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Doctors at Work Podcast.

Episode #79

How to deal with permacrisis at work. With Matt Morgan.

Mat Daniel


Our work seems to consist of one crisis after another. In this episode, Matt tells me about the importance of identifying what’s urgent and what’s important. This can be learnt, and asking others can be a useful way to develop this prioritisation skill. Checklists have a place too, as long as we don’t forget the importance of human interaction. Regular stress and pressure also means that looking after ourselves is important, and we need to dedicate time to strategic and long term thinking as well as to today’s emergency.

Matt Morgan is a Consultant in Intensive Care Medicine, adjunct Clinical Professor and regular BMJ columnist. He has contributed to >50 scientific articles following his PhD in artificial intelligence including the NEJM, Lancet and JAMA. After appearing on television and radio, he gave the 2023 Woodridge Lecture and was nominated for the Royal Society’s David Attenborough prize for public engagement. His first book CRITICAL tells remarkable stories of patients in the intensive care unit. His second book, ONE MEDICINE, explores how understanding animals can help treat human disease. His third book will look at the lives of patients after surviving a cardiac arrest. His is a member of the BMJ Commission on the Future of the NHS and is the medical advisor for The National Theatre’ in London’s production of “Nye”, the story of Aneurin Bevan. He lives in Cardiff with his family. You can find him on LinkedIn and Twitter @dr_mattmorgan and Instagram @dr_mattmorgan.

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Production: Shot by Polachek

Podcast Transcript

Mat: [00:00:00] Welcome to Doctors at Work. My name is Mat Daniel and this podcast is about doctors careers. It’s part of my mission to help doctors create successful and meaningful careers. Today I’m having a discussion with Matt Morgan and we’re talking about permacrisis. Now, I don’t know about you, but our work seems to consist of one crisis after another.

Matt tells me that it’s important to identify what’s urgent and what’s important, and that’s a skill that can be learned, and asking others can be a useful way to help develop this prioritization skill. Checklists have a place too, as long as we don’t forget the importance of human interaction. The regular stress and pressure also means that looking after ourselves is super important, and we need to dedicate time to strategic and long term thinking, as well as to today’s emergency.

Welcome, Matt. Tell me about yourself.

Matt: Thank you. Yeah. So I’m Matt Morgan. I’ve got three bits to my life, I suppose. I’m a full [00:01:00] time NHS clinician working in the intensive care unit in Cardiff. And the other two bits to my life would probably be research in the past. I’ve done a lot of research into critical care and finally public engagement, having written now two books, one called Critical in 2019, the other called One Medicine in 2023.

Mat: So I invited you to talk about Permacrisis, but actually it feels like I ought to ask you about the public engagement before we go there. So can you tell me a bit more about sort of the books? How did they happen and what do you write about?

Matt: Yeah, the truth is I fell into writing entirely by serendipity.

I was never a writer. In fact, I couldn’t even spell my name in primary school, and that’s genuinely the truth, but I was at a conference about, oh gosh, six, seven years ago, and I spoke about my particular topic, which was sepsis and immunology, and I kind of realized that, In that conference that I was speaking to a room full of [00:02:00] people who knew the topic better than me about a topic, which actually the public didn’t really know anything about, and I’d forgotten about, you know, that person who’s on the bed, you know, the patient, the family, the brother, the sister.

And so I wrote about the reason I started. Doing intensive care, which was, uh, when I looked after a guy who is 17 turning 18, who sadly died of infection. Uh, and through luck and serendipity, I was in touch with an agent, a publisher, and, and that’s when my writing career started. Wow,

Mat: fantastic. Fantastic.

Let’s come on to permacrisis then sort of that that’s our topic for today. And I don’t know what’s it like where you work, Matt, but where I am, it just sort of feels that there’s one thing that happens after another. And just, just sort of when you think I’ve got a day when I can catch up and do a little bit of thinking and planning, there’s sort of that there’s something else that becomes urgent.

You know, whether [00:03:00] that sort of finances, you know, beds, A& E, um, and I suspect it’s, is that the same for you too?

Matt: Yeah, I guess it’s the same for two reasons. Firstly, I work in an environment in the intensive care unit, which is always by definition in permacrisis, if you’re a patient at least, because everybody there is.

And secondly, I work in the public health system, which, uh, you know, the winter crisis is now just the crisis, you know, that’s internal crisis. So I guess I see that from two perspectives, really. What, um,

Mat: what’s the implications of that for doctors in the focus of the podcast is, is doctor’s career. So, you know, we, we go to work.

And presumably we go there, we want to make a difference, we want to do a good job, you know, we all started medicine because we want to help people and then, then all the time we find ourselves in this environment where it’s one crisis after another. So how does that impact [00:04:00] doctors?

Matt: Yeah, I guess you can look at it on, on the long and the short term, you know, in the short term, actually, when somebody is.

And when there’s a permacrisis in front of you, it’s kind of simpler in many ways, you know, there’s only so many things you can do in an impactful way to make a difference. So often looking after somebody who’s critically ill is simpler than looking after somebody who is in that recovery phase, you know, that’s when The complexity comes in in many ways.

So that’s the good way to look at it. And that’s why we’ve developed things like checklists and so on in order to do that. And I think that’s got a lot of application in life outside of the critical care unit. On the other hand, you know, we know we are biological machines, we are animals as humans, and the way we respond to continuing stress can sometimes not be healthy.

And so I think you’ve got to somehow turn [00:05:00] that permacrisis into, into a normality to some extent. Not accept it, you still need to work and make things better, But I think you’ve got to almost expect that to be the case. And that sometimes makes what you’re faced with a lot easier to deal with. Let’s

Mat: try and unpick those things, you know, let’s focus on the beginning of that.

So, you know, there’s, there’s a doctor, let’s sort of say an early career doctor that’s at work, and they have lots of really sick patients, people waiting in A& E, discharge letters to be done, and they’ve got, All of this work, everything is urgent. Everything’s important. Everything needs to be done straight away.

So, you know, how, how does, how does sort of a core trainee or foundation doctor register? How, how, how do

Matt: they deal with that? Yeah, well, you’ve said two really important words there. You’ve said urgent and important. And, you know, there’s a great quote, which is What is important is [00:06:00] rarely urgent and what is urgent is rarely important.

And I think when you’re faced by a patient who’s critically ill or a situation or a job setup, I think what’s important is to work out what are the things which are both urgent and important. So you can almost imagine a grid. So yes, you may be asked to do a hundred different jobs. Some of them are very important, Such as, you know, following up a scan, which may or may not show something which will impact patients in the long term, like a cancer diagnosis.

That’s really important. Is that urgent? Does it need to be done this very second? Perhaps not. On the other hand, there are urgent things that need to be done. Maybe there’s a drug chart that needs to be rewritten. The nurse can’t give a drug until it’s rewritten. That’s urgent. But is it critically important?

Well, it kind of depends on what that drug they want to give is. On the other hand, there are situations which are important and urgent. And so when I come into a [00:07:00] shift, when I start a night shift or I have a hand over on my piece of paper, I’ve kind of got things in, in my head. In those three boxes, if you like.

And the first box I always go to are the things which are important and urgent.

Mat: So you’ve presumably because you’re a consultant and you’ve been doing this for many years, you’ve developed the ability. To do that. So, so how do you know did, is, is it something that just happens or do we, do we teach this?

Or how, how does the ability to know what’s urgent and what’s important, where does that come from? For, for

Matt: a foundation doctor? Yeah, you’re right. You know, it’s, it’s not easy Sometimes the most important thing as a, uh, as a early years doctor is realizing. I’m in an emergency, you know, that recognition, that bell going off.

And I think the truth is there’s no one simple way to recognize that. You may have your gut instincts, so to speak, your heuristics, and they can be valuable. You absolutely need to also look at [00:08:00] others. Look at experienced others, whether they are fellow doctors or member of The multidisciplinary team, whether it’s physiotherapists, pharmacists or nurses.

And we also know that there are certain red flags, if you like, that you can learn, which indicates there may be an emergency or this may be important and urgent, but you’re right, you know, that’s part of those skills are developing is realizing in your head, this is an emergency.

Mat: And there’s that there’s obviously people will learn at medical school or as they go through and that’s fine.

But I like I like sort of the idea that to look to others, and you know get get advice from others in the wider team about sort of what what can wait. And, um, and sort of that interesting sort of that kind of that, that gut instinct, you know, sort of where, where, where, you know, your, your guts telling you.

So I’m thinking, you know, is that gut instinct, is that, is that a good thing or a [00:09:00] bad thing? Does it mislead us? Or how do we, how do we work with that?

Matt: Yeah, like all great questions, there’s rarely simple answers. And, uh, you know, the truth is for people who’ve read books by people like Malcolm Gladwell, who wrote the book.

Book Blink, which I highly recommend, and then, of course, the classic thinking fast and thinking slow. We know that we operate in different modes in different ways. Our brains have that very slow analytical quality on times. So maybe before a shift, when I’m looking through people’s blood results and scans, I’m thinking what could be wrong with them.

What diagnosis am I missing? And that’s fine. There’s a role in a place for that. But then when you arrive on the, on the ward and there’s something going on in the corner, you know, there’s some catastrophe happening. The alarms are all going off. There’s people rushing around. That isn’t a great time to use that, you know, very [00:10:00] controlled, rational manner.

Sometimes you need to go with that gut instinct in the early, early phase, but it’s equally important then to step back and have either yourself or someone else be that rational part of the brain because gut instinct can also miss things. So, you know, the truth is, it’s not one or the other. But it’s recognizing that there are two is important and it’s using the advantages of both systems for the benefit of you and the benefit of patients.

Mat: And I think it’s certainly, if I think for me, I think the gut instinct. I think that that develops, you kind of, you can, you can, maybe with that kind of reflective piece that you talked about that, you know, there’s a situation and you know, and gut instinct is telling you to do that, you know, that kind of fast thinking system.

Um, but then, you know, if, if afterwards, if you spend some time thinking and reflecting, you know, what it was and how it felt and. And where it came from, then, then I [00:11:00] suspect that there’s a ways that there’s ways we can get better at it. Um, but actually, you’re sort of the other thing for that, for that immediate situation that I think is really helpful is what you talk about is the checklists.

Yeah. So, you know, in a kind of emergency situation, you know, your gut instinct is going to take you in one direction and you’re going to forget that there’s all of these other things that you need to do. So the checklist. Become really useful because then you you know, you almost you can go with your gut instinct and you don’t have to think That slow thinking because there’s a checklist that tells you what you should be thinking about So so it’s kind of combining those things, isn’t it?

Matt: Yeah, it’s offloading that cognitive bandwidth and You know, sometimes the complicated things you want to do in a controlled manner, you know, you don’t want to be making really complex diagnoses when you’re standing at the end of a patient’s bed looking at 300 different data points whilst there’s all manner of clamor going on around you.

And yet that’s the environment we’re often exposed [00:12:00] to in hospital. And so if somehow you can. Do those tasks, outsource them. And when I say outsource, I don’t mean to others. I mean, think about them prior or later. And that’s kind of what a checklist does. It allows you to sit down in a calm, controlled manner.

Think what does best mean. Put that into a set of norms, but have that set of norms in that wicked environment, if you like, that we often operate within. And I think there’s a great role. For checklists outside of just clinical medicine, um, in fact, I’ve been on holiday last week, we went on a family holiday, and I don’t know about you, but that, those moments before leaving the house, no matter how well planned you are, you know, they’re always stressful for us.

I’ve got two girls who are both teenagers. And they’ll be looking for their chargers, they’ll think they’ve forgotten their favorite book, um, my wife may have forgotten [00:13:00] something she really needs for the flight. And so a few years ago, I’ve made something that I call checklists for life, actually. And one of those is leaving the house to go on holiday.

And, you know, my family always roll my rolled their eyes at me when I, when I get this thing out on my phone, but guaranteed every time there’s something you’ve got, you know, whether it’s a sleeping mask for the plane, whether it’s to turn off a device in the house that you always turn off when you leave.

So I now go through. Those checklists on what it does is it makes a stressful situation less stressful because you’ve thought about it before you’ve outsourced it.

Mat: It’s interesting because if I think, um, I don’t do adult, I only see children now, but I remember when I used to do, um, adult ward rounds and sort of for some of the complex, there, there, there was, there was sort of, there was a checklist that went in my mind, which was A, B, B, C, C, D, D, E.

So, you [00:14:00] know, and sort of, and all of those things meant something to me and that kind of, I always worked through that. Um, and, um, I don’t, I think there are large, large, large areas of medicine where We don’t use checklists, I think. I think, you know, you’re probably at the forefront of this in ITU and sort of maybe anesthesia, but I’m fairly certain that there are vast, vast areas of medicine that would benefit from this, but don’t.

Is that a fair comment, do you

Matt: think? Yeah, I think that’s true. And, you know, I’m not saying that they are the be all and end all. There are also risks to checklists. You know, it can turn what can be a human endeavor into almost a production line feeling. And so there is a risk to that. Plus, You’ve got to be able to work outside of checklists.

You know, sometimes if I’m faced with somebody who’s having a cardiac arrest, the temptation is you just go according to the standard, you know, ALS protocol. [00:15:00] But remember guidelines and checklists in some circumstances are designed for non experts. And sometimes in critical care, there can be unusual things, which sometimes you need to jump a step or do something else first.

So you, especially as you become more senior, you need the autonomy to step outside of a rigid structure. But for me, exporting those best practices mean I can actually be more human, you know, uh, I can take the time to speak to patients and families because I’m not worrying about, you know, those minor things I’ve missed.

I don’t know, giving, giving tetanus to someone who’s had a major life threatening trauma, you know, not giving, The tetanus vaccine seems like a very minor thing. But actually, you know, if you don’t give it in certain circumstances, it could be a problem. So it’s on the checklist. And it means then I can concentrate on [00:16:00] those more human and those more critical factors.

Mat: I would share with that, because you know, for me, it would be I must remember to ask about the drain, I must remember to ask about the drain, I must remember to ask about the drain. And, you know, and instead of having a conversation, how are you today? It’s all about, make sure you ask about the drain and you kind of, there’s this distraction about, I must remember this.

Um, and you know, and usually end up forgetting anyway, but you know, that, that distracts you instead of. Focusing on the human interaction with the patient that’s actually in front of you,

Matt: and it can also empower others. You know, we’ve talked about people early in training, certainly in critical care, it can feel overwhelming when there’s somebody critically ill, and sometimes people can.

We feel a little bit like, you know, they’re lost. What should I be doing whilst all these other people are doing seemingly complex, critical things? Um, so actually giving a checklist to somebody who is in that role can be really empowering for them. It can also give them a [00:17:00] task to do. And actually, you know, as long as you empower them to correct you, you know, by saying, like, We’re resuscitating this person.

Here’s the checklist. I’d love you to check that we’re doing all these things. If we are not, um, you know, please let us know. So that can be something powerful to try as well.

Mat: Actually, that would be great for team building, wouldn’t it? As well, because, you know, and, and breaking down hierarchies, because you sort of say, here’s, you need to, you know, you the F1 needs to tell me the consultant what to do.

And then sort of straight away, You know, the hierarchy is a bit a bit more equal than it was before. So it’s so it’s win win Um, you said that what’s what’s urgent is rarely important and what’s important is rarely urgent. Tell me a bit more about

Matt: that Well, I think certainly in the nhs we can be in a clamor of of the system sometimes And you’ll have emails which are marked as very urgent and yet you have tasks to do maybe clinically or non clinically That you know [00:18:00] are actually far more important than that So I think having that kind of mindset and that box thinking is this Important but not urgent or urgent and not important allows you to plan your work plan your day Uh, plan your life to some extent and it’s not to say you shouldn’t do those things in certain boxes.

It just allows you to think about things in a different way.

Mat: I hope you’re enjoying the show. Please click subscribe so you’ll be notified when new episodes become available. 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 one person who you think might benefit from listening.

Thank you now on with the

Matt: show.

Mat: Let’s move on to to the kind of slightly longer term thing So, you know, we talked about that that all the time we’re faced with these situations and that means that all the [00:19:00] time We’re going to work and we’re exposed to stress day after day after day Um, and everything’s urgent and everything’s important.

How how how do we as doctors? manage to You How do we do stuff that sustains our careers in the long term? Because I think it’s just that kind of feels like a recipe for burnout and for stress and for leaving. But you know, the reality is that our lives are all urgent and all important, and that’s just how a lot of healthcare is.

But how do we What do we do to sustain ourselves and nourish ourselves in

Matt: the long term? Yeah, it’s such an important question. And if I had all the answers, then, uh, you know, I, I’ll have a secret that nobody else knows. And the truth is there isn’t a secret everyone else knows, but I’ll maybe divide this into three ways that I do it myself.

First, some practical tips, if you like, um, without going into the details of physical and emotional wellbeing, it’s clear that [00:20:00] that plays a huge part. Um, for me, a part of that is sleeping and I still do resident night shifts. So I’ll do them all of my consultant career where I work in the intensive care unit in Cardiff.

So recovering from night shifts is really important. And I’m now quite. I get selfish about my sleep. I have earplugs. I have an eye mask when I’m ready to go to bed, they go on and I go to sleep. Uh, and there’s a lot of advice from, uh, bodies like, um, the BMA, like. Royal colleges around recovering after night shift.

So that’s something I’d really urge people listening to this to look at. I’m not an expert on it, but others are, uh, but do prioritize it because it is important. Uh, and it is urgent actually after a night shift to sleep. Well, I guess another practical tip. Uh, which is less to do with physicality and emotions, but to do with technology is work email.

I do not have works email on [00:21:00] my phone and I’d go as far as to say, I don’t think anybody should have a work email on their phone. And the reason for that is it’s just too easy. It’s too tempting to look, you know, I’ve just been on holiday for a week. If I had work email on my phone, I would definitely have checked it.

I’m not disciplined enough not to. And the problem with that is you don’t know what you’re going to get. You know, it could be the first day of a well earned break. You quickly open your email and the subject line is patient complaint. Now, that’s all you need to know, and that’s just ruined your holiday, it’s ruined your downtime.

And it may even be something very innocuous. It may be a group email to the whole hospital. It may be nothing to do with you. Um, so for me, I’m pretty, uh, vestigious about no work email on my personal, uh, mobile device. So those, I guess, are the practical tips. Um, the other two sections to think about are more about [00:22:00] setting expectations and about your career, I guess, as a whole.

For me, It was my birthday in January, and I bought myself something I haven’t done for a long time, which is a computer game. I used to love playing computer games. And I bought a really difficult game. It’s really hard. I’m swearing at it. I’m failing at it quite a lot. But, if I’d bought a game that was very easy, that I never died, that there wasn’t a big boss at the end, You know, took away all my coins and all my points every time that he didn’t have to try out repeatedly.

It would be a terrible game. I would have taken it back to the shop. And I think that’s a bit like a career and a bit like life. I think if you expect it. To have hard bits, to not kill the boss every time, to have times that make you angry, frustrated, sad, stressed. [00:23:00] I think merging that expectation is a big part of it.

And, you know, every day when I go to work in ICU, I’ll meet a family who are having the worst day of their life. That’s a normal day for me. Uh, and many people ask me, why doesn’t that, or does that make you stressed? Does it make you sad or angry? And the truth is what it does is it changes my expectations.

You know, it makes the flat tire on the car or the leak from the shower that we had last night when we got home from holiday, it makes that just, less stressful because you know, you know, in work tomorrow, somebody will be told the worst news of their life. So I think it resets my own expectations for life a bit, a bit like a computer game.

Mat: And actually, when you look at it in that way, in many ways, as doctors, You know, we’re privileged to be part of other people’s lives [00:24:00] in that way, number one, but number two, the, the, we have a built in reality check as to what’s, what’s important. Yeah. Sort of, as you know, flat tire versus a relative loved one in ITU.

So, so, um, And we’d do well to remember that, wouldn’t we? Yeah, I

Matt: think so, you know, like everything, there are dangers to that too. And the danger is that you become numb, I suppose, to the things which are important to others. And, you know, it is true that my family may come home from school and, and And say that they’re unwell in some way or complaining about the day they’ve had because it’s been stressful and it is more difficult sometimes for me to empathize and sympathize when you’ve seen that, you know, my wife might say, I’ve got a really bad foot today or and sometimes think, Oh, well, so what?

And that’s a danger. So you [00:25:00] have almost got to reset the sectors of your life, but I think having that big picture is still a good thing. I’m

Mat: laughing, Matt, because I get a lot of that. And normally I kind of say, you know, you need to go and see your GP. It’s like, but you know, I’ve got this problematic foot and it’s like, okay, I don’t do feet.

Matt: Yeah, absolutely. Unless you’re unconscious and not breathing, I’m not the right one to ask.

Mat: Normally sort of when people say, I’ve got a sore foot, you know, what should I do? And I normally sort of say, I could take your tonsils out if you think that would make sense. That’s my stock. Um, I like that. Yeah. Um, the work emails is interesting cause I think for, um, I do have work emails on my phone now, um, and at home.

Um, but actually that for me is very much a recent thing. Um, and the reason, the reason why, um, Um, I’ve done, I’ve done it recently, it’s probably because, because I do a large amount of non clinical work. I think when, when the [00:26:00] predominant thing that I did was clinical, I, I had nothing at home because I knew the stuff that would come through would, would be clinical related.

And I kind of say, no, you know, it just got to wait. Um, I think just, you know, the way that I work now, sort of, there’s other stuff that comes through. Um, but you know, the, the, the emails that I get. the non clinical emails are not sort of, you know, there’s a complaint or whatever, or, you know, or a coroner’s inquest.

So, but the downside is that sort of that, as you say, that I have it because I say, well, actually, you know, chances are that it’s going to be a non clinical email for me, but, you know, but every now and then there is a clinical email, um, which, which, which, so, so I kind of, I, I, um, I share, um, with, um, that with you, but the other thing that, uh, that I’ve, um, discovered, um, recently, which, which has, um, revolutionized my sort of life, um, has been, you know, one of the things that’s always bothered me is, is let’s sort of like today I’m working from home.

Yeah, but you know, I’m, I’m in tomorrow, but I get sort of clinical emails today. And I think I [00:27:00] can’t do anything today because I’m at home, you know, I don’t have access. So, so there’s like, there’s all of that stuff that’s come, but I can’t do anything about it. So what I now have on my emails, I have a Monday folder, a Tuesday folder, a Wednesday folder.

So if I get anything clinical related today, when I’m not clinical, Then sort of what I’m going to do is I just put it into Tuesday folder and then that that that clears my mind that then don’t have to worry and it’s going to be at the bottom of another 50 emails and I’m going to think oh you know there was that thing I have to do tomorrow but there’s now 50 emails that’s above that and then I get lost so if anything clinical comes today Then I put it, you know onto Tuesday, which is when I’m clinical and if anything on Tuesday comes that’s not clinical Then I’m going to put it into Wednesday folder because on Wednesday I don’t do clinical stuff So so that that kind of that that removes it from my in from my in tray And puts it into this is the Tuesday folder and then normally Sort of the way that I work, I normally start at 7.

30 and I spend the first half of my day, um, sort of, um, doing all the admin so that by eight o’clock when the real work [00:28:00] starts, sort of, I’ve done that. So yeah, so that, that’s, that’s been a revolutionary thing for me to have created a Monday folder, a Tuesday folder.

Matt: So yeah, I love that. You know, I got a bit obsessed with Uh, productivity hacks and systems and techniques, uh, a couple of years ago.

And I’ve been through a few iterations. Uh, you know, I’ve now settled on, I have a to do list manager. Uh, I, I use to do list, which is my particular thing, but there’s other to do list managers are available. Uh, and I also have folders for emails, but mine are a bit simpler. I just have a folder, which is. To do or reply and another one, which is waiting because there are a number of emails.

You can’t do anything about, but you need to kind of have them in the vicinity and think about them in due course. So, uh, so I tried to aim for an inbox zero just through that simple filing system. Um, but interestingly, I read a fabulous book by Oliver Berkman that I’d recommend anyone reads called now I’m going to get the title wrong.

[00:29:00] It’s either 3000 or 5000 weeks is the title. It’s certainly a number of thousands of weeks. And he too was a productivity. Guru and geek, but this book is very different and it talks about how your life is only consisting of a number of thousands of weeks and he’s even got a chart on his room in his office where he ticks off a week and he’s kind of changed very much his outlook after coming to this realization.

So I’m now kind of on a, on a tightrope between loving productivity and inbox zero. But also realizing your life is only measured in thousands of weeks. And, uh, you know, how do you marriage, how do you do a combination of those two? And just one final thing to say, I’ll just push back slightly on your email on, on your phone, just because it’s something I am passionate about.

I completely see the benefits of that nonclinical work. What I would [00:30:00] say, some of the most stressful bits of my Work actually are probably the non clinical parts, you know, people classically think it’s the clinical bits but actually Again, when somebody’s critically ill, it’s kind of easier in many ways.

It’s simpler. There’s less complexities but having emails around Oh gosh, I don’t know pension allowances or changes in job plans or Rosters, I designed the roster for Cardiff. That’s a tricky thing to do. They’re actually You Probably some of the most stressful bits of my role and so if I was on holiday checking an email and it said urgent road to clash That would that would kind of stress me out as as much as some of the other things Uh, and the point of having it not on your phone isn’t to make it impossible to check You know, you’ll probably always have a laptop around.

It just segregates, um, that device, if you like, [00:31:00] and that bit of your life. So if you do need to check it, you need to physically go to your laptop, open it up, rather than when you’re, you know, sitting in a restaurant with your family, something pings up. You quickly check it and bang that’s that’s ruined your your night off if you like so I I hear what you say But I I think it probably doesn’t change the fact I would still say I’d suggest your life would be better if you didn’t have work email on your personal my

Mat: my life would be better So undoubtedly so I agree with that and I think that’s why I resisted because I think it’s only probably been in the last year or so and that it’s for exactly Those reasons that I resisted so I mean, I suppose the the way that the way that i’ve made it happen And you know, I completely agree with you.

I completely agree with you and that’s why I resisted so I think the way for me with With, with some of my other roles, it, it’s, I just get, I, you know, I don’t, I don’t [00:32:00] expect emails like Urgent Pro Clash yet. Yes, yes. So, but the problem is that, that I check the phone and I find emails like urgent, like Pro Clash I’m looking for.

So, so it is, it is problematic. Um, and, you know, I, I don’t get notifications, so, you know, I, I am. I look at it when I look at it, and that’s

Matt: it. That’s a brilliant way. You know, that’s another great tip. You know, turn notifications off. That’s, uh, that’s a game changer too. The other thing

Mat: that, um, that I’ve discovered that is much better on a laptop, um, than on the phone is that you can schedule emails and sort of most people, if people have an out of office reply, for example, so, so I, I make a concerted effort.

For sort of so, you know, I might compose an email at six o’clock or nine o’clock at night or whatever it might be Um, um, probably not nine o’clock because actually I I like about nine or ten hours of sleep

Matt: Matt Perfect. You’re you’re you’re you’re with me. I’m with you. I feel I feel I feel your pain [00:33:00]

Mat: So probably, you know, normally i’m asleep at nine o’clock or certainly in bed Um, but i’ve discovered you can schedule emails on the new office 365.

So So normally I’ll schedule an email. I won’t send an email at eight at night, seven at night. I’ll schedule it for eight o’clock in the morning. Um, and if I get an out of office reply, I’ll schedule it for when that person is back off holiday. And then, you know, it sits in my outbox and until, until that time.

And I guess, you know, that’s kind of. That’s my effort to being respectful of other people’s times. And, you know, and again, if we, if all of us behaved like that, you know, if all of us sort of thought, you know, okay, you know, maybe your working hours are much more unpredictable than mine, aren’t they? But, you know, sort of, if for majority of us will work, you know, eight or six or whatever, if all of us sort of thought, okay, you know, Why don’t I, instead of sending Matt an email at nine o’clock at night, I’ll schedule it for eight o’clock in the morning.

Kind of, the world would be a better place, I think, wouldn’t it, if we thought like

Matt: that? Yeah, I think that’s great. And the brilliant thing about that is it’s also beneficial for you because [00:34:00] dealing with out of office replies then has a new startup cost. You know, you need to maybe resend it or send a reminder or something.

So I think that’s, that’s fabulous. And You know, in a similar vein related to that is the construction of emails can be done in such a way to minimize the back and forth, which minimizes startup costs. So, you know, often There’ll be an email that you’ll ask somebody about something, but you can also give options.

So for example, I’d love to meet and talk about your new research project. How about Monday, the 3rd of January at two o’clock? Uh, would that be okay? If not, here’s a list of other dates, uh, would meet in via zoom be okay. So you’ve given options in the initial email, which is. Perhaps prevented three other emails from being sent.

Uh, and I guess the other thing to say is life is now complex in the number of ways that you can be asked things. You know, we [00:35:00] have email, we have WhatsApp, uh, we have Microsoft teams. We have instant messaging. We have DMs through Twitter. We have so many different methods. So as well as no work email on my personal device, for my.

Okay. WhatsApp, and we do have works groups for non clinical questions on that. I tend to archive and mute them all, so again, I’m deciding when I check those things. It’s not ideal. There are other ways. You could use a different app for a different thing, like Signal or something else. But that’s another thing to maybe think about.

Mat: And if we’re talking about productivity hacks, the, the, the, um, scheduling, um, sort of like Calendly and, and BookMe and, and, and the like. So, you know, that’s, that’s revolutionized an awful lot of my life. Cause I say, here’s my diary. So to be, you know, find a slot or I’ll ask, have you, have you got a book in diary and I’ll find a slot in your book in diary.

Yeah, spot on. Maybe if I [00:36:00] can kind of, you know, bring us sort of to the final third, um, cause you talked about, okay, so, you know, we talked about, There’s the urgent immediate situation that you have to deal with, that there’s sort of something about the impact that that has on us of constantly being in that.

Um, but maybe if we could just spend the last few minutes talking about where does long term strategic thinking and planning sit? Because all the time, you know, we’re dealing with one crisis and another, how and when Do we plan for the

Matt: future? Yeah, that, that’s super important. And I think something we are not really taught at medical school, or even in postgraduate training.

I think I’ve developed a few soft rules, I suppose, for life for me. And these are things that you’ve heard before. Everybody knows these things. But until you work it out yourself, you kind of don’t believe it. And the first is, is saying no to things. I find that incredibly difficult often because I like the things i’m being asked to do um, but [00:37:00] But again, you can shift your perspective on that by thinking about opportunity costs, um, you know, opportunity costs are The things you’re missing out on because of the things you’re doing so if I say yes to one thing that’s kind of The same as saying no to something else.

Uh, and if that’s a subtle change of focus, um, and the way I can now do that is often, if I’m asked to do something, I pretend it’s tomorrow and that helps me decide whether to do it. For example. I get asked to go to a lot of conferences and speak at a lot of meetings, which I love. I love travel. I like meeting people.

I really enjoy doing that. Sometimes you’ll have a request to say, can you come to the U. S. next October to speak at this meeting for an hour on this topic? And maybe they’ll pay your travel expenses. Maybe they won’t. And my automatic gut instinct would be absolutely [00:38:00] great. Trip to the U. S. Sounds amazing.

Yeah. But then if you think about it and I say, Oh, what if that were tomorrow? What if it were next week? I’d look at my diary and I think, Oh gosh, that’s going to be tricky. I won’t be able to take the kids to this club. Oh, and I’ve got that other meeting I need to do. I’m trying to write a third book.

It’s not going to work with that. It’s in the school holidays. It’ll mean me not being there for those. And actually the answer is very simple. The answer then would be no, uh, sorry, I can’t, um, uh, and combining that with opportunity costs, I think that’s become a lot easier. So that’s the first thing to do is, is to think about that.

The other little rule for life I have is on the longer term. I think doing things for more than three to five years. Is really the time to think about, should you still be doing them? And this could be for anything. This could be for a leadership role. This could be for the particular lead in your [00:39:00] department that you do.

And that’s not that there isn’t value in consistency and expertise there absolutely is. But I think when you’ve got to that three to five year point, I often think. Perhaps this needs a change of person, a change of pace. Are there people who could do it better than me? And, uh, importantly, are there things I could do, uh, better outside of this role?

Will it keep my interest and keep my longevity better? So I tend to very, very rarely do any major roles for more than three to five years.

Mat: They’re great tips and particularly like the one about, you know, would I say yes, if this was next week, because certainly I find myself that, you know, people ask me and oh, it’s a great opportunity.

And then, then closer time you think, why did I say yes, what was I thinking? So, um, you know, the thing, the thing that I, um, Um do that helps me decide is I’ve got a golden [00:40:00] thread that goes through my career and for me That’s developing people. So, you know, so if if it’s something that fits with that golden thread of developing people You know that then then I will consider it And usually usually it’s a bit like you say i’m i’m it sounds like you’re lucky like me I have lots of opportunities to do stuff all of which is interesting and all of which which is good And that’s a fantastic position to be in Um Um, so certainly anything that for me doesn’t align with my golden thread, the answer is just going to be no.

And, you know, and people often ask me to do stuff and if it doesn’t align with my golden thread and the golden thread is absolutely full to burst in, if it doesn’t align to the golden thread, the answer is just going to be no. Um,

Matt: okay.

Mat: Maybe I’ll bring us to a close, Matt, sort of perhaps if I could ask you to summarize what we talked about and maybe, you know, what, what top tips for doctors at work would you pull out?

Matt: Yeah, so hopefully we talked, I guess, about three things. We’ve talked about how surviving and living in a permacrisis is [00:41:00] possible if you think about some top tips, such as not having work email on your phone, but also you change your expectation and treat other people differently. Life and work a bit like a computer game in many ways.

Uh, we’ve talked a little bit about some practical ways to make that possible. And we’ve also talked and touched on looking at your career as a whole, how to keep it relevant to you, how to keep motivated, uh, and how to enjoy the job. And I’d probably finish that thread by saying my kind of three rules for life.

I suppose will be to work hard ask questions and be kind to people

Mat: Wonderful. Thank you very much Matt

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