What to Do When Your Strengths Have Side Effects with Dr Joanna Bircher

Dr Rachel Morris: Have you ever spent time with friends and come back feeling that even after hours of conversation, no one really knows what’s going on with you? No one’s even asked. Are you someone who would rather share your toothbrush than share your feelings? Or perhaps someone who pours out their heart at home, but never lets on that they’re struggling with friends or with work colleagues.

In this episode, I chat with Dr Naren Senthil-Nathan, a GP trainer and mentor who knows firsthand the perils of bottling up your feelings, not admitting that you’re struggling, and avoiding asking for help. Naren shares his experiences as a BAME man working in medicine, and we explore the cultural and societal reasons why men, perhaps more than women, struggle with this. We chat about the perceived expectations and why it seems much easier to keep conversations at a superficial level, rather than showing vulnerability and disclosing more personal stuff about yourself.

So listen, if you want to find out why admitting you’re not okay can be so difficult for some people, what to do if you’re living with or trying to support someone who’s struggling, yet won’t seek help. And listen, if you want to find out how vulnerability and a little self-disclosure can help start to build authentic relationships in which we can be ourselves and admit how we really are.

Welcome to You Are Not A Frog, the podcast for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP, now working as a coach, speaker, and specialist in teaching resilience. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water. We hardly noticed the extra long days becoming the norm and have got used to feeling stressed and exhausted.

Let’s face it, frogs generally only have two options: stay in the pan and be boiled alive or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. It is possible to craft your working life so that you can thrive even in difficult circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues, and experts—all who have an interesting take on this. So that together, we can take back control and love what we do again.

We’ve had a fantastic response to the recent launch of our Resilient Team Academy Membership for busy leaders in health and social care, which gives online tools and resources to get a happy and thriving team. Now, the doors to this close this week. But if you want to buy for your PCN or bulk subscriptions for your organisation, there’s still time. So just get in touch and we can send you some more details.

A few episodes ago, we mentioned that we were thinking of running a thinking retreat for You Are Not A Frog listeners, and we’ve had an amazing response. So thank you, everyone who’s got in touch. Thank you for your wonderful feedback about the podcast. And there’s masses of enthusiasm for a retreat, particularly in nature, particularly around a fire. So we’re going to look for something in spring, summer next year. So do get in touch if you’re interested and watch this space. We’ll let when we have organised a You Are Not A Frog retreat.

Now, I’ve been going around the country these last few weeks seeing people, speaking face-to-face and also online with various courses and conferences. I’m going to be speaking at the Leaders in Healthcare Conference for the Faculty of Medical Leadership and Management in November. I’m running a face-to-face workshop on how to lead without rescuing.

We’re also doing a live online You Are Not A Frog recording all about failure. So if you have any questions about failure, please email them in or if you’d like to attend the workshop or the live You Are Not A Frog recording as a participant, then do check out the Faculty of Medical Leadership and Management website. Okay, so on with the podcast.

So it’s great to have with me on the podcast today Dr Naren Senthil Nathan. Now Naren is a salary GP. He’s a training program director up in Chesterfield. He’s also a GP trainer, and he’s a mentor for the GP-S scheme. So Naren welcome to the podcast.

Dr Naren Senthil Nathan: Hi. Welcome, Rachel.

Rachel: Great to have you with us. So Naren, I know that you have a special interest in the sort of cultural issues around mental health problems, the barriers that stop people recognising and sort of accessing help with their own mental health, I guess particularly for doctors, and particularly for men, and particularly for male doctors with a BAME background. Is that right?

Naren: That’s absolutely right, Rachel. Yeah. Now, thank you for having me on. First of all, it’s just a pleasure to be on. I know when we spoke a few months ago about this podcast, it was something that was very close to my heart. And as you say, from a South Asian background, originally born in India, moved over to the UK when I was very young, about four or five.

So having grown up in that culture and that environment, and comparing to where I am now, I just felt I could share some of my experiences, and suppose, helpful top tips for the demographic you’ve just described, to help them out in what has been clearly a very difficult few years as well for everyone.

Rachel: So now, why is it a problem in the first place?

Naren: Having had this personal experience, my parents were fantastic, my family were fantastic, very loving, very supportive. But I know from friends, family, and also culturally, that mental health just isn’t one of those things that’s spoken about at the dinner table, or even spoken about at all. People feel that there’s a certain taboo associated with it. It’s not a physical issue, so it’s not talked about as much.

It’s the usual stiff upper lip type of thing where you’re told typically, just to get on with it, deal with it, and get on with it. So, I think as a child, as you’re growing up, and in those formative years, you’ve been told these type of things, it’s pretty difficult for you to open up as you get older. I think that leads to lots and lots of issues as well. There’s a movie, I was just watching it the other day, it’s a Bollywood movie, Hindi movie where a baby’s first born, that’s the opening scene, and it’s looking up at its loving parents and its grandparents, and the father says, ‘Son, you will be an engineer.’

It’s very typical of the South Asian background where you’re told or you’re expected, sorry, to be one of three things: a doctor, an engineer, or something do with accounting or banking. Back in the day, you were thought of as a, almost a failure, if you didn’t achieve those goals, and obviously, things have thankfully changed a lot now. But some of the expectations can weigh up on an individual. And it’s a shame. It’s an absolute shame really. Those two things side-by-side just lead to a difficult situation for people.

Rachel: So what you’re saying is that mental health issues, or just even how you’re doing personally, things like that, possibly weren’t discussed as run of the mill things, and it wasn’t particularly acknowledged that it was okay not to be okay. Then that combined with this expectation that you will have a professional career and job as sort of a perfect storm, that means that it’s much, much more difficult for people to… Is it to identify that they are possibly struggling or have a mental health problem? Or is it that if you do identify it, you find it very difficult to get help? Or is it a bit of both?

Naren: I think it’s a good question. I think it’s a combination of both, in honesty. I think, because when you’ve been taught not to express your feelings, for example, or talk to someone about how you’re feeling really, you’re never really aware in the first place. ‘Okay, this doesn’t feel right. I don’t feel right. But I felt this way before so I know I can get through it’ type of thing. Obviously, we know that that can lead to problems if they’re not addressed because they can be a much bigger issue down the line.

I think, obviously, things are changing now. I can see that my friends that I grew up with, obviously, understand the impact of not speaking about certain issues growing up in obviously, the Western world. Actually, they’re encouraging their kids a lot more to be open, speak up about their issues. So hopefully, things are changing in that sense. But no, I think it’s a combination of things and obviously, if you’ve not been allowed to speak up, you don’t know how really who to go to, I suppose as well and how to express your emotions and your feelings.

Obviously, if you are feeling anxious and upset, there’s a number of ways that you can express those issues. It can be just speaking quietly, you could burst out in your anger, you may even turn to substance misuse, which is such a shame. But just I think it’s a combination of those two.

Rachel: I was gonna say what sort of problems have you seen in doctors from them suppressing this and not dealing with issues and not speaking?

Naren: I suppose if I’d taken more of a general overview of not just BAME, the BAME community, I can see that medics, I’m sure they’re… stressful jobs. It leads to earlier burnout. The level of stress, the anxiety that’s not being addressed. They turn to, as I say, substance misuse, be it your alcohol, smoking, et cetera, et cetera. It can affect relationships with friends and family, they don’t see them anywhere near as much as they should. It can eventually lead to unsafe practice at work, unsafe patient care, and it could have all been dealt with earlier on. Such a shame.

Rachel: Are there any particular coping strategies that you see maybe men from the BAME community adopting more often that may be more culturally acceptable than others?

Naren: Yes, I suppose if I use an example, a real-life example of a friend, who, he is a close friend. He is from the BAME community, and he works in healthcare. For many years, unfortunately, his dad wasn’t, his parents weren’t very good at allowing him to speak, it was just again, just brushed under the carpet. He’s got a family now, lovely family. But he doesn’t speak about his issues.

Now he’s on long-term sick, and he hasn’t really taken time for himself and any self-compassion. He hasn’t been doing the right things in terms of stopping burnout. He’s actually in long-term sick because of burnout, because of stress, which has led to not a breakdown, but just a lot of stress and low mood anxiety. Thankfully, he’s doing a lot better, but it just hit home. I think that’s the type of person I keep in mind, that I’d like to help out with by doing things like this podcast, and so on. Cause that shouldn’t happen to anyone, mostly sad to see him go through that. But as I say, back to that bad place.

Rachel: So it’s that not talking about it, not expressing your emotions, expectations, just keep going and going. Rather than just taking a little bit of timeout, actually, what happens is you end up with quite a spectacular burnout, which then just persists. And I guess if you’re not removing the problems, so if you’re not making any modifications to work, or your expectations of yourself, or if there’s no self-compassion, and you’re just going to go back into exactly the same situation, then that’s going to be very difficult to heal from. If you’re not, at a point where you’re happy to talk about it, or admit it or speak to a professional, then that’s going to be really hard to hear, isn’t it?

Naren: Absolutely. I suppose this happens socially, still to the day, Rachel, where, unfortunately, men have to be the alpha male or the macho male, where they don’t really talk about problems. No, it’s not a done thing. But we know that’s problematic. I can see it happening every day to friends. And yes, it’s difficult. You can’t just go up to a random person and say, ‘Oh, I’m feeling this way.’ Obviously not. No, because that would be a bit odd.

But obviously, if you have a trusted group, your other half, your partner, whoever, or even friends. I think that the most difficult step, the first step, is to actually recognise you have an issue and speak up about it. I think if that is done, I deal with patients all the time, especially young men, who come in and say, ‘Oh, I’ve been feeling this way.’ I tell them, ‘Well done for coming to see me and speaking to me because that’s the most important step: recognising the issue.’ They feel a lot better, and they engage with the process.

Rachel: That’s really interesting because I see that in my work as well. So when I run the Shapes Toolkit Courses, the majority will be women on the courses. Often, if I run them for training schemes or GP fellows schemes, we’ve got an equal number, and they get equal feedback from the men and the women. But if it’s a self-selected, do you want to register for it, it will be overwhelmingly women. I’ve had a male facilitator with me and they said, ‘The men need this just as much, maybe even more.’ The women, for some reason, are just happy to go, ‘Yeah, I need that. I need that training.’

Then the other thing that I have noticed, and this is a sweeping generalisation, so please do correct me. When I meet my friends for coffee, I have a group of friends I meet every week after circuit training class. Often one of us is having a hard time with talking about what’s going on. It’s difficult, and maybe someone’s in tears. It’s a really good source of support. It’s so helpful. I was in a coffee shop the other day just doing some work. And this group of about sixty-year-old men met up and sat down next to me. They’d gone for their coffee. I thought, ‘Wasn’t that nice having coffee?’

Honestly, they spoke for an hour and a half about football. Literally an hour and a half. I could hear every word of it. I thought I mean, ‘Okay, fair enough. You’re interested in football.’ But like, I was thinking, ‘You’re probably a grandfather. You’ve probably got your own business. You probably got this and that.’ Not once did they say, ‘How are you doing? How are you getting on? How’s work? How are your kids?’ Nothing? I thought, ‘Is that normal for guys?’ I don’t know. Because I don’t meet up with loads of guys. I don’t meet up with a bunch of guys for coffee. But is that your experience?

Naren: Yeah, no, I can resonate. I can relate to that. Growing up, during school, college, uni, the workplace, group of lads, it’s typically over, particularly over a pint of beer, dinner or a drink in the pub. It’s not really conducive to chats about wellbeing and how are you doing. Even if you do go to a coffee shop, for example, it’s usually to do a sport.

It’s historic, isn’t it Rachel? So men are notoriously rubbish at talking about any sort of health issues, be it physical, be it mental health issues. It’s just a case in point of the gentlemen in the coffee shop: They just don’t talk about their wellbeing and how they’re doing. A simple question of ‘How are you?’ is not heard. I suppose, how are you doing type of thing, but ‘Tell me more about how things are going’ is not a done thing in there, absolutely.

It’s so so interesting. And I’m so happy that you’ve mentioned that point, Rachel about kind of women accessing more of the courses, like the Shapes Toolkit and the mentoring. That’s what I found during my time with GP-s so far, is I think 90% of the mentees are women. I refuse to believe that men are coping okay, I really do. I refuse to believe that.

Rachel: They are not, I can tell you that.

Naren: Absolutely. I don’t buy into the thing about not having enough time, because I know lots of men, lots of friends who are GPs who don’t do the eight and ten sessions. They do have a fixed date with et cetera. So finding time is not the issue. There is something else, and I think this is one of the major issues that it does not seem to be socially or traditionally accepted for blokes to talk about their issues.

Rachel: Okay, let’s get down to it. Yes, it’s not socially, culturally, historically accepted. Is it because it’s seen either by themselves or by the group as a sign of weakness? Is it something to do with pride? What is it?

Naren: I’d say women are complicated, but blokes are more complicated, to be honest.

Rachel: I agree.

Naren: I think you’ve hit the nail on the head on all three, Rachel. I think it’s the pride thing. I think you’ll see it. If other blokes see one of their friends feeling a bit weak about things, they think less of him. It’s horrible. I think it’s that thing where the male or the man is supposed to be the strong one, the provider, whatever, and he can’t afford to be weak or talking about his issues. I’ve got a funny feeling those things will not completely go away. It’s scary to say that, but I think obviously, by doing things like this, raising awareness, is one of the ways that we can help people in that situation to come forward and get the help that they need.

Funnily enough, one of the registrars that is on the chair training program. I heard his story and he was someone who took shared paternity leave. It’s kind of working. It’s not that thing where he gets two weeks of part leave and he comes back to work and everything’s hunky-dory. No, absolutely not. I spoke to someone last week who has just come back from part leave. He missed the first meeting because he was busy with childcare; he’s got a newborn. So I refuse to believe that just because that they’re a bloke, they don’t deserve the same amount of support in that sense. But it’s up to blokes to recognise, engage, and get the help that they need.

Rachel: If you were in the pub because it’s interesting, you said, ‘Oh, the pub is not the right place to bring it up.’ But I’m thinking, ‘Well, why not?’ Because if I’m the wine pub with a glass of wine or pint of beer, frankly, I’d bring it up. Girls would. So why is a pub not a conducive place? If you brought it up in that situation with your mates, what would happen? Would it be like silence, everyone shuffles around, looks a bit awkward, goes, ‘Sorry about that, mate.’ And then goes back to talk about football or what? Or would they engage?

Naren: let’s see how many pints would have done that.

Rachel: You could reach that point where you just start weeping, isn’t there?

Naren: In all seriousness, I think if it was a one-on-one with a friend, with a mate, it would be okay. But if you’ve got a group of lads, it can be a lot more difficult. Again, it’s that whole macho thing of men being men, boys being boys type thing where they just don’t show it. And I don’t know if it’s genetic or what, but you’re absolutely right, Rachel.

Women are more likely to speak, whatever the situation, perhaps. I’ve seen with this whole child kind of thing. Two dads go to the park with their little ones, and that’s a good time as well. The problem with pubs is, you don’t know how loud it’s going to be, et cetera, et cetera. I think, one-on-one, maybe in a group of three, rather than more than four or five would be a lot easier to speak about these issues.

Rachel: I think that’s true for women as well, I think there is something about a smaller group, and one-on-one being much, much better. But sometimes we don’t sort of put ourselves in that position where we would have those sort of quite intimate, intimate relationships. I think I’ve observed over the years that I think women sometimes form those relationships more than men, I think sometimes men can get quite lonely in their social relationships, or end up just having friends who are partners of their wives, or things like that. Is that a correct observation?

Naren: Yeah, no, it’s interesting you mentioned that. So my daughter’s started at a new school. One of the first things we like to do is obviously connect with other parents. So when we went for the formal, informal visit of the school in the last term, and so on, the headteacher said, ‘Oh, there’s a mums’ WhatsApp group.’ I was like, ‘Oh no.’ Because I want to be part of a dad’s WhatsApp group, there may well be one. But it wasn’t the first thing that this headteacher said. Anyway, so the moms are obviously very good at socialising, interacting with each other, organising playdates, and such a source of useful help. They got this club on that day.

I suppose, men, just, again, I refuse to believe they don’t want to be involved. But they don’t get involved for whatever reason. The other thing is, we find that with GP trainees do say, drop their kids off in nursery or school or have those social circles external to the training program. Most cases fare a lot better during training because they formed those circles, because they formed those networks, and they’re not isolated. You’re absolutely right. The loneliness is a key factor that men tend to just get on with it and, not become reclusive, but yeah, they sort of are withdrawn from all of these activities.

Rachel: There’s something else that plays into that relationship thing as well. So you were saying that men are taught you don’t want to show weakness; you’ve got to be the strong one. And culturally, admitting something’s not right often doesn’t happen. And all the stuff I’ve been listening to and reading about, and hearing about forming deep close relationships, interpersonal relationships, is about vulnerability and self-disclosure.

So the way to form close relationships and supportive relationships is to be vulnerable with somebody and is to self-disclose something. I mean, you don’t need to completely bare your soul, but just even a little bit, that is the way we form close relationships. But if you’ve got that thing about, ‘I must be perfect. I must be the hero.’ And then you’ve got the cultural layer on top of that, and it’s not okay to admit that, presumably, that’s like a double whammy for men.

Naren: I love this concept of vulnerability. It’s just helped me out so much over the last few years. Being vulnerable, I must say, I suppose if there’s any takeaway point from this podcast, for anyone listening, is being vulnerable is not a sign of weakness. Just because you speak about things that are affecting you doesn’t make you a weaker person, in fact, it makes you stronger because you are speaking up about these issues.

You can have one person that you go to; you can have two or three people. If you want to form meaningful relationships, get to know that person, and just knock on the door and say, ‘Can I have a coffee with you?’ Obviously, the person will just have that feeling of dread. The moment you say, ‘Can we have a chat.’ It’s ‘Oh, dear God, who have I killed?’ As in work or whatever. ‘I’ve got a court hearing in question’ whatever but no, it’s just informal chat.

The main person I go to is my wife, and I think she’s helped me a lot so much. Even with work issues, she’s been the bedrock in building a solid work career and vice versa. I’ve been there to support her. So that’s kind of the kind of teamwork I suppose if I extrapolate that to work, I think with the mentoring job, I’ve realised how fortunate I am to work with the people I work with. I’m not just being biased, but I do mean that. We do look out for each other, and nothing’s too much trouble. I think that all helps. If you set the boundaries out of the start, not boundaries, I should say, set the set of expectations, tell them what you’re like. I like to chat about things, tell them to come to me with some problems. And usually 9 times out of 10, the other person said, ‘Yes, of course.’

It’s almost forming this thing called tribe, forming a tribe that you can rely on, you can count on and they’ve got your back, and you’ve got their back. I no longer get Sunday night blues, when I’m going to work on Monday, because I look forward to the people I work with to have those informal coffees and that the huddles, for example, and so on, and that improves your resilience, at the end of the day, knowing that you’ve got a supportive work environment. Having listened to your podcasts, Rachel, going back to this quote: ‘survive and thrive.’

I actually think, more than just survive recently. It’s more just thriving. That’s all because of the simple concept of vulnerability, speaking up about those issues, and what may seem like a massive issue was actually just something so minor that you thought, ‘Why was I even bothered about those type of thing?’ I’ve gone home knowing that we’ve discussed this; we’ve moved on. And it’s perfectly fine. Because I used to be the typical bloke who university, F1, F2, et cetera. It’ll be fine; I’m getting over this. My wife tells me, ‘What are you doing? This is horrible. Don’t sweep things under the carpet. Talk to people. You feel a lot better for it.’

Rachel: Did you have to practice being vulnerable?

Naren: Absolutely. It’s difficult when you’ve got a learned behaviour of not talking about things. So it would be a case of, I suppose, coming home and not debriefing, but just having a chat with my wife over dinner, and it builds from there. So if you’ve had a particularly rubbish day, whatever you might be doing, you come to have a chat to that person, or if you’re a member of your tribe.

Same with work. You might be having a rubbish day, rubbish patient, don’t know where to go in your career, you’re having a bit of a rethink in your work-life balance. You talk to that person and that you trust and that transparency, I feel improves relationships. So the more you do it, the easier it becomes. And also, if you go to that other person, you really trust them. They know how to pitch the level of challenge and their response as well because they’ve got to know you, they got to know your personality, likewise.

Rachel: It does start with a little bit of self-disclosure itself, doesn’t it? And it’s interesting when you’re saying about building your tribe. There are some practices, some workplaces that are really closed off. Everyone’s okay, everyone’s fine. But it doesn’t take many people, it just takes one person to go in and go, ‘Oh, I’ve had a crappy. Oh, that’s been awful. I’m really worried about this.’ And everyone goes, ‘Well, okay that person said that.’

You can share a little bit more than next time. It’s not about baring your soul completely to start off with; there is such a thing as oversharing. But little by little, and maybe it’s someone who really cut for them culturally, that’s difficult, or for whatever reason, just start with something, just share something that you wouldn’t normally share with someone that you think might appreciate that and see, you’ll probably be quite surprised at what comes back. Have you found that when you’ve shared with people, they’ve actually reciprocated? And they’ve told you stuff?

Naren: Oh, absolutely. 100% Rachel. So if I use actual real-life examples, so first example is this morning somebody I was mentoring and he is a UK graduate, grew up in this country, et cetera. But he works at the practice who sound like they’re very isolated, so I told him this and let’s call him Bob, for argument’s sake.

‘Bob, why don’t you go upstairs the meeting room and say to everyone in your team, “I’m going to have lunch upstairs, get away from my consulting room. Let’s have some lunch together. Let’s have a cup of tea or coffee.” Get away from our screen in front of you. And have those conversations about just how’s your day go? What did you do at the weekend? Or what are your plans for the weekend?’ Doesn’t have to be, ‘Oh gosh, I’m having crap time at home, et cetera, et cetera,’ straightaway. Little by little.

So the other example I’d like to bring in is more, I suppose the issues faced by individuals from the BAME community, Rachel. So we’ve got a lot of registrars who are from, I don’t like the term international medical graduates, but who didn’t train in the UK, for example. What I found over the years is that because of their training programs and their job nature in, say, hospitals, for example, it’s very hierarchical. There’s very little use of first name terms.

I tell people, when I first meet them, ‘Please just call me Naren. Don’t call me Dr Nathan.’ It’s difficult, poor souls, for them to get used to it. There’s a bit of a barrier in that sense. And, again, it’s more of a case in those cultures of don’t talk about issues, just get on with it. So when you do speak to them, it’s not something initially where they’re, ‘Oh, what’s going on here.’ So it’s a confused look from them. But again, it’s chipping away, chipping away, letting them know that they’re in a safe environment, in a safe place where they can share. And actually, they do open up, and we’ve learned amazing things about our registrars in these informal discussions.

Rachel: What I’m interested in is how we can help our colleagues be more vulnerable. I’m a person that well, as you know, I’ve got a podcast; that’s what I tell everybody about me. So I never really had a problem with opening up and sharing. To me, it’s really weird that somebody wouldn’t, that someone would just think it was completely dreadful to have to show weakness. So that’s completely alien to me.

If I had a colleague like that, in a practice, or in my workplace that were, maybe it was bit obvious that they were struggling, but they were very private, how to help them, how do I even approach that?

Naren: One of the quotes that I’ve loved listening to over the last few months is: ‘Be the change you want to see.’ So you knock on their door, you go for a cup of tea, or a cup of coffee, and go for a walk. Not even engage them in that issue that’s bothering them. Talk about their hobbies, what they’re doing in their spare time, et cetera. ‘Well, how’s training going? How’s work going? Did you see the football on the weekends?’ I think building up that trust with that individual can take time.

But again, if you are say, in that scenario where you’re having a meeting or you’re having lunch, and you do slip and say, ‘Yeah, it’s been a bit of a rubbish day. It’s been of a, I’ve had a difficult patient.’ They will then observe you talking about those issues, and then hopefully they’ll start to put that into practise. It’s a fine line of being too intrusive. But I think slowly but surely, that you keep engaging them in conversation, letting them know that it’s okay to talk. Let them not be lonely type of thing. Hopefully, they’ll start to open soon.

Rachel: Then how do we spot the signs? Because I’ve spoken with several guys who have been getting more and more stress things, and worse and worse and worse. And what ended up happening is they have literally burst into tears at work and completely lost it. No one had any clue. It’s been really difficult for them. How do you spot that before it happens?

Naren: I know, if I say for example, I use it myself as a case study is people have noticed that I’m not the usual jovial self; I’m not the usual smiley, chatty person. I think that’s the same. So you have to understand the person of their baseline.

So what is their behaviour normally? Do they tend to work X amount of time? And if anything gets worse? Are they turning up later? Are they staying later? Because they’re not confident in their skills and their judgment? And are they more than usually the bigger size? Are they more withdrawn? Are they coming out of their room? Are they having lunch with others? Is stuff getting missed? Are they getting more complaints? Are they even clean-shaven, and they’re now growing a beard?

Things like that, something out of the ordinary. Or if they might snap as well. I think a person I talked about before ended up crying, unfortunately. So they might have outbursts of anger, or their email responses might be a bit off, a bit out of character. So it’s like a Swiss cheese model, trying to pick up those problems earlier on, if there’s any change to the norm really.

Rachel: Then what do you do if you spotted there’s something wrong? You can tell there’s something going on but like you said, that person doesn’t feel they can admit it because of pride or because of background or because of culture. But you really know there’s something wrong that you’ve asked them, ‘How are you doing?’ They haven’t engaged. Can you do anything?

Naren: Yeah, and I think this is where it goes to teamwork, really. So you know that there’s an issue, you think there’s an issue, you tried engaging this upset individual. You then speak to your colleagues, not in a bitchy sense, because I listened to the podcast with Ed Pooley recently. So not in a bitchy sense, but more in a supportive sense that ‘I’m really worried about Bob. And have you noticed any issues as well?’ Perhaps just two of you go in or the partner goes and just has a chat with the set individual. ‘Is anything okay? Can we grab a drink or a coffee? Just let you know we’re here for you,’ type of thing.

Sometimes it’s just those words that that person needs to hear to say, ‘I think, yes, I can trust these people I can get some help.’ Or even recommending things like, ‘Have you spoken to somebody about how you’re feeling?’ Or even recommending things like your mentoring or coaching, just to help them through really. It may not be you who has to take on that burden of trying to crack through their personality, that barrier, but trying to direct them in the right place, in the right direction.

Rachel: And then encourage them to take that professional help. Because I guess in my experience, women are more likely to seek help sooner and pick it up when it’s offered. Men tend to—big, big, big exaggeration—but tend to only do it when there’s a crisis. And then they see the value, and they go ‘I should have done this years ago.’

Naren: It’s interesting because a couple of mentees I have recently, two of them are men, yes we talk about career development, et cetera. But it’s a lot to do with how because they’re newly qualified GPs. And there’s a lot to do with how they’re feeling and the emotions of bigger post-CTGP. You can see that the cogs are turning, and they’re slowly starting to express how they’re feeling, and after the session, they feel a lot better for it. So like you said, professional help, things like GP-S, your practitioner health, the BMA offers some support. They support men really, male doctors.

Rachel: I guess I’d always be encouraging guys to access it even more. Because often, women have got their informal support structures much, much better ground out. I know I’ve got several girlfriends, I could just phone up and go for a walk. I’ve got my other half I could talk to. I’ve got my, my group of gal pals. I know I’ve got it there. And then there’s also, I have my own coach. Access it, I know how important it is.

Naren, just one further question. If you’re a woman, and you’ve got a bloke at home you just know is struggling. They’ll talk to you. They won’t talk to anyone else. What should you do?

Naren: I use the example of well, my wife and me. I think it’s, again, making small inroads, just checking in on them. ‘How are you doing?’ Et cetera. But also, perhaps, if that man likes a celebrity, for example, or a sports person? ‘Oh, honey, did you notice that this person has come out in the news and spoken about their issues?’ Because a lot that’s happening a lot more, and they’re a lot more open, which is fantastic, especially if they’re on social media. They’re more likely to express their opinion on those platforms.

You might ask their best mate to come and have a chat with your partner. But no, I think the first option is quite a good one, actually. To let them know that it’s okay to feel this way because the people that they look up to, for example, they talk about their problems.

Rachel: Yeah, that’s interesting. I have been known to strategically leave books lying around, but they’re never read. But I think what I found, and my girlfriends have found this as well, that a lot of the time, their other halves will accept stuff if one of their guy friends has recommended it. So I think that point about getting another guy to recommend stuff and say, ‘Actually, this was helpful, and why don’t you try that?’ That sometimes lands better than the wife recommending it. Working in the background there, just a gentle nudge in this direction, gentle nudge in that direction.

Naren: Absolutely.

Rachel: We’re nearly out of time. What would your top three tips be for I guess encouraging vulnerability, getting deeper relationships where you can start to talk about this stuff and getting helped?

Naren: Top three would be to acknowledge that you have an issue; we honest with yourself. That would be number one. Number two would be know that vulnerability, as I said before, vulnerability is not a sign of weakness. It’s okay to ask for help. Self-compassion is not a crime. And number three, build those meaningful relationships that will treat you. Have a work family, so to speak, open up to them about how you’re feeling, and you will feel better. Relationships will be better. You’ll thrive at work.

Rachel: We do need friends at work. So important. Gosh, we spent enough time there, don’t we? So where would you point people if there’s someone listening to this who catch ‘I really do need help’?

Naren: Yeah. So I would point them to the direction as I said earlier on practitioner health UK, GP-S, and I’m happy to have the chat with people informally if they want. I have my Twitter handle and email, et cetera. And I think the best resource is actually yourself and the people that you work with, to be honest.

Rachel: There’s a lovely book called Time to Think by Nancy Klein. She talks about forming thinking partnerships with people. So her sort of strapline is: ‘The quality of my listening determines the quality of your thinking.’ And it’s a great way of finding out what your thinking is talking things through, and she literally suggests get together with someone for an hour: 25 minutes, you talk, they listen, 25 minutes, they talk you listen. So it’s very mutual, it’s very supportive.

You’ll find that you really develop a depth of relationship and you sort out a load of issues, you might not have sorted. I just did want to ask you, though, what is GP-S for people that don’t know?

Naren: Yeah, so GP-S is a mentoring scheme that’s set up in suppose our local area in Nottinghamshire, in Derbyshire. It’s a free service that’s set up by GPs for GPs and also primary care staff. And you get a certain number of sessions over the course of a few months, completely confidential. I’m sure, if you’re listening and you’re not in that area, there will be other similar services around the UK as well.

Rachel: There are lots of services, there are lots of schemes, and I think many of them are underutilised. They’ve got availability, and particularly over COVID, there’s been a lot of coaches that have been offering their services for free. They haven’t been used. Now, some of that is that people are busy, but actually, I know I would say this, I’m a bit biased as a coach, but really, coaching brought me 18 months further forward in the space of six weeks.

Naren: And we know that workload retention crisis in child practice and primary care. We know that coaching and mentoring can really help someone get that unbiased view.

Rachel: Yeah, and there’s the Akita Network where I am. Most regions will have their own network. So just really encourage people to access that. So thank you so much. That’s been really, really interesting. And I hope we haven’t been too sort of sweepingly generalistic about guys and gals. I know that it’s not as cut and dry as that, but it’s just I guess it’s really interesting to hear your observation’s actually quite similar to mine.

Naren: No, I really appreciate you having me on this podcast. I appreciate the time, and as I say if someone wants to get in touch with me, I’m more than happy to chat. It’s been a pleasure.

Rachel: Great. Thanks so much. Speak soon, hopefully.

Naren: Take care, Rachel.

Rachel: Bye.

Naren: Bye-bye.

Rachel: Thanks for listening. If you’ve enjoyed this episode, then please share it with your friends and colleagues. Please subscribe to my You Are Not A Frog email list and subscribe to the podcast. And if you have enjoyed it, then please leave me a rating wherever you listen to your podcasts. So keep well everyone. You’re doing a great job. You got this.