How to Keep Going in a Struggling System

[00:00:00] Rachel: How do we go about crafting a sustainable career that we love? One that brings real happiness and fulfillment based on following our core values and the things that are really important to us?

[00:00:11] This week, I’ve got something a bit different for you. Back in March, I ran a session at the faculty of medical leadership and management conference in Manchester. I was joined by Dr. Sarah Coope who you might remember from previous podcasts, We did a special You Are Not a Frog live recording session, where we talked about how to craft your career and we took some questions from the audience. Now it’s all very well and good talking about happiness, but how can we possibly thrive, not just survive in a system that’s overstretched and where our colleagues are exhausted?

[00:00:43] 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

[00:00:56] Dr. Sarah Coope has had many different roles, including head of case advice at NHS Resolution. She’s also been a GP and her focus has shifted towards training, coaching, and mentoring. She helps with the underlying causes of stress in health care. So we kicked off our session with the question who believes we’re working with a dwindling and exhausted workforce?

[00:01:19] Sarah: So maybe just have a show of hands. Who here feels that? The answer is yes, the workforce is dwindling and exhausted? Let’s get a show of hands.

[00:01:27] Rachel: Okay, so I think probably 80, 80%?

[00:01:29] Sarah: Yeah, probably. And I guess if I was gonna ask you, what makes you say that you’d probably have some different reasons, but also some similar reasons and some common themes. Some of you who maybe don’t see that, it’d be interesting to know, you know, what’s your experience and, and what are you seeing that’s different or, or what are you seeing that means that that’s not happening?

[00:01:46] I think from my own experience, so as I said, I’m working at NHS Resolution now, and in the practitioner performance advice, um, department where the team of advisors advise organizations where doctors are, underperforming or there’s performance concerns. And the biggest reason for that is often behavioral issues. So there’s often stress behind that, um, exhaustion behind that. We know that burnout is at a, at a real high, so we can see that, that then can feed into performance issues, um, performance concerns as well.

[00:02:15] So, yeah, and from experience working in primary care, um, and at CCG level as well, just seeing that across, across the board. Um, so I don’t think it’s totally exhausted and dwindling. There are pockets and there’s maybe experience where it’s not, but I can certainly certainly see some of the, the reasons behind asking that question.

[00:02:32] Rachel: I guess the problem is that I see, and I’m sure you guys experience that when people get exhausted and burnout, performance goes down, then the performance of the whole team goes down, and then you get sort of the organizational stress, the stress cascade that goes to everyone else, which leads to other people then leaving or going off sick themselves, meaning more work for the workforce that’s already there. So it becomes this really nasty, vicious cycle of sort of, everybody then become burnt out and overloaded with work.

[00:02:58] And so the question is, is it possible to work sustainably and have a sustainable career in the difficult system that we work in? And I do always start off any sort of sessions I do by talking or just flagging up the fact that the system is, I think, quite broken at the moment, there’s a lot of stress in the system. And if we feel responsible for that system, you know, that is a very difficult place to be.

[00:03:23] And you know, luckily there are amazing leaders at the FMLM, you know that being a real beacon of that who are working to change the system. But we can only change a tiny part of the system that we are in, can’t we? We can’t change everything. And so, if we are then choosing to stay working in a, in a difficult stress system, there are things that we can do.

[00:03:43] People often get quite exercised and quite upset when we say, well, actually it is about stuff that you do. ’cause they say, well, that’s resilience victim blaming, that’s blaming us for being stressed, work in the system. I just want to acknowledge that, that school of thought, this is in no way resilience victim blaming, but it’s just saying actually, if you are gonna work sustainably, you need to take personal responsibility for that ’cause nobody else is going to, right? And so there are things that you can do yourself. This is not, this is not resilience, victim blaming. I think that’s really important to say at the outset, because otherwise just people feel even more demoralized, don’t they?

[00:04:15] And I’d love to know from you guys if you have any thoughts as well. So just stick hands up or, um, or submit a question. I, I think first may be, is there anybody that feels that they are thriving right now, or they feel that they, they have a element of thriving in, in their work? So we’ve got some hands up in the room. That’s great.

[00:04:32] So the answer is yes, right? It is possible. ’cause there are people that are thriving, okay? So it is possible. That’s good. So we, we’ve answered that question. The thing is then how, the thing is how. And if anyone who stuck their hand up are happy to share some of their, their thoughts about how to do that, that would be really great. But Sarah, from, from what you’ve seen in your work and, and as a coach as well, what is the solution, the, the people that that, that are managing to thrive, what have you seen them putting in place that means that they’re able to do that?

[00:05:03] Sarah: I’m just gonna go back a couple of steps. I think, I think the key word in the question that was posed for us to, um, address today, the podcast is craft. Um, and I think that word, you know, how can we craft? That goes back to what Rachel was saying about, you know, what’s, what’s the bits that are within our control, despite all the other stuff going on in the system? So that’s one thing just to focus on that might be part of the solution.

[00:05:26] I think also just touching on a bit more about the problem, look what might make it difficult to craft a sustainable career. So what are the sorts of things that might stop us from being able to do that? Some of that’s external things, but as Rachel said, we recognize those things. But then we can spend a lot of energy on those things and kind of feeling how sort of limited we might be by stuff externally.

[00:05:48] And then, so then it’s thinking, is it what’s within myself that might be stopping me crafting that sustainable career? Um, you know, what, what is it about the way that maybe I am not setting boundaries or choose what the choices that I’m making that maybe are getting in the way of me crafting this.

[00:06:03] So those of you who feel like you have been able to craft a sustainable career, I guess that’s where we wanna come to. What is it that you have done, that you have chosen? What have you consciously, intentionally done that’s made that possible? And I think that’s where it’s really helpful to think about and look at, isn’t it? To see, so I guess one part of the solution, and there’s lots of different ways of looking that at that I think is going back to. What is within our own control?

[00:06:28] And some of that is recognizing, I think, what are our limits. Um, so we don’t always like that sense of, you know, thinking what our limits are. But if you think about it, we’ve all got limited amount of time. None of us have got more than 24 hours in in the day, and there’s quite a lot of evidence that shows that if even if we had more time, we probably would do more of the same.

[00:06:46] So one of the things that we need to accept is we have a limited amount of time. We also have a limited amount of energy. So obviously if work’s exhausting, if family life can be exhausting, work, um, outside work can be exhausting. That can drain our energy. But there’s also things that can increase our energy, aren’t there? So just thinking about, um, how much energy we have and in what way. That’s either a limit or something that we can actually change and we’ll come back to that.

[00:07:10] And the other thing is, um, that’s limited for each of us is our retention. So we can only put our attention on probably one thing at once. Whether we’re working as a leader, it might be that person in front of us that we need to, um, to speak with. It might be, um, the team, it might be, um, other external stakeholders. Whatever it is, it’s about where do we put our attention? Um, and then money is the other thing that for most of us, is a, is a limit.

[00:07:32] So I sometimes talk about having a square with the word. With the word team, so TEAM, around the edges. And maybe if you’ve got a bit of paper or just in your mind, you can visualize a square. Just thinking about that and thinking, um, what size do you feel your square is right now? Like, where do you feel, how, how, how much time, energy, attention, and money do you feel you have right now?

[00:07:54] Because different seasons of life, you can have that sense of certain things are limited. If you’ve got young children, often your time and energy can feel quite limited. Other times in life you can feel you have a bit more. And so there’s something about being really aware of, of that kind of square.

[00:08:08] And then recognizing what do you currently fill your square with? What do you put into your life really that actually within your limits of time, energy, attention, and money, within your career and also outside of your career, what do you put in that? Because that’s the thing, those are the things that use those different limits, aren’t they? Those different resources.

[00:08:28] And so thinking about that’s your capacity. So we’ve all got different amounts of capacity, as I said, at different times and depending on the demands of, of the job and other things. So this was just a helpful way for, for me and some of the people I’ve coached with, to, um, to think about, okay, what do you actually intentionally put in that square and choose to spend your time, your energy, attention, and your money on? And what do you feel that you’ve actually allowed in there because you’ve just allowed that to happen, that is draining your time, your energy, attention, and money in a, in a way that isn’t life giving or isn’t sustainable for you?

[00:09:00] Rachel: Well, I guess I’m reflecting for myself that I don’t often wake up in the morning going, how am I gonna manage my quota of energy this morning? You know? Does anyone actually do that? Look and say, I’ve got a limited amount of energy. What am I gonna spend that on every morning? Anyone consciously manages that every day? A couple of nods.

[00:09:16] Sarah: Can I just ask a question at that point? If you were just to check in with yourself right now and just ask yourself how much energy on a scale from zero to 10, you don’t have to answer this, you know out loud, but how much energy do you feel you have right now? If 10 was like maximum energy, zero was absolutely evil. Hopefully you’ve got at least one outta 10. Do you have a sense of that. And then if I was to ask you, what’s the quality of that energy from zero to 10? It’s a question we don’t often ask ourselves.

[00:09:40] So you could have a really high level of energy like 8, 9, 10, but the quality is low because, I dunno about you, but if I’m angry, that’s high energy, isn’t it? But for me, that’s a low quality energy. So a high number doesn’t necessarily mean that’s, that’s what you’re wanting, but you want high energy, high quality as well, don’t you? Whereas you could have, um, you know, you could have peace, which I suppose is a low in energy, isn’t it? Peace. We’re peaceful. We’re actually low in our energy, but it’s a high quality.

[00:10:10] And so that’s a good question, just to check in with yourselves at certain times and just recognize, you know, how much energy do you have right now? What’s the quality of that energy? And then goes back to, you know, where do you wanna spend that?

[00:10:19] Rachel: I’m reminded of, we did a podcast with, um, Dr. Maddy du Mont, who is a, a former GP who had long covid and she said she never, ever managed her energy before until she got long covid. And now because she knows she only has a certain quota, so she, you have four gas burners of energy and she only knows she’s got two gas burners now. And she consciously manages that. ’cause she knows she wants to spend the majority on that, the things that are most important to her, her family with, you know, young children, et cetera.

[00:10:47] But I think when we don’t curate our own energy very well, do we? Because we just feel that it is, that it is unlimited. So that is one of the things that’s really important. And going back to the gas burner analogy, I have heard it said that, you know, I’ve heard someone say, well, you, you’ve, you’ve got four gas burners in life, or whether the family, your sort of work, your social life and your hobbies and, and you can label them however you want. And someone once said to me, but you’ve only got enough energy for three of those gas burners. So you’ve got to make your choice.

[00:11:17] Now, I don’t, I don’t particularly like that. Would, would you agree that to have a sustainable, good career, successful career in healthcare, you can only have three earners out of four?

[00:11:29] Sarah: No, I, and I dunno what other people think, but I, I think we need balance, don’t we? So. Whatever is about working out what are the things that we need both inside and and outside. And I don’t really like the phrase work life balance, ’cause for me, work is part of life. So it’s sort of inside work, outside work, and there’s that integration as well.

[00:11:46] What are the things outside of working inside work that we need that will actually increase our energy overall? So one thing I sometimes think about is if I’m feeling low in energy and tired, what kind of tired is that? What kind of energy is low? Is it physical energy, emotional energy, mental energy, spiritual energy?

[00:12:01] Because what you do to restore that will depends on where your energy is low. And the better attuned we can get to ourselves in terms of what needs to happen to restore that, again, the more we can manage our capacity and start to craft that sustainable career.

[00:12:15] ‘Cause if we think of what does sustainable, if you’re gonna ask yourself, what would it look like for you to have a sustainable career? So just imagining that you, I dunno, fast forward six months time, that your career was what you would call sustainable and you’d crafted that even further in time. How would you know? What would that look like for you? Because for each of us, that’s that term, sustainable career might mean different things.

[00:12:39] Rachel: That’s a great question. Like what does, what does good look like for you? So, I dunno about you. When I first started, I had no idea what, what good, what good looks like.

[00:12:47] I just wanna quickly throw that there’s open to people. I noticed someone’s, someone’s got a mic there. I’d love to know how you guys manage your energy or if there’s any thoughts about how you could, but yes,

[00:12:57] Louis: Hi. Good morning everybody. Morning. I’m Lois Brand from Oxford. Um, I really resonate with everything that you’re saying. Um, about two years ago I stepped away from my clinical role in the emergency department in Oxford, um, uh, to take a sabbatical to look at career longevity in.

[00:13:12] Rachel: Great.

[00:13:12] Louis: In medics, um, because it was a personal problem for me. The system didn’t support a multi-stage career and development, um, within that recognition of how we change physiologically as we age and psychologically as well. And uh, I’ve run a series of workshops in Oxfordshire, ten of them now, for senior clinicians. And one of the things that really comes out very strongly indeed is how I’m sure we were all aware of Stephen Covey’s four quadrants. You are sort of talking around that, around the, the doing without thinking. I think most clinicians, because of the strain of the system, spend a lot of time in quadrant one, urgent and important, and are de-skilled at getting into quadrant two.

[00:13:53] The other thing that comes out really strongly from the delegates that come to my workshops is that they mostly love their careers, and they feel a sense of loss and grief when they think that they might not be able to sustain them. And actually with making very small changes and encouraging brave conversations, um, the long-term feedback is that this is in this tiny intervention is, one day, is really, really successful in helping people stay.

[00:14:20] So I think we’ve got to move away from expecting the system to change fast enough, and we’ve got to, to really encourage people to take control of, of what they do and step into quadrant two. Zoom out, take time to think.

[00:14:33] Sarah: That’s really helpful. I, I really like the phrase that you used there, the career longevity. And I think for me, that that resonates. You know, how for it to be sustainable, we’re hoping then that we’ll have that career longevity. Um, and, and just recognizing the prioritization grid that you’ve referred to, the different quadrants. If people haven’t come across that before, you teach on that as well. And I think that’s really important isn’t to look at.

[00:14:55] And I think what’s important, we need to each ask ourselves what’s important to us right now? And I think that’s what I was talking about in that capacity. What, what isn’t really important to us right now to, and those small changes that can make the bigger difference.

[00:15:06] Rachel: Yeah. I, we, we do notice people, and I’m so glad you brought that, being in what we call the urgency trap. So Q1 is when you’re stuck doing stuff that’s urgent and important all the time. And the problem is when you get in the urgency trap, you’re, you’re ticking off the things urgent and important and like in healthcare, there’s a lot of stuff that’s really urgent and important and, and lot of stuff that’s really important, but when we get stuck there in that sort of high adrenaline zone, it’s quite easy to drop below the line of discernment into doing stuff that’s urgent, but not important, or not important to us. It might be important to somebody else, but it’s not important to us in terms of driving ourselves forward to our important goals and things that we want in life.

[00:15:44] Now, what you were talking about is going into quadrant two. Quadrant two is the quadrant. So if you drew, drew an urgent important grid one, you’ve got two columns. One is urgent, one is non-urgent, and then the two rows, the top row is important, the bottom row is not important, and then you just sort of fill in where, where your tasks are.

[00:16:01] Quadrant two is the stuff that is not urgent, but is really important. And I think as leaders and almost the more senior you get, you should be spending more and more time in quadrant two because that is where change occurs. That’s things like team development, that’s looking at strategy, that’s looking at planning, that’s looking at personal development, CPD, developing workflows, developing processes. And for that, you need to have thinking time. And if anyone’s read anything by Cal Newport, brilliant guys wrote Deep Work. Like your job as a leader is pretty much to do the thinking so that you can then do the leading.

[00:16:36] But if you’re in quadrant one, in that urgency trap the whole time, just do it really badly. It feels really, really stressful, and you do feel very guilty if you stop and do that thinking time. That is the problem. But long term, if you never do that quadrant two work, you’ll just probably end up burning out and you’ll cascade the stress onto the rest of your team.

[00:16:56] Sarah: I’ll just make a comment on that. I think going, going in the urgency trap, so from the urgent and important to the um, stuff that’s urgent but not important. So other people’s stuff, that’s what drains our energy a lot of the time, isn’t it? And then means that we haven’t got the energy to put into that, um.

[00:17:10] Rachel: Or when we’re so exhausted, what’s difficult is being able to tell the difference between what’s important and not, not important. Yeah. Oh, and then Penny. So gentleman in the back, and then Penny.

[00:17:17] Abraham: Okay. Thank you so much. Um, my name is Abraham Marwa. I’m a GP trainee. I’m just wondering about the prac practicality of moving from qua, uh, like quadrant one to quadrant two. As a GP trainee or as a trainee in general, um, I’m faced with like the flood hose of, uh, tasks and stuff that needs to be done, uh, which basically leaves little time for quadrant two thinking the contemplating, um, thinking of lung longevity, what are your thoughts about that?

[00:17:49] Rachel: It’s hard. It’s really hard. And then to meet some difficult choices. That’s the problem. That’s where boundaries come in, because yeah, you could fill your entire day doing urgent important stuff, but in order to get to do the stuff that is really important, but not, not becoming as urgent, you will be prioritizing that stuff. And what does prioritizing mean? Prioritizing means that I’ve chosen what I’m gonna say yes to, but that also means that I have also chosen stuff I’m going to say no to. And that is where we really struggle, I think, as leaders in healthcare or just work in healthcare full stop. Because when we say no to stuff, there is a consequence. And we often don’t like that, that those consequences.

[00:18:32] And people always say, well, I can’t say no ’cause what about the patients? It’s gonna cause patient harm, but we’ll be talking about this in the session later. Very rarely does it actually cause patient harm. And if it does cause patient harm, you do it. It’s, it’s a no brainer. You, you don’t, you don’t say no to the stuff that that causes real difficulties. But often we’re saying yes to stuff because we are worried about what other people might think or it’s a bit inconvenient for other people, or people aren’t getting what they immediately want or need. And so they might, you might get a reaction, they might be angry with you or it might be career limiting.

[00:19:03] Like, you get opportunities in, in medicine, in your career all the time to take on different roles, to do different things. And I dunno about you, but I’m the sort of person goes, yes, I would love to do that, I’d love to do that and have fomo. But those opportunities will come at other times, and it’s important to have the time and space to be able to say yes to the ones that you really want to do. And that does include saying no. And then when you say no to stuff, unfortunately people don’t like it, I hate to tell you, you’ve probably experienced that already. People don’t like it.

[00:19:33] Does that mean our boundaries crumble and we just do it? Well, yes, it probably does for most of us. But that shouldn’t be the case, should it? It should be the case that we can actually tolerate. The discomfort of people not liking those decisions that we’ve made. And for me, the, the whole thing about my work is the sustainable is to be able to tolerate the discomfort of not being able to please everybody all the time.

[00:19:56] That, that is, that is tricky. But thank you. That’s a really, you can only work that out for yourself, by the way. What, what from, how do I get into quadrant two? And there is something about managing your time a bit better I think. There are some productivity hacks like managing your, like Sarah, we’re talking about managing your attention. How am I gonna actually plan what I do today? Um, and all that sort of stuff. Penny.

[00:20:18] Penny: Uh, Penny Newman. Um, former gp, medical director. Lots of other things now. Full-time coach. Um, so it is a really, really helpful discussion and I’m really interested in this sort of, this issue around, is it, you know, what can I do that’s in my control? But also the subconscious things that are going on.

[00:20:39] Sarah: Mm-Hmm.

[00:20:39] Penny: Um, and I wonder if you can speak a little bit to the, um, false beliefs that we might hold that drive our behavior? Um, because I think if we know ourselves a bit better, and we’re probably a bit more self-compassionate, we’re kinder to ourselves, then the whole thing becomes a little bit easier. If we value ourselves a little bit more, um, and that rebalancing of, actually I’m important too, um, but these false beliefs that drive our behavior, that lead us to over striving, because we’re all, as medical leaders, very high achievers, we are passionate about patients, but passion is a double edged sword. And once you get into that negative spiral of expending too much energy, burnout is insidious. You start, um, you know, feeling overwhelmed. It’s difficult then to step out, and that’s very, very brave of, um, the, the former, sorry, from Oxford, saying she actually took time off. I think fire breaks are amazingly important to know when you’re actually at your limit and you can’t carry on. And most of us don’t know that.

[00:21:43] So this over striving can send you down to this negative place of really not coping. Um, so what are the, what are the underlying beliefs that drive that? And how do we know when we’re in that place where we need to stop?

[00:21:57] Rachel: Such an important question. I’m just gonna ask you guys a question. Hands up. If you’ve ever thought to yourself, if I don’t do this, no one’s gonna do it. I need to do it. Because no, if I, you know. We all have, haven’t we? And that is the problem in medicine. Uh, well, I think in any high stress, high stakes job, if you’re in leadership, uh, in a professional role, we should on ourselves all the time. I should do this. I should. I ought to. I ought to. I have to. I have to. And then we just feel this shame and guilt if we, if we can’t do it, or shame and guilt if we choose not to do it. Because actually there’s something in Q2 that we need to focus on far more. And so it is so important to get the mindset right and and think differently so that we can say no, so that we can recognize we’re in that state.

[00:22:40] For me, the game Changer has been learning about the drama triangle.

[00:22:45] Sarah: Mm-Hmm.

[00:22:45] Rachel: Um, I think when we are in the rescuer role, because let’s face it, we have been trained to be rescuers. Like as doctors, we rescue everybody. And if no one else can do it, we’ve got it, we’ve gotta do it. But for me, that rescue role is one of the most dangerous things we can be in, not just for ourselves, but for other people.

[00:23:06] Sarah: So who here has heard of the drama triangle before? Most of you, but, so just to quickly say, so just picture a triangle and at the three points of the triangle, so we’ve got squares, we’ve got triangles today. Um, rescuer, victim and perpetrator or persecutor, um, are the three different points. And so if you think about, um, typical, uh, plots in films or, or in books, they’ll usually be a drama triangle that’s playing out with those three roles, sort of the role of the, of the villain, the role of the vi and the role of the, of the rescuer or the hero.

[00:23:37] And I think, um, you can see that playing out in many situations in, in leadership, in, um, in clinical work where we can take on that role, as Rachel said, often as rescuer because someone comes to us with a problem. Partly that’s our job, isn’t it? To, to solve the problem. And so we just, a knee jerk, our instant reaction is to go into rescuer mode and to fix it. Um, the problem with that is that then we are just perpetuating ourselves as that rescuer and setting ourselves up to continue to be the rescuer.

[00:24:06] I think what can often happen is what I’ve seen, and this may resonate with some of you, is perhaps in a leadership role, how easy it is as as a leader for to sort of, not to see other people as victims, but to, but to subconsciously, and this comes back to some of your things, Penny, I know this is about raising awareness, is how am I seeing other people and their problems? Am I seeing that they’re capable of solving their own problems or am I doing that well, it is just easier if I do it anyway, or if I don’t do it and no one else will?

[00:24:32] In which case, again, we’re perpetuating that rescuer mode and, and actually, I suppose not really allowing other people sometimes to learn how to solve that themselves. The other challenge is sometimes when we don’t then step in and solve it, if you think about the drama triangle, how do other people then sometimes see us? Then often as the villain.

[00:24:50] So sometimes when we, when we say no and we say no to a request or we say no to fixing something, because we’re choosing to set our boundaries, it then means that we are pushed into being seen as the persecutor. And then we can then feel like we are the victim because we are being blamed and you know, we’ve been given a hard time ’cause we haven’t fixed it and this just goes on and on, doesn’t it? Round and round.

[00:25:10] So I think it’s really helpful, again, to recognize that this can be some of the underlying patterns. So going back to your question as well, and then we’ll come back to the drama triangle. How do we become more aware of those subconscious patterns? It is taking that time to think, which is the hard thing, but I think it goes back to, yes, we have our job to do, which is the urgent, unimportant stuff. But then being conscious about, um, how do we protect and carve out some time to think so we can actually recognize where have I overstretched? So thinking about that square that I talked about earlier, I sometimes think about an elastic band going around the four corners of the TEAM and thinking, where am I stretching myself and overstretching myself? And I have overstretched myself many a time in the past and, and it doesn’t usually end well, does it in terms of there’s a snap at some level.

[00:25:54] And so it’s recognize where am I overstretching myself and what am I telling myself there’s meaning I’m stretching myself to that over that limit? Am I thinking, no, I have to do this, you know this, no one else will do it? Or am I thinking that person will be annoyed at me if I don’t? Or is there some sort of perfectionist, um, tendency, which many of us have? And then it’s about challenging ourselves? You know, who says that? Just because I feel I should doesn’t mean I have to.

[00:26:17] And I’ve been thinking a lot myself as well, like, just ’cause I could do it doesn’t mean I should. Do it. And I’ve been saying that to myself a lot recently, um, in a leadership role. You know, just because I could do it doesn’t mean I should. And, and that’s really helped me sometimes to say no to things.

[00:26:33] Rachel: For me, it really all does boil down to the drama triangle because when we’re in the rescuer role, is those thoughts I should do, I ought to, I, I have to. And that I have to, makes us feel so stuck. I, I have no choice. The reality is we always have a choice. We always have a choice. But what we don’t like is the consequences of the choices that we’re gonna make.

[00:26:54] And when we see ourselves as the rescuer, we see other people, like you said, Sarah, as the victim who haven’t got the wherewithal to sort stuff out themselves. We then keep them stuck as well. ’cause we’re constantly doing stuff and the conversations that we’re having are, oh, well I’m gonna do this. Yes, okay, I’ll sort that out for you and I’ll, I’ll do it, don’t worry. I’ll do it rather than okay, well what could you do to sort this out yourself?

[00:27:17] You know, looking at that person is actually you, you, you are capable of sorting this, this, this problem out. And actually it’s much better if they do because, you know, we can’t, with the best one in the world, sort out other people’s issues for them, particularly if it’s like a an interpersonal problem or a manage, you know, or, or a leadership problem. We can’t tell someone else exactly what to do. You know, it’s not like how do you manage migraine? Well, there’s these three different ways, blah, blah, blah, that’s a knowledge type question. But stepping out from the rescue role into much more of a coaching approach will take the, um, the, the pressure of you to always have the answers, to have to do stuff for everybody else.

[00:27:54] And by the way, once you start doing stuff for everyone else, you’ll keep going and you’ll keep going and people will keep coming to you. And the minute you then get overwhelmed at capacity, like Sarah said, you’ll, they’ll put you straight into persecutor because you can’t do it for them anymore. They won’t be thankful, they’ll just, they’ll just, they’ll just start moaning even more, which then you feel, you feel blamed, you go into victim. They’re in victim, and then what happens? It’s the race to who is the biggest victim. And we have, when we have teams in the, who is the biggest victim stage, it’s just, that’s just as disastrous.

[00:28:24] The way to step out of that is, yeah, okay. In your part, what, what am I, what, where am I in the drama here? What thing? What are my behaviors? How can I change my, I can’t change their behavior. I can’t change other people. I’m not control of other people, but what can I do differently? So taking that coaching approach. There’s a really good book called by Michael Bunge Stanier called the The Coaching Habit, just for the leaders that want to ask more coaching questions or do a coaching course.

[00:28:48] I, I think any sort of coaching courses is a fundamental skill. Coaching is a fundamental skill as a leader. ‘Cause what you’re, then you are empowering the other people to take responsibility, to take control themselves. It doesn’t mean you don’t support them and talk to ’em about doing it, but, but ultimately they do it. Their team then becomes much, much more functional and you just don’t feel that overwhelming responsibility. Because the, the evidence I’ve heard about burnout recently that really rang true for me is that the people with highest levels of burnout are the people who have really big things required of them in high stakes jobs, but have no control.

[00:29:25] And then there’s another group that don’t burn out who are in really high stakes jobs, but they have massive amounts of control so they don’t burn out. So it’s when we are taking responsibility for things that we can’t possibly be responsible for, like how happy people are in their, in our team. I can’t be responsible for that because like I’m probably responsible for what, 2% of their Happiness, right? The rest is like what’s going on for them and their lives and what their mindset is and all that sort of stuff. So the minute we can start to recognize from the drama triangle, and the way I recognize it is by catching those should statements, I should, I ought, they can’t, or they’re a bit helpless, or they are. If I start blaming other people, well if only they had done their jobs properly, I’ve gone straight into the persecutor role there. I might feel like the victim, but I’m actually the persecutor. And then I need to think, okay, what is it that, that I can do here that’s gonna gonna make a difference?

[00:30:15] And then there are all sorts of things you can, you can do with your team to actually uncover what’s really going on for everybody and think about how we can just shift all of ourselves out of the drama triangle and, and get it a bit more functional.

[00:30:27] Sarah: Yeah. So I think it is like catching ourselves or recognizing in a, in an interaction is the drama triangle playing out here? And I’ll often think about, I’m refusing to be pulled into either any of those sort of modes. And if I feel like, I’m, someone’s trying to position me into one of those, I I, it helps me to recognize that and catch that and think, okay, I’ve got a choice.

[00:30:43] So, you know, from, as Rachel said, if we find that we are being pushed into rescue mode, this, this, that person is sort of presenting, you know, with the problem, refusing to take responsibility. It’s kind of, it’s that thing of saying no and coaching and, and mentoring. Um, I think if we feel like we’ve being pushed into, into, um, per persecutor villain mode, then what would you say can be a helpful response as a leader?

[00:31:06] Rachel: Well, I think if you look at the causes of stress in the workplace, um, and we use something called the stresses hexagon, which has the different causes of stress, which is are, are people, um, do they know what their role is? They need to know what they’re actually required of them, what the relationship’s like, what’s the support like, what are the demands on them? Do they know about their career development and do they have control? So those six things tend to be the things that people get really stressed about in, in the workplace.

[00:31:32] So actually uncovering them and saying to people, saying to the team, and this has worked really well with teams that we’ve worked with, okay, let’s look at these different aspects. What is working well in this team? Let’s hear some things that are good, but what would be even better if? You know what is the problem here? Because if you give people a chance to vent and say, well, these are the problems here, and this is tough to do as a leader because you automatically start blaming yourself, by the way, when you hear all this stuff.

[00:31:55] Sarah: Or go into rescue mode.

[00:31:56] Rachel: Or go into rescue mode. But just hear them and go right, that’s so good to at least know what we’re dealing with here. What can we do about it? What is in our zone of power? What’s in our control? What’s out of our? There’s some things that are out of our zone of power that we cannot do anything about, and we just have to accept that. But there will be things.

[00:32:13] So I think as if you are in that persecutor role, going through the, have I been really clear about what I’ve expected from this person? I’m dreadful for just going, yeah, I think we need to do this. And then expecting that person to realize that I’m asking them to do it. Have I been as supportive as I could have been? Are there other things that might support and are there other people that could support? It’s not just about me.

[00:32:34] Uh, you know, so going around those things and thinking, what, what could we do? And then using some of the, these models like the, the drama triangle, like the zone of power to help people sort of just get out of that, that, that victim role.

[00:32:46] Sarah: I think that’s really helpful. I was thinking about, um, as well, sometimes what stops us from, from saying no and kind of rescuing. Um, I wrote down here just to remind myself that often we overestimate the negative impact of saying no. So in our minds, we imagine if I say no, there’d be a really bad consequence for myself. So that’s where again, we overstretch and expend our energy, time attention by trying to do it, and we underestimate the positive impact of saying no. So we overestimate the negative impact and we underestimate the positive impact. So we sort of almost think, oh, it’s not, it’s not really gonna be worth it. We don’t recognize maybe the personal growth for that other person by helping to coach them and develop them, or, or we actually maybe don’t really recognize the, the benefit for ourselves by saying no. So I think that can be quite helpful as well, just recognizing that.

[00:33:34] And then I think you were saying Penny as well, about how do we, how we, how can we be kinder to ourselves? And I think that again is about catching our inner dialogue, isn’t it? So that in order to have this sustainable career, a big part of that is around self-compassion, self-care. And I know there’s a lot of that talked about, um, in many ways. But again, what does it mean for you, like for you to have that sustainable career, um, and craft and be able to craft that? So there’s the crafting bit, which is actually putting the time and the energy into knowing what that looks like and then actually building that. But actually, you know, how do you need to treat yourself maybe in a new way?

[00:34:08] ‘ Cause we can sometimes get in the drama triangle with ourselves as well. You know, we can have that and again, that resilience, victim blaming with ourselves, you know, I should be able to do this. And so there’s all of those things where recognizing our self talk, I think, and our inner dialogue and just thinking, is this helping me to craft my, move me towards my sustain the sustainable career? Or is it move me away?

[00:34:26] Rachel: I think there are lots of shoulds and oughts when it comes to sort of long term career planning. I’d love if anyone got any good tips for actually long term. How do you plan and craft, um, you know, a career, how would you plan that long term? Just stick your hand up or come to you with the mic.

[00:34:38] I think, uh, someone said to me recently that when she was little, she, whenever she crossed the road with her mum, and there was like a gang of people on the way to school, her mum would always say to her, well, the whole group, you crossed the road as an individual. So you know, you, you are responsible for you crossing the road. Don’t look to your people and your left, to your right. You go yourself.

[00:34:58] I think one of the things that really stops us is looking around going well, in order to have a successful career, I have to do this. I have to reach this level. I have to work in this sort of hospital or practice. I have to be here, here, and here. And we look at other people and go that that’s what the measure of success is. We don’t look at ourselves and go, what would give me a happy, fulfilling life where I am working in my zone of genius, which is so important. My zone of genius is doing what you love predominantly and what you’re good at. Okay. There’s lots of things I love. I would love to be on the West End stage. Not very good at that. So I’ve chosen to do podcasting instead, you know. But are you spending 80% of your time at work doing that? Or actually you’re spending 90% of time in your, in a drudgery, doing stuff that you absolutely can’t bear? That to me is not a sustainable career, even if it is successful.

[00:35:48] Sarah: So its like really taking stock, isn’t there? Yeah.

[00:35:50] Rachel: Knowing yourself and understanding yourself. But yes. Tell us your top tips,

[00:35:54] Martin: uh, Martin Sutcliff from Leeds. craft, I think there’s a, coming to my mind, there’s a, a sort of element of planning.

[00:36:02] Sarah: Mm-Hmm.

[00:36:03] Martin: Um, I, I’m a bit like, bit like you. I, I say yes to far too much. Um, but I love saying yes. It gets me to all sorts of mischief. I dunno where I’ll be in five years time. And something that’s coming out for me. You used the word shame quite a few times so far, and that’s a really powerful emotion. I’m very privileged that I too, haven’t seen a patient much for 10 months after taking a sabbatical and then moving into a leadership role. I’m going back to a bit of clinical practice now, but we’re, through the FMLM conference. We’ve heard a lot of people stand up on stage saying I’m still a proper doctor.

[00:36:36] And there, there’s something about the culture of medicine of you get a job and you sit in it for 30 years. Um, I look around all my friends and none of them know what they’ll be doing in five years time. They might have an ambition. They wanna be a director, they want to be a CEO, they want to be a pool cleaner. Whatever they wanna do, they, they can have direction. But do any of us really know where we will actually be? I think there’s something about being willing to navigate, being willing to take the road that looks interesting.

[00:37:07] Sarah: Mm-Hmm.

[00:37:07] Martin: I, I have an analogy of surfing and I’m, I’m on this wave at the moment. It’s kind of fun. It’s going well, but that wave looks quite fun over there, so I might go try that. Um, I think crafting isn’t a planning exercise so much for me. It’s a, it’s a surfing exercise. It’s real time, it’s reflection, inaction, not a planning thing.

[00:37:26] Um, and, and my big tip for anyone that I think I’m thriving in my professional and personal life is do what seems fun at the time. Don’t feel shame for not seeing patients. ‘Cause actually, I, I have to have that self-compassion. I’m, I no longer look after 20,000 patients as a practice. I look after 7 million patients as a director. And that’s, that’s important. We need it. You talk about books, shame. Um, something that helped me a lot on shame was John Ronson’s book So You’ve Been Publicly Shamed. Um. And I always remember the big takeaway for me is I’ve not been publicly shamed. Um, so I might feel a bit of shame, but I’m not on the front of the Daily Mail. Um, it’s, it’s a different level. I can cope with that. It’s manageable and I thought that was important for me.

[00:38:10] Sarah: Yeah. Thank you. The thing that stood out from what you’ve just said there as well is that crafting doesn’t have to be planning and being really, um, sort of regimented. It can be about creating, can’t it? And just nav navigating. And I’ve thought a lot recently about just letting things unfold. But I think in order for that to then lead to the sustainable career, whatever that looks like, um, is knowing yourself, isn’t it, and knowing what’s important to you.

[00:38:32] And it goes back to some of the things we talked about around what do you wanna put in that, in that square, within the limits that you have so that you can keep. That going and actually enjoy it?

[00:38:43] Rachel: And for me, the thing that stood out there was that stuff about shame. I mean, if people been listening to the podcast, we talk about this a lot because shame happens when you are, as I understand it, when your behaviors clash with your deeply held internal values, then you feel, then you feel shame.

[00:39:01] Shame happens when you feel that I am not good enough, I am not enough. And if we. If our internal mindset is, I am only good enough if I’m seeing hundreds of patients every week, if I’m contributing in a certain way to society, if I’m rescuing people all the time, if that’s our identity, and let’s face it, a lot of our identity is wrapped up in what we do, I am. I am what I do essentially if that’s I our identity. If we then shift away from doing that, well Where’s our identity?

[00:39:31] And what if, if I’m not performing as in seeing as many patients as possible and always doing stuff, then that means maybe I am not enough. Because a lot of these Q2 activities, the importance of activities are like thinking for leadership. You know, I want a clinical director that’s spending most of their time thinking about leading the department, not most of their time seeing patients. Because they, that’s a different head space actually. So you almost need to think, where is my priority gonna be for this season in my life? And it can change.

[00:40:00] I agree. It’s really difficult to think more than five years ahead anyway, isn’t it? We dunno what we’re gonna be doing, but if we can get our identity away from this total doctor identity or total pharmacist as identity, or whatever you’ve got as your identity or sometimes total leader identity can be also just as toxic if we have it as a rescuer, and think, you know, I am okay. I’m good enough, even if I’m not working, even if I am just. Just a mum, just a wife, you know?

[00:40:29] And so there’s, I’ve been really looking at how do we then find identities apart from what we do. And I think there’s lots of different ways of doing it. There’s something about multiple identities. You know, I’m also a tennis player. I’m also, I love food and fine dining. And I love, yeah. I used to love ice skating till I break my leg, you know? What, who am I apart from what I do? And if we can find that in different ways, we can find opposite worlds that we talked about in the podcast. If, if it’s not all wrapped up in that, it becomes a lot easier. And then we can start to use this power language, rather than pain language of, I ought, I should, I have to. We can go. I am choosing to. I’m choosing to spend my time most of my time as a leader rather than on the shop floor because I’m choosing to, so that. What’s the reason? So that I can lead this department properly and actually that will be better for the patients in the long run.

[00:41:21] And then I think the thing we need tacked on at the end of our power mantra is even if. Even if my colleagues don’t understand and think badly of me, even if I sometimes doubt myself, even if my mother-in-law doesn’t approve, I don’t know. But you’ll have the, you’ll have your own even ifs. But if we know what we, we know the reason why we’re doing stuff, it can be so much more helpful. Penny.

[00:41:45] Penny: Penny Newman again. Um, can I just offer something someone told me, um, in my coach training around careers is sort of like, um, where do you want to go in your careers? Do you wanna go to, uh, Boston? Uh, do you wanna go to America? Or do you just wanna get on a boat? And I think that’s quite a useful analogy because. We have in our mind this false perception of a linear career. And certainly for women and in medicine there’s lots of opportunities.

[00:42:14] And so in medicine, I’ve been a gp, I’ve been, uh, trained in public health, director of public health. Um, I’ve been an innovation fellow and um, I was literally an organizational development director and now I’m a coach. And so I just went on a boat. However, when I look at my colleagues who are GPS or consultants for all their life, I just think, actually I’m quite jealous because I think they, over a 50 year career looking back or 40 year career, the depth and the compassion and the skills that they have. Is just phenomenal.

[00:42:47] So some people might say to me, oh, Penny, you’ve had a great adventure. Look at all your leadership roles. And I say, look at that phenomenal career that you’ve had with patients, um, how much you’ve given to them, um, the difference you made to so many lives. And I think there is a false value system in medicine about, about what is considered a good career. Um, I dunno what you think about that.

[00:43:13] And so really your point about who am I? Who do I want to become?

[00:43:18] Sarah: Yeah.

[00:43:18] Penny: What sort of doctor do I want to become? What are my values? What makes me feel good? Um, and this idea of Seligman that, um, happiness is fun. It’s being lost in work and it’s meaning and, and medicine gives so much meaning, and that’s the most important thing, having meaning in your life. So I don’t know what you say to that, but um, I think careers are complicated, but the most important thing, as you say, is knowing yourself, knowing your values, and knowing what will give you most meaning in your life and satisfaction. And this idea of, I need to get into leadership and I need to do this and I need to do that in order to feel good about myself, is actually you need to take the long term view.

[00:43:58] Rachel: I completely agree, Penny. I, I, I slightly think that rather than saying, well, Boston or New York, or the boat, actually, I’m now talking about much more about your North Star.

[00:44:08] Sarah: Yeah.

[00:44:08] Rachel: Because we, we know now that the, the great news for everybody is that we have the wrong success story in our heads. We think that hard work equals productivity equals success. But all the positive psychology research shows us that actually’s the other way round. Happiness leads to productivity, leads to success. We think success hard work leads to success, leads to Happiness. So if you are happy, you will be successful.

[00:44:36] And when I’m talking about Happiness, it’s not gonna say, oh, I’m skipping along with the fairies, or whatever it is, I think if we get these five things in our lives, if we get really good deep relationships and connections with people, and ourselves and, and upwards as well. If we feel good, like physical wellbeing and mental wellbeing, just feeling good, if we have meaning in our lives and we’re just doing stuff that actually gives us meaning now it doesn’t need to be that some massive meaning. It can just be helping somebody else, you know? And if we are learning and growing and developing, human beings always want to be learning something, otherwise you just get really bored, and then finally, if we are doing work that we enjoy and that we love, so working your zone of genius.

[00:45:15] If we are aiming towards that North star and you can put them on a flip chart and join up the points, that’s your north star, you’re heading towards there, then actually no matter what boat you are on or what, what town you end up in, who knows where you’re gonna end up? But you can actually guarantee that if you’ve got those right in your life, you’re gonna feel pretty good and be pretty happy, and then be successful at whatever you do.

[00:45:35] So I think for me, it’s actually shifting towards that particular position or that particular job at, but shifting to what if I follow that North Star no matter what job I’m doing. Because the one problem with career crafting is you take yourself with you, whatever you’re doing, so you’ll take your own mindsets with you. I can burn out just as much doing podcasts as I can do in general practice. Believe me, being there, done that seriously. So you take yourself with you, you’ve gotta change the way you think.

[00:46:01] And finally, from me and before Sarah gives us the three top tips, as leaders your job is to model this to everybody else, by the way. If you are always rescuing and never saying no, what are you telling to the rest of your workforce? Then they will follow your example and they will get to please yourself. So it’s vitally important that you get this right, not just for your own sustainable career, but for everybody else’s.

[00:46:23] Sarah: Yeah. Thank you Rachel. So just to really quickly wrap up three things. I think one is take stock. Where are you at right now? How, um, sustainable is your career? All the things we talked about around capacity and limits, tech stock. Knowing yourself, knowing what you love and what you want. And then third one, intentional choice around, whether it’s around boundaries, saying no, what do you say yes to as well? And just knowing that you always have that choice.

[00:46:47] Rachel: Thank you so much for being with us. I hope, I hope that’s been helpful. I would just say that if, if you are struggling with this, you’re not quite sure what to do, then get some coaching. I think that’s the, the, probably the best way to think about this. And there’s loads of free coaching available, particularly for, for leaders through Leadership Academy and things like that. I know FMLM provides coaching as well, so, so do that. We will, um, when the podcast comes out, we’ll also make, um, some resources available to use some handouts about the drama triangle and stuff so you can download them. So just, uh, look for the link in the show notes. But I hope you have a, a great rest of conference and thank you so much for being here today.

[00:47:19] Sarah: Thank you very much.

[00:47:24] 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.