Why “Keep Calm and Carry On” Fuels Burnout

[00:00:00] Rachel: Why is it that in healthcare we so often blame ourselves if we are burning out or we minimize our feelings, telling ourselves we just need to keep calm and carry on? More often than not, it’s a system that causes burnout and blaming ourselves is just gonna drive us further into feeling anxious or depressed.

[00:00:18] Rachel: This week I’m joined by Dr. Richard Duggins,, who’s just written a book specifically to help healthcare professionals avoid burnout. This episode is jam packed with insights to help you figure out whether you are in danger of burnout or if you’re simply working through it to the detriment of other vital parts of your life, like your relationships, or frankly, your own happiness

[00:00:38] Rachel: Burnout doesn’t always look like a dramatic event. Stress and moral injury can build up over time. So if you find yourself irritable or you’ve noticed a change in empathy for your patients, this episode has got some really practical steps for you to follow. There’s loads more information in the show notes, which you can find on our website.

[00:00:58] Rachel: 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.

[00:01:15] Richard: I’m Dr. Richard Duggins. I’m an NHS Psychiatrist and Consultant psychotherapist, and I work for and lead our regional north east and North Cumbia staff mental health and wellbeing hub. And I also work as a psychiatrist in the outstanding NHS Practitioner Health. I’m also the author of a new book, Burnout Free Working, and I’m really pleased to be here today.

[00:01:36] Rachel: the book is really great, and I would encourage any listener to check it out, and it’s absolutely packed with such useful information. And the thing I really liked about your book is it is talking about the workplace and also stuff you can do as well. Because the biggest issue with burnout and with resilience training with wellbeing and stuff is people feel like they’re being blamed, resilience, victim blaming. And that’s something you talk about in your, in your book. How, how do you see resilience, victim blaming, showing up?

[00:02:05] Richard: It’s one of the motivations for writing the book because the people coming to see me often feel it’s a personal weakness, that it’s some strength, they’re letting their team down. And actually that’s not what we see. And when we speak to people and they tell their histories and they can start to see it, what we really see is what’s going on is something in the system. It’s a change or some change in the balance of what’s going on around people rather than what’s going on inside people.

[00:02:33] Richard: So I often talk about radiators and drains. So what are the things that are radiating energy and keeping people resilient, but also what are the things that are draining their energy and, um, making them more likely to burn out? And what we see clinically is a tip in these radiators and drains.

[00:02:51] Rachel: And I, I did laugh in the book ’cause you talked about the fact when you talk about this and you show people the stress curve, which we use all the time, which simply plots your performance against, uh, pressure and as the pressure increases initially. ,You get this good stress, don’t you, where you perform well. But then as the pressure increases, you tip off the, uh, the top of the curve and your performance starts to decrease. And you said you often hear sort of audible gasps when you talk about this as people realize.

[00:03:14] Rachel: That happened to me in a training session. We, I, a woman, um, it was a non-medical training session actually, but a woman ran out of the room, um, really in distress, and I caught up with her at the break time. I said, I’m, I’m so sorry, ar you okay? Is that something I said? She said she’d recently, recently been off upset with burnout, and it was such a relief for her to know it wasn’t her fault and there wasn’t anything wrong with her.

[00:03:37] Rachel: So why, why is it that we do blame ourselves? And do you think people in healthcare blame themselves more readily than other people?

[00:03:48] Richard: I think it’s a narrative throughout many professions in high stress. I think it’s certainly there within healthcare, but I think it’s there within teaching. I think it’s there within social work. It’s there within law. I’ve done some work with the police. It’s certainly there within the police. So it’s, um, I think it’s a misunderstanding. I don’t think resilience and burnout are understood very well, so I think it’s a misunderstanding and, you know, that’s why your podcast and, and things like that are so important, ’cause they, you know, they, they correct these misunderstandings.

[00:04:21] Richard: But I also think organizations at times have found it more convenient when people are struggling with burnout in their mental health to say, actually it’s that individual and to scapegoat them rather than to ask the harder questions, which is what are we doing that’s burning out our staff? What, what could we change? It’s, it is easier to blame the individual, I think.

[00:04:42] Rachel: Yeah. And as medics, I mean, we have been used to pretty high pressure for most of our careers, haven’t we? You know, starting with doing a Levels, quite frankly, and then med school with all those exams and working much harder than it seemed like, than anybody else who only had, you know, my husband only had like three lectures a week at uni. He was there nine to five every single day. And then you go straight into house jobs, which were incredibly pressurized. So do you think we have a, that our normal pressure gauge is just set a bit higher than everybody else’s perhaps?

[00:05:12] Richard: It’s certainly the case that, um, the medics I meet in my clinic are incredibly resilient people. They can manage a lot of stress, but we are all human and we can all only take so much. And at times there will be too much stress at work, often combined with too much stress at home, combined with too little support or a change in support, and we all reach our limits and at that stage we’ll start to develop problem stress or, or burnout and may even progress to anxiety, depression, or some physical complications.

[00:05:51] Richard: So it’s, um, I agree we are used to and trained to manage high stress, but too much for too long will burn us all out.

[00:06:00] Rachel: And do you think in the people that you’ve seen, it’s a problem with the drains have increased? Or is it a problem that the radiators have de decreased? And actually it might be quite helpful for you to just tell us what you think the drains and radiators are, particularly in healthcare.

[00:06:15] Richard: Yeah, absolutely. So the drains are, there’s three drains, um, typically they are, um, work stress, both the hours worked and the intensities of those hours worked. They’re home pressures. So that’s also, you know, what’s going on at home. Are there changes? Are there disputes? Have we suffered a bereavement? All sorts. Pressures that are at home, caring responsibilities. And then the other drain, which is a really interesting one, is negative experiences about work. So this is about how we feel about work, and this is very much the culture of work. This is our support at work, how we’re treated at work, how investigations are handled at work, how we feel valued at work.

[00:07:01] Rachel: when you talk about negative experiences of work, are you talking about what, what the HR department would call employee engagement?

[00:07:08] Richard: It’s related, but. In my mind is slightly different. So certainly negative experiences at work do stop employee engagement. But, but no, I’m talking more about the way we feel our work treats us. So how we feel treated by our organization, our line management, our colleagues, how fair work is. So it’s more of a cultural thing about, about work if we’re exposed to moral injury, those sort of things that affect our relationship with work.

[00:07:37] Rachel: so it’s not just about the hours and the workload. It’s not just about the pressures at home, it’s actually about how we are treated by people if we feel the culture is supporting us and is fair. So you can have a high load of hours and high workload, high load of home pressures, and be just about coping, but then suddenly you start to get these negative experiences at work and that can then tip you over into burnout.

[00:08:05] Richard: Yeah, that’s, that’s what we see.

[00:08:07] Rachel: that’s interesting. So do you get patients coming in, going, well, the workload hasn’t changed, you know, so I don’t quite understand what’s going on here. You know, we’ve sort of got the same workload, but for some reason things are much, much harder.

[00:08:18] Richard: absolutely. Yeah. Absolutely. And, uh, and people tend to just look at the workload. They don’t tend to look at the other drains.

[00:08:25] Richard: So the, the radiators are, are how much support we’ve got. Um, and we’re doubly blessed if we’ve got support at work and at home. So this again, is the culture of work, line management, but also our colleagues, you know, have we got a buddy at work, but also have we got support at home.

[00:08:45] Richard: The, the second one is, um, whether we’ve got any. Opportunity for fun and social time. So, um, that, that’s often done outside work. But, but you know, to be honest, why can’t work be fun? It should be fun at times, but, um, but, you know, the, these are our hobbies and activities.

[00:09:03] Richard: And then the third one, which I think is really helpful for medics to think about particularly is, is there some intellectual stimulation in our working week? So this is, do we feel stretched and developed within our working week? And some people can have extremely busy jobs, but there’s something in that week where they really look forward to, they really enjoy a particular clinic, a particular role, an education role, or something like that. And that really helps us keep going. So that can be a radiator.

[00:09:31] Rachel: I love that. I remember in one of my, uh, GP jobs, I was incredibly stressed but incredibly bored at the same time. And I was like, how can that, how could those two coexist? But you fit the nail on the head. Yeah, the, there was a lot of, the workload was really, really high, but there was really, at that point, no intellectual stimulation. And actually I fixed that not by changing jobs or changing the workload, ’cause I actually, I think started to doing a, a, a master’s or doing some more training. So that was something that suddenly started to intellectually stimulate a bit more. So we, we don’t often think about that, do we?

[00:10:02] Richard: No, absolutely. And it’s important to think about. It’s also one of the things when people get busy at work and they start to burn out, the thing they often drop is that what they see is that optional extra, which might be the most intellectually stimulating bit of their week. So they might stop the teaching or the additional clinic they offer or the minor surgery or something like that. And actually, that’s a real mistake because you are, you’re dropping the thing that’s keeping you going. But, but you see it quite often ’cause people retreat back to doing the core, often the bit that isn’t that stimulating and enjoyable.

[00:10:36] Rachel: And you talk about that in the book, don’t you, with the, uh, funnel of exhaustion. I think Mary Asberg, um, uh. Where yes, you just give up doing everything that you need to survive mentally and physically. And yes, I certainly talk about that a lot, but more in relation to the, the wellbeing factors, but actually learning and growing that is a wellbeing factor. So, um, often I think about, well, we just give up exercising, don’t we? We give up the yoga class and resting, but, but you are right. Often because the learning and the developing feels like an optional extra, that is just put on the back burner.

[00:11:09] Rachel: And I have lost count of the amount of doctors who’ve said to me, well, I just haven’t got time to do that masters or do that course that I really want to do when actually what you are saying is that could actually be the thing that saves them from burnout weirdly.

[00:11:21] Rachel: But how do you do that though? Without, without it just becoming one extra thing to do? One extra pressure on workload and time, because that is the real crux of it, isn’t it?

[00:11:29] Richard: Yeah. Well, avoiding burnout and then managing burnout, well, I don’t need to tell you. It’s, it’s really hard. I mean I, I run a, um, a therapy group for, professionals who’ve, burnt out. And, these are great professionals, very creative, and they’d have solved their problem on their own if they could have done, but it’s, these problems are really difficult to solve, and that’s what were the group’s so helpful ’cause people get to think together.

[00:11:54] Richard: And sometimes it requires really difficult decisions and courageous conversations and to try and get that balance back. Um, the balance between the radiators and the drains back. And I think, um, one thing I certainly see with the patients, uh, and the professionals I’m working with is, is that that often requires not them having to solve it all on their own, because they would’ve done all that already if they could have done, but having to reach out and have those conversations about how do I get this balance back? Uh, you know, who can support me with this? Who, who can help that balance in my work. So I’m, I’m not just burning myself out doing lots and lots of hours of unstimulating work, um, when I know I can contribute in other ways too?

[00:12:41] Rachel: But then we’ve got another problem, haven’t we? And I know all throughout the whole of your book, I’ve noticed the theme is reach out, reach out, get support connects, which I, I totally agree with. But the problem I see is that in healthcare, often the people that you reach out to are your colleagues who are in the same boat, and often they have a vested interest in you keeping on, churning through the workload that might not be simulating to you to, you know, to keeping you going so you can do the service delivery.

[00:13:11] Rachel: You can reach out, reach out to your manager, who is probably even more stress and burnout than, than you. Um, so that’s another problem for them to deal with. So I’m not sure you’re going to get the best support and unbiased support from people at work.

[00:13:24] Rachel: So then the question is, well, yeah, you can reach out to your friends and family, but they don’t really understand the workplace and what, what you’re going through, particularly if they’re not in a healthcare context. So, so who wanna do you reach out to for this support?

[00:13:37] Richard: Yeah, and it’s, yeah, there, there are, there aren’t simple, easy answers and, and I think it requires quite a lot of courage, assertiveness. Persistence. I think a, I think a key thing that people start to accept when they come forward for support and help is actually, this is really serious, what’s going on.

[00:13:58] Richard: Burnout is horrible. It’s a terrible feeling and it can lead if you don’t manage it to anxiety, depression, physical health problems, like high blood pressure. So it needs managing. And as good work is good for us, bad work is bad for us. And, uh, I think it requires us in a way to take a stance where we’re saying, actually, I can’t sustain this. I need changes to happen.. And, and that can feel very difficult.

[00:14:26] Richard: But actually you burning yourself out, having to take time off work or. Performing poorly because you’re burnt out and making errors or mistakes or having poor conversations with patients or colleagues isn’t worth it. It’s not helping anyone, and, uh, it’s not really, it’s not helping your colleagues, although it may feel like it.

[00:14:49] Richard: So although organizations and colleagues might want to turn a blind eye at times, they might want to just keep us going until we burn out, we, we really aren’t doing us any favors in that, but we’re also not doing them any favors for that. We’re not doing our patients any favors.

[00:15:07] Rachel: I, I totally agree. And, and it’s this sort of weird cycle of people saying, well, I haven’t got time to do anything about this because there’s so many patients I’ve got to see, or I can’t say no because it will let people down and it pass the stress on. Or I’ll get a complaint and then I’ll say, okay, fine, well you may get a complaint if you say no, but what’s gonna be worse? The complaint when you’ve said a well thought through, no, or your colleagues may be thinking you are letting them down. We don’t have any control over that, or properly letting them down when you are off for six months.

[00:15:39] Rachel: I mean, I’m not saying, you know, and that’s not a judgment, but you won’t be there to do the work, or getting an even worse complaint because your judgment’s gone and, and we know that doctors that are near a burnout get, make many more mistakes than than people who aren’t.

[00:15:54] Rachel: So then you’re gonna get that complaint and let people down anyway. It would be better to have that difficult conversation in the first place. So that’s one whole thing about, you know, setting boundaries, saying no, having those conversations. And as you were talking, I was thinking about the difficulty of finding people to reach out to.

[00:16:08] Rachel: But I’ve had this, a situation, not about stress, but there’s been a situation where I want to find out about something and I’m really not sure about who to contact. I’m thinking, oh, oh gosh. And my other half said, Rachel, you know, lots of people you could contact. And I thought, okay. And I just sat down and I wrote a list. So it turns out having said, oh, I don’t know what to do, I don’t know who to buy advice from, there are at least 10 people I could literally email and ask some advice from. But it takes a bit of thinking, a bit of putting my neck out there and a bit of being ready for people to say, actually no, I can’t help you type thing. So yeah, I don’t, it probably isn’t that We don’t know anyone who can support us, right?

[00:16:44] Richard: Well, absolutely. And for me, it’s one of the joys of being a doctor, uh, and being in the NHS. And for me, one of the key values and why I do this work, really for being a doctor and in the NHS is we help our colleagues. We are there for our colleagues. And I increasingly believe that actually helping our colleagues stay well is, for all of us, whatever our roles is, the best way we help patients because healthy, thriving colleagues deliver great services. So I, I almost think it should be our priority.

[00:17:17] Richard: The, the, the other thing I was reminded of when you were talking was, um, how we change culture. And I think we have an op we have an opportunity sometimes, especially if we’re reasonably senior to do that. And I was thinking about, there was a service I worked in about 10 years ago, and we used to see all sorts of doctors. It was a self-referral service. Lots of doctors came to us, really popular, but no surgeons came to us. So, and I was like, well, these surgeons are under a lot of pressure. I know that I’ve got friends who are surgeons, but they never came to us.

[00:17:49] Richard: And then one day a very senior surgeon came to us. He was burnt out, he’d become depressed. He referred into our service. He did very well, ’cause most people do. And then he went back and this was the remarkable thing he did. He talked to all the other surgeons in the region and says, look, this happened to me, I was overworking. There was a lot going on at home, I went through to this service. I’m much better, you can see I’m much better.

[00:18:14] Richard: And then the flood gates opened, and we never, ever had any problems with surgeons coming through to our service. So that person, I’m sure he doesn’t know it, but probably saved a lot of people’s careers, will have benefited patients and maybe saved some people’s lives. So I, I do think there’s something else about just battling on and waiting for burnout to hit us, and doing it silently doesn’t help our colleagues either.

[00:18:41] Rachel: No, it really doesn’t. And, and the minute you share something, the shame dissipates, doesn’t it? And let’s face it, we still all feel shame when we think we’re not coping because we feel I’m not good enough as a doctor, I should be able to cope with everything, which is totally bonkers thinking. It’s a superhero thinking that it is so unhelpful for us, but the minute someone’s senior tells their story, it’s like, okay. Yeah, we can do it.

[00:19:02] Rachel: And we’ve been involved in coaching programs for new to GP fellowships and there’s coaching programs around the country that are fully funded for doctors and not being used by anybody, which is total madness. Now either people just don’t know about them, that could be one thing, but I think people firstly feel they haven’t got time, which is again, total madness, we’ll talk about that in a minute. Or, or people maybe don’t want to admit how bad things have got. Why do you think people aren’t using these services that are available to them that are out there?

[00:19:38] Richard: I mean, there’s a lot of talk about how far we’ve come on about mental health and de-stigmatizing it. And yet a lot of, the lot of professionals I still meet with, a lot of doctors I still meet with, they’re really ashamed to be meeting with me. They’re, you know, the, the, the line usually is, I’m, you know, I’m sorry to be wasting your time. I’m sure you see people a lot worse than me, and a sense of a weakness, a failure, letting their colleagues down. And it’s still there. And, um, and it’s a miss, you know, as I said earlier, it’s a misunderstanding of what burnout is. It’s a, you know, it’s not true what they’re saying. And when they tell their stories, they can see it’s not true, but that’s there.

[00:20:16] Richard: The other thing is I think people need to trust these services. They need to trust that the services will be, be for them, that they’ll be rapid to access, that they’ll be confidential, and the outcomes are really good. I mean, NHS Practitioner Health is a fantastic example of that in the UK. So I, when Clare Gerada set it up, she said, if we build this, people will come. And I’m not sure people were sure about that at the beginning, but it was built. People come to NHS Practitioner Health, they get really, really well, they start thriving, they then go back and tell their teams about their positive experiences, and the service has grown into the kind of, you know, massive trusted services at the moment.

[00:20:58] Richard: So I, I, I think it, it does take a little bit of time to make people trust things. I think people can worry that if they come through to help that it will be opening a kind of Pandora’s box and that they’ll suddenly be off work and they won’t be able to get back to work. And that’s not true at all. You come through to help, you’ll do really, really well. It’s when you don’t come through to help that the problems can come.

[00:21:20] Rachel: I think as well, when some of these services were first set up, um, I’m thinking of a, a particular coaching service, it was like, oh yeah, come and see us, and they’d give like one day of training to people and then so people would use it and think, well, actually that wasn’t very helpful because actually they saw someone that wasn’t very experienced and also almost felt like they were just trying to persuade them to stay working rather than, or, or they were doing mentoring, which is great, but probably what, what wasn’t needed at, at the time. And so they’re put off. But I think things have very much developed and, and improved since then.

[00:21:54] Rachel: I think one of the reasons why people do put off getting help is they don’t recognize it. And you talk about this in your book, that the burnout cliff, that people go along, along, along think, well, I, I can’t be, I can’t be burnt out. But you know, I’ve spoken to someone who’s a director of medical, director of wellbeing and a, a local hospital trust. They surveyed their doctors recently, using, I think there’s a Maslach inventory. 50% of their doctors are working in burnout. And we are led to believe that actually burnout is so severe, you’d know when you’re in it, uh, you can’t carry on when you’re in it.

[00:22:30] Rachel: But actually a lot of people are actually working in it, so, absolutely. And I’ve had those sorts just the same as your patients. Well, I think I might be wasting your time because I don’t think I’m actually that bad, but you actually are, but almost you felt like that for such a long time, or even, dare I say it, for most of your career, it’s become normal to you.

[00:22:49] Rachel: So. is it true that we’ve almost normalized burnout and a lot of it are working in burnout without even knowing it?

[00:22:56] Richard: Yes. I, I think that’s right. And I think, um, I think I talk about a culture, in high stress professions, particularly in the NHS where we keep calm and carry on. We, we listen to, uh, Dory in Finding Nemo. We, we just keep swimming that that’s what we do. And that is terrible burnout advice. It’s a way to get through a difficult night shift, but, you know, it’s like, it’s like trying to run a marathon in the way that you handle a sprint.

[00:23:23] Richard: So, so keeping calm and carrying on doesn’t work, but it’s the way that it’s our go-to, I think in high stress professions. So we keep our heads down despite, you know, feeling a lot of problem, stress, early signs of burnout, even even quite severe burnout, and we just try and keep going.

[00:23:41] Richard: What we do is we try and protect our work and the core work. And often other things are, are, you know, we’re neglecting home life. We’re neglecting, uh, social activities, we’re becoming quite isolated from our community, but, but we do try and keep calm and carry on. And some of that I think is because doctors and I see this all the time, are really quite hopeful, optimistic people. And they say to me, it will get better. It’s just a really busy

[00:24:09] Rachel: yeah. Next year when I get my new colleague, it’ll be

[00:24:11] Richard: Yeah, absolutely. So you, you hear a lot of that and you know, and hopefulness is wonderful. We need that when we work with our patients, but it can get to the point where it’s fooling yourself. And, um, and the danger with the, um, that stage is what I call the plateau, where people are just putting their heads down hoping it’ll get better. But the danger with the plateau is you end up sleep walking towards the burnout cliff. So it comes to a point where things go, there’s too much for too long, and then there’s one thing, the straw that breaks the camel’s back and that will potentially take you off work or you’ll have to, um, you’ll have to then, um, reduce your commitments. And that’s where we really don’t want to get to. So it’s much better for people to act early to try and recognize things.

[00:24:58] Richard: I, I also think you’re right that people don’t necessarily look out for them. So one of the things I do when I’m lucky enough to be able to do some workshops with people is spend a bit of time saying, you know, what are your signs of problem stress? Do you know them? Do you know them as a tick list? And, and often people don’t know them, but, but really, they, they should be on our dashboard. We should be monitoring them.

[00:25:18] Richard: And, uh, you know, we should be watching out when we’re not sleeping as well, when we’re withdrawing, whether we’re, when we’re becoming irritable, when we’re getting muscle tension. But I, I’m not sure people are monitoring those and, or if they do recognize them, sometimes they’re ignoring them.

[00:25:32] Rachel: and I’ve just had this real realization as I’ve been talking to you, because this burnout cliff is really interesting. And you, you have it in the book ’cause you know, you have this wiggly line, you go along and then suddenly you go into burnout. Because the question I’ve had for a long time is, okay, why is so many doctors able to work in burnout when the traditional advice is their performance will go down? You know, so you can’t perform if you’re in burnout yet, they are still just about performing.

[00:25:58] Richard: That’s right. And I, and I think it’s, um, there’s two people I think of in the kind of history of burnout that I often go back to. And the first one is he’s got a wonderful name. He’s Dr. Herbert Freudenberger. And he was a psychoanalyst in New York in the 1960s, and he burnt out , um, and then he coined the phrase to describe his burnout. And, um, and he, he was doing a public addictions clinic during the day and doing a private clinic at ,night and too much for too long with too little support.

[00:26:26] Richard: And he, he coined the word burnout because it reminded him of what he was saying in New York at that time, which was there were burnt out buildings. And he said, if you look at a burnt out building, it looks okay from the outside, but inside there’s a kind of desolation and emptiness. And he said, that’s what I feel like. People, people look at me, they think, I think I’m fine, but inside I’m feel terrible.

[00:26:49] Richard: And, uh, and that is, I think the burnt out clinician at work. They’re, they’re protecting their work, they look okay, but inside something really quite serious is going on. But when they, when the straw that breaks come off back and they need to take work time off work, it sometimes takes them by surprise, but almost always takes their colleagues by surprise, they don’t see it coming. The other key name is the name you’ve already mentioned, professor Christina Maslach, who did the Maslach Inventory and she described burnout as three things. So I think at that stage she didn’t talk about performance, but what she talked about is emotional exhaustion. So that kind of absolutely exhausted at the end of the day, all you can do is sit on the sofa and have a glass of wine and fall asleep. Emotional detachment, so that kind of robotic, kind of compassion fatigue, feel not there for your colleagues and your patients. And then the third thing she said was a loss of joy in work. So that kind of where you don’t feel those, that joy that brought us into medicine or these high stress professions, you don’t feel those small wins anymore.

[00:27:51] Richard: And lots of people have those three symptoms and are still at work and manage it. And it’s only, I think, much later in the burnout kind of well warm path that you get the drop in work performance, but because people stay off so long, you get a sudden drop, you get this kind of slow burnout and they’re then a very quick burnout.

[00:28:10] Rachel: And this is diagrams in your book that you’ve got this plateau, um, which is slowly going down, which is your performance, and then suddenly the burnout cliff suddenly drops down. But what really struck me about what you said, Richard, is that actually your performance isn’t carrying on well. Your performance at work is so you protect your work. But if you look at your performance at home, so I’ve drawn another wiggly line underneath, and that is your relationships, that’s your thriving in life. That’s your family life. That’s any friendships, your exercise, your wellbeing, all that, your performance in terms of thriving in life, well that is starting to go down and you’ll, you’ll drop all of those as long as you are protecting your work. Well, thinking, well, I can’t be burnt out ’cause I’m still performing fine even though, like you said, joy has completely gone, you’re this hollow, empty show with nothing in your life, but work because you’ve given up doing anything that brings you happiness, joy, or whatever, so that you can protect your performance at work.

[00:29:04] Rachel: And then something happens, the straw that breaks the camel’s back, be it a complaint or a tricky patient or a colleague going off sick or maybe something happening at home, and then suddenly boom, your performance everywhere plummets. Is that a good interpretation of, of, of what you’ve

[00:29:20] Richard: Yeah. I mean, it’s, exactly right and that’s what we see. We see people protecting work at far too heavy a cost to them personally, um, and, and to their families and, and ultimately to work. So you might see somebody, in fact, I’m, I’m thinking about somebody who, know, example of somebody who’s just had a baby, but they’ve also just had a promotion, so that’s great. These, these are great things, but massive increase in home and work stress.

[00:29:48] Richard: Because they’ve had a promotion, they’ve also changed line manager and their new line manager isn’t very supportive, they’re expecting them to get on with it. So there’s been a decrease in support, but the, the way they manage that is focusing on work. So working really hard, focusing at home, but absolutely no time anymore for themselves. So they’ve stopped running. Uh, you know, they, they’ve stopped seeing their friends, um, they become more isolated, they don’t come outta their office much, so they’re not talking to their colleagues unless it’s in a Teams meeting, and they’re not doing anything fun at work or enjoyable or stimulating.

[00:30:23] Richard: And that’s where it tips. So, so you get a change and then the way people manage that change gets things even more out of balance.

[00:30:31] Rachel: That makes a lot of sense. And the problem is that just the time where you are being promoted, where you are taking on leadership experience often coincides with life stuff going on, babies, kids, teenagers, elderly parents, all that, all that sort of stuff. So you can see there’s a lot of things that are gonna break the camels back, as it were.

[00:30:49] Rachel: And you also talk about curve balls in the book. Are these things that will also like plummet you down that cliff quicker?

[00:30:54] Richard: Yeah, absolutely. And I, I talk about these cause a lot of people who come and see me in these conversations, the conversation initially is all about work. And work is really important. And they probably wouldn’t be seeing me unless things were very demanding at work. But there’s also often things at home and, and, and it’s only at home, only comes in when I often ask about it. Well, you know, what’s happening at home?

[00:31:17] Richard: And, and you, I talk about curve balls ’cause there’s typically kind of four home curve balls that are important. also we can have strategies to, to manage. And, um, these curve balls come from interpersonal therapy, a type of therapy that I’m trained in, but, but the, the big curve balls to watch out for are change, so has something changed at home? So the example I gave there, new baby. Big change at home,

[00:31:42] Rachel: moving house would be one. Even though it’s a positive change, it is emotionally very draining,

[00:31:46] Richard: Yeah, absolutely. And yeah, so lots and lots of changes happen in people’s lives. Um, caring responsibilities, as you’ve said. Um, the, the menopause is a massive, massive physical change. So the other thing that’s going on is, is maybe disagreements at work, but disagreements at home.

[00:32:03] Richard: So, you know, if you’re working very hard, very long hours, things can often be a bit difficult at home. How, how do you manage those disagreements at home with a partner or sometimes with parents or sometimes with children, they’re very stressful.

[00:32:15] Rachel: Yeah. Just say that I, I had some friends who there was a massive dispute going on with their neighbors and that, i, I just couldn’t quite work out why it was affecting them so much. I mean, it’s not very nice thing to happen, but it absolutely knocked them sideways. For six months they couldn’t think or talk about anything else. So it’s, it’s a big thing, isn’t it? Whether it’s with parents, families, partners, or neighbors or, or anything else really.

[00:32:37] Richard: And absolutely. And you throw that in alongside a very busy job or a job where you’re not particularly supportive from, that, that will be the thing that will tip it. So we’ve got change, disputes. The third one is bereavement. And natural process losing people, natural process grief, but do we ever allow any time for it in healthcare? Sometimes you might get five days off or something like that. And people are expected to work just the same alongside being bereaved. And that is a very big ask and often not very possible.

[00:33:08] Richard: And then the fourth, um, the fourth curve ball I put in is, is loneliness. And, and this is, this is something we don’t talk about a great deal within high stress professions, but we, we do see people can become quite isolated, because ’cause of how many hours they’re working and how intense they’re working.

[00:33:26] Richard: But, uh, a, a group that I particularly think about here are international healthcare graduates who are coming over to the UK. it’s a wonderful opportunity to come over here and develop, develop their career, but they’re quite isolated and expecting to do really difficult work without the normal support. So isolation can be really important.

[00:33:45] Richard: We can really feel it when we’ve got a good friend we rely on, um, a good buddy moves away. You know, that can be the difference. Um, so, so isolation’s a really important curve ball to think about as well.

[00:33:58] Rachel: If you can tell someone’s heading toward that, that burnout cliff, how do we get people to, to take action? Because I’m presuming most people leave it till it’s too late

[00:34:09] Richard: They do, they do.

[00:34:10] Rachel: Or leave it too late. Not till it’s too late. Nothing’s ever too

[00:34:13] Richard: No, nothing’s no. And, and absolutely. And people, people come forward to services for support when they’re very burnt out, they’re an, you know, they’re anxious, they’re depressed, and they still do really well. You know, I mean, it’s an important message here. But, yes, we can avoid an awful lot of distress of ourselves, our families, our colleagues, our organization, if we come forward earlier.

[00:34:35] Richard: The group that are really good at coming forward, forward earlier are the people who’ve burnt out previously. And I, um, I love seeing people have burnt out earlier in my, in my clinic because they, they say, they say, I’m coming forward because I’m starting to feel these symptoms of problem stress, they’ve been with me for a few weeks now. I’m, I’m a bit worried ’cause I’m not kind of caring quite as much for my PA patients, I used to feeling a bit robotic. I’m not going down the roof to burnout again. I’m coming forward for some support. And that’s exactly the great thing to do.

[00:35:07] Richard: So what, what would be wonderful, and one of the motivations for writing the book was can people do that? Can people learn from all of the people who come forward later to come forward earlier? Because if you come forward earlier, it’s much easier to get things back in balance, to balance out your radiators and drains, to, to make changes that protect you from burnout. it’s much easier, it’s much more effective. It’s much quicker and it’s much less disruptive to everyone.

[00:35:34] Richard: But it’s something about self-monitoring. It’s about, it’s about recognizing those symptoms, but equally important, it’s about taking those symptoms seriously. Don’t just ignore them and keep, keep calm and carry on. Don’t just keep swimming. Stop, reflect, but also act, do something about it.

[00:35:53] Rachel: I think people put off coming A, because they’re not recognizing it and because everyone is in the same boat as then everyone’s working in burnout. B, they think they’re only deserving of treatment when they are in full burnout. They actually, no one wants to see me now. And to be honest, there have been anecdotal reports from people that have written in, um, to the podcast saying, well, I was feeling really stressed and overwhelmed, I went to see occupational health, they said, the only thing we can do is sign you off, that was it. Or they see the GP, he goes.

[00:36:20] Rachel: And to be honest, with most GPs, the only thing they can do is say, well, do you wanna take time off with, you know, they can point people towards, well there’s Practitioner Health and there’s some other services, but they, they themselves, that is the only, they don’t have time in 10 minutes to go through, okay, let’s look at your radiators and drains and coping mechanisms and all that sort of stuff. So people are very fearful that they’re told, they’re just gonna be told to take time off and then they’ll be going about against medical advice.

[00:36:44] Rachel: And I think it’s a real conundrum because we’ve seen, if you look at the stress curve, I think if you are going to get some help when you are at stress and just before overwhelm and someone takes, tells you to take time off, then actually sometimes, sometimes it’s absolutely what they need to do. But sometimes it’s like the the last thing you want to do and it’ll make things a lot worse for you. Yes, you need to rest and make some changes, but this prolonged time, time off that most people are just told to do as a sort of panacea for burnout management. That’s just like, that’s not gonna work for me right, right now, and so let’s wait until I a hundred percent can’t actually go into work just to be told to take time off.

[00:37:19] Rachel: Now, I know I’m being a little bit harsh, but I think that’s genuinely some of the experiences of our listeners.

[00:37:24] Richard: Yeah, and I, I, and I, I’ve heard people report that to me as well, and, um, who’ve gone to other services and, um, you know, and other services are limited. They haven’t got the knowledge. I mean, you know, we we’re still quite early with our understanding of burnout, I think. And it’s not, you know, it’s not, it’s not greatly understood. It’s, um, it’s still not considered a medical condition. I don’t really understand that, but, but it isn’t, so I think you’re right. But, what I would say is that, if you can come forward early. it is much easier. It’s what you should be doing.

[00:37:59] Richard: To take, uh, examples of us as doctors, we don’t really say to our patients, let’s not sort this out early on before, while it’s mild, let’s just come back when it’s really, really bad, and then, then we’ll tackle it. ’cause it’s much easier to sort things out when they are mild. It’s mu you know, and you’ll need much less input and, you know, and there’s a greater range of people who can help you when it’s mild and it, you know, it, it may not be that you want to come through to service, you might want to do some, coaching. Or you may, you may have some peer support or things like that. The, there can be other things, so it is, you know, I, I would say it’s really important people

[00:38:34] Rachel: I mean, this is why we have our Shapes Toolkit system because we think there is nothing between stress and burnout for people often even to help themselves. Because with the best will in the world, getting an appointment to talk to people that might be a few, few days away or even a few weeks away.

[00:38:49] Rachel: But there are things that we know help, like staying in your zone of control, you’re of power working out what you control, of what you’re not actually facing reality, having conversations, learning to put some boundaries around your time and, and workload, things like that, which are really, really helpful and can just pull you back up that curve and away from the burnout cliff.

[00:39:07] Richard: Yeah. And, and if you act early, I dunno whether this metaphor work, but sometimes I think of it a bit like driving a car, that if you steer a little bit and use your brake a little bit, that’s how you drive. What you don’t drive is wait until you hit the corner and then just go like that and slam your brake on.

[00:39:22] Richard: So, so so actually if, if you do, if you do take things seriously and you do monitor things and you do come forward and make the sort of changes that you’re suggesting, they often don’t need to be massive changes. What you want to be doing is self-correcting and making these small changes and learning these small, these ways of doing it, um, early on.

[00:39:40] Rachel: So what do you wish your patients had done or been able to do or had support to do to self-correct early?

[00:39:47] Richard: Well, what I see, I, what I see people doing, uh, when they recover, I mean, it’s, it’s individual and it, but, but I think there’s five, five key things that I see people do. The first one is that if their basic needs are out of whack, they do something to attend to it. So that is, if they are working massive hours, intense hours, they’re not getting any time to talk to their colleagues, not taking their annual leave. Or if it’s something at home that is out of whack, they try and address it.

[00:40:19] Richard: Because the danger is if you take time off and you come forward for help, you will get better. But if you go back to the same problems, it only lasts so long. And there’s good research evidence that shows that too. So I, I think if it is about basic needs that are making you become unwell, then you need to address it.

[00:40:39] Richard: The second one is decompression activities. So this is the idea that stress builds up on us every day, so we need to do something regularly to manage that stress. And that could be something that’s active, like running, joining a choir, or it could be something that’s quieter, a restorative niche like, um, you know, might be reading, might be mindfulness. I’ve heard you speak to Paula Redmond, she talks about knitting. You know, these are all really important things and they’re different for different people. So you know, Don’t listen to somebody who says, oh, you should go running if that’s not what you wanna do.

[00:41:11] Rachel: My idea of

[00:41:12] Richard: yeah, but, but, but do do something that you like to do, that. Now, um, Matt Morgan is an ICU consultant, and I love the way Matt Morgan talks about this. So he talks about early on in his consultant career, he was sort of soaking up this stress and he, and he found himself perhaps drinking a little bit too much or more than he wanted to, and, uh, and also being a bit irritable. And, and he talks about the idea of what he discovered, which he, a kind of brainwave came to him when he had his, he was kind of, um, bathing his young children, uh, and he talked about squeezing the sponge.

[00:41:49] Richard: And he said the idea that came to him was that, um, at work he was like a sponge for stress and he was filling up and filling up with stress. And, and, and because he was over full. that he wasn’t coping very well. He was, uh, you know, taking out on other people sometimes.

[00:42:02] Richard: But he said what, what he learned was that to be a consultant and sustain his career, he needed to regularly squeeze the sponge. He needed to do something to get the stress out of him. And, uh, and, you know, and need, he took, he talks about the various kind of activities that he made routine within his week, um, to manage his career, so that’s a really good one.

[00:42:22] Richard: The other thing is, um, social support. So, um, having your support team, you know, knowing who’s there for you at work and home, and uh, and really, really reaching out for people. And it’s not just about a shoulder to cry on. Just those normal kind of everyday social activities alongside people, those chats, you know, before and after meetings, those chats in the coffee room, or those, you know, just those chats down the pool, but in a coffee room are really, really important for our health.

[00:42:50] Richard: The fourth thing is a don’t do, which is to evol to avoid false cures, to evolve, avoid, um, things that are unhelpful, like drinking too much. Um, and you know, I’m seeing a fair, some, some professionals are using gambling, and this is a way of kind of taking you outta things, but it doesn’t solve the underlying problems. And beca can become in time a bigger problem than, than the underlying problem.

[00:43:16] Richard: And then the fifth thing is, what I see people do, and I’ve mentioned this already, is they keep calm, but they nip things in the bud. So people get really good at taking their, their wellbeing and their mental health seriously, and they look out for symptoms and signs in themselves of when things are getting out of balance, and they act quickly to do something about it. So they don’t keep calm and carry on. They keep calm, nip it in the bud, do something about it, and, and that is a really rewarding change to see people make.

[00:43:50] Rachel: I think we are quite bad at doing that. I’m thinking of people, friends that I’ve had in the past who, um, have been quite flaky. Like they haven’t been doctors. Doctors always, you know, doctors turn up when they say We will, we’ll go out when we do it, you know, but some non-doctor friends have been like, I can’t come out this evening, i’m just feeling a bit tired and I’m like, gosh, I would never cancel anything. Just I’m feeling tired, you know, because like we’ve been programmed that like tide is just normal so you wouldn’t, you know. But actually looking back, they were nipping it in the bud. They’re like, actually. I can’t do that tonight, ’cause I know I don’t have the emotional capacity for it. I’ve just canceled that. I’m not gonna do that.

[00:44:25] Rachel: And yeah, they, they recognize it and they do it. But I think in medicine we’re like, oh, well that I, I can keep going ’cause I, I always had, and when I was younger I did 120 hours a week. Therefore I can manage that now. And yet this weird mindset we have, isn’t it?

[00:44:39] Richard: it’s inter it’s interesting, isn’t it? Because the other thing that we are quite good at, at medics, especially if our patients is taking control and advocating and, and, and acting, but when it comes to our own wellbeing, we are not very good at it. Um, but, but we have got those medical skills to, you know, we are not, we’re not normally afraid of acting. We, we, we make difficult decisions, but we need to start doing that for ourselves.

[00:45:06] Richard: So I think a lot of high, professionals in high profile jobs have got these skills. They just haven’t yet harbored them for their own wellbeing.

[00:45:14] Rachel: The other thing, it’s just come to me, it’s a bit of a play on the word acting. Um, we like to get into action. We’re very good at getting into actions and solving problems, but actually sometimes the action that we need is to subtract. So I’m just thinking, you know, it’s actually very hard for me to go, I actually need to sit in my hanging pod in the garden for an hour and read and read a magazine. That’s what I need. I’d be much more, but I need to do this, this, and the other. So if we can change resting and subtraction into an action that we know is good for us, maybe we’d be more keen to do that.

[00:45:46] Rachel: I mean, it’s interesting, you, you’ve talked about those five things and actually nowhere there have, you talked about therapy and counseling and psychotherapy and stuff. So where, where does that all come in, in, in any of this?

[00:45:57] Richard: Yeah, no, it’s a, it is a really good point. So, so PE-people who are coming through are making these changes. Um, and I don’t think you have to be in therapy or in a therapeutic relationship to make these changes, but pe-people are, are doing that within a therapeutic relationship. And I think there is, there is something about coming through to a support service or a wellbeing service that allows you to stop and reflect and think, actually things are outta balance. What do I need to do to kind of correct this?

[00:46:26] Richard: So that sort of therapeutic support can be really helpful in helping people reflect, take things seriously, but start to make a plan and making those, those steps and goals and focus. And I don’t think that, you know, if you’re coming through early enough or with burnout, it doesn’t have to be a long time. You know, you can, you can do that within, you know, a relatively brief therapy, six to 12 sessions, you know, maybe even less actually. So that’s important.

[00:46:53] Richard: Where therapy does come in, I think is your burnout’s gone on for a long time. So if so, some people will be on the plateau, will be prioritizing their work, be become really quite severely burnt out. And if you’re still at work and you’re still under a lot of stress, it’s reasonably easy for that burnout to turn into a medical condition like anxiety or depression.

[00:47:17] Richard: So it’s, um, I’d see it as rather a continuum of kind of problem stress to different levels of burnout. And then if it’s still not managed, you run a quite a high risk of developing anxiety or depression or physical health complications like high blood pressure. And I think if you are moving into that anxiety depression area, then that’s where therapy comes in and an evidence-based therapy comes in.

[00:47:41] Richard: It may also be, and professionals tend to be a bit resistant to this, it may also be a conversation about, actually I’ve got anxiety and depression, do I need to consider, um, some medication here to treat this? But most anxiety and depression, the first step would be therapy and it would be an evidence-based therapy like, um, CBT or IPT would be the top, the top ones in the evidence base to do.

[00:48:05] Rachel: most of us sort of know what CBT is. What, what? Can you just explain what IPT

[00:48:09] Rachel: is? Yeah. So IIPT is, um. type of therapy, um, developed for depression. It is available in the uk. It’s available in, um, pri in most primary care, uh, services for anxiety and depression. Um, it’s also developed in some secondary care. Um, we have got, uh, an IPT specialist within NHS Practitioner health, and, and within the service I work in regionally,

[00:48:34] Richard: it’s an interesting, um, therapy because it was developed by somebody, um, asking therapists, if you’re treating somebody for depression, what do we need to have in this therapy? What’s it need to look like? And they, they offer a big list, and the therapy of IPT was designed upon that.

[00:48:50] Richard: And, um, CBT tends to be about Modifying your thoughts, distorted thoughts, um, and then that leading to a change in your feelings and behavior. IPT is, um, much more about looking at your social support and your relationships and who’s there for you. And also, um, we talk about, um, in IPT, the idea of antidepressant activities.

[00:49:14] Richard: So often when people become depressed, they stop doing the things that are good for them. So they become very tired. They think they’re no good, they’re not good company anymore so they stop seeing friends, they stop doing those nice things because they’re too exhausted to do it. So we focus on people getting those things back into their life as well.

[00:49:32] Rachel: Okay. That makes, that makes a lot of sense. And can I quickly ask you about the relationship between anxiety, depression, and burnout? Do you think that all burnout, if it gets severe enough, turns into an anxiety and depression?

[00:49:45] Richard: No, I don’t, I don’t think all burnout does. Um, I think all problem stressed us. So if, if we start off with problem stress, if we’re in problem stress for too long, we’ll become burnt out. And then if we stay in burnout too long, we’ll become increasingly burnt out. Burnout. Burnout is a spectrum. But some people will then, if they’re, if they’re severely burnt out, will have a high risk of developing anxiety and depression, but not everyone will but quite a lot will. And the longer you are burnt out, the higher your risk of developing anxiety and depression is.

[00:50:18] Rachel: And is the other way round true that if you suffer with anxiety and depression anyway, are you at high risk of burning out?

[00:50:26] Richard: I wouldn’t say necessarily. So, because, what determines whether you’re at risk of burnout is what’s going on around you. So, so we burn out because of those balances between our radiators and drains. Um, you know, when the drains are high and the support is low, and that is the same for ev everyone. So we, you know, whether you’ve got a history of anxiety or depression or whether you haven’t, whether you’re gonna become burnt out or not is because of what’s going on around you.

[00:50:54] Rachel: And what for you would be the red flags that someone in burnout is tipping also over into anxiety and depression?

[00:51:01] Richard: So it’s the diagnostic factors for, um, anxiety and depression. So, for, for anxiety it would be, you know, feeling worry and anxiety over most days for, for several weeks. You know, probably over, uh, you know, to a couple of months really. That’s kind of, there often goes alongside, um, physical symptoms such as heart racings, sweaty palms, those kind of things. Um, so the, that kind of feeling, that protracted, constant feeling. And along alongside those physical feelings as well.

[00:51:37] Richard: Depression is a feeling of being low or a feeling of not really being able to enjoy things most days for at least two weeks. Um, and often depression also affects both the way that we see the world. So we tend to see the world through the opposite of rose tinted glasses. So we tend to see the world as viewing us as worthless, we might feel guilty, uh, we might lose our optimism. Uh, we might feel hopeless, you know, um, thoughts that, um, actually I might better, the world might be better off if I wasn’t here, or I might be better if I wasn’t here, quite common within depression. Um, so they’re the feelings.

[00:52:17] Richard: But the other, the other kind of hard signs, uh, to look out for are physical signs. So people’s sleep goes off. There’s a change in their appetite either reducing or increasing. People often feel worse in the mornings. Um, there’s a lack, lack of energy. So there’s the, the, those are kind of key, key signs to look for for depression.

[00:52:38] Richard: As I say, you only really need those signs for most days, for a few weeks and at that stage, I, I would start to wonder if I’m depressed and, um, and I might seek further advice and treatment for that. It doesn’t help to ignore those for too long. And, and if talking therapy was the first step.

[00:52:56] Richard: There are some screening tools available free on the, um, on the web. Um, and I link to them in the book as well, but anyone can find them. The PHQ9, for depression, really good screening tool, very simple to use. And the GAD7 is for anxiety. So if you are thinking, oh, am I tipping into anxiety or depression, just do one of those and you’ll get a score and that score will give you, um, some advice about what to do next.

[00:53:21] Rachel: That’s really, really helpful. We also provide a free toolkit called, Am I Stressed, Overwhelmed or Burnt Out? And it contains all the burnout, uh, free inventories as well. But what I might do is add into that the GAD7 and the PHQ9 that people can access just to make sure, and obviously getting your book would be really good.

[00:53:38] Rachel: As you said that I’m thinking, well, gosh, it’s actually very difficult to tell because you get fatigue and burnout, you get fatigue and depression. You get this sort of cynicism, don’t you, an emotional detachment in burnout, and then you get this hopelessness in depression, which is probably why it’s so important to actually seek professional help because they’ll be able to sort of tease it out and, and work out what’s really going on for you.

[00:53:57] Richard: Yes, and it is important, it’s teased out because, burnout is different from, um, from anxiety and depression, and, and we’d use a different approach. So I, you know, for example, I wouldn’t consider antidepressants in burnout. But if, uh, a talking therapy hasn’t resolved a depression or anxiety, or it’s very severe, then it’s worth considering.

[00:54:17] Richard: I think if you’re getting, if you’re wondering if you’re depressed and you’re getting those physical symptoms, so your sleep’s going off, your appetite’s going off, you might be losing weight, you are got a, an awful lot of kind of fatigue, especially in the mornings, it might push you a little bit more to, to, to thinking I’m, this might have tipped into depression, but once again, depression, anxiety, really easily treated, so don’t worry, you know, just come fu for help.

[00:54:40] Rachel: And a lot of the treatments are very similar to the treatments of burnout, aren’t they? Which is which, which is good news, which is really good news, which shows why it’s so important, go.

[00:54:48] Rachel: This might be again, talking about some of these talking therapies, but there’s a chapter in your book all about what we bring to the table, which I, I found fascinating because we know that not all burnout is the same. Um, as Paula Redmond said that there’s different causes. It might be due to moral injury or it might be due to just pure work overload, or it might be due to sort of under confidence in ourselves and things like that.

[00:55:11] Rachel: So what other things are these sort of, could be some of the underlying causes? I know you mentioned attachment theory and then there’s moral injury and, and things like that. But what do you typically see in your, some of your patients?

[00:55:25] Richard: so I’m, I’m gonna start this with a kind of warning, which is I firmly believe when I’m meeting people in my clinic that they’ve burnt out because of some change in the system. So, you know, whatever their personalities or coping systems are, they’ve often been doing perfectly fine for many years, and then something’s changed. So it’s not the cause of burnout. Um, so I want to be that, but we do see some, some things.

[00:55:53] Richard: So Herbert Freudenberger, who I mentioned, who was the, the, the wonderful psychoanalyst who first coined the term burnout. One of the first terms he toyed with around burnout was super achiever syndrome, and, and the reason he did that is because he said there are some people who are really dedicated, work really hard, really want to make a difference, and for them they will, they will work very hard, they’ll try and do a lot at home, they won’t necessarily reach out for support, and that is a group that are vulnerable for burnout.

[00:56:24] Richard: And the group that are vulnerable for burnout in the NHSI think because I think our organizations take advantage of those super achievers. So I’m utterly amazed when I meet healthcare professionals who are allowed to work ridiculous hours, allowed to wear too many hats. These are super achievers and, and they’ve been allowed by their organization to burn out. And I kind of think, you know, how did the organization think this was gonna turn out? What did they think was gonna happen here? Um, but, but that happened. So, so there is this idea.

[00:56:53] Richard: The other thing I think is really interesting, and then I’ll move on to attachment is there’s a double edged sword in, um, high performing professionals. So, high performing professionals tend to be conscientious, they tend to be determined, and they tend to be quite outgoing. Not always, but they tend to be. Now that’s good, you know, that, that they’re the sort of people you wanna accrue often.

[00:57:15] Richard: But under pressure, those same characteristics can become a kind of achilles heel. So your conscientiousness can become perfectionism. Your determination can become obsessionality and your, um, outgoingness can become kind of a little bit of narcissism, so you stop listening to people stop taking advice. So, so it, it’s interesting that the things that make us really good at our job under stress can also get in the way of us doing our job really well.

[00:57:46] Richard: And, and then the final thing I’ll talk about is attachment theory, um, which is, um, something I’m interested in for various reasons. But, uh, one things that I tend to see in doctors particularly, but other, uh, you know, other high level professions, uh, you know, I’ve seen lawyers like this is a couple of typical attachment patterns.

[00:58:05] Richard: One is a dismissive attachment pattern where we play down our emotions and our relationships. So this is the, the doctor who just kind of, keeps a, stiff upper lip and just gets on with it, just kind of, um, uh, manages things. Often very effective, but the problem is with this, is this doctor isn’t necessarily processing their emotions. So there’s an emotional impact of work, but they’re just getting on with it, going from one thing to another, dismissing their emotions, and eventually that can catch up with you.

[00:58:37] Richard: The other attachment style I tend to see in medics, but less common than dismissive one, but it’s there, it’s a preoccupied attachment style, which are these medics who are the opposite of dismissive, they really, really prioritize emotions and they prioritize relationships. So, uh, a typical warning sign for a medic that I meet with this is they tell me they’ve never had a complaint. So these are the, these are these wonderful medics who keep everyone happy. And that is, that is great, that’s great, but it takes a big emotional toll doing that and keeping everyone happy. And what these medics can do is they tend to neglect their own needs in the ear by prioritizing the other.

[00:59:17] Richard: So attachment’s very interesting. Um. Um, I also think it’s interesting because, um, if we recognize we’re one of those attachment styles, it might inform what sort of therapy we want. So if we’re dismissive, um, don’t really do emotions, we might be attracted to CBT, let’s, let’s get our thinking right. But what we might more benefit from is a relational type therapy where we can actually look at our relationships and things like that and how we process emotions.

[00:59:41] Richard: And similarly, um, people who are preoccupied really in touch with emotions often think, well, I want a relationship therapy, I want to do something where I can think about my emotions, whereas actually, they might be, might be more beneficial from CBT because what they might benefit is a more structured approach that that helps them kind of prioritize their self-care and helps them kind of order their thinking and their relationships. So i, I think it’s really interesting.

[01:00:07] Rachel: That is really interesting. I, I re remember reading about that in your book actually, and thinking, gosh, I’m the sort of person, I’m an Enneagram seven, so I’m like, I like, don’t like to feel difficult, but just like to move on and have fun. And actually, what I’ve been thinking for a while, actually, some therapy where you, I’m really looking, you can inter, you know, emotions, feelings, somatic, you know, where, where am I feeling that would be, would be really helpful rather than, yeah, just staying in your head and thinking it through, thinking it through. Just really quickly what, cause, what would have been the underlying cause of those two attachment styles?

[01:00:39] Richard: Yeah, well, a attachment tends to be, um, they, they, they tend to be styles that will develop from, um, that will, will start to develop from, from childhood. So most of us are securely attached. So, and, and most, most of most of the people I meet in my clinic are securely attached. But you might become dismissive of, uh, emotions and relationships if you are the sort of, uh, if from a young age you’re kind of expected just to get on with it, perhaps not talk about emotions, and perhaps look after someone else. There’s quite a lot of medics who’ve kind of been in a care role from quite a young age. And, and so they might need to, to have put their needs to one side, uh, and just get on, get on with it and, and manage things. And, and that could lead to a dismissive attachment style.

[01:01:24] Richard: We also train people, you talked about, you know, what we’re doing in A levels and, uh, and, and med school and things. Unfortunately, we can sometimes train people to be dismissive. So we can train them just to get on with the next thing, you know, don’t think about how you are feeling, just do the next exam or the next case, and things like that. So we, we can encourage that, unfortunately.

[01:01:45] Richard: Um, preoccupied people tend to be the children who, um, perhaps have been very sensitive, very caring for others. They, they again might have been in a caring role, but in a different way, they might need it to be particularly attuned to someone in their family and look after them in that way, so that, that might, might create, um, a preoccupied attachment style. But it’s complicated, and some people might have features of both. So it’s, uh, it, it’s not, it’s not always a straightforward thing.

[01:02:12] Rachel: And that’s probably where a skilled therapist would be really, really helpful to help you identify those underlying things, then what you can do about it, right?

[01:02:20] Rachel: What was your top three tips be for someone who can recognize themselves on that plateau and thinks, oh, crumbs, okay, maybe I, I wanna do something right now before I get to that burnout cliff. Just the three, well, let’s say rather than three top tips. ’cause all your top tips are in the book, your three next actions.

[01:02:37] Richard: First thing is fantastic. They are thinking about what’s going on. You know, have I got problem stress? Have I got burnout? So they’ve stopped fantastic and they’ve reflected. The next thing they should do is reach out for help, nip it in the bud. that could be to a support organization, you know, like NHS Practitioner Health, if you are a healthcare professional. Or it could be to a coach, or it could be just to friends and family. Let people know how you’re feeling. You know, people often carry this alone and in silence, you know, don’t do that. So stop and reflect, reach out for help.

[01:03:13] Richard: And the next thing is be hopeful and positive. Because actually, by reaching out for help, you will do incredibly well. People do incredibly well, they make amazing recoveries. And in fact, some people, quite a lot of people, if they have time to stop and reflect and recover, say, actually, I’ve developed through this. I feel different. I’ve made important changes and decisions, and my life feels more aligned now. So, be really hopeful. Coming through to help is a positive thing.

[01:03:43] Rachel: Yeah. And that was another great chapter. Your book on sort of post burnout growth, posttraumatic growth. So actually often, yeah, the good news is that after a burnout, people can actually be a lot better, um, or feel a lot better than before. But you don’t actually have to go through the whole massive burnout thing to get there. You can actually nip it in the bud and then be better, right? So let’s avoid that massive dip, shall we?

[01:04:05] Richard: Yeah. that’s right.

[01:04:07] Rachel: Thank you so much, Rich. We’ll have to get you back ’cause No doubt. We’ll, we’ll have lots more to talk about and if anyone’s listening to this, you’ve Got questions for Richard, please just, just uh, email them in. And Richard, if we get some questions when you come back to answer them?

[01:04:18] Richard: Oh, I’d love to.

[01:04:19] Rachel: That would be wonderful. And yeah, we would love to have you back and to talk about this more, ’cause it is, is such a big, big thing for doctors. Well, 50% of doctors working in burnout. So whether you’re a doctor, dentist, nurse, other healthcare professional, we have accountants, lawyers and teachers as well, and I would think that their levels are pretty similar.

[01:04:35] Rachel: But for me, the big revelation has been you might be in burnout but your performance is still okay at work, ’cause you’re protected that, but the performance everywhere else is down and then suddenly you’re gonna crash.

[01:04:46] Rachel: So thank you so much for being here. If people want to get a hold of you, or find out more about the book, about you, about your work, where can they go?

[01:04:53] Richard: So yeah, well I haven’t got a webpage, but I’m on LinkedIn. Always really happy to hear from people. So Richard Duggins and if people wanna know about the book or the audio book, all good bookshops. It’s on Amazon too,

[01:05:04] Rachel: And of course, if you are working in the NHS and you are eligible for Practitioner Health, it’s a fantastic organization. Rich, can you just remind us who, who it serves?

[01:05:13] Richard: So it serves any healthcare professional who finds it, is finding it difficult to get confidential local support. So that’s every doctor and every dentist in the NHS, can come through or it’s any health professional who’s who hasn’t got local confidential support.

[01:05:31] Rachel: So do get in touch with Practitioner Health and if you, you’re not in the UK or you can’t access that, there will be other ways for you to get h help. It might just take five minutes of digging around and, and Googling. So employee assistance program, your own GP, your family practitioner. Please, please don’t struggle on alone, even if it’s just telling a colleague about it. So, thank you Richard. Um, and hopefully speak again soon.

[01:05:56] Richard: Great. Thanks so much, Rachel.

[01:05:59] Rachel: Thanks for listening. Don’t forget, you can get extra bonus episodes and audio courses along with unlimited access to our library of videos and CPD workbooks by joining FrogXtra and FrogXtra Gold, our memberships to help busy professionals like you beat burnout and work happier. Find out more at youarenotafrog.com/members.