Rachel Morris: (00:09)
Welcome to You are not a frog the podcast for GPs, hospital doctors, and other busy people in high stress jobs. Working in today’s high stress environment, you may feel like a frog in boiling water. Things have heated up so slowly that you might not have noticed the extra long days becoming the norm. You’ve got used to feeling constantly busy and are often one crisis away from not coping. Let’s face it, frogs only have two choices: to stay in the pan and get boiled alive or to hop out and leave. But you are not a frog and that’s where this podcast comes in. You have many more choices than you think you do. There are simple changes that you can make which will make a huge difference to your stress levels and help you enjoy life again. I’m your host Dr Rachel Morris, GP and executive coach and specialist in resilience at work. I’ll be talking to friends, colleagues, and experts, all who have an interesting take on this so that together we can take back control to survive and really thrive in our work and lives.

Rachel Morris: (01:12)
I’d like to tell you about our new CPD forms. If you want to learn while you listen and claim CPD points, then go to the link in the show notes and sign up to receive our fully downloadable podcasts CPD forms. Each one is populated with show notes and links so that you can listen, reflect, and then note down what you’re going to do. A quick, easy, and enjoyable way to do your CPD. In this episode I’m chatting with Dr James Thambyrajah. James is a portfolio GP in the first five years after qualifying as a GP. He is the outgoing lead for the First5 group for the South West Thames and he also sits on the national RCGP First5 committee and James has an interest in wellbeing and resilience and I wondered if newly qualified GPs had a bit of a different take on resilience to us and what we could learn from him. I hope you enjoy this conversation.

Rachel Morris: (02:01)
So I’m really pleased to have on the podcast with me today and Dr James Thambyrajah. He is a portfolio GP and he’s also the First5 lead for South West Thames regions. So welcome James. Thanks for joining me.

James: (02:13)
Thank you for having me.

Rachel Morris: (02:15)
So James, as well as, um, being a portfolio GP and the First5 lead, what other stuff do you do with your time?

James: (02:22)
Yeah, so I suppose, I know I do eight sessions a week. Um, I do out of hours at the place that I trained at, The Frimely Park Hospital, which I I love weirdly. I do really enjoy that. Um, I do prison work as part of my contract as an eighth session. So I do a women’s prison clinic once a week, which is very challenging but very rewarding at the same time. I do Saint John’s ambulance I’ve been doing that for about eight or nine years, coming up to nine years now. So I do crowd medicine. I’m very interested in, um, being a crowd doctor. So I’ve done Lord’s cricket ground for nine years, done Wimbledon three or four years, um, made a lot of good friends and colleagues through that way. Yeah, those are the main, and I look after a nursing home as well. So that’s kind of elderly medicine as well. And on top of that, do the First5 RCGP stuff, which I’m very passionate about.

Rachel Morris: (03:11)
So not very much then.

James: (03:15)
Yeah, well no, no.

Rachel Morris: (03:15)
As well as being father to two with one imminent on the 12th November.

James: (03:21)
Yes. So any day. So our first two children came two weeks and one week early. So yeah. So we’re kind of, you know, we’re about 38 weeks now, so yes, anytime now.

Rachel Morris: (03:31)
Okay. So could actually be during this podcast.

James: (03:33)
Yeah, my wife is upstairs, so we’ll see if she calls me. That’s the only thing I’ll go up for that, yeah.

Rachel Morris: (03:38)
Yeah. You’re not allowed to disturb me apart from labour.

James: (03:41)
Yeah apart from labour.

Rachel Morris: (03:41)
Then that’s fine.

James: (03:44)
Yeah. She’s very understanding.

Rachel Morris: (03:44)
But nothing else. So I wanted to talk to James because I think we first met because you got in touch with me about coming and doing some wellbeing talks for the faculty for a day that you were having for your First5. And we got talking about resilience and I was just really interested in the work that you were doing sort of with the First5, but also I guess as a First5 GP yourself, when did you qualify?

James: (04:08)
So I qualified 2016 and towards the end of 2016 from The Frimley Park GP training scheme and pretty much started straight away. So started as a salary GP in Southwest London, in Cheam in January of 2017. I’ve been doing eight sessions a week since then. So it’s almost coming up to three years now.

Rachel Morris: (04:26)
Wow. And so how did you get involved as the First5 lead?

James: (04:32)
Um, funny story. I, I qualified, I was on this high, you know, you do all these exams and you kind of achieved what you wanted to achieve. And I was very aware that I wanted to be, you know, I found my GP training scheme very supportive. I found my friends supportive, my mentors and my trainers and I realised that the reason why I moved to Cheam to work was that I was commuting from Southwest London to Frimley about an hour each way. And so when I, I chose this job close to home because it’d be great to be close to my family and help with school pickups. And then I realised, actually I didn’t have anyone around that I knew, kind of both GP friends or you know, trainers or even the hospital was different. So everything felt very new and I felt if I’m honest, quite fright, you know, frightening.

James: (05:18)
So I wanted to get involved with the First5. And I’d heard about that and I, you know, I was kind of, you know, wanting to get involved and I did some, you know, inquired and they basically said oh James, there’s no First5 small group around here. And there used to be, but it kind of fell away. And I was like, okay, that’s a shame. And they said, oh, James, but there is a vacancy for a First5 lead. And I went, um, well it’s not right. It’s not really, really well, what I was hoping for, but you know, like everything in my life, I you know, came back home, discussed it with my wife and um, you know it was a big decision, but I just thought, you know, you know why not? And I just thought I’d be First5 lead. And I thought it was a great way just to get to know my cohorts and get to know the area and just to kind of, you know, it kind of started by joining the faculty and then pretty much down for First5 lead, being voted, but as First5 lead by my faculty. So it wasn’t just becoming First5 lead it was getting to know the faculty and being on a few board meetings, which I still enjoy and I still carry on. And so yeah, that’s how I got to become First5 lead. Fortuitous and a bit, you know, it was a surprise, but you know, it was a happy one.

Rachel Morris: (06:26)
That so often happens doesn’t it? You see a need and you go, well, what can meet my need? And they go, well, there is no one coming that you can meet, you got to meet it yourself. And then you end up sort of running stuff for the people.

James: (06:38)
Completely. I completely felt unprepared, but uh, you know, it was just one of those things where I thought, well, if I wanted to see change I thought I can, I can be that change and just do it myself.

Rachel Morris: (06:47)
Yeah. And for those of you that are listening, who are doctors not GPs or, or work in, in sort of other industries, uh First5 we were referring to the first five years after a GP’s qualified and they can be quite a lonely, quite a difficult time, can’t they?

James: (07:03)
Oh yeah, absolutely. Yeah. You know, it’s, you know, like I alluded to before, when you’re training as a GP, or as a junior doctor, you’re surrounded by people; be it the hospital or the practice or you know, as a GP trainee, you have your training, your teaching sessions once a week and you meet up with friends and you study, revise and suddenly you become a GP and you’re all alone. You’re all in a room by yourself. Our GP is in a old house, so there’s no real meeting room. And in my training practice we would have a coffee break. All of us would be together. Whereas you know here, you know we don’t have the facility for that so you’re pretty much isolated. So it’s a big culture shock to be honest, urm when you become a GP. So having that First5 community, um, was really important for me even being your lead but just having people who are in the same boat as me and are just qualified and we could all talk to each other. And I found that incredibly useful.

Rachel Morris: (07:55)
And what other pressures are there on, you know GPs when they first qualify, cause I know that you know, I guess you suddenly leave your quite nice training scheme where you all know each other, you get quite good level of supervision from your trainer. Suddenly A) it’s the world of working. You don’t get the level of supervision. But is there anything else that becomes a real pressure on people?

James: (08:16)
I think the pressures of keeping up to date, um not just academically but keeping up to date with your admin. I found the admin just kind of increased to another level when you become a GP, keeping up with letters, the referrals, um, working in an area where people wanted their referrals yesterday as opposed to you know in a weeks time. I found that a huge challenge and still do; trying to keep up with local guidelines as well as national guidelines, trying to keep up with kind of new clinical reviews, new papers and all these kinds of things. All kind of, without having the kind of safety net or being in a training scheme or having kind of a trainer to look after you, you just do it on your own. I’m really thankful for my practice, I have a mentor who’s brilliant and that’s, we meet up regularly and that he’s been you know, amazing really, kind of just shepherding my career so far for the last three years and he’s been a partner about 25 years, so it’s helpful to have him in the practice.

Rachel Morris: (09:11)
Wow. And was that put in place for you by your salaried scheme?

James: (09:15)
Yeah.

Rachel Morris: (09:15)
I’ve not really heard that happening very much.

James: (09:17)
Yeah. No, it was, um, it was a real privilege and blessing really because it kind of, you joined the practice and you’re just assigned to a partner as a mentor. So it was very nice to feel that I could still go to him if I needed help or advice. And I still do. And there’s still things obviously I struggle with and things that I’m still working on even three almost three years in. I’m not ashamed to say that. And you know, I’m really lucky and our practice is not just the partners but you know, healthcare assistants who’ve been there for a long time or nurses who’ve been there for a long time. It’s just people who you can go to and talk to. So we’re very lucky. Our practice is called Cheam family practice and it sounds cheesy, but we really feel like a family. It’s very nice. And you know, it’s very supportive. That’s what I’m saying.

Rachel Morris: (09:58)
So I’m really interested in what issues you’re seeing in terms of resilience. Obviously this podcast is about what, what small changes we can make to make life better. And you’re not just the lead for the Southwest Thames First5 sort of scheme. You also sit on the, the the RCGP First5 committee. So what are your colleagues saying? What are you hearing from people? Is that, what are the main issues people are facing?

James: (10:20)
I think what we’re saying a lot is, you know, kind of time pressures, and working long hours and wellbeing, really wellbeing, you know, I’m not just saying it to you Rachel because this is about a wellbeing podcast, but wellbeing is a big factor for us within the First5 because we’re seeing a lot of, you know, I have colleagues, my friends who are kind of my cohorts, you know, regards to, don’t want to get involved with wellbeing or you know, dealing with burnout, dealing with stress, taking time off. You know, these are very real issues in First5 GPS. You know, you hear it a lot in senior GPs, but we’re seeing it a lot in First5 GPs, which I found the most surprising. Oh you know, GP’s taking too much more than they can handle or giving, and then you, there’s all sorts of things like bullying in the workplace or sexual harassment. These are things that we can hear GPs, um, who I meet who are the same level as me, you know, and I met them a couple of years ago and they’re working 12 hour days, no breaks, no coffee breaks, no time for lunch. And it’s just, it’s a dire situation. And so that’s, I’m hearing that lack of support, long hours and poor wellbeing. Those are the three main things I would say.

Rachel Morris: (11:28)
And what do you think people should do about it? The million dollar question.

James: (11:33)
It is. I can say, you know, with confidence, what helped me was talking with other people who are in the same boat as you is really important. And I think if you kind of isolate yourself and just kind of stay in your room or kind of, in this, I won’t mention them. There’s some Facebook groups which are helpful and some which are not. And I think sometimes there’s a danger when you go online, whether it’s social media or Twitter or Facebook or social media. And that in itself can be quite toxic. So I think sometimes just talking to people face to face or messaging someone or meeting up with someone, having a coffee with someone, I think that’s really important. And so for me, meeting up with my GP friends and colleagues, be it kind of with the committee or with it coffee or meeting up for a meal, that’s really important for me. So I think that helps. To answer your question, I think meeting up with people, physical contact, even if it’s not physical, going to WhatsApp or phone call, something that’s intimate and not kind of, you know, trees of social media, which can be quite dangerous I think sometimes. So does that make sense?

Rachel Morris: (12:32)
Yeah, it does make sense, and I’ve just sort of reflecting that. I think it’s not just, you know it’s not just First5 GPs that need this. It’s older people too. It’s, you know, people like me or you know, I qualified as a GP in 2002 and I’m also presenting a lead, manage, thrive course weekend the other week and Chuck came up to me and said, Oh, I just want to say, you know, the thing that’s kept me sane is my young practitioners group and it’s been going for like 25-30 years. And you know, he was just about to go off for the weekend and I think he’s going to come on the podcast and talk to me about, because you know, I think actually the longer you work in a profession, sometimes the more isolated you can get because I guess you end up running the practice or you end up in management or a lot of your friends move away or it’s just easy to lose touch with people. And in a way there’s a sense of we’re not all in the same boat because we’re now in very different positions. We’re, where someone ‘s doing this, someone’s doing that, I guess that at least with the First5 you are generally, you know, there’s a lot of commonality there, isn’t there?

James: (13:32)
Yeah. I think you’re right. I mean, you mentioned the lead, manage, thrive, and I’ve told you this before, but I don’t want to embarrass you, but I remember I didn’t know much about wellbeing. You know, you, you kind of had a mentor, had a supervisor and I just thought, well, I wanted to try this course out. I remember seeing on red whale, and I thought, okay, let’s try it out. And I remember your lecture, and that’s how we got in contact afterwards didn’t we, for the wellbeing event. And you brought up something in your lead, manage story, which I still do to this day, which really helps me, um, is the work reflection diary. It’s, um kind of reflecting on your work throughout the week and that I still do that, um to this day and it really helps me. And you know, I know I’ve shared that with other people because I think that’s really important and I think perhaps it’s drummed into us reflection, reflection as degree trainee. But this is slightly different. So I put this on a separate folder. I put it as a kind of a Evernote tab so I can always go to it wherever I am, whether it be on my phone or whether I’m on a train or on a bus and I can just think about how my work week’s gone. Uh, that’s really kind of a good way for me, it’s been you know really helpful in regards to kind of processing what’s gone on, what’s going well, what’s not going so well, what can I improve? And they’re not very long entries. But that’s really helped me and I learned that from lead, manage, thrive, and then you kind of meet people at these courses who’re like-minded. So I think kind of a long story cut short going into a course like lead, manage, thrive, or going to wellbeing course or going to a First5 committee meeting, you may not feel like going, yes it’s another annual leave day or a study leave day or, but I think the benefits of going to these courses or meeting someone or meeting committee members, you know, has positive kind of ripple effects, doesn’t it? So you know, for the rest of the, you know, at least for a few months until you meet again.

Rachel Morris: (15:14)
Yeah, yeah, finding, it’s finding your tribe, isn’t it? It’s this sense of belonging. And interestingly, I did some training for receptionist this afternoon and I talked about the inner Chimp and you know, how, how this comes out when you’re, your stressed, it’s your amygdala response, etc, etc. And looking at the feedback forms and afterwards, you know, almost everyone said in the feedback forms, it was so helpful to talk to other people in the same situation.

James: (15:39)
Absolutely.

Rachel Morris: (15:39)
You know, and so I think whatever profession we’re in, just feeling we’re not alone in dealing with stuff and we, we’re not abnormal for feeling like we’re feeling, we’re not weak because we’re struggling. That is really, really, really key. So one thing I think we can learn, so when I say we – us really old GPs. 14, I guess qualified 14 years, um past, before you, you know, people have made the observation that there’s quite a difference in the way we’ve approached careers. So when I qualified, most people sort of went off into partnerships or went and got salary jobs with a view to perhaps becoming a partner. And on often worked, you know, I guess eight sessions like yourself or even nine sessions or, or even 10 sessions. And now people are saying to me, actually it’s pretty unheard of for a newly qualified GPs to want to go off and do more than six clinical sessions. They’ll always go off and do something different. And I mean I think that is entirely sensible because in my view, the more we can diversify in our careers and do other stuff, the more resilient we are because we can use other bits of our brain. You get different team around you. Um, you know, do you think that just happened gradually or do you think that something you guys have been taught or is it just something that got fed down the grapevine of this is the best way to do things?

James: (17:02)
I think it’s a good question. I think, I think it’s a change in culture cause I was coming up as a junior doctor during the junior doctors contracts kind of strikes and things.

Rachel Morris: (17:08)
Um, okay.

James: (17:09)
So that, I think that was a shifting tide. You know, I think, you know, we were – as a junior doctor I was very much aware of my hours, my rights as a doctor. And then suddenly this new contract came when I was on the picket line, so to speak. You know, when I joined that contract and we had a very supportive chief exec at Frimley Park Hospital where I was a GP trainee. So that was very helpful. So I think there was a culture change, whereas my dad who’s an ENT surgeon and who’s 69 or is sort of retiring this year. I don’t think there’s very much difference between his generation, my generation, how junior doctors – where you kind of get, you got on with it and didn’t talk about your problems and you didn’t talk about your struggles. Whereas when I started SHO, you know there was suicides amongst young junior doctors and you know, we were told as an induction, you know, if you needed anyone to talk to to come and talk to us. And you know, in the firm that I joined as F1. So these kinds of things I think, were wellbeing was pretty much, to answer your question, very much drummed into us that we could talk to our consultant, we can talk to our trainer, um, if we needed support. Now sometimes, you know, there’ll be an overlap between the two systems, you know, the old school, the new school, and sometimes you’d have some consultants who’re very supportive and some who weren’t or, and similarly with GPs. So I think it all depends on the culture that you grew up in. I do think that, you know, there has been a shift in the way my generation sees their work and, but I think it has been for the greater good in the sense that we’re talking more about our mental health and we’re talking more about our wellbeing. Resilience is a big factor amongst GPs. And I think that’s something that wasn’t discussed about 20-30 years ago. So to answer your question, I think it’s definitely more apparent, but I don’t think there’s as much of a stigma as there used to be. I don’t know whether that, you would say that, Rachel, if that makes sense. That, I think we’re more open talking about it than we were perhaps 10-15 years ago.

Rachel Morris: (19:04)
So I have heard some sort of older GPs having a little moan about the new generation of GPs thing, you know, they’re much, they know, they know their rights and then they’re not prepared to go the extra mile and yeah. And I would say maybe that’s the right way to be is actually know where your boundaries are and be able to stick to it. And what do you think about that?

James: (19:24)
I think it’s a culture change isn’t it? It’s a, you know, regards to, I suppose that generation or older generations, you’ll do everything to, you work longer, work later to kind of work for that job or that consultant job or that GP partnership job and, and the work was paramount. Whereas now actually, you know, for me it’s more I want my family to be my priority. I want not just my family, I want to be able to do stuff outside of work, you know. And I think if a GP said, oh they, you know, you know your rights and you know, you know, you’re not working as hard. Well I think, I think that’s a good thing. I think if you want to focus on your family or focus on your hobbies or you want to focus on doing triathlons, then great, you know. Or if you want to focus on travelling and take your time, because you know, without sounding morbid at the end of your life, you don’t want to be, I want to be the best doctor I can be, which is great. You want to be that, but you want to also be the best husband, you want to be, or the best father, or you know, the best cousin or brother, and you know, or stepdad or whatever it is. You want to be.

Rachel Morris: (20:27)
Yeah you know, no one’s going to write on your gravestone here lies beloved GP or you know, beloved lawyer or you know, they’ll write beloved husband, and father, and um. And that I, I do think that’s something that, you know, my generation, the generation before probably, you know, my dad was a GP and he was very much in that cradle to grave type thing, you know, very much sort of would deliver the babies and then sort of see them married and you know, then look after their kids and everything. But it just changed. I think I was a bit of the transition of that. I do remember in my first job being heavily pregnant with my first, with my first child and we got a call for quite a late visit. It was about half past six or something and it was dark and it was to a really dodgy block of flats and going to one of the senior partners who was coming past and I said, I’m really not comfortable doing this visit on my own in the dark to that, and you know what his answer to me was? He said, Rachel, you’ll go to heaven.

James: (21:21)
Oh wow.

Rachel Morris: (21:21)
That was it. That was it. That was it about the visit. And you know, that was the only response. It wasn’t like, you know, I think, I think that’s sort of, you actually give your, your all, even your, you sacrifice your personal safety to do this was, you know, I guess, yeah, I don’t know, is that, it’s a bit of a cusp, isn’t it? And then I guess there’s a school of thought thing that thinks, you know, we let the job get to this point where by not standing up and saying, no, that’s not right then we’re working like this or whatever. It’s, then nothing’s really been done about it. And then at the end of the day, what happens is everyone just leaves.

James: (21:55)
But at some point you just have to see where your priorities are and you have to see what’s best for you and your family and all your wellbeing. But yeah, it must be very difficult. Sometimes you want to do the best you can for your patients, but at the same time it shouldn’t mean sacrificing your own health.

Rachel Morris: (22:11)
So what would you say to a GP like First5 or final five or mid-career who felt like they were working far too much and were sacrificing their health, and their, perhaps their families or their hobbies or their happiness, you know, what advice would you give them?

James: (22:27)
Um, so I would say to that person who is thinking that just work is just work and nothing else. I just think take a step back and think, what made you happy before this? What makes you happy outside of work? And for me it’s music, spending time with my family, you know, for other people it could be, you know, I’ve started running again. So that’s really helped me as well. And that gives me a lot of head space to think and reflect and I’ve really enjoyed this.

Rachel Morris: (22:49)
I guess people then think, well, I don’t have time for that. How do I do it? I guess I’ve observed when I’ve been coaching people that, you know, people say, I just don’t have any time I want to do stuff. We actually ended up mapping out their week and just seeing what they’re fitting into their week, you know, they’re fitting, you know, six sessions, which isn’t really six sessions. It’s more like nine sessions. Because for me a 13 hour day is not six sessions, you know, three days of that is not six sessions and you end up saying they’re doing and then there’s kind of trying to squeeze in so much extra things as well, be it maybe being an appraiser or doing this or doing that and doing this on the side and actually it’s looking at what does your week actually look like how much time does your work actually take and what can you drop? I think this, this concept of I don’t have time for this. I don’t have time for that. There’s a really good talk about a good Ted talk about time management, this sort of time management coach said that she’d got this woman to write down every single thing she’d done in a week. Really busy business woman that said, I don’t have time for anything. Anyway, during this week this woman’s basements had flooded and she had to get the plumber in and get someone to clear it up and they calculated that within this week, it took her seven hours to sort out this flood. And if you’d asked her the week before, do you have time to deal with a flood in your house next week? Do you have? She’d have said, no way, no way do I have seven hours. Actually she made time for it because it was important and she did it. And you’re right. I think a lot of the time we think we are overloaded and often we are overloaded with work, but actually we do then just fritter away the the other time that we got and we’re not too intentional about doing stuff that will build us up and refuel us, like playing the violin or something else and we just sort of waste it on, well screen, screens a lot has a, it’s a big culprit.

James: (24:40)
DIY doesn’t come easy to me and I’ve been trying to do more DIY around the house in you know half term. So making time for that because that needs to get done as well. So not, might not be the kind of cool hobby. It might be something that, oh I need to fix that shelf, or I need to go to the post office and things like that.

Rachel Morris: (24:55)
Yeah, come about the time to find a man to fix the shelf. Don’t do it yourself, get someone, you can pay someone else to do something you don’t want to.

James: (25:04)
YouTubers saved my life Rachel. Their YouTube, yeah, oh that’s screen time, isn’t it? Sorry. But, um yeah, YouTube videos for regards to DIY and things like that, that’s kind of healthy.

Rachel Morris: (25:14)
I managed to fix my daughter’s brakes on her bike using YouTube. I was very proud of myself.

James: (25:20)
Yay. Yeah, there you go, yeah.

Rachel Morris: (25:20)
So it’s really helpful isn’t it? Yeah.

James: (25:21)
Well I think I remember, I’m really sorry but I’ve forgotten her name, but she came on your podcast a few weeks ago. She was talking about the little things that made big gains.

Rachel Morris: (25:30)
Oh yeah Catherine Hickman.

James: (25:32)
Yeah. And she was saying little things about doing something little that kind of triggers something to do something extra. And that really kind of helped me. So for example, I’ve been running more and I just thought, well let me just put my gym kit in my car and putting that in my car. Because that means that, okay, I’m passing the gym on the way home. I have no excuse because my gym kit, my bag is in my boot. So that kind of helped me and I think those little things, it sounds very obvious, but actually that little trigger really helped me regards to kind of running or gym. I’ve been challenged more recently to be be around for my friends and be there for my friends and my colleagues. But I was really challenged because I just felt like, well actually I can be very selfish and just think about what I’m going through. And then I you know, completely neglected my friend who is halfway across the country and you know, and he’s going through something and I, you know, I want to make sure that I’m there for him. So I think that’s been a challenge because obviously our lives are busy as you’ve said, but I think for me, sending that email or sending that message or meeting up for coffee with that friend is important. And I think, you know, especially we’ve recently had world mental health day and when I think what I really liked about this kind of campaign this year, which was a couple of weeks ago was asking someone, are you okay today? And I found that really kind of moving cause I just think, you know, it’s really important. Sometimes you don’t know, especially with the GP, we talked about how isolated it is, you can go through your whole day without talking to anyone.

James: (26:58)
Okay. Of course you talk to patients but you won’t talk to any of your colleagues. And then one of my colleagues came the other day, she said, oh James, thank you so much for that chat the other day. And I, you know, well honest I don’t remember what I said but I just think it, why I try and do that in between patients just to, I have a smart watch that tells me off when I don’t move around and I kind of, I get up, go to the kitchen and speak to receptionists on it. Mainly because my watch tells me off, but I took it as an opportunity to say, okay, I’m going to go talk to so and so and see how they’re doing today. I’m going to talk to the receptionists, I’m going to offer them to, you know, cause I want a coffee, does anyone else want a coffee? So for me that was a good way of kind of getting plugged into the people I work with. Because like you said, as a GP, sometimes you’re just sitting in your room all day, see your patients, do your admin and go home. And then sometimes you find that you’ve gone a whole day without talking to anyone who’s not a patient. Our colleagues are friends, and we spend most of our time with our colleagues really throughout our lives.

Rachel Morris: (27:57)
Yeah, I like that question. Are you okay today? It’s much better than how are you isn’t it?

James: (28:01)
Yeah. Yeah. Yeah. And I think that’s, you know, it’s a bit more layered, isn’t it?

Rachel Morris: (28:07)
Giving is one of the ways to wellbeing. So giving by being able to send messages and spend time with people is you know, actually will make you feel better as well as making them feel better.

James: (28:17)
Exactly, yeah.

Rachel Morris: (28:17)
That’s good as well. And I just think this, this whole thing about connecting with people at work. I think my next campaign is going to be for the coffee break cause there’s just so much evidence about informal connections making teams stronger and all that sort of thing. And it is so isolating being in your, yes, of course patients you’re talking to them, but there’s something about the support you get from colleagues just in a coffee break going, oh you know, what would you do about this? Or you know how are your kids, or you know.

James: (28:46)
Well I think, you know, my training practice when I trained kind of in Yateley, which is kind of in a friendly park hospital, we had a coffee break every day at 10:20am for the whole practice. There was no patients seen during that time. So 15 minutes. So the whole practice we get to this coffee room and nurses, receptionists, staff, we’d talk about, you know, what was on TV the previous night. Be it Downton or bake off or whatever it was. And also we’d talk about stuff that was going on in the news and all the doctors would talk about patients, not so much so you know, all the time. But it was a place where we felt comfortable. We can support one another. And I just felt as a registrar at the time, I thought this was brilliant. I thought all practices have that, but you know, they don’t. And then I just thought that’s something I miss. And it’s difficult because I think in our practice we can’t do that because we don’t have the space, but we’re hoping to get a new premise soon. So that’d be something that I’d be championing definitely. But I’ve seen the benefits firsthand and it’s, it’s fantastic and you get to know, you know, I’m still friends with the GPs and my trainers from that practice to this day because I’m, not just because I trained there, but because of those coffee break connections. If that makes sense.

Rachel Morris: (29:54)
I heard an astounding stat the other day. That if you have friends at work or if you have a good friend at work, it adds seven years to your life expectancy.

James: (30:03)
Oh wow. Yeah.

Rachel Morris: (30:05)
Seven years.

James: (30:06)
Seven years.

Rachel Morris: (30:06)
That’s amazing. I don’t, not sure if I complete that one. I believe it will add some years, but seven!

James: (30:11)
Oh I’m glad I’m prioritising it now. Well yeah I can see that though. I think this goes back to full circle what we’re talking about, wellbeing wasn’t it? It’s about kind of looking after yourself and I think sometimes if you work so hard that you know you don’t see the positivity around you, you don’t see the people around you and I just think you’re missing out so much on life.

Rachel Morris: (30:32)
I mean that is the way that trust is built within a team. And I always, you know, think the practices that really don’t have, I mean there are some practices that can’t, you know, with the premises issue is a big one I think with some people. But obviously you, sounds like you actually do have a coffee break cause you said you get up, you go get a coffee, you go talk to people so that, there’s your, there’s your mini coffee break there.

James: (30:50)
Oh yeah.

Rachel Morris: (30:50)
Even if it’s just one or two of you stood in reception with a cup of tea talking to each other and you know, it’s that that builds up trust because if you sort of know someone and know what their weekend was like and you know what their kids are doing and stuff, then actually the relationships there. And then if you do have a difference of opinion and disagreement, that’s okay.

Rachel Morris: (31:12)
I find it incredible when, you know, on courses I’m talking about the importance of connecting, meeting each other at work and there’s always someone who goes, oh no, we just don’t have time. We just don’t have time to do that. It’s like, oh my word first of all you need a break. Right. So that it’s just, you are so much more efficient if you’ve had a break. And secondly, connecting with people, it’s, it gives you such a sense of wellbeing. You know, having friends at work, that you don’t really have time not to do it. And I was asked by a GP recently who came up and asked us after the course, you know, I’m in this practice, she said with two partners who hate each other, who won’t speak to each other. And I’m trying to get this, I’m trying to do something, I’m trying to make a change in the practice and it’s really difficult and we didn’t really know what to say to that because actually if there’s no communication, if the, if the feelings like that in the practice, then what’s the culture going to be like and how are you going to do anything?

James: (32:03)
And there’s no way, there’s no nowhere to hide when that’s the issue. So that must be incredibly tough. And I think, I think it’s important to be open, you know, you know, you’re bound to have disagreements with the people that you work with and you’re bound to have differences of opinion. But I think you need to respect one another and you’d be able to talk to one another. But, um, yeah, like you said that you know, if that happens then it becomes a very toxic atmosphere and then that can lead to, you know, communication breakdown and relationship breakdown, um which, I don’t know without sounding cheesy, Rachel, I think that’s, you know, if we’re not communicating with each other when then we won’t be able to communicate with our patient properly.

Rachel Morris: (32:37)
Well I guess that’s exactly what, I was really worried, I thought, well you know, if that’s happening in the practice then actually what other issues are there going to be in terms of, you know, patient safety and how are you going to provide a great service for your patients if you can’t even get over it yourselves.

James: (32:52)
Yeah, and I think, and that goes back to what we were saying about kind of looking after each other because if we’re not looking at each other, not only are we looking after our own wellbeing, but we’re looking after our patients’ wellbeing. You know, your patient doesn’t want to see you stressed or upset or angry. Obviously then no one wants to see us like that. But you know, I have a GP and I would, I would hate the fact that if my GP was struggling or I’d feel very sorry for them, but at the same time, you want them to be at the best kind of peak physical and mental health really, wouldn’t you? You want them to be well supported and looked after. And I remember, I think after, you know, I went up to your lead, manage, and thrive course where I heard someone say that talking about kind of wellbeing and thinking, do you want your doctor to be kind of stressed or tired? Would you want them to be refreshed? And you want them to be kind of re-energised. And I think it’s important that, you know, patients realise that we need those breaks. We need to be able to go on courses and study leave and things. And we’re not robots, we’re not machines. And I think it’s important that they realise that, but if we’re not looking after ourselves and we’re not talking to one another in the practice, and that’s just a recipe for disaster. Really.

Rachel Morris: (33:58)
Yeah. Yeah. She’s like, how would you like your GP? Right? I’ll have a GP who’s well caffeinated, shook it up and not knackered. Thank you very much and that will be fine.

James: (34:08)
Right, exactly. And then they say, well, you know, do you want your GP to learn? Yes. Do you want them to like study or learn, or be up to date? Yes. Well you need to give them time to do that. They’ll say, no, I want to see them today. And is it all that kind of, it’s that you can’t have it both ways. You need to make sure that that is, that’s the pressures of the NHS isn’t it? You know, I have a patient who said to me yesterday, I don’t know, a few days ago she said, you know, doctor, getting an appointment with you is like getting an appointment with the Pope. I just thought, okay, well I was like, well I’m really sorry. You know? But at the same time it’s, I do work there full time.

Rachel Morris: (34:40)
I think it’s really important as well for GPs to realise that actually looking after number one, i.e. themselves isn’t a selfish act. It’s actually really important for their clinical performance. For, you know, for their own happiness, which actually then leads to good performance or all that sort of stuff. So it’s not selfish. It’s actually vital. So James, I, we could talk about this all evening I think. But um, we’ll wrap it there. James, if people wanted to contact you, how could they find you?

James: (35:08)
So you can contact me on Twitter. I do a lot of First5 stuff from there. So it’s J and my surname is Thambyrajah – @JThambyrajah on Twitter; through the First5 South West Thames page as well. I’m on there. And what else? Yes. And also through kind of faculty board members at the South West Thames as well. So I’m kind of heavily involved in those, in events there. Um, but yeah, that’s been pretty much those two things.

Rachel Morris: (35:30)
Great. Well thank you so much for coming on and we’d love to get you back again another time soon. Thank you.

James: (35:35)
Thank you very much, Rachel. Thanks you. Bye. Thank you.

Rachel Morris: (35:37)
Thanks for listening. If you’ve enjoyed this episode then please do subscribe to the podcast and also please rate it on iTunes so that other people can find it too. Do follow me on Twitter at Dr. Rachel Morris, and you can find out more about the face to face and online courses which I run on the youarenotafrog.co.uk website. Bye for now.