Why Loneliness Can Kill, and What to Do About it

[00:00:00] Rachel: Isolation and disconnection were on the rise even before COVID and that can be incredibly harmful to our health. Now loneliness isn’t just about being on your own, but it’s about the quantity and to a greater extent, the quality of your relationships. If you’re a doctor or a busy professional working in healthcare, you might spend most of your day talking to people, but that’s not the same as connecting with your colleagues over a coffee or a glass of wine after work. And with more meetings being moved online and teams being more distributed, we’re losing those personal connections we took for granted before lockdown.

[00:00:34] This week, Dr Richard Pile is back on the podcast, following his Ted talk to discuss loneliness, and just have risky to our health. It can be. It doesn’t just affect sales of the people. It increasingly affects younger people just out of university and entering the workforce. So listen to this episode to find out how we can cultivate better, closer connections with people and not just wait and hope for those personal connections to form by chance.

[00:01:00] If you’re in a high stress, high stakes, still blank medicine, and you’re feeling stressed or overwhelmed, burning out or getting out are not your only options. I’m Dr. Rachel Morris, and welcome to You Are Not a Frog.

[00:01:19] Richard: I’m Richard Pile I’m a GP partner, uh, with a special interest in lifestyle medicine and cardiology. Uh, I’m a clinical lead for our ICS in lifestyle medicine prevention and inequalities. And also I do a bit of work with some, uh, healthy lifestyle, providers,

[00:01:33] Rachel: It’s great to have you back on the podcast, uh, Richard, ’cause you’ve been on before talking about, well, I think sort of all things lifestyle and wellbeing. Is that right? A, a while back now or was it ikigai that we talked

[00:01:44] Richard: We did, we did well remembered. It was, um, first of all, thank you Rachel. It’s, it’s lovely to be asked back to one of my favorite podcasts. And I, I say that not because you bribed me to say it. Um, yeah, we did, what was it, episode 94, I think it was, um, purpose. And so yeah, to come back and talk about something else that I think is equally important is great.

[00:02:01] Rachel: It’s wonderful to have you back and, uh, this, uh, topic is, is very close to my own heart. Um, and also you’ve recently done a TEDx talk on it, haven’t you?

[00:02:10] Richard: I have, I was very fortunate, um, to be selected, to do a TEDx talk. Um, St Albans, I dunno if you know how it works, but, um, TEDx is a sort of franchise and it was St Albans’ first go at doing a TEDx talk. So I applied, um, the theme of the day was on connections and I said I wanted to talk about loneliness. And, um, I was lucky enough to be selected. So yeah, we did it in October.

[00:02:32] Rachel: So what was it about your take on loneliness that they were particularly interested in?

[00:02:36] Richard: I think with TEDx, obviously it’s all about kind of educating, informing, and I guess to some extent they’re looking for a new take on things, not something that you’ve heard a million times before. So I did give that some thought when I submitted my little, um, application, my little audition. And, and I thought that the angle I would take, which was the, the direction we went in the end, was comparing loneliness to other health problems in terms of its severity, which is how I came up with the, with the title that, that loneliness may be worse for us than cancer, um, which I did back up with some facts you’ll be pleased to hear.

[00:03:10] Rachel: And that is quite a worrying statistic really, isn’t it?

[00:03:15] Let’s just start there actually, when we’re gonna sit un unpick this, you know, why is it worse for us than cancer? How, how can that actually be?

[00:03:21] Richard: Absolutely. It’s a brilliant question and, and when I first started looking at it, um, I thought, my feeling was this, this probably stacks up, but, you know, can I justify it? Can I find the facts that will make that a fair statement? ‘Cause obviously when you do a, a TEDx talk, everything has to be fact checked and you have to provide references, ’cause you can’t talk rubbish if you’re gonna do a telex talk.

[00:03:40] Um, and, and the, the stats are actually quite frightening, Rachel. So I, now, you know, the, the talk has already begun to seep outta my brain, so I’m not now about to give you a verbatim recitation of my talk, partly because of course I’d love all your listeners to go and watch the talk. Um, but essentially, I mean, the stats that I found included. the fact that you are as likely in your lifetime to be faced with significant loneliness as you are cancer. The stats are roughly the same, which is one in two. Um, that in the UK at the moment, it’s estimated there are 3.8 million people living with severe loneliness. And that’s actually more than the number of people living with cancer, which is about 3 million.

[00:04:16] And the stat that really got me, uh, as well as the most, which age group’s most vulnerable, which is another thing that we could talk about, the stat that really got me is that if you take into account. All the risks of loneliness and inflammation and disease, and we can go into that, you, your cancer may increase your risk of premature death by, depending on which study you look at, which analysis you look at, which you believe, somewhere between 25 and 30% increased risk of premature death, greater individual risks to your health than smoking, physical inactivity or obesity. And you, you read that and you think the campaign to loneliness, for example, will, will give you some of those stats.

[00:04:55] Just shocking. And, and, and yet we take cancer really seriously, which is what the talk was about. How we screen for it, how many lives it saves, and yet loneliness, a lot of people, including medical professionals who are, who are my close friends who listened to that talk and gone, wow. I, I never knew it was, it was that big a problem.

[00:05:13] Rachel: So many questions. How do you define significant or severe loneliness?

[00:05:19] Richard: So I suppose in terms of loneliness, I would say, as I define it in the talk, I would say it’s simply a mismatch between the quality and quantity of relationships that you would like or need and the quality and quantity of relationships that you have in your life. And I suppose as far as I’m aware, there isn’t a, you know, there isn’t a numerical scale which says if you score six outta 10, that’s severe loneliness and four outta ten’s only moderate.

[00:05:46] But I, I suppose my answer to that would be when it gets to the point at which a bit like depression, It’s beginning or is significantly impairing your life, your, your function. You know, the quality of your relationships, your ability to perform at work, the, the, the things that you wanna get out of life. I would say that, you know, that’s, that’s how we think about mental health, isn’t it?

[00:06:07] We, we used to ask the screening question, do you remember back in the days of QOF, people with heart disease or diabetes were asked two screening questions about depression, and then do you want help with that? And, and because it interfered with their lives. And that’s, that’s how I would view the loneliness thing. If it’s impairing you, if it’s effectively disabling you, I would say it’s severe.

[00:06:26] Rachel: it’s interesting what you say about a mismatch between the quality and quantity of relationships because I was, my impression is, and I think that people who are very busy, who work very hard, are often very lonely. I think a lot of doctors are very lonely, but we don’t recognize it because we have the quantity of the relationships is there, you’ve got your colleagues, you’ve got your patients, you’ve got your family. But if the quality is really, really low, then, then you can be at risk of severe loneliness, presumably.

[00:06:57] Richard: Absolutely. If you think about, um, you know, you and I talk about lots of the topics we’ve got similar shared passions for. So for example, the concept of blue zones and the, the, the MOI mates that people like Rangan Chatterjee and others talk about. That, that that small group of people, typically five plus people that you, um, grow up with have got your back, you know, can lend you money, will be there in a crisis. Those the kind of quality relationships that you need, I think, aren’t they?

[00:07:25] I’m, and I’m, I’m careful to put a few caveats in when I talk to patients about that because I think that, uh, relationships and, and connections are a little bit like food or exercise, other areas of wellbeing like sleep. You, you need the right dose. So, so some people probably only need one or two close friends. Maybe if you’re a bit more of an introvert, uh, and you get your stimulation from within, you don’t need validation from loads and loads of external sources. But if you’re people like me, you, you, you might need a bit more, but it’s the quality that that really counts, uh, because you could be surrounded by people and still be lonely and, and have no one that you can talk to when you’re really struggling.

[00:08:04] And that you know, that that could never be more true than in a busy GP surgery. We, we have 80 people employed on our team. And if you’re not careful, you could get through a day just with a brief exchange of social pleasantries in the morning, maybe a coffee break, maybe before you go home and you sit in your room all day and you see one patient after another, um, and, and it can be really tough. So yeah, it’s quality and quantity. And I, I would emphasize the quality, I think more than the, the quantity.

[00:08:32] Rachel: Totally. I, I remember when I was working as a GP, I felt very, very lonely in my surgery because yes, there are other people around, but we were all Working so hard behind closed doors, and you are, you are seeing patients again and again and again. It’s nice to see patients and, you know, you have good relationships, but it’s not, it’s not the same is it?

[00:08:50] And you might get 10 minutes for lunch and like you said, it, exchanging pleasantries and, and then you go off home and everyone’s rushing around so much. And I guess for me, the way I managed that was having other roles. So I, I really enjoyed my teaching job at the university, ’cause actually then I was sat in an office with the others and we were chatting and we were brainstorming about how we were gonna run this particular seminar for medical students. And that was where I felt my deep connections really were at work. Because when I was at the surgery, every, everyone is just getting on with a day job, which unfortunately, you know, the nature of being a doctor, you cannot sit in the same room as your colleagues and see patients. So I guess if you can, sometimes if you’re in telephone triage, but you know, because of confidentiality, privacy, you, you can’t. So it can be a really, really lonely job.

[00:09:38] And I can imagine, I’d be interested in your take on this. Richard is yours obviously still practicing GP, post Covid, that’s got even worse because we can, we used to have meetings, fa at least, we used to have meetings face-to-face with our colleagues where you could do the presentations. But now for meetings, quite a lot, practice meetings or PCN meetings or if you’re in a department of hospital, people just dial into those. They don’t get in the same room. ’cause it, it’s much, it’s much easier, really. You don’t have to travel and you can, you can record them, but I’m, I’m wondering if that might be contributing to, to the loneliness people are feeling.

[00:10:12] Richard: I think it could be, you’re right. I think there are pros and cons out there. So for example, before Covid, I, I’ve worked for the CCG now the ICS for the past 10 years. So like you, I’ve had a portfolio career. Um, before Covid, you, you spent an awful lot of time traveling to meetings that weren’t always that great. And I would say the plus side of me able to dial into one meeting and it, I’m not saying you wanna do one meeting after another meeting after another meeting, but the ability to connect with people quite quickly and be environmentally friendly and not lose hours of your day is quite a good thing. but we, we do miss the face-to-face.

[00:10:43] I, I, I think being a GP I was very fortunate, although life was undoubtedly stressful, particularly in the early stages of Covid, when people just didn’t know what to expect, and it was kind of like a, felt like something out of a Danny Boyle film. You know, it was kind of a doomsday scenario, wasn’t it? And the doors were locked and what was gonna happen next? And we all had packets of drugs at home, whatever. Uh, not, not illegal drugs, you know, antibiotics and that kind of stuff, um, mostly, um, we, we, um, we, we actually still, I know that there’s a misconception if you, particularly if you’re a reader of the Daily Mail or the Day Telegraph, but actually we were still going into work every day face to face.

[00:11:17] And at the time, I didn’t really think of it this way, but fairly quickly I began to think this is a massive privilege. My colleagues, my my friends who were not doctors were sitting at home, you know, if they were lucky enough to have a, a spare room or a study in their house. If not, they were sitting on their, you know, their parents’ bed or whatever, trying to do their life, their work remotely with minimal contact with their friends. I went in every day. I saw my friends. Okay. They weren’t all my closest friends, but I saw my friends every day. Um, we still kept up social contacts and we would sit and we would debrief at the end of the day.

[00:11:49] ‘Cause let’s be honest, if we’d been sat in a surgery all day, encountering each other at close quarters, having clinical conversations, making cups of tea, the idea that you’d just pack up and go home and you wouldn’t sit and have a chat for 10 minutes is a nonsense, isn’t there? So that was actually really good.

[00:12:05] And what’s interesting now is that, so some things I don’t miss. So for example, I haven’t been in a CCG or ICS meeting face-to-face for over two years. Well, not one of the big ones. ’cause they’re all, they’re all teams now. But people are now saying, oh, I love having a face-to-face conversation. So I try to offer that to my appraises. Some of them really like that. Some of them request face-to-face instead of teams. And when I say to the senior appraisers on our mandatory training days, oh yeah, I still do about 20% of my appraisals face-to-face, they look at me like I’m mad. ’cause a lot of them are doing it remotely.

[00:12:36] So yeah, I think it’s a mixed bag, but working in a surgery is great. I can appreciate if you’re doing a different job in the NHS, maybe you would still be doing it predominantly through a screen. And I think that does throw up, that does throw up challenges.

[00:12:50] I saw someone today who was really having a hard time and she disclosed at the beginning of our chat that she was having a hard time ’cause of a family member being very unwell. And I think it would’ve been easier to have a chat with her, to engage, to maybe comfort her a bit if we’d been in the same room. And it all I could really do was kind of talk to her on the screen. Three other people were present and send a little message afterwards. So that was, that was probably not quite so good.

[00:13:14] Rachel: It’s difficult, isn’t it? it has really altered things, I think. I don’t think things are great in the first place, but it, it, it’s got a lot worse. I was speaking to a, a consultant, I think pediatrician who, who literally had not been in the same room as the rest of the consultants in, in, in her department for, for two years, which is really, really, really tough.

[00:13:33] Um, going back to this quality of relationships. It’s interesting because I’ve been thinking a lot recently about what makes us happy. Like what fundamentally makes us happy. Is it gonna be all the holidays or a new car or whatever? No, it’s actually feeling good. And, and, and I was listening to a talk about someone who’d really identified what our key desires are, and one of our key desires is deep connection. Just like one of our key desires is to, you know, be fit and healthy.

[00:14:03] And it’s interesting. When we think about our health and fitness, which I’m thinking about a lot at the moment. ’cause I’ve broken my ankle again and I was like, I just got into shape after the last time I’ve broken and now I’ve broken it again and I’m, my fitness is gonna go, and I make a plan about my fitness. I sit down and I plan it and I go, right, I’m gonna do yoga once a week. I’m gonna do tennis once a week. I’m gonna make sure I’m taking time to relax and really care for my body. So I’m planning that out. That’s one way of being happy and healthy.

[00:14:31] But if deep relationships is one of our key desires that makes us feel, feel good, what am I doing to actually plan how I’m gonna have deep relationships? Because if I’m honest, I just expect them to happen. I just expect them to happen with my friends who I don’t see as much as I want to. And I expect them to happen with my, with my husband who, you know, we would love to make a regular date night and we should do, and that’s on my list to do that. But you know, if, if you don’t actually make any effort, how are you gonna deepen that relationship?

[00:15:03] What about my kids? You know, I’m not actually planning that. Why is it we plan other areas of our lives, but not our relationships and our connections?

[00:15:12] Richard: who know? It. It’s an interesting question to think about, isn’t it? It, it, it’s, you are right. It’s a fundamental pillar. And just like when we last spoke, I said purpose I think is probably the most important pillar. I’ll hedge my bet slightly and say, I think connections are probably, if not the most, then equally important with purpose. And I think if we have purpose and if we have connection, the rest of it probably falls into place for a lot of us.

[00:15:34] And it is so fundamental. Why don’t we plan it? Maybe it’s because when life is going well, it kind of happens without you having to think about it too much, doesn’t it? And perhaps in olden times, even, you know, even before I was young, those things happened more naturally because interactions all took place face to face, and life was less busy, less full on, less 24 7 less always connected, less distracted.

[00:15:58] Now with all these things jostling for our attention, like a lot of other stuff in life, we’ve ended up in quite a default toxic environment. The food we eat isn’t good for us. The sedentary lives that we’re kind of accepting aren’t good for us. Um, and, and the lack of meaningful relationships and face-to-face interactions aren’t good for us.

[00:16:17] And you know, we have evolved to live in tribes and we’re not yet really to live without them. You know, who knows? 10,000 years from now, obviously, you know, neither of us will be around, um, it may not matter because maybe mankind will have survived to live at 400 degrees the bottom of the ocean. It won’t matter. You haven’t got any friends and you can eat whatever rubbish food you like because we’ve evolved. But the reality is, we, we, we haven’t evolved that far. We’re still those people that need tribes and need connections, but we’ve very quickly moved into a world which is hostile to those needs.

[00:16:47] And so some of us won’t thrive and some of us won’t survive. Hence, my comments about, about cancer. So it’s really important that we do plan those, those things. So, you know, I highly recommend your, what sound like some New Year’s resolutions you’ve got there, Rachel,

[00:17:01] Rachel: Yeah, it’s gonna be very expensive ’cause it mainly involves going to spas with my friends and nice restaurants.

[00:17:07] Richard: if you need a letter from a, from a GP, just let me know. Yeah,

[00:17:10] Rachel: I think I need that, Richard. I, I think I will definitely need that. Um, Like you say, our environment now isn’t very conducive to that. The other thing I was wondering about is, is our environment now even less conducive to it in terms of social cohesion? You know, with the demise of people regularly going to somewhere to worship on a Sunday morning to together, the whole community used to go, didn’t they? Um, I have found just my stage of life, my community, when my kids were really little was very easy because school gate, school community, you had to take people on play dates. You would just naturally meet other people. And now of course they cycle themselves to school. So I don’t do that unless I make the effort.

[00:17:53] So I guess there’s a stage of life, but also we’ve just sort of lost our community centers. Like now where do you go to get the deep connections if you don’t have them? It’s not immediately obvious to me.

[00:18:05] Richard: And I think we used to be more plum into our communities. We were more connected where we lived. And now as you say, that’s, that’s less so. And, and you are right. Things like nursery and school groups offer ready made groups, but not everybody has that. And I think we we’re more connected digitally, but I think it, we are less connected in, in reality.

[00:18:27] And the stats do suggest, if you look at the campaign to end loneliness, um, or many other organizations that measure it, I, I try to stay away from using words like epidemic of loneliness. You know, I, I’ve avoided using that term when I, when I wrote my book, but there is evidence that it is increasing and, um, the problem is that if, if the evidence is that it’s beginning to increase by the time that we do anything about it, it’s, you know, the tsunami will be upon us.

[00:18:52] And if we look back at things like Covid, you know, there was the initial shock of covid and the disease, but then there was the aftershocks of, all the mental health problems around that. And now we’re seeing aftershock after aftershock with lonely adults, lonely children, isolation, people who’ve been raised in that environment. So I think it is, we haven’t yet seen the worst of it. So it is really important to think about how can we restore those connections.

[00:19:16] And you make the point about communities, you know, uh, I’m not here today to, to proselytize there, to advertise for any, the belief in any one particular faith. But the, the lessening in some areas of the, of faith communities and the importance of things like the church and other faith-based organizations being diminished sometimes, understandably, because of, you know, history and, and, and, uh, all those kind of problems. Um, if we denigrate everything about religions, for example, and other purposeful communities, then we lose that, uh, we lose the good, uh, as well as the bad. We throw the baby out with the bath water, and, and that is a real problem.

[00:19:55] As, as families become more fragmented, as communities become more fragmented, we all become more isolated. And so that’s a real challenge and I think it’s important that we consider that. And when we come talk about things like social prescribing, for example, which can be the sort of mo if you like, the kind of modern day, I don’t mean modern day religion ’cause religion can be modern day, but it can be, it can be a religion or a belief that, that people can quite happily get on board with, and engage with.

[00:20:18] Rachel: I used to have a article from the Times on my Fridge, and it was the Top 20 Ways to Be Happy. This was about 10 years ago, and number one was live close to where you work, which was interesting. Number two was go to church regularly or, or mosque or synagogue or whatever your place of worship was, and there is a lot of evidence that if, yes, if you attend a, a religious gathering regularly, you are, you are more happier. More happier. You are happier for, for a number, a number of different reasons.

[00:20:47] I’m, I’m interested in this relationship and connection piece. Are there differing types of relationships? What’s the, what’s the relationships we should really be focusing on, on, on, on trying to deepen? Because I’m imagining that not all, not all connections are equal. Some will give you more benefit than others.

[00:21:06] Richard: Absolutely. So one of the sort of analogies I make is imagining your relationships like being in the garden and do, doing some of your gardening. So, and I encourage people to do this in Covid. I remember doing a talk, a webinar on it. Um, you might wanna ask yourself, let’s look at my relationships. Which ones do I want to nurture? I might need a bit of pruning, but I want to kind of grow them. Uh, which ones do I want to plant? ‘Cause I recognize that there are significant gaps in my social circle, whether it’s people that I can really talk to, whether it’s people that challenge me, people that can support me, or people that I can support. And actually, which relationships do I want to weed out and, and get rid of? ‘Cause they’re toxic and like wigs, they kind of drain me and they take the nutrient, the nutrients away from the other relationships I’d like to nurture.

[00:21:51] So yeah, I think not all relationships are equal. I, I, I’ve known people over the years, this is just my personal thing, but. I quite like to have deeper, meaningful conversations with smaller numbers of friends. And when I’ve encountered people where the relationship’s very superficial, and after you’ve met with them 3, 4, 5, or 6, 7, 8 times, you realize you’re never going to get any deeper. The conversation is always banter. And don’t get me wrong, as a football supporting middle aged blo, I like a bit of banter, but only so much.

[00:22:19] And when you get to the point where you realize it’s only ever banter, every conversation’s an anecdote or a joke, it’s exhausting. I mean, how much effort do you wanna spend on those relationships? So it is fine to have a few of those scattered around ’cause that’s sometimes how you manage relationships at work. But you want those few deeper ones. Um, I think it was, um. Johann Hari, I might be pronouncing their name wrong, who, who wrote the book about Lost Connections, who talks to, I know Rangan Chatterjee’s interviewed him on the po on the, his podcast. Talking about something like home is what is a place where people notice if you’re missing or if you’re not there, or words to that effect. You want those people in in your life.

[00:22:56] Rachel: There’s people that that really get you.

[00:22:59] I’ve heard the phrase recently, useless friends. useless friends? Yeah. I love that. I think I mentioned it in a, a quick tip recently, but it, so many people, I think as you get older, as you get, you know, as maybe you are in more leadership positions there, there’s a lot of people that you know who are friends and acquaintances, you know, such as people you work with might be your friends, but they’re not useless friends. ‘Cause they sort of have a stake in your, in you being okay and you being able to deliver for the practice or for the business or whatever. Um, you might, you know, people might want something from you and yes, they’re your friends, but they want something from you.

[00:23:37] And I just heard someone talk about it’s really important to have useless friends. Friends that literally they’re not gonna benefit from, they’ll benefit from being your friend, but they won’t benefit from you in any other way. Like, you’re not gonna give them loads of cash or you’re not gonna look after their dog for them, or you’re not gonna, I’m not just thinking to Motherland, which is one of my most favorite series. Like she’s constantly trying to make friends so that they will look after her kids, or so that they’ll do the school run for her and she can get in the car share and she’s just hilarious. But, you know, useless friends, they like you just ’cause of you. They like hang out with you just ’cause you know, I think, oh, those are the ones that I want.

[00:24:12] Richard: I really like that. I, I’m gonna, I’m wondering, I’ve got a, a WhatsApp group. We we’re called the Manly Men, and, uh, we meet up every few weeks. Uh, we’re not, we’re not terribly manly to be honest, but we meet up every few weeks and, and I’m gonna tell them all that they are officially, um, useless friends and see how that goes. I’ll let you know,

[00:24:27] Rachel: Very good. What, what’s the most manly thing you’ve done in that group, Richard?

[00:24:30] Richard: Uh, well, you usually consist of meals and having a drink, but in fairness, we, we do do weekends, uh, we do a weekend away every year. We had to break for Covid a couple years, so we, we once did one, we did once very manly day, which involved paint balling, laser questing, go-karting and drinking beer whilst having a barbecue. That is the most man I have ever been in my life. Yeah, yeah,

[00:24:54] Rachel: Yeah.

[00:24:54] Richard: It’s, I’m trying to compensate for something obviously. Yeah.

[00:24:57] Rachel: I remember when I was doing the Red Whale Lead Manage Thrive courses in, in a break, this absolutely lovely GP came up to me and he said, because I’ve been talking about connection and and resilience, the wellbeing factors, and he came up to me. So I just want to let you know that I’m now 62 and next weekend I’m going away with my young practitioner’s group who said, which I have been in for the past 35 years. And every year we go away for weekend and it’s just wonderful and it’s literally the thing that has kept me in general practice and has kept me sane. And I just thought, that’s such a wonderful story.

[00:25:29] Richard: And I’m not gonna, I know we’re not leaping straight to the top tips yet, but exactly the same for me. I was invited to join a young practitioners group when I was young, which was 23 years ago. We’re having dinner together tomorrow night for our delayed Christmas meal. We always do it in January, and we’ve now been going away for 24 years for a weekend away. We’re doing Dubrovnik this year. And that, that I think has helped some of us stay in, in general practice. We have shared bereavements, uh, the ending of relationships, um, issues about fertility and child rearing, you know, something we might dump under the bracket of sort of, you know, nervous or near nervous breakdowns. Uh, it’s been, it’s been a really, really helpful group, and I’m very grateful for that. Um, and, and you know, we’re not young anymore.

[00:26:15] But, um, the young thing that, that’s what concerns me. ’cause one of the things that I, I talked about in the TED Talk is one of the questions I asked was, do you know what the loneliest age group in society is? And I haven’t primed you for this, Rachel, but would you like to have a guess?

[00:26:31] Rachel: I think 48.

[00:26:33] Richard: People do say your fifties are tough. The answer is, and I I promise you I can back this up with, with the relevant research. Um, 16 to 24 year olds are the loneliest age group in society. They are actually lonelier than people in their seventies and eighties. Uh, and the point, the point that I’m making the talk is that you could be frail, elderly, sick and bereaved, and yet objectively still feel less lonely than people that that would be, you know, you would assume are in the prime of their life.

[00:27:03] And, and that’s just so important both for people of those age, but also I guess when we’re thinking about, you know, younger doctors who’ve just started work. Um, you know, it can be a really tough time.

[00:27:13] Rachel: Do you know why that is, richard?

[00:27:14] Richard: Uh, I, I mean, I think there’s lots of speculation around it, isn’t there? Um, it obviously it is a time of life where you are quite naturally going through an awful lot of change physically, mentally, um, and of course your life circumstances, you’re going through, you know, secondary education, maybe higher education, maybe not. Job, leaving home, asking the big questions about life and what, what’s really important. And I think now when you throw in the isolating effects of social media, and I don’t like to, you know, bang along about the toxicity of social media every single time I’m, I’m on a podcast, but, you know, that is undoubtedly contributing.

[00:27:51] And of course, these young people, 16 to 24 year olds, they’re, a big chunk of their lives has been affected by Covid as well. You know, you and I, even though we’re very young, obviously, um, uh, only a small proportion of our lives has been affected by Covid, you know, uh, uh, 4% or whatever, in my case. Um, in my 18 year old’s life, you know, two or three years of, of his life, which is a big chunk. So I think for all those reasons, you know, maybe they’ve, maybe they’ve always been the loneliest. I don’t know. But I, I think it’s certainly more of a challenge than ever.

[00:28:21] Rachel: certainly have noticed that, you know, my daughter’s just left school, school as well. And I think there is something about the fact that at least at school, you are thrown together. You have to be together, you have to meet people, and it’s dead easy. As soon as you leave school, it’s so much harder to, to meet people and get to know people, and then you, go to university and a lot of universities online as well, so you’re not, you’re not mixing and meeting people in the way that, that you used to. So that, that, that’s a really sad statistic. Um, I said 48 for a reason, obviously, obviously.

[00:28:50] Richard: I wasn’t going to ask a question, Rachel.

[00:28:52] Rachel: But I be implied. But I, you know, I have noticed that, um, and I know there’ve been a lot of talk particularly about, and obviously I’m, I’m thinking you might be able to answer middle-aged men, Richard, but I think you already have talked about that, that there’s a lot of banter. Often people are leading companies on leadership positions, so you don’t know which ones are really your friends and which ones are just sort of tolerating you. And you’ve put so much time and effort into your work, and this is true for women as well, that often you’ve let the friendship slide ’cause they’re not the people that are calling out to you. And then suddenly you realize that the only people, you actually really know your wive’s friends or you know, the people that maybe you, I, I, I don’t know

[00:29:31] . So I, I wonder if that’s going on, but I do think doctors slip into it quite quickly because I know my dad was a GP, I’ve been in a G GP and I remember my dad coming home from work when I was little and he was so busy that he just, all he could do was, you know, on holiday, he just wanted to go away as a family and not see anybody else at all. And there is that thinking that I’ve been so busy today, I’ve seen so many people, my energy is so drained that I cannot see anyone else today. And so that is to me, throwing the baby out with the bath water. So you’re not seeing the people that you really need to see to, to build up those deep connections ’cause you’re so exhausted from the draining connections that you’ve had.

[00:30:12] Richard: And I think friendship and connections are about giving and receiving, aren’t they? So In that situation, you might feel you might benefit from being in the company of somebody, whether that’s your other half or um, just your friends or whatever. Uh, or being in a situation where you can just relax, you know, there’s not a lot of expectation of you. You aren’t required to hold forth and be funny and carry the conversation and organize loads of stuff. It could just be a just sitting down, relaxing, having a drink, going for a walk together, because you know, there’ll be other times when you are giving and, and they’re receiving.

[00:30:43] Uh, and, and I think people do make a mistake. ‘Cause I think we all need, we all need people. The question is just what the, what the right dose is. It’s probably a dose response curve, isn’t it? Like there’s a dose response curve for exercise. There’s a dose response curve for sleep. I know people who are so driven have such fomo that they have a massive number of in quotes, friends. But the risk there is that sometimes they end up squeezing out those relationships, which actually are the most supportive to them and the most meaningful. And it’s only when they then get into difficulties that they realize that some of those friends have drifted away.

[00:31:17] Rachel: I always think that the people who you get on with the best, who really get you are often not the people that are crying out for you to see them or, or, or connect. You know, they’re busy themselves and they’re not going, oh, please, I’ve got to see you, you know, where, where are you? But the people you know, and sometimes the people that are a bit more draining are the people that say, oh, I need to see you, blah, blah, blah. So you do end up ignoring those people that are their sort of main energizers for, for you. So what suggestions have you got?

[00:31:48] Richard: I think I would probably break that down into kind of, on a, on a patient level, perhaps ’cause you know, that’s what we have to think about as GPs, but also for ourselves. ’cause I believe whenever we talk about wellbeing, whenever we talk about lifestyle medicine, clearly, you know, what’s good for the goose is good for the gander. We, we, we shouldn’t ever ignore the doctors in all of this as well as, you know, and what’s good for them, what’s good for their patients is good for them.

[00:32:08] So from a clinical perspective, I now do ask people much more than I ever used to about their connections. And sometimes it becomes apparent actually that, that might need dressing before you start going down the route of talking about eating well and, you know, whether you’re doing, you know, 150 minutes of moderate intensity activity a week.

[00:32:29] Uh, and we’ve got, uh, you see it very particularly in, in, I know we, we can’t call them frequent flyers anymore, can we? High intensity users. There are the correct, correct, politically correct term is in our surgery. The reason that most people, and the ones, by this I mean, the ones that ring up every day, or at least every few days, they’re lonely. That’s why they ring. They are lonely, 99.9% of the time. And some of my. Doctor, colleagues take the view, oh, it’s all right. I don’t mind chatting to Mrs. So-and-So, ’cause it helps them, whatever. And that’s kind of them. But actually, doctors are a massively expensive resource, aren’t they?

[00:33:00] So I think we should, we should inquire about relationships. And if we sense that, and people confirm that one of the key sources of their stress in life is lack of networks, lack of lack of communi, uh, lack of, uh, connections, then we, we try to help them, signpost them in that direction. And social prescribing is brilliant for that. And, and I mentioned this in my talk as well.

[00:33:22] Um, you know, social prescribers, interestingly, uh, I, you know, you and I know, know about this. Most imagine, I would imagine most doctors know about it, but loads of people who went into the talk came to chat to me afterwards and said, social prescribing, I’ve, I’ve never heard of, of that. What’s that about? And I just put it to them very simply and said it basically a social prescriber is someone, or the movement of social prescribing is about helping people to understand what matters to them in life, not just what’s the matter with them and how to connect to that. And then with the right support and guidance, ’cause obviously some people do need a lot of support and guidance, um, helping them to take back some control in, in their lives, which can be, you know, otherwise very difficult, challenging, and even chaotic lives so that, so their, you know, their lot in life is, is improved, their Happiness is improved, their health has improved.

[00:34:06] So I recommend referring people to social prescribers, and every GP practice or primary care network has got one or more social prescribers in it. Most practices have got one. We’ve got volunteer social prescribers as well. And, and you know, they’ve been trained to be able to talk to people, to listen. Uh, this goes back to the three Ls of loneliness that I talked about, um, in my, in my talk. So look, listen, and, and lend a hand. So look for people who are behaving differently. You know them, something’s off. They might be angry, they might be isolating themselves. They might be using drugs including more alcohol. They could be self neglecting. Um, li listen to them. ’cause again, we both know that if you let someone tell you their story, whether they’re your friend or your patient and you don’t interrupt them, um, and you listen carefully, they’ll tell you most of what you need to know just without you even having to fire questions out them and break up the whole process and make it unwieldy. And then there’s the, there’s the lender hand bit. And that’s, you know, we can do that as friends, we can do that as family members. We can sometimes do it directly as doctors, but also we can sign base people to the people like social prescribers who are really good at lending a hand. ’cause they know all about all the different networks in our respective communities. All the different services that, that people could take advantage of. Gardening, walking, dancing, learning together. Um, support for carers, uh, financial support. Um, so I think that’s a big one for patients for us to, and of course, you know, we can take advantage of those ’cause we’re all patients too.

[00:35:39] And then I think when it comes to the professional side of things, I think it’s the same thing. It’s, it is looking for people in your practice. You know, when you go in in the morning and you make a cup of tea, there’s the usual, uh, social exchange of nineties, isn’t there? Hi. How are you? Yeah, I’m good. Good. You? Yeah, yeah, fine thanks. And sometimes, you know, you haven’t got any more time than that because you’ve, you arrive late, you’re first on triage doctor and you’ve got to jump on the phones and you actually haven’t got time to chat to someone for 10 minutes.

[00:36:06] But I would encourage all of us to think about, get there five minutes early, talk to someone maybe that you don’t normally talk to or that you haven’t had a chat to for a while. Make it clear with the way you look ’em in the eye and your body language and when you offer to make them a cup of tea, that you are interested, genuinely interested in the answer. And if they are in that moment wanting to open up, give them those extra few minutes. You know, or arrange a time when you will chat later on in the day if it’s better for both of you.

[00:36:31] And I’ve learned, you know, some quite significant things from people, I would’ve had no idea if I’d just gone. And it’s amazing how crap people’s lives are and they will still go, how are you? I’m fine you. Yeah, I’m fine too. I mean, I used to say that when I’d been up all night with my son Luke, and the ambulances had been called because he’d been in status and that, you know, so it’s amazing what people can put up with. Um, so I would say that’s really important.

[00:36:55] And then I think thinking the bigger picture, how you’re doing in your surgery. I’ve just done a, a wellbeing survey for our surgery, which Okay. Is, is motivated by the quality improvement domain of the quality and outcomes framework for which we get, you know, incentivized. But some of the answers I’ve had back from that are really interesting, and a lot of them around mental health and stress and, and dealing with loneliness. And so we’re gonna put on some talks, some, some, you know, some more team building, some social activities to kind of address some of these issues. So, off the top of my head that those, those would be some of my answers to your question that you asked quite a few minutes ago.

[00:37:31] Rachel: That’s great about, yeah, how, how do we help people? I mean, how do you inquire about relationships in a, I mean, yes, you, you can, you can sort of work out in a bit of a roundabout way, but you know, without going, are you lonely, Richard? Or, you know, have you got any friends? Without it being a bit clunky, are there any good phrases that you could use?

[00:37:48] Richard: There, there are actually official loneliness scales. There’s the UCLA, uh, 20 point scale and there’s even something called the five point alone scale, it’s a bit sad, sad title, isn’t it? But the evidence that I looked at said asking one question when it’s been validated by the experts is probably just as good as you’re using a complicated scoring system. And actually it was more or less the question that you just asked Rachel. It was, do you often feel lonely? Not just do you ever feel lonely? ‘Cause loneliness is natural and part of life, and it’s to be experienced and, and learn from, uh, just like many other unpleasant experiences in life are. We should never be afraid of that. But it’s do you often feel lonely?

[00:38:28] Now you are right. I wouldn’t lead with that now. Hi Rachel. How are you? Do you often feel lonely? But, I think if you know someone that’s easy because you are having conversations with them and you can build up to asking a question like that. If I’m sat in a consultation with someone, I might ask something like, who are the significant people in your life? You know? Um, being connected to others is generally considered quite important for our wellbeing. What about your connections? You know, are you happy with the quality of your connections? Have you got enough? Are the ones that you’ve got deep enough? Are, are there, are there any ones that you’d rather not have that might help improve your quality of life? And then from those conversations, you could lead up to the do you often feel lonely? Question, which I think that the analogy I would, the comparison I would make is, we used to worry about this when we were first junior doctors. I’m sure we all did, asking people about suicide, suicidal ideation. You know, you wouldn’t leap straight in with have you thought about killing yourself, but you would work up to that. How do you see the future? Is the hope for it? Have you thought about harming yourself? Have you ever thought about ending your life?

[00:39:25] I think you lead up to the loneliness question, but you shouldn’t be afraid of it. ’cause if we don’t ever find out the answer to that question, we risk having a patient who is lonely, who therefore gets the fight or flight response in their body, who therefore becomes inflamed with, you know, raised levels of inflammatory biomarkers and all that kind of stuff, who therefore goes on to develop. Non-communicable diseases, um, by which I mean things that you can’t catch. So whether it’s cancer, going back to the cancer thing, diabetes, dementia, depression, heart disease, strokes, rheumatoid arthritis, they go on to develop long-term conditions.

[00:40:00] And all those conditions, they’re all called different things. They all have different diagnoses. They all appear in a different part of the diagnostic manual. But the reality is that, that most, if not all of them have the same root cause. Maybe there’s a bit of genetics and, and trauma and other things in there, but a lot of them have the same root cause. And a lot of them, if we’re really practicing lifestyle medicine, could be reversed or improved with the same simple approaches to life.

[00:40:23] So if we don’t honor that, if we don’t ask people about loneliness, we’re taking the easy way out. It’s easy to let them leave the room and give them some flux, isn’t it? That’s that, that’s what a lot of us have done historically.

[00:40:34] Rachel: So what you’re saying, and I’m glad you covered that, the reason loneliness causes these problems is ’cause you’ve got raised cortisol. ‘Cause essentially you haven’t got your tribe that causes stress. So in the same way that stress causes all these nasty non-communicable diseases. So does loneliness cause that.

[00:40:50] And I’m thinking, I think the reason doctors don’t ask is because we don’t like in general asking questions about something if we have no idea what to do about it. And that’s what we find, you know with um, in our training, lots of people shy away from asking these like really personal or, or difficult questions ’cause they think they’ve gotta fix it. We get into this, oh, well if I ask the question and then they say, yes, I am lonely. I can’t fix that. And I guess the one thing would be it’s just like you said, listen, you said, well, you know, what could you do? What do you like doing? What is it that’s worked in the past? You then go into coach mode rather than rescuer mode, and just find out what’s been working for them, presumably.

[00:41:31] Richard: Yeah. And, and I think also if we don’t ask the question, we’re not getting to the root cause. So again, this is one of the things I finish off the talk with. We do worry about it being a can of worms. We might think it’s not our job as doctors, uh, with waiting rooms full of all the lonely people. But if we don’t ask those questions or we don’t give people the space for someone to ask those questions, even if it’s not us, although I think initially it can be us ’cause we know the patient, we’re in the middle of a conversation, why would we duck that? Then what we’re doing is we’re saying we don’t really want to address the root cause, but we would, we’re quite, you know, we don’t mind some slightly rubbish symptom management with some drugs that don’t really work very well, but we don’t want to address the root cause. But it’s ahead in the sand moment, Rachel, because then we’re not practicing prevention. We know prevention is better than cure.

[00:42:13] There was a study that showed that people who referred into a social prescribing scheme were 24% less likely to need an appointment with their GP. Uh, sorry, 28% less, less likely to need an appointment with their GP and 24% less likely to attend the emergency department. So that as a return on investment, if we start talking in financial terms, that will prick up the years of the chief financial officer of the integrated care system, that is a massive return on investment, so it makes no sense to duck it.

[00:42:43] I do appreciate in a pressured 10 minute appointment, you might not have time to address it, but it could just be the start of the conversation. And then you either get them back to talk to you or you refer them on to social prescriber. And like with our friends, if we have that rushed conversation and we’re both going opposite ways on the school run or someone’s catching a bus, just come back to it, you know, follow up on it. Don’t, don’t miss that opportunity. Once someone’s opened up to you. It’s kind of a, it’s an invitation to, to continue the conversation. Then you’ve got a foot in the door.

[00:43:14] Rachel: I wonder if we avoid it a bit though with our friends or people we see on the school run or, or, or whatever. Because again. If you talk to someone about, you know, well, are you, are you lonely? What, who have you got around you? Whatever. We then feel beholden to help if they then say, well, yeah, I am, I am really lonely at the moment, i, I don’t, I don’t have anybody around me. And we’re like, well, I’m already up to my neck in helping people. Like I’m, I need time.

[00:43:37] Richard: Uh, I appreciate the challenge. There is some evidence to show that, hence it’s the, um, what is it, the five ways to mental wellbeing that the, um, the NHS, talks about or the, the government or whatever. Helping other people is one of the waste of mental wellbeing. You know, most people, I agree, you could take it to extremes and there probably are some people out there. I suspect they’re in the minority, but there are probably are some people out there who could do with cutting back a bit. But helping other people improve your own wellbeing and your sense of connectedness.

[00:44:06] And also it’s a two-way street, isn’t it? So hopefully if you’ve got good relationships that you’ve nurtured, sometimes you’ll be helping others and sometimes they’ll be helping you. And you, you asking other people and being open about when you are struggling, invites other people to, to be honest about that themselves. And when they help you, they’re also help. So I would argue that it’s, it’s not as bad as it sounds and generally speaking, most people probably end up better connected for it.

[00:44:32] Rachel: I, I totally agree. It’s interesting when, when we do our training around wellbeing and yes, we, we do use those, those five ways to wellbeing and giving is definitely one of the ways to wellbeing. But we get people to rate their, their connections and we say, you know what, what, what connections that you have that really re-energize you? And, and then try and see those people as much as possible or basically have a strategy for how you’re gonna see people.

[00:44:54] And then people are like, well, uh, if, does that mean that people that don’t reenergize me, I, I just dump? We’re like, no, not at all. You don’t do that, but what you do is you move that from your connection bucket into your giving bucket. Because actually if, if there’s someone that really drains me that I, I find it, I find, you know, I, I might like seeing them, but actually I feel net energy negative after I’ve been with them, then actually, if I, if I look on it as my interaction with them, and this sounds really sort of holier than thou or whatever, but for the, maybe for some period of time, maybe someone’s going through some really difficult stuff and it’s really difficult to spend time with them ’cause you feel really drained and it’s really difficult. But you look on, that’s my giving time, that’s my giving to that person. And it’s in a completely different bucket. And I make sure that I go and have the connections with the people who at the moment really re-energize me, then that will, that will balance it out. And it just, for me, that has really helped me not get so resentful.

[00:45:51] So say if I’ve been out for an evening with someone that, that I have found quite draining. If I’ve been thinking, oh, this is gonna be a really lovely evening, and I, you know, and then I come back feeling awful, then you just get resentful. But if you think, actually this is an evening where I’m really gonna give of myself to that person ’cause they need it, and then you come and you feel, well I’ve, I’ve, I’ve done the job and that makes me feel good. So it’s bizarre. It’s, it’s about expectations really is, isn’t it?

[00:46:15] And, and I guess there’s something about managing your energy and actually identifying which connections you have that are deep and really energy giving, and which are not, and, uh, which are actually very draining. I, I have heard this, I think actually we did a podcast on this, on VDPs, VNPs, and VIPs. Have you heard of those?

[00:46:36] Richard: I, I remember listening to that episode, but I can’t remember what they all stood for.

[00:46:40] Rachel: Very important people. So those are the people that really, really, uh, give into you. And the problem with VIPs is they’re not that needy. So you could go for ages without seeing them, but you love seeing each other. It’s like the, that, it’s like just get a regular routine of, of, of seeing them and meeting up, even if it’s just once a year, like, like your young practitioner group.

[00:46:57] Then you’ve got your, so this was the interesting thing to me. You’ve got very nice people and very draining people. And the thing about very nice people is there’s like those people you’re talking about with a lot of banter. They’re really nice, and it’s quite pleasant talking to them, but you don’t get re-energized by spending a lot of time with them. And, and the problem is we can surround ourselves with just very nice people who it’s pleasant to be with, but we think, well, why, why am I feeling not so energized? Why am I feeling that I don’t have deep connections? Well, actually, too many V NPS in your life, very nice people, actually is net energy zero.

[00:47:32] Now, before I get any further, I wanna say that I can imagine. I’m a VIP for some people, I’m a VNP for some people, I’m a VDP for other people as well. So I’m not trying to say there’s one category of people. You can be different things to different people, most definitely, before anyone just thinks I look, I’m, you know, I’ve got too high an opinion of myself, but you need to know who those people are.

[00:47:55] And I think we haven’t, we don’t actually spend the time thinking who are those people that I really need to see regularly and who are those people that I’m going to be seeing? But that’s my giving. And who are the people that actually, it’s nice to see, but I don’t need to overload myself with seeing them all the time.

[00:48:09] Richard: I think that’s a really good way of describing it. And, and it’s a bit like that, the surgery, you know, um, as we don’t all live in each other’s pockets as partners. Some of us, we have a little meeting once or twice a week. Um, at the end of the day we call it the Parkbury Arms. We don’t go to the pub, we sit upstairs and chat in the, in the stuff room. And some of those people I see outside of work occasionally, um, other people, just a relationship at work, but it’s still a very positive one. Um, so, so you’re right. Yeah. We’re all different. Uh, we’re all VIPs or VIPs or BDPs out at different times in our lives.

[00:48:41] And I suppose all I would say is it’s give and take is good. So I can think in our lives where we’ve very much been taking, where we’ve been in receipt of kindness from other people who’ve really helped us at a very difficult time in our lives, uh, when we needed a lot of support. And in return, some of those very same people have been helped by us when, when the, when the time comes.

[00:49:01] I would just ask the question, if you’ve got a friend that you’ve never, ever been helped a friend, a, a connection that you’ve never, ever been helped by and is constantly draining, and you’re not quite sure about the, the point of that relationship, um, I think, you know, it’s good to give, but you might just have to consider, you know, whether, if you’ve got a finite amount of energy to spend, you know, should you be spending it on them? Because sometimes people might need to learn from their behavior and the consequences for it and, you know, it might help ’em to smarten up their and to be a better friend possibly.

[00:49:30] Rachel: Yeah. And, and also you can’t be friends with everybody. And you’ll getting better with some people than others. I, I was thinking earlier when you said that the most lonely people are the 16 to 24 year olds and actually often much less lonely than the sort of 70 to 80 year olds. And I think it’s because when you are 70 plus, the evidence is, I think I’ve read it somewhere, you’re really careful about who you spend your time with. ‘Cause you’re Like, well, I’ve probably not got that many years left on this planet. Like, I’m not gonna spend them with people I don’t like or, you know, bore me or whatever. Like, you have a much smaller group of friends, but boy, do you like them.

[00:50:05] Richard: Yeah, I get that. I think also you’ve, you’ve seen more of life. You’re more, you, you are more certain about what life’s all about. You’ve probably got a lot of connections ’cause you’ve got maybe children, maybe grandchildren, difficult when you’re, when you’re younger for the reasons we talked about.

[00:50:16] Rachel: Yeah, Richard, but we are nearly out of time. I do want to ask you if I can imagine there lot will be lots of people listening to this, I think actually I am quite lonely at the moment. I’ve got an incredibly busy job, an incredibly stressful job. I have very little time. I’ve got family, blah, blah, blah. I am feeling really lonely, where would people go? What should people do and how can they find some more of those deep connections that will really make them feel a lot better?

[00:50:43] Richard: I think we should remember that in reality, no person is in Ireland and that we, no one truly flourishes by themselves. So however little time people think they’ve got, it’s like saying, I don’t have time to eat properly, I don’t have time to sleep properly, I don’t have time to have, you know, meaningful friendships. That that won’t work ultimately, things will fall apart if that’s the case. So it is definitely worth prioritizing. Um, and we’ve talked about how it could be worse than even having certain illnesses.

[00:51:08] It’s like when we talked about purpose on the previous episode, it’s giving yourself the time. Start with giving yourself the time to think about, okay, where am I? I’m gonna give myself half an hour today just to think about this. Um, where are the gaps in my life? You know, do I feel well supported? Is it at work? Is it amongst my friends? Is it amongst my, my family? Are, are there some relationships that need repairing there? if those resources are available to me, I’ll, I’ll work on that. I’ll work on developing those, those friendships.

[00:51:35] I’m not saying you, you go out to people and you say, would you like to be friends with me? But, but, but in reality, so think about it, when would somebody being friendly to you, showing an interest in you, having a chat with you and inviting you to socialize with them, would that ever be offensive, as long as they’re doing it nicely? You know, you, you can still make friends at any stage of your life, however difficult things might be right now, whether you’re in your twenties or your seventies, you can still make friends, even new best friends. So, so it’s definitely possible.

[00:52:01] And if you, if you are in a difficult situation where maybe you don’t have family around you or you live by yourself, think about, and this is really what we’d say to patients as well, isn’t it? Think about the connections that you could forge. Think about the community where you live. Is there a community group in your block of flats? Is there a walking group nearby you or a running group you could go to? Park run and make friends in the cafe afterwards. Um, do you have a hobby that you would like to either take up or, uh, rediscover? You know, whether it’s cycling, archery, painting, whatever. Um, because all of those things come with ready-made groups, and then you can figure out, um, what you wanna do.

[00:52:38] If you’re medical, you know, are you in a first five group, uh, as a younger doctor? And if you never got the chance to join one, you know, look, look around your surgery, look around your peers. Are the people who’d like to join a group with you? And just start by saying, you know, why don’t we do a, I feel, I feel really boring saying this, you know, why don’t we start a journal club? Okay. I probably wouldn’t say that. I’d probably say, do you wanna go to the pub? But, you know, whatever, whatever works, whatever works for you. So those are all things that I would, I would think about.

[00:53:04] And, and also, you know, if you do have a faith, uh, maybe it’s something you might have drifted away from or you’re not actively practicing, but you know, that’s something that you could re-explore as well. Um, and people can be lonely even in a church setting, so it may be a question of looking at the groups within those faith groups, groups within groups that you could perhaps connect with. Um, so those are the sorts of things that I would suggest.

[00:53:26] I, I think because people are made to connect, you will, you will hopefully be pleasantly surprised even if you’re worried that putting yourself out there does usually result in a bit of reciprocity, and then chance for you to decide which relationships you’d like to pursue. And maybe look for people who are not just the same as you. You talked about the people who are nice. I don’t mean horrible people, but do you want friends that challenge you? Do you want friends who’ve got a slightly different perspective? You know, if you, if you know you’ve got a bunch of middle class, highly educated overachieving commuters as your friends, you know, may who work in the city, you know, maybe you should be looking to have a slightly more diverse group of friends to make your life a bit richer and, and whose lives you could enrich as well.

[00:54:08] Rachel: Yeah. Side note, I did read recently that you will become in character most like the, I think three or four people you spend the most time with. Which is quite worrying when you think about some people, you know, if you, literally, the only people spend time with are the, the, the four toxic people at work.

[00:54:26] Um, and I think, you know, if you are feeling stuck then you can do no worse than actually just go and serve, like they said, help out an park, run, volunteer at the food bank, go and do something. And when people say, I haven’t got time, well it’s, you do have the time. It’s what are you going to prioritize in, in your life.

[00:54:42] And something that I’ve noticed in my own life is that it’s really good to do something regularly. It’s very hard to build up relationships when you only see somebody, particularly, it’s fine if there’s somebody that you’ve known for 20 years and you can just catch up with old friends. That is very different. But yeah, I do a regular circuit class and it’s become, you know, with some mates that I’ve known for 20 years, that’s wonderful. But there’s some people that I didn’t know before and actually they feel like really good friends and I’ve just from sheer regularity of seeing them so they know what go, what’s going on in my life. So there is something about just persistence and habit and just being there and being known, I guess.

[00:55:19] Richard: A, absolutely. And I would add to that all great points. I would add to that, um, the, the fact that when you join a group and you meet people, then they, they become people who can hold you accountable as as well, aren’t they? So, so they notice when you’re not there and they, they give you a call or a message and check that you’re okay. And you turn up because even though you don’t really feel like it of going running this morning ’cause it’s one degree and raining, um, you know, that other people are counting on you or looking forward to seeing you. Um, and that could be really helpful as well. Mo most things that you want to change in life when it comes to behavioral psychology, you’re always gonna do best if you socialize it and you do it in a group.

[00:55:55] Rachel: Right. So Richard, what are your three top tips for people if, if you were pushed on your three top tips?

[00:56:01] Richard: So my top tips would be, remember that we need to be in some kind of tribe to thrive, um, however big or small that tribe may be. And although much you don’t think that’s true, it is for pretty much all of us, uh, so no one is really an exception to that.

[00:56:19] Um, take loneliness seriously because it can be worse for you than than many diseases and can shorten your life and, and make it less happy as well. So when it comes to you talking to your patients, think about that. And when it comes to yourself and the people that you are, your friends and family and loved ones and colleagues, and just bear that in mind as well, be, be, be looking for it.

[00:56:40] Um, remember the three Ls of loneliness Look. Listen, lend a hand. and that’s, that’s three, isn’t it? I think.

[00:56:47] Rachel: You say we need to, in a tribe to thrive. Is it okay for your tribe to be your work, or is it better to have another tribe outside of work?

[00:56:55] Richard: I think there probably isn’t a hard and fast answer to that. The only risk of having all your tribe in one place is that if you then get disconnected from that, say family separation, leaving your work of leaving your place of employment, you’ve suddenly lost your tribe. So when I say a tribe, my tribe’s made up of different people from different parts of life so that it doesn’t fall over if I suddenly move on from one place to another.

[00:57:20] Um, so it’s probably better to have, it’s like, um, almost like a spider’s web, isn’t it? The more connections you’ve got, the less likely you are if one or two of them are severed for you to then sort of fall out of the sky. Um, so maybe not put all your eggs in one basket.

[00:57:33] Rachel: Thank you. That’s, that’s helpful. Yeah. My top tips. So I think number one, habit and presence builds relationship. You know, just seeing people regularly, um, can build those connections. And, and really we need to be planning our deep connections. Just don’t expect them to ra to arise just ’cause they are. If, if they are, then brilliant, but you cannot expect that particularly to get older and busier, I think.

[00:57:54] And, uh, yeah, identify who your VIPs, your VNPs and your VBPs are, and you know, try and get the right balance. And the VDPs, put them in the bucket of giving, so the people that really drain you just look upon your interaction as something a little bit, a little bit different.

[00:58:09] Richard: That’s good. I’m going to take that one away.

[00:58:11] Rachel: You do, you do. So Richard, um, where can people get hold of you and find you if they want to find out more? And, and where Yeah. Obviously we’ll put the Ted talk in the show notes. Um, but yeah, where can they get a hold of you?

[00:58:23] Richard: So, uh, all the usual social media things. I’m at Dr. Richard Pile on LinkedIn, and Dr. Richard Pile on Twitter. Uh, my website’s called, uh, feelgoodforlife.uk, and you can find my TED Talk on YouTube. Oh, and my, my book Fit for Purpose is, is, uh, linked to from the, uh, website as well, and you can find it on Amazon and all reputable bookstores.

[00:58:46] Rachel: And I was also gonna say, if anybody wants to have a real think about their wellbeing, what we will do is put a link in the show notes to a toolkit that you can download. So I’ve got a Dials dashboard, wellbeing dials, which contain the five ways to wellbeing. So, uh, giving, learning, being active, uh, eating well and noticing, those are the five plus another three. And you can actually rate yourself and then and think about it. So that’s quite helpful. So, and there’s some resources with that. So we’ll put that in that link in the show notes. You can sign up and get that free download. And, um, just remain to say thank you so much for being with us, Richard. It’s just been wonderful and we’ll obviously have you back another time when you have your next take talk right.

[00:59:26] Richard: Yeah, it might be a while till I do that again. That’s hard work. But Rachel, thank you very much again for the privilege of of coming on the podcast. It’s great.

[00:59:36] Rachel: Thanks for listening. Don’t forget, we provide a self coaching CPD workbook for every episode. You can sign up for it via the link in the show notes. And if this episode was helpful, then please share it with a friend. Get in touch with any comments or suggestions at hello@youarenotafrog.com. I love to hear from you. And finally, if you’re enjoying the podcast, please rate it and leave a review wherever you’re listening. It really helps. Bye for now.