How to optimise your mental performance. With Krystle Kustanovich

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 other doctors create successful and meaningful careers. Today we’re talking about mental performance. Now as doctors we have to perform to a high standard in a variety of settings, whether that’s leading a ward round, a cardiac arrest, or operating.

Our technical skills of course are important, but our mindsets matter too. In this episode Krystle Kustanovic and I discuss mental performance. We talk about career transitions and how they relate to our own self identity, and we discuss the need to be aware of what matters to you and the need to let go of some of the things from the past.

We talk about how our strengths can also become a weakness, and how doing things to the extreme is not going to be good. You need to ask yourself, is this belief serving me or is this belief harming me? Mental performance starts with self awareness, and self awareness is a lifelong journey, not something that you do once and forget about it.

Self [00:01:00] awareness includes your thoughts and your feelings, but also body sensations. And those body sensations can be particularly useful. When difficulties arise, we need to identify what we’re afraid of. What’s the worst that could happen? What’s at stake? And what exactly the issues are? Because of course, this might be a learning need or style as much as anything related to thinking.

And that needs to be done with no judgment. So we convert limiting thoughts into thoughts that serve us. We can choose what we think. Visualization is a really useful tool to prepare for the future. Now, visualization is not about magical thinking. It’s about mentally preparing yourself and planning for whatever you need to achieve.

And of course, your mind is like a muscle. So that means that the more you visualize, self reflect and reflame, the better you’re going to get at it.

WelcomKrystletal. Tell me a little bit about yourself.

Krystle: Thank you so much. It’s so wonderful to be here. So I have a really eclectic [00:02:00] background. I have a Big, a big part of my experience in my life is through the theater and through drama. And so a lot of the studying that I did throughout my life was in the theater.

And it was when I was in my honors that I discovered that drama and theater are actually mechanisms that we can use to do other things in life. So for example, you can use drama as therapy. And I also discovered that I really love directing. So that kind of like took me on this whole other path that, that happened next.

So I went into my masters, uh, doing applied theater and I analyzed teaching as a performance. And it was through that that I started. Diving more into psychology and, you know, the relationship between a person who’s like this all knowing, uh, bottle of information and an audience who’s trying to like understand everything.

And [00:03:00] from there I discovered, Oh, actually I really love helping people, but not by telling them what to do and not by knowing all the answers, but, but by actually being the person that can extract. what they already know, but maybe are not, you know, it’s kept in the back of their mind. And then I discovered coaching.

Um, so I’ve had a really interesting journey of working in fields where, you know, it’s all about human behavior and human psychology. And now I’m working as a men’s performance coach for professional athletes, predominantly in the rugby world. In the field of rugby and

Mat: what a fantastic career and actually that mental performance.

I think that’s also very relevant for us as doctors, you know, which is which is how I found you and I thought, you know, what a great topic to talk about. And I wonder if you could tell me, you know what, why does mental performance matter. So

Krystle: as human beings, the mind [00:04:00] is in control. So whether we like it or not, the way that we are wired, we are wired to survive and we are wired then to be in fear so that we can maintain the survival status.

So in terms of mental performance, it’s about going, well, if we’re wired for survival, how can we adapt that? Because we are a very. Evolutionary species. How can we adapt survival into thriving and flourishing? And that’s what the process of mental performances is going. Well, we know how we’re, we’re wired to, to be a species, but what if we take this to the next level?

What can we do that transforms the survival into thriving and flourishing?

Mat: And before I move on to doctors, can you tell me a bit more about how, how does this play out in, in athletes? You know, what kind of, what kind of things people come with and, and what do you do and what the outcomes are? I’ll bring us to doctors in a second.

Krystle: Oh, [00:05:00] with pleasure. Um, so with athletes, what’s really interesting, you, you know, like, uh, if you think about athletes, you think that these confident people, they don’t need any help, but actually they are human at the end of the day. And the fact that they’ve. Learned how to master their bodies is a really fascinating thing because that’s actually one of my favorite things about coaching athletes because the fact that they understand their bodies means that they already have the tools to understand their mind because our mind works.

Like a muscle. So just like the, the body works stuck with muscles, um, but with athletes, there’s still self doubt. There’s still fear. There’s still overthinking and anxiety. There’s still, you know, worry about making mistakes. Um, if they’ve had an injury, then they stuck in this, um, This old way of thinking because the injury has now actually changed what their future is going to look like.

So, I mean, [00:06:00] recently I’ve been coaching a, an athlete who’s come out of an injury. So he’s a year later and he’s still working through the. The stuckness that he’s feeling when he’s on the field. So as much as we think that we get over things and we overcome things, having an injury, there’s a memory in our body.

And if you get touched in a specific way that might be the similar or the same way, That it happened when you got that injury your body’s going to take over your mind Your brain is going to start going danger danger danger. We got to get out of here No matter what you think that you’ve done to overcome it.

So we’ve been working on Re evaluating what their future is going to look like with this change in their identity because now they are a a recovered injured athlete, whereas before they were a fully functional [00:07:00] athlete. So the, the change in identity is a huge part of what I do with athletes. Can I just

Mat: stick with the identity thing?

Cause I guess, um, you know, maybe how that might be relevant to us as doctors is we have so many career transitions, you know, you’re a medical student. on the 31st of July and on the 1st of August, you’re a doctor. And then, you know, and then one day, you know, the sort of 10 years later on the 31st of July, you’re a trainee on the 1st of August, you know, you’re a GP or a consultant.

And, um, and, and I’m guessing that that identity, there’s not, there’s not a magic thing that happens at midnight where you will have this identity one day and then the next identity.

Krystle: Yeah, absolutely. And you know, quite a lot of, and we all go through this. So even in terms of like our age, okay, so psychologically, we go through these phases and each or stages and each stage has a [00:08:00] priority and a set of values that we start, you know, Becoming aligned with.

So if you think about what, what you cared about when you were in your 20s versus in your 50s, it’s, it’s like two completely different humans. And sometimes it’s also about releasing those old identities. So, I mean, I’m not a doctor. I am one of those people. I’m so sorry, doctors. I’m sure you’re going to hate me.

I do watch Grey’s Anatomy, but if I think about, if I think about like the characters, you know how they started as interns and then obviously now most of the characters that started the series are now the attendings. I think that’s right. Um, so if you look at the, their change in their identity, when they started up leveling.

That old identity comes with you and sometimes it even prevents you from stepping into that new, new bigger piece [00:09:00] of responsibility because you still have this belief that either you belong in that old role, or that, That, that is who you are and you can never be anything else. So it’s, it’s a really fun thing.

And if, if I’m saying something and a penny is dropping, definitely check in with that, um, because we’re, we’re in, we’re in evolving. Species and we’re constantly that’s why we’re so, you know, we’re so amazing So if you think about the old parts of you that are no longer serving you That are actually keeping you stuck or getting in your way or creating challenges.

It’s time to go. Well What is this thing? Why am I why am I still staying attached to that? Is it important to me or how can I replace it?

Mat: So penny’s definitely dropping. Yeah And and kind of you know, I think for me personally, so I’m doing a number of stuff that’s that’s around leadership that’s based in [00:10:00] systems.

Whereas, you know, maybe for, for the last 12 years or so, much of my identity has been as a frontline consultant serving the one patient in front of me. And now I’m not serving the one patient in front of me, I’m serving the system and I’m trying to, to, to, to, to work at system level. But, but often I find myself thinking, yeah, but you know, how, what’s in it for me and what’s in it for my patient.

And I’m thinking, well, hold on a second, I’m not here for me and this patient, I’m here for the system. Is that, is that what we’re talking about? So this, you know, I’ve got, there’s me that’s taking it for the system versus there’s me that’s here for the patient in front of me. That’s so

Krystle: interesting. So, so you’re saying that.

the motivation, your motivation has changed or what is it when you say that the, it’s not about me, what is that? Like, what is the, what’s, what’s underneath that? I think my

Mat: behavior has changed because, you know, when I, when I’m a frontline consultant looking after the patient in front of me, [00:11:00] then, you know, I, I behave in a way that prioritizes that patient and, you know, anything that comes in the way.

of me looking after that patient is a threat. Okay. Um, so, because, you know, cause I need to fix this patient and anybody that, that’s tries to prevent me, you know, God help you because you are a threat to me helping this one patient here. Yeah. If you like, you know, I’m exaggerating a little bit, but that’s sort of as, and I think a lot of people will relate to that.

Yeah. Sort of those of us that try and balance a system role with a patient facing role. And then sort of the system role is then is, is, you know, Well, it’s all of a sudden, well, you know, I, I don’t know, you know, if, if, if, if I think, you know, lack of theatre space, for example, you know, I can’t serve the one patient in front of me because there’s lack of theatre space.

Therefore, lack of theatre space is a threat. But at system level, I’m kind of thinking, well, I can see why there’s a lack of theatre space because of A, B, and C. And, you know, and like, there’s no point in me trying to fight that. I need to understand it [00:12:00] and work with it rather than, rather than fight it. Is that sort of what you mean when you’re talking about different identities?

Krystle: Oh, that’s really interesting. So it could be, it could definitely be that. So if whatever I say, if it’s attaching to something, then that’s the thing, you know, that’s the thing to bring up. Um, because you know, the, the thing about communication is it’s like, it’s semiotics. I give out information, but the way it’s received is based on.

Your, your, um, plethora of circumstances and experiences. Okay. So that’s really interesting. So your mindset sounds like it’s changing. So your, so what your priorities, what feels important sounds like it’s changing. And is that something that’s like a conflict for you? That’s the, you know, at the end of the day, that’s the thing to look at.

Mat: Okay. So we look at what, what the conflicts are. And um, I’ll tell you where, where that also plays up a lot is when people first [00:13:00] become gps or consultants, you know, ’cause again, you know, what happens at that transition is one day you are your team member. You sit in the, in the staff coffee room, you know, you, you joke sort of with the nurses and the therapist and you know, you, and, and then the following day you turn up and you are the boss.

Yeah, sort of, and, and then, then, and, you know, whether you like it or not, you’re the boss. And a lot of people say, no, I don’t want to be the boss. I want to be part of the team. You know, I want to go and have pizza with everybody else. But at the same time, it is you that the buck stops with, and you are responsible for everybody else’s performance.

And you are responsible for that patient’s outcome. So that, that’s, if I think for, you know, my journey, that’s a conflict, you know, am I, am I one of the team just having a play around or am I the person who’s the boss, who’s in charge of the patient and the team and is accountable for the outcome?

Krystle: You know, what’s really fascinating about that kind of thing.

So I’ve also been in a position where I was also a team player and then I got promoted [00:14:00] and then I kind of got ostracized because now I had to tell people what to do. And. It boils down to self awareness. So for me, I had to think what is more important to me. So, so is that promotion more important to me or is being a part of the team more important to me?

And. It’s a really interesting thing because very often it’s, it is as simple as going, it’s one or the other. And then once you have, once you know what is more important to you, then you can start making decisions accordingly because then you’re still staying aligned to what you value. So if it is, so if you have this promotion, but it’s very important for you to be a team player, then you’ve got to lead as a team player.

It’s not so much as a dictatorship. Okay. To be extreme, but it’s more as, you know, I’m going to be on the front line with you. Um, so it’s, it’s, you know, [00:15:00] there’s different styles of leaders. So. I mean, and I’m from South Africa. So when I, when I think of leaders, um, I remember when I was at school, I, we watched this movie about Shaka Zulu.

Now this might be a little bit, uh, controversial for some people, but I remember thinking this guy’s leading, but he’s not. From the back telling people what to do. He’s standing right next to them. So if he is at war, he’s standing next to the guy right there. They’ve got the same weapons. He’s not on a horse at the back and everyone’s protecting him and he’s screaming what everybody must do.

And that for me was like, Oh my word. I didn’t even know a leader could be like that. So just that, you know, like as an example, um, but if you are the type of person who cherishes the way people treat you and the way you interact with them. That’s something that you need to take into consideration when you decide [00:16:00] what kind of leader you want to be.

And there’s

Mat: also something there about, you know, the world’s not, the world’s not this or that, you know, the world’s not binary. So it’s not that either, either I’m part of the team. You know, or I’m boss, you know, what, what you’ve outlined there is okay. Well, where do the two meet? Yeah, so it’s not thinking i’m here or i’m here at either extreme But you know where where’s the balance between the two and that’ll look different for different people won’t it because you know It depends on it depends on how much of a team Um, and it says how many players you are or team member you want to be and how much in control you want to be as well, I’m guessing, sort of, you know, how or how much do you need to be in control versus how much of that control, are you happy to let go, or maybe how, how fixed you are in, in how things should be, you know, that problematic should, you know, versus being able to listen to others and, and, and accept that actually there’s lots of different things.

Okay. Yeah. Yeah. I want to go back a little bit. You said that the mind is a muscle. And I’m [00:17:00] interested sort of in about that analogy of the mind as a muscle. Can you tell me a bit more

Krystle: about that? Oh yes, this is one of my favorites. So, um, we’re not, you know, when we just, when you study coaching, you start learning about neuroscience.

So doctors out there, you are welcome. If I say something wrong, please correct me. But, uh, cause now I feel, I feel very like, Oh my God, I’m so scared. I’m going to pronounce something wrong. But, um, You know, you learn about neuroplasticity and you learn then the mind or the brain. So I think I must make the distinction because the brain is the organ and the mind is like the, what comes from that organ.

Okay. So just the same way that, um, the heart is the organ, but the feelings are what comes from the, from that organ. Or, um, if we have a muscle, The muscle is the, you know, the tissue, but the strength we feel is what comes from that. So in terms of the mind, what I love learning about neuroplasticity [00:18:00] was that we are not destined to be stuck the way we are.

We can change anything basically. Okay. So obviously there’s always a, an exception to the rule, but. At the core of neuroplasticity is your beliefs and your thinking. So in order for us to work our brain as a muscle, we have to use our beliefs and our thinking in order to use like a, as like a mental gym.

And the way we do that is also to connect with the body. So when I learned that when we focus on our body, it lights up different parts. Like it, it gets our brain to move from the amygdala to the prefrontal cortex. I really hope I’m getting this right. I’m going to be so embarrassed, but I think I’m right.

Mat: I’m an ENT surgeon. So, so it sounds all right.

Krystle: So it’s, so what I [00:19:00] learned is that, you know, when we, when we are infected, Fear in flight or flight of, uh, fight or flight. Different parts of the brain like the amygdala and the brainstem, they are the ones firing. But when we are feeling empathy or compassion, or when we are focused on some kind of bodily function, we are lighting up our prefrontal cortex.

’cause that’s where all our executive functioning is. Mm-Hmm. . And when you learn that you can actually get the brain to exercise. moving from one to the other, stuff starts changing. And I’m, I’m one of the people who’s experienced this because I was a person who used to worry about everything and through focusing on my body and my beliefs and my thinking, I’ve adapted from being a warrior into a person who can recover from it so much quicker because I can get myself from [00:20:00] that worry state into my executive functioning much quicker.

And it’s from practicing.

Mat: I mean, let’s try and sort of think and apply that, you know, let’s, um, let’s imagine that we’re talking about somebody who does a technical task, you know, whether now that might be an operation or it might be leading a cardiac arrest. You know, or it’s sort of, it might be, you know, being in charge of the acute medical um, unit sort of, you know, all of those, it’s performance, you know, people go into work as doctors and, and they are expected to perform, you know, whatever, whatever that performance is.

And one of the things that often happens at doctors at all stage is that anxiety sort of you kind of think, okay, you know, I’m going to be in charge of acute medical unit for a week, you know, you know, I’m going to be holding the cardiac arrest bleep for a week, you know, uh, or, or, you know, I’m going to have to go and sort of in perform this really difficult operation, um, or, you know, hold a difficult MDT and sort of in people kind of have anxiety.

So how, [00:21:00] you know, how, what would be your advice or how does somebody deal with that?

Krystle: Brilliant. So the biggest thing I need to say is that you cannot out think thinking. So if you’re an over thinker, if you have ruminating thoughts, you’re not going to out think your way out of it. All you’re going to do is strengthen that muscle of thinking.

Okay. Create a stronger way of thinking. So what we do is we interrupt thinking with focusing on the body. So this is something that I do with my sportsmen because they also, they are anxious. Like I said, if they’ve had a injury and now they have to go into a scrum and that’s how they got injured before they start getting that anxiety before the scrum.

So what we do is we, we say that The easiest way to think about it is to focus on one of your senses. Okay. So as a doctor, I’m assuming that your training is so robust [00:22:00] that you kind of like, not, you’re not even thinking when you’re doing things. So when you’re in the action, you’re not actually thinking, you’re kind of like going into autopilot according to what you’ve done in the past.

Am I, am I

Mat: usually, or, or, you know, If in the best case scenario, it’s kind of, it’s a flow state. Yeah. So, so that, you know, you’re, you’re, you’re, you’re in the moment, you’re enjoying it and sort of in time stops, but in a worst case scenario, people, people panic and sort of anything. Okay. You know, I can’t do that.

Last time I did it, it all went wrong. I got stuck. I’ve never made it beyond this step. I always need my trainer. Sort of to move me beyond this area and you know last time there was a complication and you know The patient had a bad outcome, you know sort of or you know, what what if maybe you know, if I get it wrong You know the patient will die.

So I think people get stuck in their heads and they don’t do the task

Krystle: Oh, amazing. So they actually freeze. Okay. Yeah. Amazing. So that’s really helpful. So [00:23:00] in terms of that specific example, what I would say is a really amazing tool to use is visualization and The reason for that is because our mind cannot differentiate between whether we’re actively doing something for real or if we’re just imagining it.

But it’s really important that there’s, you understand that visualization is not a fantasy. Visualization is a tool where you’re seeing what is you are capable of. Okay. So if an athlete is a basketball player and I tell him that he must visualize jumping 10 meters high, but he actually can’t, that’s a fantasy.

That’s not visualization. But if he can jump three meters and I tell him to visualize doing that, then he’s actually really doing it in his mind. So you must make sure that when you’re visualizing, [00:24:00] it’s something you can do. Okay. And in terms of this, you know, like going, Oh, I need my supervisor. I need someone.

I need that. That is a belief that you’ve created to protect yourself. So, Oh, if my supervisor is not chair, then that’s why I make a mistake. No, you are probably capable of it, but you’re afraid of making that mistake again. So I would say if something has happened in the past and it hasn’t gone right.

Sit down and go through it again, but visualize what you would have done instead. Now that you know what the solution is. So if you, you know, and, um, you know, I, I don’t know if you’ve ever watched, there’s that woman. She was a really fair, I can’t remember her name right now. She was a really famous pole, uh, pole jumper.

I think it is a jumper, you know, they use the pole to jump. And she, before she would visual, she would like literally do this. before she would do the jumping [00:25:00] and that was her visualizing doing it. So you go through that, that operation or whatever it is that, that, uh, where something had gone wrong and where you got to the mistake, you stop and you give yourself the opportunity to visualize.

What did you need to do instead and do that in your mind? Because that’s going to give your brain evidence that you can do it.

So that’s a really, that’s a really, really powerful tool. There’s like a, there’s a really interesting study where they’ve taken actually two group of basketball players and, but they both professional and they both have the equal, you know, skills. The one is only told to visualize. uh, throwing three pointers and the other group is told to then actually practice it.

And when they got tested after a few hours, they had the same results. Okay. [00:26:00] It really, it really is a, is a, an incredible tool when you can visualize, sit and visualize. That’s why even when you watch things, you know, when you watch an operation, but you actually do the movements with your hands and you give yourself that opportunity to place yourself in that situation, it’s as if you are doing it.

But of course, in the moment, Your adrenaline is pumping, the cortisol is off the, out of the, you know, you’re, you’re shaking, all kinds of things are happening, um, but that you need in that situation, you need to practice with that.

Mat: So this is really important because, of course, we deal with human beings, so you can’t really say, well, just practice and practice and practice, you know, because that, that, that just can’t happen.

You’ve got to do it right. Yeah. So, so the, the, the, the fact that, that there’s, you know, this visualization here, that strikes me as a really, really, you know, important way where, you know, you can, you can think ahead and plan instead of practicing on the patient. Cause clearly that, that we just can’t do [00:27:00] that.

It’s not like throwing basketball, is it? You know, it can’t be.

Krystle: No. So yes, I mean, so I would assume that that would be a great tool for someone. And even if you are going into something that you’ve never done before, if you can watch something, Where you see the process because I’m sure you guys you do that in your in your training Do it and then and actually picture yourself in that situation Because that is creating evidence and the brain loves evidence.

Oh, it loves evidence

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Thank you Now on with the show

[00:28:00] So this strikes me as important because if I think for me as a surgical trainer So that, that, you know, sometimes if I kind of give two extremes, sort of, I have one trainee who watches me and then I, then next time they do exactly what I did before, okay? And I kind of think, you know, wow, and sort of, and then I have another trainee at the other extreme who watches me, and sort of, and next time, and I kind of say, were you even there?

Yeah, so What’s the, what would be your analysis of the difference between those two trainees? You know, what, what did, what did they do? What did they do differently? The first trainee that, that, I mean, they clearly took it in, and they were able to exactly replicate, and the second trainee that was also there, but clearly didn’t take any of that in, you know, I’m polarizing, yeah?

But sort of, the person that took none of that in, and you know, And I kind of think he like, he couldn’t have been there because you like, you’ve seen [00:29:00] nothing. So what? I

Krystle: mean, I would assume that it’s something to do with like the way that they learn. So if they’re a visual learner versus an auditory learner versus a kinesthetic learner, kinesthetic.

You know what I mean? I think it would be possibly because, so for me, for instance, I learn the best when I can see the thing and then I can do it immediately. So I’m a see it and then I must do it. Okay. And that’s the best way for me to learn. If someone tells me what to do, I switch off immediately. Okay, I can’t listen.

It just, it just is not good for me. So I would assume that it could be something to do with the learning style. Um, it might be something to do with, um, like performance anxiety. So, you know, now you have to step up to the plate and do it. And the fear of that failure could be, could be quite a predominant driving force behind [00:30:00] it.

And, you know, some people really, they don’t work well with criticism, but they work really well with words of affirmation. You know, I would assume that it’s, it’s something to do with You would’ve to ask them.

Mat: Okay, so there’s two, there’s two things here. There’s one, how do they learn? And then sort of in that kind of, you know, the performance psychology, that, that, that may or may not be helpful.

I mean, how, how do I know or how do they know how they learn? I mean, you know how learn, but how, how, how, how does anybody know how they learn? Or how do I know how my trainees learn?

Krystle: You’d have to ask

Mat: them, okay, but how do they, how do they know themselves? So

Krystle: that’s the beauty of self awareness. So, you know, they would have to, they would have to reflect.

So if they don’t know off the cuff, you’ve got to self reflect. So, uh, we cannot do anything. If we, okay, so let me, let me rephrase [00:31:00] this. So I realized very soon in my training and coaching, that self awareness was the key to everything, because if you don’t have self awareness, if you’re not aware of how you function, what is your best, you know, what is your potential, all that stuff, if you’re not aware of it, if you’re not aware of where you feel anxiety versus excitement, if you can’t differentiate between the two, if you.

If you don’t have that type of awareness, then you are really going to constantly look for solutions that might be the surface issue versus the underlying one. And that is often what happens actually in coaching is that people come to me saying, Oh, I need conf, I need to be more confident. And then when we, when we unpack it, it’s not that they need confidence sometimes, sometimes it’s actually that they need to feel safe.

Because they’re not [00:32:00] feeling safe in their environment and because they’re not feeling safe It’s making them feel insecure. So therefore they think they need confidence That’s like just one of the examples So so when you are self aware You actually are able to figure out what the real challenge is And when you know what your real challenge is Then you can find a solution that’s going to help you versus a superficial solution.

And you’re going, why isn’t this working? You know, like nothing, nothing is helping. And it’s probably because you’re, you’re using a solution for the wrong problem.

Mat: So maybe if I think, you know, with that, with that example in the operating theater, so you know, for, for me, there might be my self awareness, which is that, that, you know, I, I mean, I assume that they’re all, because I probably don’t talk because normally when I operate, I focus, I don’t talk.

So, so I’m, I’m assuming that, that I’m assuming that they’re a visual [00:33:00] learner or that they’re a kinesthetic learner. And actually, you know, they might be an auditory learner. Um, and, you know, and, and what I’m doing for them is completely wrong because I’m assuming if I show them, you know, That they will see, but if they’re not a visual learner, then that just won’t work.

So maybe that’s kind of my self-awareness or the, the, the time not paying attention to, to how they, how they’re learning. I suppose the other thing also then is, you know, that kind of safety, you know, do, do I, do I do, I make people feel safe That, that, you know, that they, they can do that. They know that, you know, I’ll stop them, I’ll bail them out so that the patient has a good outcome.

You know, do, do they feel, do they feel safe? Maybe do they feel safe that they won’t be criticized and do they feel safe that I will stop them and that I have the skills to make sure that the patient has a good outcome? Because maybe if they’re thinking, well, Matt won’t stop me or Matt’s not paying attention or you know, Matt’s going to let me do something dangerous, then that’s not going to be good.

Equally, if they think Matt’s going to shout at me, then that’s also not going to work. [00:34:00]

Krystle: That’s amazing. Like, I really actually want to just take a moment to acknowledge you because it takes a It’s, it really takes a person who is not ego driven to go, how can I be better? And it sounds like already you’re going, how can I be a better teacher?

That is so amazing because some teachers I’ve had in the past are like, well, this is the way I teach. And that’s the way it is.

Mat: Well, the proof of the pudding will be in what the trainees say. Remember,

Krystle: it’s not an overnight thing. Hey, it’s not a magic pill.

Mat: You’ll have to ask them. But so I’m thinking, you know, from, from, from a trainees point of view.

So, you know, the self awareness then is, Is you know, if if you’re a trainee, how do I learn? and um Probably only ever i’ve only ever asked that question once Um, and it was it. Um, and and and I don’t think that the training knew the [00:35:00] answer So so maybe the sort of the obviously, you know, the trainer needs to be self aware, but but as as does the trainee So, you know, I’m interested in that, you know, self awareness.

I mean, how, how does one develop that? Where does that come from?

Krystle: Great question. So a lot of people have issues with these, but I can tell you from my experience and from all the people that I’ve coached doing self assessments. Because what happens is even if you, you know, like when you do like the Myers Briggs, uh, personality test, uh, there’s a free website called 16 personalities that you can do.

There’s the VIA strength, um, test that you can do that’s also free. And that teaches you, you know, like what your top strengths are. My number one is love of learning. Um, so I’m always driven by that. However, it also is, My biggest weakness, because sometimes I will learn versus doing. So that’s [00:36:00] also something to keep, uh, uh, be aware of.

There’s also assessments about what, like, if you’re auditory or, uh, visual or whatever, or if you’re a mix, um, you can do these assessments. Now, the reason I love them is because even when you do them and you read the thing, if you go, that’s not me, That means that you’re aware of something. It means that you’ve got this thing inside of you, you know.

So the fact that you’re doing something, very often we might do a, you know, one of these assessments and we will answer it according to what we think we should be, or what we wish we were, or, you know, what we think the right answer is versus the truth. So that’s sometimes why the, the results seem a bit skewed, but even when you read through them, you might go, Oh my gosh, that’s exact.

Yes, that’s me. That’s amazing. And then other parts you go, Oh no, that’s not really me. And that’s a part of the process because you’re [00:37:00] going, you’re, you’re starting to discern between who you are and who you are not. And, and it’s a continuous process. So starting there is probably the easiest. Um, and then literally becoming a more conscious person in your day to day life.

So for example, like if I think about myself, um, you know, I would just, you know, I used to be a teacher and I would come home exhausted and I couldn’t understand because I’m an extrovert. So I thought that I would, you know, be energized, but there was a part of my job that was very emotionally draining.

And it was only once I started to become self aware that I knew, Oh, I’m an extrovert. So yes, I’m getting all my energy, but I still have. Introverted tendencies. I’m like 70, 30. So for 30 percent of the time, I need to be by myself to re energize. Um, whereas I thought, oh, I’m [00:38:00] extroverted. Therefore, you know, every time I need energy, I must be around people.

So learning that about myself was really interesting. And I would learn that. I would start getting a very specific headache in my neck. And that’s when I knew I was getting drained. I was like, Oh, the energy’s okay. I need to, I need to adjust now. So the next level was like, I don’t, I don’t want to get to that headache phase.

But, uh, that was just like one of the, the things that I started noticing because it does manifest in the body. So that

Mat: self awareness then, that’s not just about what you’re thinking or even feeling, but there’s also the sensations in the body as well. Yes.

Krystle: And it’s trying to remember, I wanted to say feelings are manifestations in the body.

So feeling emotions are a physical manifestation of a thought. So if I’m feeling anxious, I feel a burning sensation, me [00:39:00] specifically, I feel a burning sensation in my stomach. If I’m feeling like sad or depressed, I have a heaviness on my chest. That’s the, that’s the physical manifestation of my emotion.

And when you, when you start actually taking notice of that, they become such a great, um, like trigger to say, Hey, you’ve got to do something about this.

Mat: So there’s that self awareness then, you know, noticing what you’re doing, you know, what’s happening for you, what you’re thinking, what you’re feeling, you know, sort of body emotions, etc.

All of those things, you know, that kind of, it struck me that what you’re describing is, It’s, you know, for me, a mindset, so self awareness, there’s a mindset where I want to be more self aware. I want to pay attention to what’s going on for me. So it’s not so self awareness, it’s not a course that you go on, you know, sort of, it’s not a book that you read, you know, it’s not [00:40:00] sort of, you don’t go to a therapist and you know, you walk out sort of, you know, with a list of things.

So it’s a, it’s something that, that, you know, you, you do and you develop and you continue doing and you continue. You know, a lifetime of, of noticing and paying attention to what you’re doing rather than a kind of one off event. Does that, does that sound fair?

Krystle: Yes, it’s not one off. It’s always. And you know, I’m, I’m very self aware, but I can switch it on and off.

You know, I don’t, uh, it’s really, really important to understand that self awareness comes with no judgment. So if I’m feeling anxious, I’m not judging that I’m feeling anxious. I’m just, I’m just noticing it with no expectations or outcomes. Oh, I’m anxious. Oh, okay. Ah, I have anxiety. There’s something going on.

Then my next step would be, okay, well, what do I want to do about it? So yeah, it’s really, [00:41:00] really important. There’s no judgment whatsoever. And for, and I would assume for people like doctors who are high achievers, There is, and, and I have a high achieving traits in me, and I know that there’s a tendency in high achievers to put ourselves down, to try push ourselves.

So you’re constantly being judgmental on what you’re doing in order, because you think that it’s a good way for you to push yourself even further, but it’s actually very draining on the brain. Judgment is extremely draining, um, whereas encouragement is extremely energizing. So when you’re encouraging yourself, if you’re coming at it from that angle, it propels you further and more sustainably, but it feels foreign to a lot of us.

It feels like, oh no, that’s stupid. You know, only loses the encouragement. [00:42:00] And that’s

Mat: how it used to be. I can tell you, you know, I mean, this happens all the time. Again, if I kind of think of that example of, of somebody that says, you know, I always get stuck as they step. This is always difficult. They always get it wrong.

There’s always a complication. I always have to call for help. So to, you know, all of those kinds of. Thoughts. And then on top of that kind of comes, you know, I’m paralyzed again. You know, I’m being anxious. I can’t believe I’m anxious, you know, I can’t believe I’m worrying about that again. So, but I mean, you know, how, how would you, how would you go from that?

I can’t believe you’re, ans I can’t believe I’m anxious again. You know, I can’t believe I’m worrying about this again. Sort of, you know, how how do you go from that judgment to encouragement?

Krystle: So I would go, Oh, I’m anxious. Something must be at stake. Okay. So it’s no longer a judgment on myself. It’s now data.

So if you think of your emotions as data, they become a tool. [00:43:00] They’re no longer something that gets in the way or, you know, it’s they, they, they actually become, I like to call it like my, my epic sidekick. When my emotions come up, they try to tell me something. They’ve got a message. And if I actually just take the time to go, well, what are you trying to tell me?

So not, Oh, this is so irritating. Oh, I’m anxious. Oh, there’s something at stake. What is at stake? Or what is my biggest fear? And you obviously look, it’s really difficult, um, to do this. It’s, it’s a, this is a better reflection exercise. So you can always think back to the past. So when that happened and unpack that and go, Well, what was at stake?

What was my biggest fear at that time? Uh, was it true? What was true about it? You know, because sometimes the truth is only like 50%. So, so you’ve got to [00:44:00] like give yourself that opportunity to go through that. And then, so that when you’re in that circumstance again, And you’ve done that self reflection and you’ve done it more than once.

Okay. Again, it requires like a muscle, you know, if you’re not, if you’re not exercising that muscle at least three to four times a week, it’s not going to strengthen. So you’re, you’re, you’re reflecting and you’re learning and you’re becoming self aware. And then when you’re in that situation after practicing all that time, then you’re like, Oh my gosh, I know what’s going on.

I’m afraid that this is going to happen. Is that true?

Mat: Yeah, no, so I think that that strikes me as really important. So the, the, you know, going from so think thinking ahead. Okay, you know, so I did that. And, you know, and I had to call for help and I couldn’t progress, you know, and, and, and whether, you know, maybe there was a problem before or maybe there wasn’t a problem before.

But then you reckon, you know, what, what’s at stake here? You know, the [00:45:00] patient, because, you know, we all care about the patient. We’re all worried about the patient. And I kind of think, you know, well done, you, you’re worrying about the patient. Congratulations. You know, what a lovely doctor you are. You’re worrying about the patient, you know, well done you.

You

Krystle: should, but I’ll tell you that you’re worrying about the patient. But you’re worried about the repercussion if something goes wrong with the patient. You’ve got to take it another level because yes, at, at that time you must worry about the patient. Never get rid of that. We don’t want to get rid of anxiety.

We need anxiety. We want to get rid of anxiety that is preventing us from doing what we need to do.

Mat: And then I like, I like sort of that, that idea of, You know that that checking on reality that you know, this might happen There might be this complications that you know kind of it. It just mushrooms, doesn’t it?

This thing, you know, this could happen that could happen that could happen Well, you know, yes it could but you know, has it happened before what the chances of happening [00:46:00] and then and then also Do you know the sort of the like a muscle thing what’s coming up for me? At least in the kind of surgical world is practicing What you do, if you find this, what are you going to do?

If you find that, what are you going to do? So, so that you, you’ve thought ahead, you know, if, if there’s these complications that happen, if these problems occur, they may have done, they might not have done in the past, but then, then we’re back to that, to that, um, um, um, visualization, sort of, you know, what, what am I going to do?

If this happens, what am I going to do? How I’m going to deal with that? Um, and it, and then we’ve kind of, so. You know, we’ve, we’ve married that idea of this is data that means something and we’ve got, you know, that reality testing, um, and, um, we’ve removed the judgment and sort of and say, okay, this is important and reality testing.

And then, you know, then we’ve got visualization as the next step so that you kind of practice, you know, okay, you know, if this disaster does happen, what do I then do about it? Um, so that, that, you know, you, you’ve considered and you thought [00:47:00] ahead so that, that. I guess, you know, it becomes a bit, it becomes much less anxiety inducing because, because you’ve thought, and actually as a surgeon, I think that’s a quite a good thing to think, what would I do if, what would I do if, and, and the reality is that, that many of us won’t face those situations, you know, ever, or certainly not regularly, but if you’ve thought about those scenarios and visualize them, then, then it’s, you know, it’s less of an issue because you’ve thought ahead and you know what you, what you’re going to do.

Krystle: Yes. You know, we have very, very often we avoid thinking about those things. Like, we don’t want to think about it because we’re also afraid that it’s going to make it come true. You don’t have that much power. I’m so sorry, but your thoughts, yes, our, we, we, there is something called the self fulfilling prophecy that is, you know, about how, what we believe in and then our beliefs ensure that we act in a certain way to confirm that what we [00:48:00] believe is true.

That’s fine. But actually just giving yourself that moment to go, what’s the worst thing that could happen? And go for it. Say, go, go as far as you can. And once you’ve actually put that out there and you go, well, what would I do if that happened? You’ll realize I’m equipped for this. I’m amazing.

Mat: So I can just go to that self fulfilling prophecy because I like the idea, you know, that powerfully, if I think of, Say, you know, you discover an anatomical variation that the patient has.

Yeah, I quite agree You know, I my thoughts do not have the power to change another person’s anatomy Yeah, so but but it’s good if I’ve thought ahead about variations of anatomy and then what I do with that But i’m wondering, you know Uh, there, there’s, there’s an instrument that we’ve got that’s quite powerful and, and you always kind of think, you know, don’t touch the uvula.

So I now have a vision of a train thing. Don’t touch the illa. Don’t touch the illa. Don’t touch the uvula. Don’t touch the uvula. Don’t touch the illa, don’t touch the uvula. So, so what’s, what’s the, what’s the con? Because that, I think [00:49:00] that’s where, that’s self-fulfilling prophecy comes in, isn’t it? So how, how does one deal with that?

Don’t touch the eula, don’t touch the eula.

Krystle: I think that’s, that’s like kind of connected to our primal brain, you know, that’s like, well, what will happen if I do that? Um, the self fulfilling prophecy is, is really about, you know, we want our, our, our, our ego wants to, Be thought of as relevant. Okay. So our psychological ego and very often I’ll believe stem from that.

So we believe that, you know, Oh, your belief might be, Oh, I’ll never, I’ll never get promoted. Okay. I’m going to use that as a belief. I’ll never get promoted. That’s my belief. And then what happens is that’s what you believe. So therefore you start thinking in a way that’s going to sabotage Any opportunity that comes your way, then you start [00:50:00] feeling resentment or you feel frustrated or upset or angry.

And then that’s going to determine how your actions and those actions are then going to confirm the belief. Oh, I’m never going to get promoted. That’s how it works.

Mat: So how, so how, how does that get outta that? You know, again, if I kind of think, you know, in surgical world, they think, oh, I’m not a very good surgeon and you know, I’m not a very good surgeon.

Then I go in, you know, sort of, you know, irritate to the next consultant or the next trainer, or whether you’re an A and e, another set, and they kind of say, oh, you know, this is a struggle and if they get, you know, I was right all along, I’m really not a good surgeon. And then you go to the next person and you just sort of, I mean, how does one get outta that?

So

Krystle: again, it starts with self awareness. So you first have to, you have to first, even you’ve got to even acknowledge that you have that belief. Fine. Okay. So you’ve got to catch it because it’s just a belief. [00:51:00] Okay. And the amazing thing about beliefs are that they’re a choice. So that means we can choose a new one.

So what we in the coaching world, we call the ones that limiting beliefs. And what we do is we unpack that and we go, well, what’s a true liberating belief? So it might not be the exact opposite. So if you, if you’re going, I’m a terrible surgeon, well, okay, that’s your limiting belief. What is a true liberating belief that you can, so maybe you’re very meticulous.

You very, you know, you, you pay, you are really good at details. You’re amazing at spotting something. So you focus on that versus the thing that it’s probably not even true. You probably had one instance and now it’s anchored in your subconscious. And in order to [00:52:00] preserve your ego, You are attaching yourself to that belief because if you’re going, well, I’m not a good surgeon, and then you get the evidence, your ego goes, yeah, you see, I told you I’m right.

Mat: Yes. Um, okay. So I, I, I like that, that idea of choosing different beliefs, but you know, I’m going to come back cause you’ve outlined there. A strength being a weakness because let’s also say I have somebody who’s really really meticulous and pays very detailed attention But they never make any progress, you know, they’re sort of they’re very very perfectionist They’re very pedantic, you know, which is many ways is a great characteristics to have a surgeon It’s also a terrible characteristics to have a surgeon because you know Because if you spend 12 hours doing something that should take you half an hour That’s no good for the patient, you know, and everybody else would be really fed up and earlier We talked about this idea of you know You talked about your own strength and actually you said your biggest strength, it’s your biggest weakness.

So I might sort of say paying attention to detail, that’s your biggest strength, but it’s also [00:53:00] your biggest weakness. So what, what’s, what’s the relationship between strengths and weaknesses in this context?

Krystle: So everything at an extreme can be, it becomes negative. So when we take it to the extreme, it generally becomes negative.

So my love of learning. is a huge strength of mine because it’s constantly moving me forward. But when I’m afraid of something, I generally will fall into learning because I’m avoiding doing the thing. And that, again, comes down to self-awareness. So I know when I’m learning because I’m genuinely wanting to learn something to progress versus learning as an avoidance tactic.

Mm-Hmm. And once I, once I catch myself in that, uh, that state, I can go, oh, what, what am I afraid of? And once I’ve surfaced that and I know what [00:54:00] it is, you know, that same process, Oh, I’m afraid, I’m afraid that I’m going to look stupid. That’s a huge fear of mine. Okay. I’m going to look stupid. Okay. And then what?

Well, actually I wouldn’t mind if someone corrected me because then I would learn. Oh, okay. So this fear is actually not even. It’s not even such a big deal. Okay, well then let’s do this thing. And you’re not

Mat: learning anyway. So, so that’s great. Exactly.

Krystle: So it even just becomes like, whew.

Mat: So, you know, I think that the way that that would play out would be in surgery would be that sort of some of this perfectionist and, you know, and, and they kind of, if, if that becomes, if that is overdone, Um, then, yeah, it’s that, it’s that, you know, what, what are you afraid of, you know, people, people be afraid of making a decision.

Um, and you know, they get, they get stuck at the step. They just keep doing the same step over and over again because they’re afraid of making a decision or, or they keep doing the same stuff because they, they, [00:55:00] they think, you know, it’s not perfect enough. And then actually, you know, they’re afraid it’s not perfect or they’re afraid of moving on.

But there’s a reality, which is that, well, you know, you can’t spend 10 hours doing something that should take you half an hour. Yeah. And then, you know, is that sort of what’s the cost and the consequences? And then I’m guessing that, you know, once you realize that, you know, OK, you know, I’m what I’m worried about is I’m worried about, you know, what’s going to happen.

I’m worried. Well, once you know what you’re worried about, you can then make progress, isn’t it? Yeah, because if you’re if you’re worried that it’s not going to be perfect, yeah, you know, well It’s well done you but equally, you know, you’ve got to at some stage you’ve got to finish the operation Yeah, and if you’re worried that you’re going to make a mistake, it’s okay You know, where’s the learning need here and you know, how are you going to learn and then we kind of back to that visualization Yeah

Krystle: Exactly.

And you, you can always tell when your strength is becoming a weakness, when it’s harming you. So that’s my differentiator. Is it serving me or is it [00:56:00] harming me? Yeah. So if I’m learning and it’s harming my progress versus is it serving my progress. So that’s kind of how I discern between the two. So if I’m being a perfectionist and it’s delaying me, it’s harming me.

So you can also say, well, I am a perfectionist. That’s amazing. Great. We need you. We want you. Okay. How can I use this perfectionism to, to get myself to go quicker? Like you have to, you have to like reinvent the wheel. You’ve already got the tool. The app already have this amazing muscle. You just got to focus it somewhere else.

Mat: I now have a vision of, of, of being a perfectionist when it comes to making progress or to timing, you know, I’m perfectionist, I always finish on time. So it’s a totally different focus, isn’t it? Yeah. So, but it’s the same, the same [00:57:00] characteristic, but, but, but focus in a different way. I’ll bring us to a close if that’s okay.

Maybe if I could just ask you to, to, to summarize and you know, what would be your top tips for doctors at work in relation to mental performance? Thanks

Krystle: Start with giving yourself the Opportunity to get to know yourself, because I know that you guys are thinking guys, girls, everybody, you’re thinking about others a lot, and that is so noble and wonderful, but the more you can also direct that focus on yourself, the better you’re going to be as a doctor and as a partner and as a person, and maybe as a parent, whatever you’re.

So the more you can give yourself that opportunity to work on your self awareness, it’s not a self criticism, it’s not so that you can see what you’re doing right or wrong, it’s to see how you work so that you can You can make it even better. You can optimize it. [00:58:00] So if you think of it like that, it’s an optimization tool.

It’s not anything, it’s, it’s not used for any other reason. So start by going like, Oh, but how, how do I like to do this? And if you don’t know. Think about it. Journal. Journaling is a great tool.

Mat: Perfect. Wonderful. Thank you very much.

Krystle: Thank you for having me. Please find me on social media. Thank

Mat: you very much.