Why Doctors Don’t Ask for Help – And How to Do it Right

[00:00:00] Rachel: it is truly pointless, everyone else has burnt out, you are not special. My manager told me we only thought we were too busy. If I go off sick, my colleagues will have to work double. Now, if any of that sounds familiar, yep, that’s direct quotes from the survey that we sent out recently. Finding out why doctors and healthcare professionals don’t seek help when they’re nearing burnout.

[00:00:22] Rachel: Now in the summer last year, I jumped out of bed and immediately fell over. I couldn’t weight bear on either of my ankles. The day before I’d been doing a charity walk. It was only 14 miles, but it was in Norfolk, and some of that walk included a three mile stretch on a shingle beach. When I got home, my ankles had swollen up, and the next morning I just couldn’t put any weight on them at all.

[00:00:47] Rachel: Now, I’ve had this all my life. My mum has the same thing with her ankles. For some reason, when I’m on my feet all day, when I’ve walked up or down a mountain, or particularly on uneven ground, I will be hobbling for the next few days. I’ve seen physios about it. I’ve seen all sorts of different people about it. No one’s had any answers for me.

[00:01:07] Rachel: But after I’d fallen over, I thought, well, this is really serious. And I was seeing a physio at the time for my back and I went to him and I said, look at these photos of my ankles. They’re actually more swollen than when I broke them ice skating the other year. He took one look and said, right, I’m sending you to a rheumatologist.

[00:01:23] Rachel: So off I trot to see a sports medicine specialist who you know, examined me. I showed him the photos and he said to me, well, you know what? At your age it’s probably because you’re just not in shape. It was my fault. I, I wasn’t in shape. I hadn’t looked after my body enough and that was the reason for it. And that’s pretty much what I’ve been told the whole of my life.

[00:01:45] Rachel: However, I knew that I’d been doing a lot of exercise. I’d been lifting some weights. Uh, I regularly cycled everywhere. I played two or three hours of tennis a week. Was it really ’cause I wasn’t in shape? But you know what? I believed him Because I couldn’t see any other explanation and I couldn’t see what on earth could be done about this. Nobody seemed to have any answers for me that actually helped.

[00:02:08] Rachel: At the end of the consultation, he said, well, you know what? In order to be certain, we’ll just send you for an MRI of your ankles. And I thought, well, okay, fine, i’ll go for my MRI. A few months later went for my MR. I thought nothing more of it until I got a note from the clinic saying can you come back? We need to talk about your MRI. I went back to clinic and I was greeted by, Well, this is interesting.

[00:02:29] Rachel: They have found that I have a congenital problem in both of my ankles where two of my bones are partially fused, which means I don’t have enough movement. There was significant bony edema on one side, and that was the cause of all the trouble.

[00:02:41] Rachel: But every time I sought help, I was told, Hmm, probably not much we can do, or it’s probably your fault, or been given very, very wishy-washy advice, and I had just decided it was pointless.

[00:02:54] Rachel: Now knowing what’s wrong, I can make adjustments to the way that I exercise. I can try and help things. I can take some medication that will reduce the swelling when I know it’s gonna happen. There are things I can do. I can’t necessarily cure it, but I have a plan. I’m not stuck anymore.

[00:03:13] Rachel: And the problem is, this is what I see us doing with our own stress, our own wellbeing, our own levels of burnout. We think we already know A, what’s wrong, and B, what everyone else is gonna advise us to do. And often through past experience, we know that there’s not a lot that anybody can do about it. Or at least we assume that, and then we think that asking for help is totally pointless.

[00:03:39] Rachel: You see, people say that doctors don’t ask for help because they’re too proud. They don’t like admitting they’re weak or they can’t cope. And yes, there is an element to that. These stories we’ve been brainwashed into thinking that we’ve always got to be the strong one, that we’re got this particular superhero quality which means we can keep going longer than most people.

[00:04:00] Rachel: But actually, that’s not what I’ve experienced In talking to many, many people, and the survey that we sent out told a sharper truth. People were saying it would’ve felt pointless as the job would’ve still been the same when I returned. Someone even said, I called the staff psychology service. The message was two years out of date, and they said they wouldn’t be in touch, so why bother?

[00:04:22] Rachel: So we either know it’s gonna be pointless or we’ve tried before and it was pointless. That’s futility, when the doors you try when they’re not opening, you eventually stop knocking on them. And then it gets worse. When we do ask for help, it’s often minimized or we are gaslit by ourselves or by others. People told us in the survey, my manager told me we only thought we were too busy, and I was told the burnout didn’t exist. Unbelievable right?

[00:04:50] Rachel: And sometimes the external gaslighting that we have becomes internal gaslighting. We tell ourselves, well, everyone else is coping, so why can’t I? And then we tell ourselves, well, you can’t stop. ’cause if you stop, who is going to do the work?

[00:05:04]

[00:05:05] Rachel: This is a You Are Not a Frog quick dip, a tiny taster of the kinds of things we talk about on our full podcast episodes. I’ve chosen today’s topic to give you a helpful boost in the time it takes to have a cup of tea so you can return to whatever else you’re up to feeling energized and inspired. For more tools, tips, and insights to help you thrive at work, don’t forget to subscribe to You Are Not a Frog wherever you get your podcasts.

[00:05:32] Rachel: So let’s just do a quick reality check. If you are in a place where you can do this, I want you to stop. I want you to put your hand over your heart to make you feel safe. If you’re driving, obviously don’t do that. Uh, but just check in with these questions.

[00:05:45] Rachel: My workload today is, how bad is it? What’s it like? My control over it is what? How much control do you have? And right now my body feels how? What do you feel like in your body?

[00:06:03] Rachel: Now you can say to yourself, given those facts, it makes total sense that I feel this way. Because the first step in doing anything is facing reality and naming it. Naming it is incredibly helpful and it’s one way that we can lower the temperature in the pan that we’re in.

[00:06:21] Rachel: Because here’s the trap that we all face, and I think you know it by now. It’s literally the name of this podcast. We are like that boiling frog in a pan. The workload builds up slowly and you don’t notice it, the extra long day is just becoming the norm.

[00:06:36] Rachel: But here’s the extra kicker. When you’ve got the other frogs in the pan with you and everybody’s overheating, you look around and you just think, oh gosh, well, it’s not just me, so this must be normal. Oh, or is it normal? Why aren’t they jumping out? Why aren’t they turning down the heat? And what’s wrong with me? And we acclimatized with this rising temperature until we have no idea what’s normal anymore. We’ve got no idea what’s safe or manageable for us anymore.

[00:07:03] Rachel: And this is exactly what people told us in the survey. Everybody’s in the same position. Patients still need care, or it is expected to keep going, especially. In senior roles. So then we’ve got this frog soup of futility, of gaslighting, and then of normalization, and as a result, everyone keeps quiet, there is silence, and all we end up doing, it’s just going, yeah, everyone’s burning out, but it’s pointless. What’s the point? I’ve tried, I’ve said this and we’ve had comments on Facebook saying, yeah, I reported it, nothing was done. Yeah, no wonder you are feeling like this. No wonder we feel it’s pointless and futile.

[00:07:41] Rachel: And what’s even worse is that asking for help actually makes you feel worse. So a lot of you told us in the survey that you didn’t seek help ’cause you knew you wouldn’t be listened to. You feared being seen as a failure. and someone was previously told, well, everybody’s struggling. And it was implied that they were the problem. So when help is minimized or reframed as your personal flaw, you don’t just feel tired, you start to doubt your reality, and that is exactly what gaslighting is, whether it’s a system doing it, whether it’s a manager or a person doing it, or whether it’s you doing it to yourself ’cause of what you can see around you.

[00:08:20] Rachel: Uh, I’ve experienced this myself. When I was really struggling as a GP. I went to a family member who was also a GP, and I was told Rachel, it’s such a privilege to be a GP, you know, implying that I shouldn’t be moaning because I was in a very, very privileged position and I was just being really unreasonable.

[00:08:38] Rachel: It felt completely undermining and didn’t acknowledge the issues I was having. ‘Cause yes, it is a privilege and I was really struggling. The two do not cancel each other out just as, just ’cause everyone else is struggling. It doesn’t mean that you are not struggling. That doesn’t cancel out either. Two wrongs do not make it right.

[00:08:57] Rachel: And then beyond futility and gaslighting, our survey highlighted even more reasons why doctors stay silent. This over responsibility and guilt, which we talked about all the time. When you’re not a frog, you know this, if I go off sick, my colleagues will have to work double. And that, that’s a really difficult thing to put onto people and and it is a reality and yes, that happens. We fear the consequences. Several people said they feared it being on their records, being brought up in their appraisal, affecting their reputation, being labeled a trainee in difficulty, or even worrying about having something like that on their record. For insurance reasons.

[00:09:35] Rachel: We compare ourselves to other people. You know, everyone else is coping. What’s wrong with me? That makes us feel immense amounts of shame. There’s the toxic culture, you know, of bullying, patronizing responses with almost zero psychological safety when we do raise things.

[00:09:51] Rachel: There’s also that thing about, I’ve just got no time to even sit and think, let alone seek help, and where would I go anyway? People say, well, I’m too busy to stop, who do I even tell? Somebody said, well, I’m a GP partner, so who would I even speak to? I’m my own employer essentially.

[00:10:07] Rachel: There’s financial implications. You know, I might be a locum if I don’t work. I don’t get paid. And then there’s this feeling of helplessness within the system. There’s long term vacancy freezes, rotas are all over the place. There’s these wellbeing tick boxes that just don’t help anybody at all, and it just makes us feel helpless and angry.

[00:10:31] Rachel: So what happens is that it’s this unspoken truth that everybody knows that doctors and other healthcare professionals are burning out. It’s been proven in studies, and as I shared recently, one survey in a trust said that up to 50% of their doctors were working in burnout. But we keep silent, we don’t mention it, and we keep borrowing performance from the rest of our lives in order to keep up our performance in work. But eventually our performance starts going down. We start making mistakes. We get really edgy. We get numb. We can’t recover as well on holidays or or rest times. And lots of you in the survey said, you know, I feel exhausted. I’m hopeless about the prospect of change. I resigned. I jumped out the pan. Someone else said, yeah, I’m retiring earlier than I planned.

[00:11:20] Rachel: And you know what? This isn’t you being weak. It’s a really rational response to impossible conditions. And sometimes when people say, you know, it’s okay not to be okay, sometimes I would say, it’s not okay to be okay. If you are working in conditions like that and you are totally fine about it, then what’s going on with you, right? Is there something deeper that has just been silenced that’s not able to speak out?

[00:11:43] Rachel: And then because we feel so helpless, we just become very angry about other areas, about the political situation or, or management, you know, things that are totally outside of our control. ‘Cause that’s sort of safe to get angry about.

[00:11:56] Rachel: So, so how do we break this sort of futility of asking for help and seeking help? Well, it’s not with platitudes like, oh, put your own oxygen mask on first, or these, these thought limiting cliches. Yeah, they’re true, but they’re not necessarily helpful for us, particularly when we’ve tried putting our own oxygen mask on and we’ve been told we are weak for needing to. No,, we need small things that we can control.

[00:12:21] Rachel: In our Shapes toolkit, we talk about the zone of power, which for me is the most powerful tool I have ever used. It’s simply working out what’s in your control and what’s outside your control, because we can’t do anything that is outside our control, but we can do a lot that’s inside our control.

[00:12:37] Rachel: Some of it is scary and it feels like we can’t do it, but it’s the only place that we can start. So think of what you might be in control of. Here’s three small suggestions. Maybe think about one of these that you could do this week.

[00:12:51] Rachel: Maybe you could drop one low value task this week. Just one. One thing that’s not really having much of an impact. Could you protect one small pocket of rest? Maybe take one lunch break or one evening where you don’t stay late. And maybe you can have one honest conversation with somebody that’s talking about workload and capacity and the risk.

[00:13:15] Rachel: Now, of course these little acts, they’re not gonna fix everything. They’re not gonna fix the system, but they will break this feeling of futility, this feeling of pointlessness and helplessness, and will help you start to test out what could be.

[00:13:30] Rachel: And there are other things that you could try. You could flag stuff up, you could ask for help even if you’ve done it before and it was useless, and here are some scripts that you could use which might actually be more effective.

[00:13:47] Rachel: So if you’ve got a, a team lead or a manager, you could say to them, well, I’m flagging a capacity risk issue. It’s not a motivation issue. To stay clinically safe, I propose. X, Y, or Z, or you could say one subtraction or one thing that would protect you, or one way of supporting. Could we agree these and review them in 30 days? That might be one thing. And just a side note, as a sort of manager leader myself, when people come to me saying they’re overscheduled and they’re feeling quite stressed, I care deeply about it, but often I don’t have the answers. And if someone actually is able to suggest something that would really help ’em, that’s really helpful for me, ’cause I can look at it and we can talk about it and we can work out the thing that’s gonna be best for them and best for us. So coming up with the solutions yourself and suggesting it is wonderful, but don’t come up with a solution that’s completely unworkable, ’cause, ’cause nobody’s able to say yes to that.

[00:14:40] Rachel: You could go and see your own GP or your own occupational health department, and here you could say to them, I’m not just seeking coping tips alone. I’m not just seeking the advice of take time off. Please help me to document the impact that this is having on me and my function. And agree some concrete things that we can do at work to help. That gives them something to start with perhaps.

[00:15:06] Rachel: And then there are always those other sort of boundary sitting conversations that we talked about before. And I’ve done a podcast recently about a boundaried yes. So check that one out. It’s got many, many more ways of saying like a a, a sort of Yes maybe sort of No, rather than a direct No. So you could say something like, well, I can’t do this by then without getting rid of this other thing, and that’s actually gonna affect safety or standards or something. So I could do this other thing or that thing, or we can drop that one. What do you prefer? Giving them a choice, but just flagging ’em. I can’t do all of it. What’s the most important?

[00:15:44] Rachel: And here’s something that will probably help a lot, and that is planning a review date, putting it in your diary, and that turns this from a suggestion into a plan. Let’s try something, let’s review it. Let’s see what helped. And it is really, really important if you are in burnout or you are worried in any way to see a qualified professional, do not assume that you know it all. Even if you are somebody, even if you are a GP that sees people who stress and burns out yourself. I assumed when I went to see the rheumatologist, there was nothing that they’d be able to do. But actually after that particular investigation, it flagged some stuff up for me. So don’t assume you know.

[00:16:22] Rachel: We have blinkers on when it comes to ourselves, how bad things are and our own health. I shared in an email and another podcast about the fact that I didn’t realize how close to burnout I was a year or so ago when I was at my ADHD review and my psychiatrist started screening me for depression that was a real wake up call ’cause I had no idea how bad things had got.

[00:16:48] Rachel: So please go see your own GP,, occupational health or practitioner health if you can. And if you don’t have practitioner health, a really supportive manager, a good GP, or you are just gonna be waiting weeks. Here’s what you could do as well, is name it.

[00:17:06] Rachel: Name it with one person that you trust. And it doesn’t even have to be someone from your own department. It could be somebody outside of work. Say something like capacity is just below safe. I, I need a tiny plan. Can you, can you help me work something out? Have a contract with a buddy. Meet up for 10 minutes a week for four weeks, and just decide what are each of you gonna subtract or protect or find support over? And in 30 days you review that and see what’s changed.

[00:17:31] Rachel: If there’s a group of trusted colleagues you could join and, and, and talk to, then do that. Lots of trust, lots of people are actually running coaching groups now, and often nobody attends them. Go along. It’s amazing how supportive they can be.

[00:17:44] Rachel: You might wanna actually leave a paper trail, write it down, you know, write a a capacity note. Just say that this is how I’m feeling right now. I’m worried about my capacity. I’m worried about the risk if this goes on. Write it now. You can look at it later and it will validate stuff for later.

[00:17:59] Rachel: And another thing is don’t use your annual leave just to mask sickness. If you really are ill and sick, you need to go and get signed off sick, not just take a holiday and come back to exactly the same. And we all know that if you’re going into exactly the same thing and nothing has changed, then you’ll just burn out even quicker. And just remember that you need to keep yourself safe first. So look out for red flags and look out for red flags in your colleagues. If you’re making a lot of uncharacteristic mistakes, you’re feeling numb or really angry, you are feeling life is getting really pointless, you’re relying on alcohol or drugs, any thoughts of self harm? Please, please go and see somebody. This is not about forcing you to do something. It’s about looking after you, keeping you safe. Tell somebody, prioritize your urgent support.

[00:18:47] Rachel: Because we’ve all got this choice when we feel that we’re burning out, it feels like we don’t, but we do have a choice. You can do nothing. You can just carry on. Your sleep will get worse as you get more anxious, the errors will creep in. The water will be heating up, you’ll be borrowing your performance from everywhere else in your life until you suddenly crash out and your performance at work drops.

[00:19:09] Rachel: Or you can act now. You could actually have a plan, get some tools. Start really small. Work out what you are in control of. Do one little thing, one pocket of rest, one honest conversation, one review date. The same thing, same job, but a slightly different trajectory. You are turning down the heat here.

[00:19:28] Rachel: And if you want to go deeper with any of this, we have our Beat Stress and Thrive course which shares all the tools that we use to go from overwhelmed and near burning out back up to protecting your time, back up to peak performance zone. So do check that out.

[00:19:45] Rachel: So you are not a frog. You are a healthcare professional or a professional in a high stress, high stakes job in hot water. Now feeling that hot water, it’s not a failure, it is feedback. And the great thing about not being a frog is that you have things you can do. You can turn down the heat, you can choose to step out the pan if you want to. You could go to a different pan, a different environment, same job, different place, that often works brilliantly. You can choose if you wanna step out the panel together and go to a a completely different lake.

[00:20:16] Rachel: Now, I know from bitter experience that the problem is when we do that, we take ourselves with us. So that’s not always the answer, but it may be for some people. But you also can turn down the heat bit by bit by bit. Start with facing reality, and you can grab our free burnout self-assessment, PDF toolkit. Am I Stressed, Overwhelmed, or Burning Out? It’s a really fast reality check with the next steps.

[00:20:42] Rachel: Next, start with one small thing, tiny step that you can take, which you can control. And if you want more support, you can go deeper into these practical tools with our Beat Stress and Thrive course, or one of our Shapes Toolkit live training programs.

[00:20:56] Rachel: But if you do nothing else today, just take one small step. Small acts will break the seeming futility. And don’t assume that when you ask for help this time, it’s gonna be like every other time. You are not weak. You are wise for facing reality, and there are things that you can do.

[00:21:16] Rachel: And there is hope. There are ways of turning down the heat. Check out all our other episodes of you Are Not a Frog. Check out the toolkit. Get in touch if you need to and look after yourselves. Self-care, necessary care is not weakness, it’s leadership.