let us know.

You'll get to review the recording before it goes out.

Um, b um, if you say something, you wanna repeat it, rather than

just stopping in the middle of a sentence, sentence and repeating

like that, just stop and do the paragraph again so that it, so it

will flow better in the recording.

And our wonderful editor, mark.

Hello, mark.

Mark will edit, edit everything out.

So, um, oh, my boy's back.

Nevermind.

I'm gonna have to just

It is not honestly, I even looking for it.

I can't see it.

Okay, good.

Um.

Okay, let's just go for it.

What I, what I tend to do, so we speak for about 45 minutes.

Is that okay with you?

Yeah.

Um, and I tend to start with you actually introducing yourself.

So if you just do it like a two, like, so my name is br, I'm a consultant in

blah, I specialize in, uh, I do this.

And then we'll, we'll go on, we'll go on from there.

And we met at the, um, it was the FMLM conference, wasn't it?

Is that

Yes, we did.

I can't remember when that was.

Was it April?

Was it?

Yeah.

March april

Yeah, I think it was back in April.

You were doing the breakfast podcast and so I dragged myself outta

bed to come and listen to you.

'cause your topic really was so aligned with what I'm interested in.

Cool.

Right.

So let's just give us five seconds to just like settle

in and then just you start.

And if we have to repeat the start a few times, sometimes happens.

Don't worry about it.

Okay.

Can I ask you something as well?

So when I listened to that podcast from the FMLM conference, I was

thinking, have they speeded me up?

Of course you haven't.

But, uh, I notice that I tend to speak very fast and obviously when I'm a

bit anxious I'll do it even more.

So if you notice, good grief, this woman sounds like she's on speed.

Just

I'll tell you.

Yeah, I'll, I'll stop and go.

Slow down.

Don't worry.

I talk fast as well.

I think doctors do.

I think it's all right.

There we go.

Right.

Let's, and then just start when you're ready.

So just, hi, I'm blah.

Hi Rachel.

Um, my name is Lois Brand.

And I am an emergency physician by background.

I spent, um, a couple of decades working as an emergency medicine consultant,

uh, mainly in Oxford, and I've been working in medical education for the

last, oh goodness knows how long.

But I'm, I'm associate Director of clinical Studies at Oxford

University Medical School.

It's wonderful to have you on

the podcast Lois Thank you

so much for coming.

We are talking today about how to have a sustainable career, and we met at

the uh, faculty of medical and leader.

We met at

the FMLM conference.

That's the Faculty of Medical Leadership and Management Conference,

uh, I think April or May this year.

Um, and we were, oh, let's see.

I always have to redo this.

We met

at the FMLM conference

earlier this year where I was recording a breakfast session.

It was a live podcast recording

about just this Is it possible

to have a sustainable career?

And, and Lois came along and you gave us

your sort of two pennies worth, which

was really, really helpful.

So we've got you on the podcast because I know that this is a, a

particular area of interest for you.

What, what got you thinking about this in the first place?

Lois?

So this, I got interested in career longevity really for personal

reasons, because as an emergency physician, it's a really broad

specialty, but it's also very immediate.

So you have to be ready to deal with all sorts of things from acutely, um, unwell

adults to, uh, traumatize children, um, to psychiatric emergencies.

And you don't really have time to go away and look stuff up.

You have to be right there and ready to do it.

So it is a very, I'm gonna start this again 'cause that's

not what I want to talk about.

right.

That's right.

And let, I'll say bring the mic to your, to your face.

Can you move it just slightly to the side so it's not so, 'cause

what happens, it needs to be not in the direction of flow of your

breath, otherwise you get popping.

Yeah, yeah, that, that's fine.

That's fine.

Then fine.

There we are.

So just start, start that.

Start that passage again.

Yeah.

Phy, I know that you've got a particular interest in career

longevity and sustainability.

How did you get into that in the first place?

So I've always been interested in medical careers and I've

got a, a Masters in medical

career management, which is a little bit niche.

So I've always been

interested and nosy in other

people's careers.

Um, and then a couple of you, well, about three or four years ago, um,

my own career, my clinical career in emergency medicine, which I was doing

part-time, I became more and more uncomfortable with feeling, actually,

this is really difficult to sustain.

It's a very broad, very technical, very immediate specialty.

And I was thinking, how am I going to continue with this?

Um, only working part-time, and I came to the conclusion that actually

I would either have to do more in order to stay sharp enough or to stop

altogether because all the other ways of doing things, which I've tried about

narrowing my focus, um, that, that they, it wasn't, it wasn't, um, okay,

I'm gonna do that last, last bit again.

Um, I'd actually tried to narrow my focus, um, in, in the

emergency department, which had worked for a couple of years.

Um, but unfortunately that the geography of the department

changed at a massive expansion.

Um, and it wasn't possible for me to do that more focused role.

Um, so I felt stuck between doing more in order to make it sustainable,

um, or, or needing to stop.

Um.

And I felt very sad about that, um, and disappointed.

But as I thought about it, I realized that actually there were

people all around me who were experiencing a similar thing.

Um, and despite conversations with, um, my trust, um, there weren't

really, uh, options to allow me to stay and, and develop my career.

Um, so I started to explore what might make a difference.

So what did you start with?

Where did you start with all of that?

Um, I started on a walk with my sister.

We are walking the, uh, southwest coastal path very slowly at the moment.

And, uh, so every, every few months we meet up on some chunk

of it and walk along the coast.

And it was on one of those walks that I just started talking about

what I'd like to do, really what I would've liked for myself, which was a.

Place to think, a structure to think in.

Um, and so I started to think about, um, a day to take consultants or

senior GPS away to a place which was beautiful, um, and spacious and to

encourage really positive thinking about what they can do to make their careers

sustainable, what they want for the next chapter of their lives and careers.

Um, and as a trained coach as well, I was thinking there were quite a few

really simple coaching techniques which we could use with people co-coaching

each other, just peer coaching in pairs.

Um, and so I started to put this.

Together.

Um, and it started to take shape.

Um, and the deanery, the, the Thames Valley Deanery, um, when I made

this proposal to them, they said, well, let's give it a try with

our educators and let's pilot it.

And so nearly two years ago now, I ran the first one in a barn in Oxfordshire.

And um, yeah.

Since then I've done another 14.

Wow.

Obviously very much in demand.

How did all this thinking that you were doing in these days

that you were running make a difference to your own career?

Yes, I think what started with a conversation with my, uh,

medical director after I decided to step away from my clinical post.

What started as, I think there's something that needs

to be done in this space.

I think there's something creative that can be done.

I think there's something that this trust can do to make a difference in

this, in this area, then became real.

Um, and it's, and it, and I could see the difference it

was starting to make to people.

My original concern was that I would just encourage people towards the

exit, uh, that, that people would stop and think and then they'd

think, oh, good grief.

This

is, this is awful.

My set of circumstances is terrible.

What am I doing?

I need to get out.

But actually that didn't happen.

And when I started to get the longer term feedback, three to six

months post the pit stop day, what I was hearing back from people

was that they were able to make

small changes.

Most of them

weren't that dramatic, but they were small changes.

They'd been able to have conversations that they'd been putting off or

they'd had before, without, um, without getting the result that

they needed to make small changes, which would make their next chapter

more fulfilling, more joyful, um, and most importantly, sustainable.

Um, and what I was worried about didn't happen that there

wasn't a mass rush for the exit.

Um, and in fact, so far of the people who've responded to the long-term

feedback questionnaire, uh, only one has actually left her clinical career and

she's gone off to do, uh, she's opened an amazing jewelry business actually.

Um, and, uh, yeah, her stuff's gorgeous.

Yeah, it's really interesting though, isn't it?

'cause I, I worry about that.

I do a, a keynote talk on how to design a life you're gonna love.

A lot of the stuff we have in the podcast is about transferable skills,

uh, career development, what you can do in your different roles and.

Yeah, I was worried, yeah, that it would be mean a ma mass exodus for

medicine, particularly when you got a very burnt out workforce.

A very disillusioned workforce.

But the emails we get back from people are all saying, oh my goodness,

that helped me stay in medicine.

What, what you, you know, what your guests there talked about?

Or this session that we

did, or the Shapes Toolkit or something.

It's given me tools to be able to stay in well, rather than leaving

badly or if they are leaving to, to leave well into a another career as a

positive step as opposed to that's it.

I've had enough.

I'm totally burnt out.

I'm just gonna, I'm just gonna go.

And I think you are right.

When we think about career development, often we are thinking about, well,

I've gotta just have a change.

I've gotta change absolutely everything.

I've gotta do something completely different.

But the reality is often it is just small tweaks in what you do on the day

to day, or just doing a bit less of one thing, a bit more of another thing.

Make, makes a lot of difference.

So when you did your initial sort of leave le, when you did your

initial, you know, going down to focus more, how did that help you?

And then what helped you actually make the transition to, to then

move outta that and try something else over those period of, what,

three or four years was it?

Yes, it was, and I'm trying to remember where

Covid fitted into all of this.

It was pre Covid.

Yes, pre covid that I recognized.

So I, I I, I think everybody that we're all on a sort of spectrum of, of how

seat of the pants we are and emergency physicians are often quite seat of

the pants type of people, I think.

Um, and for the, for that, it, it wasn't a great fit for me because I'm

not a good seat of the pants person, but I am somebody who likes a lot of

variety and change and action and speed.

I like that.

Um, so increasingly I was feeling uncomfortable with all the things

that I needed to be able to do in Oxford, which is a major trauma center.

And so I thought, well, what does the department really need that

would fit with what I can offer?

And I realized that actually, um, care of the elderly

within the department was.

Was an area of need.

Um, and my background is as an MRCP medical background rather

than a a, a surgical background.

Um, I'm old enough to have been pre, um, membership for the, uh, Royal College

of Emergency Medicine, so I've got a a, a foundation in general medicine.

Um, and so I thought actually, I wonder whether that would be something which

would work for the department and also narrow my focus and allow me to come to

work without feeling sick when I drove past the helicopter landing pad where

the major trauma people were brought in.

So that took quite a lot of work actually to, um, to, to establish

that, um, and work out how that role was going to be within the

department and work that out within, um, the rostering and timetabling.

But it did work and it worked really well.

Um, and I felt reinvigorated in my work, I felt, um, valued.

And that's so important, isn't it?

When when we're at work to feel valued and feel that you are doing

a good job, it's so important.

Um, and that did work really well.

And I really enjoyed actually the, um, the new interfaces that I was having

with, with the, the care of the elderly teams and the, um, I was working in

a more multidisciplinary way with the occupational therapists and physios.

Um, so it was a really, really positive time.

Um, and then came two things, covid and also a physical change in our

department, which meant that our department was, uh, grew enormously, um,

in size and we needed to have the two consultants who were on the same time.

Um, one of them needed to be running the department as had always been the

case, but the other one had to be in recess all the time because it was

geographically quite separate from, from the main hub of the department.

And so the luxury of saying the second consultant can, you know, do a bit of

this or a bit of that, or if it's lower, she's going to look after all the people

who are elderly in the department.

Um, we lost that luxury, so I then had to move back into a much more

general role of either running, running the shift or being in recess

and, and dealing with all that stuff.

And then there was covid too.

So I did that role for a few years, um, back in, you know,

as I had been doing before.

Um, oh, I've dropped my AirPod, hold on.

So I did that role.

Again, um, as I had been doing for many years before that, um, and it was then

that I started to think, actually, I'm not sure this is sustainable for me.

What does the next bit look like?

And if I didn't change, I could see the natural history of this

was that I would become less skilled, uh, more uncomfortable

and less I invested far more time.

And what you are talking about I think is something that a lot of.

Older doctors go through and they older people in general.

I've just written a written, I wish I'd written it.

I've just read a really good book by Arthur C.

Brooks, um, I can't remember what it's called.

It will come to me, but it's about sort of the second half of life and

how you create a, a, a sustainable career and how you really thrive

in the second part of your life.

And he talks about the fact that your sort of knowledge and skills

increase when you are younger and they sort of hit a peak, I don't

know, late twenties, early thirties.

You know, you are

really skilled you're really

bright, you're really on it.

You really, you know, you can solve problems really, really quickly,

but that, that declines quite a lot in your, after your sort of

thirties through your forties.

And by the time you know, you're

50 60,

you have much less

immediate Immediate

sort of intelligence to solve those problems.

Your brain works a bit slower and certainly for women

around the age of, you know,

anytime from 40 you're hit by the

perimenopause and menopause, I dunno about you, but my brain

is a bit fried at the moment.

Uh, I can't remember keep, can't remember the name of that book.

Can't remember my own name.

Sometimes no idea from coming or going, which doesn't help, does it?

When you've gotta make quick decisions.

And, and as a consequence, even if we are perfectly well skilled, we

sometimes then feel the feel de-skilled.

And of course you've got the new people coming in with all the new techniques

and they just out med schooled or they've been on the latest training

courses and we compare themselves to them and go, oh my goodness, I'm

just, I'm just not worth it anymore.

I'm, I'm just rubbish.

But actually what happens is that your experience grows,

obviously through life.

Your wisdom grows and so you are much more likely to

spot patterns in things to.

Recognize stuff that's gone before to be able to step back and give some sort

of wise judgment to use your intuition.

And that is a skill that is, you know, not really talked about very much.

That he, Arthur C Brooks talks about it a lot in his book and I

found that so profoundly reassuring.

But often we just expect ourselves to be doing exactly the same as we were doing.

And in medicine it's quite weird, isn't it?

'cause you could, I don't know, I qualified as a gp,

I think I was about 26, 27.

I'll be doing exactly the same thing for the rest of my career.

You know, in terms of seeing patients.

But most other careers, you, you progress up and then you're

doing different things at the end of your career that

you're doing at the beginning.

But as emergency physician, you are still seeing patients the

same way you would've done when you were, when you were 30.

That's not reflected in the structure of what, of what happens

to us in our medical careers.

And we don't value the wisdom, the experience that that, that we get.

And that makes us feel really inadequate, really worried.

We really nervous, worried that we're gonna drop balls and, you

know, some of that anxiety I think is fair enough, anxiety, fair enough.

If I don't know the latest guidance and I'm not so skilled up on that particular

procedure, or there's something wrong, I can see why things get worrying.

But also we compare ourselves to our younger colleagues who can also

stay awake longer without sleep and also perhaps don't have the family

situations at home to deal with.

And all of that now is, does that, is that ringing true at all

to you, Louis

Oh, totally.

Absolutely.

And I, I totally agree around the, the tacit knowledge and wisdom that you gain

as, as you have seen more and more and more have made all the mistakes and,

and you, you just don't really realize that a bit like your, your frog analogy

of the, of the water getting, you don't notice because it's just happening

so gradually over time and it's not so visible, I think to yourself.

I think other people can see that and know that they trust

your judgment as somebody who's been around for a long time.

But what I, and I think others tend to notice more is exactly what

you said about these people who are coming through, who've been

trained in the latest techniques through their registrar years.

And you just think, oh gosh, that's another thing I can't do.

Oh, that's another thing that I,

embarrassingly don't know how to do.

And there was, there was a time a few years ago where, um,

fascia iliaca blocks, um without,

uh, just, just to be done sort of, um, blind with, with

u using, um, anatomical, um.

Landmark techniques came in and we had a great teaching session

organized in the department on that.

And I, I, I thought, great, okay, I'm happy I know what to do.

And then predictably, it was a long time before I actually got some hands

on time to, to do it with a patient.

And increasingly I just thought, oh, actually I'm not

so sure I'm, I'm ready anymore.

Um, it's been a while since that, that training session and all the

juniors were doing it, you know, they could do it with their eyes closed.

It was just easy for them.

And I thought, right, come on, Lois, you've, you've got

to do something about this.

So I thought, the next time I see somebody about to do it,

I'm going to go and watch them.

So I saw a middle grade doctor about a setting up and I said,

do you mind if I watch you?

'cause it's been ages since my training and I just want to refresh my mind.

And he looked at me like he didn't believe me and that I was actually,

you know, assessing him or something.

And I said, no, honestly, I really, I'd really appreciate that.

Um, and he, it, uh, yeah.

Okay.

Um, and uh, and then behind me came, um, a more senior consultant

who I have massive respect for.

Um, he was a real giant in the department and he just whispered

in my ear, uh, Lois, do, do you mind if I watch that too?

And I thought, it's not just me.

It is not just me.

It is very, very difficult to keep up with all the skills and all the

new bits of equipment that come in.

And it's something that we don't talk about enough.

I think it's almost like a guilty secret and it becomes a real discomfort.

But we need to get that out in the open.

We need to talk about it.

We need to normalize that.

And it's just striking me that, I mean, clinical skills,

new guidance and stuff, actually, they're quite easy to learn.

You'd have watched it, you'd have done a few, and then if you're

doing it every day, you'd have just become a total expert in it.

What's not easy to learn is how to deal with a difficult colleague, is

how to deal with yourself and be aware of your own emotions around things.

How to deal with complaints and failure, which we hopefully get

a bit better at as we get older.

The, it's the interpersonal stuff, it's the leadership stuff, it's the, it's the

wise old owl stuff

that really one can only get through going through it yourself, and that,

that's one of the things that really pisses me off about resilience is.

The best way to build resilience.

Go through rubbish, go through crap, go through, go through stuff

that'll build your resilience.

Like,

like no training ever will.

And so it's like, oh, you know the best way to learn how to have

a difficult conversation with

someone.

give difficult

feedback.

Yeah, do training, but go and do it.

Go and have one.

You'll learn what it feels like.

You'll learn what works, you'll learn what doesn't.

Coaching, you can't learn coaching, but by learning about it, you've

got to go and do it, haven't you?

And this is experience that builds up over the years, excuse me.

But we are not recognizing the value of it.

We are not recognizing the value of it in ourselves.

And sometimes we're not recognizing the value of it in our colleagues.

And in my mind, when we, when we pivot our career or we're crafting our career,

we should really be thinking out what have, what am I really experienced in

What can I, what can I help people with?

What have I been through myself that I can now share and help help others with?

I think one of the reasons why I'm doing this work as a career change

is because I've had ADHD all my life.

I didn't realize it.

And that's why I'm so obsessed with like self-awareness and self-help because

I really struggled in a way that I don't think other people did as much.

And so I was reading this stuff and I was thinking, well, that helped me.

Therefore can I share it with, with other people?

So in a way it's, it's like making a message out of your mess, as it were.

And that's exactly what you've got done with this this day, right?

That you were like, there's something I really need 'cause

I'm really struggling here.

What, what would I want right now?

And so when people have had a think about their career, what positive

steps have people actually taken when they've been feeling like

you and I have been describing?

We, we felt like in our careers.

That's actually made a difference.

What, what people done that is, is there a pattern in the things that they're

doing that, that have made a real difference to you, that you've noticed?

Yeah.

So I think, like I said, I've, I've been surprised that that people have

been, now gonna start that again.

Can you ask me that question

Yeah, you might, but if you wanna jot down notes, I'm gonna ask you

yet about pat patterns, what things are there that you've noticed that people

have gone and done that actually,

There's, okay.

There's something else actually that I think would be really useful to bring

out at this point, which is about, um, what surprised me as a theme that

comes out on the day is, is around how people are feeling about their career.

And it's not just about ogre grief.

How can I carry on with this?

Okay.

Let me ask you that first and then we'll ask you a pattern.

Yeah, that's a great, that's great.

Yeah.

So that, this thing about, about wisdom, about experience, but about maybe

feeling that our skills are a bit, a bit lower, that's obviously a theme

that you've noticed coming through.

Um, in all the people that you've helped, have there been any

surprises for you in, in why people are attending these days or, or

really needing help with stuff?

yeah.

So I think one of the things that's really surprised me is

a theme that's come out across all of the workshops actually.

Um.

Is about how people are feeling about their career in terms of almost,

well, not almost everybody, but a huge number of people who come on the

course are really clearly articulating how much they love their career,

actually, how much they love the clinical medicine side of things.

And alongside that is often a clearly expressed sense of grief and loss

about not being able to see a way through to make this sustainable.

And it becomes so that the loss to the system becomes so tangible because

you can see these people in the room with people nodding heads and, and

really acknowledging, yes, I feel that too, of, I wish there was a

way, and I'm not sure there is a way.

What can we do?

Um.

And we do an exercise at the beginning of the day, which

encourages people to think in a different way by using metaphor.

Um, and often that can become quite emotional actually, as people

open up, um, and articulate, maybe identify actually the way that

they're feeling and, and feel.

Actually, I feel sad.

I feel this sense of loss.

So that has really surprised me, but it's driven me more to think this is

something that needs to be addressed.

Um, there's such a lot to lose, um, for, for the system, for our

patients, for the organization, but also on an individual level as well.

There's so much to lose here if we can't find creative ways to, to make

our careers more sustainable as doctors.

And what, what ways have you found that people have done that?

So what quite frequently comes up is people saying, well,

I want to talk about my job plan.

I want to perhaps think about in another year or so coming off the on-call rotor.

Or I want to, uh, work fewer hours and cut down my PAs.

And then they often say, but I've asked before, and it didn't go very

well and it didn't go down very well.

And phrases like cherry picking come up.

Um, and they feel worried about, um, dumping on their younger colleagues

and, and these sorts of things.

Um, so we talk o openly about that.

And the good thing about, uh, getting older, um, when

we're thinking about, um.

Cherry picking is that everybody is going to be in

that situation at some point.

Not everybody's going to get pregnant and have babies.

Um, um, not everyone's going to, um, have a, a, a chronic health condition,

but everybody is going to get older.

And I think that people are beginning to think more about, okay, well I might

have to do a little bit more of the out of hours, um, during my younger years,

but then if I can look ahead and see actually as my career develops, I'm

going to be doing a little bit less of this, a little bit more of that, then

I think it's actually quite positive.

So, so.

Encouraging people to have these discussions to, to make small

changes in their job plans.

Another thing that people are doing, which again, is very, is, is it's not,

um, it's not anything new, is actually planning a sabbatical and taking

that time away to really reflect and think about what they want for their

next chapter, or just taking a break and, and allowing a different pace.

Focusing on their relationships, focusing on their wellbeing.

Now, most trusts, of course, offer that, but I, from my experience, quite,

quite a few trusts don't trumpet it.

Um, and it, you have to delve quite, quite a long way into, into the,

uh, trust intranet to find out how you might actually go about that.

Um, some people have, um, increased the amount of, um,

non-paid volunteering work that

they're doing.

Recognizing

that actually now my children have flown the nest.

I, I don't actually need all of this disposable income.

And actually what I want to do is, is, is work a little bit less, um, for, for

the trust, but actually I'm going to be re-energized by, by going to work

in a, a low resource, um, situation for, you know, a few months each year.

So, uh, lots of, lots of things that, that people have done, but I've just

been so reassured by the fact that almost everybody has talked about

small ways to change, to stay, um, and, and that they're now enjoying

or they see more sustainability.

there's so much in that.

I think the sabbatical thing, that's a no brainer, isn't it?

Because the amount of people that, well, like you said, it was very difficult

to really think straight when you are just caught up in the throes of

busy, busy clinical workload, you're basically just in survival mode.

And the idea that you might have a even an hour to think, like if you've

got an hour, you wanna go and do some exercise or just sleep or go get

your haircut, or something like that.

Not just sort of sit and think, what do I, what do I

really, what do I really want?

And I have never, ever heard of anyone who did a sabbatical or took

some prolonged unpaid leave that didn't get a bit of perspective about

their job and what they really want once their brains are settled down.

And once your nervous system settle down, and I think it takes

a while for your nervous system to settle down so you can think well.

I think it's always quite dangerous when people are in a state of burnout

and they make career decisions because at that point you just wanna get like,

that's it.

Just wanna lose it all.

And you, that is when you are very, very much in danger of throwing the baby out

with the bath water because there will be bits of your job that actually you

are really suited to and you can do.

Um, but if you're in a position where you are just so exhausted because

you've been running from your cortisol, from your chimp has been running,

running the show for the last six months, whatever, then it's impossible.

And what you said about, you know, disposable income plan, a sabbatical,

even if you, even if there's no provision in your contract, you can

save up, can't you, for six months, put a little bit of money aside

every month and just say to your trust, I really, you know, I really

need to go Now you can only ask.

You can only ask, they might not pay you.

But if you said like, I'll do it unpaid or whatever, you might, you

might get what you're asking for.

I was coaching someone once and um.

She was wanting to go down on some sessions and she was really worried

about ask, uh, asking about stuff, you know, well, they, they won't let me.

I just know they won't let me.

I said, well, if they don't let you, what's the option?

She said, well, I'll probably leave and go somewhere else.

I'm like, well, why don't you at least give them the chance to, to

give them what, what you want, because otherwise you're gonna leave anyway.

And that summer saw her, she was like, jumping around.

She said, they gave it to me.

I asked for the outrageous, and they just gave it to me because the,

the other option was me leaving.

And so that worked.

Really?

That worked really well.

Have you found that people have gone and asked for stuff and

surprisingly, they, they've got it.

Yes.

So this, in the long-term feedback, that's a common theme that people

say, I went and had that discussion.

Um, and quite often I can hear, so we, we uh, uh, for quite, um, quite

a few sections of the, the workshop, we'll pair people up to go and have,

um, coaching discussions and we use really simple coaching frameworks.

So that's the sort of takeaway from the day as well.

If people aren't familiar with those and at the end of these, I can

sometimes hear people going, right.

Okay, so I'm going to, I'm going to email you on Wednesday and make

sure you've had that discussion.

So I know that there's, that, that people are, are making

really, really determined, um, decisions to get going on this.

And I'm finding that actually people, I think what makes a difference

that when they go back and have that discussion is that it's been,

their situation has been normalized.

In the balm

um, that they understand it's not me.

I'm, I'm not deficient.

This is just a normal part of development through my career.

It's just that the system isn't properly set up for that yet.

So I think it makes them, it, it allows them to go into it

rather than on the back foot.

And I'm so sorry to be asking, and I'm probably, I can understand

why this might not work very well, going in with a Okay.

I'm a valuable resource.

Um, and, uh, my, my trust will, will want to flex in some way.

If the other option is that they might lose me and not going in as a

threat, but recognizing their value and recognizing that what they're asking

for is very reasonable, actually.

And let's just stop.

I can hear some banging.