Episode 100: Dealing With the Guilt of Not Being Okay With Dr Nik Kendrew
We often think everyone is constantly on the grind. Productivity has become the gold standard of happiness and success. As a result, we regularly compare ourselves with others and persistently tell ourselves we can only be happy when we’ve finished our to-do list. There’s nothing wrong with being hardworking, but this obsession with hustling makes us feel guilty about taking a break even if we’re not okay physically and mentally.
In this episode, Dr Nik Kendrew unravels why we experience guilt when bad things happen to us – even if they’re not in our control. He shares some tips, techniques, and resources on how to deal with guilt, especially in these difficult times and circumstances. Apart from this, Nik talks about the significance of scheduling our entire day to prioritise what matters most. Finally, he discusses why setting boundaries is necessary to maintain our sense of self.
If you want to learn how to deal with guilt, set boundaries, and find happiness, tune in to this episode!
Here are three reasons why you should listen to the full episode:
- Learn why we feel guilty for things that are out of our control
- Discover how we can cope with stressful situations
- Understand why setting boundaries is necessary not to lose your sense of self
[6:10] About the Boggle Docs
- Nik hosts the Boggle Docs. He gets to invite guests and talk about popular TV shows or movies portraying medical issues.
- The podcast gives useful medical advice to make everyone’s lives easier.
- Nik said the show Squid Game is not far from reality. Tune in to the full episode to hear a few of the stories he shared about the topic.
[9:43] Dr Nik, the 100th Episode’s Guest
- Nik was invited over for the 100th episode because he was the podcast’s first guest.
- Rachel is thankful for all the people who offered their time to be a part of the podcast.
- She encourages anyone interested to help doctors and other professionals in high-stress occupations to get in touch. She would love to have you!
[13:16] Nik’s Heart Problem
- On his way to work, Nik suddenly had difficulty in breathing and experienced terrible chest pain. A paramedic immediately came to his aid and found he was experiencing Atrial Fibrillation.
- As he was wheeled out in front of his patients, he felt ashamed. He also felt guilty because his colleagues needed to take over his pending work.
[16:56] After the Incident
- As he was recuperating in the emergency department, all he could think about was that he had to host a webinar on Thursday.
- Nik just felt awful for letting people down even though they told him to rest.
- Guilt means feeling sorry for something we did or did not do.
[18:31] The Feeling of Guilt Among Doctors
- Nik felt guilty for things he could control. Other medical professionals went through this, too.
- Some doctors perceive not getting things under control as a sign of weakness.
- What you feel during stressful situations is a normal physiological response. You are not weak.
[19:41] Give Yourself a Break
- We usually don’t give ourselves a break.
- If you’re not doing what you’re supposed to do, you feel responsible for the people who are left to pick up the pieces.
[20:51] Gaslighting in Health Care Service
- The health care service is already on its knees before the pandemic.
- When COVID-19 happened, primary care had to change drastically.
- From face-to-face consultations, hospital staff must adapt to the triage system and remote check-ups.
- Despite their hard work, health care workers are recipients of gaslighting from the public.
- Listen to the whole episode to hear Nik’s personal experience on gaslighting.
[23:43] How To Cope With Stress and Pressure
- Nik dropped his practice from four days to three days a week. He did this so he could take care of his physical and mental health.
‘I think it helps you to realise that things will get better. You’re going to focus on one foot in front of the other to keep going.’
- It took a while for him to run again because he was worried about his AF diagnosis.
- Practising mindfulness while running made all the difference. For the past few months, he was able to run for 10 kilometres without stopping!
- Tune in to the whole episode to learn how Nik does mindful running.
- When times are tough, it helps to take it one step at a time and keep going.
[27:03] Why Stay In the Present
- Our stress is caused by thinking of situations that haven’t happened yet or reliving events in the past.
‘[Staying in the present] teaches you that within you somewhere, there is some calm.’
- Staying in the present teaches that there is calm within you.
- You can tap into it to cope with what is going on at the moment.
[29:04] Substitute Stress for Happiness
- Others say they’ll only be happy if they get to complete their goals.
- However, there will always be something in our lives that will be unfinished.
‘We feel stressed when there is stuff on, and we know that we don’t have the resources or the capacity to actually deliver it.’
- Happiness is not about the destination but about what you’re doing to get there.
‘Happiness isn’t the destination. It’s actually what you’re doing at the time to get there.’
- If you are enjoying your journey to happiness, that’s more productive and powerful.
[29:55] Why Achieving Your Goals Would Not Make You Happy
- We are preparing ourselves for failure by setting unachievable goals.
- If everything you do is for the future, and you are not enjoying the present, you are completely wasting your life.
‘If everything you’re doing now is for something in the future, and you’re not deriving any enjoyment out of your life right now, you’re completely wasting your life.’
- Rachel talked about the Eisenhower matrix and how it can help with the prioritisation of tasks. Listen to the full episode to know how to do it.
- We spend our time accomplishing urgent tasks. We fail to focus on important things that are worth living.
[34:08] Focus On What’s Important
- Nik got stuck reading Dr Rangan Chatterjee’s book, The Stress Solution, because he did not realise the importance of scheduling his entire day.
- After some time, he listened to Rachel’s podcast with Liz O’Riordan about making time for what matters, and something just clicked.
- He realised that scheduling meant organizing what he would do for the entire day when he was not in the clinic.
‘We are never at the end of that urgent, important list, and unless we actually make time for those important stuff that aren’t crying out for attention…life will just be a bit rubbish.’
- Scheduling made him more productive because he knew what he was supposed to do and where he should be.
- When you block off time to do something, it takes away stress because you know there’s a plan.
[39:27] Set Your Boundaries
- We know what our boundaries are, but we’re not good at setting them.
- When you put others first, you sometimes lose your sense of self. It can lead to codependency.
- Healthcare workers may suffer from codependency because they were taught to prioritise their patients.
- When you are in stressful situations, focus on things you can change.
- Listen to your body. It will enforce its limits.
‘Stress and burnout is not a functional problem. It is a physiological problem.‘
Dr Nik Kendrew is a GP Partner, Red Whale GP, and Update presenter. He studied medicine at the University College London Medical School and trained on the Maidstone GP Training Scheme.
Nik is passionate about medicine in the media and believes it is a powerful medium to educate people about their health. He is also known to have vast experience in his field. From 2006 to 2014, he was a Partner at Stockett Lane Surgery in Coxheath. Afterwards, he became an accredited GP Trainer in 2011. Nik wak also a part of the Urgent Care project for admissions avoidance with the West Kent Clinical Commissioning Group. He has also worked as a GP in Accident & Emergency.
Nik hosts the Boggled Docs podcast. You can also reach him through his Twitter account.
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Dr Rachel Morris: Is getting the day job done right now overwhelmingly hard? And, do you ever feel guilty about the things that happen to you that are beyond your control as a result? Perhaps things like exhaustion and stress or a serious health problem. Meaning, you have to take time off which may leave your colleagues in the lurch.
This happened to this week’s guest and you are not a frog regular Nik Kendrew. He actually ended up in resus with a cardiac problem, worrying about who was going to do his on-call for him. Whilst we may look back on the situation with incredulity, many of us can recognise similar behaviors in ourselves. And, this leads to us not taking time off when we really need it, soldiering on for far too long, and sacrificing our own health and well being for a misplaced sense of guilt about our own limits.
In this, our 100th episode of You Are Not A Frog, Nik and I chat about this overwhelming sense of guilt that we can feel when bad stuff happens. We talk about the small things that Nik has found helpful as he copes with an escalating workload in general practice. And we chat about a whole host of tips, techniques and resources that we’ve discovered over the last few months that have helped us cope with difficult times and circumstances.
So listen, if you want to find out why we need to stop feeling guilty when bad stuff happens to us. A particularly effective way of managing your to-do list, which actually works. And listen if you want to find out how mindful running principles can actually help you get through a difficult day at work, and why achieving your goals in life is not the thing that will make you happier.
Welcome to You Are Not A Frog, the podcast for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP, now working as a coach, speaker, and specialist in teaching resilience. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water. We hardly noticed the extra long days becoming the norm and have got used to feeling stressed and exhausted.
Let’s face it, frogs generally only have two options: stay in the pan and be boiled alive or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. It is possible to craft your working life so that you can thrive even in difficult circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues, and experts—all who have an interesting take on this. So that together, we can take back control and love what we do again.
Thank you to so many people who’ve shared the podcast with friends and all the listeners who have emailed, giving me feedback. I always love to get emails from people telling me how the podcast has helped them. And I feel so grateful to all the amazing guests who have shared their time and their wisdom.
Now, I’d love to hear from you. Is there a particular topic you’d like to see covered? Are there any guests you think we really need to get on? Or would you like to come on the podcast yourself if you’ve got something to share? Or an interesting take on how to beat burnout or work happier? You may also have some questions you’d like answering. If I can’t answer, then I’ll probably know someone who can. So, just get in touch with me at firstname.lastname@example.org.
And finally, if you’re enjoying this podcast, please tell your friends and colleagues about it. Or perhaps share your favourite episode with them. And please leave me a rating and a review if possible. This really helps the podcast to be discovered by others, and it also makes me really happy. On with the episode:
Totally fantastic to have with me back on the podcast. Dr Nik Kendrew. Hello, Nik. Good morning.
Dr Nik Kendrew: Good morning. How are you?
Rachel: I’m alright, you know what? I have just been on a dog walk.
Nik: Amazing and fast. And that is how far did you go?
Rachel: Literally around the block and you’re going, why is that so amazing Rachel? I can hear it in your voice, because I don’t have a dog.
Nik: Okay. So you borrowed one, or you’re walking with those invisible leads.
Rachel: I went with that, I want a dog walk without a dog. And that is because I have been sitting in my office there, staring at a screen and then, and it’s difficult to get out, isn’t it? It’s sort of six o’clock when he wants to get out. And I was moaning to a friend who’s a personal trainer about it. And she said, ‘Oh well just go for a quick walk before you start anything.’ And I thought well, my time before I start work is where I sit down and I do my sort of prayer meditation app.
So, that won’t work. And then I thought hang on a sec. What if I did that whilst I walked? And so I took the imaginary dog for a walk for just like 10 – 15 minutes. It was brilliant. It made a big difference actually.
Nik: I once got a, this was from a patient. And this parcel turned up one day as his great big long parcel, probably a bit, probably about four foot long but quite narrow. And I was like ‘What on earth is this?’ And he said, “Oh, open it.’ And I was like, ‘okay,’ so I opened it. And it was one of those comedy dog leads without the dog. So it’s like, you k
now, it’s like you’re walking in a visible dog. And they said, ‘I thought you looked a little bit stressed the other day, so I wanted to put a smile on your face.’ And I just went, ‘Wow, thank you very much. Goodness me.’ So yeah, so I think she was expecting me to go for an imaginary dog walk as well.
Rachel: Please tell me that you have actually used that.
Nik: Maybe in the house.
Rachel: Oh come on, Nik. Please, please. I want you to tweet us some photos, the view of an imaginary dog with your lead. I need to get myself a lead there.
Nik: You do? Exactly. People will stop and stare.
Rachel: Yes. It’s your third or fourth or fifth? I can’t, I’ve lost count how many.
Nik: Might be my fifth now? I think fourth or fifth?
Rachel: Yeah. Well, for people that haven’t encountered you before, which is very few. Just tell us tell us a little bit about yourself who you are.
Nik: Well, hello, I’m Dr Nik Kendrew. I’m a GP based down in the South East, down in Kent. And I have a particular interest in medicine in the media, and how that’s portrayed, and how that can be harnessed and used to make our lives better in primary care, but also, our patients’ lives better as well.
And on the back of that, I have launched my own podcast, which has been going for a year now called Boggle Docs. And every week we get guests on and Rachel’s been on a few times. And we talk about hot TV shows or movies, which have got medical issues that patients might have seen, which would bring them in to see us and the whole premise is that we talk about that show, look at some resources linked to it.
So that basically our listeners are ready for that patient when they come in. And they go, Oh, I know what you’re talking about. I’ve heard all about that. Here’s some resources. And it makes everybody’s lives a bit easier.
Rachel: It’s such a great podcast. It’s not just about that, the TV shows and being equipped to talk to patients. It actually contains some really great advice and some really good stuff. Now, Nik, when you say, when you say hot TV shows, we’re talking about hot topics, right?
Nik: Yes, we’re not talking about anything after the watershed or anything naughty? Not like, did you hear about them? There’s an angling website, which has been hacked. And it’s redirecting all their traffic to an adult website. So there’s nothing like that, actually.
Rachel: So yeah, so have a listen to Boggle Docs, I think it’s really good. Even if you’re, even if you’re not a doctor actually. Lots of quite useful, quite useful health advice on there as well. It’s just really interesting interviews about some of the TV that’s on at the moment. I haven’t quite got to listen to the one about Squid Game, but I’m really interested to hear about that.
Nik: Squid Game. It was very interesting to talk about. I need to finish watching Squid Game. I’ve watched a few of them, some of them through kind of half closed fingers, because it’s quite shocking to watch. But it’s been interesting how it’s grown, because there’s been several landmark episodes and, and it was grand going along nicely.
And then in I think, January, February time, It’s A Sin happens, which you might have seen on Channel Four. And we did a couple of episodes around that. And then literally, the whole podcast just went stratospheric, because we had an amazing couple of guests talking about it and, and it was such an emotive topic and and then we did the follow up episode.
And people had, had dialed in and left voice messages about their experiences on the wards. And we had nurses contacting us and leaving messages from, they worked on the wards in the 1980s. And they’ve seen some absolutely horrific things. There was one nurse that contacted us to say that she had, she’d been forbidden from going into a room which had an HIV patient in it. And, and she said, and just one day, I just thought you know what, I’m going to do it and she went in, and she found this poor patient all alone. And then there were sort of urine bottles all over all over the place, no dirty plates, and nobody been in to clean their room. And she said, ‘Goodness me,’ and, and she cleaned the whole place up. And she made them more comfortable. And she chatted to that patient.
And just hearing that, from a personal story. And that’s when I realised that, that, that what we were doing was quite there’s something so special to be able to connect with the audience that way for them to share their experiences. I feel really privileged to be able to be involved in that kind of thing.
Rachel: Yeah, I mean, wow. That’s such a moving story. But I think it’s about connecting with the audience when podcasts are brilliant, aren’t they? And the reason why I’ve got you back on this episode in particular, well, I’ve been wanting to get you back for a while anyway. But this is our 100th episode on You Are Not a Frog
Nik: Congratulations! That’s amazing. 100, wow. Because it’s been two years now. How long?
Rachel: Over two years? I think we started in September 2019. So just, just over two years, We’ve had a few gaps. You know summer holidays and Christmas and stuff like that. So we reached 100, and you were on our very first episode.
Nik: I was, I was. And also, I was, because I interviewed you for the one year anniversary, didn’t I? So we turn the tables.
Rachel: It’s just been a fantastic journey. It’s been so interesting. And I mean that you’re I’m sure you’ll massively agree with me. The podcast is all about the guests, isn’t it? And actually, I’ve just had such amazing amazing guests and amazing people agreeing to come off on or, or even offering to come on, which is definitely beyond the call of duty. I’m just so grateful for everyone who’s, who’s offered their time. And if there is anyone out there who has got something to say that they think would be helpful to help you know, doctors and other professionals in high stress jobs, speak better and work happier. Get in touch, because we’d love, love to have you on.
Nik: I was just gonna say that on the back of the one year anniversary episode, I said to you. Well, I asked you who would be your dream guest? And who did you say?
Rachel: I said, I said Rob Bell? And I thought there’s no way in a million years Rob’s gonna come on the podcast. But, he did!
Nik: Exactly, amazing!
Rachel: Yeah. Did you listen to that episode?
Nik: Yeah, it was very good. Very, very good.
Rachel: He’s, he’s just an amazing human being. I was totally chuffed. If you listen back. I know that they’ve regular listeners, listen, that you’ll just hear the nerves in my voice. It’s like, well, if I say something wrong, but what if I asked something really stupid, but actually, he was so gracious. And you know, he’s such a pro. And he just like, say one thing. And off he goes with all these amazing ideas and stuff.
So yeah, dream, dream guest, Rob Bell. And I’m thinking, ‘Oh, my goodness, where do we, where do we go from here?’ But actually, I think it’s really great to have some of these, you know, big names on. But I think what’s great about my podcast, and yours as well, is that you don’t need to be famous, that’s really important to say.
Nik: Absolutely. And I’ve had some amazing guests as well. And there’s been so many of my guests that sometimes you kind of think, you know, I wonder what angle they’re going to come at it from, and, and it’s, they always surprise you. And it’s amazing the engagement you get. And, I’ve been blown away as a Boggle Docs running club, which I didn’t know about until they started tweeting about it. And there’s a, there’s a hashtag for the Boggle Docs running club. So it’s really lovely. They often listen to Friday morning to the podcast.
Rachel: They run together or they running separately and sort of messaging each other?
Nik: I think they’re running separately and then just messaging each other, which is just lovely to see. That’s brilliant.
Rachel: That is so cool. Oh, well, well done you. So we thought, you know, the very first episode we did, I think was was that it’s called Why Doctors Get Ill, I think it was and you were sharing some of your experiences. And then we’ve done some sort of self help book groups, which people have enjoyed. And I guess I wanted to do a bit of a hybrid really about, you know, I guess another self help book crew.
But, but let’s, I think we both expanded into self help podcast, as well, obviously, since we started we’ve had COVID. And these ways of helping ourselves survive and thrive, it no longer feels a bit rubbish to be talking about self help, does it, it’s actually really, really important to be talking about self help. And I think if you’re if you’re feeling that you’re not thriving, and you’re not then looking for the resources to make the change, you need to get he completely missed the check, because actually, there’s so much out there isn’t there,
Nik: There is so much out there. It’s about filtering it out. So I think we all find our own path. And what works for us is interesting, because when we, when we did first, have a chat for the first episode we were talking about when doctors get ill. And at that point in time, so I talked about when I had leptospirosis when I was on my elective and the impact that they had on my life. And the reason I talked about that was because I was at the time, I was also having some, some difficult problems with my heart. But, since then, it’s kind of all come to a head and in fact, so I was having some investigations around the time of the first episode, and then in November 2019, so just before the whole COVID thing hit, I was on my way to work. And on the back of these heart investigations.
My consultant told me to get some GTN tablets, because I was getting chest pain. And, and it’s worst, I wasn’t able to run properly, and I was getting chest pain. If I walked up the stairs at home, I’m getting really short of breath. And they’ve done all these tests of cardiac MRIs in bits and pieces. And I remember that morning, just not feeling quite right. But not feeling unwell. Just feeling. I remember thinking, Oh, I wonder if this is cardiac nausea. So I wouldn’t leave the house until I’d found my in-date GTN tablets, just in case I needed them. And I drove to work felt fine and just a little bit old.
And then I literally as I got out of my car, I’d put my foot on the car park in the staff car park, and then suddenly, bang, I couldn’t breathe. I had really bad chest pain. I had terrible palpitations and felt absolutely dreadful. And thought, Whoa, what’s going on? And I went into the building, and all I could think was on GT, Doctor, what am I going to do? And I went up to the lead receptionist, and I, I couldn’t. I was so short of breath I couldn’t actually speak.
And I had to mime to her. It’s my heart. Can you call an ambulance? Which is quite a comedy mime, when you think about it. And it’s like, almost like all three syllables, you know, as you can see what. Okay, I’ll get an ambulance, she got an ambulance and I went into the, we’ve got a treatment room where we do ECGs and stuff. And our practice paramedic came in and she did the ECG. And I remember when she just handed it to me, and she just said, You’re in fast AF. And I was like, ‘Oh, my goodness.’ Because I knew there had been something wrong, but nobody managed to pick it up.
And I’d felt what’s really odd is that I’d felt the same symptoms, but they’d only been very brief, when I’ve been doing things like presenting a course. And I’m thinking, ‘Oh, this is only this anxiety.’ And I’ll be checking my carotid pulse, whilst there’s another presenter on stage thinking, ‘this is a little bit irregular,’ but then it was finally getting and okay, must be just anxiety. And then to have the diagnosis, and then, then to be taken to hospital, because my blood pressure is quite low, my pulse was going at about 170-180. And there’s quite a level of shame to be wheeled out of your own waiting room in front of all the patients by the ambulance crew and taken to hospital. I’m pretty sure I heard somebody say, ‘Oh, who am I going to see now?’
Rachel: Yeah! What about me?
Nik: Exactly. But also the level of guilt that you have about you feel so unwell. But equally, you’re thinking, Oh, my goodness, I’m meant to be duty doctor. Who on earth is going to mop up that mess I just did? And I felt so guilty. And I was in hospital for about 24 hours or so, maybe a bit longer. And that whole time I remember being wide awake in the morning. And just this terrible guilt thinking, What’s tomorrow going to be like for my colleagues, because I just left them in the lurch?
Rachel: Well, Nik, that’s such a powerful story. And for me that, the fact that you were sat in the hospital, feeling guilty. Now, unpick that a bit for me, what were the stories going on in your head?
Nik: I just felt this terrible responsibility that I had to be doing what I was doing. And what was even worse, was I feel like I’m in confession now. So basically, I was in recess. And I was not feeling very well. But all I could think of was that I was meant to be hosting a webinar on this on Tuesday. I’m meant to be in Reading, the hosting a webinar on Thursday, and I was texting people on the team game. ‘Don’t worry, I’m in resus, and I’ll be fine by Thursday. No problem.’ And they were calling back, going ‘I think you just need to get yourself better. And you know, I’m sure we can cope on Thursday, it’ll be absolutely fine.’ But again, it was that level of you know, I felt so awful about letting people down at such short notice. Yeah, it’s the I don’t know what’s the matter with me.
Rachel: Only a doctor: ‘I’m in resus, but don’t worry, I’ll be fine by Thursday.’
Nik:No, it just sounds so ridiculous, doesn’t it?
Rachel: It’s crazy. But for me, it’s a story that you’re telling yourself. So guilt is when we feel very sorry for something for one of our actions. It’s something that we’ve perhaps done or not done. Right? So you’re sat there in resus with a health condition that you’ve been trying to sort out and then feeling guilty. I can understand how you would feel concerned that there’s no one to do the webinar, or worried that there’s no one to do the webinar. But this, this guilt implies that there’s literally anything you could have done differently or about it.
Nik: Yeah, I think the other thing was that I would want to do this webinar as well. But I was like, ‘I’m not gonna be able to do it but I can, I’m fine. I feel,’ I think I was trying to convince myself I was fine. I really just want to reassure myself.
Rachel: And we see this a lot with doctors, Nik, this sort of feeling of guilt, when, when something happens to them, it’s completely out of their control, that they blame themselves or they feel that. And in your case, I’m sure you didn’t feel like this is a sign of weakness or anything like that. But I have been coaching a doctor quite recently, who was at the end of his tether. I mean, the workload had been so bad, and there were so many issues in, in the practice, out completely, out of his control, nothing to do with him.
And yet, he was apologising for feeling like he was feeling like, ‘Oh, I’m so sorry. You know, oh, I can’t believe I’m like this. What is wrong with me? You know, why am I, why am I so weak?’ Almost. And I’m thinking, ‘What do you mean? Why am I so weak?’ by events have conspired to put that amount of pressure on you that what’s happening is you’re having this normal physiological response to what has happened. And then your first response is to blame yourself, oh, it’s me, because I’m weak in some way.
Nik: Exactly. And I think the thing is that we just don’t give ourselves a break, do we? And you’re right. I mean, I didn’t think I felt weak, but there’s this level of responsibility that if you’re not doing what you’re meant to be doing, then somebody else has to pick up the pieces. And I think what’s really, if you think back so at the moment, we are all firefighting in primary care, and, and in the health service generally because of the pandemic and everything that’s happened since then. But it’s very easy to forget.
So this happened in November 2019, before all of that, and I keep reminding myself and others that actually, we were on our knees before the pandemic hit. And it’s so easy to just blame it all on the pandemic, but it’s not at all. And, and I think that, the, the effects that the pandemic’s had on top of it have been far reaching. But this goes back much further than that, doesn’t it?
Rachel: And how much do you think that we could have controlled? What’s happening now, or we could possibly control it just by putting some more boundaries in? Or do you think it was always just going to be inevitable?
Nik: Well, I think you know, people were talking about, I can see the NHS imploding or collapsing way before the pandemic happened. And then the pandemics happened and it brought everything to a halt. And I think the thing is that it would have been difficult enough for us all to pull together. And that’s what we did in primary care, we all pull together and, and we changed literally overnight from being everything was a face to face, mostly, to changing it to be completely totally triage first to be able to speak to people first and then bring them in, they needed to be brought in, which we did.
And, and we weren’t, you know, there’s press releases that say that, that you must do most of your consulting remotely. We can all find those, we can all prove those. And then what’s happened since then, is that that’s almost being used as a rod to beat us with and say, well, you’re just seeing people remotely now. And but, but this, this gaslighting of the public by the press and the government I don’t get why, what, what are they trying to achieve and just, just to show how effective the gaslighting is.
So all the way through the pandemic, you know, I’ve been doing my share of duty doctors and stuff, and I, I’ve been seeing patients face to face when they need to be seen. And we have a cleaner that works in the practice. She starts her shift about five o’clock and goes through to when she’s finished. And so when your duty doctor particularly, she has seen me walk up and down the corridor at work in my PPE, you know, apron mask gloves, seeing patients in a hot room, going back to my room doing stuff in there, back and forth. You know, she goes, ‘Oh, Hi, how are you doing?’ And we’d say, you know, say hi.
And I roll my eyes go here we go again, kind of thing. And she came into my room a few weeks ago, having been reading what’s in the papers? And she said to me, ‘When are you going to start seeing patients face to face again?’ And I literally, you know, I just said, ‘Sorry, what’s what, what do you think I’ve been doing?’ And she went, ‘Oh, yeah, no, of course you’ve been seeing patients. Why did I think that?’
I just said, Well, maybe it’s you know what you’ve been reading in the press? Well, yeah, well, the press have been giving you guys a really hard time. And I just thought, wow, you know, somebody that has actually seen us seeing patients face to face actually believes that then it just shows the power of this gaslighting manipulation, doesn’t it?
Rachel: Yeah. Well, our colleague Gandy from EGP learning. He said he’d finished examining a patient, the patient was putting on his shirt. The patient says to him and says ‘So doctor when are you going to start seeing patients again?’
Nik: Just, yeah. No words.
Rachel: No words, no words. So lots of pressure in the past continued pressure now and you are still doing a huge amount of clinical work. Nik, what have you put in there to help you know have there been any particular solutions, any methods, any systems any books, any podcast? What is helping you survive right now?
Nik: So there’s been a few things. And one of the main things I have to thank you for, so thank you in advance. So basically, we had a chat a while ago, and you said to me that because I do other stuff as well, that it’s I need to sort of rationalise my clinical work. Because I was doing eight sessions, so four days a week in general practice. And I was trying to squeeze everything else in.
So I dropped down a day to three days in general practice for my own sanity and for particular for my physical health as well because of what happens with the AF, which is fine now. And it’s all under control. And it’s great. So after I’d had my diagnosis, and I was on the right medication, it took a while before I would have the confidence to go for a run. And ever since then I had, if ever I got a twinge of chest pain or a bit shorter breath, I would stop because I thought ‘oh my goodness, I don’t want to send myself back into AR.’ And I’d go a bit easy, have a pause, and then go on again.
So, I literally for about a year, I wouldn’t have been able to run even for a few minutes without stopping because I was taking it as easy as I could. And so I, you know, I was used to doing trainings for half marathons and stuff. And so it just felt really odd that I couldn’t, you know, run for more than two minutes without stopping. And then I was listening to Headspace more and more. I really rate Headspace. It’s fantastic, I have a subscription to it. They don’t pay me or anything. I don’t, I’m not promoting them from that respect, I just think they’re good. And they have a running app. And so I got a fitness watch, a smartwatch about a year ago. And I use the Headspace app on that to go running. And mindful running has completely transformed my practice of running. So in the last few months, this is such a major step forward for me. I’ve been able to run to 10k without stopping, which I haven’t been able to do for 18 months or more, if not two years. And, and what they get you to do is to, to kind of start off and you’re more aware of your surroundings.
And so you’re not thinking about your running, you’re just thinking about what’s going on around you. And then they get you to concentrate on your feet, and about your feet hitting the floor and the rhythm of that. And then they start you counting. And they say you can, you can either, depending on your attention span, you can count to 100, if you want to, or you can count to 10, wherever you want to do, I count to about 20. And once I started doing that counting, that’s when it kind of broke that barrier. And I could start running and almost enjoying it again, and just running and just keeping going and not worried about my heart and stuff, I think because I was so focused on, ‘oh my goodness, what’s that? What’s that?’
So with this running, and the counting, it’s really made a difference. And, when you are on a difficult part of your run, you can drop down and count to 10 or whatever is a really steep hill, one to one, two, but whatever you do, just to keep you going. And, and I think often it feels like it’s a bit of a metaphor for life as well. Because, you know, some days, we have rough, rough, rough times, and particularly when we’re duty doctor or something we might have been bombarded with stuff. And I often feel that I’m under one two part of my run, when I’m a duty doctor. And but it but it, I think it helps you to realise that things will get better, you’re going to focus on what one foot in front of the other to keep going. And I just found that really, really transformative for my running practice, and my mental health too.
Rachel: That’s really important. So I know that when I do webinars about stress and anxiety, and particularly the ones to do with Dr. Caroline Walker, the joyful doctor. We talk about this fact that, you know, most of our stress is caused by either pre-living stuff that hasn’t happened yet, or reliving stuff that’s in the past. And so like when you’re running if you’re constantly fixated on ‘Oh, no. Is my heart gonna be okay? Is it gonna be okay? That’s really stressful, right? And like when you’re a duty doctor, you’re fixated on, when am I ever going to finish? Is it gonna go pear shaped? It’s gonna be awful. That’s really difficult.
It’s very difficult to cope with. But yes, if it’s just, Okay, what’s the next, next right action? What’s the next step? What’s the next thing that I have to do? Just staying in the present moments, really, really powerful, difficult to do, but really powerful.
Nik: It’s a great technique to learn. And I think that’s what’s really helped me is to running as always like the practice, that makes sense. And what’s also been really an amazing revelation and listening to other relaxation things as well is that whatever is going on around you, it teaches you that, that within you somewhere there is some calm. And if you can tap into that and find that even if it’s just listening to your breathing or, or slowing your breathing down for a bit. It can make all the difference to be able to cope with what’s going on at the moment.
Rachel: Yeah, and I was listening to something the other day actually a podcast I’m still halfway through. So I haven’t finished it. But they were talking about this calming yourself. And I guess it’s getting yourself out of that sympathetic fight flight or freeze and down into your parasympathetic zone. And that’s how to beat stress. It’s not about when I finish that really difficult task, I won’t be stressed or when I’m when I got rid of this work, I won’t be stressed. Or when I have done this, when I’ll have done that. Because actually, there’s always going to be support, it’s going to be something there’s always going to be something else, there’s always gonna be something in your life that is unfinished, or not quite right or threatening to be a complete disaster, always.
Nik: Exactly what you just said, you could substitute the word stress for happiness as well. Because if you say, Well, I’ve completed this task, I’ll be happy. Or what I’ve learned is that happiness isn’t the destination. It’s actually what you’re doing at the time to get there. And if you can be happy doing that, and that’s so much more productive and powerful than, than actually aiming for this unattainable happiness that you’ll never get to.
Rachel: Yeah, that’s true that there’s a lot of research about happiness. And one of the things that was really interesting is if you set these lofty goals to your business, so they looked at entrepreneurs who had these amazing startups and things and it’s like, if I get to this, I will be happy if I get to this goal. And they compared how people felt when they achieved the goal compared to how people were feeling on the journey. Actually, they were happier on the journey than once they have achieved the goal because you choose something like okay, well there you go. What’s next?
Nik: Yeah, exactly. And it’s, you know, I think the thing about these ridiculous goals is that we set ourselves when they are completely unachievable, then you’re setting yourself up to fall on you.
Rachel: And also, there’s that thing about if everything you’re doing now is for something in the future, and you’re not deriving any enjoyment out of your life right now with your you’re completely wasting your life. I mean, there is something to be said about, you know, I’ve been doing quite a lot of work with trainees recently. They, yes, sort of have to put up with a few jobs that you really don’t like when you’re training, don’t you in order to, to get to where you want to be.
But you can see an end to those jobs. And you know, that if I just put up with this for, you know, a few months, I’ve done that placement, I’ve done it, we’ve got that box ticked off, and I can progress. But if you’re thinking, Well, I just need to put up with this for a few years, or it’s going to be like this, till the kids leave home in 10 years time or, or whatever. That’s, that’s a complete waste of your life, your life if you’re in, in situations that you’re not enjoying, and you are only doing stuff for, for future gain. And I guess it said, one thing for future gain might be if you’re only doing it for the money, for example.
Nik: Exactly. And I think for me, it’s about to try, and be happy and less stressed. It’s also about managing my time better. And about getting things done in a way that’s less firefighting. And I think we’re all firefighting so much at the moment, and you’re, I’ve heard you talk about it before. And it’s such an amazingly brilliant concept to get to grips with when you talk about things that things that you have to do now, things that you can do, maybe tomorrow, but so basically helps you to prioritise your—
Rachel: The prioritisation grid. Yeah. So it’s based on the urgent, important grid. So you divide stuff into urgent, important and you’ve got, you’ve got four boxes. Yes. Yeah. Originally was the Eisenhower matrix, actually. Very old, old system. That was really helpful.
Nik: Yes. And so can you just talk me through just to make sure I’m getting it right?
Rachel: Yeah, so it’s a simple two by two diagram. On the x axis, you’ve basically got things that are urgent things and that are not urgent. And then the y axis, you’ve got things that are important things and that aren’t important. So you end up with four quadrants. So you end up on the top row, you’ve got things that are important, but some things are urgent and important. Some things are not urgent, but important. And the bottom row, you’ve got things that are urgent and not important, and you’ve got things urgent, not urgent, and not important. And we use this all the time in the training, because we get things really muddled up. We think that if something is urgent, it is automatically important. There’s that thing. And we also think that there are lots of things that are important, that are just absolutely not important.
And so you know, things that are urgent and important that are in that box, you just have to do it, you have to do it now, your typical on-call day. You’ve got a potassium of eight, sort that out right out, right. But if we spend all our time just doing that urgent stuff, we never get on to the stuff that is not urgent, but important. And if you think about the stuff in your life that is not urgent, but important. That’s often stuff that makes life worth living and is really, really important. It’s like, date night, for example. Yeah, a date night is never urgent, well until it becomes urgent. And we’re like, we can’t bear each other anymore, we probably just need to get a drink. Oh, I quite like you actually. Oh, thank goodness. I just think a life spent working in the urgent, important bits is really rubbish.
Actually, I did hear someone say recently that the busy life is the empty life. And I think when you’re just in that quadrant, it’s difficult. But here’s the rub: is that often, we are never at the end of that urgent, important list. And unless we actually make time for those important stuff that aren’t crying out for attention, we’ll just get more and more stuff that pings into the urgent, important box. And life will just be a bit rubbish.
Nik: And that’s I think that’s my problem at the moment is that I keep not doing stuff that’s non urgent, but important. And then and then as time goes on, it becomes urgent, unimportant, and then I had to do at the last minute, become better at that. And I’ve been looking at how to do that. And this came up because I’ve been reading Dr. Rangan Chatterjee’s book, The Stress Solution, which is very interesting.
So I basically got stuck on one point, and with self help books, if they’re telling me stuff that I don’t have to go away and do practically, then I kind of read them fairly quickly, and I don’t get stuck. Whereas something happened with this book. And I just got stuck and I just left it for months because I thought I just haven’t got the time I can’t do that. So just didn’t feel like I could progress with that. And the bit that he talks about is scheduling your entire day on a train ticket. Oh goodness, what on earth? Why would I want to do that? get you more stressed. So I just didn’t do it basically, and, and the books out on the shelf for a bit. And then, I was thinking about how actually I need to make time for these, these things that aren’t that important, but they’re not urgent yet I need to, you know, regularly make time for that. And this is perhaps might be something that would help with that. And then I listened to a couple of your podcasts about time management.
And and there’s one, particularly with Liz O’Riordan, who was on talking about that, suddenly it clicked, I thought, Oh, she’s talking about scheduling your day, as in not so much your your clinical days, but days when maybe you’re not clinical, but you’ve got lots of things to do. So I thought, well, I’ve got nothing to lose. So I literally one morning before my non clinical day, I scheduled everything I needed to do. And in fact, it was a day when I was producing my podcast. And, and with I don’t know about you, but when I make my podcast episodes, it’s almost like a jigsaw. And I know all the different elements that need to be done to slot together to make the episode. And so because you have done that so many times, you know, and they can be done in any order, then you just slot them together, and it makes the final episode. And I put every single thing on that day into my diary. And I even put in, you know, lunch to make sure I had lunch.
I even gave myself some me time for half an hour just to relax and not do anything. And you know what, it was the best day, the most productive day I’ve had in such a long, if not ever, it was an absolute revelation. And I think because I’m quite a complete finish. And I like to look at a list and then what I’ve done. And so I could see on my schedule, this is where I’m meant to be, this is what I should have done. And even if you kind of fall behind a little bit, and you already know a half an hour behind now, it actually is really helpful to keep your motivation going. Rather than if you are running around trying to put fires out everywhere and not in control of the whole thing.
It’s a completely different experience. And so I have to say, well, thank you to you, and to Liz. And to everybody that recommended this. It’s life changing. And it’s been phenomenal. So thank you.
Rachel: It is a really important technique. And the episode I did with Anna Dearnon Kornick, she actually said that you guys, so GPS and doctors and people that have sort of things scheduled in clinics scheduled in are really fortunate because your almost your time is managed for you. And it is people who have this, you know, whole day they’ve got loads to do, but they have to arrange it themselves, it’s almost quite a lot harder.
And if you’re anything like me on a Myers Briggs piece, so having a full day schedule is like, ‘Oh, where are my options? What if I want to do something different?’ And it can be a bit counterintuitive, that it’s going to make you feel better and actually freer.
But I find that if I have planned really meticulously and blocked off time, my mental load is reduced so much. So I’ve heard a lot recently about the fact that rather than making to-do lists, you should time block your diary. So you put tasks straight into your diary and block off the right amount of time to do this. And I thought well, that’s ridiculous. That just sounds like what all what’s going to happen is you get this massively overshare overstuffed diary.
But you know what, I found myself here a few a few months ago, looking at all the I had a lot of ups in a lot of conferences, a lot of Shapes toolkit training, a lot of delivery stuff, and, and it was all happening over two weeks, and I’m looking this week. What am I going to do and what am I gonna prepare? Or what am I going to do? And so I went through the diary beforehand, blocked off the time.
So it was an hour here, prepared this slot an hour here prepared that an answer. Once I had blocked off my diary with the slots when I was going to prepare it all, it was almost like all my stress was completely gone. Because I knew I had scheduled time to prepare to get it done. To do it. And stress, stress gone, I was like I can definitely handle those because I’ve got time to prepare it then. And it’s when I think when we feel stressed is when there is stuff on and we know that we don’t have the resources or the capacity to actually deliver it.
Nik: Yes. And I think when it’s all in your mind, and it’s not actually physically somewhere, we can see oh, this is what I’m going to do that this or I’m going to do that. Then, then there’s that added stress that you almost forget to do this, that or the other so it’s about physically putting it somewhere. And that would be the to do list bit. But when you schedule the time to do it, then that takes away the stress because there’s a plan. And we like to have a plan, don’t we?
Rachel: And I have found with people I’ve been coaching in a particularly say GPS, who get very upset and annoyed, quite rightly about the fact that they have all this admin to do after they’ve just done a 13 hour day and they’ve still got more admin even if they’ve only been paid for, you know, eight hours of that. And the thing that really stresses them out is having it hanging over them and not having a time locked into that. And so just booking in two or three hours, yes, it might be your day often.
Yeah, that sucks, right? But you have to make the choice, you know, ‘am I gonna do this job?’ And if I choose to do that job, then I’m gonna have to choose when I’m going to do that, that extra admin, but knowing they’ve got time to do that, then frees them up to do other stuff other times. So it’s really just taking a look at your workload and being completely real about how much time stuff is gonna take blocking it in, and then that making some some hard choices, you know, say, Well, I’m not going to be able to do that, if I’m, if I’m doing this, and saying no, and putting a few putting a few boundaries in, I think that’s, again, something that we’re not very good at doing.
And I’m, I’m really guilty of this. So Rachel, can you just do this webinar here or fit this session in? And I look at the day and go, Okay, well, I, I do have an hour free second slot in there. And then you get through it, you think, what have I done, you know, I’m jumping from this to this to this to this. And you never, you never thank yourself. So being able to know what your limits are. And then say, and I will not cross over those limits, I will put those boundaries in really, really important, but interesting, I’m doing a lot of work around boundaries at the moment and, and doctors and really thinking about this, I don’t think we have a problem with setting boundaries, I think we all know what our limits are and what boundaries we need.
The problem we have is the consequences of those boundaries. Because you put boundaries in you, you have to say no to things, and you have to stop doing things. And then people might not like that, we might get a bit of flak, we might get a bit of criticism, and then we can’t cope with that. And then our boundaries collapse.
Nik: Exactly. And I would actually say that maybe sometimes we’re not great with bounds, I think we know what our boundaries should be. But perhaps we’re not so good at setting those boundaries. And I think that’s because, because I, I’ve read a lot about codependency and about how you can be affected by this, this problem with blurred boundaries and stuff and how it can make your life worse.
And, particularly people who work in healthcare can be affected by this, because we are always taught all the way through from when we’re at medical school, that we have to put the patient first, which is fine. And that’s absolutely true and mentally, right. But by doing that, you can lose your sense of self. And when you lose your sense of self, that’s when it can all unravel. And it can happen in relationships as well, it can happen, particularly if you have been in a family situation where there’s a member of your family that has been unwell. And so you’re used to putting them first.
And so it’s a fascinating area to get into because it is, it’s linked to our jobs as well. And because of that all that stuff to do with the healthcare stuff, so we’re all vulnerable to, to codependency. And I think it’s something that if we all had a read about it, we co
uld all relate to it in some, some shape or form.
Rachel: So do you think we’re a bit codependent on our patients, then?
Nik: I think possibly. And in fact, if you if you think about it, in the most extreme cases, when we’re really under stress, and we’re putting our patients first because the thing about codependency as well is that you often see it with with carers in that they putting their their relative first who’s really unwell, they lose their sense of self, but then there’s this resentment that they can’t do what they want, and it becomes this vicious cycle, and it almost becomes a downward spiral as well. And so it’s an important thing to be aware of, and to tackle within ourselves, but within the carers and, and patients and the whole spectrum of people.
Rachel: You can see that kind of, you know, people put their patients first, they try and do their best and then and then those people just criticise you it feels like they’re rude because they say well you’re not giving me what you want and then we feel absolutely dreadful and really very cross and our responses just even give even more and try even more and sometimes that is not the right response that the response is actually okay. This is my limit.
This is what I can do. And we’re really sorry this is what, this is what we can’t do. And then maybe just choose who you then listen to. So listen to those voices that are being highly highly critical that actually haven’t really got a clue. Nik. Oh, you know what we had this list of all these different books and things we were gonna talk about that’s just been a really useful conversation. I think this, this, this almost codependency on patients or wanting to give our all and put people first because we’re good people right that’s what we do.
But it gets to the point where we then feel guilty when stuff out of our control happens when our bodies go ‘you know what I’m not very well now. I’m in, I’m in resus.’ Can’t get a lot poorly than being in resus, and I’m still feeling guilty about the fact I can’t serve you in the way that I, in the way, that I want to serve you. And there are some like your heart condition. You know, you couldn’t have prevented that. It was from leptospirosis as you said from years and years and years ago.
Nik: That was what was linked to it. Yeah, exactly.
Rachel: Linked to it. So nothing— completely out of your control. There are some health conditions that perhaps are slightly more in our control, right? Like if you’re absolutely knackered because you’re working really late and not getting any sleep or if you’re, if you’ve got burnt out, because you’re in a work situation or workplace that really, really is toxic, and, and isn’t helping you with, there are some things you can do about that in terms of changing where you work. So I’ve just suggested that people do really have a look at stuff that is in their control that they can change. Because if stuff goes on for long enough, what happens that your body will enforce its own limits when it—
Nik: Exactly and listen to it. Because, you know, looking back, there were several warning signs for me. But to be fair, I was getting investigated. But interestingly, I was told at one point by my consultants, do you think this might be functional? Could this just be in your head? And I was like, ‘No, I don’t think this is causing me to walk up the stairs.’
But what was interesting is that that was actually mentioned in the letter, it wasn’t actually mentioned to my face to start with. So she was doing this. And so in a way when it actually kicked off properly. I was like, well, actually, I feel vindicated, because I knew there was something wrong. And here it is. So yeah, I would be very careful about labeling people who’s having functional problems. So they think that there is something properly wrong.
Rachel: Yeah. But also can I just say stress, and burnout is not a functional problem. It is a physiological problem. Your physiology is altered, your body has had too much cortisol for too long, and you have physical changes in your body. So just saying it’s all in my head. I just need to deal with it. That does not cut it.
Rachel: Oh, Nik, such or such good advice from it. As usual. The books you mentioned with The Stress Solution by Dr. Rangan Chatterjee, the podcast with Dr. Liz, everyone, and we talk about the book called Make Time, which has lots of really fantastic, you know, advice in it. So that’s probably the advice about check times time blocking your day. That was by Jake Knapp and John Zeratsky, really, really good book. He talks about the Headspace running app. And before, before we actually recorded this, you were telling me that Headspace does a load of really good shows on Netflix.
Nik: Yeah. Yeah, if you’ve not experienced headspace before, and you want to check it out before you maybe subscribe to it. And Netflix, I’ve got a number of CF miniseries that they’ve launched. There’s the Headspace guide to meditation, which is very good. They’ve got a guide to sleep. And they’ve also got a new interactive episode whereby you can choose what meditation you need, based on how you’re feeling at that point in time, which is phenomenal.
Rachel: Brilliant, brilliant. So, all those, we’ll put links to those in the show notes. Just suggest you listen to the Boggle Docs podcast, it’s absolutely fantastic. Even if you’re not, it’s brilliant, I would highly recommend that. And, yeah, we need, we need to do this again, because we’ve got all these things that we haven’t talked about that we really, really need to talk about.
The one book I really want to talk about is called 4000 weeks by Oliver Burkeman. So, some of us will do another self help book group soon. Is that okay? Yes, we’ll definitely do that. Really. Well, thank you so much for sparing the time and have a brilliant rest of day.
Nik: Thank you. It’s my absolute pleasure. And we’ll chat soon. Cheers, Rachel. Take care.
Rachel: Cheers. Bye. Thanks for listening.
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