Episode 79: How to Give Yourself Permission to Thrive with Dr Katya Miles

Do you ever feel guilty for taking a break, even if you pour so much of yourself into your work? Do you struggle to take care of yourself the way you take care of others? Working in high-stress environments, we tend to push ourselves to our limits until we run out of energy. By not taking the time to replenish our mental and physical resources, we end up pouring from an empty cup. To prevent ourselves from burning out, all we need is to give ourselves permission to thrive.

In this episode, Dr Katya Miles joins us once again to talk about burnout and giving ourselves permission to thrive. Having experienced work burnout, Katya shares her story and discusses the red flags of burnout. We also talk about why we find it difficult to give ourselves permission to thrive and how we can overcome our own internal barriers.

If you want to learn about how you can listen to your needs so that you can thrive in work and in life, then this episode is for you.

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

1. Discover the warning signs that you might be heading towards burnout.

2. Learn why it’s so challenging to overcome perfectionism, which can lead to overwork and burnout.
3. Katya shares her top tips and strategies for granting yourself permission to thrive.

Episode Highlights

[04:13] Katya’s Burnout Story

• Katya became a GP because she was interested in holistic medicine.
• She also got interested in occupational health when she served as a civilian medical practitioner for the Armed Forces.
• It took a long time for her to realise that she was experiencing overwhelming stress. That’s why she kept burning out.

[05:53] Perfectionism and the Permission to Thrive

• Katya thinks that medical training isn’t the best fit for those who have a tendency for perfectionism.
• Identifying with your work is important, but overidentifying makes it harder for you to acknowledge that you’re struggling.
• We need to have a mental attitude that embraces learning through making mistakes.
• We often beat ourselves up even if nobody else knows the right thing to do. That’s why we need to give ourselves permission to thrive by learning from our mistakes.

[11:37] Factors That Lead to Burnout

• Aside from excessive perfectionism, too much uncertainty can also lead to burnout.
• A lot of professionals in high-stress jobs think that stress is normal even if it’s not. We have to be self-aware of how our work affects us.
• Learn your personal red flags that signal if you’re overstretching yourself or your performance is dipping.
• Giving yourself permission to thrive requires pausing, reflecting, and listening to yourself and others.

[16:29] Other Warning Signs of Burnout

• Aside from Katya’s tooth breaking from anxious teeth-grinding, she also ate a lot of chocolates as a stress response.
• Another sign of burnout is when we stop doing healthy habits such as exercising and sleeping early.
• We turn to unhealthy coping responses because they give us a temporary dopamine kick that numbs our pain.
• We have to be mindful of the reasons behind our unhealthy practices.
• Having some form of accountability helps in embedding healthy practices in our lives.

[23:43] Why It’s Difficult to Give Ourselves Permission to Thrive

• If you’re a healthcare professional, caring for other people is your main goal. Thus, looking after yourself often comes second.
• In 2017, the Hippocratic Oath was updated to include the doctor’s health and wellbeing. This change helped Katya overcome some of the barriers she faced.
• If your identity is so linked with your job, self-care is more difficult.
• The word ‘burnout’ is being used more colloquially now. Katya thinks this is a good sign that people are becoming more comfortable with acknowledging their struggles.
• We don’t reflect enough on the fact that we are all finite resources.

[33:34] How to Give Yourself Permission to Thrive

• Having honest conversations about your struggles is important.
• Take any action that would help you embed healthy habits into your lifestyle. Nudging yourself and taking tiny steps can help you in staying consistent with your habits.
• Put yourself in a reflective space through journaling, creative pursuits, or being in nature.
• Think about the consequences if you don’t give yourself permission to thrive.
• Aim to do the things that would make you feel good now but would also be good for you in the long run.

[38:51] Drive Zone, Threat Zone and Soothe Zone

• We spend most of our time in the threat or drive zone.
• This leaves us little time to enjoy the soothe zone.
• Studies have shown that resting improves cognitive performance and overall well-being.
• It’s also been shown that resting makes you work better.

[41:32] Katya’s Top Tips

• Give yourself permission to thrive. Pause and think of what you need right now.
• Try to deliver on what you need at the moment.
• Through this, you teach yourself to look after yourself.
• Eventually, you’ll form a habit of giving yourself permission to thrive.

7 Powerful Quotes

[10:32, Rachel] ‘I think we need to give ourselves permission, that we need to be getting things wrong and making mistakes, because how on earth are you ever going to learn unless you put it out there and make mistakes?’

[11:19, Katya] ‘Just think about striving for excellence, versus striving for perfection.’

[13:36, Rachel] ‘It’s not a normal physiological state to be stressed, and anxious, or nearly burnt out.’

[16:05, Rachel] ‘You just need to stop and pause. Give yourself permission and reflect and start to listen.’

[29:49, Rachel] ‘No matter how resilient you are, if you are working in a very difficult circumstance in a difficult workplace where you are not allowed to rest or recover, you will end up burned out.’

[30:01, Katya] ‘We are all finite resources, I think that’s something that we don’t reflect on enough. Within work, of course, we are replaceable, because that’s what the workplace is.’

[34:11, Katya] ‘There is something about allowing people to step out of their roles and be in a reflective space, be in a space where they’re allowed to think about themselves and their needs.’

About Katya

Dr Katya Miles is a well-being trainer and consultant who has broad experience in training healthcare professionals and students. As a trained GP and occupational health physician, Katya has served both civilians and the Armed Forces. She is also a content writer and Deputy Editor at Medic Footprints and has worked with Mayo Clinic, USA.

Katya enjoys her role as the Associate at Clarity Associates Ltd and the Head of Training at the Joyful Doctor. As the Working Well Doctor, she offers a variety of wellbeing workshops to high-stress professionals who care. Her goal is to make these solutions largely accessible as she is passionate about empowering everyone to “work well” and thrive in the real world.

If you want to connect with Katya, you can email her at theworkingwellexperience@gmail.com or follow her on Instagram, Facebook, and Linkedin. Visit her website if you want to know more about the Working Well Doctor’s services.

Enjoy This Podcast?

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

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

Learn to master your destiny so that you can thrive even in the most difficult of situations. If you enjoyed today’s episode of You Are Not a Frog Podcast, then hit subscribe now!

Episode Transcript

Dr Rachel Morris: When you feel stretched to breaking point, do you ever still feel guilty about taking time to put your own needs first? And do you sometimes struggle even to know what these needs are? And why, as professionals, do we fight so hard to care for ourselves in the way that we try to care for others?

In this episode, I’m joined by Dr Katya Miles. She’s a GP and she’s an occupational health physician turned well-being trainer. She founded Working Well Doctor, and she’s also a Shapes Toolkit trainer. We talk about Katya’s own experience of burnout and how our innate perfectionism can sometimes lead us into overwork and over-worry. We discuss how difficult we can find it to give ourselves permission to care for ourselves, even if we know we really need to. So listen if you want to find out how to pause long enough to figure out what you really need. And there’s a link to a free download of the Stress Curve worksheet in the show notes that will help you to do this. Listen if you want to find out how to stop trying to pour from an empty cup. And listen if you want to give yourself permission to thrive, even at work.

Welcome to You are Not A Frog, life hacks for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP turned coach, speaker and specialists in teaching resilience. And I’m interested in how we can wake up and be excited about going to work, no matter what.

I’ve had 20 years of experience working in the NHS and I know what it’s like to feel overwhelmed, worried about making a mistake and one crisis away from not coping. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water, working harder and longer. And the heat has been turned up so slowly that we hardly noticed the extra-long days becoming the norm, and have got used to the low-grade feelings of stress and exhaustion. Let’s face it, frogs generally only have two options: stay in the pan and be boiled alive, or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. You have many more options than you think you do. It is possible to be master of your destiny and to craft your work and life so that you can thrive even in the most difficult of circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues, and experts, all of who have an interesting take on this. So that together, we can take back control and thrive, not just survive in our work and our lives and love what we do again.

For those of you listening to the podcast, you need to get some continuous professional development hours 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 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? Choose a CPD that’s good for you. So check out the link to find out more. Thanks for listening to my shameless plug. And back to the episode.

It’s great to have with me on the podcast today Dr Katya Miles. Now Katya’s a GP. And she’s founder of the Working Well Doctor. She’s also an occupational health physician and a wellbeing trainer. So welcome, Katya.

Dr Katya Miles: Thank you very much indeed.

Rachel: So it’s really good to speak to you today. And I’d like to kick off by asking you, how did you get into all of that, having started presumably as a GP?

Katya: Yeah, it’s interesting, isn’t it? So I think I had a background interested in holistic medicine, the whole person, that’s what general practice is about, I think. So I knew a bit about that anyway. And then I started to do some work in occupational health because as a civilian medical practitioner for the Armed Forces, so that got me interested in occupational health. But along the, in parallel with that, I was having my own personal struggles. I’d had anxiety; it took me a long time to realise that was what it was. For a long time, I was just telling myself it was normal work– normal stress and that took me quite a while and ended up burning out. And between those two experiences, the personal experience of not really noticing my own well-being, and then coming through that, which was quite the journey, along with the background of occupational health, which does kind of get you thinking about work and health, performance and all those things. And then obviously GP where you’ve got a fair bit of knowledge and background expertise, and they all kind of dovetailed together.

And I’ve also loved teaching. For my whole life, I used to teach children dance, I taught special, special needs assistant before med school and to all the way through med school. So I’ve always loved teaching and training and doing workshops and all that stuff. I’ve had some really good feedback about the stuff I did, before finding work of a doctor. And so it just all seemed to dovetail together.

Rachel: So a bit of a journey. And it’s interesting that you say that you had anxiety for a long time. Do you think that started as a child or just when you qualified?

Katya: Good question. I think some of it was there before med school, definitely. But I don’t think medical training was the most helpful fit for somebody who had a tendency for perfectionism. And yeah, I think it was really fascinating. One of the things I think that’s challenging about medical training, and actually talk about in my training, is often medical training rewards perfectionism. Inasmuch as it’s possible in theory to get 100% in an exam, so you can strive for that and get a pat on the back or a certificate. And then when you pop out, and you actually qualify as a doctor, it’s almost impossible to get 100% in clinical practice, or indeed, real life. And so it was a bit of a– for me, that was a struggle. And I know, it’s a struggle for some other types of doctors. And I think there’s that piece as well about how we identify with our work, which again, is amazing, of course, it’s a vocation, so there’s something within it about identity.

But I think if you over-identify, and I think I did over-identify, then it becomes such a high stakes game, it feels high-risk for you to even contemplate anything that might challenge your ability to work as a doctor. And that makes it much harder to notice or acknowledge things are going– you’re struggling because there’s a big threat, the threat of, ‘I might not be able to do this. What will happen to me if I’m so closely bound up in my identity with being a doctor?’ And so I think those are a couple of the barriers, along with other barriers, but a couple of them that meant I kind of became more anxious through my work as a doctor. I think that was the question was, I can’t remember that.

Rachel: You know, it’s all about it when did the anxiety start? I think it’s interesting, your reflections about perfectionism. I don’t know many doctors, I don’t know any lawyers or accountants who aren’t perfectionist, actually. You know, really high standard, because we’re taught through our training that that’s what you’ve got to meet. And if you get this wrong, you know, there’s going to be big consequences. And the problem is, that’s reality.

Katya: I know.

Rachel: It’s that actually, if you did get something wrong, there may well be quite big consequences. And as a result, we are absolutely terrified of making mistakes. Well, not firstly, not being up to scratch, not being 100% perfect, but then making a catastrophic error. I was doing a keynote talk at a conference last year for a lot of physician mums, actually. And I had a little– did a little survey at the end about what’s the one thing that keeps you awake at night? And I would say 95% of the people that return that survey said it’s making a mistake or worrying that I’ve done something wrong.

Katya: Yeah. And it is difficult, isn’t it? I think there’s that exactly that, that check-in with yourself going, ‘What’s the worst that could happen?’ And obviously, in general practice with so much uncertainty, that’s part of what they suggest you do when you’re making a diagnosis. ‘What’s the worst that’s going to happen, let’s manage for that safety net, and so on.’ And that’s obviously as you said, needed, but it can be quite difficult mentally, or maybe not mentally, but emotionally for certain types. And I think boundaries help and I’m not great with boundaries. So if you’re able to bound like, you know, it’s almost the inverse of that over-identifying with your work, but if you don’t over-identify with your work, if you’re discreet and like your life and your work and able to set good boundaries within work, between home and work. I think that allows some, makes it a bit easier to contemplate these things that keep people up at night, you know. ‘How could I manage if, God forbid, something went wrong?’ As well as your worries to the actual patient. There’s the kind of impact on yourself and your self-esteem and all those downstream consequences. And I think that it’s very common, isn’t it? Yeah. And it’s not just in medicine that you’re saying it’s other high stakes, professions, other say, critical professions.

Rachel: Yeah. And they don’t teach you about this in med school. They don’t teach you about how to overcome perfectionism. And how good enough is probably okay. And how– I mean, there are some things that absolutely, you’ve got to get 100% right. But there are most other things, there isn’t actually an answer, there isn’t a right or wrong answer. You know, medicine as much as art as it is a science. And sometimes, with the best will in the world, everybody will get it wrong. Because you don’t know what’s– nobody knows what the right thing is too. Yet we beat ourselves up, and we don’t give ourselves permission that it is okay and that no one’s gonna judge us. But more than that, I think we need to give ourselves permission that we need to be getting things wrong and making mistakes. Because how on earth are you ever going to learn unless you put it out there, make mistakes?

Katya: It’s funny, isn’t it? Because that’s the real growth mindset thing Carol Dweck talks about, all of that. So of course, for your resilience as a human, and also for your professional development, you need to be learning and that’s a great way we all learn. And you need to have that kind of what you said, this mental attitude that embraces learning and it’s okay to make mistakes. But then it’s difficult to juggle, I think you’re right, there is a way you can manage it. Because you can just say, ‘Okay, these things are high-risk; really, really good if I don’t make a mistake in this area. But there are other bits that aren’t always so high pressure, high-risk.’ I put up a picture of a leaf when I do my well-being training. It’s a really beautiful fern with one tiny frond missing. And just say, ‘Look, this is an excellent leaf, but it is not a perfect leaf.’ And just think about striving for excellence, versus striving for perfection as a maybe more helpful approach.

Rachel: Yeah, it’s– we’d have to think about, I would never learn to ski without thinking I was gonna fall over. Or play the piano, I’m gonna get it wrong. But we do expect ourselves to get it right, we set very high standards for ourselves. Is that why you ended up burning out, do you think?

Katya: I think it’s partly, definitely yes. And although I love general practice, there’s a lot more uncertainty in general practice, because there’s so many possible differentials. Whereas by the time we get into acute medicine, the problem is not, ‘What’s the diagnosis?’ We know that person’s having a heart attack. It’s what– ‘How do we treat it?’ That’s a whole different approach. Whereas in general practice, there’s a lot more uncertainty. And I think you’ve got to learn how to manage that. And the interesting thing is, I think you learn by doing and one thing I was reflecting is that we’re all better at managing uncertainty this time this year, compared to this time last year, whatever our job, because we’ve had to. We’ve lived with so much uncertainty in the pandemic that we just wouldn’t have experienced before.

So there is a part of learning by doing but I think there’s also a part where you have to be self-aware. ‘How am I doing? How has this affected me?’ And I think at the time when I was not doing so well, I wasn’t as self-aware as I am now. And I did struggle to give myself permission to even notice how I was feeling or name it. Honestly. As I’m saying lots of stress go, ‘Actually, no, this is really, this is a big deal for me, and how am I gonna work through this?’

Rachel: That’s a really important point, because I think many professionals in high-stress jobs, just think that stress is normal. And the symptoms are normal. I was talking to a physio and she said that she’d had somebody who had come in as a runner with a running injury, and then sat down and gone, ‘I’ve got this really dreadful knee injury, but I guess I should just expect it. I’m a runner. We will get injured, don’t we?’ She’s like, ‘No, it’s not normal to be injured, not normal.’

Yet, whenever I do my sort of resilience training with doctors and other people, it’s like, always stress, but you know, everyone’s stressed out, it’s just normal. That’s what we have to be. If we are a doctor, we will be stressed. We will be perhaps on the edge of burnout. And we’ll probably not be enjoying things, we’ll just be trying to survive and get through. And I’m thinking, hang on a sec. That is not it’s not a normal physiological state to be stressed, and anxious, or nearly burnt out. But in our minds, I think possibly because, you know, we’ve done 120 hours a week as junior doctors and we know what that was like, and you just had a sort of suck it up and do it, we think then that’s normal to carry on. So we are really then bad at spotting in ourselves if we do have something that is really affecting us that needs some help.

Katya: It’s tricky isn’t it? I was thinking when you’re saying about junior doctors, I think that’s really true. You get habituated into really basic, poor self-care. You literally won’t eat, you won’t nip to the bathroom because of the needs of the others. And sometimes that’s fair enough if you crash rate blows off, but your crash rate doesn’t literally go off all day every day. But nonetheless, you get into the habit of just deferring your needs. And I think that’s– and then those, that then spills over into the mindset you’re just describing when you’re like no longer junior doctor, but you’re still having a similar approach to saying, ‘It’s normal to defer my needs, it’s normal to be tolerating some level of stress.’

And I think you’re right, I think that point about not noticing and saying it’s just normal is kind of a mask, isn’t it? And it allows us to not look beneath what’s happening, and I don’t– I definitely did that. And when I do some training I took the old good old Yerkes Dodson curve. Your stress versus performance and we’re all just drawing a little bit of a cross for those on the podcast, you know. The top peak, it’s okay we can tolerate short term stress. In it, we get good performance. And that’s fine. If a cat runs in front of the car, we’ll slam on the brakes. And that’s good for the cat, good for us. And we can tolerate that short-term stress like you were saying. But when it becomes chronic, then it’s much more damaging, like you pointed out.

And I think there is something there about noticing red flags in yourself. So there might not be the traditional red flags, you might learn that medical school or post-grad. But for you, what are your red flags that show you’re under strain versus being in that sort of stretch part of the curve? You’re going down and performance is dipping, you’re kind of getting towards the lower part of the curve where you might be heading to burn out. And I was rubbish at that. I was terrible. Looking back at it, I was like– I can’t remember exactly when but during– but when I was heading into burnout and in burnout, I managed to crack my own tooth, went to the dentist had all the treatment there. ‘Oh, you’ve cracked your tooth.’ ‘Oh, really?’

And did all that, got the treatment for the tooth. Yeah, the dentist was perfectly competent. And it’s not rocket science intellectually. And that was it. I didn’t reflect any further. Why am I grinding my teeth so hard at night that I’ve cracked my own teeth? You know, but it is kind of, it’s not always that difficult. But you just need to stop and pause. Give yourself permission and reflect and start to listen, I think, to yourself. And also if you listen to people around you, they might give you an occasional clue whether it’s at work or at home. But yeah, you got to give yourself that permission. If you don’t do that, then you can really remain quite blinkered.

Rachel: Were there any other early warning signs that you probably ignored for too long?

Katya: Oh, golly. I think I ate a fair bit of chocolate. So yeah, I think a bit of that. And I think other things, I think we all do it when we’re stressed when we just say– I’ve heard you say this before, actually, when you just park the stuff that’s good for you. ‘I just don’t have time for it. So I’m not going to exercise, go to bed early, whatever it is.’ And I think that is quite a red flag because it just– what it tells you is you’re feeling overwhelmed. And your response to that overwhelm is, in my case, it was poor prioritisation instead of going, ‘Okay, now I need to take stock and put in place the key things that I know will help me.’ You kind of do the inverse.

Rachel: It’s weird, isn’t it? We– why is it and I noticed this myself and the other night I had a really stressful conversation with them. And I was just like, ‘Oh.’ And instead of just going to bed, I thought I’m just gonna stay up and watch something rubbish on telly. So I need to– and I was then really knackered the next day and I think I headed straight to the cupboard and got myself a large thing of chocolate, even though I wasn’t supposed to be eating any carbs at that point, which didn’t really help. Yes. So we– why is it? This is a philosophical question. I’m not sure you can answer this, Katya. Why is it that the stuff we use to self-soothe is never very, very helpful for us? Choc– I’m thinking chocolate, I’m thinking alcohol, I’m thinking binging on Netflix. I’m thinking caffeine, other drugs of addiction, all that stuff. Why, why?

Katya: I don’t know, but they haven’t– there’s something in common about them. And there’s other– you can even call what I mean, that’s the other thing, maybe work itself isn’t numbing. I think there’s something about them where they numb or they mask or they give you a temporary little squirt of dopamine in your brain. I’m talking about me and chocolate now. You know, a temporary, something, some positive, but it’s always a short-term, isn’t it’s? It’s a short-term, positive. And then there’s the long-term consequences. Even if the one bit of chocolate, it’s not the end of the world, apparently, it’s the chronicity of your chocolate consumption.

But also it’s that the other damage it does is, you’re not looking at what sits beneath it. And it’s that whole piece about sitting in your discomfort doing that mindful thing where you just sit with and you acknowledge it’s not nice, but you actually just sit with it instead of trying to ignore it or squash it with anything: the chocolate, the alcohol, even overwork is in itself another distraction just like Netflix. So I think it gets really back to being mindfully aware. Why am I doing this? It’s okay to eat the chocolate, it’s okay to work, it’s okay to watch Netflix. But why? And if the why is perfectly acceptable, healthy why, fair enough. Or you can sometimes just go, I know it’s unhealthy, but I’m gonna do it anyway. You’re like, ‘Well, at least I’m consciously incompetent,’ or whatever that phrase is.

Rachel: My known– it’s my known knowns. Yeah, I know why I’m doing this. I know that actually– one of the reasons I do a lot of this stuff is just to switch my thinking off because it’s just going too crazy. Actually, I know that if I say, went for a run or had a bath or got into an inflatable hot tub. It’s honestly seconds. It’s not exactly very stylish, is it, but you know, kids love it. If I go and get in there. It’s a really lovely sensation. And it seems, and that’s much better for me, then you know, doing something else that’s going to try and switch off my thinking. So it’s maybe just knowing– sometimes it’s not knowing what you need.

Katya: That’s something I think it’s important, isn’t it? Something I try. And I often mentioned the teaching, it’s about pausing. And thinking, ‘Right now, what do I need now?’ I did a mindfulness course, the Doxing Mindfulness Center. That was something I learned there. It’s like, ‘What do I need right now?’ And it doesn’t take long. And often the answer is something– for right now, it’s often really simple. I just need a glass of water. I just need to walk around because I’ve been sitting down all morning. And you can do that– if you can do that one thing for yourself that, first of all, helps you for that immediate need. But also, it’s giving yourself that nourishment emotionally, say, ‘Okay, I listened to myself, and I’ve delivered for myself what I actually needed.’

And that kind of starts to open up this habit within our neural pathway, you might want to say, where you walk this path, and you build your neurons, which allow you to think and permit yourself to do that healthy thing. And I think that’s one reason why stuff like accountability partners help. You know, because if you’re not in that habit, having some form of accountability, whether it’s a partner or your own self, putting a note in the diary to check in, is– helps you move through and sort of embed these habits. Actually, but I knew I was doing your podcast, and I’d listened to– I knew I was doing it today. And I was like, I want to do it. And I’d listened just recently to your podcast on exercise, which was really good. And I was like, I’ve got to go for a run, I’m gonna be speaking to Rachel later.

Rachel: I’ve been checking up on you, Katya.

Katya: Exactly! And I was just like, it’s absolutely ticking down, is really absolutely freezing and muddy. But I just went for a run, and it was really good. So you were my unconscious accountability buddy. Because now I feel better because I went for a run, despite the fact it was freezing and wet. But it’s really interesting, isn’t it? I might not have done that, I might have done another behaviour prior to this podcast to unwind or take a break. So there is something I think about working out what your motivations are and using them to leverage good behaviours. One is start to have some accountability buddies, and that, for me, really helps. So it’s an actual human being who I check in with. And sort of you check in with how you’re doing on your goals, whatever you use that.

Rachel: Yeah, the accountability is really good, because it’s not only someone checking in with you, but it’s someone affirming that those things are important.

Katya: Yes, that’s right. It’s I guess you wouldn’t necessarily have an accountability buddy for how much chocolate I’ve eaten. But yeah, you’re right. It’s like you’re choosing and articulating together what are good– are good choices. Rather than being maybe one that you wouldn’t want to be sharing out loud with all your, I don’t know, you can tell people you’ve eaten chocolate and watched Netflix, but it wouldn’t necessarily want somebody to–

Rachel: –want the world to know, like on a podcast or something. We’d like, bare our souls on a podcast and tell thousands of people what we’ve been eating or thinking or doing. Oops.

Katya: I know. I really loved the chocolates delivered to me, actually, by the deputy editor for medic footprints and the team that sets up chocolates, which is really lovely. So I have been eating chocolates because they were sent through yesterday.

Rachel: Well, we want to know exactly how many you’ve eaten every day, Katya, for the next month.

Katya: I will send you a text update.

Rachel: Yeah, please do. Let’s go back because you’ve mentioned this word quite a few times: permission. And I think there’s, you know, why aren’t we looking after ourselves? Why are we noticing when we’re anxious and getting towards the edge of that stress curve? And by the way, what I will do for people that are listening, I’ve got some downloads of the experts on stress curve, so you can rate yourself which could be helpful. I’ll put the link in the downloads. But why is it that we find it difficult to spot when we’re anxious? And then even if we know what we need to do, why we find it difficult for ourselves to give ourselves permission to do that thing?

Katya: Yeah, I mean, I think there’s lots of parts to that. And my personal reflections– not just my personal reflections, but I think is that stigma is a big part of that. And I think for doctors, in particular, there’s something about that– or carers, in particular, whether you’re caring in your day job or caring in your home and personal life, there’s something about caring for the other. And that’s– you kind of identify with that. You’re like, ‘My job is to care for the other’ and often, you– it’s very rewarding. We know that giving gives you purpose, and there’s lots of benefits. And of course, there’s actual benefits to the person you give to. So that’s all amazing. And especially if you’re a healthcare professional, you get paid for, you get a pat on the back, you know, you get letters after your name, all that good stuff. So there’s lots of real benefits.

But I think one of the problems is that there isn’t within that until recently mentioned that you need to look after yourself. And it was, I really struggled and like I was saying, and one thing that helped me was to read the updated Hippocratic Oath which was only updated in 2017 to include a phrase saying something along the lines of, ‘I will attend to my own health, well-being and abilities in order to provide care of the highest standard’. Now that was only added in 2017. That was like three years ago. Isn’t that– I just think that’s crazy! And I think that reflects a lot. I think that answers your question in some part that why was it only three years ago that was even added. And it was only because a great doctor called Dr Sam Hazledine Australia lobbied for that. He runs Medworld, and I’ve done an interview for them. They’re based in Australia, but you know, through the Wonder of the world wide web, you can—

Rachel: We have listeners in Australia, hi!

Katya: Great place you’ve got there. So yes, I just think that’s really important actually. And for me, having sort of sworn the Hippocratic Oath when I joined up as a doctor. And then seeing later on that, there was this actually in black and white in the Hippocratic Oath, they had this part of this clause saying, ‘I will look after myself’. For me, that helped. It helped overcome some of those barriers we’re discussing. And I think there’s something about people being so thoughtful about others that they forget that they’re a finite resource. We— even if we want to carry on giving, it’s actually very difficult for human beings to do that if they don’t receive as well. So part of that is about thinking about, again, gets back to identity. If you’re able to say my identity is separate from my job, then you can say, ‘Yeah, I’ve only got so much time on the planet, just like everybody else, I just have to look after myself in and of myself.’ But if you’re so bound up with your identity, then sometimes it’s difficult to make that separation. I think that can be difficult.

And I think that just the general stigma. Sometimes people still fall into that hero, kind of persona. I know, there’s a lot of jokes and discomfort in the first wave, when people were clapping, and so on. And people felt awkward with that hero label, which I can understand that. It’s probably quite healthy to be a bit, just think, ‘Oh, I’m not sure if I’m comfortable with that’. Because if you’re in that role, then it’s very difficult to say, give yourself permission to do anything except for look after the other. I think there’s some things that helping. I think the pandemic has helped a bit to me. Obviously, the pandemic has been very difficult in so many ways. But one thing it’s helped has been a bit more narrative in discussion about, you know, looking after, caring for the carer in all different walks of life, whether it’s healthcare workers, people caring for elders at home, people caring for others who are vulnerable during the pandemic.

And I think one thing that’s come up, you know, is the use of the word burnout has been used a lot more colloquially. And I think that’s helpful, because it’s a word that people seem comfortable using to say, ‘I’m struggling’. And I think that’s good. Because it allows them, it gives them permission to say, ‘I’m struggling’. Whereas maybe they wouldn’t have they might not be comfortable to say, ‘I’m anxious, I’m depressed’. But somehow people are more comfortable to use the word burnout, which my view is, it’s a good thing, like I just said, obviously, there’s a definition of burnout. And not everybody who uses the word burnout, colloquially will meet the definition of burnout. But for the purposes of just people saying how they’re feeling and starting that conversation and starting to seek help, starting to give themselves permission, I think it’s great to have some change in culture and narrative that allows these topics to be discussed more freely.

And that’s one reason why I founded the Working Well Doctor, because I really want to just to tell my story a bit and just try to start that conversation or be part of the conversation that had started because there’s something there about, you can’t be what you can’t see. There was nobody that I knew of who was doing what I’m doing when I was really struggling. So I couldn’t see anybody just saying, ‘This is what happened.’ And you know, ‘I’m human,’ and all those things. And it just so felt very difficult. Very difficult.

Rachel: Because it’s not like there’s no one out there. Who’s that— you know, there’s hundreds of doctors out there, and lawyers, and pilots and accountants and teachers who have burned out. And I think it’s a really interesting observation about the change in the phrase, you know, I think we used to call it, I guess, nervous breakdown or things like that. Which was a pejorative term.

Katya: It is.

Rachel: Because you’re nervous. It’s because your nerves on right and you’ve had a breakdown. Whereas burnout is much more sort of— well, burnout’s will happen to anybody you know. It’s based on the rocket, isn’t it, the NASA rocket that was carrying on but it completely burnt out of fuel so you can do anything with it.

And we now know that burnout is a very physiological phenomenon where you literally burn out your hypothalamic-pituitary axis and you haven’t got enough cortisol going around, you haven’t got enough, get up and go, it’s literally gone and it’s a physiological thing. And it’s something I’m quite keen on educating people about is, no matter how resilient you are, if you are working in a very difficult circumstance in a difficult workplace, where you are not allowed to rest or recover, you will end up burnt out.

Katya: We are all finite resources, I think that’s something that we don’t reflect on enough. And I think, and within work, of course, we are replaceable, because that’s what the workplace is. People come into work, and if they’re upset or they’re not available, then someone else will cover or you cross cover or people, you know, whatever, it’s not always ideal. There’s— as we all know, when people are away from work, it can be challenging for those who remain. But nonetheless, in the notion that, if you’re not there, things will carry on around you. Whereas in your home life, your personal life, it’s much more difficult, you know, people don’t want you to not be functioning or to be really burnt out or poorly or even worse, you know. You matter as a human being in and of yourself aside from your work role.

Yeah, it’s— I think it’s a really tricky one, actually. And I still think there’s some way to go. But I think you’re right, there’s some, there’s some shifts which I think are positive along with all the challenges that we’re having. And it’s a shame, isn’t it, that often people don’t notice they’re burnt out until they’ve got to that third step, you know. They’ve got the exhaustion, you know, doesn’t just get better after the holidays, and doesn’t get better at the weekend. They’ve got that kind of internal emotional distance, wherever they’re feeling cynical about the patient, or ‘I just want to hear what you’ve got to say.’ All those things that you can feel really awkward about because that’s not why you went into your caring profession.

And then finally, you end up with declining performance. And that’s what everybody notices, including you. And that can be really, really negative, because then you get lots of negative feedback for you, without you or even anybody else knowing all these antecedents that you’ve struggled with. And it can put from, when— it can take people who are— who fit the definition of burnout, the OCD definition, it could take them quite a long time to actually recover from that. It’s quite a tough one.

Rachel: Yeah, I would say it takes months. Always remember, you know, patients come in, they sit in front of you, and they go, ‘Doctor, I’m feeling really stressed.’ And you, thinking, ‘Crumbs’. They say, ‘Can I have a couple of days off work?’ You say, ‘Yeah, you know what? Why don’t I give you a couple of weeks and let’s see how you feel come, back aft—’ They’ll say, ‘Oh, well, I won’t use it. I’ll just go back in a couple of days.’ But come back every couple of weeks going, ‘Oh my, I think I might need another couple of weeks.’ And then before you know, it’s nine months or a year that they’ve taken off. It is a thing, it can be really severe. It completely changes your life. And everyone I know who’s had a severe burnout. Well, I guess like but you Katya, have completely reset what they do in their life, because they’re like, ‘Well, I’m not gonna go through that again. That was awful.’

Katya: Yeah, I think you’re right. It is that real burnout? It is like you said, exactly. It’s a real thing. And it’s impossible to ignore. So having spent all this time, you know, ignore— we talked just now about ignoring and suppressing and how can you deal with this, carrying on, carrying on, ignore, ignoring, and then you just go, ‘Phbbt. Okay, that is it. I cannot.’ And that is a massive wake up call for people like, for me, and I’m not sure, there are others like me. And absolutely, you’re absolutely right. There is no other way except to regroup and to rethink.

Rachel: Yeah. It was, like I said, the third way would be not getting to that point to be actually. You know, it’s much easier to treat, when you’re just at the beginning, you know, when you’re starting to go off the X or support curve, when you’re starting to tip-off that point. And you’re getting the sense of distress, you’re getting the sense of anxiety. And that brings us back to permission because we’re healthcare professionals and other people listening, we know what to do, right? We know what to do to look after ourselves. That’s when I do well-being training, I don’t tend to give people, you know, chapter and verse about what they need to do. Because they know, I spend most time getting them to work out what they need to do for themselves, and then how they’re going to, how are they going to put that into place. Rather than what is it they need to do. But I can give them a few pointers, of course. So how do we get people to give themselves permission?

Katya: I think conversations like this is really important. Yeah, I think it’s about having the conversations and, you know, telling your story. And like I said, that’s why I founded the Working Well Doctor. I think it’s about when you are— like when I— I think you’re right, it’s about telling especially healthcare providers— I actually have a section in my training, which is I’m telling you what you already know. So exactly that and there’s some evidence isn’t there that when you’re in your doctor role, or your caring professional role, you are the giver, and psychologically you’re not gonna— it won’t land with you. Even though as you say, you know it. So I think there is something there about allowing people to step out of their roles and be in reflective space, be in a space where they’re allowed to think about themselves and their needs.

And I think these things land more with them. I’ve had pretty good feedback from the training I’ve done. And some of the consistent feedback is you know, GPs and stuff saying, ‘I know that, I tell my patients that, but I haven’t really thought about doing it for myself until I came in to listen to you.’ And then exactly that, you encourage people to take actions, write things down, have an accountability partner, whatever it is that works for them just to try and embed these habits.

I talk also about you know, tiny steps as tiny steps or Atomic Habits, various books and theories out there. But ultimately it’s about that taking that first step isn’t it? Nudging yourself towards the change. So for the— I used to not run but I’d literally just put my trainers by the door. And then after a few weeks of walking past my trainers one day, I put them on, and then a few days later, I actually walked out the house, and walked around the block. And then you build up to running. And I think giving those little strategies to help people embed their habits. So they’re not just knowing it intellectually, but they’re practising it, I think is, is helpful. I think reflective practices help for people, whatever they do, whatever is your thing, journaling, creative pursuits, being with nature, whatever it is that allows you to have that more reflective space, I think is helpful really think about yourself and start embed these things and give yourself permission to actually make changes for you. And doctors and other healthcare professionals, we’re all very cognitive, aren’t we? We’re all really thinky-thinky intellectual. And it’s all— that’s just great. But you’ve got to actually embed some practices to actually get some benefits from these things we’re discussing, I think. I need really— I really feel this gives myself permission to do the actions.

Rachel: Yeah, I think you also need to spend some time really thinking about what the impacts will be, if you don’t do it, if you don’t give yourself permission. Because making a mistake, we know that with burnout, you know, you get poor performance, you get lack of insight with stress, we don’t behave very well. So you’re going to, you may want to end up in front of the GMC, you may affect your relationships, you’re not going to be happy, you can see the health going. So even though you can’t see what the difference that will make next week, but actually put yourself a year or two into the future. And that’s one of the reasons why I did the career change that I did. Because it’s just thinking, ‘What’s gonna be like in five years’ time, if I’m still doing what I’m doing now?’ Because if you always do what you’ve always done, you’re always going to get what you’ve always got. That’s the problem and what is going to be the impact of that on— you know, actually getting out of your own head, what’s going to be the impact on my family? Or on my patients? Because it’s I might not be feeling very happy. But I think we’re very good at just putting up with ourselves feeling not very happy and stressed. But actually, how’s it gonna affect other people?

Katya: Yeah, I think that’s really important. I think that I was quite rubbish at that. But I think you’re right. If you can do that, then I think it helps you take action sooner, absolutely. You got to be honest, when you do that, as well. You got to say, ‘What’s it really gonna be like five—’ I’ll probably go like, ‘I’ll be alright.’ I just like, ‘It’ll be better when—’ I did a lot of, ‘It’ll be better when. It’ll be better when, I’ve now got this hurdle, got this exam, got this job.’ That kind of thinking. It’s funny, isn’t it? Because deferring, that deferment mentality is linked to success. And we all know that, you know, you revise now because we’ve got the exam, and that is rewarded again, isn’t it in our professional lives, but then you’ve got to watch out that that doesn’t become a trap where you’re constantly saying, ‘It will be better when—’. That prevents you doing what you just said, which is thinking, ‘Okay, really what will happen in a few years, rather than this wishful thinking about it’ll get better.’ Yeah, so I said.

Rachel: Yeah. And that really reminds me a little, little diagram, I just got it right in front of me, it’s in this book about happiness from our pal Tal Ben-Shahar and basically talking about the fact that, you know, a lot of us defer stuff because we know that we’re gonna be future benefit. Like, ‘If I just work all these shifts, I can spend, I can save up this money, it will be better when, I wait till my holiday’, and you’ll leave somewhere—. So we’re not experiencing happiness now, because we’re trying to throw up for the future, which often never comes. Or we flip to the other side, where we’re going, ‘Right. I really need that chocolate now, because that will make me feel better now.’ Knowing that that’s actually not gonna make us feel better in the future. And so we end up just eating, eating that McDonald’s burger or junk food and all that sort of stuff. Whereas actually what we’re aiming at is things that we know that actually gonna make us feel good and happy now, but also going to be good for us.

Katya: Yeah.

Rachel: That’s why you’re looking at the mindfulness and the running and the bath. And the relaxing. I think that that’s something that I have realised in myself. And this is, this is another whole podcast episode, those three, you know, your drive zone, your threat zone and your soothe zone. So medics, other professionals in high-stress jobs spend most of their time either in their threat zone, with that adrenaline going on or their drive zone, we’re getting that dopamine hit and achieving. We spend very little time in our parasympathetic rest and digest, which is really important for us. And I’ve had to learn how to rest.

Katya: Yeah, interesting book on that, isn’t now, I’ve just started reading about resting, and that you did a really, it was my bookshelf. Oh, I can’t remember his name, it’s a blue book.

Rachel: Oh, I have that. Yes. I can’t remember what that is. You’re right. Yeah.

Katya: It’s really interesting. And yeah, I listened to your really cool thing you did on the PHP about rest as well. But yeah, I think that’s, it’s really massively important, isn’t it? And if you want any arguments, it’s the argument that it’s not just good for you, but it will help your cognitive performance. Back to performance again. You know, if you rest if you allow your brain to switch off, if you lose up to look at nature, or even just a potted plant, that will help. I talk about micro bits in my training, you know, people say, ‘I never have time.’ ‘You always have time for that one or two minutes in the middle.’ And they even did a really interesting study with surgeons where they had the parallel studies, surgeons doing surgery straight through. And then other surgeons in parallel doing the same operation. But they were, they stopped and took a break mid-surgery. They stayed scrubbed in, didn’t touch anything, they just actually stood to one side, the patient who was made safe took a short break, and then continued.

And the really interesting thing was the surgery time was no longer. So the break the surgeons took paid for itself because their performance post-break was better than that of the surgeons who’ve worked all the way through. And you just think, you know, that kind of thing really makes you think about it. And what else? Yeah, there’s some studies about time since last break on nurses doing telemedicine, and their decision making gets sort of a little bit more tricky as they get further away from their last break. So there’s all these, again, back to your work and your performance and your safety-critical job and your brain, your decision making is your resource. And you got to look after it. So taking a break for a short time within your work is important. But you’re right for the bigger piece for you, as a human, you do need that time outside of work. And it gives you time to connect as well. Connect with people around you, your loved ones, and so on.

Rachel: Yeah, there’s so many good reasons to do it. But for people that are used to just serving others and giving their whole self, it’s good for you, because it will make you better at serving others. So there you go. If you need one reason to do it, even if it’s not just to feel better, better yourself.

Katya: Yeah.

Rachel: So Katya, we’re out of time, if you had three top tips, you’d like people to go away and do following the steps, would they be?

Katya: Gosh, that’s a good one. I think— three top tips. I think, I think there’s something I’d like people just to… yeah, just give themselves permission. I guess that’s one. But permission just to do that first step, the first step is just to pause, permission to pause and think, ‘What do I need right now?’ And if you do that, then you’re taking a step, and you’re starting to practice. And then if you then deliver for yourself that thing, that glass of water or whatever it is, then you’re teaching yourself, you’re setting up a new neural pathway, aren’t you? You’re rewarding yourself for the behaviour. And hopefully, then you will, you will start to embed that practice. So yeah, I think that’s just off the cuff. But I think that would be what I would say.

Rachel: What do I need right now? And permission to do it for my own good, for my family’s good, and the good of my customers, my clients, my patients, and you know, everyone around me.

Katya: Yeah.

Rachel: Brilliant. Katya, thank you so much. If people want to contact you, how can they find you?

Katya: Yes. So you can find me at my website, workingwelldoctor.com, on Instagram @working_well_doctor. I’m on Facebook and LinkedIn as well, under Katya Miles Working Well. And then if you want to email me, it’s theworkingwellexperience@gmail.com. And we’ve not taught loads about working from home because we sort of running short of time, but that’s another passion of mine. So I’ve got permission to make sure you look after yourself when you work from home. Just drop me an email. I’ve got all, go to my website. I’ve got a freebie there if people are interested.

Rachel: That’s great. Actually, we’ll get you back on the podcast to talk about that. Because I think that’s something that a lot of us are facing at the moment and struggling with.

Katya: Yeah.

Rachel: Another whole episode.

Katya: Absolutely.

Rachel: Great. Well, thank you so much, and we’ll speak soon.

Katya: That’s great. Thanks so much.

Rachel: Bye.

Katya: Bye then.

Rachel: 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.

Podcast links

Check out our Permission to Thrive CPD membership for doctors!

Shapes Toolkit

Get the FREE stress curve worksheet!

You Are Not A Frog Episode 57 – Exercise Is Fertiliser for Your Brain with Michael Ledzion

Connect with Katya: The Working Well Doctor | Email | Instagram | Facebook | LinkedIn

Working Well: Dr Katya Miles and the Working Well Doctor on Medworld

Free ebook — How to Work Well From Home

The Joyful Doctor

Mindset: Changing the Way You Think to Fulfil Your Potential by Dr Carol S. Dweck

Atomic Habits: An Easy & Proven Way to Build Good Habits and Break Bad Ones by James Clear

Happier: Learn the Secrets to Daily Joy and Lasting Fulfillment by Tal Ben-Shahar

You can also tune in on Google Podcasts, Apple Podcasts or Spotify.

You can also join the Shapes Collective Facebook group where we chat about the hot topics and regularly post interesting articles. Have any questions?

Contact Rachel through these platforms:

LinkedIn: @Dr-Rachel-Morris

Twitter: @DrRachelMorris

Email: rachel@wildmonday.co.uk

Find out more about our training here. Here’s to surviving and thriving inside and outside our work!