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Doctors at Work Podcast.

Episode #82

What can doctors learn from elite athletes? With Phil Doyle

Mat Daniel


Phil is a doctor and an Irish Olympian rower. In this episode, we discuss how his understanding of elite sport performance can help doctors at work. He describes a great analogy of his whole life / career being a four legged stool, and that whilst you might only be able to function on three, you cannot do so on two legs. I love the idea of always making choices about what is prioritised today, and always understanding that there are long term as well as short term goals. He tells me that pressure is important for learning, and that the key is to understand what the pressure is and how it helps you progress. And I love how he talks about the importance of having mental clarity instead of jumping into situations in the middle of an adrenaline rush.

If you enjoyed this episode, you might also like Episode 56 how to perform under pressure, 82 what doctors can learn from elite athletes, and 80 optimising mental performance.

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Production: Shot by Polachek

Podcast Transcript

Mat: [00:00:00] Welcome to Doctors at Work. My name is Mat Daniel and this podcast is about doctors careers. It’s part of my mission to help doctors create successful and meaningful careers. Today I’m having a conversation with Phil Doyle who is an Olympic rower as well as a doctor. We talk about how his understanding of elite sport performance can help doctors at work.

He tells me about a great analogy of his whole life and career being a four legged stool, and how you might be able to function just on three legs, but you wouldn’t be able to function on just on two. And all the time we are making choices. What’s important today? What can I do today? What will I be doing tomorrow?

So all the time we’re balancing different aspects of our lives, and we’re making decisions about what is important today, as well as more what is important in the long term. He tells me that pressure is important for learning and that the key to understanding is how pressure is affecting you and how that pressure helps you progress.

And I love how he talks about the importance of having mental clarity instead of jumping [00:01:00] into a situation in the middle of an adrenaline

Phil: rush.

Mat: Welcome, Phil. Tell me a little bit about yourself.

Phil: So, thanks very much for having me. My name is Philip Doyle. I’m a 31 year old current full time rower on the Irish national team based out of Cork in the south of Ireland. Um, but I’m also I’m a part time, uh, SHO as well. I’m currently working in the Acute Medical Unit in Cork University Hospital, but completed my foundation training in the NHS in the north of Ireland.

So trying to dual manage both of those.

Mat: Sounds like you must be very busy. How do you manage to combine this really, really top level rowing, um, with a clinical career? Well,

Phil: when I’m, when I go back to work, I usually go back to full time practice, especially for the foundation years. I take a leave from [00:02:00] international duties, but have to maintain the training to acceptable standards to still hit rowing machine numbers and targets that are quarterly targets set by our funding that comes through Sport Ireland.

So government. based funding on performance. So you have to hit the targets as you’re, as you’re working. So usually what I do to manage that is just cut sleep a little bit. So I, I would track my sleep with like, you know, uh, technological fitness trackers, uh, such like, you know, whip and things like that.

So what I see then is what happens is my sleep. Time will probably go down into the sort of five to five and a half hours, and then you just maintain that. But then whenever you get a day off work, actually, I take that as a full rest day rather than being a weekend warrior as such. So what I do to manage it is I just have a very strict schedule on work days of before and after work.

When I can, obviously, you know, time runs on and you maybe get held behind, but [00:03:00] try to stay as strict to that as possible. And then whenever I get the rest days, then actually take that to recover, bring the sleep tally up. And that’s how you manage it because fatigue and rest are going to be your, your two main factors.

Anybody can run on smoke for a certain period of time, but then the body starts to deteriorate. So you have to give it that boost. The management is, it’s, it’s purely time management, um, and rest and recovery that you need to work on because the, the training will get done, you know, whether you’re faster or slower on that day, your management is all about your, your body and making sure that it’s ready to try and perform when that time comes.

Mat: So actually that’s really interesting for me because This for me is a concept that I call that, um, interval stressing. Um, so that, that, that this, this, you know, we all say we have so many things we all want to do, you know, in, in, in, in all of our cases, in your case, you want your clinical career, you know, and, and also you want to do the rowing.

And the reality is that, that often it’s just isn’t [00:04:00] possible to do everything. At the same time. So instead of trying to do everything at the same time, you kind of, you do it a bit sequentially. So, you know, like you said, there’s, you know, you, you, you sequence your rest and your exercise. So you can’t have rest and exercise at the same time.

So you have a block of exercise and then you have a block of rest or you have a block of rowing and then you have a block of clinical work.

Phil: Almost, yeah. I kind of use this, this sort of mental tool that I, that I visualize this stool. And if I had to support my life on a four legged stool, I would have, you know, social, um, and friends, you know, going out and meeting somebody for dinner, et cetera.

And then you have, Your medical career or your studies is another leg and then you have family and relationships as you know your third and then you have your fourth leg is your sport, your activity, your hobby, whatever you want to advance in outside of that. So I always say that at any given time, I can take one away.

So I can [00:05:00] either Not to see my family for a week and focus on the other three, or I can take the sport away and be very social and see my family and work hard, or I can take the work away, which at the moment I’m full time for the Olympics coming this summer, which means that I can have family, social with the, I live with a few other rowers down here and it’s, it’s, it’s, it’s nice.

And then I have my sport, which is then. uh, improving, but then I can’t have the medicine side of it, so I’ve taken that fourth leg away. But at any one stage, you can’t support performance and a healthy lifestyle or healthy balance on two legs. So at any stage, if I take two of those four away, the whole thing will collapse.

So I have to maintain focus on keeping a minimum of three of those pillars or legs of the stool strong to keep that tabletop balance aloft, because if it collapses, then it’s a week, two, three weeks to rebalance [00:06:00] that and to get it supported back up again. You have to rebuild from a broken structure. So you have to try and keep the structure strong and you can afford to, to take, to damage one at a time, but you must strengthen that before you start to damage another, if that makes sense.

Mat: I have to say that that’s a great analogy. And maybe a follow up question is, it sounds like that takes a lot of discipline because, you know, because if it was me, I kind of thinking, okay, well, you know, I’ll just, I’ll cut my sleep, you know, and I’ll lead badly and I won’t exercise. And you know, and it’s so easy to, for me, it would be very easy to just drift and drift and drift, but it sounds like you’re really disciplined.

So what, what helps you be so disciplined?

Phil: Uh, well, somebody is looking, looking for you for a performance. Okay. Do you know if I, Say, for example, we have a test on the rowing machine next week, um, and the number that is on the screen whenever I finish the 2000 meters is, you can’t, uh, [00:07:00] argue with it. It’s non negotiable.

It’s, it’s five minutes and 57 seconds or point what, you know, I can’t say, oh, but I didn’t get much sleep or, you know, so give me an extra second or I didn’t eat very well. So I’ll take an extra, you know, it’s. It’s there in black and white. You can’t argue with that performance. It’s a metric that can’t be changed.

So it’s up to me to make sure that that number is as good as I can make it. So I obviously have to be in control of the variables that provide that performance, sleep, rest, food, nutrition, recovery, everything. So the, the, the thing with, with, with that is. that you’re right with the drifting. Um, and it’s very easy to drift.

And it’s, I, I do a bit of coaching with some young rowers around the world online, um, to try and help them with balancing mostly time management, to be honest, they want to, they’re usually trying to get into college and they want to get growing [00:08:00] scholarships and do well on exams. So we always look at that, that I’ve never called it the concept of drift, but I always call it like you can have a bad day.

And you can have one bad day, everybody can have it, where you do eat junk food and you lie around and you’re not bothered, um, but that one day isn’t dangerous. It’s the second day that’s dangerous because the second will lead to third and the fourth. And it’s when that drift starts to spiral and continue on and you don’t check it.

So you can allow that one day, those two days, but you must, you must be aware, like have that awareness and that mentality that after your second day to be like, right, that’s enough. Um, back, back into routine, back into, uh, To, to things that we know we’re going to keep that number on the screen. honest, um, and, and, and healthy because at the end of the day, you can be, you can be dropped.

So, you know, I can be kicked off the team. I can be dropped [00:09:00] out of the Olympic team. I can be told I’m not good enough, which is what obviously spurs you on. It’s the same in medicine. You know, if you turn up to a patient and they have symptoms, you don’t know what to do. You don’t really know what avenue to go down with your investigations or you don’t have a working diagnosis, you’re, you’re very easily caught out.

It’s embarrassing, number one, and it’s also humbling because you’re like, Oh my goodness, I need to sharpen this up or I need to improve this. And so those situations are what keep you working on because if you could go around your whole life being wrong. Um, I’m being slow and everybody just saying, don’t worry, keep, keep going, you know, you can move up from CT1 to CT2, even though you didn’t really know anything, that’s fine.

So it’s the procedures in the way, those, those tests, those trials, those situations that establish your knowledge or establish your physical performance that keep you honest and keep you forced into those, that balance. But the hardest thing about the balance is, When you do drift and you [00:10:00] lose that day or you lose those two days in a row is being able to get back on track quickly.

And what I find that gets me back on track quickly is establishing habits. So establishing, um, a healthy wake up time, knowing, having the right food in the house. You know, if I’m in a bad day and I’m drifting, I’ve had bad food and I feel rubbish and I’ve had bad sleep. Then the next night I need to know, right, you don’t sit on your iPad watching Netflix You have to get up the next morning when you get up the next morning, you have to have the food in the fridge to have a good breakfast to start the day.

You have to have something else in place to get, you know, have somebody that, you know, is reliable that you can say, look what we go and we’ll start training early tomorrow at eight o’clock. I’ll meet you there. So if you’re trying to do it on your own, the fridge is empty without the right food in it.

And you know, you’re sitting and then you’re, you’re going to watch this. You’re going to scream, we call it doom scrolling. You’re going to scroll on your phone till 1am and then your rest. So your rest isn’t going to recover. Your nutrition is going to stay poor and you have [00:11:00] no accountability with somebody to help you.

So if you don’t establish those habits and have those in place beforehand, it’s very difficult to right that drift. So then you’ll just keep going. And over time, it’ll just escalate. And I see it as well with a lot of people my age. You know, I’m 31 and obviously I’m doing a full time physical output. You know, rowing is very physically demanding.

So you kind of stay in shape a bit. And I’ve noticed a lot of my peers around my age are going Maybe starting to get into a bit tougher part of their career, time is running away. And the first thing is, you know, they stop eating, right. They stop, you know, physically exercising, start to put on a bit of weight, start to put on a bit more weight.

Oh, it’ll be OK. I’ll get it back two, three months later. I’ll get it back. I’ll get it back. And then we meet for some kind of a social gathering. And I’m looking around. I’m like, everybody here’s put on two or three stone. And then I’m like, like, like, obviously, you don’t want your body and somebody or anything, but it’s a.

It’s, I’m, I’m thinking in the back of my mind is [00:12:00] they let that spiral because they don’t, I’m sure they don’t want to be overweight, you know, all the health implications of it. So I’m like, I’m sure they don’t, but they’ve probably had a kid recently. Their job has probably got stressful and they didn’t have.

The procedures and the habits in place to, to step that back whenever the child had a bad night’s sleep or they were up late and work ran over and they didn’t have that habit of, I’ll just go for a quick 30 minute cycle or run or something to keep that off. So I see it as it’s a habit and a behavior that they haven’t got in place to as a backup.

So they’ve been drifting now and you sort of think that like, actually you’re thankful as you have. That ability to, to track that, that progress, to be able to step back when, when those moments come, when you do start to drift and spiral away from your normal habits.

Mat: There’s loads and loads of, of, of really interesting stuff there.

Can I start with picking up on this idea of goals? Because, you know, right at the [00:13:00] beginning that, that, you know, you, you’ve got, you know, a trial coming up and, and, or whatever it is, you know, you’ve got, you’ve got Olympics coming up. You know that you need to perform to a certain standard and I’m guessing it’s brutal.

If you don’t make the cut, you know, you, you, you’re going to go. Um, and actually, I mean, in some ways, that’s quite similar to, if I think about medical exams, for example, um, or some of those things is, is the, the, you know, interviews, for example, you know, if you’re not good enough, you know, whatever good enough is, you, you, you’re not going to make it.

Um, and, um, And, um, I wonder if, um, so I’m, I’m, I’m, I’m wondering what’s the downside of sort of goals, because I think there’s still the part of me that’s thinking, okay, you, you know, obviously you put a lot of pressure on yourself for when people come for exams or interviews, they’re putting a lot of pressure on themselves.

So what’s, what’s, what’s good pressure? And what’s the kind of pressure that becomes counterproductive? You know, where’s, where’s the line between pressure that spurs you on and pressure that undermines [00:14:00] things?

Phil: So it’s actually a great question. Something I’ve been massively reflected reflecting on this year, especially because I have had some success and we won a medal at the World Championships last year.

Congratulations. Thanks. There’s been a lot of other athletes in Ireland that are doing exceptionally well and winning medals and things as well. You know, winning medals, qualifying, setting world records. Um, and you’re kind of the downside to your goal setting is the goals you hit not being enough. So what we look at is, um, if you don’t either, don’t you meet the expectations of your goals and then you’re, you’re not satisfied because you wanna bronze, bronze instead of a silver, or, you know, your, your peer want a gold and, and set a record and, and you only can forth or you start when, then those goals can become negative because you, you under.

[00:15:00] You think you’ve underreached and you don’t value how far you’ve come forward. And it’s sort of maybe like an ego thing as well, where there’s a little bit of envy in others achieving goals that are maybe greater than yours. So like, because everyone’s a peer, um, on the sporting scene, whether it’s, you know, you’re comparing yourself with a cyclist, a swimmer, a rower, a track athlete, um, and obviously from those performances come opportunities.

And whenever you that they get opportunities that you don’t, it can be very negative. You can get a lot of negative feedback because you’re like, Oh, my performance hasn’t been validated or my goal hasn’t been validated. Even though I achieved my goal for me. And it’s hard then when you look in the mirror to think, Oh, but where’s my validation now that I’ve achieved my goal.

So it’s, it’s, if you get the exams and you have all the tick boxes and you’ve done the courses and presented your poster and you go for your interview and it’s a no, that’s where the goal setting [00:16:00] can become negative. When you set the goals, either you achieve your goals and they weren’t high enough to really get the validation you wanted from them, or others around you who maybe didn’t set goals.

Achieve things that are greater than yours. And then you get that sort of that envy and that, why me? Why didn’t I, I did this, I did all the right things. They ticked all the boxes in my head. I hit all my goals. So where’s my reward? Where’s my validation? Where’s my next step? Um, I think that that’s the hard part with this, especially because in high performance and elite sport, there’s, a certain level of selfishness that has to be there.

You can’t, you can’t, you can’t make it here without that because you need to be self focused. I think it’s the same in medicine. You know, you do need to have a little bit of self career focus, take opportunities, take learning opportunities and make the most out of everything, um, that you can. Same with, [00:17:00] with sport.

But it’s whenever those don’t work out, then you don’t get what you expected at the end of it. You know, you get to the end of the rainbow and the gold’s not there. And you think, why did I bother coming here? So you said, that’s the negative that I find with, Elite rowing and, and medicine is when, when the boxes don’t get ticked, but the reward isn’t there.

When it, what, what did you, did you expect it? Did you see your peers and you see the other people achieving, so you compare yourself to them. And when you compare yourself to other people, it’s very hard because of your ego and everybody has an ego. I don’t care what they say. It’s very hard for you to genuinely understand.

Oh, okay. They got that because. They didn’t work harder than me, but they’re better than me. So that’s, that’s where the, that, that strictness and that goal setting and that tick box exercise is, it can be negative. I think

Mat: I, I have to say, you know, they, for me, it’s [00:18:00] interesting that, you know, if I kind of think in medicine that, you know, somebody, somebody got there and I didn’t, and they didn’t work as hard.

I think people are very good at hiding how, how, how hard they work. I think it’s quite, it’s quite interesting. Sort of, you know, you have, you know, On one hand, we have this conversation when everyone says I’ve done a thousand audits, you know, I can already do a mastoid, you know, I’ve done a leg amputation as an F1, and sort of, you know, you have sort of all the people that talk really big about, you know, what they’ve all done, and sort of impart to me kind of things, really, you know, you’ve done a leg amputation as an F1?

I somehow doubt it, yeah. So, there’s that when people build themselves up, but I think at the same time, somehow people are also, really good at sort of saying, Oh, no, I’m just innately brilliant. I don’t, I don’t really have to work. And maybe there are some people that really are innately brilliant, but I suspect there’s an awful lot of people that, that, that, that like to portray themselves as sort of somebody who’s really good at achieving all of these amazing outcomes without having to work very [00:19:00] hard.

And, and I’m not, I’m not convinced that it’s always. People like to put on a face, I think. Yeah. You know, the thing that sort of struck me as, um, as, you know, maybe similarities between elite sport, um, and, and medicine and what’s relevant for me, something about, about the type of goal. Yeah. And, and if I kind of think, you know, with that, with that 30 year old, Um, person.

So I was very overweight in my thirties. Yeah, I wasn’t, I wasn’t sort of as a child during my twenties and, and then just, you know, sort of, I, I removed the health leg of my four legged stool for 10 years, um, and sort of in just focused on everything else. And that helped me progress my career. Um, but, but that was a short term goal because actually sort of, you know, I hit 40 and, you know, yes, my career was great, but I was overweight and, you know, and was I still going to be, I’m 50 now, you know, was I going to be 50 healthy, able to work if I’d carried on like that?

No. So, you know, yes, that did help me hit my goal sort of, you know, to achieve my career and get [00:20:00] there when I was 40. But if I’d carried on on that trajectory 10 years later, I’d be ill, you know, sort of, you know, to have, you know, diabetes, neuropathy, and wouldn’t be able to work. So I would have invested all of that in my career and achieve that short term goal, which, you know, for me, would have been becoming a consultant, et cetera.

But it, but it actually wouldn’t have given me. So, you know, for me, it’s, it’s what, what’s the goal, you know, is, is the goal, is the goal getting selected into higher training is the goal, you know, getting your ideal consultant job, you know, or, or is the goal, you know, being a thriving consultants GP, whatever you choose to do, you know, for 20 years, um, and, um, And I guess I think you need to think of both.

Yeah. Because, you know, it’s all very well to say, you know, I’m going to have a wonderful life balance when I’m 50. I’m going to be really healthy and in good shape, but that’s fine. But, you know, if you haven’t passed your exam, then, then you’re not going to be a consultant because you haven’t passed the exam.

So, so [00:21:00] it’s, it’s, it’s, I think in medicine, it’s, It’s, you need both, you know, yes, there’s an exam you need to pass. There’s an interview you need to do, you know, the certain number of operations, the stuff that you need to learn and you need to do that. And you also need to think, you know, of, of, of the longterm and sort of, and maybe, maybe, maybe sort of what, what’s perhaps different in what you described is, is this, this, there’s the goal, you know, or maybe you’ve got today’s goal performance, you know, Olympics in the summer and sort of, and, and, and that’s, that’s the stuff that matters.

In medicine, I think is, you know, yes, there’s an exam. that matters in a consultant but actually I’m still going to be doing this when I’m 50, 60 and I need to also think is, is this sustainable for the next 20, 30 years time and in medicine that real push often is not sustainable for a career that’s going to span 20, 30, 40 years.

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Thank you. Now on

Phil: with the show.

Yeah, but you also have to look at it this that, you know, you have your family and things as well. So would you have, you could have still achieved your career goal and kept the weight off by instead of Putting time and energy into your family and your kids and things, and then, you know, done triathlons or whatever on the side, and then you would be your 50 year old healthy bachelor consultant.

Yeah. So that’s the, the, the idea, the key about that, that, that stool is it can survive on three legs and you don’t. You can swap, you can put one in to take the next one out. But the problem is you can’t hold two at the same time. So it’s a fluctuating analogy of, uh, it’s, it’s like at the moment, I was getting very [00:23:00] frustrated at the end of last year because I had taken a full year away, qualified for the Olympics, won my world medal, increased my funding.

So I was like, okay, that’s a little bit more financially secure. But then I was like, Look, I had to give up my GMC license to get my Irish medical license because I couldn’t um, ARCP because I wasn’t in the country. Um, and they were saying, look, it looks like you’re avoiding your annual appraisal. Um, just give up your license and stay on the register.

So I was like, okay. Yeah. Then I was like, my goodness, my medical career, that, that leg is, is really becoming weak now. I don’t know. I need to be able to put that back in whenever I take the rowing away. So I need to keep it in the back of my mind. So then I was like, right, I get my Irish license. And then I’ll start.

I needed to get a, uh, consistent locum contract of three or four days a week in one department where I can get to know the consultants, take some learning opportunities, [00:24:00] have a reference of someone who can, you know, back me up when I reapply for my GMC license. And I was thinking in the background that, you know, this, this leg of that stool has, you know, I need to be able to rebuild it at some stage in the next six months.

So I worked on that up until Christmas and the rowing, leg came out a little bit and weakened. And then whenever Christmas hit, I was like, right, I’ve strengthened the medicine leg that I can now bring it back in, in July, in August, I can now take that away and just go six months full rowing, social and family.

And that’s it. And then once August comes, I can swap those two back out. So that’s, that’s, that’s, It’s the dynamic analogy of it is that it can swap and change, but you need to make sure that you don’t completely destroy one that you can’t bring it back in because like you said, there would have been no point in you getting to 50 and having to get your done by one of your orthopedic colleagues and taking six months [00:25:00] out of work.

So you have to balance both. And, you know, if you did see that that’s what, you know, it’s what’s what was required. So you have to. Be able to see the longer term situation

Mat: and you know that that’s the mistake that I made is that that I didn’t clock that sort of that these were choices that I was making, you know, you’ve outlined there are choices that you’re making all the time from from month to month from year to year.

And, you know, recognizing that, you know, there’s four things that matter and, and, you know, you’re swapping them in and out and. And maybe the thing that I didn’t do very well in my thirties, you know, was, was, um, recognizing and making those choices. Yeah. So, so, and, and I think that’s, you know, that, that, that really is a key, you know, there’s choices that we’re all making when it comes to our careers.

Um, and I mean, no right or wrong decision, but, but there are choices and it’s that, you know, short term as well as the long [00:26:00] term goals and, and the importance of both.

Phil: The hard thing I think, which I’m very lucky in the elite elite athlete. realm is I didn’t just wake up one morning and think, do you know what?

Life’s like a stool. You have to have four pillars. You know, I struggled during college with the balance and had a sports psychologist available to me through sport Northern Ireland, who helped me work this out and sat down with me and gave me this. Not like, you know, I did. I’m not this guru who made this all up.

So, I think that’s the hardest thing is I have so many resources available to me and it’s probably one of the things they’ll miss about the elite sporting world. You know, I have physio. I have a team doctor. I have a sports psychologist. I have, you know, I have so many resources available at all times.

And I’m so thankful for that because that gives me insight that maybe somebody could be. Going to their turning up to work every day as an F2 struggling a wee bit coming home to [00:27:00] flat on their own in a city where they don’t really know too many people, you know, that can be very daunting and you maybe have to Google it or read about it in a book, but you might not be that way inclined.

And then that’s where that knowledge and that insight needs to be gained from somewhere else. And I think that’s a really great thing about social media is that you can pick that up from people who are. Influencers or what, you know, people who are putting knowledge, like genuine, credible, useful knowledge out there, um, for people to pick up on.

But you have to realize that, like, you’re not just going to magically wake up and think, you know, I need to rebalance my life. Somebody has to give you the information, but you have to be willing to take it on board as well.

Mat: I think it’s one of the things that um, I think what’s important there also is what senior doctors do and how senior doctors support people early in their career and you know how, how willing senior doctors are to have those kind of discussions and also what knowledge um, senior [00:28:00] doctors have um, and, and how, how that’s shared.

I want to, to, to move us So I know we kind of, we talked about career and goal setting. I’m interested in, in a performance, you know, in our role. So, you know, so I’m a surgeon. So, you know, somebody comes in and, you know, they have to perform a certain operation. And, um, or, you know, somebody comes in and, you know, and you have to do the cardiac arrest bleep, or there’s a trauma call that comes in and, you know, and you’re on the trauma team that’s attending that.

Because that’s, that was kind of really, really. stressful situations or the often stressful situations. Um, and I’m, and I’m interested, how, how do you, how do you deal with stress that comes when you’re, when you’re about to compete?

Phil: Um, it’s, it’s, it’s, it’s kind of, I’m not entirely sure which one helped which, but racing is, is kind of, I liken a race to like [00:29:00] a cardiac arrest.

The first time you’re ever involved. It’s chaos and there’s a trolley and there’s needles everywhere and all of a sudden you look down and there’s five cannulas in because everybody was trying for the same thing. And then a senior doctor arrives and stands at the end of the bed and says, everybody stop, you do this, you do, you know, organizes the team, focuses the, the, the operation.

And it’s, and. Provides some kind of mental clarity and they don’t get involved in the chaos and they step back and it’s ordered and it’s practiced and it’s rehearsed and performance, especially for rowing is like that because it’s a two K race and there’s a lot of adrenaline on the start line. Um, and at the start I was like, great, you know, get the adrenaline and let’s go, let’s go, let’s go, let’s go and buy.

1500 meters in the energy was so chaotic and your mind was going so fast that you didn’t notice that somebody had moved in the middle or all of a [00:30:00] sudden you were winning by lows and your energy was gone and you were wrecked and you had to crawl the last part of the race because you’re so what my partner and I practice now my rowing partner is we practice this thing called mental clarity during a race so it Where we try and stay relaxed.

We have our rehearsed race practice that we do over and over and over in training that we know we can execute the same 240 strokes over and over. And we’re thinking clearly during it, even though the adrenaline is high, we still have that mental clarity of thought process that we can adapt and change.

We can correct. Technique. We can adjust for weather, wind waves, and another boat, you know, doing a big burst or a big push to move ahead. And we can, we can counteract that during the race. And I’m not sure whether [00:31:00] I’ve picked that up from, you know, ALS courses and rehearsing those high adrenaline scenarios and then being in them in the hospital on their S bleep where you come in and the nurse is like, I don’t know what’s going on.

And the person’s not breathing and not speaking. And you have to just be like, thank. The adrenaline’s high, next step go, you know, you have to go back to that training of ABCD, ABCD, you know, whatever training it is, is you have, you know, it’s a complication in the operating theater. You have to be, you have to have a process in your mind that says, okay, Figure out the problem and then come up with the solution.

Yeah. So you have to have that ability to be mentally clear in any situation. And I’m gen, I really honestly don’t know. I always say that the, the medicine helped with the rowing, but I think now at this stage it’s probably vice versa. Um, and it, it, it’s, it’s a bizarre feeling to come outta the end of such a high adrenaline scenario and just be relaxed.[00:32:00]

And to be calm and know that you were able to think and process and work through every, every possible scenario and change to come up. And there’s sometimes then at the end of those situations that we do race pieces every week to practice this scenario against all of the other boats that are with us.

And there’s sometimes I come out of it and I’m not mentally clear and I am a bit, I let the adrenaline over me and I come off, I’m frustrated and I’m stressed and I’m annoyed with myself. And there’s sometimes I’ve come out of an arrest situation or a high pressure situation and I haven’t done the right thing, or I’ve missed, I’ve missed a measurement on a blood gas, you know, that, that was key to, you know, to fix the problem.

Um, Or like, you know, the CO2 was miles high and we’re pumping them full of oxygen, wondering why the sats aren’t coming up. And then, you know, you looked at everything else, the pH, you looked at everything and then you were like, why, how did I miss that? You know, because I let the situation get away from me and then you get frustrated and you reflect on it.

So, I [00:33:00] think just being, you know, practicing that mental. Clarity and that relaxation is the biggest thing that I’ve learned from both and they’re applicable to both as well for performance in both sectors. And it was whenever my first week as an F2 after a year out, one of the F1s came flying out of this room on account of the elderly ward.

He pulled their S button and was screaming, this guy’s not breathing. And I walked in and the guy was a cactic, really a messy headed 87 year old guy who had. Been in hospital long term and he’d be, I know I’ve met him earlier in the week and I just walked into the room and he didn’t do anything. He’s like, get over here, get over here.

And I was like, I just said, I was like, could somebody get his notes really calmly? And he’s like, get over here, get over here. And he was about to start CPR. I was like, stop, read the notes, big DNAR. The gentleman was, you know, there was, he was just at the end of his life. And I just said, just step away. And he was like, what, what, what?

[00:34:00] And I was like, just Step away. And then the senior nurse was like, I’ve never, she’s like, how long have you been working? And I was like, I was like, you know, this is just a process I’ve learned from recent as like, it’s a mental clarity thing. And like, this is not, Oh, I’m brilliant. And, but you know, it’s that, that was just a scenario where I walked away from it.

And I was like, I would have very easily last year or before I had been involved in the high performance side of things, just rushed in there and started. And then as I was being, I then started to think through the process. That’s where the, I feel like they both land each other really well.

Mat: So that, that I can see the link between, you know, training and you repeat is, is it just the training that helps you have mental clarity or, or are there other things that you do to achieve mental clarity?

Phil: It’s the training, not as much as it’s, there has to be the risks. Simulation, like it has [00:35:00] to be like side by side, you know, maybe there’s a decision being made at the end of it. Pressure on the line, you know, there has to be. And you’re looking for an outcome. It’s very difficult to get it in just a training scenario because you know you get another chance the next day, but it’s when the pressures on the adrenaline ends up those high stress situations is where I feel like I do a bit of sort of self reflection.

And. Myself as well that I’ve learned from the portfolio system of like reflecting on events. I have a bit of journaling and things, but mostly what I, I find that it really helps us in those high adrenaline situations.

Mat: So that, so I’m thinking then, you know, for, for people that are coming through the, the, you know, it’s, it’s always tempting as a consultant to say, Oh, don’t worry.

And I’ll be there if there’s any problem, I’ve got you back. But actually, sort of what you say that that might not be the best way to train people maybe somebody very beginning that might be [00:36:00] helpful, but somebody who’s much more advanced, they would benefit from from me as a consultant taking a step back and saying you’re in charge, you’re making the decision, you know, there is something on the line here.

Um, obviously, you know, in, in, in a safe way, um, in the same way that you would do stuff in the same way, but, but that doesn’t need to be, you know, like when I as a consultant, when I’m training people, that doesn’t need to be a bit of pressure put onto people is that, is that.

Phil: I feel like the pressure is, is, is what really stimulates the growth and the change.

Even if the change is negative, you learn from it. So say for example, for example, if you were the reg and I was the SHR, SHO and they said, look here, I’m in, I’m in theater for the next three hours. There’s these two cases coming in. I’m on if you really, really need me, but try your best. You know, because some people can very easily be like, Oh, I [00:37:00] don’t know.

I’ll call. I don’t know. I’ll call. I don’t know. I’ll call. And then what do you really learn from that? You don’t have to genuinely problem solve and adapt. And then whenever you really can problem solve and you’ve really have tried to learn and change and use your own knowledge that you have, then you can step in or you can have the other person step in and help.

But it’s that. That sink or swim moment when the pressure’s high and the adrenaline’s there that you do that’s when you, you learn the most and you remember the lesson as well.

Mat: It’s interesting, the, you know, my, my feeling would be that, that, that people, often early career doctors, They ask for help way sooner than they need to, okay, because, you know, because often I think, like, you, you, you’d know that, or sometimes I even kind of think, have you Googled it?

Yes. So because I think, you know, if you Google the question, you would have had the answer [00:38:00] instead, instead of sort of calling for help. So, so that, and that’s kind of that, that’s the old belligerent part of me. And then there’s a very modern educational part of me that sort of things. But it’s great that they’re asking questions.

You know, I don’t want to put people off. I want to be approachable. I want to be welcoming. Um, and it sounds like there’s a bit of attention between these two things, which is, you know, you’re in charge, sort of, I’m giving, I’m giving you, you know, I’m giving it, it’s on you and, you know, and I do need to, as a trainer, I do need to, to, to build in a little bit of pressure, but at the same time, I still have to be approachable so that people are not afraid.

I don’t know. So where, where do you think, where’s, where’s the balance between being approachable but at the same time giving people an opportunity and a bit of pressure?

Phil: I think the system we have in AMU and CUH is it’s, it’s run by the registrars and the SHOs and the consultant comes round at two different points and does a board round with everybody and then, you know, that’s your opportunity to ask your [00:39:00] questions.

They are on the phone if you really need them and we work as the SHO to problem solve and to try and figure out and get the person a discharge plan because we send them home same day. Um, before and have it ready for the consultant when they arrive and you know, maybe five times out of the 10, we have it in place and the consultant’s happy when they, when they come down and they’re like, yeah, that sounds good to get that organized.

Or the other five times out of 10, we’re like, look, this is what our thoughts are. We have this, this, and this, we tried this, this, this, we’ve done that scan and this thing. So we’re waiting on those results. But is there anything else? Cause we’re stuck. And if you’re genuinely stuck. They will say, okay, right, this is another avenue or this, you know, this is what we might do, or I’ll go and see them.

I’m not sure myself, but I felt like in the NHS. It’s a very, it was a [00:40:00] very much more, um, you wouldn’t really have, you wouldn’t have booked a scan until you discussed it or you wouldn’t have done the next investigation without having senior approval. It was much more sheltered and you would have been happier to ask more questions, but you would have asked the questions with less answers.

Yourself would have been, what is it? Don’t know. I’ll ask. Whereas now I’m, I’m pushed more towards that. What is it? I have to have four options that I think it could be and have maybe tested a couple of those before I go and ask the question. So it’s that balance between the two, because obviously you’re going, you need to learn from above, but you also need to have that kind of bit in you that is able to, to test and probe it before you look for the next stage.

Mat: Yeah. So, so it’s [00:41:00] that, you know, the consultants available, you’ve got those common junctions, you know, they’re going to come around twice a day, you know, any questions can wait, you know, you know, they’re there sort of an, an available. Um, but, but it, but they’re not too easily available. So, so that that kind of makes you think, you know, okay, I suppose, you know, the other thing that, that actually is coming up for me as to how I might handle when that happens next time is, is, you know, I might, I might turn it for me into a coaching question, which would be, you know, okay, how, how might you find out, you know, what might you do?

What have you thought about? Because it’s often it’s easy to just give people an answer, isn’t it? But from an educational point of view, you know, the thing to do is perhaps rather than me giving them the answer, you know, or, or, or making a facetious comment that doesn’t really help anybody. Um, it would be, it would say, okay, now what, what can you do and what have you done?


Phil: yeah, the best thing that I have had done for me Is when you, you really genuinely can’t figure it out, there’s some [00:42:00] strange hematological thing going on and the person has been fatigued for six months, but you, there’s a little part of you like, you know what, I think there is something here. I’m not sure.

And you’re sitting there and then you say to the consultant, look, genuinely, I don’t know what to do. And then it’s the best thing that was ever said to me, it was the turnaround to be like, are you worried? And I was, I’d either say yes or no. And if I said yes, they were like, right, what are you going to do next?

And then they’re like, do you think you can do this? Or do you think you need somebody else? And then I’d answer that. But if they, if they said, are you, geez, are you worried? And I said, no. Then they’re like, okay, so you have time. And then they would say, are they sick? And then you would say yes or no. And then they would say, right, this person’s sick.

We need to do something now and get to the bottom of this. Mm-Hmm, . So it doesn’t matter, you know, order a few investigations. If they’re wrong, if they come back negative, then that’s good. But to say if they’re not sick, then there’s no pressure on this decision. Take your time and go and figure it out. [00:43:00] And that was the best advice ever because you feel like, especially that you have to go to the next person having done something, whereas sometimes not doing something and figuring it out is the best thing to do.

So I feel like the performance environment as well is, am I faster? No. Am I going to get faster by worrying about being faster tomorrow? Is that going to make me faster? No. Do I, do I need to be faster in the next 24 hours? No. Do I need to be faster in six weeks time? Yes. How much faster do I need to be?

Three seconds. Three seconds over six weeks is half a second per week. Can I do that? Yes. How am I going to do that? One, improving my technique, improving my physiology. How am I going to do that? Will I train more or will I train better? Will I do more video analysis or will I do more bad weather rowing?

Come up with a solution then, break the problem down. Is it urgent? Yes or no? Is it, does it matter straight away? Yes or [00:44:00] no? Do I have time? Can I figure it out? What will I do? And that’s the easiest thing. That

Mat: sounds like great advice. I’ll bring us to a close, Phil, and maybe if I could just ask you to summarize and tell me what would be your top tips for doctors at work.


Phil: Um, summarize top tips. Take every learning opportunity going. Don’t fall on your sword. You’re not a martyr. You don’t have to stay six hours past your time just to say you stayed. If there’s work to be done, stay and get it done. Don’t shaft the next person. But you also don’t need to be a martyr and be in the hospital 24 hours a day to learn and improve.

And number three is look after yourself because if you’re sick and if you’re tired and if you’re not in a good headspace, you’re not going to be able to make most of those opportunities that are going to come up. Those are my top three tips.

Mat: Wonderful. Thank you very much, Phil.

Phil: Cheers. Appreciate [00:45:00] it.

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