Episode 91: How to Break Up With Your Toxic Relationship With Your Career with Dr Pauline Morris

As a professional, you’ve likely been told to put your patients or clients first. However, many of us take this too far and neglect our own needs in favour of others. It can be difficult to recognise toxic patterns of behaviour, especially when the toxicity is self-inflicted. However, some tips on how to get the most out of your career can help you take the first steps towards a revitalised career.

In this episode, Dr Pauline Morris joins us to share her career counselling advice for physicians and other professionals in high stress jobs. We discuss the common pitfalls that lead doctors to unsustainable work habits. Pauline also sheds light on why staying in your comfort zone can be detrimental to your performance. To avert this, she shares tips on how to better recognise and advocate for your own needs. We also learn about the importance of self-care and taking time for yourself.

Listen to this episode to know some expert career counselling tips that will make you happier and better at your job.

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

1. Find out what makes doctors prone to career dissatisfaction and how career counselling can help address these.

2. Learn tips on how to balance altruism and compassion for others with self-care.
3. Discover the three areas that you need to reflect on to have a successful career.

Episode Highlights

[02:55] Top Career Concerns From Doctors

• Many doctors that approach Pauline for career counselling and coaching think that they aren’t in a work environment conducive to growing as a physician.

• Some of her other clients are rethinking their careers in medicine.
• It’s a common issue that these doctors know that something is wrong but can’t pinpoint what’s causing their problems.
• The truth is that many people love their medical careers. The issue stems from a lack of direction, which is where career counselling can help.

[05:32] Career Counselling in Medicine

• Most physicians are told to separate their personal lives from their professional ones in pursuit of standardisation at work.

• However, this mindset pushes people to ignore their preferences and personality traits when choosing career paths in medicine.
• As doctors become more aware of this dissonance, they become more curious about having careers that can make them happy.
• Career counselling delves deep into what you want out of your life and career.

‘We’re well within our rights to have medicine give something back to us. And that’s the novel idea.’

[09:53] Problems with Work-Life Balance

• Doctors tend to have altruistic personalities, and they carry this over to their careers through adopting a “patient first” perspective.

• They are expected to devote themselves to their work at the expense of other aspects of their lives.

‘You’re naturally seeking ways for you to make other people’s lives better. And an unfortunate side effect of that is often that you neglect yourself at the expense of others.’

[14:12] Three Common Issues of Doctors

• First, many doctors don’t know what makes them happy and motivated to work.

• Second, they tend to be perfectionists who struggle with changing their minds. They equate not finishing something with failure, even if quitting and pivoting might be more sensible.
• Lastly, the medical community looks down on career path changes. The current system discourages physicians from switching practices.

‘Looking internally, in general, as people is really difficult because you have to face yourself in ways that you’ve never faced yourself before. And it’s very challenging, and it can be very emotional, and it can be quite daunting as well.’

[17:53] Staying in Your Comfort Zone

• Doctors usually prefer to stay in their comfort zones because they know what to expect from it.

• They are also concerned with the comfort of their loved ones and the people around them.
• Making others uncomfortable is something that many doctors shy away from, even if it’s for the best.

‘I think sometimes, for us, to know that you’ve made somebody else uncomfortable is difficult. So we often don’t do things because we worry about what other people will think, and how they will react, and what they will do.’

[21:28] Don’t Be a Passenger in Your Own Life

• Everyone is capable of infinite compassion and care, but spending your time caring for others requires meeting your needs

• How do you give love and show compassion? What environment are you in?
• Training doctors to constantly give themselves fully to others is causing much of the dissatisfaction in medicine.
• You can change your unhappy circumstances with deliberate action.

‘We do have a choice, but it does take deliberate thought and deliberate action. You cannot be a passenger in your own life.’

[25:09] Career Counselling Tip: Take Time for Introspection

• Self-reflection is the first step in career counselling. Taking stock of your skills and preferences will guide you towards making good career decisions in medicine.

• Look inwards and ask yourself the following questions: What do you enjoy doing? What are your strengths? How about your values?

’The first thing you need to do is really start to understand your own strengths and your own values. And often that is, the easiest way to find that out is to go well, what do you actually enjoy doing?’

[31:15] Career Counselling Tip: Cut Back on Perfectionism

• Many doctors feel the need to be giving their all, no matter what. Even hobbies can feel like a race to the top.

• The key is to step back and set priorities based on your existing skill sets and preferences.
• You can’t do everything perfectly. And you don’t need to.

[36:01] Career Counselling Advice on Working with Your Strengths

• There will always be some part of your career that you enjoy. The key is to identify your preferences and build upon them.

• Getting the perspective of other people can help you understand yourself without potentially self-serving or limiting biases.
• In career counselling, you’ll look at your speciality, your environment, and yourself as a person. Interventions in any of these aspects can improve your career satisfaction.

‘It’s the speciality, the environment, and you as a person. And it’s working through those three pillars that start bringing us to the future that you want for yourself.’

[40:59] Diversifying Your Career

• Diversifying your career, whether by changing tracks or employers can be a useful career development tool.

• However, your reason for diversifying is essential.
• You need to make sure that what you’re trying to change will improve your job satisfaction.

[44:55] Pauline’s Top Three Tips

• You need to know yourself. Devote sufficient time for self-reflection, no matter how long it takes.

• Invest in yourself. That is, invest in something that brings you joy, centres you, and grounds you.
• Take time to create alignment with who you are and what you do.

About Pauline

Dr Pauline Morris is a career development coach helping physicians develop rewarding careers. She is the founder of Doctors Caring for Doctors, a support and coaching platform for physicians. With 10 years of experience as a consultant anaesthetist in the UK and Qatar, Pauline has leadership positions in acute pain management, maternity, clinical governance, and other fields.

Pauline has first-hand experiences with the challenges of being a doctor. Her mission is to help physicians navigate the complexities of a medical career without burnout. Her guiding principle is, ‘you don’t have to do it all to be a great physician.’

Pauline also wrote Ten Coping Strategies for Physicians, a checklist that doctors can use to better cope with work stress and transition towards better work-life balance.

You can reach out to Pauline through Facebook, Twitter, and LinkedIn. For more resources on career counselling and development, visit the Doctors Caring for Doctors website.

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Episode Transcript

Dr Rachel Morris: Do you feel stuck and unhappy in your job? You don’t want to leave, but something’s wrong, and you can’t quite put your finger on what it is. Maybe you’re not happy, but you’re comfortable being unhappy, and changing things seems too much effort and is downright scary.

In this episode, I’m joined by Dr Pauline Morris. She’s an anaesthetist and a career coach, and we talk about tips and strategies to help you do the inner work and explore your strengths and interests to work out what you actually want and need out of a job and a career. Listen to this episode to find out why we so often stay stuck in a toxic career, which is making us miserable. Listen if you want to think about your career in a brand new light, focusing on the right things, not just what you’ve always been told.

Welcome to You Are Not A Frog, the podcast for doctors and other busy professionals if you want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP, now working as a coach, speaker and specialist in teaching resilience. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water. We hardly noticed the extra-long days becoming the norm and have got used to feeling stressed and exhausted.

Let’s face it, frogs generally only have two options: stay in a pan and be boiled alive or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. It is possible to cross your work in life so that you can thrive even in difficult circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues and experts—all who have an interesting take on this. So that together, we can take back control and love what we do again.

I wanted to let you know that we’re now taking bookings for our Shapes Toolkit programs for late 2021 and 2022. Now, these programs help doctors, professionals in health and social care and other high-stress jobs take control of their workload, feel better and beat stress and burnout.

We’ve also got some brand new sessions on how to influence and negotiate even if you’re not the boss, dealing with conflict and how to support your team through the new ways of working without burning out yourself. We’ve also got bespoke sessions for those new to roles in general practice and for frontline staff on topics. Find out more by emailing me or get in contact through our website.

It’s fantastic to have with me on the podcast today, Dr Pauline Morris. Now, Pauline is an anaesthetist, and she’s a career coach who specializes in the careers of doctors. Pauline, welcome. It’s really great to have you.

Dr Pauline Morris: Thank you very much. I’m really happy to be here as well.

Rachel: Pauline, let’s kick off because I’m fascinated in what people come to you with. Typically, when a doctor approaches you for some coaching, what do they tend to be struggling with in terms of career?

Pauline: When people come to me, they tend to be struggling with one of three things. One is they think that they are in an environment that’s not really conducive to them growing in a way that they want to as a physician. The other thing they come to me with is doubt about whether or not they actually want to continue in medicine, the unfolding out of medicine thing.

Unexpectedly, the third one is people having a combination of those two, inasmuch as they’re struggling to work out where to place their focus, and they kind of feel as if they’re sort of running around the headless chicken hamster wheel, and they’re not really sure what they want to be doing, and they don’t know why they’re feeling like this. I put it in the umbrella term of ‘I’m struggling with my CPD. I’m struggling to meet my professional obligations, and I don’t really know why.’ It causes a great amount of angst, actually. That is the one that I’ve found to be most interesting since I started career coaching with doctors.

Rachel: That’s interesting so people will come to you saying, ‘There’s something wrong, but I don’t quite know what it is.’

Pauline: It’s this feeling of, yeah, just what you said. ‘Something’s wrong. I’m not sure what it is. I’m getting more and more unhappy. I’m not sure what I need to be doing with my career. I thought I knew what I wanted to do and now, I’m not so sure.’ That’s a very, very common one. When I first started, I thought it would have been more along the lines of ‘I just don’t know if I want to do medicine or not.’ But it’s really amazing how many people really love medicine, really want to stay in medicine but feel directionless, wonderless.

I haven’t got the career counselling that perhaps would have helped them earlier on, make the decisions that would help them feel good about where they are and what they’re doing at whatever place they are when they talk to me. Yeah, that’s a fairly common one.

Rachel: It’s interesting, isn’t it? Because I think that we don’t ever get any career advice when we qualify. You sort of know the different tracks that you go down to. It’s like, ‘Surgeon, boom, that track. GP, that track.’ But we don’t ever get the actual advice about what’s really going to suit you, how would you like your job be. And then, if you’re going to do surgery, whichever surgery you like and you choose, well, there’s different types of career even within that one speciality. No one ever seems to sit down and prepare you for that, do they?

Pauline: Correct. You hit the nail on the head right there. That’s exactly it. Again, even picking your career, we, as physicians, have been taught, and most of us believe that we are separate from our professional career. Who we are as a person is separate, and we’re told that that’s what was supposed to happen. You’re supposed to leave all your values, and beliefs, and put on your cookie-cutter cape as soon as you walk through the door. Because of that, people find themselves in jobs that don’t align with who they are or who they want to be.

Because as you said, ‘Oh, you like surgery? Okay, great. Oh, you like babies? Go do peds.’ You get that. But then, the career counselling that goes deeper than that is, ‘Well, what kind of life do you want to live? Are you okay working nights? Are you okay working weekends? Do you want to go into private practice? Do you like working in teams?’ These kinds of things that come along with those kinds of questions, ‘Do you enjoy sitting at a desk seeing 20 patients in an hour? Is that okay for you? What is it?’ Does that match with who you are? Does that match with your personality traits, with how you best bring your energy to the world?

If you’re somebody who really enjoys chatting with people, you might find that as much as you enjoyed radiology, that it actually isn’t fulfilling as a career for you and vice versa. It’s these sorts of little things that we never were counselled on and we never were coached on. How will your career fit into your life? As we come down the road now where people are beginning to realize that actually, it wasn’t like 20 years ago where once you got into it, once you became a consultant, you were kind of stuck. You were kind of there, and this is what you were expected to do.

People have started to wake up a little bit and go, ‘Well, hang on a minute. I realized I’m not happy, and I think there’s something I can do about it.’ But a lot of people just don’t know where to start because they’ve never had the experience of looking inside for answers and being curious about what it is they need from their career, as opposed to the way we always do medicine, which is we give, we give, we give. Actually, we’re well within our rights to have medicine give something back to us. And that’s the model idea.

Rachel: Yeah, well, it’s a very powerful idea, isn’t it? All the research has shown that if you’re happy at work, you do a better job; you’re better at it; you’re a more productive asset. What you said, I love that cookie-cutter analogy, and we had Sarah Goulding on the podcast recently talking about the fact, she sometimes felt like one of those shape sorters you had when you were little. You put the star through the star hole and round through the round hole. She said something that she was like a star trying to get through this square hole.

Pauline: A square peg in the round hole.

Rachel: Yeah, well, quite literally, isn’t it? You get your stuff. I think the problem for many doctors, and not just doctors, but also other professionals, I think people that go into these very high-stress jobs, such as law and accountancy, is that you sort of know what that job looks like and what you need to do to do that job.

What you don’t know is about your own strengths and values and skills. It was a real revelation to me when I did a strike, I was like, ‘Oh, those are my top five strengths. Well, that explains why I haven’t quite liked that bit of my job because actually, then at that bit, I’m not using any of those strengths and skills at all.’ Why do you think we find it so hard to understand ourselves?

Pauline: Oh, that’s multifactorial, I think. I think one, for many of us, our lives as doctors were kind of mapped out for us very early on in life. There was the ‘Well, you’re a bit smart, and you’re the first doctor in your family, or everybody else is the doctor in your family.’ Those sorts of things, and then, there’s the inherent nature of, ‘I want to help. I want to give back.’ And being a healthcare provider is a wonderful way of being your brother’s keeper. So that means you’re not truly a giving person. You’re naturally seeking ways for you to make other people’s lives better.

An unfortunate side effect of that is often that you neglect yourself at the expense of others. And when you get into a profession like medicine, which is thought to be so altruistic, and we are encouraged to be altruistic, there’s no physician who hasn’t heard ‘the patient comes first,’ or sometimes you just have to leave late, start early, miss the birthday, the weddings, the funeral, whatever it is. And it’s an expectation.

Quite rightly so. It should be that because there are times when you just won’t be able to walk away. The problem is, it’s a norm; it’s an expectation. It is not the exception; it is the rule. If you look at the history of medicine, where 50 years ago, a hundred years ago, when the profession of a physician actually became known as a profession, they were all males. They came together in their clubs, in their groups, their wives, and their servants, and everybody else because they tended to be of higher class and monetary standing.

Their lives were taken cared for them outside of pretty much everything else. This idea of, ‘I will go to work and sometimes, I will just not come back,’ was accepted, and it was socially acceptable. But when we look at who becomes a physician now, it is not acceptable to just never be home for your husband, your wife, your children, your parents, your friends, for your own self. The way we train in medicine and the way we think in medicine has not trained, has not changed with the way our community within medicine has changed.

We haven’t followed that change. This idea of putting ourselves, I’m not even going to say first, but off the back burner, it’s still challenging for us because it’s just not the done thing. And it’s almost frowned upon to say that ‘Yeah, actually, no. I’m not going to stay late today. I’m going to leave.’ It’s not encouraged. It’s not expected. When my daughter was working, she does desktop software engineering, they used to get a little bell telling them it’s half an hour before it’s time to start wrapping up, get yourself home. Could you imagine that in medicine?

Rachel: I get a bunch of GPs saying, ‘If only the bell goes half an hour before the specific end time of the surgery.’ And he’s there like, ‘Still got three hours to go!’

Pauline: It is hard for us, but we’re coming to terms with it, I think.

Rachel: It’s getting better. I think that this thing about our own, in particular, what’s important to us, what our strengths are, what we want out of a career, is something that we really, really need to think about. I wonder if when you get people coming to you, do you sometimes have people coming saying, ‘Right, that’s it. I just got to get out. I just got to leave medicine.’ And actually, after having some coaching sessions, it’s not that they want to leave medicine; it’s just that they need to make things fit them more. They need to make the job or the career that they’re in actually suit their unique skills and interests. Do you find that?

Pauline: Absolutely, absolutely. There are two issues there. As you said, one, we don’t tend to know ourselves. We don’t tend to know what makes us happy, what makes us feel energetic and joyful, what makes us want to get up and come to work in the morning. That’s one thing. The second thing is we are inherent perfectionists, and we struggle with the concept of changing our mind. It’s like, ‘Well, no, no, no. You can’t or so. You’ve started now. You’ve got to finish. If you don’t finish, it means that you’ve failed. You haven’t completed something. You’ve quit.’

The idea of ‘Actually, this is not working for me, so I’m going to stop. I’m going to take stock, and I’m going to start over,’ is alien to us. The idea of putting the fact that you’ve invested 7, 10, 12 years down a particular path and gone, ‘I’ve just worked out this doesn’t work for me. I’m going to go again,’ that is a really difficult concept for us. Actually, the system does not make it an easy process for us either. There is not a lot of respect for an ophthalmologist deciding to be a GP. Respect is probably a bad word. There’s not a lot of accounting for the skills and experiences that you would have had in another speciality and decided to go to another one.

There are practicalities to that. Definitely, that is true. But we could really be a lot more flexible about how we ask people to retrain when they decide they want to go down a different route from the one they’ve started on. There’s three issues here. Two of them are personal, and one of them is systemic. But to be fair, a lot of people never make it past one or two to actually get to struggle with number three. Because as I said, in the beginning, looking internally for us, looking internally in general as people, is really difficult because you have to face yourself in ways that you’ve never faced yourself before.

It’s very challenging, and it can be very emotional. It can be quite daunting as well. As physicians, we almost feel as if we are above such issues because we’re strong people, and we know what we want. We’re determined, and we’re perfectionists. That whole idea of cowering before yourself in a mirror is unthinkable. Often, the barriers to us getting that successful career and a happy and fulfilling life is our own selves.

Rachel: Yeah, yeah, it gets labelled as all that touchy-feely crap that I don’t need to do. I just need to do the job or whatever. My husband would laugh at all these, I call them business-development books I read, he calls them self-help books. It’s just like, ‘Why are you reading those?’ Well, actually, they really helped. They really helped me change who I am, and understand myself and everything like that.

I think so. I think you’re absolutely right. It’s this perception that it’s a bit woolly and weak. I think sometimes as well, we just don’t have the time to do it either. It’s like, ‘Well, yeah, I just haven’t even got the time to do that.’ There’s that. But I think there’s something that you and I talked about before this podcast as well. That is ‘I’m unhappy but I’m in a comfort zone. I know I can do this job, and it’s okay. Yeah, it’s not great, but actually, that’s a little bit scary. As soon as I start to look outside of that or to think there is something else that I could do, that I might fail, or that might get really uncomfortable.’

Pauline: Yeah, the comfort zone, the dreaded comfort zone. We’ve all got all kinds of ways to talk about ‘The devil you know versus the devil you don’t know,’ and ‘You can be jumping out of the frying pan into the fire.’ Yeah, we’ve got all kinds of idioms and ways of describing it. But it’s actually just about being comfortable and understanding where you are and knowing what’s coming next. There’s a certain amount of comfort in that, even when you know what’s coming next is something that you don’t want.

It’s really weird how the psyche works because we think to ourselves, ‘I really don’t want this. But actually, I know how to deal with it. I know how to cope.’ And as you quite rightly said, ‘I don’t particularly enjoy my job, but I can do it. It doesn’t challenge me, and it pays the bills, and really, if I thought about it, I’d upset my parents, and my spouse would be disappointed, and then my kid won’t be able to say that “My mom is a surgeon”.’

We give ourselves all kinds of reasons to stay in that comfort zone because it also makes us comfortable to know that we are not stressing anybody else, and that’s really difficult. I think, sometimes, for us, to know that you’ve made somebody else uncomfortable is difficult. So we often don’t do things because we worry about what other people will think, and how they will react and what they will do.

I’ll be honest, I couldn’t imagine calling up my mother, God rest her soul, one day and going, ‘You know what, Mom? I’ve decided I don’t want to be a doctor anymore. I’m going to, I don’t know, paint for us.’ I could never imagine having that conversation with my mother. I think I’d probably just never tell her. I do recognize that it’s a really… Because when you make a decision like this, it doesn’t just impact you. It impacts your family, and your marriage and your children. And there are a lot of reasons to stay comfortable because you don’t find out anything that you don’t want to know. You’re going to get answers to questions that you don’t want to ask.

Rachel: Yeah, it’s a lot more comfortable being comfortably miserable and just whinging a lot. But if you wanted to actually make some changes, it means you’ve got to be proactive about stuff, and it might fail. Then, if it fails, you haven’t really got anybody else to blame. At least if you’re in your comfort zone, you can just blame the system, and the job and it all being dreaded so I get that.

Pauline: We all love a good whinge, don’t we?

Rachel: We absolutely love a good whinge. I think something you said to me earlier was just because things are familiar, doesn’t mean that it’s good for you. Interesting, I was just in a lunchtime webinar. Actually, one of the doctors on the webinar said that her husband said that when they come home from work, they’re a husk of a person because all their care has gone into their work and their job during the day, and they’ve got nothing left for their family.

That was such a sad comment to read, that someone is just living like that and feeling that there’s no choice, or that the comfortableness of being there is actually better than the alternative, which is a bit scary but gosh.

Pauline: Yeah and this is one of the things. We have this belief that it just has to be like this. It can’t be any other way, and you’ve only got so much love and so much energy, and you pour it all out into your job for 8, 10, 12, however many hours a day. The thing that I would like to say is we are infinite in the amount of compassion and love that we can give. The problem is how we do it and in what environments that we find ourselves in because to give that compassion and that care and that love, we have to be getting something back.

It’s infinite; it’s never-ending. Your capacity to love and care is never-ending. However, it doesn’t mean it doesn’t need fueling. And this is where we fail when we train as doctors, and we train other doctors. We don’t encourage people to fill their cups. We just expect people to just give, and give, and give, and give and give. Going back to what you said about the woolly stuff, the fluffy bunny stuff, it is important to understand what energizes you and where you get your energy from.

If you are in the right job for you, I’m not saying that you’ll never have bad days; and it will never be difficult; it will always be smelling roses. That’s not what I’m saying at all. But what it means is that expression, a husk of a person, you’re not in the right place. You’re either not in the right environment; you’re not in the right job; or something else in your life is completely out of alignment.

But all of us have the capacity to have successful careers and happy lives. But it is a path. It does take thought, deliberate thought and deliberate action. And often, as physicians, we’re very passive in our careers. We kind of just do what we’re told and follow on from whatever we think we should be doing. And we get lost along the way. We think that the path must be straight, and it must be direct and there must never be any side alleys or wandering off, so rest on the footpath or whatever.

This is where this lack of joy comes from in our job so that when we come home, we have nothing left. But we do have a choice. We do have a choice. But it does take deliberate thought and deliberate action. You cannot be a passenger in your own life. You can’t. You’ve got to take control, and that is difficult.

Rachel: I think that it’s such a profound thing: you can’t be a passenger in your own life. It’s quite an obvious thing, but it’s really difficult to do. This podcast is all about helping people thrive in their work rather than getting everybody to leave. I guess for some people to really thrive, you do have to maybe change professions but for some people like you said, to thrive, you can stay in what you’re doing but maybe it’s just the environment you need to change.

It needs to be in a different surgery, or a different department, different hospitals, and maybe that’s what’s needed. For some people, actually, it might be staying exactly the same, in the same role, in the same place, but just changing the way you do things a little bit and maybe taking on some different types of roles. Doing some teaching rather than being the QI lead or baby things, I don’t know. Do something that’s going to suit you much more. How would you even get people to start to approach finding out what approach they need to take on this?

Pauline: Okay, so usually, most people who come to me, they come to me with career issues. They’re always shocked when I start with ‘Okay, great. Tell me what you enjoy doing.’ You kind of get this sort of deer in the headlights. ‘What do you mean? What do you mean? Well, I like skiing.’ ‘Okay, that’s great. That’s the hobby, and that’s great. I’m glad you have hobbies. But what do you enjoy doing? What makes your heart sing? What makes you happy? What is it that makes you want to get up in the morning at the risk of sounding a bit cheesy and a bit corny?’ Right?

It’s just what you said. We understand very clearly that medicine has become so complicated that we need different people for different jobs. You need an obstetrician; you need a gynaecologist; you need an ophthalmologist; you need an intensivist. We understand that, but for some reason, and you kind of alluded to this just now, we don’t understand that we can’t be masters of all the things that surround medicine. We’re not all good auditors, researchers, teachers, leaders, managers. We are not all interested in education.

And as you said right at the beginning, it’s about playing to your strengths. So the first thing you need to do is really start to understand your own strengths and your own values. Often, the easiest way to find that out is to go ‘Well, what do you actually enjoy doing? Do you actually enjoy being a college tutor? Yes? No? Well, if you don’t enjoy it, don’t do it. There are other people who are better at it and who want to do it. It’s okay to step back and let them do that.’

We’ve got this thing in medicine still. This sort of all-boys thing where it’s your turn to lead now, it’s your turn to do this job now without actually going, ‘Hang on a minute, does this person have the right skill sets to do this job? And do they want to do it?’ Every one of us can think of horrible mentors and teachers we had in medicine, and we can think of the great ones as well.

That’s one of the very first things that you need to come to terms with: what do you value? Do you want to have your name in the lights? Do you want to be invited to speak at international conferences? Do you want to be part of NHS England? Do you want to be in a teaching hospital as opposed to a DGH? Do you want to be in the city? Do you enjoy city life, or do you enjoy country life? It comes back to these sorts of things. And people sort of look at me like, ‘Well, what do you mean? Oh, yeah, I live in London. What does that have to do with anything?’ ‘Yes, but do you want to live in London? Is that where you saw yourself over the next few years? Or do you believe that this is what you should be doing?’ ‘Oh, I should be in a teaching hospital because they’re better than DGHs, right? I really need to have 20 publications a year.’ ‘Okay, but do you enjoy doing 20 publications a year?’

The start is knowing yourself. And often, that’s where the biggest challenges for me, as a coach, with my clients because everybody, almost everybody comes with the expectation of ‘Right, this is going to be about my career.’ No, this is about you, the person, the individual, the doctor, not just whether I should be a surgeon, or I should be a GP. There’s so much more to it than that. And it starts from looking inwards. And we’re just not comfortable with that; we’re not accustomed to it. That’s usually the biggest hurdle. When I say to people, ‘Right, let’s start looking at what you want.’

Rachel: Yeah, and I can imagine that that’s hugely difficult because I know when I first went for some sort of career coaching, and I was asked that question, ‘What do you want?’ I was like, ‘I have no idea. I don’t know who I am anymore. I don’t know what I’d like to do because I’ve done this job for so long that I don’t feel… I don’t know. I don’t know.’ I think your point about doing things is because of the prestige, I think that is completely an endemic at doctors.

We think that there’s a particular type of job and a particular type of hospital where they’re getting to do all these presentations at international conferences, and this is the hierarchy of what you can achieve and doing all this research, but you’re right, you might not like research or doing this and that. Then, you find someone who says, ‘Actually, I don’t want to do that,’ or ‘I don’t want to take the clinical director lead for my department anymore. It’s your turn. Nope, not interested.’

It’s like suddenly, someone has broken the pattern and said, ‘No.’ And you’re like, ‘Wow, that is good.’ I have a mate. He was a fantastic surgeon, and he offered lots of jobs in a teaching hospital. he’s like, ‘No, I want to work in a DGH because that will suit me because I have this team around me; I have this different lifestyle; I want that.’ And he chose that. It’s still pretty stressful. And I thought that is absolutely brilliant that he knows himself well enough to know that that’s not what he wants there. He wants this, and that’s going to work out really well for him.

But so often, we do things because of the prestige and what it looks like. I never quite understand why some things are a little bit higher at the hierarchy than other things in medicine. I guess it’s just human nature, isn’t it? If you can look important, and you look like you’re in a leadership role, then you’ve made it. But actually, some people are really good technically, and that’s where they need to stay, doing the technical stuff or doing the creative stuff, rather than doing the leadership stuff, which sort of takes you away from your practice. but we haven’t really grasped this yet. I guess the biggest hurdle is yourself, isn’t it? Not other people’s, your own perception?

Pauline: Yeah. Correct. This is a really tough one for us because as you rightly said, we are told this idea of what a good doctor is, and it’s this all-singing, all-dancing. I call it the back page, your back page of achievements. I remember one of my clients. One of the things that really stressed her was she didn’t have a good hobby. I was like, ‘What do you mean you don’t have a good hobby?’

To cut the long story short, essentially, it’s this concept that everything we do must be exceptional, and we must be exceptional at everything we do. So if your hobby is knitting, that’s great, but you need to have won some awards for knitting. You can’t just sit quietly in a corner and enjoy your knitting. You got to be climbing Mount Everest; you got to be base jumping. You got to have these really exotic things because you’re a doctor.

‘What do you mean, you knit? What’s your hobby?’ ‘Oh, yeah, I enjoy reading and sitting under the tree in my garden.’ ‘Really? That’s what you do?’ ‘Oh, okay.’ I remember in the coffee room, even in the coffee room, there’s this competition. ‘Oh, what did you do on the weekend?’ ‘Oh, I went skiing.’ ‘Oh, you know that Japanese place?’ I’d be sitting there thinking, ‘Well, I mowed the lawn. I walked the dog.’

Rachel: ‘I saw some friends.’

Pauline: I just could not take part in this conversation of all these amazing things that people did with their 48 hours away from work. I was like, ‘Well, I spent an extra two hours in bed.’ You felt that it was like, ‘Yeah, I’m just great. I’m so great. Even my hobbies are great. Every spare moment I spend, it’s great. I’m just great.’ It is hard work. It’s just hard work.

Rachel: You’re making me laugh, Pauline. Because honestly, I have had both thoughts myself. ‘I need to do a really good hobby,’ and actually, I did Myers Briggs and found out my personality profile. I’m somebody that likes to do loads and loads of different things. I do loads and loads of different stuff, but I’m not very good at any of it.

There’s tennis, and ice skating, and running, a bit of music and a bit of singing, but I’m not very good at any of them, and I’ve been beating myself up about that. But actually, it was suddenly when I found that actually, some people go really deep into one thing, some people just like to do loads of different things. That is okay. Like what you just said, it’s just spending time with your kids, or mowing the lawn, or sitting under a tree in your garden, looking at the birds, that is also totally fine.’

Pauline: All okay.

Rachel: With your job, just going and seeing your patients and doing a good job, that is good. That is good enough. That is good enough.

Pauline: It was one of the things I really struggled with when I was a trust appraiser. I had these wonderful physicians at the end of the year, they turn up on time; they haven’t got any complaints; they do their job well; they’re really good at what they do; they may or may not be doing something else like clinical governance, or medical education or something. Then, I had this whole tick box of things going, ‘Oh, yeah, but have you done an audit? Oh, yeah, but have you done a presentation?’

I’m going to be sitting there thinking, ‘This is ridiculous. This is absolutely, totally unnecessary.’ That was kind of the start of my… Well, no, I kind of started it myself with my own career. But by the time I got to that stage, I was like, ‘Okay, no, something has to be done. This is ridiculous.’ We are making people feel inadequate and incompetent just because they don’t want to have their hand in every single cookie jar.

It’s totally unreasonable. Where else would we expect people to work like this? Nowhere else. Nowhere else do we expect people to do this. But for some reason, as you said, well, not for some reason, it’s a cultural pressure; it’s a historical pressure. It’s time for us to evolve in the way we think about ourselves as healthcare providers because healthcare provision has evolved past that kind of individual.

We cannot be the jack of all trades and master of none when the consultant was the hospital administrator, and the teacher, and the mentor, and in charge of the nurses and in charge of the budget. Those days are gone. So why can we not just embrace our own strength, promote the people who want to do what they want to do because they will do it well, and allow people that freedom to say, ‘Right, this is what makes me a good doctor, and that’s all right. I don’t need to do anything else.’?

Rachel: Pauline, what would you say to someone that comes to you for careers advice and says, ‘Look, I don’t really want to leave medicine, but I want to use more of my strengths at work, and at the moment, I don’t feel that I am in my particular role’? How would you help them with that?

Pauline: That goes back to the very beginning like I was saying. Inevitably, there will be parts of your role that you do enjoy. Whatever it is that you do, there will be some things that you do enjoy. One of the things that we need to do is pull those things out and go, ‘Okay, so you are a surgeon, and you are the clinical governance lead, and you teach an ATLS course. Of those three things, what do you enjoy most, and what about it do you enjoy the most?’ Right?

It might be around the actual job itself, the speciality. It can be around the pillars of medicine: safety, governance, education, those sorts of things. It’s about getting to the root of those things. The second thing that we need to think about is the environment that you’re in. And you talked about that earlier on. It might be that you are doing the right speciality, with the right adjuvant, but you’re in the wrong environment.

Maybe you want to be in a teaching hospital, and you’re in a DGH. And you’re frustrated because you’re trying to achieve things that are more difficult to achieve in a DGH learning to trust and vice versa. Quite frankly, some environments are quite toxic. You could be in a team that doesn’t function. You could be working in a department that’s dysfunctional. It could be you as well. You could be facing issues that impact your career, and you have to come to the realization that that’s what it is.

There are three prongs to answering this question. And often, people struggle so much with answering the question themselves. One of the first things I’ll say to them is go ask the people in your life that you trust. Go ask them. What do they think? What do they think you’re good at? When do they see you at your happiest? What do people come to you for? How would they describe you? That’s when people start coming out of their shells a bit more, when they get that information from trusted people in their lives. That’s when the threads start to weave together a bit, and we can work on is it that you’re in the wrong career? Is it that you’re in the wrong place? Or actually, is this something personal that has now impacted on your professional life, and you haven’t actually acknowledged it? It’s the speciality, the environment, and you as a person.

It’s working through those three pillars that start bringing us to the future that you want for yourself. It’s really difficult sometimes because for instance, when it’s a work environment, sometimes, it’s really hard to be able to put those things into words, terminologies that we have now that we didn’t have 20 years ago like microaggression, and compassion fatigue and poor team.

We didn’t think in those ways before. Now, it’s about bringing those complex topics to the surface in a way that is tangible and recognizable, and that can be quite difficult. It’s very easy to follow an algorithm. It’s very easy to try to fix a process and a system. It’s not so easy to fix those soft skills. And that can be coming from you; it can be coming from your environment. So it is a very complex issue. That’s part of the reason I think we struggle with it so much.

Because we actually haven’t realized the depth of complexity involved in how to have a successful career and a fulfilled life. It’s complex. but again, deliberate thought, deliberate action will get you down the path, always. But it is hard work. It takes commitment, and you’ve got to be ready to pivot.

Rachel: Yeah, that’s interesting. I think you’ve hit the nail on the head there. It actually takes hard work; it does take hard work. It takes a lot of thinking, a bit of self-exploration, which could be quite uncomfortable, and being then ready to pivot, to say, ‘Actually, that wasn’t suiting,’ and getting out of the mindset that ‘I failed; I failed at this.’ You haven’t failed; you just found something you don’t like doing, so try something else.

Before we finish in a minute, I’m going to ask you for your three top tips for anybody who’s sort of got these questions and struggling with this. But what about this thing about diversifying your work? Because I found that actually doing something different within my role as GP was the thing that enabled me to carry on because it enabled me to use my brain in different ways. So I was very much into medical education and set upon a professionalism course. That, I really, really loved, and it just helped me use my skills in different ways. So how would you help someone who was thinking, ‘I just want to diversify and find the right roles’? First of all, would you say it’s a good idea?

Pauline: It depends because it depends on who you are, and it depends on what stage you are at in your career. because if you had asked me that question 10 years ago, I would have said, ‘Diversify. Don’t be ridiculous. I’m just about managing as a physician. You want me to do something else? No, I can’t. I just can’t.’ One of the things I talk people through is why you want to do something.

That diversification is something that worked for you, and it’s something that worked for me later on in my career. It’s not something that would have worked for me at the beginning of my career. And I really struggled with the concept of people asking me all the time, ‘Oh, so do you want to take the lead on that? Do you want to do this?’ Because I was just like, ‘Well, hang on a minute, hang on a minute, hang on a minute. I actually just want to really enjoy being a consultant that needs to display a little bit. I just want to do that. And once I’ve got my head around it, I feel firmer, and I feel grounded in the sand. Now, I can use that to leverage off, and push off and think about how else I can work and make the system better in which I am working.’

But at the beginning, I found it really overwhelming and really stressful when people kept asking me, ‘Well, what are you going to do? What are you going to take on?’. And so I think where you are in your career is very important and why you want to diversify is important. It comes back to our earlier conversation. Are you diversifying because you feel that you should? You’ve been told that it’s time? How are you contributing to the department?’ ‘Hang on, I turned up for work. What more do you want?’

Rachel: ‘To do a good job.’

Pauline: ‘Let me do a good job.’ Right? Or is it that you have a genuine interest in something, and you really want to put your time and energy into growing this idea, or this project or this thing? Again, to sound at risk of sounding corny, is this a passion for you? Your ‘why’ of diversification is very important. Because if you’re just doing something because you’ve been told to or you think you should or you’re being pressured into it, it’s not going to be helpful. And if it’s at the wrong time in your career, it can be downright harmful, and you’ll end up splitting yourself and not doing a good job in any way.

Why do you want to do diversity would be my first question. Then, we go back to the beginning again. What are your strengths? What are your values? What are you good at? When you diversify, you actually pick something that is going to be meaningful for you and be useful to the whole system of health. Whether it be in your little trust, or DGH or in a teaching hospital, what contribution of you will this be making? Because that’s the only way you’re going to really have a meaningful relationship with it.

Rachel: Yeah, yeah, and I know you talked about this before that many of us have these toxic relationships with our careers thinking we ought to, we should do. We’re going to stay in this exactly same, stuck place because it’s comfortable even though it’s uncomfortable. But it’s more comfortable than the fear of doing something else. Just to finish off, what top three tips would you have for listeners who are feeling a bit stuck but a bit like, ‘Ah, I’m a bit worried. I’m stuck, but I’m comfortable’?

Pauline: Well, first, I will always start with physician, know thyself. You’ve got to take the time. you’ve got to find the time to do the self-reflection. You’ve got to really stop and think about your why, your what, and your how. What do you want? What do you really want? How do you want to work? How do you want to live? Why do you want it? Do you want it because you think you’re supposed to want it? Does it bring you a sense of security? Is this how you see yourself? Why do you want what you want? And then, how are you going to get it? Are you focused? Are you laser-focused? Or do you know your path, and you’re going to go down it? Or are you actually willing to stop, take time, meander around, ask some questions? And then who, who do you need? Who do you need to help you on this path? Right?

Get yourself a mentor. As I say to people all the time, if you are planning a trip, yes, you would Google it, and then yes, you could go to TripAdvisor. But if you could, you would ask somebody who’s done it, who’s been there, who lives there, who’s helped somebody else get there. You always ask for help. We’re not good at asking for help, and we are not good to responding to people when they ask for help either. It works both ways. So those are the things I would say that you need to focus on to start with. And then, be truly honest with yourself. If you’re struggling, ask the people that you love, and ask them to be honest with you about it

Last but not least, invest in yourself. Find the time to take care of you. Find the time to bring peace to your mind, to your heart and to your soul because there is no investment too big or too small to make in yourself. Because anytime you turn up as the best you, the world is a better place for it no matter what it is you’re doing. This one is a really difficult one for us as physicians.

When I say invest in yourself, I don’t mean go and do another degree or go do another course. I mean invest in something that brings you true joy and happiness, helps you centre yourself, ground down, and really take time to appreciate who you are and what you do. That is a very important investment we need to make.

One of those buzzwords that have gone a bit funny is self-care. Self-care can mean whatever it means. It means brushing your hair a hundred times at night? Fine. It means walking the dog? Fine. Self-care doesn’t have to be elaborate. You don’t have to spend three and a half hours in meditation. Self-care is whatever it is that works for you, that investment in yourself. Those are the three things: know yourself, invest in yourself, and take time to create that alignment with who you are, with what you do.

Rachel: Brilliant. Thank you so much, Pauline. I think that’s going to be hugely helpful to many, many people. It’s been really helpful to me just talking to you today. If one of them wanted to get ahold of you… It’s like my personal coaching session, thank you.

Pauline: You can always find me on Doctors Caring For Doctors. We’re on Instagram. We’re on Twitter. We’re on Facebook. I’ve got a lovely little, I’ll call it an ebook but really, it’s just a little guide about 10 coping strategies for physicians. You get on to the website. You can download it for free. People have found that really quite helpful. Doctors Caring For Doctors, you can find me on all social media platforms, and I look forward to seeing you and everyone else there.

Rachel: Thank you so much, and we’ll put all those links in the show notes. Pauline, I feel we’re going to need to get you back again at some point to talk to us more about this. Will you come back on again?

Pauline: Yeah, I haven’t told you my other three pillars yet.

Rachel: Oh, okay. Right, you’re on. We’ll get you back to do the other three pillars. Brilliant. That’s fantastic. So thank you so much for spending the time, and we’ll speak to you soon.

Pauline: Absolutely. Thank you so much, Rachel. Bye Bye.

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.

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