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In today’s high-stress work environment, you may feel like a frog in boiling water. The pan has heated up so slowly that you didn’t notice the feeling of stress and overwhelmed becoming the norm. You may feel that it is impossible to survive AND thrive in your work.

Frogs generally have only two options — stay and be boiled alive or jump out of the pan. Fortunately, you are not a frog. You have many more options, choices, and control than you think.

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Rachel

Episode Transcript

Dr Ed Pooley: It’s useful to ask yourself periodically, ‘Is what I am doing leading me to where I want to be? If not, why not? Will I care about what I’m about to do in a month, a year, two years, two months? Is that really the be-all-and-end-all? Or do I need some perspective on this?’

Rachel Morris: Are you at the beginning of your career and feeling a bit disillusioned for the job which seems very different to what it said on the tin when you signed up to your career? Or are you an old-timer who can look back and see how things would have been much easier if you’d had a different perspective on life and work from the start? Maybe, you still feel like you’re sometimes floundering navigating the world of work, dealing with difficult colleagues, working in a system which is less than ideal, and trying to reduce your rising levels of stress?

This week, I’m joined on the podcast by Dr Ed Pooley, communication skills expert and Dr Hussain Gandhi from eGPlearning to discuss what we wish we learned at med school, why we feel so disempowered, and how we may struggle to separate our identity from our chosen career. We also talk about the unhelpful mindsets which can lead to taking on far too much and difficulty delegating. We share our top tips, the things we wish we’d known when we first qualified, and talk about some of the changes you can make in your daily work life.

There’s also a free download of the Eisenhower Matrix. That’s the urgent important matrix which you can use to help plan your working day. That’s in the show notes. Listen, if you want to find out what we think the essential skills are for anyone in a high-stress high-stakes job. Find out why we often have difficulty taking control over the things we really need to take control of, and listen if you want to find out what the latest Spider-Man movie can teach us about how to stop behaving like a victim.

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.

We talk a lot in the podcast about the zone of power and other coaching productivity and resilience tools and principles which I found made a huge difference to me personally, and also the teams which I worked with. I put all these principles and tools together to form the Shapes Toolkit. This is a complete package of resilience, productivity, tools and training for doctors, healthcare teams and other busy leaders.

We’ve been delivering Shapes toolkit courses all over the country in the form of keynote talks, webinars, workshops, online memberships and courses and full or half-day live programmes. We’ve been working with GP training hubs, new to GP fellowship programmes, return to practice programmes, trainers, groups, health and wellbeing projects, and many more organisations.

We’re now taking bookings for summer and autumn 2022, and have a few slots left for spring 2022. If your team are feeling overwhelmed with work, one crisis away from not coping, and want to take control of their workload, build karma and work happier, do get in touch to find out how we can help.

It’s really wonderful to have with me on the podcast, Dr Hussain Gandhi and Dr Ed Pooley. They’ve both been on before completely brilliant guests, really valuable episodes. I let you guys introduce yourself. Ed, tell us a bit.

Ed: I am a communication skills trainer with a background in general practice. My kind of focus is on how I can help doctors communicate more effectively with their patients and with each other.

Rachel: Brilliant. Thank you, and Gandhi

Dr Hussain Gandhi: I’m Hussain Gandhi. More people know me as Dr Gandalf. I’m a GP partner trainer, PCN clinical director, and owner of eGPlearning, which is designed to enhance your primary care and learning, which is probably where most of you heard me from.

Rachel: He’s been just producing such useful resources recently can I just say. We’ll put lots of links to those in the show notes if anybody wants to find out about that. But I’ve got you on the podcast today to share some of your wisdom because I had an email question. There’s someone said, ‘Really enjoying the podcast’, and had a suggestion for a topic. This particular person said GP3ST — about the CCT thing — she’d love it if we could have a podcast on good habits or tips, or bad habits to avoid right from the start of your career.

She was asking, ‘Can people share what they wish they knew right at the start? What would have saved you stress and time?’ For me, there’s such a long list. That would have helped. But where would you even start on this? Gandhi, tell us what are your top tips? What do you wish they taught you at med school?

Hussain: I’m going to go for two just because I want to beat Ed and not give them a chance to go for the same ones. The first one is learn to say ‘no’. I think it’s one of the hardest lessons most doctors learn as they go through their career. You either know how to do it or you don’t. That doesn’t mean that you say no to everything because that’s the misnomer with it.

Sometimes, people think when they hear that phrase that you need to learn to say no to everything you don’t. But how to say no in an effective way doesn’t mean that you annoy everybody else, and more importantly, doesn’t mean that you then know yourself to the point where then you struggling or revert back to just saying ‘yes’ to everything, which is often the worst solution if that’s the case.

The second one is understand the whole concept of delegation and prioritisation. I think especially in general practice is a real challenge for people to learn. It’s something I try and make most of my trainees go through in terms of understanding the difference between prioritising a task and also delegating a task, which doesn’t mean that they end up doing everything….

Either everything themselves or nothing themselves because both of those are polar opposites which are definitely not the best place to be, but understanding the nuances that come into play and how to do that. Because let’s be honest, they don’t teach you that in med school, they expect you to learn that on day one when you start on medical wards. It doesn’t happen as effectively as we’d like, would it?

Rachel: I remember starting on the medical wards, and I thought, ‘Well, I’m a nice person, and I’m quite friendly. Therefore, when I ask someone to do something, they’ll just do it.’ Right. That’s how life works, isn’t it?

Hussain: Not quite.

Rachel: Then, bring on three months worth of no sleep or whatever, starting to come a bit tetchy, and relationships deteriorate anything, ‘What’s happened to me? I thought I was a nice person. I’m being really aggressive with people and no one’s doing anything that I want them to do.’ So I’m rubbish at delegating, I’m overwhelmed with work and I can’t say no to anything. That would be really helpful.

Let’s get the tips out. Then, I’m going to delve deeper into some of these tips. Ed, what are your tips to start off with?

Ed: Oh, well, Gandhi put me on the spot by taking the first one. My area of interest is communication, kind of the psychology of why we communicate and the way we do. I think for me, probably the most important thing is recognising that you are a person as distinct from the job that you do. For instance, if you’re a GP or a lawyer, that is something you do. It’s often worth kind of reminding yourself that it’s not always who you are. I think that’s a key one for me.

I think the second thing I would do is it’s important to build habits that stick. Do today’s work today, make sure that you are chunking time in terms of, ‘This is my job. This is my home time.’ I think those would be the two key things I would say.

Fantastic advice there. When I was thinking of the sorts of things that I wish I’d known about. I think a lot of it again it’s about communication and relationship building. A lot of it is about what’s in my control and what’s not in my control, and actually being a little bit more proactive about things — feeling very disempowered.

When I was a junior doctor, and wish I could go back and tell that sort of disempowered, aggressive, sleep-deprived person that wasn’t getting on very well that there are different ways of managing this. But we were just not prepared for it very well. I’m hoping we do prepare people for a bit better now.

I was talking to a load of JP partners the other day, and they were saying actually they had really not been prepared at all for managing people, for employing people, and being that those managing leaders as well. There’s a lot of stuff that we do seem to fall through the cracks.

Let’s start with this whole saying ‘no’ thing. It’s probably the one thing that I’m asked about the most whenever we do our training courses, and everyone seems to be really bad at it. You think if everyone was bad at it, someone would have worked out that it was a really important thing to be teaching, and we’d all be knowing about it more or getting better at it. Why do you think we are so bad at it?

Hussain: I think it’s because it’s probably ingrained in us. Let’s be honest, the NHS runs on goodwill. It doesn’t run on money and it definitely doesn’t run on people, because there’s not enough of us. It runs on the goodwill of the staff that are there. It’s because we’re all this altruistic type that wants to do the best for our patients that we always end up saying, ‘Well, okay, fine, I’ll do that.’ Or, ‘I’ll do that this time. But I won’t do it next time.’ But then it happens again, and it happens again, and it happens again.

Part of that is also, sometimes, it’s harder to say ‘no’. The system is designed itself that if you do say ‘no’, it’s actually more difficult because to try and change it takes so much more effort than just doing the thing in front of you. It’s, sometimes, just easier to just do it rather than the chaos and the challenge that comes of trying to push this back, or the retaliation you sometimes get from the patient which is often the one that scares more people than anything else.

Because it’s harder to say ‘no’, we choose the path of least resistance — which is just to do it. Then, because you’ve done it, you do it again, and then you do it again, and it builds up every single time. The next thing you realise, you’re just doing loads more than you ever agreed with, and then say ‘no’ almost feels impossible. That’s my view.

Ed: I think there are two things that feed into this. I’ve mentioned this before when you’ve had me on. When children announced that they want to do something that is associated with a high status. Let’s say they want to be a doctor, they want to be a lawyer. When they announced this, their parents go nuts. They’re like, ‘Brilliant, you’ve made the best choice ever.’ Then, all of a sudden, everything becomes about that — which slightly feeds into my comment about distinguishing between defining yourself by the job you do versus defining yourself – ‘is that something that you do?’.

Because when you’ve grown up in that type of environment, you’re almost primed to please other people. Your validation is driven by what other people say is good about you. Now, you see you go off to med school, and everyone’s like, ‘Wow, you must be amazing. You must be really clever and smart.’ All of that external validation is brilliant. But when you come to do something that is not going to get you external validation — at least initially — it becomes very hard. I think that’s a real challenge.

The other thing — I learned this from TikTok the other day. It was a mum explaining something. It was brilliant. She was explaining about her child who was playing with a toy. Then, another child came along and said, ‘I want to play with that toy too.’ It’s almost like we’re primed to say, ‘Okay, here you go then. You have the toy.’ Not, ‘I’m playing with it right now. You can have it when I finished’, which is about sharing, and cooperation, and negotiation.

It’s kind of, ‘I’m giving this to you now because I want to please you.’ And we often get caught in the cycle of saying ‘yes’ because we put our own needs last and the needs of others first.

Rachel: I think there is something as well about the whole amygdala response. If I say ‘no’, you’re not going to like me. That’s an existential threat because if we were living in caves, ‘You’d throw me out the tribe, and I would die of exposure and be eaten by a lion, etc, etc. I’ve got to do everything to please you.’ We go towards that.

Hussain: Or the other thing is the more negative aspect of it in the fear of the complaint which I think is the one that drives a lot of people to not say ‘no’, ‘If I say “no”, I’m going to have a complaint about this.” Again, it’s that whole pressure aspect — the fear of the complaint, it drives many people sometimes to then just say, ‘It’s easy if I just say yes.’

My personal view has always been if you’re worried about the complaint, then you are worried about the wrong thing because that’s going to dictate what you end up doing. Inevitably, that’s going to lead to a bigger problem down the line.

Again, something I try and encourage to my trainees — and I know Rachel did an amazing episode short while back about complaints and stuff, which I recommend all my trainees listen to because it picks up some of the fear and the challenges we all face about the concept of a complaint, which annoyingly in the past couple of years has got really bad with post-COVID and stuff.

Rachel: It’s like the worst thing that can happen to us — getting a complaint. I do remember place where I worked. One of the partners said, ‘If you get a complaint because you’ve practised good medicine, and you’ve said no to someone who wants something that they shouldn’t have, we will back you to the hilt. We’ve got your back.’ It’s sort of knowing that was okay was very freeing releasing.

But sometimes we just don’t like saying ‘no’ because we’re frightened of someone’s response. Yes, if you take it to the extreme, it’s going to be a bad complaint against us. But if it’s a colleague, can’t necessarily put in a complaint against us, but they could conflict with us, or even get a bit upset. I think, actually, we’re so sensitive to other people that we can’t even cope with someone being slightly put out.

If you say ‘no’ to someone, and then cave the minute they start to complain or not like that, it’s ridiculous really if you think about it. Of course, someone’s not going to like it if you say ‘no’ to them. That is just normal. I don’t like it if I asked for something and someone says ‘no’ to me.

I might huff a bit, but then I’ll understand. I think if we could just train ourselves to put up with huffing a little bit just to be able to cope with the fact that that person doesn’t like what we’ve done but hold our ground, and it’s going to make life a lot easier. But we do tend to cave in and we almost predict the huffing as well.

Ed: One strategy that works quite well to say ‘no’ is to shift the mindset from ‘I won’t’ to ‘I can’t’ because we never have a problem saying ‘no’ to something that is illegal or that is totally inappropriate.

It’s very much easier to say ‘I can’t’ because — and it might be, it’s not in your best interests, or ‘I can’t because there’s a better option’, or ‘I can’t because that’s not appropriate for right now’, or ‘I can’t because that’s the policy of this organisation.’ That makes it very much easier than the assumed reason behind the ‘no’, which is ‘I won’t’.

Hussain: I echo that in terms of saying that whenever you do say ‘no’, it should never be ‘no’ and that’s it. ‘We’re not talking about this’, ‘we’re not discussing this’ — that’s not helpful to the situation. When I’ve had trainees, in particular, I’ve been talking about this — imagine if you went to somebody for help, and they just turned and said ‘no’ and walked away, how would that makes you feel?

That’s not a good feeling for you. When you are saying ‘no’ to somebody, ‘The answer is no — but there’s a reason why I’m saying ‘no’. Here’s the other options that we could consider.’ Sometimes, there’s other options — may be still things that the person is not happy with. But they are the options that you’re giving them. Often, that’s a way to try and mitigate that whole concept of, ‘Well, I’m just saying “no” to you.’

Rachel: Another concept that’s been very helpful for me is say ‘yes’ to the person but ‘no’ to the task. You’re saying, ‘I’d love to help you. I can see this is really important to you. I’m really sorry, I can’t do that now. This is why — but have you tried this or that and the other…’ You’re really validating them that you’re saying ‘no’.

I think in the training that we do that the biggest help is just the pause button. When someone asks you to do something, giving yourself a bit of space and time before you agree or disagree to actually think about, ‘Do I want to do it? Is it the right thing to do? Are there any other ways to do it?’ But often, we just jump up and say ‘yes’ before we’ve even given ourselves time to think of it.

Ed: I think, particularly for people like receptionists or where they’re confronted with that immediate emotion, saying something like, ‘I will check on that and come back to you’, just buys you that time so you get yourself out of that amygdala response where you’re just dealing with the fear and the ‘I’ll do anything to make this horrible sensation feel better’.

Just doing that, it reinforces the fact that the person’s issue is important enough for you to check something and to find out an answer. It also reinforces the fact that it’s not just them saying ‘no’, but it’s other people that have sort of decided this, and it sets the patient or the person up to recognise that ‘no’ might be a response.

Rachel: I just think that’s like a warning shot isn’t it, to brace them for bad news. Rather than just saying ‘yes’, it’s like, ‘Oh, no. They haven’t just said “yes”. Or maybe they are going to say “no”’. You can always buy yourself time. My colleague, Dr Caroline Walker, she always says, ‘Nothing needs immediate attention apart from CPR.’ Literally.

‘Someone’s glad, that needs sorting.’ But everything else, you’ve got at least 30 seconds, right? This saying ‘no’ stuff, I think that’s tied really closely with delegation because delegation can feel like — I think it can give us the same sort of emotions as saying, ‘No, we feel like we’re shirking our duty that we’re not being a good person, that we’re not being a good doctor, etc, etc.’ How do you get around that? How do you shift that mindset into actually delegation is part of my job.

Hussain: I think the way I approach it is that if you were to do everything that comes your way, you’re never going to go home. That first lesson of, if you want to go home, you need to learn how to delegate because otherwise, you’ll still be there at 10 o’clock, 11 o’clock at night and that kind of thing.

I think for me, it’s understanding how have you got a system that helps you understand what is it you need to do? What does he need to do now? What is It needs to be done that doesn’t have to necessarily be either be done by you or be done today? Like I’ve mentioned, finish today’s work today, bye. If you’ve got other stuff that doesn’t have to be done right now, can that be done in a different way potentially?

That’s the stuff that you sometimes then thinking, ‘Actually, can I delegate that somewhere else? Or more importantly, is there somebody who’s better at doing it than I am?’ The classic one we have in general practice is the medication review. Generally speaking, the medication review can be often done better by pharmacist and by GP because they understand the medications far better. Working out what’s good for now, what’s good for the importance — and all that kind of stuff.

My method is the Eisenhower matrix. That’s what I love for all this kind of stuff. I think Rachel we talked about it on one of the previous podcasts — going through an exercise, working out, what in your day needs to be done today, what needs to be done immediately, what needs to be done possibly by somebody else and not by you? All those kinds of things can be really effective I find.

Rachel: If you’re using that Eisenhower matrix — which I know is that urgent, important matrix — you’re talking about the urgent important stuff gets done today, you delegate, get rid of the other stuff. How do you deal with this stuff in quadrant two — the important but not urgent stuff?

Hussain: They’re the things that you need to then schedule some time to do. That’s where things, either having admin time or having admin session or just recognising that needs to be done. That concept of batching the work together so that then, you’re doing those tasks that actually you probably need to do, and spend a bit of time on — but then doing it in a solidified piece of time.

The classic when I say to most people’s is the pathology stuff: a) you’re only preferably trying to do that type of task once a day. But then, you’re getting through it in an effective time frame. I won’t do that multiple times throughout the day. I will just do it once a day. Then, I’m not going to touch it again until tomorrow because I’m reassured the process in practice. If it is super urgent, it should come through a different route.

Ed: But for me, I think delegation is an interesting one because delegation is kind of being stuck in that moment and deciding what to do with something and making the choice, ‘Is it me? Or, is it someone else?’ For me, you can kind of avoid a lot of that by having appropriate systems and processes in place that everyone in your organisation is aware of so that it becomes standard behaviour. I mean, 80% of what doctors do is kind of the same stuff every time.

If you haven’t got a system in place that everyone understands and knows about, you’re kind of needlessly creating decision fatigue for yourself and your staff, and you are repeating the same errors. This goes back to that whole psychological journey that they go through are very used to being seen as very good and very competent that things. There is that feeling that that competence extends to other areas.

We only really find out that we’re not competent other than when something goes wrong. You’ll see this on the partnership training that you guys do, there’s almost an expectation that people who’ve been through medical school and medicine are good medics, and therefore they should be good partners. But actually, people struggle with that process. They struggle to kind of recalibrate that they’re not good at everything.

Again, that feeds into that delegation decision making. You need to recognise, ‘What are you good at? What are you not good at? Am I the best person? Is there someone who is better, cheaper, quicker than me at doing this?’

Rachel: There’s a really good book by Michael Hyatt called Free to Focus, and he talks about these different zones that you can get in. I love my two by two grids. There’s another two by two grid — things that you’re good at and things that you love doing. As much as possible, you need to stay in that zone — your zone of genius that you’re good at and you really, really love doing.

Everything else, you might have to do a few things you’re good at, but you don’t like doing. But if you’re really not good at something, that’s much better to delegate that stuff out because there’ll be someone else who’s much better at it than you, and probably enjoys doing it a lot more. It’ll be in their zone of genius, and you’re sort of denying them that opportunity to do that.

I think fear losing control as well. But something I always get challenged about when we teach about delegation is — and I think a lot of maybe more junior doctors feel this — and particularly if you’re a trainee in a practice or a junior doctor on the wards, or maybe even a salaried GP, I don’t have anyone to delegate to. I’m not in control of this practice or this hospital, so I don’t get to make that decision about delegation. But what would you say to people who were thinking like that?

Hussain: I probably take from the hospital. That’s the kind of stuff you need to share with the organisation. Those are the really powerful exercises that you do within the practice where you find out actually, probably — if that’s the case for you — other people having the same emotion or challenge with that particular task. Then, actually organisation then needs to think about how can we do this better?

The answer is not necessarily that the junior doctor goes off and does this task every single time because actually, if they had to look at it properly and realise it was a problem for everybody, that’s where you potentially get the compound gains. From fixing that system, to then actually meaning that you freed up that capacity of your junior doctors — the really expensive part of the hospital to do the more effective stuff, look after the patients, and then maybe come up with a system that means that that’s no longer a challenge.

Rachel: What would you say to someone says, ‘Well, there’s no one to delegate to and have no control. I’ve tried raising it to my organisation, they can’t do it. They haven’t got any money.’

Ed: I think I would separate out the feeling that you have no control from the reality of control. When we are in that panic state when we have to make a decision there and then, you can either approach it two ways. You can either do it pragmatically — and you can do it to the best of your ability and change what you do the next time because there will be a next time. Or, what you can do is you can sit down and say, ‘Well because we have a tendency of grouping together when things are fearful.’

If we’re under stress, everything is sort of compressed into one entity because that’s how our fear system works too. We don’t see — let’s say we’re on the plane to the caveman state, we see the sabre-toothed tiger running towards us. We’re seeing a sabre-toothed tiger running towards us. We’re not calculating distance, we’re not calculating how big they are. We’re just saying, ‘Sabre-toothed tiger! It’s really frightening.’

Actually, if we sit down and break out that that task into, ‘What are the components of this task? What do I need to do? What don’t I need to do? What do I have control over? What information do I need?’ That will help you be as effective as possible with that task then and that task in the future.

Rachel: I love this concept of control. I do think this thing about being empowered is really, really important. I think as you get older, you do become a little bit more empowered. I’d be interested in your opinion on this, Ed because I know that you did graduate medicine. Is that right?

You were a mature student — I don’t know if you went straight into medicine from school like I did. I was a junior doctor at the age of 23,24, and I remember feeling I had no control over anything. I was completely disempowered. I just did absolutely what everyone told me to do, and then talking to a colleague of mine at Red Whale.

He did graduate medicine, so he’d had a career before. He then went into medicine and had been running a very busy department and something completely unrelated. He did graduate medicine. Then, when he was a junior doctor, he said, ‘Well, if there was a problem in the ward, I just go to the consultant and go, “Mike, how are we going to sort this out?”’ We’d never would have done that.

It’s something about he just had given himself permission to do that was more empowered. Ed, what was your experience of that sort of thing?

Ed: There is that hierarchy in medicine that is almost trained into you that you can’t step outside. Actually, it goes back to that feeling that — when you go on that conveyor journey from. I don’t know, the four or five-year-old who says, ‘I want to do medicine’, to the freshly minted med student who pops out the other end, sort of 18, 19 years later.

You haven’t really had the experience to say, ‘Is this normal? Is this what people do when they have a problem? Is there a reason to stick with the status quo? Or actually, can I just do something different? At the end of the day, you’re in an organisation with humans who have desires and wants and things that stress them out.

Actually, what we know from when people make errors is that hierarchy becomes a problem, and that people can’t seem to get out of the hierarchy to say, ‘Well, why don’t I just speak to the person who’s in charge and get this problem sorted?’ I guess going into medicine as a graduate student gave me that perspective that I think we’re not trained always to look for until something goes wrong, or until we have enough experience within the hierarchy to bend those rules that we’ve kind of enforced upon ourselves.

Rachel: That’s interesting. Gandhi, did you feel that you were very subservient, disempowered when you first started — and you’ve become more of that?

Hussain: I think it’s definitely there. When you start, there’s always that concept as well as — I’m probably going butcher the word, so apologies on this — infantilism of junior doctors. They are baby doctors, they are junior doctors — the whole concept that they are below everybody else and the hierarchy that Ed mentioned.

Because of that, you kind of slot yourself in whereas potentially — and I’m going to make a slight assumption here — for the mature graduates that come to medicine, they’ve actually had life experience that shows them that that’s not actually the case. Therefore, I trained with a few people who also came from other careers to medicine, and was marvelled at how confident they were trying to manage different things.

I was like, ‘How on earth are they doing that? How could they say “no” to that midwife about doing that task?” ‘Okay, if they can say “no”, does that mean I can say “no”?’ That’s kind of where I gradually started to learn that actually ‘no’ sometimes is the right answer. Therefore, from that, I think it’s built more. Obviously, in general practice, we practice a bit more independently outside of hospitals and things.

Therefore, you learn that if you don’t understand how to delegate, how to say ‘no’, it means you will end up doing everything. If you end up doing everything, you’re not going to be doing the career very long, to be honest, because it’s the quickest route to burnout in my view.

Ed: You kind of experience the consequences of your decisions, and I think that’s a very useful feedback tool.

Rachel: Definitely. When I was thinking what would I really want to tell myself — my 24-year-old self, it was that bit about being empowered to take control and take the initiative, and not be frightened to express what I needed or wanted or to raise issues in a non-windy, non-moany way. Now, I’m going to go a bit off-piste here, but bear with me — this is related to it. I’m taking a bit of a risk. Either of you have you seen the Spider-Man movie?

Hussain: Yes.

Rachel: Yeah.

Ed: The new one, yeah?

Rachel: It’s the new one. Okay.

Ed: I haven’t seen it, so no spoilers, please.

Rachel: Okay, I think I can tell this story without a spoiler. The bit where Spider-Man… Okay, it’s right at the beginning of the film. The end of the last film, something happened. Now, the whole world knows who Spider-Man is. They know his name. It hasn’t gone well because he gets vilified and everyone thinks Spider Man’s the worst thing in the world.

Spider-Man, and his girlfriend, and his best mate have applied to MIT. MIT has rejected all of them because they’re associated with Spider-Man, so he feels awful about this. He goes to visit Dr Strange and he says to Dr. Strange, ‘Please, can you make everybody forget who Spider-Man is? Everyone forget who Spider-Man is, please.’

Dr Strange starts doing his weird things with the — he got some…

Hussain: Magic.

Rachel: Magic.

Hussain: There you go.

Rachel: Magic. He starts doing some magic and is weaving this really complex spell, which if it goes wrong, could possibly create some really bad consequences. He’s shifting the timelines in the universe. Halfway through this spell, he stops and he says to Spider-Man, ‘What did they say when you phoned the admissions office for MIT when you sort of challenged their decision? Spiderman says, ‘Oh, well, I haven’t done that.’ Dr Strange’s just says ‘What? I’m messing with the fabric of the universe and you’ve not even picked up the phone!’

At that point, I just fell off my seat in the cinema and I’m poking my husband, ‘This is so good. This is such a great illustration of how people get into this victim. This is spiderman going, ‘Oh, this is so awful. Can you just make this magic thing happen?’ Actually, he’s not done anything to help himself. I thought, ‘Gosh, I think that’s what I was like a bit when I first qualified.’ Is that ringing any bells, or am I completely off-piste here?

Hussain: Definitely. Marvel teaching us life lessons as ever.

Ed: There’s a podcast, seriously.

Hussain: Life Lessons from Marvel Films, there you go.

Rachel: I mean, there’s got to be some advantage of fitting through all those amazing films that my children absolutely love to bits. But I just think it’s this thing about empowerment, it’s this thing about taking control of what you can take control of. You sit and whinge about all these things that are wrong and the rotor, and this, ‘It woes me and this is awful.’ It is really hard. It is really hard.

But a lot of the time we are not doing those those basic things that we could do to make things better — like having the difficult conversations, like saying ‘no’, like doing this delegating — because we are so frightened of what people think of us — or why is it that we’re not doing it?

Ed: I think the way that medical education is structured — when we start day one as an F1, it feels like you’re still in school because there’s been no break. There’s been no separation from school and work. It’s just one continuous conveyor belt.

I think we were still in our heads in that school mode waiting to transition into being sixth formers where you get to be a bit cool and break the rules a bit. We don’t get that overt permission until we realise it until we’re faced with a decision where someone says, ‘Why don’t you just pick up the phone?’ ‘Oh, can I do that? Is that allowed?’ Or, ‘Cut on that corridor.’ ‘Can I do that?’ You’re almost waiting for that permission to be given.

Rachel: Just giving yourself permission a bit earlier to make those difficult choices, to have those difficult conversations. It feels to be an adult about it, right?

Hussain: You’re not fearing the outcome. I think that’s part of the challenge, isn’t it? Because we’re not exposed to, or we’re often challenged with the fear of the outcome. If you make a mistake, there’ll be a complaint. If you make a mistake, you’ll hear from the GMC — or those kinds of things that we’re constantly told that if you do something wrong, it’s the worst-case scenario that can always happen because…

Let’s be honest, that’s sometimes how clinicians think. It’s always that the worst-case scenario will always happen even though we have evidence to show that no, that’s not really the case. I think many of us worry about that, and that’s what tunnels into doing the thing that’s with the least resistance, which is just doing the task in front of you and taking it on.

Then, what happens is you experience the fact that everyone else gets what they want and you don’t, and you’re not having a good life outside of work or even inside of work, and you’re sort of sacrificing yourself for your career.

Ed: I think there is a kind of a move to make the option to speak up to breach the hierarchy. I think that’s a good thing. I think it’s really quite sad that it has to happen because of clinical negligence cases, because of abuses of that hierarchy, unfortunately, that particularly women have had to experience. I think anything that promotes the concept that you are being enabled to speak up, and that movement is a positive thing.

Rachel: Right. I think we’re nearly out of time. I think there’s some really interesting and useful stuff there around saying ‘no’, about delegation, about not having your identity all wrapped up in your career about being something out outside of work, being a human being, about being empowered and giving yourself permission. If you were to come up with three things that you were going to go back and teach yourself on day one of your doctoring career, what specific advice would you give?

Ed: I guess, for my learning to say ‘no’. The best way I would say that you can figure that out is to have an argument with your kid without saying the word ‘no’. If you can do that, you probably figured out a route to start to understand the principles behind it and stuff — because it’s a lot harder than it sounds, especially when they want something.

Rachel: Have an argument your kid without saying ‘no’. Brilliant. Any other tips?

Hussain: For me, it’s going to be the Eisenhower matrix, absolutely. Have a go, just sit down in your day, list out everything you’ve done that day — if you want to do it reflectively, fine. Do it at the end of the day and stuff every little thing that you’ve done, and then make yourself put it into the four boxes. The key thing is that the ‘urgent and important’ box, try to make it as small as possible.

What things can you not put in that — because I guarantee when people try it, the temptation is stick everything in there. Then, the flip part of that is go to someone that you like or trust — could be a partner could be somebody else in the practice — and ask them to do the same thing from your perspective and see how different their list and their quadrant is compared to you.

Best thing is always do that in your practice. Do it as a team exercise because actually, like I said, that’s when you find that really powerful blocks of the system change delegation one. But if you can’t do that, someone you like… If you don’t want to take that exposure or whatever, just find someone you trust, ask them to do the same thing, and see the difference. That often gives you a route to figure out a few different things you can change.

Rachel: That’s fantastic advice. I’m going to try that. We use the Eisenhower matrix all the time as the privatisation grid. I’ll put a handout to that in the show notes if anybody wants to download that.

Hussain: Download the Android version — it’s called the Ike app. Unfortunately, Apple doesn’t have one as far as I’m aware. But the Ike app nickname for Eisenhower… Nickname, Eisenhike.

Rachel: Brilliant. Okay, we’ll try and find that link as well and put that there. I must say it’d be wonderful if they had an iOS version, but no. What about you, Ed?

Ed: I think it’s useful to ask yourself periodically, ‘Is what I am doing leading me to where I want to be. If not, why not?’ I think that can be in terms of what you’re doing at work, what you’re doing in task management, in processes. I think the other way of flicking back on it is to get some perspective sometimes because perspective gives us that psychological distance and enables us to behave in a way that we might wish to rather than that we all feel we have to, which is, ‘Will I care about what I’m about to do in a month, a year, two years, two months?’

It’s having that difficult conversation with the midwife, or speaking to my boss about something that I think could be done in a different way. Is that really the be-all-and-end-all, or do I need some perspective on this? Will the Ed in five years time thank me for doing this right now? I think they would be my key things — it’s about getting that psychological separation from who you are and what you do because I think that’s very important to have. I think it keeps you resilient when you’re faced with challenge.

Because if you’re faced with challenge and your identity is tied up in who you are, it’s a very difficult thing to overcome — psychologically, that can lead people to some very dark places. I think having that separation is important. Those would be my three things. Get perspective, separate that sense of who you are from what you do, and ask yourself, ‘Will I care about this in X amount of time?’

Rachel: Absolutely fantastic advice. That reminds me, though. I was reading a book quite recently. It’s a business book, actually, and this chapter was saying that every day he reads his obituary — he’s reading his obituary, and he reads that just to remind him of what does he want people to say about him. They’re probably not going to be writing, ‘Okay, he achieved this, this, this, and this as a GP, and this is a…’

They’re going to think that, ‘He was a kind father who spent loads of time with his family. This is what made him laugh.’ There’s more to life and what he wants to be remembered by what brings you joy and actually, what really, really matters to you in life. Keeping perspective is really important.

We’re out of time, guys. Thank you so much. I think that was really helpful to me. Hopefully, that will be helpful to some of our listeners. Loads of useful stuff to explore there. I’d love to have you back on the podcast at some point. Thank you. I will put all the links in the show notes. Just quickly, if people want to find out a little bit more about your work, where can they get ahold of you or find all the stuff that you do, Ed?

Ed: I run a company called Ten Minute Medicine. That’s tenminutemedicine.com and there’ll be some updates to that coming over the next month or so. I run the Facebook group — difficult conversations in medicine, where I look at challenging topics and how we can improve communication skills.

Hussain: Just search eGPlearning and I’m pretty sure some of my stuff will come up whether it’s the website, the YouTube channel. If you’re on Facebook, eGPlearning as well. I also run the system on Facebook users group and about five other Facebook groups, especially for medics, which I highly recommend everybody joins

Rachel: Brilliant. Thanks guys. I will speak soon.

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