How to Stay Calm When You Don’t Know What Will Happen Next

[00:00:00] Rachel: Have you ever had a day recently where you felt really tense and wound up? Well, I’ve had several of those recently. We’ve had A level results. We’ve moved house. I had to get flight to the airport going around the M25, that was stressful. Was there gonna be a traffic jam or not? And I’m sure you know how that feels.

[00:00:17] Rachel: And what about the even more difficult stuff? Waiting to hear if you’ve got a job or not. Funding applications, outcomes of patient complaints. Maybe you’ve given feedback to a colleague and you’re not quite sure how it’s landed, or if you’re a parent, maybe one of your children is having a difficult time at school and every day when they come home, you are not sure how it will have gone. Now, nothing’s actually happened yet, but your shoulders are up by your ears and your stomach’s just in knots and you can’t think straight.

[00:00:46] Rachel: While I was away on holiday this year, I read an amazing book called The Awakened Brain. It’s by Lisa Miller. She’s a psychologist who was looking at spirituality in the brain. Now, one of the chapters really caught me because she was talking about when they put people through an MRI scanner to see which bits of their brain particularly lit up when it came to stress. Because they had found that there were certain bits of the brain which were activated when somebody was really worried or anxious or even depressed, and they seemed to be counteracted by the bits of the brain that lit up when there was some sort of spiritual connection.

[00:01:21] Rachel: That was fascinating in itself, but the bit that really fascinated me was the way that they got people to feel stressed and anxious in the MRI scanner was they asked them to tell their stress story, so they, they wanted them to tell the stories about experiences that made them feel really, really stressed.

[00:01:37] Rachel: And the thing that she noticed about these stress stories were that the vast majority involved uncertainty. They involved a decision or something that had happened to them where they had to wait, where they did not know the outcome, and that for them seemed to be much, much more stressful then a bad thing that had happened to them where they knew the outcome, they knew what had happened, and they could just get on and cope with it.

[00:02:01] Rachel: Because when we are uncertain about something, where when it could be a good outcome or a bad outcome, nothing’s actually happened, but you’re telling yourself so many stories about what might happen about who might be angry, what dreadful outcome will there be. And if we’re those frogs sitting in our pan of water, it’s a bit like swimming around in cloudy water in your pan or in your pond. You don’t know what’s on the bottom.

[00:02:26] Rachel: So we tell ourselves it’s uncertainty that’s stressful. But it’s not the cloudy water that’s hurting us, it’s the fact that we can’t see through it.

[00:02:38] 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.

[00:03:05] Rachel: When I was on holiday a few years ago in Portugal, I was having a lovely time in the waves and surfing until I saw a fin and I thought it was a shark. And at that point I was completely unable to go into the water. What I’d once seemed amazing now seemed totally perilous, even though I had no idea if there was a shark or not.

[00:03:23] Rachel: So it’s the way that we respond, the way that we really thrash around and cause extra problems for ourselves, which is on top of the situation that’s already happening, because our brains, they find it very difficult not knowing the outcome.

[00:03:35] Rachel: So what they do, they fill in the blanks with the worst case scenarios. And before we realize it, we’re not just living in the moment. We are pre reliving disasters. That may never happen.

[00:03:45] Rachel: One of my favorite quotes, it’s a quote from Mark Twain. He said, I’m an old man. I’ve known many troubles. Most of them haven’t happened. So in today’s quick tip, we’re gonna dive into this cloudy water and think about just why uncertainty fries our brains, why doctors, people in high stress, high stakes jobs like healthcare feel it so keenly, and how to deal with it, how to get the water clear enough to see your next step.

[00:04:08] Rachel: Because in healthcare we live in a world that just worships certainty, doesn’t it? And certainly as a GP, I was trained to diagnose the problem, be really certain about it, predict what might happen, and then fix it. And more to the point I had to be right, or when I wasn’t, I felt very embarrassed and stupid, really.

[00:04:26] Rachel: So when we are in that cloudy water, it doesn’t just feel uncomfortable, it feels wrong, and we feel that we are at fault. And as doctors, as senior healthcare professionals, we have these amazing traits that help us practice well. But when it comes to uncertainty, they can make it feel a lot worse.

[00:04:45] Rachel: And I always talk about these traits, which are our Kryptonite to us. Firstly, we have over responsibility. We think, well, if I don’t fix this, who’s going to? But actually, what is it I need to fix? So we can’t fix it, that makes us feel dreadful.

[00:04:59] Rachel: We are quite perfectionistic. We think, well, if I get it wrong, someone’s gonna get hurt. But we don’t know how to get it right because nobody knows how to get it right. It’s uncertain. How can I get it right when I don’t know what’s gonna happen?

[00:05:11] Rachel: We have this idea that we are superheroes, that everyone’s relying on me, and yet I don’t know what to do. We are terrified of making mistakes, aren’t we? We want to be right, and so we think that, well, if I’m unsure about what to do next, then I must be failing in some way. even if nobody else knows what to do. And yes, we are brilliant at problem solving, but when it’s a problem that nobody can solve, we blame ourselves. We say, well, if I don’t know this, I’m probably incompetent.

[00:05:40] Rachel: And these are great traits for saving lives in an emergency where the next step is really, really clear, but it’s really toxic when there are no nice guidelines for what’s going on right in front of you.

[00:05:51] Rachel: And of course, the system that we work in, it just doesn’t help in high stake jobs, you are often held responsible for things that are completely outside your zone of power, they’re outside of your control. Things like staffing, waiting times, funding, policy. And so when uncertainty hits, it can feel dangerous, not just uncomfortable because you’re telling yourself, if this goes wrong, I’m gonna be blamed, I’m going to be for it,

[00:06:16] Rachel: And that is the reality for many, many people. They are often held responsible for things they’re not in control of. And that shouldn’t be the case. But you can argue with reality, but a hundred percent of the time, reality is gonna win. So even if someone else says you should be responsible for it, if you’re not in control of it, you can’t be.

[00:06:34] Rachel: So pausing and waiting in uncertainty just feels like you’re drowning, ’cause it feels really personal. And we don’t just experience it as uncertainty. We internalize the system problems, we turn them into self blame.

[00:06:49] Rachel: So it’s this thing about taking that double arrow. There’s the situation that’s going on, and also the stuff that we are layering on top of it. You know, why don’t I know what to do? I must be in the wrong for being in this position of uncertainty. Everyone else is gonna blame me. No wonder we get stressed in uncertainty.

[00:07:05] Rachel: But here’s what’s going on. The amygdala, which is your threat detector, that ancient emotional bit of your brain that sounds the alarm, that was built to detect lions, not to detect difficult emails. Our brains have not adapted very well.

[00:07:21] Rachel: And the amygdala wants to keep you safe but not happy, so it decides to see everything as a potential threat. It will always tell you the negative story, so it will always tell you that the outcome from that complaint is gonna be really awful, that if someone’s late home from work, they’ve been in a dreadful accident, that the worst is going to happen.

[00:07:41] Rachel: So your amygdala will panic and it will tell you that there are monsters under the surface. There are really bad things just waiting to happen. In fact, I experienced this recently. I’ve just done a house move. I’ve had some time off work, and there was this little nagging feeling the whole time that perhaps something was gonna go wrong, that because I wasn’t checking my emails all the time, that there was gonna be this massive disaster about to happen. I was constantly scanning for threats.

[00:08:07] Rachel: And of course nothing did go wrong. It was all totally fine, but it was my amygdala instead of doing its job. And if it doesn’t find anything to latch onto, it will find something else. I’m sure you’ve experienced that.

[00:08:19] Rachel: I remember when I was an SHO being away on holiday and just before I went, I received a complaint about the way I had spoken to a GP on the phone. And I’d been really sleep deprived. I think I’d argued with them about where this patient should go, and this GP had written a really stinky complaint about me to the consultant.

[00:08:37] Rachel: Now in actual fact, there’d been no harm to the patient. Everything had been fine, but the whole of that holiday, I worried. I pre-live stuff that hadn’t even happened. I absolutely fixated on what was gonna happen to me when I got back to work.

[00:08:53] Rachel: In actual fact, I got back to work. The consultant had a quick word with me and said, Hey, next time just be a bit less bolshy. That was it. He’d actually totally sorted out while I was away. But when our amygdala makes us tell ourselves stories, we can’t actually separate what’s real from the stories that we’re telling ourselves. And then that puts us into our sympathetic nervous zones. We pump out adrenaline and we’re convinced that catastrophe is coming. So no wonder we can’t sleep. And when we finally do find out what’s happening, it’s very rarely as bad as a story we’ve been telling ourselves.

[00:09:26] Rachel: Now side note, the Morris rule of worrying, I tell my friends this all the time, is there’s no point worrying because the stuff you worry about never happens. The stuff you don’t worry about, that does often happen, but you can’t change that by worrying. So let’s just try and stop worrying.

[00:09:40] Rachel: It’s really important to recognize that when you are telling yourself these scary stories, that is normal. Amygdala loves a scary story and that has kept us safe all our lives. But if you name it, you can start to step away from those thoughts. You can start to see that they are just thoughts. They are not the truth. You could say to yourself, this is uncertainty. It’s not danger. You know, it can be a bit of a warning. You could say, I need to be careful, the water’s getting a bit cloudy, but it’s very unlikely that there are sharks.

[00:10:10] Rachel: And the thing about all this pre reliving of stuff is that actually right now I’m safe. Right now I have a job. Right now, in this moment, nothing is going wrong. I’m warm, I’m dry. I’ve had enough food. I’m okay. I’m sitting. I’m breathing. There is no line. There’s no physical threat. I’m not literally standing in front of a judge. I don’t have a redundancy letter in front of me. So in the present, I am safe.

[00:10:37] Rachel: And you can try a grounding exercise. Just put your feet on the floor, take some deep breaths and just be in the present moment. One helpful thing would be to notice five things that you can see, two that you can hear, one that you can feel. Just exhaling longer than you inhale, can move you back into your parasympathetic. So you need to manage yourself and then manage what happens next.

[00:11:02] Rachel: So yes, there is uncertainty, but it’s over there. You are in reality right now, and there will be something that you can do. You can ask yourself, what do I know? What am I in control of right now? What is certain? What is in my gift to do right now? What’s the next best step? And so even one tiny action, one tiny hop, replying to one email, getting yourself in the right state of mind before the meeting, that just helps them with the cloudiness settle

[00:11:32] Rachel: here’s the thing about uncertainty, certainty does not equal competence. And the real mark of maturity in mastery is the ability to calm even in uncertainty.

[00:11:46] Rachel: I remember when I was a very new GP, I really wanted some clarity about my patients. I wanted to know exactly what was gonna happen. But as I got more experience, I learned to hold some of those gray areas to watch and wait and see and not be right all the time, and tell patients that I didn’t always have the answer.

[00:12:05] Rachel: So perhaps our goal needs to be, not to remove the uncertainty, but actually to develop the muscles. Just sit with it without panicking. Because of course we can’t eliminate uncertainty. Actually, that would make life really, really boring. But we can change how we deal with it. And actually, your job isn’t to get rid of all uncertainty. It’s to stay steady enough to make some wise moves while the water clears. And that is leadership. It’s not about having all the answers. Often it’s about staying calm for other people, they might be flailing around and really panicking.

[00:12:40] Rachel: And the good news is that working in healthcare, if you are a senior clinician, you are already an expert at managing uncertainty for patients. So, because every day you probably say, well, we don’t know yet, but here’s what we’ll do. And if this gets worse, we’ll do this. If it’s gets better, we’ll do this.

[00:12:57] Rachel: It’s called safety netting, isn’t it? You set review dates. You don’t lie to people and give them false hope, but you also admit that you don’t know everything.

[00:13:08] Rachel: I remember distinctly a, a patient coming in while I was a medical SHO. He was really young, a couple of weeks before he’d been fitting well, but it looked like he had metastatic lung cancer. The X-ray looked awful, and I distinctly remember my registrar saying. We are not gonna break bad news to him, we’re gonna tell him we don’t quite know what it is.

[00:13:26] Rachel: And I remember saying, well, shouldn’t we be sort of saying to him, oh, it really, really doesn’t look good and all that? He said, well, we can give him some warning shots, but we still don’t know. And actually a day later, I can’t remember what the diagnosis was, but it wasn’t metastatic cancer. It was something inflammatory, and he got totally better.

[00:13:41] Rachel: So as we get more experience, we learn how to live with the fact that yeah, things might go and be awful, but actually they might be okay, and not to go too far down the route of either one.

[00:13:53] Rachel: So as doctors we can do that for other people. We do that for our team, but we need to learn to do it for ourselves, don’t we? And one thing you can say to yourself is, well, I don’t know yet. That patient we didn’t know yet, and that wasn’t a failure, we just needed more data.

[00:14:12] Rachel: A bit like wifi buffering, you know, you’re looking something up and the WiFi’s buffering, the data’s just loading. We don’t know yet. It doesn’t mean it’s bad, it just means we don’t have enough data.

[00:14:25] Rachel: So why am I talking about this now? Well, recently I did a talk with a bunch of very senior clinical leaders and I asked them what was stopping them giving their best at work right now? Now I’ve been used to people saying, oh, it’s workload. It’s workload. We can’t recruit people, it’s workload. But this time they said, actually, yeah, workload is bad, but it’s the fact that the ICB doing a total reorganization, and our teams do not know if they’re coming or going. They don’t know if they’re gonna have a job next month or not. It’s almost impossible to operate at the moment. It’s so uncertain, and it was causing them a lot of stress in their teams a lot of stress.

[00:15:01] Rachel: And many teams are like that at the moment, waiting on funding decisions, reorganization, posting under review. And part of what makes it so stressful is that everybody secretly feels responsible and accountable for outcomes which they can’t control. And the leaders were just feeling awful in this team for their teammates, even though it wasn’t their fault.

[00:15:23] Rachel: And they were also waiting to see if, if their jobs would still exist or they’d be doing the same thing next week. But we feel that we might be blamed for bad news that we didn’t cause. And clinicians particularly worried that they’re gonna be criticized for delays that they couldn’t prevent.

[00:15:39] Rachel: And so this waiting actually becomes loaded with shame, thinking, well, I’m not good enough, even though in our heads we know that it’s out of our hands. We can’t do anything about it, we still feel guilty and we still feel some shame around it.

[00:15:55] Rachel: That’s why naming the uncertainty out loud matters so much to you and the team. It gives everybody permission to stop pretending that they are in control or that their leader is in control.

[00:16:07] Rachel: So if you’re a leader, just saying it straight, here’s what we know. Here’s what we don’t know, and we’ll next have an update here and even say, well, let’s review it at this point, or let’s review this in three months. You give the amygdala calendar and you can worry about it then. It’s about not rescuing people, but just being solid, being the anchor for them.

[00:16:28] Rachel: And remember to listen to people’s concerns without trying to fix it, ’cause you can’t rescue people in this situation, even though every bone in your body wants to, you’ll end up just overpromising making promises that you can’t keep. But share your thinking with your colleagues and ask for help.

[00:16:45] Rachel: And if it’s you feeling the uncertainty yourself, so check reality. Say what is true today. Make sure you stay in your zone of power. What am I in control of? What do I have to accept that’s outta my control? And then just park the rest. Say I’ll review that next week or in two months time, but stop going over and over it daily.

[00:17:07] Rachel: And I like to use this question, which is, what is the next right move? Not every single move, just the next right one. Now, 99% of the time when things are uncertain, we are predicting bad outcomes, but we all know that sometimes things are actually better. That decision that we didn’t like, it’s actually done a lot of good. That team restructure, well it actually made a lot of sense and things are working out a lot better now.

[00:17:31] Rachel: So sometimes this uncertainty leads to much, much better things. You know, there’s times where I didn’t get a job but actually freed me up to do something else, or a colleague has gone but actually got somebody even better.

[00:17:44] Rachel: And there’s so many times in my life when I was really upset about something and I didn’t get into the particular university that I wanted to go to, but thank goodness for that. I met my husband and all my friends at at Nottingham where I went. And as Daniel Pink talks about in his fantastic book, The Power of Regret, there aren’t many things that he would actually remove from your life without having to remove everything else that’s happened. I’m not talking about absolute dreadful things that happen to people, but quite often things that we see as very negative in the long run turn out to be okay.

[00:18:17] Rachel: So uncertainty isn’t necessarily the villain. It might just be the sort of transition between two different things. And you’ve survived everything so far. You don’t need complete certainty to move. You just need to know which direction to go in and getting more certain, well, that comes from actually taking action, not from waiting.

[00:18:41] Rachel: So often we put off decisions because we are uncertain and we’re unclear. And absolutely there are times where it would be absolutely daft to go ahead with that decision, particularly when it’s got huge consequences. Now, those of you that have seen the Indiana Jones films, there’s. Very, very famous bit where he takes the step of faith. He basically steps out into this massive chasm, and as he steps, the path reveals itself.

[00:19:06] Rachel: Now, I think that’s completely daft, because the consequences of him getting that wrong certain death. But actually all the leadership thinking nowadays is that leaders need to make quick decisions, but make decisions that you can fail at fast. So these quick decisions need to be small decisions that can be reversed. Choose something where there’ll be a small consequence where it’s not life or death, you can reverse it. ‘Cause often you only know what the right next decision when you make it. Or you’ll know that it’s the wrong next decision, but it didn’t mean that it was wrong to make it ’cause you would never have found out.

[00:19:43] Rachel: We have got to get ourselves away from this thing and that we’ve got to make the perfect decision every time. ’cause half the time we do not know.

[00:19:51] Rachel: I remember starting a job as a clinical assistant in a E because I thought that’s what I wanted to do. And it wasn’t until I was doing it that I realized it was totally the wrong job for me. I hated it. But there’s no way I could have known that without trying it. Was it the wrong decision? No, it was the right decision, ’cause I then found out what I did like and what I didn’t like.

[00:20:10] Rachel: Now, just like Indiana Jones falling off that cliff, things could go really, really wrong but the problem is a lot of us just avoid thinking about it. And it almost feels too scared to look into. But one thing about looking at the worst case scenario right in the face is that you can start planning for if that happens.

[00:20:33] Rachel: I’m sure that lots of you will be like me and have issues with funding right now. Those of you that working in the NHS, everything is being cut. And for me and the team, funding has been a real issue over the last 6 to 12 months. We do live online and face-to-face training to help doctors and other healthcare professionals beat burnout and work happier, and many of our clients say, we really want you to come do it, but the funding’s just been pulled for the new to GP Fellowship program or for this thing that I was running.

[00:21:01] Rachel: So it’s been tough. And I started to worry about well, could I afford to run my organization if the funding got worse and worse and worse? And there was one point I didn’t really want to look into, but I thought, no, I need to face the worst case scenario. And so I did.

[00:21:18] Rachel: And we got together with the team and we made a plan, and it actually forced us to make some changes for the good. We’ve made sure that all of us are working absolutely in our zone of genius and doing the things where we have the biggest impact. We’ve made some savings. We’ve also got a plan for if funding in the NHS continues to be really, really difficult. And we’ve pivoted to make sure that if someone’s organization can’t fund the training, they can access it themselves.

[00:21:46] Rachel: And by the way, side note, if you’re a member of FrogXxtra or FrogXxtra Gold, or any of our memberships, thank you because you are helping to fund this podcast, which then continues to be free for everybody. I couldn’t keep doing this podcast if we didn’t have our memberships and our amazing supporters, so thank you.

[00:22:05] Rachel: So face the worst case scenario. Instead of ignoring the numbers or ignoring the complaint or that awkward meeting, just face it and ask yourself, well, what is the realistic worst case? What would I do if it actually happened? Who could help me? And what is still within my control, and this isn’t pessimism, is it’s scenario planning. GPs call it safety netting. Try it.

[00:22:27] Rachel: Facing the facts actually makes a water surf seem much, much less cloudy, much quicker, rather than just pretending that everything is fine, because you just stop guessing what the monsters are and often facing the worst case scenario is better than imagining what might happen once you actually know it’s rarely as bad as what your amygdala is telling you. And the great thing is that most times the worst case scenario doesn’t happen.

[00:22:52] Rachel: So what can you do about this? What can you try this week? Well notice when you start to feel fearful, when the water starts to get a bit cloudy, ask yourself, is there any uncertainty in this? The instant you feel really tight in your stomach or your mind starts telling you stories, pause and then name it, yes, uncertainty.

[00:23:12] Rachel: And then try this ritual, ground yourself with some breaths or looking around noticing. Tell yourself I am safe right now. Right now I am safe. Ask what’s mine to do right now? What could I do? If you need to talk to a fellow frog, and then take one small hop, do one small action, send one email or write down a review date, or even just write down your worry, and then leave it.

[00:23:41] Rachel: It is not dramatic leaps, it’s just small steps. And there’s a great question that my best mate and I ask each other every time we are just freaking out about one of the children. And that is, if you knew everything was gonna be okay, how would you be acting now? It’s a great question. If you ask yourself that, you’ll come up with a next step and it’ll be a wise next step. It won’t be one motivated by fear.

[00:24:08] Rachel: Because we have a choice in all this. If nothing changes, if we keep freaking out when things are uncertain, we just keep thrashing around in this cloudy water, we’ll be making the stress of what’s happening. Even worse, pre reliving disasters, that will never happen. You’re literally toning up your own heat in the pan.

[00:24:27] Rachel: But if you pause, you breathe and just let the water settle, you might start to see what’s really there. You’ll realize that these monsters under the surface, well they were figments of your imagination all along, you’ll find your next step and then the next one.

[00:24:41] Rachel: If you want more tools to keep the water calm, just even maybe the next step, then download our free Burnout Self-assessment Toolkit, or you can join our Beat Stress and Thrive course. They’ve got loads and loads of practical next steps and ways to stay in your zone of power.

[00:24:55] Rachel: And please, if uncertainty is tipping you into constant anxiety, sleeplessness, or you’re feeling really despairing, then please speak with your own GP or practitioner health, or a trusted therapist. You need support. You don’t need to do this on your own. Because you’ve already proved that you can hold uncertainty for others, you need to be able to hold it for yourself with the same calm, compassion, and confidence that, that you’re giving everybody else.

[00:25:19] Rachel: Now just before we finish, I just wanna talk to you about three mistakes I see people making.

[00:25:23] Rachel: When we are facing uncertainty. Doctors and people in healthcare are always, always able to give one example of a total disaster that happened. So someone’s child came to harm, or a marriage failed, or a patient died, or something like that. Medics have always seen the worst things happening. My daughter had raised glands in her neck the other day. I’m worrying about lymphoma, my friends are just worrying about their kid missing school the next day.

[00:25:51] Rachel: Don’t let the exception be the rule, and instead of asking, well, what if X happens? Ask, well, what if X doesn’t happen? We’ve seen dreadful things happening to good people, and we have a skewed version of reality. But conversely, don’t assume you can always fix it or puzzle it out yourself. If there may be a serious consequence, get help sooner rather than later. It is not a weakness to ask for help.

[00:26:17] Rachel: And finally, we often seek reassurance from other people. Yes, it’s really, really important to check out the stories in your own head, find a, a friend, a trusted friend who you can say, I’m thinking this, does that sound right? And they can help you know whether that story is totally mad or not. And they can help you get some perspective. But what they can’t do is they can’t tell you that it’s all gonna be okay.

[00:26:41] Rachel: And if they do, that’s not that helpful either. No one has ever been reassured by someone going, don’t worry, it’ll all be fine, because you’re telling yourself, well, it might not be.

[00:26:51] Rachel: So the aim in life is not to live in total certainty all the time. That’s really boring anyway. The aim is to know what to do with yourself in the face of uncertainty .When the water gets cloudy, to stop staring up the mud, to let it all settle and trust that the bottom will appear again.

[00:27:10] Rachel: You can’t stop these things happening. , Can’t stop uncertainty, but you can choose whether you are disturbed by it and how long you stayed disturbed by it. Because you are not a frog. You don’t need to jump out the pan or the pond as soon as things are uncertain. You’re human being. You’ve got a brilliant brain, you really, really care. And sometimes the water is incredibly cloudy.

[00:27:33] Rachel: Uncertainty isn’t the enemy. It’s just life.