Hi, welcome to the Transforming Stress with Dr. Ash podcast. And today I'm really delighted and excited to invite Dr. Rachel Morris. Dr. Morris is the host of the very famous podcast You Are Not a Frog. And I've been listening to it for the last three years. Dr. Morris is a former GP. She's a senior executive coach. And she has passionately driven the cause of physician and healthcare well-being. Dr. Morris, you are really welcome to the podcast Transforming Stress with Dr. Ash. Thank you for joining us.
SPEAKER_01It's so good to be here. Thank you for having me.
SPEAKER_00So I want to give a little bit of a context to how I came to know about you are not a frog. For many listeners, you are already familiar with the analogy of the boiling frog. This is an analogy which is commonly used in organizational psychology for chronic stress. And I have been uh I have been talking about this for the last more than a decade in medical grand rounds. For the non-medical people, it is a formal teaching session we have monthly in the hospitals where we share our learning. So when I was presenting in 2002, early 2022, uh the on the topic of the boiling frog in the Jersey hospital, one of the participants, uh a nurse, she asked me, Have you heard of uh have you listened to the podcast You Are Not a Frog? I said, No, I have not never heard about it. So she just go and listen and you'll be really hooked onto it. I listened to it and Rachel, it was really amazing insights. And since that I've dipped in and out, and really congratulations for the work you have done in this very important area of physician and healthcare wellness. So I would be grateful if you share your story about You Are Not the Frog.
SPEAKER_01Oh, well, we started the podcast in 2019, and it was really based on the fact that I was struggling myself, and I was getting more and more addicted to what my partner calls self-help books, but I call them self-improvement um resilience books. I was reading everything else I could get my hands on, but not really the medical journals I should be reading. And I realized I had developed a real interest in what makes professionals in high-stress jobs ticked. At the same time, I was working as a GP and I had that weird um problem of being very bored and very stressed both at the same time. I've also had a career in which I have struggled, I didn't like a lot of my jobs, I pushed on through. I thought that when I wasn't doing very well, the the only response was to work harder and harder. And I found myself with three small children, uh two different roles, one in medical education, one as a GP, and and really feeling pretty miserable thinking, well, is this all the areas for life? I don't actually like the career I'm in. I don't think I'm doing a brilliant job. So I thought, well, is there anything else that I can do? And I felt pretty trapped, to be honest. I felt like I had no choice. Um and I think it was just after my 40th birthday. I was at a New Year's Eve party and I said to my husband and my sister, Oh, what are your New Year's resolutions? And they said to me, Well, we don't have any, Rachel, but yours is to get a new job. And it was the first time I'd ever thought could I do that? Or do I actually have the choice? And they said, Yeah, of course you do. I said, Well, I have no idea what on earth else I would do. And so that started me in my journey. I got some career coaching, I did a lot of investigation, I did a coaching course, I initially started for health coaching, um, I then trained as an executive and a team coach. And during that time, I learned some fundamental models which shifted my thinking. They were based on coaching and productivity and neuroscience, and I just wish I'd learned them when I was at med school because they would have really, really helped when I was on the wards and really, really struggling as a junior doctor. So I put those together, put those shapes together and those models together to form the Shapes Toolkit course. And I've been, me and my team been going around the country, both live in keynote talks, um, live sessions, online sessions, I've been delivering this course all around how to be burn out and work happier to healthcare professionals since then. And as part of that, I started the Earl and Our Frog podcast just because I like the idea of podcasting. I thought, well, I wonder if I can do it. I wonder if anybody will listen. Um really to find out how do we be burn out and work happier? Because you do always have a choice, but in healthcare, it feels really hard to make the right choices. And that is the problem. And part of the way along the journey, I went on a uh retreat um in the Alps, where a lot of the business people had gone on that retreat and uh they had moved the entire family over to the Alps. I thought, wow, this would be brilliant. Imagine if I could move my family to the Alps and they were working in the morning and going skiing in the afternoon. I thought, wow, what an amazing life. And so I was reading the Mary Oliver poem The Summer's Day. The last line says, Tell me, what is it you plan to do with your one wild and precious life? I thought, oh great, I'd love to have a wild and precious life, but I can't move to the Alps. I've got a family, they're all at school in Cambridge, my half runs a business, so I can't move to the Alps. Um I have no choice. And then I realize that I do, I do have a choice. But I'm choosing to stay in the life I'm in, I'm choosing to stay in the job I'm currently in. And if that's the case, how can I have a wild and precious life? Even on a Monday morning, even in the life that I'm currently living. So we call our organization wild Monday. Because I thought it must be possible. And and so the You Are Not a Frog Podcast is not just looking at how to beat stress and burnout, but actually how can we have the life that that we all want, in which we can thrive and not just survive, even in our current work, even working in healthcare, which is getting harder and harder and harder.
SPEAKER_00Harder and harder. Harder and harder. So thank you so much for sharing that, Rachel. Uh what you described, you were what you described where you were in 2019. I was there in 2014 when I was feeling burnt out. I was working in the one of the hospitals in Midlands, and everybody in that hospital seemed to be very angry, angry and grumpy and exhausted. Later I came to realize that this hospital was uh under a public inquiry, and there was a huge prevalence of burnout. Around the same year, I was traveling to the United States where I met Di Grammund, who was speaking to around 4,000 doctors, predominantly from the US, on the area of physician well-being and burnout. So after doing the Mass Lacks burnout inventory, I realized that I was severely burnt out, and but on the surface, I seem to be performing. And that started my own journey of coaching and leadership. And I have to share with you in the last 10 years, it's been a small gradual increment, but I've I've I have been having my cake and eating it too. And I have been successful in transforming it into a this boiling frog environment into a comfortable jacuzzi. Now it's been a journey, it's not happened overnight, it's happened over the years. As we discussed with you, that if you throw a frog into a hot water, it will jump out. If you throw a frog into cold water and slowly increase the heat, the frog succumbs to it and dies. Chronic stress has a very similar effect. Now we see in the healthcare, like was my case, that I wasn't aware of the burnout. Even if we are severely burnt out across the three different domains of uh MASLAC's burnout inventory, physical exhaustion, uh, mental, and spiritual. What is the purpose? So, Rachel, what is your experience working with healthcare professionals and professionals in other high stress performance that people are not even aware of their own wellness? And that is a very difficult starting point.
SPEAKER_01You're so right. It's such a difficult starting point. I think there's a few things to say. Firstly, is that I think stress and burnout has been normalized in in medicine, in healthcare. So it's a bit like, well, actually, yeah, you're feeling better out. Well, the rest of us are, that's just normal. That's just normal if you work around here. So we've been so used to being in the hot water that we haven't noticed that it's hotter, just like that frog. So we think that stress is normal. And one of my messages is to people like, stress is common. Doesn't mean it's normal. It's actually really bad for you physiologically. Stress is a warning sign. But if your warning sign's going off constantly, you just ignore it, don't you? And then it has to like go off even harder to get your attention. So we work in an environment where stress is normal, where burnout is so prevalent that it's quite hard to tell if you're burnt out or not, particularly if you're comparing yourself to your colleagues. If they're burnt out as well, and you're looking and saying, Well, I'm not as burnt out as that person is, then what we're doing, we're comparing ourselves to someone who's really, really burnt out, then we don't think we need to do anything about it ourselves. So part of the problem is you can always see somebody that is more burnt out than you. But I've also had this other realization. I had Dr. Richard Duggins on the You and Out of Frog podcast recently, and he works for practitioner health. He's written a book about burnout, and he talks about the burnout cliff where doctors just carry along, carry along, and then suddenly they drop off this burnout cliff. Now, one of the models we teach is the stress curve, which I'm sure uh you you talk about as well, where based on very old old work, Yerkes Dodson. Yerks Dodson 1908, um, in a journal of um some psychological journal. Anyway, it basically shows what happens to your performance under increasing pressure. So as the pressure increases, your performance goes up, but at some point you plateau off, and then as the pressure increases, your performance then starts to come down. So my question is, well, how come so many doctors who are in burnout? So we've a colleague of mine measured all the doctors in his trust, 50% of them on the Maslac inventory were in burnout. If 50% are in burnout, how come we're not seeing that in their performance? How come they're not all going down the performance curve? And I asked, asked Richard this, and he said, ah, that is because they borrow their performance at work from every other area in your life. So what you're doing is you're preserving your performance at work. So it looks like you're doing fine because you're functioning at work. But then every other area of your life, like your hobbies, your families, your well-being, your health, that has just taken a nosedive. And so I think that's what happens when we get to the burnout cliff. It's when everything has got so bad that we can't even preserve our performance at work anymore, and we just go we just go off the cliff. So I think that is that is a big problem. It's why we don't recognise burnout, because we go, well, I'm doing quite well at work, I'm I'm functioning pretty well. And we don't recognise the other signs, we just use performance as a measure, and we know that the other signs, according to the World Health Organization, the classifications, are extreme fatigue, you know, that's not relieved by arrest. And I've got several colleagues that are absolutely knackered all of the time, and no matter how much they sleep or nap or try and recover at the weekend, they're not feeling better. And then you've got this other um dimension, which is sort of the cynicism and the lack of empathy and the sort of depersonalization and all those sorts of things. So you find yourself getting really cynical about the work, about the patients, about your colleagues. And and I think that could be masked as well, because quite frankly, looking at the state of the country and the resourcing and that, who wouldn't be cynical? So it's pretty normal to be cynical as well, because just look at what's happening. So it's quite hard to spot when someone's extra cynical or they've really, really lost their empathy because of burnout. So you've got all these things colluding to mean it's difficult to recognise, then add to that that people don't like to admit it because they feel that they're weak. And we also ran a poll recently amongst our members and people on our our mailing list and our podcast listeners is that one of the reasons healthcare professionals don't ask for help, yes, they don't like doing it, they think it makes them look weak. But a lot of them said, What's the point? I asked for help, nothing happens.
SPEAKER_00Nothing happens.
SPEAKER_01Or they're gaslighted in thinking, well, that's your fault, you just sort yourself out, you know. Or they think it will affect their, you know, performance review and things like that. So fear even if you are burnt out, you might not put your hands up to it or certainly not seek help, because like last time I looked for help, nothing happens, so it's just futile.
SPEAKER_00Very true. I mean, you mentioned the state of the country, and what we have been seeing in the hospitals and possibly in primary care also, that there is more and more staff shortages, more and more cut on the staff. Now, what's happening there, Rachel? That people who are remaining have to do more work. Now, if they do their damned, if they don't do their damned, if they do it, they are taking more on their plate, and as you said very correctly, it's coming from other areas of their lives, their personal lives, their family lives, their own health. If they don't do, then there is that culture of fear, culture of shame, culture of guilt, a culture of bullying. And that kind of unrealistic expectation for people who are remaining on board to take the take the work of other people, how can that be normalized? And what are your experiences with this situation?
SPEAKER_01It's really, really hard. And here we get into the systemic issues now. The system is well above my pay grade, and luckily there are some very clever people looking at the system and how we can change it. But in my lifetime, the NHS has been reorganized a million different times, and you know, each time it seems to get worse, and the more it's used as political football, the worse it gets. I think that we need systematic change. But the problem is an individual can't create that change. So I think we can slip into the mindset of learned helplessness that nothing can get better for me until the system changes. I'm not going to be okay until the rest of the system is fixed. And the problem is if you think like that, you're going to be waiting a very, very long time.
SPEAKER_00Not in this lifetime.
SPEAKER_01Not in this lifetime. And so we have to acknowledge that the system is broken and things are being done, some helpful, some really, really unhelpful. And I always, any training I do, I always talk about resilience victim blaming. Because the system would love to say, you know, well, actually, if you're not surviving, it's your fault. But if you put someone in a toxic system and then they're not doing very well, well, of course it's not their fault. So, you know, let's not blame victims or who are burning out. Absolutely, it's not their fault. However, whilst we're choosing to work in this system still, and remember it is always a choice to carry on working, you know, at the bottom line, you could leave. No one's got a gun into your head saying you have to work. Now, that's very controversial because it's like, well, how am I going to feed my family? What else could I do? But you know, there are people that are choosing to hop out of that pan that are choosing to leave. Now, I don't think that's the best option. I would love people to be able to stay, but like you said, Ash, we need to turn down the heat in the pan. And yes, the system is trying to do that, but you know, we might be waiting a long time. So, what is it that you can do yourself to turn down the heat in the pan? So, what I teach is about actually what is in your control. And I think the control thing is really, really important because one of the quickest ways to burn out is to get the control issue wrong. And I I see that healthcare professionals generally have two problems with control. Either they take far too much responsibility for stuff they have absolutely no control over. I remember doing a talk with some GP trainers. I said to them, Well, you know, what do you feel responsible for? And they said, Everything, you know, their trainees, if their trainees passed their exams or not, if their trainees were happy, some of them were even feeling responsible for the state of their trainees' relationships, you know, all of this stuff totally out of their control. You know, in actual fact, what they were responsible for was what training the practice gave, how they organise a time label, what they asked people to do, and the sort of boundaries they set. That was pretty much all they were in control in. But when we try and take control over stuff we have no control over, that is an incredibly anxiety-evoking state to be in. You know, you can't do anything. All you can do is get very, very stressed, or you can learn to accept it. And accepting it is is is hard. But that that way serenity lies. We've got the serenity prayer, grant me the serenity to accept the stuff I can't change, the courage to change the stuff I can, and then the wisdom to do to know the difference. So I've noticed that healthcare professionals when they try and take too much responsibility for things that they can't control, they feel stressed. But what's even worse, they often feel guilty. And I think that is particularly toxic for us because we feel guilty that that patient can't get the treatment they they want, you know. But there's no way we could provide that, you know, it's nothing to do with that secondary care if you're a GP or you know, or we feel guilty that that person hasn't been resourced to do something, or we feel guilty about other members of our team going off sick with stress when it was nothing to do with us. But we are programmed in healthcare to sort of carry that responsibility even when it's not ours. So I try and teach people well, maybe we can talk about we're feeling guilt-ish, not guilty. Maybe it's just like, yes, we could acknowledge that guilt, but it's not ours to carry. So that's the first way that that we sort of make things worse for ourselves. The second way is not actually doing the things that we do have control of. Because there's a lot of things that are in our zone of power. And we we draw a simple circle on a sheet of paper and go, everything that's out of your control is outside your zone of power, everything that's in your control is in your zone of power. So there are things that we could do, like really prioritizing our work, really work working out what the most important thing to focus is. And it's great to be able to prioritize stuff, but that also means you've got to de-prioritize other things, so you have to say no to things. And what about raising issues with people? What about calling out behavior that's not helpful? A lot of us just don't do that because it's a bit too scary. So we don't do the things that we could do because it's just too hard or it's just too scary. And that is where I do a lot of my work is like, how can we change our mindsets and how we're thinking in order to do that hard stuff that is in our control so that we can protect our time and manage our energy and really embrace a our our our finite capacity, because that's a side note, that's another issue we have, I think, in healthcare. We have this superhero delusion. We think somehow we can cope with less sleep than other people, or not eating or or not drinking. I mean, I I I'm sure you've come across that.
SPEAKER_00Yes. Yes. Those are all the faulty paradigms and faulty beliefs which are incorporated right early in the medical education. The lone worker, the superhero. So, you know, one of the things you mentioned mentioned, Rachel, about you know, physicians and healthcare workers feeling guilty about things, there are more and more things which are causing moral injury. Moral injury is a term which is more and more used where things are really deeply jarring with you. Like I gave you the earlier example with the staff shortages, staff cutting. Now, when people are put in that situation where they can see the harm is being caused to the patient, they can see it in front of their eyes. But if they speak up, they are aware there of other whistleblowers who have gone down the hole, and they would rather keep keep keep their mouth shut. But in that they are there is really a jarring of their soul. So more and more these kinds of things are happening where people are seeing things all around them. There are there are uh your colleagues who are working who are either burnt out, who are either incompetent? How many kind of how many challenges are you going to manage at one point of time? And how many such issues which are really causing such moral injury, really it is hitting at the core of the reason you got into medicine. How do you navigate that kind of landscape in your experience?
SPEAKER_01It's really tough, isn't it? It's really tough. I think the first thing is just to go. This is really tough. And I think a lot of the sort of well-being resilience stuff is like saying, Well, there's an easy answer to this. Why aren't you doing it? And I think there's absolutely not. In fact, um, Dyke Drummond, um you know, who does amazing work, uh what he said once that you know, physician well-being is not a problem, because the problem has a solution. Physician well being yeah, physician well-being, physician burnout, it's a dilemma. And for dilemma, you need strategies, you need lots and lots of different things. So I think when it comes to moral injury, 100% we need we need strategies. And I think first of all, you start with yourself, think, well, if I'm experiencing that, what can I do? Right. And that one of the first things is to flag it, to connect, to speak up, to find a colleague to talk to. It's amazing how actually just talking about something makes it, you know, makes it much, much better. And there are there are sources of support for doctors and people out there. In fact, you know, we've been part of running, you know, groups and things where people can go to and talk about this stuff. There's practitioner health, but in my experience, they're not attended very well. Because people are saying, well, I haven't really got time to go to this thing and get the support that I need. Well, this is one thing you can do is to prioritize the support that you get. Talking to practitioner help, go health, going to a psychologist, going to a counsellor, debriefing, spending time with your team, teams on team development and team debriefing, all that sort of stuff you could do yourself. You can't rely on the system to do that, but it is out there if you look for it. So there are things that we can do ourselves. What what the the real barrier to getting all this help and support is actually the urgency trap that most of us fall into, just trying to firefight urgent stuff all the time rather than paying attention for these really deep and important things. So, particularly when it comes to moral injury, you know, that's something that is very individual, and and I think you really need to talk to somebody about and uh, you know, and and and get a strategy and maybe get some coaching around. So, how do you cope with that? Well, first of all, think to yourself, what is going on? And what is it that I can do to help myself right now, and and and get a list of things because at least if you're working in your zone of power and you've got a list of things you could do, even if you don't do any of them, even if you do just one or two, action feels much better than paralysis. At least you are taking action. And then the other thing that I say, in fact, I I heard this the other day, you know, that very glib phrase of, oh, it's okay not to be okay. I think sometimes we need to tell healthcare professionals, and I've got a going to do a podcast on this very soon, that it's not okay to be okay sometimes. Sometimes, with everything that's happening, if you are okay, maybe there's something else wrong. You know, if you are so numb to it that you're okay, gosh, maybe that's that's a different issue. So maybe we should be saying to people, look at what you're coping with right now. Of course you're gonna feel like this. And in my experience, a lot of people make it far, far worse by saying, Oh, I'm so awful, why can't I cope? What's wrong with me? The answer is there's nothing wrong with you. You're a normal human being, right? You've noticed that there's stuff going on, therefore, time to make extra time to sort yourself out, to look after yourself, to connect, to get some talking therapy, to see a doctor, to talk to your manager, all those different things. Because look at what you are coping with, and I think that's a sign of wisdom to be able to spot that and pause and then go and do what's needed. But when the workload is really high and we're stuck in the urgency trap and everyone else needs us, that's a really hard thing to do.
SPEAKER_00Yes, Rachel. Um, this the group group work together, you know, in the GP land, there used to be groups. Is it is it in the GP or the psychiatry land?
SPEAKER_01Lots. I mean, GP started off ballot groups, yeah. Now you've got the the ward rounds. I can't remember those amazing ward rounds, um, Schwartz Schwartz rounds in hospitals. But also, I know many, many people have been running just you know, some some groups, staff groups that they can drop in um and and talk to each other. But I think people maybe feel uncomfortable, but honestly, when I talk to psychologists and they often use this group coaching techniques these days, actually it's really effective. Uh, we run some communities, and one of our communities is called Permission to Thrive for for doctors. It's a personal and professional development community for doctors, and we go and we share, and it's about self-care and it's about creating a working life that's going to work for us. And half the benefit we get is just knowing that there are other people going through the stuff that we're going through. Exactly the same as us, honestly. And and also when you when you talk about stuff, it just cuts off shame. Because in my experience, underlying all of this is these stories we're telling ourselves, like I'm not good enough, why aren't I coping? Or I couldn't treat that patient the way I could because wanted to because of limited resources, I'm I'm a bad person. And when you speak shame, it cuts it off at the knees. Well, that's what Brene Brown says. Shame cannot survive being spoken. So even just saying what's happened and how you feel about it, that's half the battle. Makes you feel a lot better. We are human beings, we're pack animals, and pack animals need human connection. But when you're heading towards burnout, when you're so busy you haven't even got time for a coffee, we we sort of cut the the one thing that we need, which is that that connection. So even just taking that 10 minutes to go for a coffee with a colleague or have lunch or something will make a world of difference. And it's a bit glib, isn't it? You know, that all take your breaks. But honestly, I think it's probably the most important thing.
SPEAKER_00Absolutely. Well, shame, one thing you said that when you speak about shame, I think the other thing is that when you share, uh, when you share and the connection is the antidote for shame. That's why in my jacuzzi effect, you see there are two frogs who are sitting in the jacuzzi and they are having a coaching conversation. They have tempered down the tempered down the temperature of the environment, and they're indulging in self-care, they're empowering each other, and they are having these jacuzzi moments. Now, coming back to what you mentioned earlier, Rachel, mindset shift. Now, I believe in the quantum physics. We have talked a lot about doom and gloom, and I fully agree that there is a lot of doom and gloom. I have lived there for the last decade, and as I mentioned earlier, I've had my cake and eaten it too. What the quantum physics says that to every perceived negative, there is a positive. I learned this from the work of Viktor Frankel in Man's Search for Meaning. How do you get shift that mindset that you are able to see the positive and are able to enlarge the positives? In healthcare, there will be many such moments of connection, of joy, of meaning, of growth. One of the strategies you mentioned was finding out your locus of control, where you focus on, and things which are outside your control. Any more strategies you could share where people can transform these challenges in spite of the toxic culture, toxic environment, stuff you how what else can somebody do if they are finding themselves in this situation?
SPEAKER_01There's loads of different strategies. Um I think it's it's interesting, isn't it, that the whole thing about positivity, and we know that gratitude is is one way of you know giving yourself a real antidote to anxiety. Because gratitude, we're looking at what we're grateful for right now, it helps us really stay in the present moment. Because actually, for most of us, in the present moment, we're safe, aren't we? We're safe.
SPEAKER_02Yes.
SPEAKER_01Um the problem is what our brains are telling us about what's going to happen, and that's where all the stress comes. Now, I'm very wary of toxic positivity because I think that's all oh, it's all gonna be fine, and let's just manifest all the it doesn't work like that, but gratitude's saying, uh I'm I'm safe now. Yeah, it's been a dreadful day, but I'm at the end of it, you know, we we finished it. The problem is that our brains constantly pre-live things that haven't even happened, and that is due to the amygdala, as we all know. This is our threat detection system, and we're so constantly scanning the horizon for threats, a physical threat, a hierarchical threat, or a group threat. Because when we lived in caves, if we annoyed somebody, they would kick us out of the cave and we'd die of exposure or beaten by a lion or both. So this threat of letting people down, disappointing people, we feel as a physical threat. So our amygdala scanned for threats and they tell us negative stories because it's much safer to assume you're gonna be attacked by a tiger and hide than it is just to think, oh no, there's no tiger around. So your amygdala wants to keep you safe, but it doesn't want to keep you happy. So we've got this negative bias of predicting bad stuff's gonna happen. So when the amygdala detects a threat, you tell yourself these stories of, oh, they're gonna hate me, or I'm a dreadful person if I do that, or I can't possibly say no because I might lose my job, or if I don't see that patient, something awful is gonna happen. And when that happens, it puts us into our sympathetic fight, flight, or freeze zones. Well, fight, flight, freeze, or fawn, because fawn's another thing where we just get overhelpful. So one thing is understanding that, and then the second thing is just taking a pause. When we notice our amygdala, our amygdala's have flared up, they've triggered us into the corner. We call it being backed into the corner, where in your sympathetic nervous system, you know, high pulse rates, maybe a bit sweaty, that where the blood's literally diverted from your prefrontal cortex into your big muscles so you can run away. We recognize we're there and we just take the pause. Because doing anything in that state never works well. I can I don't know about you, but when I look back to all the bad mistakes, all the time I was rude to colleagues or patients in my career. It was because I was in that zone. I was in the corner, and I know Professor Steve Peters calls this your inner chimp in the chimp paradox, that this chimp comes out and you have this dreadful reaction. And the main thing is just recognize it because it's quite difficult to stop it coming out because this is an ancient emotional limbic system response, the reptilian response, in fact.
SPEAKER_00Yes.
SPEAKER_01But just take the pause and recognize it. And then for me, the the game changer has been saying, Well, what is the story in my head here? What is this negative story that I'm telling myself about what's happened, about me, about the other person that's causing me to have this stress reaction? And the pause, it can be 10 seconds, it can be 10 minutes, it could be overnight. But most of us act far too fast and we just plow on through, working out of our stress zones constantly rather than taking the pause, getting yourself back into parat sympathetic, doing some breathing or grounding or just getting a good night's sleep or talking to somebody or whatever, and just really thinking, well, what is going on here? What am I telling myself? And what is really true? Because the truth here quite often is I'm doing my best in a really hard system. Even if I've got something wrong and failed, like that's okay because I'm a human being, we get things wrong. It doesn't mean I'm a dreadful person. So it's that sort of thing, it's slowing things down, taking a pause and recognizing it once we've taken the pause with the pause, we then have a choice of how to respond. And that's another line from Victor Frankel, isn't it? Like between stimulus and response, there's a space, and that in that space is you is your power to choose. And sometimes the only choice you've got is to choose your response when you're not in control of anything else. But that's a very, very powerful place to be in.
SPEAKER_00That is that is very, very empowering. And how you respond in that pause and what choice you make, that is what defines our own trajectories moving forward. Because there are you we saw that picture of the boiling frog, which I shared with you, the the article from the British Journal of GP. That is almost a decade back, uh Rachel, and the problems are still the same, even worse. And I can project, I can project that in the next 10 years that it might be even worse. Then what do you do? We can only keep choosing our response because this is not just a problem, this is a dilemma. These are multiple dilemmas, and we need to have dynamic and multifaceted and dynamic strategies to deal with these multiple curveballs which are coming our way. So I'm going to just uh talk about one more topic which I feel is very important. I think this culture of bullying, the culture of shame, uh, and on paper, the values in healthcare, compassion care, but what is practiced is covered up, bullying, shaming. I think that has to be really changed to coaching. And you have done commendable work in this area already. You are a prime mover in the area of having that coaching culture. My own vision, Rachel, is to that every physician and healthcare worker should have an access to a coach or coaching resources. That I feel is the only hope because these factors are not going to change, even they might become worse. So if we want to really be here, now some people are leaving the profession, and that might be the right thing to do in certain circumstances. The understanding should be that when you move to a new place, you should find a place which where values can be served. But we also know then in other professions there are 70 to 80 percent burnouts. It's not only in only in healthcare. If you see pick up the Gallup studies, Gallup studies are going to show you country by country, continent by continent, profession by profession. This is a huge issue. So we need to really up our skill sets and mindsets to move forward. Rachel, I would really want a more insight from you about how to change this culture of bullying, perfectionism, perfectionism, shaming to a coaching culture. You are doing already amazing work, and how we can take it, take, continue taking this uh forward.
SPEAKER_01Gosh, I'm not an expert on bullying, but I can share some thoughts. I think if there is proper bullying, it needs to be dealt with you know very quickly through the proper protocols. What I've observed is quite a lot of what some people call bullying, probably is well, it wasn't intended, it might have been received as bullying. I always say, you know, people don't go to work to be evil, but they end up being stressed themselves and then their behaviour is impacting on other people. We did a brilliant podcast with Dr. Chris Turner from the Civility Saves Lives Movement, and he talked about how to challenge people's behaviours. You know, when you witness um some bullying behaviour or some difficult behaviour, what what should you do? And he talks about if you do witness this, you actually go up to the person that you see has done the behaviour. And first of all, you say, Can I just check? How are you? Are you okay? You know, let's just show them we care about them because there's probably stuff going on for them. And then you say, Well, what happened with so and so? It's just I noticed they were upset. Now, Chris was talking to a physician in the States that was using this in a really big healthcare organization and that had sort of six or seven thousand doctors sort of reported for fairly bad behaviour. And they took this approach that when people started seeing the behaviour, they'd go and challenge them. Out of that six or seven hundred thousand people after they had been challenged, only a few hundred then had to go want to be performance managed. Because actually, most of them had no idea of the effects of their behaviour. They had no idea. Now that seems amazing to us because like if you yell at someone, of course they're going to be upset. But these people that just got used to behaving like that, or that's what been role model to them, and they thought that's just the way we do it in medicine. So just a sort of friendly, how are you doing? But what happened with that person now? That person may have overreacted, who knows? But it gave that person, the other person, a chance to go up to them and go, I'm so sorry, what did I do to upset you? Can you give me some feedback? Can you tell me what I could do differently next time? And I think that if we all did that and gave the person some proper feedback about how their behaviour is being received, what's the impact of what they've done, then actually people would change it overnight because people don't go to work to try and bully people. Often they're just sort of exasperated, or they've got a lot of people pushing them, and so they try and push their team. And it can push us straight into the drama triangle. So we put those people as persecutors, and then if we feel they bullied us, we become victims, we become totally helpless victims, we can't do anything. And then we want someone to come along and rescue us, like the organization or our line manager to rescue us if it's not the line manager that's the perceived persecutor doing the bullying. But what happens then is that you know, you just stay stuck because the rescuer can't really rescue you. The the persecutor doesn't quite understand what's going on and they feel like a victim because everyone's accusing them. Um and then the rescuer can't rescue properly, so they feel like a victim. So you're going to who's the biggest victim? The only way to change that dynamic is to flip the drama triangle. So instead of being um a victim, this helplessness is that I can't do anything about it, we turn into activators, we turn into, okay, what is in my control? What can I do about this? I know I've got the resources, I can deal with this, I might need some support, but there's things I can do. Um and then the persecutor, instead of being a persecutor, we we view them as a catalyst. So somebody who's trying to get the job done, right? Trying to get the waiting list down, trying to provide good health care. They don't always get it right. Um and if you are being accused of bullying or you see yourself in that persecutor role, just using our stress as hectic and then going, well, have I told everyone what I actually require of them? Have I been clear? Do they have enough support and resources? What else can I do to make their jobs easier? But then the crucial thing, Ash, is that rather than being a rescuer, and this is what I see burning doctors and senior leaders in healthcare out, is we're so busy rescuing everybody else. And it's exhausting and it doesn't work. And what's more, it's the most toxic form of leadership and it keeps people stuck in victims. Like, I'm a hero, I'm gonna come, you're helpless, you can't do anything, I'll just sort you out. And okay, I'll do that work for you. And oh, poor you, that person's spelling you, blah, blah, blah. Rather than coming along as a coach or taking a coaching approach and going, okay, what have you thought already? What solutions have you got? What are your options? What's really going on here? How can we help and support you? Not a good way, I'll do it for you. And I think if we could get much more into that coaching approach, you get into a much more functional triangle of coach, activator, and catalyst. And I think half of the bullying problems will probably be solved.
SPEAKER_00I completely agree with you.
SPEAKER_01And then the other half of the bullying problems, you know, you've just got to deal with the toxic people. That's another whole podcast, isn't it? You know, a few narcissists around in in healthcare, as we know.
SPEAKER_00Yeah, no, I think you're you're absolutely right. That the culture of coaching has to be uh has to be uh encouraged. And I think is the only way forward, uh, in my in my opinion, because uh otherwise this is going towards a very unsustainable, unsustainable uh direction. What I was talking about, and I'm not going to go into deep dive because it's a full podcast in itself, is the low grade bullying, the culture of coercion, fear, getting people to do what they are not interested in, what there's pushing people in a corner where it doesn't match their skill set in order to meet financial targets and things. So uh anyway, we'll park this here, possibly another podcast with you on that. Rachel, we are coming to the top of the hour now. I know we have covered a lot of ground here. This is really a minefield, but what we want is what we are doing here is we are sowing seeds for people. We are sharing, bringing things to the awareness, like the amazing work you have done is with your podcast is bringing things to the awareness of people. And so to summarize our conversation today, Rachel, if I were to ask you to share with the listeners top three points of transforming the boiling frog environment to a comfortable jacuzzi, what are the what are the what stands for you the most important things and the strategies? The strategies.
SPEAKER_01So my three top tips, and this is funny, Ash, because as you know on Neonot Frog, we always end up with three top tips that I have.
SPEAKER_00I have learned from you! I have learned from you.
SPEAKER_01Something on the hoof, right? So the first one is that you always have a choice. Yes. Even if the choice is just how you respond to things, we always have a choice. Um and and make sure that you are aware of your choice. And the problem we have there is we often say, well, I haven't got a choice because we're wanting the choices that aren't actually available to us. And often the choices are difficult, but we always have one. Um, my second top tip would I think would be the pause. Taking the pause, giving yourself space and time when you feel yourself triggered, when you feel yourself stressed, give yourself time to get back into your wise brain, into your parasympathetic rest and digest nervous system so that you can examine what stories you're you're telling yourself. And I think the third one for me is around self-awareness. So many of us are just sort of walking blind through life and we're not aware of our own reactions, we're not aware of what we need to do to progress and rejuvenate, we're not even aware of our own levels of burnout, and then if we're not aware of it, we don't know what we can do to change it. So the more self-awareness we can get, the better. And you know, whether it comes to understanding our our own brains and the way they work, I've recently been diagnosed with ADHD, and that's been a quite shock to me. Um quite a you know, uh a difficult thing to come to terms with, but it's also been really helpful because it's meant that I have then been able to work out and read a lot about it, you know, how will I actually work best to thrive and do my best for other people as well. So do as much as you can to understand yourself, and like you said, coaching is a brilliant, brilliant way to do that. And if I'm allowed a fourth one, I would say get support, get people around you, get air cover, join communities, you know, find your tribe because it just gives you that extra, that extra layer of of armor in in the journey.
SPEAKER_00Rachel, to the ADHD, I would say the the people with ADHD I have known are the smartest people who are creators, who are entrepreneurs, and who are doing amazing work. They are able to do that because of the uh the way their brains are wired. So, congratulations to you. I would say you are you are blessed that you are able to affect the life of millions of people. And I think not everybody has that skill set to be able to do that, to be bold, to be getting so many ideas together, to having so much energy. So, really, really, I am uh I am uh really blessed to have this conversation with you. And you know, last time we met, I came for your retreat. You are not a frog retreat, which I attended in the Devon or Exeter with my friend who was visiting from California, and I was sat there in the jacuzzi, and that is where when I was planning to write this book. So, next time I come for your retreat, please ensure that jacuzzi is there because I want to get with a with a glass of wine in the jacuzzi and have these jacuzzi conversations. These conversations are as as you said, getting the support kills the shame. Shame cannot survive if you share. So fantastic work. I'm really, really uh inspired by the work you are doing from the time I heard about uh your podcast in when I was working Jersey, which was a boiling pot there at that point of time. I had to get out of the pressure cooker there. Uh and um um, if the listeners want to uh listen to your podcast, I'll put the link here of your website uh of your podcast and any other ways they can uh reach out to your uh inspiring work.
SPEAKER_01Yeah, well if if you go to youannotfrog.com, you can find out that stuff. If you want to know about our um various communities, we've got permission to thrive.org, we've got Shapes Academy. Um so if you just have a look at the the Shapes Talking website, our World Monday website, worldmonday.k.uk, we'll give you all the links. Ash you can follow me on Instagram and on LinkedIn as well, and we also do post and of course listen to the You're not a Frog Podcast available wherever you get your podcast, and uh that'd be wonderful. We also run um virtual conferences a couple of times a year called Frogfest, where we talk about stuff. The next one's coming up in November. I don't know if this will be out by then, but we're looking at boundaries about how to set boundaries.
SPEAKER_00Very important, very important.
SPEAKER_01Yeah, my my particular obsession at the moment. So that is on November, the end of November.
SPEAKER_00Well, Rachel, thank you so much uh for finally having this conversation, which I was really yearning for the last three years. Thank you for taking that uh out the time. And like in Ireland, what we say until we meet again.
SPEAKER_01Oh, thanks so much, Ash. It's been wonderful to speak with you.
SPEAKER_00Thank you for having me.
SPEAKER_02If you enjoyed today's episode, we'd greatly appreciate it. If you could leave a five-star review, a like, or subscribe on Apple, Spotify, or wherever you listen to your podcast. Your support helps us reach more people to transform their stress into new content. We'd love to hear your thoughts. So don't forget to comment and share. Support us and updates. Please be sure to check out our social media links in the description box below. We can't wait to have you with us next time as we can see. Remember, it's not the stress itself, but how we rise above it that defines our strength. So stay resilient and keep thriving, and we will see you next time.