Episode 64: What to Do When You’re Out of Fuel with Dr Jess Harvey

Do you think you’re superhuman, able to carry on despite all the stressors life throws at you? Or do you feel on the edge of burnout and wonder how you’re going to make it to the end of next week? Your energy bucket has its limits. The past year has robbed us of normalcy, and becoming burnt out in a high-stress job may seem inevitable.

In this episode, Dr Jess Harvey, a GP partner and GB triathlete, talks about what happened to her after running out of fuel and experiencing burnout. She discusses how we often ignore the symptoms and signs for too long and why resting and refuelling is as important as what we’re doing in the first place.

If you’re running on empty, tune in to this episode to find out how you can plug the holes in your energy bucket!

Here are three reasons why you should listen to the full episode:

1. Gain valuable insights from what happened to Jess Harvey and what she did when she ran out of fuel.
2. Find out how to check in on yourself and know if you’re already nearing burn out.
3. Discover why resting and refuelling is more important than you think.

Resources

• Leah Gilbert Performance + Wellbeing
• Feel Better, Live More with Dr Rangan Chatterjee
• More Than a Woman by Caitlin Moran
• Connect with Dr Jess Harvey through email or on Instagram.
• Find out more about the Permission to Thrive CPD club for doctors here.

Episode Highlights

[04:02] Jess’s Story

• Whenever Jess gets stressed, she gets injured or something goes wrong with her body.
• Towards the end of medical school, she developed an eating disorder that turned out to be anorexia.
• Because of her condition, Jess couldn’t run anymore.
• Running is her coping mechanism. Being unable to run got to her, so she started eating again.
• While going through GP training, she caught a rare eye infection and had to miss two months of work.

[12:22] The Importance of Rest and Recuperation

• Jess became a partner in 2017, and her responsibilities increased. The first thing that happened to her was a stress fracture in her foot, and she had to wear crutches for four weeks.
• After a case with a young girl, Jess started to second-guess herself. She also kept everything inside because she didn’t want to burden her colleagues.
• She then started to have sleepless nights about an upcoming CQC inspection, and her eye started projecting again.
• Jess realised she was completely burnt out. She likened herself to a bucket of water that is full of holes. To fill it up, you should do things that bring you joy and make social connections.
• Rest is essential for the muscles to adapt and the body to develop. If you keep working without rest, you’re not going to be productive. We need to acknowledge vulnerability.

[25:13] What to Do When You’re Burnt Out

• There’s a stigma around stress wherein people think they should have coped better.
• For Jess, being burnt out allowed her to check in with herself and reflect on what happened.
• Check in with yourself — think about how you’re feeling physically. Do you have enough energy?
• You also need quality sleep. If you’re not sleeping well, what is keeping you awake, and is there something you could do to help with that? Think about your mental and emotional factors.
• Finally, look at your stress levels. We all have different stressors — these are the holes in our energy bucket that we need to check.

[30:54] How Micro Doses of Stress Pile Up

• When you go running and pound your feet, the bones experience a little bit of stress. Similarly, small doses of stress can eventually become too much.
• Our stress and lifestyle choices all pile up.
• We should accept that we are fallible as humans.
• Jess realised she needed something else in her life other than work and training.

[38:47] Changing How We Deal with Ourselves

• If you’re tired, don’t force yourself to do anything because you’re just going to make things worse.
• We often spend a lot of energy at work making sure our colleagues are doing fine.
• However, we never look at ourselves, and this leads to us struggling even more.
• You are your most precious resource. You have to take care of yourself to take care of others.

[45:20] Top 3 Tips for Professionals

• Allow yourself to be vulnerable.
• Try to check in with yourself.
• Be kind to yourself.

7 Powerful Quotes from This Episode

[09:48, Rachel] ‘It’s amazing how when the bad stuff comes, you’d never want it to happen again, you’d never wish it on anybody. But often, it does produce a change of direction or something that is beneficial to us, and that we would never have seen coming’.

[11:01, Rachel] ‘The way you learn resilience is by going through crap, and that really does make you stronger.’

[22:46, Jess] ‘I think it’s also hard to admit when you are struggling. I think that’s something that I’ve really struggled with and that sort of being vulnerable with somebody. There’s great strength in vulnerability, and I think we should probably learn that’.

[31:38, Jess] ‘Everything mounts up, and then one day you find yourself sat with your head in your hands on your desk. You think, “I can’t do this”. And it’s I think it’s us being aware of that. And I think part of it is actually as accepting that we are fallible as humans’.

[32:52, Rachel] ‘The thing about burnout is it’s very physiological, isn’t it, you literally burn out your hypothalamic access, your cortisol’.

[37:38, Rachel] ‘All the evidence points to, if you are happy at work, you will be productive at work—not if you work hard, you’ll be [happy]’.

[45:23, Jess] ‘Allow yourself to be vulnerable. If you can’t be vulnerable to somebody else and say, “Oh, I’m not good. I can’t do this, I need a break”, then at least to start with being vulnerable to yourself and saying, “Okay, I acknowledge this”’.

About Jess

Dr Jess Harvey is a GP partner and a GB triathlete, having competed in her age group for Great Britain. She is passionate about proactive prevention and education for all. Jess is also interested in resilience, well-being, rest and recuperation after a series of what she describes as fortunate events in her life.

You may find her on her Instagram or reach out to her through her email.

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Episode Transcript

Dr Rachel Morris: Welcome to another episode of You Are Not A Frog. What to do when you’re out of fuel? Do you think you’re superhuman and can carry on going despite whatever macro and micro stressors life throws at you? Or do you feel on the edge of burnout and wondering how you’re going to make it to the end of next week?

In this podcast, I’m joined by Dr Jess Harvey, a GP partner and GB triathlete to talk about what happened when she ran out of fuel and hit burnout. We talked about how we so often ignore the symptoms and signs for too long, and why resting and refuelling is as important if not more important than what we’re doing in the first place.

So listen to this episode to find out what happened to Jess when she experienced one too many holes in her energy bucket. Listen if you want to find out how we justify our behaviour, and why we think it’s okay to keep going. And listen to find out how to check in with yourself and plug the holes in your energy bucket.

Introduction: Welcome to You Are Not A Frog—the podcast for GPs, doctors, and other busy professionals in high-stress jobs. Even before the coronavirus crisis, many of us were feeling stressed and one crisis away from not coping. We felt like frogs in boiling water—overwhelmed and exhausted. But this has crept up on us slowly, so we hardly noticed the extra-long days becoming the norm. And let’s face it, frogs generally only have two choices, stay 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. You have many more options than you think you do. It is possible to be master of your own destiny and to craft your life so that you can thrive even in the most difficult of circumstances.

I’m your host, Dr Rachel Morris, GP, and executive coach and specialist in resilience at work. I work with doctors and other organisations all over the country to help professionals and their teams beat stress and take control of their 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 thrive in our work and lives.

Rachel: For those of you listening to the podcast who needs to get some continuous professional development house under your belts, did you know that we create a CPD form for every episode so that you can use it for your documentation and in your appraisal.

Now, if you’re a doctor, and you’re a fan of inspiring CPD, and you’re sick of wasting a lot of time, you don’t have—on boring and irrelevant stuff. And you want to put those 50 hours that you have to do to good use and why not check out our Permission to Thrive membership. This is a new venture, a joint venture between me and Caroline Walker, who’s The Joyful Doctor. And every month we’re going to be releasing a webinar fully focused on helping you thrive in work and in life. Every webinar is accompanied by an optional workbook with a reflective activity so that you can take control of your work and your life. You can increase your well being, and you can design a life that you’re going to love. You’ve got to get those hours so why not make your CPD count to CPD does good for you. So check out the link to find out more. Now, thanks for listening to my shameless plug and back to the episode.

It’s really great to have with me on the podcast today. Dr Jess Harvey. Now Jess is a GP partner. She’s also a GB triathlete, so she’s competed in her age group for Great Britain. And she has a particular interest in resilience, well-being and particularly rest and recuperation after a series of what she described some as fortunate events that has happened to her. So Jess, yay. Jess, welcome for a start. It’s really great to have you.

Dr Jess Harvey: Oh, yes. Thanks for having me on.

Rachel: Could you start with by telling us about this, what brought you to this interesting well-being, resilience and rest and what’s your story? Because I know you’ve got quite a few things that have happened to you over the past few years.

Jess: Yes, I think it’s been an interesting few years. And I guess if you sort of think about things in those sort of chapters in your lives, those headings, there’s been a few that have definitely sort of marked my way thus far. I guess the—as I know, we have the great upbringing, normal school, and all that sort of thing. Medical school’s great, really enjoyed it.

I think the first chapter heading thereafter was when—so towards the end of my medical school, I developed an eating disorder, and it was sort of full blown anorexia by the time I qualified. And I guess it’s a period of my life that you look back on and think, ‘It definitely changed me’. And I think it’s taught me a lot of things.

But I remember I started running and through medical school, and when I was a kid, I used to play loads and loads of hockey. But then in medical school, I trained in Cardiff, so we went all across Wales doing placements. And I—it got difficult times playing for a team in Cardiff, and I was placed in reel for six weeks. So I started running or something else to do. And found out I loved it. And I carried on doing that. And with my eating disorder is obviously when you sort of dropped to a low weight, you get to a point where actually running isn’t really that conducive.

But the moment that was my sort of pin-drop moment for that, which is I tried to go for a run, and I got down the road and literally, couldn’t. I just didn’t have the energy or the wherewithal to move. And that was the moment that I thought, ‘Right, okay’. And then you sort of realise then is that that was what I loved doing. And that was what my—that was always my get out for stress from work for everything else, was running.

And so all of a sudden, I realised what I was doing, it wasn’t what I was doing to myself or my body, my bone health, my fertility, all that stuff. It was that my coping mechanism was going to go. So that was what then—so to me, and that was the moment that I was like, ‘I will do something about this’. So then I sort of started eating, and definitely, things improved. And I guess that was kind of that little chapter that started to then move on. I think it’s something that we’ve had an eating disorder like that is you sort of live with it. And like, I’ve got healthy BMI and stuff now. And, but yes, it’s something that you live with, I think for a lot of people. Some people fully recovered. But I think I’m more one of those people who probably lives with it if I’m honest. But it certainly taught me how much—so exercise was important to me as a person and not for weight control or anything like that, but for other benefits that I got from it. So that was sort of that chapter.

And then I sort of moved on and did various other jobs and wasn’t sure what to do with my life. So, I decided to apply for GP training, hoping I’d have an epiphany in the first 18 months of my GP training. So that was to do 18 months of different specialities.

And then partway through that, I got a really bad eye infection. And it basically meant I ended up missing two months of work with it. And to cut a long story short, it is a really rare infection called Acanthamoeba, but you get in contact lens wearers. And with hindsight, I was a walking risk factor, because I did everything wrong. But then it just destroyed the top layer of my eye, and I got a superinfection with it. And the brief version is that my eyes sort of self perforated in the kitchen mirror one day. And so I ended up down in Moorfields in London, and who were brilliant, and I can’t thank them enough for it. Because I’ve really looked after me over the years.

And I haven’t been an easy patient because I’ve had; also every complication you can possibly have. So I ended up with a corneal transplant sort of the next day. And I’ve got a secondary [07:44 unintelligible], so I’ve got tubes that had to be put in and a lot sort of stuff. But it certainly taught me—I definitely learned a few things from that. One, so my knowledge of ophthalmology is a lot better than it was before. I’ve got a new appreciation for the transplant service. Like it’s amazing. I don’t think when people filling out the forms, they quite realise the impact that can have.

Rachel: I remember what we were chatting before the podcast, and you said that one of the ways you know when you’re stressed is things that—or every time it’s failed, it’s been in a period of your life where you’ve been particularly stressed. Is that right? And most of us don’t look after ourselves like that. We think that our organs are completely expendable, I guess. And it’s not till you’ve had something really important happen like that. You stop taking yourself for granted.

Jess: Yes, yes, completely. And it’s been—yes, there’ve been times when… It’s funny because when I’m getting really stressed, it’s normally one of two things that happen. Either A, I get injured, or like in terms of like, running injuries or whatever, or something goes wrong with my eye. And it’s always the way. I guess the other thing that I learned with my—from my eye, I’m forever grateful for it is that I had one operation with my [09:01 unintelligible] and they said ‘Right’. And as my one of consultants was walking out the door, she said, ‘Oh, by the way, you can’t run anywhere for six weeks’. At which point, I sort of hit the ceiling and grabbed the back end. That was my get out. That was—that’s how I coped with the whole thing.

And so we compromised on indoor bikes and shit, right? You can go and sit on a stationary bike, and that’s it. So I was like, ‘Right, I’m going to learn to ride a bike now’. And anyway, that sort of led into me doing triathlon randomly. I’m not a swimmer, but I knew how to swim. And sort of within like a year of doing it, I found myself in Canada doing the World Championships, my age group, Great Britain. So yes. And if it hadn’t been for all my eye stuff that never would have happened.

Rachel: It’s amazing how when the bad stuff comes up, you see you never wanted to happen again, you never wish it on anybody, but often it does produce a change of direction or something that is beneficial to us, and that we would never have seen coming. So it’s strange that—isn’t it? Life is strange in that way.

Jess: Oh, absolutely. Yes. It’s funny because before we were—so just before we started this—recording this—I was thinking about stuff that happened to me. I thought, ‘If I could wave a magic wand and change it? Would I not have had all that stuff happened to me’? I wouldn’t change it now. Because everything that’s happened since then has been so great. And actually, even the downsides when I’m sucked in a hospital bed, and overnight and by myself in London, and stuff, actually is fine because you learn to cope with these things. And something good does come out, like my triathlons stuff. And I’ve got so many amazing friends I ended up meeting through triathlons.

Rachel: I think that’s the funny thing about resilience. I was reading some research the other day, which was, I guess, slightly depressing, but it’s how do you really teach kids resilience and children resilience? And it’s like, ‘Well, yes, you can teach them about emotional intelligence, you can teach them this and this’, but actually, the way you learn resilience is by going through crap, and that really does make you stronger.

And it’s a bit depressing because you think, ‘Well, I don’t want my kids to have to go through dreadful stuff in order to make them more resilient’. But on the other hand, maybe it doesn’t mean that that issue that they’re having with their friendship, or that bad grade that they got, actually isn’t the disaster that I think it is. Maybe that’s how they’re going to learn. And that’s going to how they’re going to develop.

So I think we really, really need to get away from our thinking about things being really good, or things being really bad. And just actually, things are just what they are, aren’t they?

Jess: Yes, I think they’re just that like—they’re just experiences, aren’t they? And it’s an experience that you’ve had, and you can take something from. You can choose to take something from that experience and go forward with it or not.

Rachel: I’d call that thing, and you say in the past, that the whole resenting is like, ‘I wish it didn’t happen. It’s so bad, why me’? Well, that’s nothing you can control, nothing you can change has happened.

Jess: Right?

Rachel: If you’re staying in this inner path, and actually what can I do now? That’s what’s really important. And so one of the reasons why I wanted to talk to you is because I think after this, you’ve experienced some more issues in terms of overtraining, and then that’s gone on overtraining syndrome, that’s make you go on to really think about the importance of rest and recuperation. I thought that was the message my listeners really need to hear. So tell us a bit about that?

Jess: Yes, so I became a partner in 2017. I was living quite a nice partnership life. So going along, so doing what I could, but didn’t have massive responsibility. And then it sort of started to increase, which is good. That’s what’s supposed to happen. So it’s last year, and there was a sort of sequence of events.

So the first thing was that I got a stress fracture in my foot. And so then I was on crutches for four weeks, and working still through it, which was a challenge to—being on crutches wasn’t the issue for me. It was, I couldn’t go running, I couldn’t go cycling, anything I could do with swimming and to get doing a how-to cobble up with my crutches to the poolside and do it. I think I was kind of falling apart inside because of that. And I don’t think any of my colleagues quite realised at all. And so that happened.

And then, just as I got off the crutches, I was involved with a case of a young girl and ended up going to the coroner. And it was very difficult. And it was something that nobody could have foreseen coming, but the way the coroner was sort of wording things was that I was responsible either way. But that really cut me up a lot. Because it was a young person. And either way, I felt very much to blame, even though it’s something that no one—I know, deep down on would have seen coming. But that also played on me. And I found that really hard because your clinical judgment, then it’s starting to come in to question and—you, sort of, think start to question that I was two years into being a partner, and trying to stand on my own two feet, and be independent, all those sorts of things. But I really started to fumble a little bit with that.

And I remember just every patient that came in just second-guessing everything that happened. And you don’t really feel that you can sort of burden your colleagues with this sort of stuff. They’re just going to think I’m a bit of an idiot. And I should be able to cope with this, and that’s that. I think I’ve got quite, sort of, inward thing that I should be able to cope. And you have to think about why I’ve learned now that why should I? Because I wouldn’t treat anybody else. Like I feel that’s something that we all have to sort of think about.

And then and just as that was sort of going on, then we got the CQC call. So, and this was obviously my first CQC inspection, and I was absolutely breaking it, and I thought we’re gonna fail it. It’s been because of me, I’m going to get interviewed, and that’s what we’re going to lose. And I can see my partners around me, we’re all really stressed, and we all do loads of work for it to get prepared. But I was absolutely breaking it. I don’t think they actually have any idea what was going through my head. And how I was just having completely sleepless nights, since it’s going to be me. I’m sure. And I knew that they were having sleepless nights over various other things. But I think that you sort of assume that they’re just whole sleepless nights, over general things, not it being them. But, yes, so that wasn’t the best.

And then the week before CQC came, my eyes started projecting again. So then we trip down to London, and we started having conversations about them taking my eye out, which I wasn’t very impressed with. And so it was funny because, like, we had the inspection, I remember sort of leading up to it, getting out my bike, it just feeling really hard and thinking, it feels like I’m riding through mud. And then I just tried to go for a run about a week after the CQC inspection and I just couldn’t. And it was like that eating disorder moment, again. I literally just couldn’t put one front in front the other. And it wasn’t because I hadn’t eaten. It wasn’t because I wasn’t fit enough. It was literally because I was just completely burnt out.

And you look at everything, and you look back. And with hindsight, you can see all happening and that tanks are draining. And the only way I can liken it is it’s a bit like getting a long car journey. You’ve got a tank full of petrol I started off the year with and it sort of went down, and there were chances, and I went past garages where it could have stopped and filled it up. But I was like, ‘No, it’s okay, I can get to the next one. I can get to the next one’. And then it sort of got to where it was all coming to a halt. And it’s that realisation that I’ve gone too far. I’m not going to make it to the garage. And you can feel the engine stuttering, and you just come to a grinding halt, and you keep thinking ‘It’ll get there, it’ll get there. As long as I can just get through this thing. It’ll be okay’. But I just couldn’t make it.

And yes. And with hindsight, you can see if you imagine that tank, and this is how I think of it now, is if you imagine having a bucket of water. And we’ve all got the stuff that drains out like work and training and family sorts of things. And we’re—and you fill it up for doing the things that you enjoy doing, like walking the dog or meeting out friends, going for meals, stuff like that, or the yoga sessions, anything that makes you happy, that brings you some joy helps to fill a bucket back up. But what was happening to me was that there were just more and more holes getting put in the bucket. And it was coming out faster and faster. And even though I thought I was putting in enough, the holes that were already there, and we’re getting bigger like the work hole was the inspection and then like my—I was—it’s probably always there as a little hole that I just try not to imagine is there, but it is there. But then that all of a sudden got bigger. And when all that’s coming out, unless you do something major potholing one of them you’re never going to win. And that’s what happened to me really.

Rachel: That’s really interesting. Because you see you’re doing your exercise, which for you was part of your re-energising. But that wasn’t enough. So what else? What was missing there, from you in terms of the energy filling up? Do you think?

Jess: I think when you look back, you think, ‘Well, I wasn’t doing those other things’, that we know—that I now know. I have read a lot more about— it actually does make us happy and do help. So things like those social connections, most relationships. I didn’t see anyone really for about like a month other than people I worked with, maybe I’ll see my parents for Sunday meal because I was just working and training. And I saw the people that I trained with, which was probably my saving grace in a way. And that was probably the one thing that really did keep me going was sort of seeing people that I trained with, like those I swam with, those I rode with, and but losing those social connections and that sort of downtime. I think it was probably that I think it’s that also sort of taking care of yourself. Like I wasn’t doing yoga or anything like that at the time. And certainly, now I’ve learned that that sort of has definitely a benefit for me in terms of almost like a sort of meditative but also like the physical benefits but also the mental benefits of just switching off and just having that headspace.

And I think it’s just generally by looking after yourself, isn’t it? Are you sort of eating well? Are you sleeping well? Are you seeing your friends? Are you doing things you enjoy doing? And the reality was that I was kind of enjoying exercise, but I was getting so tired. I wasn’t even enjoying it anymore. But you know, that’s who we are, yes.

Rachel: I think that’s fascinating because I would always think someone who is a GB athlete like you would have completely nailed the looking after themselves because you need your body to be functioning as well as possible. But I think it’s quite possible to focus purely on one well-being factor, fitness and completely neglect all the others, which are so, so important, aren’t they? And I know, I was reading one sort of personal coaches in a fitness coach, not a coach coach. But they were saying that the rest days that athletes have are as important or if not more important, than the training days, is that true?

Jess: Oh, yes, totally. Like you think about how you wouldn’t give a sprinter a sprinting session and say, ‘Right, Sprint 100 meters. And as soon as you get to the finish line, turn round. Sprint another 100 meters. Run and expect every 100 meters to be as good as the last one. You’re going to do that for an hour, you’re going to get a drink, and then you’re going to do that for another hour, and do that for another hour’. But that’s what we’re doing in life a lot of the time, and unless—and so actually, if you’ve got them sprint to you, get them to run 100 meters, and then they have like five minutes, 10 minutes rest. And then they’ll do that session, and then they’ll go home and have a nap, and then come back, and maybe do another session later. And then they eat. They’ll have a massage and sleep really well and have a line until 10 o’clock or whatever, then.

So actually, the rest is more important in many ways. And if you don’t—so if you think of it in sort of an athletic terms, if you don’t rest, then your muscles don’t adapt because the whole time with training is your causing those little micro-traumas, and that’s what stimulates muscles to develop, and all the rest of the stuff. So you need that rest time for your body to develop. And actually, I think the workwise were exactly the same. Because if you work and work and work, we all know, you’re not as productive. I’m nowhere near as productive at 6:30 am as I am at 9:30. And I know that. And I can tell. But then there’s a part of you that’s like, ‘No, go hard or go home’ like, ‘Come on, like keep going’. I think as a profession. We’re terrible for that, in many respects.

And I think it’s learning that actually, the time off is just as important, if not more, as when you’re there. And that whole presenteeism thing, I think wasn’t as much maybe in medicine at one point. But I think I started to sort of, to creep back in a bit. I think it’s hard to rein back from that. I think it’s also hard to admit when you are struggling. I think that’s something that I’ve really struggled with, with that. And that sort of being vulnerable with somebody. And having this great strength and vulnerability. And I think we should probably learn that. And it’s acknowledging that vulnerability within ourselves to say; ‘actually, we’re not invincible’. So we do need this time, downtime. And maybe if things are getting crazy, then we need to take time off or have a bit of extra leave or something like that. But it’s having the confidence to have that vulnerability with somebody, I think it’s really important.

Rachel: But we don’t do that, do we? We don’t go, ‘Oh, I’ve been working really hard. I’m feeling a bit knackered. I really need some time off’. Well, we might just about allow ourselves to say, ‘Oh, I really need a holiday. Thank goodness, I’ve got a holiday coming up in six weeks time. I’m just living for my holiday’. But we don’t go. ‘This week has been awful. Therefore, tonight, I’m going to cancel those plans. And I’m going to go and have a bath’.

Jess: Yes.

Rachel: I’m gonna do something that’s going to sue the neck after me.

Jess: Yes, that’s exactly it. And I think actually, what’s fascinating is if as a profession, we cared for ourselves anywhere near as much as we cared for our patients, we would be a far healthier, more motivated, and our well being would be far greater. And I think actually, we have a lot of compassion for other people, but to have compassion for ourselves, we struggle with.

Rachel: Yes, we really do, don’t we? And I think this whole idea that we’re weak if we need a rest, weak if we need a breakaway, weak if we’re struggling, it’s just so pervasive, and it’s so destructive. And it’s not helpful, and I think it’s not helped by the workload and the fact that if you do notice someone else is struggling, then maybe you don’t say anything because that means that you’ve got to take some of their work off them or see some of their patients or it’s hard. But it’s so vital because we’re losing so many people in terms of people leaving or having to cut back down or burning out and going off with stress and sickness and things like that. But that actually, it’s a false economy, isn’t it? What did you do? What did you do when you had your—that burnout?

Jess: And so that’s interesting. Since I’m a bit of a hypocrite. So I remember not. So I didn’t—no, I don’t think anyone claims that she knew what happened. And I think I was quite—I was really embarrassed actually. If I’m absolutely honest, I was quite embarrassed by the whole thing. And because you think, ‘I’ve done this to myself’, and you think, ‘There were so many opportunities that I could have had. And there’s so many things I didn’t have to do, but I did’. And so I think part of that, and I think part of it is the stigma and that you think just like we said, is that you think, ‘Oh, I should have been able to cope with the stress of the—better. I should have been able to cope with the coroner asking me those questions and all this sort of stuff. I shouldn’t have been in a position where I had a stress fracture’, and all those things played into it. But I think actually what happened was I, it really made me sort of look inside and look at what happened.

And I reached out to a friend who’s a sports counsellor in Australia, who works in this area, mainly with athletes. And she looks a lot in terms of your recovery in that sort of area, for athletes. And she’s got a system of check-ins, and it’s really interesting. I started doing it. And it’s been the best thing that I’ve done because it’s a way of checking in on yourself. But there’s accountability because you have to do it because I get an email saying, ‘Here’s your check-in thing, check-in please’, sort of thing. So as a people pleaser, so I have to do that. And so you do that, and it’s just thinking about, and it’s almost like ‘we could all do it’. And everyone that listens to this could do it. And it’s just having that—so it’s on a Friday, which I think is quite a good time to check in how you’re feeling. And it’s thinking about how you’re feeling.

So how are you feeling physically? So in terms of athletes, it’s like ‘Do your arms and legs feel heavy when you’re doing stuff? Are they burning’? Those sorts of things. But actually, that applies to any of those, like, ‘Do you have enough energy? If I said you want to go for a walk around the park, could you’? Because if actually, you’re so knackered that your legs wouldn’t take you then formation and things like you eating you looking after yourself physically.

I’m talking about sleep. So think about how you’re sleeping. So are you sleeping well or not? Because that’s normally the first thing that I think starts to go with this. And it’s quite interesting when you speak to people about how they’re sleeping, and what’s keeping them awake. And why is that keeping you awake? And is there something you could do to help that?

And then thinking about sort of your—sort of mental and emotional factors like, how are you feeling in general? Are you feeling sort of depressed or low? Are you feeling like, anxious because there’s nothing worse than that constant adrenaline when you are on the edge, and you’ve got it coursing through your veins, and you think ‘It’s okay, it’s just the duty doctor session is making me like this’. But actually, it’s not. It’s because you’re sort of approaching the edge. And your cortisol levels and everything else are just like pumping. So it’s thinking about those sorts of things.

And looking at, like, your stressor levels. So how have you got extra stress? Like has—have you got an issue with one of the kids at school, that’s stressing you out? Have you got an issue with one of your family members in a nursing home? Have you got problems at work, like, not getting friction with a colleague or a difficult patient or a complaint or something like that? Have you got extra stressors, no physically, like, are you training for a fun run or marathon or something like that?

Because all those sorts of things. They’re all stressors for us. And they’re all holes in that bucket that we have. Unless we check in on how we’re doing with all that, then it—we’re never going to understand that we need to stop, we need to slow down, we need to help to try and fill it.

Rachel: Yes. I think that’s a really interesting point because I think we all know the big stressors in life like losing—somebody dies, that’s a huge stress. Getting divorced, huge stress, moving house, huge stress, getting married, huge stress, maybe starting a new job, huge stress. But there’s all these other stresses, micro stresses, like you said, like, knowing you got a CQC inspection, having a complaint—well, that’s a huge stress having a complaint. Difficult relationship with someone, having a difficult conversation, one of your kids is a bit bully. This has happened; this has happened.

I know Rangan Chatterjee, who’s written The Stress Solutions of GPs. It’s a brilliant podcast. And he talks about microdoses of stress. So often he could say ‘You could have had 20 microdoses of stress before you even had your breakfast. Like, the alarm clock goes off to where you didn’t sleep very well. A little bit of stress. You run out of toothpaste, a little bit of stress. You have argument with your partner, a little bit of stress. That you’re one of your children’s routine micro stress’, but it builds up.

And I think one of the phrases that we use that’s not very helpful sometimes is, ‘well, no one’s died’. So, things aren’t that bad. Actually, we don’t know that we don’t realise how much effect these little stresses are having on us. And yes, we might not be experiencing a big problem that other people can recognise. But actually, it builds up like you said. And if you, if you’re not filling up your energy bucket, you’re just gonna keep leaking. And in these, all these tiny holes, they’re gonna keep poking, and it’s, keep going to go out.

Jess: Well said. And I think that the whole thing is like saying, ‘Well, no one’s died’. It’s like, when we say, ‘Oh there’s, so and so’s there’s people worse off than you think’, but that doesn’t diminish the experience that you’re having. That doesn’t diminish what you’re going through right now. Just because somebody hasn’t died, that doesn’t have to happen for you to feel bad.

Rachel: Yes.

Jess: Yes, I think that’s, yes. But your sort of analogy is the micro stresses. Do you put—think of that sort of in athletic terms. That’s exactly what happens with a stress fracture, is that you pound—you go running, you pound the feet, and the bones get that little bit of stress. And every so often, it’s a bit of stress, it’s just a little bit too much. And you get those microfractures. There’s a theory that you sort of get these microfractures that happen. And each time you’re pushing your luck a bit too much. So you’re not eating right, or you’re doing too much mileage, or you’ve done it too much too soon—all these sorts of things.

And, but all of them, sort of, confined news. We’ll get microfracture to microfracture then one day; you just push your luck, one step too many and bang, it’s gone. I don’t think that’s too indifferent to what happens with us is that you, everything mounts up and then one day you find yourself stuck with your head and your hands on your desk and you think ‘I can’t do this’. And it’s I think it’s us being aware of that. And I think part of it is actually us accepting that we are fallible, as humans.

Rachel: Yes. 100%.

Jess: Yes, naturally comes to doctors.

Rachel: And I’m reminded of this stress curve that I use all the time with training, that’s basically performance on the x-axis—no stress on the x-axis, pressure on the x-axis, performance on the y-axis. And with increased pressure comes increased performance we need a bit of pressure to perform. But we think it just keeps going up and up and up and up. But it doesn’t.

With too much pressure, you start to go down and your analogy of petrol in the car, I think is brilliant because so many times as professionals, we think, ‘Oh, I can just make it to the next, to the next, I know I need to refuel, but I can just make it I can just make it’. But actually, you can’t. There is definitely a finite amount. We are physical beings. We wouldn’t expect a car to make it when it literally doesn’t have enough petrol, but we think we can.

And because we think that the stress will just keep going. But the thing about burnout is it’s very physiological, isn’t it? You literally burn out your hypothalamic axis, your cortisol, because you’ve been—had so much increased cortisol. You’ve down regulated your own production. Suddenly, it’s all gone. And you genuinely are burnt out, and all the energy has gone. And I think we’re very bad at realising that that could happen to us until it happens to us. And then we think, ‘Oh, crap’.

Jess: Yes.

Rachel: This really did happen to me. And it takes a while to recover from, doesn’t it?

Jess: Oh, yes, definitely. I mean, I’d say I’m pretty much touch wood recovered now. But go to the months are just sort of doing once I was basically allowed to do one session a week that was like a proper, like—what was i’d term it, proper hot session. So I’m gonna go rowing because I’ve got my roommates. So that was great. And that I had that sort of social element. And it was just sort of taking a step by steps and didn’t read.

So the good thing, the really good thing other than all’s resilience thing is I was like, ‘Right, I need something else in my life other than work and training because that was all I did, really’. So anyway, so now but my dog who I can’t imagine being without, and I think that was like a moment. I was like, ‘Okay, I need something else in my life’. And each everyone’s got their own thing, but I think sometimes it’s those sorts of things. But that was like another good thing to come of it.

Rachel: And when we spoke before you were telling me about this really innovative system that this coach has got you to do. And I thought that was absolutely brilliant about this system is not just—athletes—you know that you’ve got to hit certain targets for training every week, but actually, she’s completely fit that on her head and made you reach certain targets for rest every week.

Jess: Yes, absolutely. So yes, so I fill out that check-in and then basically she tells me how much I need to do with my filling my tank stuff. So all the stuff that I get, I think about. So it’s all got like points allocated to it and that sort of thing. A simple version that anyone listening to this could apply was if you—on Friday night if you’re driving home from work or sat on the train on the bus or anything like that. Just like check-in with yourself and think, ‘Oh, how am I feeling physically? Like, am I feeling full of energy? And I’m ready and raring? Or do I want to collapse on the safe? How do I feel mentally? Am I exhausted? Am I getting snappy? Am I being irritable? Am I feeling anxious or low? Like, have I got lots of stressors? Am I sleeping well? Am I eating well’?

And if those things you’re starting to think, ‘Actually, well, this is bad, this is bad, this is getting worse’. And then actually, that’s indicating to you that those things you need to do over that next week. Fill your tank up, need to go up because otherwise, it’s going to drain out. It’s going to drain out a lot quicker than you can imagine. And yes, I get like a points-based system. And as someone who’s quite sporty, though, quite like having a target. I like to see everything turning green. I hate it on the app when it looks red, I can’t bear an orange. I’ve run up and down the front of my house to make sure that it’s green and not orange, the mileage. So that sort of stuff.

And so actually is, if you have a number that you have to hit, then you think ‘Right, okay, so maybe it’s not a Friday night, you’re driving home, you think, ‘Right, okay, I’m feeling terrible. I’m going to do five things next week. That’s good for me. So I might have a bath. I might go meet a friend for coffee, when we can do that. And I’m going to go out for a walk twice’, and telling yourself right and put a number on it. Because there’s evidence that if you put a number on it, or you tell somebody what you’re going to do, there’s a much greater chance that you’re going to do it.

So maybe you get home and say to your spouse, child, dog, cat, whatever, I’m going to do five good things next week. I’m writing down, I put it on the fridge. I put what number 1, 2, 3, 4, 5 on the fridge and fill them as you go. And remember that each of these things you do, mean more to you, as a doctor, and as a person than anything that you will do workwise that will be of more benefit to your patients, to your family, to your friends than anything that you’ll do. Doing extra audit on the weekend isn’t going to make you a better doctor. But I’d be willing to bet that having a bath and having a meal with friends or Skyping someone you haven’t spoken to for ages actually will make you better, will make you happier, and you will function better. And I think we really need to learn that and not feel that it’s just work work work because it doesn’t work like that.

Rachel: Yes, that is such wise advice. Doing an extra audit won’t make you a better doctor, but Skyping, an old mate, might. And it’s so true all the evidence points to if you are happy at work, you will be productive at work. Not there, not if you work hard, you’ll be productive if you’re happy, you’ll be productive. And I think the thing that I’ve realised, and I recognise this in myself, and I’m quite good at doing the whole, ‘Right, I’ve got to eat properly. And I’ve got to do this X amount of exercise a week’. I’m not very good at saying, ‘I’ve got to do this amount of nurturing a week’ and I’m starting to learn how important those rest and digest activities are for us that get us into our parasympathetic. So meditation and yoga. It’s gonna give you that subtle, whatever it is that switching off, that nurturing, that self-compassion is as important as the drive bit of the running and doing it. That’s as important as me doing my nought to 5k app, or doing my gym circuit session or something like that. And it needs to be in balance. Otherwise, all we’re doing is flitting from our drive zone to our threat adrenaline zone, and we’re not going anywhere near that parasympathetic, rest and digest thing.

Jess: Yes. That’s it. I think part of it is and I think in sort of, I guess doctors are always considered high achieving professionals and all that sort of thing. And to do that, you have to have that work ethic, and that drive to do it. And I as an individual, I always very much been like go hard or go home type personal. I’m the one that’s always like, ‘Yes, we’ll do an extra rep. No, we’re not stopping’. And like, I know my friends on my training, wind them up, and we’ll get everyone going. And I think it was a real—it was only because of what happened to me that all of a sudden, I really understood what I needed to do. And we see it as a weakness. Say, ‘No, I’m not doing this. I’m not doing that because I’m getting my bath’.

And like in my head, for me to say that would be like, it is really hard, or even to say, ‘I’m not going to do my bike session because I’m knackered’, and it’s taken me a long time to accept that actually if you are really tired, what’s the point in you forcing yourself into doing anything because you’re not getting anything from it. You’re going to make everything a whole lot worse.

And I think that’s not just with sport, that’s with everything. If you get in and you’ve got a work project, if you want absolutely shattered, don’t do it because you’d be better off not doing it—sort of recuperating for the evening, and then just doing it later date, because it’ll be there tomorrow. And, yes, I think so much of it is getting over that stigma.

Rachel: Yes, and the best advice anyone ever gave me actually was when trying to do work, it’s like, ‘Follow your energy. If you feel like doing that thing, do it, do it now when you feel like’. If you really can’t face it, don’t force yourself to do it. I think as well speaking as a middle aged woman, that I’m reading the Caitlin Moran book at the moment More Than a Woman, which is hilarious and fascinating. And she talks about the fact that there’s so many other commitments in life, that literally work is her joy because she—everything else she’s got to do. She’s there for everybody else; she loves work, but then there’s no, there is no time.

And I think we have to fight for that time, to nurture and look after ourselves because no one else is going to fight for it. But be—if you want to be there to look after other people, you’ve got to do that rest—resting for yourself. Otherwise, you’re just no good, and you’re not a very pleasant person to be around. Well, I know I’m not when I’m when I’m strung out. I’m much, much more compassionate and caring and tolerant and patient of teenagers when I feel like—when I feel I am in a good place in my bucket, my energy bucket is full. Otherwise, it’s just a disaster.

Jess: That’s it. Well, I guess it’s quite wise knowledge, though, isn’t it, is there’s like that whole thing of—on the plane, you’ve got to put the oxygen mask on first because you’re no good to anybody else if you can’t breathe. And it’s a bit extreme, but actually, it’s just like that.

And I think at work a lot of the time. We can spend a lot of our energy and investment, a lot in sort of making sure our colleagues and other staff members are fine, and you do so much for them. But actually, you’re never looking at yourself, and you’re never putting on your own masks. So you’re putting on all their masks one by one, but the whole time, you’re struggling, even more.

I think the other way to think of it is that it’s going back to that car. And if you’ll spend the whole time thinking, looking around the car and your passengers being your colleagues or your family or whoever, and it’s your now ‘I’ve got to get to the next I’ll make it to the next one Because I’ve got all these people in the car and they don’t want to stop. I’ve got to get all of them to wherever we’re going. They’ve got to get there’. But actually, if you don’t take the time to take yourself into the petrol station, no one’s getting anywhere. No one’s gonna make it to that destination because you’re going to run out. And actually, we’ve all got what you say, ‘No, no one else is going to do it for you’. And you are your own most precious resource.

Rachel: So true. So just where are you now? How are things going now for you? Are you fully recovered?

Jess: So yes. So yes, such as words, yes, fully recovered. And so yes, I’ve been out strolling with the dog running on. And I’m doing a lot of running off-road and on the mountains at the moment. So that’s quite nice. And because it’s not time-related, so I’ve struggled with trying to get back my running speed since it all happened. And I realised that sort of chasing times, especially once COVID hit wasn’t really going to help me because it wasn’t helping my self-esteem. I think times aren’t getting better. And I was sort of feeling frustrated in that respect. So I thought, ‘Right, I’ll go and hit the hills’, which is great because your watch is kind of irrelevant because one day it’s like muddy and you’re wading through stuff the next minute or dogs chasing deer. So you got to go back and get over and stuff. So yes, so that’s been really good.

And I think the training goes—is that yes, I’m hopefully on the way to recovery and hopefully can decently compete again next year. But I think I’ve certainly learned a huge respect for where rest, recuperation, resilience lie in the sort of hierarchy of importance in my life. I think they were very, very negligible at the very bottom of anything before. But then now it’s up there at the top. Because without that, I can’t imagine being where I was on that day when I couldn’t run and then bumped into three people I knew on the way home as I was walking home, doing the walk of shame. Trying to put a happy face on it. And then realising that the next six months, we’re going to be pretty difficult for me. So I think it’s just understanding learning from where you’ve been.

And sometimes you have to—they say you got to get to the bottom. I don’t believe you have to hit the bottom, but I think for some people like me, that probably has happened to me for me to believe it could happen because I refuse to believe that it could. I thought I was invincible. And I think if I was sharing what happened to me, I think it’s probably just trying to let people know that actually, we aren’t invincible. We think we are, but we’re not. And if it stops anybody else from getting to that point, be it from work, exercise, home, whatever it is, then it’s a story well told.

Rachel: And we’re so grateful for you sharing it with us today. What was your top three tips be for any professional—be it doctor, lawyer, accountant, other manager leader, who’s sort of feeling a bit burnt out and feeling? What do I do? What are your top tips?

Jess: The first thing I would say is allow yourself to be vulnerable. Either, if you can’t be vulnerable to somebody else and say, ‘Oh, I’m not good, I can’t do this, I need a break’. Then at least to start with being vulnerable to yourself and saying, ‘Okay, I acknowledge this’. And actually realised that in you acknowledging that and be and that vulnerability is a huge strength. And it shows that you are a far stronger person for doing it than for just hiding it and trying to pretend it’s not happening. Because it’s happening to lots of people right now, I’m sure.

And I think my other thing would be to try to check in with yourself. So—and either, like—technology is a great support reminder on your phone, like check-in on a Friday at six o’clock, or wherever it’s going to be. Put that reminder in there and do it. I’m sure there are loads of apps out there that you could use for it. And it’s something that we all have to do. And I think we—it can be one of those things that we say I haven’t got time to do it. Well, I’d be amazed if you genuinely haven’t got time, the two minutes to sit there and just think. Because actually we all have, and it’s an investment of your time. And I think sometimes we put off self-care type things because we say, ‘Oh, I haven’t got time for that’. But actually, as we’ve talked about, that’s the one thing that you should have time for, more than anything. You should have time for that over [46:51 unintelligible] or admin, or paperwork, or anything like that.

And I think the other thing is just to be kind to yourself because we are all—as I said before, we don’t care for ourselves anywhere near as much as we care for patients. And we don’t talk to ourselves like we would talk to our friends. But we need to. Because take—telling yourself that you’re a failure because you’re afraid of the CQC inspector isn’t going to help anything. And it’s not true. But that is certainly something that we all need to just acknowledge and just be kinder to ourselves, and everything.

Rachel: Yes, thank you. If there’s anything I can add to that, I just think that is such good advice. If only we could make ourselves take it.

Jess: Yes.

Rachel: That being said. So yes, so just thank you, thank you so much for being on the podcast. And I do just want to say to anybody listening, if you are feeling at the edge of burnout, at the end of your tether, then please get some help. Please go see your own GP, access a practitioner health program, access your own employee assistance service. You go and talk to a friend. Do something about it. Do not suffer in silence. And do not feel any shame in doing that.

And I think everybody else remember that life is precious. Our bodies are precious, and we only have one of them. And that involves your mind as well as your physical body. And we need to look after ourselves and rest is just as important as achievement and everything else. So just be good to yourself. Be kind to yourself and listen to your body. It knows what you need. So Jess, thank you so much for being with us. And let’s have you back another time to chat further about this such an important topic.

Jess: That’s right. No problem. Thanks for having me on.

Rachel: Bye.

Jess: Bye.

Thanks for listening. If you’ve enjoyed this episode, then please share it with your friends and colleagues. Please subscribe to my You Are Not A Frog email list and subscribe to the podcast. And if you have enjoyed it, then please leave me a rating wherever you listen to your podcasts. So keep well, everyone. You’re doing a great job. You got this.

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