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Doctors at Work Podcast.

Episode #52

How to build your psychological survival kit

Mat Daniel

27/12/2023

Medicine is an incredibly rewarding profession, yet we also work at a time of constant change and uncertainty. We are all likely to face adversity at least sometimes. In this episode, Will Mangar tells me about the idea of the psychological survival kit. When faced with difficulties, we first need to have self awareness to recognise that something is amis, and then put in some circuit breakers that would take us towards wellbeing rather than away. This means proactively building the sorts of behaviours that are nourishing and sustaining for the long term, such as relationships, exercise and creativity.

Spanning three decades, Will Mangar has worked as a family physician in general practice within the UK National Health Service. He has spent many of these years leading organisations within primary care. He has a special interest in men’s psychological health and wellbeing, and specifically with principles of meaningful purpose and its relationship with personal fulfilment and happiness in life. He devotes his professional time to his practice and raising awareness of men’s mental health with the perspective of meaningful purpose through speaking, writing and broadcasting. You can find him on LinkedIn.

Podcast Transcript

[00:00:00] Mat: Welcome to Doctors at Work. My name’s Mat Daniel and this podcast is about doctors’ careers. Today I’m having a conversation with Will Mangar and we’re talking about the Psychological Survival Kit. Now medicine is an incredibly rewarding profession, yet we also work at a time of constant change and uncertainty.

We are all likely to face adversity at least sometimes. In this episode, Will tells me about the idea of the psychological survival kit. Now, when faced with difficulties, we first need to have self-awareness to recognize that something is amiss. And we then need to put in some circuit breakers that would take us towards well-being rather than away.

That means proactively building the sorts of behaviours that are nourishing and sustaining for the long term, such as relationships, exercise, and creativity. I hope that this helps you build your own psychological survival kit.

[00:01:07] Will: Hi Mat. Thanks for having me on the podcast. Yeah, I’ve had a listen in actually to a couple of your episodes already and they’re really fantastic. And I think just before we get started, I think top marks, because it’s really something that is needed within the kind of medical community at the moment, these nourishing.

Sort of discussions and conversations that are quite, pastoral, I think for doctors at the moment. I think it’s fantastic. So I just wanted to give you a thumbs up before we get started in case I forgot. My name’s Will Manga. I am a generalist. I’m a GP general practitioner. I’m, I’ve done a couple of decades now in primary care.

I’m just about to stretch into my third decade as a GP partner. So I’m old enough to have seen lots of changes within the NHS, but more specifically primary care GP land some for the good, not all for the good, some for the worse. And I think it’s interesting in the sense that I’ve been involved really with kind of medical sort of leadership on a micro scale, shall we say, GP practices, I was in a.

10 years ago in a partnership of eight people. And now it’s just myself and my opposite number, Chris retires next year, so just leaves me as a single handed GP possibly. That’s where things are at the moment for me. I also do some coaching with men. I’ve become very interested in a particular type of man, men.

Generally about my age what we call middle age now, who run into this period whereby they’re, should we say just becoming a little bit detached from the kind of vision of life, purpose, meaning, meaningful purpose, that kind of. Existential, vacuum that we can all find ourselves dropping into in our sort of mid-forties and fifties.

So I’ve been working with guys for a bit now and it’s quite nourishing work. And it very much dovetails into. primary care as well. I think my own personal interest is how, we talk about men because I know men, I’m a man. So I think they resonate in that respect.

But for me, it’s really trying to understand the antecedents of certain diseases, chronic disease, whether it’s mental health, diabetes, other chronic diseases, sometimes. I’m interested what happened before that, sometimes men struggle with meaning and purpose. And there’s a bit of a kind of nosedive when it comes to health span, shall we say, after that.

So I’m getting excited at that at the moment. Hence why some of the Kind of work on doing, but for me, I’m yeah, very much a sort of generalist primary care. And it keeps me keep me keeps me busy, Mat.

[00:04:21] Mat: And actually, I saw you posting about psychological survival. Jim, I imagine that. that some of that may have been directed or aimed at, the kind of person that you coach.

But it struck me that would be a great topic for this podcast, which is about doctor’s careers as well. So what is a psychological survival kit?

[00:04:41] Will: No, absolutely. I think it’s, there’s no use us getting niching down and being. Kind of tunnel visioned working silos and saying, look, just because this works for, a guy who’s 45 or 50 that’s struggling in a career, maybe in the city, how that very much those principles can be translated to any of this.

And let’s be honest, you can be a, a male, a female, whatever doesn’t matter. These are all the sort of core principles that We need to embrace to create that kind of psychological wellness. I think tracking back a little bit I think a lot of your podcast, a lot of the work you do is about the kind of resilience, which is an overused buzzword in, in medicine at the moment for doctors.

I think my feeling is that over the last. Should we say 10 years, the kind of word resilience has been interchangeably used and it depends who you talk to, they give you a different definition of what resilience is my worry is that we’ve been using the wrong kind of tools, as it were, to try and unlock that, war chest of the answers to what resilience and Wellness, even for doctors is and I think we maybe need to think a little bit conceptually, a bit laterally about how we keep ourselves.

As an aside, I think I’ve not appreciated a time within. Within medicine where it’s been so tough, I think for medics, nurses, anybody working with the NHS, anybody at all, the, we’ve got major challenges where it comes from. The cost of living crisis to career issues with working conditions with general feelings of autonomy and professionalism within, within, within medicine, I think a lot of us feel that.

Our roles are changing as we move through our career. I think those coming into the career early, that in their twenties who are qualifying have a real kind of, I’d say, existential question mark over what the career is going to look like and how they received by. Those around them, the general population and I think when you come to the other end of the kind of age span, those sort of forties and fifties, I think there’s definitely seeing a change in.

Their kind of role in their kind of perception from the public and others. I think some of us are worrying, whether there’s some sort of change in autonomy. So I think that’s the, that’s the background of where we are as doctors. And I think we have a bit of a crisis as a profession with our identity who we are, our meaning.

What our general role is in the big hierarchy, where we fit into things and as we said before we came on air, Mat, a lot of us feel we’re being outsourced, should we say, being replaced and substituted by other roles, whether it’s allied health roles coming in, moving into positions or whether, we’re worried about the future and what happens to us what happens to our con specialty, what happens to our ability to practice.

So I think let’s just say we’re in a, we’re, medics are in a position of, it’s a profession at the moment of transition. We don’t know what the end game looks like. So I think there’s a lot of. I wouldn’t say disillusionment or perhaps there is, there’s a lot of uncertainty and quiet, I’d say unease within medicine.

We’ve come out of the pandemic and I think we’ve come out of the pandemic with more questions and answers. I don’t think we’re quite sure where we fit in, what the public feel about us. And I think that feeds back into us from a kind of more shall I say earthy or, self. Awareness, self-worth in our perception of ourselves.

and I think there’s very much a feeling that actually we’re working hard, but you can be happy and work hard and you can think I’m working sort of 60, 70 hours a week and I’m very busy. But I think if you’re feeling generally unhappy or not quite sure of. The kind of what the perception is of the profession as us as individual practitioners and how we land on, to people that I think that can create quite a lot of unhappiness.

And I think at the moment, it’s, there’s, as I said, there’s a lot of uncertainty within the profession. So I think, having said all the negative stuff, which I did promise you, I wouldn’t go too negative. I think it was literally. I thought what can we do as individuals, particularly as medics, what could we do to have some sort of toolkit.

I’ve flippantly called it the psychological survival kit. I think I drew an infographic, but it was very much something that didn’t represent any kind of deep thought. It was literally just what are the key things in life that when it comes down to it, the most important things to latch onto.

and I think what we need is the ability to automate happiness, I think automate some sort of core go to settings whereby we can just deploy, some sort of battle sequence and have a, a sort of a number of steps in the pathway that resonate with us in some way that they create happiness or states of flow, or just things that.

Let’s be honest, provide a distraction from what’s happening within life. I Think whether we’re struggling professionally, whether we’re struggling, every day with our own personal lives, I think we need a, an ability to like a fire alarm, we need to break the glass.

We need to be able to press the button and activate a number, a sequence, a number of things. I think for me, it was like saying if you were to create a hierarchy or even a flow of important steps that you would go to when you were struggling, what would you do? And I think. I thought about this morning, I thought we’re going to do the podcast and I was out and I thought, how do I, how do you conceptualize something like this?

Because I think, for example within a professional capacity, if something goes wrong professionally for you, it’s a significant event, a complaint, something doesn’t go to plan, or, in your personal life, you Something hasn’t gone to plan, you need to say you have a fork in the path, you have a bifurcation, you can either choose to go down the route of, doing something that maybe isn’t in your best interest, maybe it’s a negative kind of health outcome for you, whether it’s alcohol, whether it’s drugs, whether it’s, some sort of addictive behaviour, because it’s a compensatory mechanism, let’s be honest, because that is delivering us some sort of.

feedback, if we’re under stress, we perhaps want to do something like drink alcohol. We don’t do it because we want to drink the alcohol. We do it because it provides us a space of distraction and it provides us with some sort of escape and respite from a difficult situation. And that’s pretty much how many addictions may start, even with a background of trauma.

So you have that on one hand, but you have a discernible option of, a plan B, which is to purposely activate or deliver out a sequence of positive, as you say, positive health steps that may have a different outcome to if you chose the other route. And being honest, it’s just.

Something as simple as CBT, it’s the cognitive behavioural aspects to being able to make that choice or recognize the behaviour as it’s being delivered as it’s manifesting and being able to put a circuit breaker and saying, okay, I can feel something happening in me.

I’m feeling stressed. I’m getting a lot of negative thought patterns. How about if I activate this. magic, psychological emergency kit, toolkit, alarm system and you can imagine it conceptually, you can think okay, you’ve got this kind of bag of tricks, as it were, any bag of tricks, you’ve got the important nourishing things that you know, and you have confidence in that provide you with The ability to just offset and detach that kind of negative thought loop and the thought traps that we can get ourselves into.

And I think if I remember rightly, I think I just numbered them out. I said number one is always going to be relationships. It’s going to be your family and your friends. Those. People around you that actually you connect with at the moment, we’ve got this connectivity virus going around.

We’re all connected with each other. We connectivity, but that’s not the same as connection. We’re not building the same connections we had before. We all got teched out with stuff because we’ve got hundreds of connections with people, but they don’t have that depth to them.

And I think that’s what we need to feed back into. So we need to really understand those people in our lives that are very personable to us. And we know that, just pick up the phone, speak to a friend, speak to a family member. Because very often these things that are on our mind, they just rattle around these negative thought loops.

And often. We’re humans and human nature is if we can just share the problem, it’s so simplistic and just talk it out with somebody, it just makes such a difference. And we can all resonate with that number of times that we’re under stress with something, and it’s that kind of insular thought loop that is the thing that creates the damage.

And that’s the thing that we fear. It’s not the actual underlying. Stress or as it were, but if we can just chat to somebody about it, it just makes that little bit of difference.

[00:15:56] Mat: And it works as well, doesn’t it? The connection, because, in the past you would have gone for lunch together. We all had Friday afternoons where people didn’t do clinical stuff in hospitals in general practice.

It used to be Wednesday afternoons when, the general practice was closed and people had time to do stuff. Whereas now we work in all the time and spend all of our time in remote meetings and it’s all business, and then not really any. Deep, meaningful relationships.

[00:16:25] Will: Yeah, that is, that’s absolutely spot on. And I think we’ve neglected the kind of the huddles and the little kind of nourishing things that we do. They certainly within primary care, the kind of coffees in the corridor and five minutes out. I don’t know. I think we seem to have reframed things in a way that these things aren’t productive or seemingly in inverted commas, maybe a waste of time, or this kind of dead time within the day that we just want to get through the day so that we can finish really.

And I think it’s definitely a problem. And I think we’re losing The deep connection and now we’re doing everything like this. Everything is remote. We’re doing kind of zoom and teams and it’s fantastically convenient. But I think the ability to truly connect with people has been compromised, but I think it was, for me, it’s very much.

Going back to the kind of the concept of this sort of toolkit is just understanding, right? I need to open up to somebody that’s number one, because I think from my experience, the trouble we tend to get ourselves into is when we just let things fester and we ruminate on things and we worry and we worry, but I think the very act of talking to somebody that kind of, A nice, empathic conversation with somebody often very much reframes our kind of thought processes on something and it’s so simplistic and just building the connection with somebody.

I think it’s so key. Yeah, I think that’s the 1st thing. And I think it’s, it’s again, it’s understanding that you have these kind of. These action, this action sequence, but it’s there’s no good sort of having it in the back of your mind. It’s something that you need to keep using and keep exercising and rehearsing because it has to be a sort of automated response.

And I think that’s why you’ve got this kind of in the next steps, which are the things that are very important for you. And this is a very kind of specific bespoke, things. So for me, it’s, it’s okay. I know the things that I do that get me out of kind of psychological trouble.

If I know I’m getting myself into a kind of loop on something or, my, my thinking is not helping. I know that actually. It’s the simple stuff. It’s like exercise and exercise means something to different people, whether it’s golf for somebody, whether it’s kettlebells for somebody else, whether it’s running up a hill or just walking in the park, but it’s just the production of very simple, chemicals in your system, endorphins, dopamine, all these little things that actually just, again, provide that.

Sort of mental space for us to start reframing things. And again, we, the old saying is for runners, you never regret a run. It may be bloody awful, but you’d never regret it. You look like a runner,

[00:19:33] Mat: Mat. So a very slow one, but I never regret it.

[00:19:39] Will: No. And you must know in your career as a surgeon, it’s the amount of tension and stress that you must have that, you must resonate with that ability to feel so different after.

Going for a run, it’s simple and it’s free, but you know what it’s going to do once you’ve done it, and you don’t want to do it, but you know how you’re going to feel after but

[00:20:04] Mat: I might add into that one, Will, that so I have two dogs. So even if I don’t want to go for a run, the dogs want to go.

So my for me, that’s all very automated because whether I want to or not, the dogs want to go and they will pester until we go.

[00:20:20] Will: Yeah. So having that said, you’ve got that sense of kind of duty and it’s, and that’s, you’ve almost built that into your template as it were, because now you have a reason, and.

You’re a fit guy, you run with the dogs, but there are some people out there who maybe can’t run, but it’s the dog that’s the only thing that’s going to get them outside. And those are little circuit breakers we implement into our system that allow us to keep doing what we do because we know they make us well, they keep us well psychologically.

[00:20:58] Mat: Is that what you meant by the idea that it’s automatic because I mean I’m guessing that for most people it’s as you say you know, it’ll be on the sofa it’ll be binge watching Netflix or chocolate or as you said alcohol. Yeah. Might be is that you have structures in your life that means that when you don’t have to think about it, they just happen.

[00:21:19] Will: I think that’s the kind of nirvana, isn’t it? Let’s be honest, you want, we need to be at that stage whereby the kind of behaviours are. Predefined automated and a reflex response, it’s I’ve had a bloody stressful day today. I’ve really blown the doors off it. I’m going to.

As soon as I get in, I’m going to lace up my running trainers and I’m out and that’s the kind of narrative because, and once you’ve done that, you as a runner, Mat and other people listening will say, I know I’ll be all right. I know I’ve had a crap day, but I know I’ll be all right once I get back from that run because you’ve got the fork in the path.

You can either get in the house, look at your trainers, or you can look at the box set and the. Bar of dairy milk or whatever you’ve got and you have a choice and I think anyone that’s spent any time working in CBT, having CBT, working with clients or from themselves will understand that it’s practice, and it’s knowing that you have to keep rehearsing the thought process until it’s an automated thing.

and I think it, it builds that, the cliches. We’ll run now the mental strength and the psychological resilience, but it’s nothing more robust or technical or fantastic as just rehearsing good behaviours and good habits. And we’re sitting here being ridiculous because we’re over complicating something that’s really quite basic and simplistic.

If we look at those who came before us and said just. Practice as you preach and just keep doing those things that you know are good for you. And I think we can all start talking cliches about the habits of highly successful people. But I guess those habits are recognizing the kind of positive health behaviours that keep people well and keep them whatever successful looks like to them.

[00:23:29] Mat: I hope you’re enjoying the show. If you are, please click subscribe so you will be notified when new episodes come out. This podcast is part of my mission to help doctors create successful and meaningful careers. You can be part of that mission too by forwarding this show to any one person who you think might benefit from listening.

Thank you. Now on with the show. I’m also hearing what you say that There’s an element of forward planning and recognizing that at some stage, we will all have problems, all of us will have difficulties. That’s how life isn’t it? So what I’m hearing you say is proactively planning and building this behaviours and actions, in, into the toolkit or into the, into your armamentarium of behaviours that you do.

Because I guess it’s, when you’re well, it’s probably easy to do this kind of stuff. When things are difficult, it becomes much, much more difficult to do some of the things that keep you well. So you know, what you’re saying is build this practice.

And then these things become automated, and it’s becoming automatic response, you don’t have to think about it, therefore, it makes it easy.

[00:24:35] Will: Yeah, I think you’ve put it really well. And that’s a really good summary of how we create something, which is a kind of go to settings that we have, our sort of user settings and we know we just, upload it and we’re going to be okay.

Because I think what you’ve quite eloquently said is that when we are well, things are easy to implement because we have quite very good clarity in our thinking, but what happens is when things. Are going wrong and we were stressed. We don’t feel, our thinking is clouded. We get confused and we get unsure and we don’t have confidence in our own actions and we second guess ourselves.

And that’s the key thing. Once we second guess ourselves, the risk of defaulting on established good behaviours is high and we tend to seek out the kind of negative behaviours are things that don’t do us any good because we’re not, we can’t really fathom out what we’re doing.

and we become, if we become chaotic, that is always going to be the risk. So I think the more we can implement something that is hardwired into ourselves, the higher the chance that. We can activate it and recognize it before things go wrong with those early warning signs. I’m not right.

Therefore, I take the foot off the accelerator. I take two days from work. I do these things because I know I’ll be okay. and I think probably those in medicine who have longevity in the career and the sustainable probably have some sort of rudimentary. Toolkit, whatever you want to call it, or just roadmap to themselves that they are very good at self-regulation and self-awareness that I know what’s happening and I can see what’s happening even before other people say.

Oh, you’re not right. Are you okay? I think that’s always going to be a good thing for us to be able to listen to the little voice. Or I think I’m recognizing something’s not quite right here. And if we live a life where it’s just too noisy. I’m too busy and there’s too much going on. We miss that little voice.

I think that’s really why we have to be better skilled in being self-aware. I think that comes back to the conversation, Mat, about how we teach resilience and map resilience out to our young folk coming into the profession. About how to understand and spot little kind of black swans in our thinking and in our behaviour.

That we can put a circuit breaker and say, okay, I don’t, even if it’s just not sleeping well, opting for less healthy lifestyle factors or getting snappy, it can be absolutely anything. But I think for us to be self-aware, I think is really key and that’s when we can say what do we do?

Do we go out for a run? Do we take time off work or do we do something like this? Do we do some. Something creative and we had this we came up with this buzzword on LinkedIn, Mat, and I’ve never used it before it was creative resilience and I’ve never heard it used before. We’ve never, I’ve never mentioned it, but I thought, isn’t that a fantastic phrase?

And I think you played it back to me and I thought, I, I think, you must have touched on this in the podcast so far about how. The kind of medical career is wonderful and so effective at basically extricating any form of creativity we have in us, and the number of medics I speak to over the years who say, Do you know what?

I used to love drawing. I used to love writing. I used to love playing the piano. But as soon as I became a doctor, I left medical school. I stopped because it became too hard. Suddenly, It was all about shift work started a family and next thing, they’ve had 2 decades in practice and they’ve lost any form of creativity.

and I think when we say creativity to each other, we look a bit confused because we don’t quite remember what it means, because I think medicine, and I know they say it’s the kind of, it’s an art, not a science, maybe, but we we’re not allowed to be creative. As soon as you’ve got a creative surgeon or a creative doctor just walk away because it’s like having a creative account.

And you don’t want that. You just want somebody that tells you. This is how much you got to pay. And so it’s an exact art, it’s an exact science. I think because of the exactness of our profession that there’s no room for things to go, there’s no, you can’t be sure you have to be sure.

And I think it’s even worse for lawyers, they’ve got no room for lateral growth. It’s all about you’ve got to be sure and you’ve got to think the worst case scenario. So I think, sorry, going down this bloody rabbit hole and going down is that we as medics, we. We end up losing so much of the creativity that we once had, that sort of childish awe and creativity that we had when we were youngsters tends to just gradually evaporate.

And we hit a certain age group, we get to our sort of 40s or 50s or even earlier. We suddenly think actually it’s work, it’s family, it may be a bit of exercise, but I can’t remember the last time I was creative. And if you say to somebody, what for you does creativity represent, they’ll look at you a bit blankly and say I like a bit of DIY.

I’ll say, okay, that’s fine. But what do you do to get into a state of flow? And I say what’s flow? I said do you know when you do something and. You’ve been at it for about an hour, but you’ve only been at it for about three minutes and you’ve lost all kind of concepts of time. You’ve been doing something for an hour and it feels like three minutes.

And actually, that’s probably because you’re in a state of flow. You might have been playing a computer game. You might have been, playing an instrument. You might have been drawing something. You might have been writing a blog or you might have been doing something that. inspires creativity or is using the other side of the brain.

And they’ll say, yeah, that’s right. I was doing something and I didn’t realize, but I was doing it for four hours, but it only seemed half an hour. And I said this is the flow state. And I think we flow at the moment seems to be a real buzzword for people. And everyone’s talking about flow, but I think the reason it’s.

Great is that it kind of tech ticks off that kind of that sort of good life, that meaningful life aspect, which is doing something that creates a kind of internal intelligence. It creates a degree of fulfilment and happiness.

and being cynical, probably all it does is just distract us from everything else that’s going on. So whether we’re doing, for here, for me, it’s music. So I think. Again, it’s part of that talk here. I know that if I do something like some music for a bit I’m out of trouble. If I feel psychologically, I’m getting into trouble with something.

And actually something’s gone wrong, maybe, clinically, or I’m worried about something. And some of us are better than others at not taking work home. But some of us do worry about. Things and I think if you have the ability to do something and distract yourself that’s all you need to do and it doesn’t have to be anything more technical than that.

So I think for me it’s something as simple as just doing some music for a bit. That actually you’re getting that kind of creative blue time that just builds that little bit of flow state and the flow state just creates that kind of Zen feel, and you are just suddenly you’re no longer distracted by all the other sort of, the psychological warfare of being a doctor.

And actually you’re doing something different.

[00:33:41] Mat: Yeah, I’m smiling because I can imagine that some of our theatre nurses saying when the surgeon says, it’s going to take them 45 minutes and then two hours later, the, the surgeon’s lost track of time. And yeah, and actually the way that I always think of that is I think as doctors, we are.

We’re selected, chosen, promoted, assessed on our ability to tick boxes. And the way I see us, we’re professional box tickers and that is really unsatisfactory because, if we have people that are. altruistic and driven and creative and wants to make the world a better place.

But we sit within structures where we’re assessed and rewarded and voted for our ability to tick boxes that there’s just a total mismatch between how our careers are structured and how we wrote it and assessed and the reality of the kind of people that we number one attract and number two need.

Yeah, because we need people that are great. I’ll probably bring us to a close.

And

invite you to just tell me what would be your top tips for doctors at work?

[00:34:46] Will: I think there’s so much really that we can, implement for medics. But I think, we’ve talked about this kind of happy toolkit.

Type thing, really. And I think it’s no cliche alert, Mat, but it is know thyself and I don’t mean that in a flippant, arrogant way, but know thyself, understand what for you are your baseline user settings of happiness. Fulfilment and feeling rewarded in life, because I think it’s very easy to get to life stage of life professionally, and you don’t know what makes you happy.

And I know it sounds really simple and ridiculous, but there are a lot of us walking around who still not sure what actually makes us tick and what makes us happy. And if you can find the things, you’re passionate about, if you’ve identified the things that fire you up, then. You’ve you’re, you’ve become successful.

and I think once, what those things are, just hold on to them and, you don’t have to do them all the time, but. If it’s music you like, if it’s exercise, if it’s drama, everybody’s got their own core medium that creates that kind of Zen happiness, that feeling of just wonder. And if you can identify what it is, then champion it and work with it.

[00:36:19] Mat: Wonderful. Thank you very much, Will.

[00:36:21] Will: Thank you, Mat.

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