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Doctors at Work Podcast.

Episode #48

How to think differently about challenges at work. With Sanjay Popat

Mat Daniel

02/12/2023

We all face challenging work situations, but what makes makes one instance stressful and the other one not? And how come some doctors just seem to rise above it all, but others struggle? Sanjay Popat has researched stress in foundation doctors, and identified that the way people make sense of situations really matters. We all have “schemas” which are lenses through which we see the world, and these schemas influence what we make out of the situations we face. Seeking professional help can be useful to unpick ingrained ways of thinking, and individuals can also make sure that they pay attention to and notice what is going on, what triggers them, and how they think. Once you have identified ways of thinking,  you can then fact check the assumptions that you make, look at possible alternative explanations, and recognise that situations are usually complex shades of grey more than binary all or nothing thinking.

Dr Sanjay Popat is a researcher in Organizational Psychology at the University of Leeds. He has a keen interest in the well-being of employees, and particularly healthcare professionals who suffer from elevated levels of stress in comparison to the general population.  His PhD research involved asking 58 foundation doctors to keep audio-diaries for 2 months to understand their stress experience. His work was included in the international media coverage of the junior doctor strikes and won the award for Outstanding PhD Prize from the University of Leeds.

You can read his blogs summarising his research here and here, and you can find him on LinkedIn.

Podcast Transcript

[00:00:00] Mat: Welcome to Doctors at Work. My name’s Mat Daniel, and this podcast is about doctors’ careers. Today, I’m having a conversation with Sanjay Popat, and we’re talking about how you can think differently about challenges at work. Now, we all face challenging work situations, but what makes one instance stressful and the other one not? And how come some doctors just seem to rise above it all, but others struggle with the same problem? Sanjay Popat has research stressed in Foundation Doctors and identified that the way people make sense of situations really matters. Now we all have schemas. These are lenses through which we see the world and these schemas influence what we make out of the situations that we face. Seeking professional help can be useful to help you unpick ingrained ways of thinking. And individuals can also make sure that they themselves pay attention to and notice what’s going on, what triggers them and how they think. And once you have identified ways of thinking, you can then fact check the assumptions that you make. You can look at possible alternative explanations and you can recognize that situations are usually complex shades of grey, more than binary all or nothing thinking. I hope that it’s useful.

Welcome, Sanjay. Tell me a little bit about yourself.

[00:01:25] Sanjay: Hi Mat. First of all, thank you for having me on to the podcast. So my name is Sanjay Popat. I’m a researcher in organizational psychology at the University of Leeds. And I’ve actually a few weeks ago, just finished my PhD there, looking at stress and mental health in foundation doctors.

And I guess just more broadly, I have an interest in mental health. And I think a lot of the public take the view that perhaps their lived experience is the only experience of mental health. So I’m really passionate about trying to reduce that stigma and use the evidence base to help catalyse that.

And yeah, so I’m also a mental health first aider. So I try to practice what I preach on my day to day basis. But now really looking forward to sharing some insights on how we can better protect against stress for doctors in particular.

[00:02:11] Mat: Congratulations on finishing your PhD and I know you did your PhD around doctor’s health and being and careers.

How did you become interested in that area?

[00:02:21] Sanjay: Yeah, so I think that’s a really good question. So I have a lot of friends that are foundation doctors or were at the time starting my PhD and I noticed when they started work just A lot of change in them personally some of them, I lost contact with for a bit.

Some of them ended up in therapy, different things like that. So for me, it was just a real push to understand actually, what is it about this profession that is so stressful? What do we know about that? What don’t yet we know about that? And obviously the latter was the drive behind my PhD. And real, really trying to bridge the theory and practice.

Debate so using the research and the evidence base into actionable insights to help people actually at work

[00:03:02] Mat: I’ll come on to what you found in a minute But I’m interested in your comments about people that you know and the challenges that they face Are things different in medicine than other professions?

[00:03:14] Sanjay:  I think so. Yes, I think just the nature of medicine is incredibly different to a lot of other professions and actually the research shows that stress levels could be up to 10 times worse in the medical profession in correspondence to people of the same age in other occupations.

So there is something about medicine that is incredibly stressful and not to be too doomy and gloomy, but we know that mental health conditions are more prevalent amongst healthcare professionals in comparison to the general population. So there is that elevated risk there.

[00:03:47] Mat: And you’ve got a unique perspective because, you’re not embedded and meshed in medicine in the way maybe that I am or some other people are because, and you understand there’s a world out there and you understand the world of occupational psychologists.

What’s your analysis about the reasons why? medicine is different and maybe more challenging.

[00:04:08] Sanjay: So I think a lot of it stems from the caring nature of it. So there is obviously an emotional bond there between the patient and the doctor. So I think that’s one of the core reasons which you may not get in other industries.

There is this, psychological link between the patient and the doctor. And also a lot of. responsibility in those early years. And unlike other professions myself included, if I make a mistake, in the worst case scenario, it probably isn’t going to affect someone’s life to the extent that a doctor’s mistake might do.

So though, I think those were just my first thoughts coming into it. Obviously, the research has shed light on some other aspects, but I think it is this humanistic relational component and the kind of, I guess the worst they see the worst of society in some cases. And for a young doctor as well That’s quite a lot to deal with going into the workplace for the first time

[00:04:59] Mat: and I guess that those two components, you know that psychological emotional bond that you have and you know what you owe to the patient coupled with the fact that what you’re doing has potentially such high stakes circumstances, there’s a bit of a storm in there that on one hand you have this psychological bond and on the other hand the capacity or the potential for the consequences of error is so great.

But if I maybe start with that idea of, the emotional bond with the patient because I guess I’d say, surely that’s a good thing. So surely that, that should give us energy. That should make us thrive. That should fill our glass, the fact that we do have those strong connections.

So how do those strong connections become something that makes it challenging rather than something that, that, that fills our cup?

[00:05:50] Sanjay: So yeah, you raise a good point. And actually this. social connections are the foundation for human behaviour. We need social connection to thrive. And it is the basis for flourishing in many domains.

I think what makes it different in the healthcare domain is there is obviously a potential there for, like we just said, for the doctor’s own actions to influence that negatively. But actually what we found as part of the research is. Oftentimes that’s to do with the doctor’s cognitions themselves.

So two doctors may actually experience a very similar situation, a patient, a bond with a patient. But one may go down a quite difficult pathway and the other may be absolutely fine and not affected much in the longer term. So I think it comes down to that individual doctor’s own psychology, their set of thoughts, which is influenced by their past and often by childhood as well.

[00:06:37] Mat: Okay, so let, tell me a little bit more about your research then. So what did you do and

what did you find?

[00:06:42] Sanjay: So what we did as we’ve said, it’s no longer contentious to, to think about healthcare as a stressful environment. But I think a lot of the prior work has been cross sectional.

So really static, just understanding a snapshot of what a doctor is going through. And so what I wanted to do is to get a really experienced near account. So following these doctors on day to day experiences to understand their stress in real time. So what we did is we asked these doctors to keep a diary and particularly an audio diary.

So they recorded their stress their trauma, any, anything that wanted to reflect on the days that they experienced them. And I think that’s quite novel because tends to be distorted through memory in other kinds of accounts. We also interviewed them before and after this period to follow up on that and see how things may have developed over time.

So I guess just giving it a time perspective to, to what people’s experiences of stress are, cause that’s, what’s missing at the minute in the literature many different findings, but as I alluded to. We found that many doctors tend to take one of two pathways. So a very positive one, and that builds on each other.

And also a negative one, so leading to these vicious cycles. And that’s based on their internal thoughts. And it can become quite distorted and irrational as they go down that trajectory.

[00:07:54] Mat: Can you give me some examples about a doctor that, that goes down one thought pattern versus a doctor that goes down another? And I know that, we’re talking about dichotomies and reality life is often more complex than that. But, for the purposes of our discussion, I think it is useful to think of two extremes as to how one might think about a

[00:08:14] Sanjay: situation.

Of course. So one

of the widest examples was a high workload. And What we tended to see is initially a lot of people found a high workload, very stressful, but over time, they’re how they made sense of that situation developed.

So for some, they gave meaning to that in a very positive way, in a functional way. So for example, I can’t do everything, but I’ll do what I can and someone will pick up the slack or I’ll hand this over, the system isn’t built. It’s not a reflection of myself. But that’s all I can do and I’ll pass it on.

So what we found is this then tended to be the lens with which they viewed that moving forward. So almost accumulated and stress really time tried to reduce over time, or even if that initial encounter was very stressful for them, but other people. Tended to give meaning to that in a very different way.

I am the reason I can’t come do this amount of workload. If I was better at my job, I’d be able to do this workload. There’s something wrong with me. So not necessarily that they internalized it, but they gave meaning to it in a dysfunctional way and much in the same way.

When they then experienced that high workload again, they rationalized it with these new thoughts and the meaning they’d given to it. And oftentimes it sent them down a very dark path, becoming quite symptomatic. And in some cases, there was a sense that people were developing more severe mental health conditions.

So it’s really about how they made sense of it in the initial instance and how that propelled them forward on these paths.

[00:09:41] Mat: Where do those two different ways of thinking originate?

[00:09:46] Sanjay: So they originate in what we call schemas. So schemas are very simply a pattern of thoughts and behaviours that we use to interpret the world.

So if you can imagine wearing a pair of glasses, the lenses of those glasses are our schemas. And We all have schemas about different things. How people act in social situations, how we feel, ourselves, other people, the world. And often they’re from childhood often, but as we go through life, we may remodify or reformulate entirely these schemas.

And that’s where these thought patterns come from. And that’s why. We’re all very different so two people can face the same situation but think about it very differently because of the schemas that develop throughout life and they guide us. They’re helpful because they help us see things and very quickly know what to do, but they can also be dysfunctional as well.

And that’s what we saw in the research.

[00:10:40] Mat: So I, I suspect anybody that’s got children is going to now be thinking, how do I give my children schema number one? So how do people give their children the first set of schema rather than the second one?

[00:10:53] Sanjay: So I think it’s important to know that for parents you do have a lot of impressions on your children, but it’s not everything.

School is something else. Peers, there are a lot of different influences. So it’s not all on the parents. But I think one of the biggest things is just to create an early validating environment. Yeah. Listening to your children if there are any conflict, teaching them healthy conflict, how to process your emotions effectively.

And just general things like that. But being very validating, I think that’s to say that’s not overly, because we know that can lead to other problems, but, giving them praise where they should receive praise. And if there are areas for development, then reassuring them in a very. Positive way that there are areas to develop, but not scolding them necessarily or being too harsh.

And it’s very difficult to find that balance. But we do know that early childhood experiences formulate schemas quite powerfully.

[00:11:44] Mat: And

how do organizations influence the schemas of the employees?

[00:11:50] Sanjay: So this is a very new thing, and there hasn’t been much research about how organizations can do this.

But managers are potentially one gateway into that. So just as a parent might be as a child, a manager may be for the employee. So again, it’s about that validating environment. Yes, we may be talking about adults now. But it’s the same concept, really, a validating environment. And if someone is joining the organization, that is a particularly prime time to be able to curate these schemas and potentiate good schemas rather than negative ones.

So I think I’m sure I’ll talk in a bit about how individuals can help with their own schemas. But just checking in, if you’re noticing that someone is adopting a particularly bad schema. For example, I’m not good enough for my job. They’re potentially reminding them of times where they have done a good job or in the healthcare industry if they did help to save a patient’s life to just remind them of that, because our mind can sometimes play tricks on us, but not misinforming them.

The goal isn’t to misinform them, but to add shadings to that thinking. So that it’s more balanced depiction of reality.

[00:12:57] Mat: So for me As a senior consultant, then what you’re saying is that there’s things that I can do that, that help the team around me, whether young or old or medical or non-medical in terms of giving appropriate praise and giving appropriate recognition.

And, appropriate is the key. Not telling people it’s wonderful if it’s not. Because people themselves will know if there was something that wasn’t good. People will know themselves, won’t they? I don’t mean to tell them. So that appropriateness. Okay. And you talked about, individuals.

So what can individual healthcare professionals do?

[00:13:30] Sanjay: So I think schemas are very, they’re a very individual thing. So it’s, it can be quite difficult to first identify them. But if you do, I think there’s just some general advice I would give. First of all, that just knowing that schemas and the thoughts that arise from schemas, just checking, is that based on a fact or is it based on an assumption?

And oftentimes it is based on an assumption, which is loaded with interpretation there. So it can be distorted and just recognizing that in the first instance is quite powerful. The second thing is if you do have a schema, for example, I’m not likable, I’m not good at my job. I think the first inclination is to want to be I’m amazing at my job or everyone loves me, but in reality, very few people are always amazing at their job or always likable, even if they are very competent and likable people.

So most of the world is actually grey. It’s not black or white. And so just actually being realistic that, maybe you could reach a schema where Some days you’re better at your job than others not necessarily that every day you’re amazing at your job. And I think that can be quite helpful.

And third of all just being able to note that you may be able to challenge your own schemas. So are there alternative explanations for that? For example, if you come into contact with a colleague and you notice they’re not really looking at you and you’re thinking, oh, it’s because I’m unlikable, can you see that perhaps a patient is requiring their attention and just picking things out in the environment, which may help to challenge that.

So one of the things I always say to people is to keep an evidence log. So an evidence log is, it’s very simple. It’s a piece of paper with that schema at the top. So as I said, Maybe nobody likes me or I’m not good enough at my job, having a column that’s supporting that, but also one that’s contradicting that.

Maybe go throughout your life for a week and just make notes there of the different things. So we know that may help to identify things that contradict that schema. But it also may help to identify key triggers. So am I feeling like this when I’m around certain types of people? Or am I feeling like this at particular times of the day or when I’m doing certain tasks?

And that can be particularly helpful. So for example, if you do have that schema that you’re not likable, maybe you notice that an employee is Has invited you to for a cup of coffee, or it could be even smaller that they’re holding a reciprocal conversation with you or they’re smiling and giving positive body language.

So these would be the kinds of things that you include in that. And just to add to that as well. I think Sharing that with someone that you trust, someone that knows you well, can be really helpful as well because they may be mindful to pieces of evidence that you’ve dismissed and they can also ask questions to help you evaluate it.

But I think in general, that’s a good thing. And you can also add. percentages to how much you actually believe that evidence. For example, if someone if someone maybe smiled at you last week, and you write that in your contradictory column, you may not actually believe it. You may say, okay, 20%, I believe this piece of evidence is contradicting the schema.

But the week after, if someone gives you a hug, then you may say, actually, it’s about 40 percent now. So you can work up because it’s You know, unrealistic to assume overnight you’re going to suddenly believe that contradicts the schema, but that’s just a few ways that someone could do that

[00:16:48] Mat: So change takes time, doesn’t it?

Yeah, but I’m interested. You said the first thing is identify the schema. So I’m thinking, I wonder what my schema is. How do I identify what my lens is?

[00:17:02] Sanjay: So it is very difficult because they’re quite deep rooted. Sometimes we not may not even be aware that we have. a certain schema.

And that’s something that we saw in the research as well, that when we ask people, they weren’t even aware that they were operating these lenses. But I think when you have a negative reaction, maybe you feel the stress, maybe you feel the anxiety, that would be a time to say, okay, why have I felt this?

Is there a pattern? Because last week I felt this way. And sometimes that schema will be the consistent thing that has caused that. Feeling in both situations. There are also online questionnaires. So psychologists, therapists have developed questionnaires which can help you examine your schema.

So there, there are different ones about, for example, belongingness or emotional needs, all these kinds of things. So you can just type up, schema questionnaire on the internet and that may help you as well, but just a disclaimer a mental health professional is best placed to probably guide you through these things.

But just some of these techniques may help you challenge them if you do notice them very early on.

[00:18:03] Mat: Yeah, and I would agree with the importance of seeking professional help. I think it’s great. We can all do stuff ourselves, can’t we? I think one of the issues is that many of us as doctors think that we’re perfect and, every, everybody else has got it all together and everybody else has a perfect life.

And I’m the only one that’s struggling and I’m the only one who has issues with that and therefore I don’t ask for help because I’m the only one and everybody else has this amazing perfect existence and the reality is that many of us struggle and we would be better off if we did ask for help more than we ask for help.

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Thank you. Now on with the show. I think in terms of what people can do themselves, I like this idea of looking at, what triggers you or what problems are, something that provokes a strong reaction. And then spending a bit of time reflecting and thinking, okay, why does this bother me?

Why has this provoked this strong reaction? Why is this an issue for me? And then trying to identify. Patterns of thinking or patterns of triggers or patterns of behaviour.

[00:19:26] Sanjay: Absolutely. And actually one of the main things that could help people with that is usually it’s because something is at stake for an individual in terms of their goals or values.

So really asking that question, Why is this bothered me is anything at stake for either my goals or values. So it could be that, maybe a patient is unwell and a doctor says that’s bad for me because it could affect my reputation or it’s bad because the patient may actually.

die. So reflecting on that and that would then help you challenge those things. Is it true that it would really, one mistake may help you, may damage your reputation if it’s a small mistake or do senior consultants expect doctors to be perfect 100 percent of the time and then you can actually use that to feedback and, is it really damaging to my, what’s at stake for me?

So I think that’s just something to add on there.

[00:20:15] Mat: You talked earlier about this idea of distorted memory. I know you said that you research, you capture things straight away because, if you ask people later, they put several layers of interpretation and the original story has gotten lost.

Tell me a little bit more about how our memories distort the facts.

[00:20:35] Sanjay: So usually it’s either because it’s been so long that information is decayed, so we just, we haven’t rehearsed it enough and we forget what’s actually happened or sometimes we can actually have interfering memories. So something else has happened. And we’re actually replacing that with the original memory. And so both versions can be particularly harmful for research, where we’re trying to understand what’s happening in that moment. So for example, this one. We can only use that data to understand how to prevent someone if that data is really accurate of that time period.

So that’s why we did it there. So there were no interfering memories. And there were no kind of forgetting simply. And also there’s this thing called the peak end effect. So when you ask someone quite late on about an event, a stressful event, we tend to only remember the peak. So the most into emotionally intense period.

Or the end of it, so the bits happening in between there tend to be a bit fuzzy as well. But they may be very useful in treating whatever happens. That’s why getting an accurate contemporaneous account is quite important.

[00:21:38] Mat: And if thinking as a doctor, if I, if something bad happens two weeks ago, and I only remember, the height of the emotions and I forget everything else.

That’s also. problematic because, I’m now thinking about a situation from the past and actually what I’m thinking about now isn’t actually what happened.

[00:21:58] Sanjay: Yeah. And then you may put together a plan based on the height of those emotions, which doesn’t capture the totality of that experience.

So really understanding the actual, the whole of that process, then using that to make an implication or a recommendation is more accurate.

[00:22:15] Mat: Can I, can I pick up this I’ve written down shades of grey because you talked about the fact that it’s rarely that, that, we’re not either perfect or rubbish.

We’re all in the middle, but I think that, the, all or nothing thinking, the binary thinking, I think that’s, Very prevalent, I think, isn’t it?

[00:22:32] Sanjay: it is quite prevalent, particularly in in high stress states or for those that do have a mental health condition. But generally that is generally, I’m speaking, that is distorted because as I said, most of it is grey.

We’re not something a hundred percent of the time or nothing, the end of it. And that’s just part of human behaviour

[00:22:52] Mat: and what can we do about that? What can individuals do about that?

[00:22:56] Sanjay: So I just recognizing that actually the grey. it sometimes is okay. And obviously if you’re, you are on that all or nothing thinking, then it may be the schema that is driving that.

So some of the steps we talked about will help with that. But as I said, it’s not just about getting to the complete other side, getting to the grey area is fine. And actually that’s what therapists often suggest because that’s how I think when you go. one way, you want to fling back the complete opposite way, but actually being in the middle is often the optimal place.

[00:23:27] Mat: If I think a little bit wider than you, we talked about that, healthcare stressful and individuals experience things particularly strongly, maybe because people are, there’s an emotional psychological bond with the patient and. The potential for error makes it very stressful.

From, I don’t know if you’ve got any experience of other sectors, other industries, how, cause medicine isn’t the only sort of stressful, high stakes industry out there. How do you know, how do other sectors deal with that or how do other organizations help or how do people with other organizations deal with some of the issues that you’ve outlined?

[00:24:05] Sanjay: Generally speaking, organizations, corporate sector, there’s primary and secondary intervention. So primary intervention means getting rid of the stress at the source. So almost putting out that fire. So trying to reduce workload trying to put more staff on these kinds of things. We also have secondary and also tertiary interventions, which are not getting rid of the source of stress itself.

But it’s about changing the employee’s reaction to it. So that may be with therapeutic techniques. It could be reframing how an individual perceives that source of stress. But we do know from the evidence that the primary interventions are the most effective, but in medicine, it is perhaps harder to do that than in some other organizations, there’s always going to be patients.

It is more strained than other sectors potentially. So that’s why. I think a lot of the talk in this field is aimed at those secondary and tertiary interventions, although that shouldn’t discourage us from trying to get rid of the sources of stress themselves, which the research also does speak about.

[00:25:07] Mat: Because one of the things that I hear a lot is people say, but I shouldn’t need this. I shouldn’t have to have this secondary thing, if the organizations were better, if there was more staff in the workload was less, I shouldn’t need all of these, and. What would be your thoughts about people who say I shouldn’t need any of this?

[00:25:25] Sanjay: So in certain cases that is that may be true, but also, we know that there are some individual differences, some personality styles that may predispose someone to experiencing that amount of stress. Yes, potentially it’s true that the organization has a ridiculous workload that has led you to become burnt out, but not always so it’s not.

So we can’t make sweep sweeping statements about that.

[00:25:52] Mat: I think it’s challenging also. Because the reality is that, you talked about workload and more staff. I can’t see that’s going to change anytime soon in the NHS. Because the workload is o is only going up. Okay, so here’s a really big question is, people say the workload’s bad and this is difficult.

So you know why. Why do I keep going to work? Why do I bother with that? So if a doctor came to you and says, I shouldn’t have to do that, I shouldn’t need all of these things, that it’s so difficult. I suppose that’s a schema, isn’t it, that I’ve just outlined?

[00:26:23] Sanjay: Yeah, potentially. It could be a belief or a broader schema, but yeah, that’s the kind of negative thinking that that may capture a schema. Yes. Okay.

[00:26:32] Mat: Okay. Anything else about your research? What else did you find?

[00:26:37] Sanjay: So there were a few different things. So because we’re on the topic of workload and so forth, so a high workload was the most problematic thing for foundation doctors.

So 339 mentions in the diary. So really prolific. But what we actually found by asking people in real time, One of the reasons that they struggled with a high workload was because of the inability to prioritize, which I found quite interesting, and I wasn’t really expecting that. So I think for the individual doctor, I’ve been speaking to quite a few senior clinicians this week, and they’ve said, they’d be happy, in the appropriate setting to actually discuss a day or a set of tasks with the junior doctor and go through what is a clinical urgency, what can be left till later.

And you may not experience that exact same set of tasks again, but hopefully there’s some gems in what your senior has said that you can then take forward. So I’d just be just saying, don’t be afraid to ask. for help on prioritization, just say, okay, I had this patient today, this, what would you do in that situation?

Because at the end of the day, foundation years are learning opportunity as much as a job. So you’re there to learn and pick up things. And we also found that. negative anticipation was really common. So what I mean by this it’s linked to the schemas, but a bit separate as well. Doctors thoughts of the future influence the stress they experienced in the present, sometimes more than present stresses themselves.

So that is a really big thing that we were seeing. And one of the main things that we know helps with negative anticipation is mindfulness. And I think Mindfulness is often touted as this panacea that will solve everyone’s problems. And I’m not saying it is that, but for those struggling with negative anticipation, then that can help ground your thoughts potentially and keep you in the present moment.

So there are some really good apps like Headspace and Calm and these kinds of things.

[00:28:29] Mat: Tell me a bit more. So what is negative anticipation?

[00:28:33] Sanjay: So it’s just where people’s thoughts of the future. So not in the present moment, but the thoughts of the future influence their stress in the present. So for example, I have a night shift coming up tonight.

So I’ve got palpitations now. So there’s almost this crossover between time states. Or another example we had was very busy this week. I’m tachycardic or my thoughts are racing. So it’s not even in the present work day. It’s about what the future is coming in.

What the idea of what is expected to come rather than what is actually happening.

[00:29:03] Mat: So it’s stress about stuff that hasn’t even happened yet.

[00:29:05] Sanjay: Exactly. Yes. Okay. And it’s funny cause when we talk about it. Like this, you think, I can’t believe people are worrying about stuff that hasn’t even happened yet.

But the reality is people are worrying about stuff that hasn’t even happened yet.

Absolutely. And because we did the diaries, we could then see when it happened what was their thoughts. And like you say, when it passed, they were like, I don’t know why I was worried about that, or I don’t know why this.

So it is the idea of what’s coming, not in all cases but in a lot of cases.

[00:29:34] Mat: What did the doctors that were in your study, what have they learned about themselves?

[00:29:37] Sanjay: So I think because it was diaries, one of the main things that helped them work was the method and actually this kind of almost confounded our study because the method we were using to look at stress was alleviating the stress for many people.

But I think it just helped them to identify their key triggers. And that was different for everyone. So I can’t give you like a generalized principle, but they were able to see, okay, this is stressing me out because of this or this is stressing me out because of this and make those causal connections.

And also the importance of just. sharing your feelings, even if no one is listening to that. So that would be actually another suggestion of mine is potentially keep a diary or journal of some kind. And I know lots of doctors do journaling, but the benefit of an audio diary is it’s very quick.

So when you’re writing things down, it tends to act as a cognitive speed bump. So you’re analysing before writing, and that can lead to. Not getting an accurate account of your thoughts. So actually doing it in very quickly in, in a, in your phone or whatever can be very good. And it’s actually been shown to reduce cortisol levels and doing that diary may actually show you when you’re on that pathway that I was talking about.

So that you can ask for help before you reach the breaking point. And also you may be able to see more clearly. Okay. I was exposed to this stressor on day five. I was then re exposed on day 27 and I can actually see after day 27 my thoughts are a bit more distorted and I’m bringing that lens with me.

So you can actually evidence that over time and listen to it yourself. And that’s, that was another thing that the doctors said that they were doing and continue to record after the end of the study.

[00:31:13] Mat: So it’s the simple act of noticing, that in itself makes things better. No, noticing what’s going on noticing the patterns, noticing the changes, noticing the trigger, that of itself makes a difference.

[00:31:28] Sanjay: It does. Yeah, that’s what we’re seeing. But I think as human beings, we Sometimes think I know what’s stressing me out then, and we make these general conclusions, but actually it’s almost like an iceberg.

There are different layers to our mind, how our mind works, trying to get as deep as possible. Even if you may know the general reason, digging a bit deeper and deeper. I think that’s often quite useful and diaries may help do that.

[00:31:54] Mat: Okay. And let’s, maybe if I bring us to a close, what would be your top tips for doctors at work.

[00:32:01] Sanjay: So I think the main thing is to try and identify your thinking try and notice what those schemas are. You can seek out any alternative explanations, know that’s not often rooted in fact, if you can keep an evidence log, that’s really helpful oftentimes.

With the, if you’re having these negative anticipations, be very mindful. You can engage in mindfulness as well. If you’re struggling with workload because of a prioritization, try and ask maybe your seniors to talk you through that. And then just some things that I haven’t talked about today, but we know that healthy eating, sleep good exercise.

There’s more and more evidence to suggest that these play a really important role in our mood as well. But just to close things off, this is all self-care. But if you do try these things and they’re not working, then I would obviously suggest seeking out professional advice as well. And for those of you that may not be experiencing stress, but are still listening to the podcast, just understanding that you may be brushing shoulders with people that are going through very difficult times, having that empathy and also understanding.

that can happen to anyone. I think those would be my top tips.

[00:33:03] Mat: Wonderful. Thank you very much Sanjay.

[00:33:05] Sanjay: Thank you for having me, Mat.

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