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Be good evening everyone. Uh My name is Michael. I'm one of the um wellbeing leads uh from Mohan Academy and welcome all of you joining us tonight. Um First uh series of the WEM organized by the Mons Academy in conjunction with the Royal Medical Bene Bene funds. Um Let me uh have a privilege to introduce um uh Doctor Richard Stevens. Doctor Stevens studies, psychology and physiology at Oxford before his medical degree. He was a GP principal in Oxford for 30 years and uh was a trainer and appraisal and tutor for the last seven years. He has worked as a coach for the Thames Valley Professional Support Unit and is currently acting assistant director. The PSU provides coaching for doctors in need of support for a range of reasons. In 2016, he wrote the vi the vital signs, a guide for doctors experiencing stress and pleasure at work for the RMB fa primary version of the guide sponsored by the, the NHS England was launched later in 2016 and a version for medical student is planned. I'm pleased that he has agreed to join us today and to give a talk on um behalf of Mon Academy and Royal Medical Panel Fund on the topics of interest, burn out and stress in doctors. Thank you, Michael. Um, look, the only thing I can add is actually the, uh, the vital signs and lockdown was a good time for writing. So, er, we've got um versions of dealing with stress for medical students, er, for anesthetists, for people who are coming back to work after a break for whatever reason. Um, I'm sure there's another one. Anyway. Good evening. Thank you. Um, really, really grateful for being asked to talk about this subject, which is just, um, so important. Um, and so topical actually, um, it's a shame that we're not in the same room. I mean, I'm just talking to my computer but I, um, we've got a couple of, of polls to make a little bit interactive, um, scheduled. Uh, and I think this is the single most important talk, er, in your surgical careers. Why do I think that because it doesn't matter what, you know, it doesn't matter what you can do if the delivery system is flawed, then what is delivered, the knowledge, the skill is going to be flawed. And so this is absolutely fundamental that we start to think about doctors, health doctors wellbeing. And, um, if you like productivity, I mean, the way we deliver or what we know, um, we're doing a bit Chris Whitty style. So, next slide, please. So, just a little outline of what I was planning a little bit about the RMB F, a little bit about how doctors are different. I mean, you saw that spoof advert um while I was talking before, I mean, essentially we take high performing perfectionists and put them in a toxic environment and then we worry why, wonder why things go wrong. So a little bit about doctors reactions to stress. Um and then go off peak a little bit about the future because, uh, it's changing so fast and then all the other things that are, that are topical COVID is still, well, still rearing its head, the effects of COVID on your log books and your training. Um, and I, and the reason why people feel they have to take it and the most recent thing about the, uh, females in surgery might be an issue as well, but I hope we have a good chance to have some Q and a later next slide. Right? I have a trustee or none of the Royal Medical benevolent Fund. Can we do the poll, Michael? Uh, just what I find worrying is so many people have not heard of it. Er, and in a sense that's good, er, because I hope that people don't need a benevolent fund but you need to know it's there in order to help your colleagues and yourself if you ever needed it. So, next slide, the Royal Medical Be Fund has nearly 40 million lbs. Reserves and they offer principally financial support for doctors and difficulty, but they also are canny enough to realize that let's not wait until people need financial support. Let's get in there early. So they have money advice, students, er, refugee doctors retraining, um, and Dock Health with the BM, which is a confidential psychotherapeutic sport. And it's an incredible service. You see, I mean, you see a consultant psychotherapist within two weeks and that's unmatchable anywhere in the health service that's for severe burnout depression. Uh oh, mental distress. So a lot of advice there just go to the website and see all the things they do and park it somewhere in your memory and I hope you never need it next slide. So yeah, financial helps really uh what they do but with um coaching and psychotherapy specialist advice as well. Excellent. And this is out of date. II I saw another slide today. The RNBF is over 100 and 80 years old and it was set up mainly for people who had fallen upon hard times, widows of doctors who um weren't able to support themselves. Um and for people who had fallen off their horse and broken both their hip or something just basically, um but accidents and illnesses that we associate with old age now, it's now over 50% of the cases that are seen are broadly mental health, which includes burnout anxiety, a lot of everything else and that's going up now that's got implications because it's, it's easy if you've fallen off your horse and broken your arm, you know what you need and what support you need and for how long mental health it's difficult to classify. It's er, harder to know what the prognosis will be and how long and how long you're going to need support for. Um, but that's, I mean, that's no surprise but over the 180 odd years, mental health was nowhere originally and now it's over half of the cases. The RNBF CS, thanks. Uh and a little run through um the sorts of things that uh that we offer. Um and if you are interested, we always need volunteers, we need people to er help with fundraising uh people to get funds. Um but also to act as ambassadors and um flag holders for waivers for, for what is I think absolutely brilliant um organization in helping doctors because there aren't many of them just for doctors. So Michael, do we ever get the results of the poll or do we have to wait until we? Oh, no, it's there. Ok. No, I, I can see the first questions that you have um um that we released earlier on. Have you heard of Royal Medical Ban Funds? So, 21% of um people who say we say yes and 78% of um participant have not heard uh the charity, I thought this is such a shame that four out of five people had never heard there was a, a fund that should they ever need it or should they have a colleague who needs it might be able to help out. Um, and there are rules about eligibility and you can't, just because you want a new iphone doesn't get it. But, but if you fall upon hard times then, er, that's what it's there for and it's got funds. So, if we had that again, I hope that would be 100% excellent. Ok. That's just a word about the RNBF. Um, our sponsors as it were. So, let's get into it. I hope you all read the, uh, the spoof advert next slide, please. Whether we like it or not, doctors are different for all the reasons that are there, uh, that it's grueling, it's grueling physically. You know, if you guys are doing a week of nights, it's not easy. It's grueling emotionally when you deal with death loss, death of a child, uh, when you think you might have been able to do something better and something went wrong, um, they all take its toll. They have heavy responsibility at a very early stage. Actually, f ones feel they are responsible for support, manage huge risks. I mean, life and death on a daily basis, uh, highly regulated. Um, I said your portfolio and your observed Cots and Dots and all those things, um, examined to death, lifelong examinations and increasingly the litigation threat, which is ever present and, uh, changes the way we work, changes the way we think and a huge stress. And in fact, one of the topics that the meeting I was at today was, um, how can we support people going through GMC investigation? Given that a risk for suicide? And, I mean, doctors suicide will higher than average anyway, but even higher if you're under investigation. Thanks side, I just to make the point about that being, er, poor, poor support. This is quite an old survey done by the RNF and lo and behold, about 80% of the doctors, they knew someone asking for a friend who was ex experience mental health issues and again, 80% were unlikely to mention it. There's always the stigma about, you know, you're weak, you can't cope. Um, and the similar figure thought there was a lack of sympathy within the medical, medical profession for doctors who seek support next slide. And I don't think you need figures for that. I think we all know that. Um, but it's nice to have something approaching evidence. Ok. So doctors are different, the 18 year olds, they're bright, they're driven when they start and the, with very little preparation we throw them into, uh, I don't know just if you're 18 and seeing a leg ulcer for the first time and that's pretty horrible and, you know, and there's far worse, um, things that we do and see things that are frightening, er, things that are emotionally demanding, things that are just frankly disgusting as well. But having good a levels doesn't make you a different person going through medical school. You are a human being just like everyone else and you will feel the full range of emotions and all these stresses are working on. What is your normal psychological architecture. Um, and that's where the problem starts. I think just like everyone else, there's no difference to a doctor except that I've been exposed to really weird, er, sets of stresses next slide, please. So I'll just go through, I just pick up for consequences for sequelae of the unusual stresses of being a doctor. Um, as mentioned on people who are just normal. I mean, actually it might be slightly more vulnerable. Um, er, if you're a high achieving perfectionist, then you're not gonna tolerate change and uncertainty and criticism particularly well. So I'll just run through these four ending with the big one and out looks like this. Ok, survival post, not, this is a normal psychological response, er, a way of continuing to function in difficult circumstances. And the best example I think I can give you is if you were a soldier in combat and your best friend next to you was shot and killed, that is not the time to grieve. It's clearly a dangerous situation, you need to shut that out, carry on, do your job and that's what we have to do as doctors. I don't know, you lose a child or something. You go back the next day you park that you wear a suit of armor, you don't let these things get to you and that's fine. And that allows us to continue to go back to work, allows us to continue to function by, by shutting out some things that we find unbearable. But if you don't know, that's what you're doing, it's become a bit of a bit of a liability. Actually, you're not a great partner, you're not a great friend, you're not a great colleague. Probably not a great student actually because you're, you so contained um and not feeling the emotion. So, er, as Clare Gerardi used to say one of the advantages of the white coat was that it symbolic, you could take it off when you left work and I would encourage everyone, just be aware that you will be shutting out stuff that you can't deal with. It's too difficult. Know it's there. Take off your suit of armor, take off your white coat when you leave your job and you'll be a much better parent, partner, friend, colleague. Hello, next side. Ok. So survival personality is a normal response. Um You see it in emergency services and military and in doctors there is a much more narcissistic variant, a much more malignant variant, er, which is when people start almost believing it. And the whole, the whole medical persona is so mixed up in our sense of self and I'm sure that's what's behind the, the GMC and um, high suicide rate of people under investigation in that you criticize my job, you criticize my work, you criticize me. I'm no good as a person and it's, I think, pretty peculiar to medicine. I mean, no one likes to complain but you don't hear of architects killing themselves because someone didn't like what they did. Uh, so medical narcissism, it's when you, when you take on this, that you are everything to do with medicine and you have a, er, over reactive survival personality, you're shutting out so much and, um, see it particularly in mistakes but I think you see it in, in everyday work of some people as well, usually older doctors, usually more experienced, er, but certainly mistakes when the idea that they made an error is such a challenge to their self image and their ideas of competence control, um, that, that they can't admit it and they blame other people, they blame the system. So it wouldn't, well, I wouldn't change outcome doesn't matter. And, and they've s, they've gone slightly beyond what is a sort of normal psychological defense and I think it's become pathological, um, and I suspect you may be able to think of some people who you are or have worked with, um, who demonstrate this sort of, er, malignant defense when it's so caught up in, in their sense of being, which is why I want you to do, recognize your survival personality. So it never gets to this stage like this. This is a, er, observational work and it was, um, published in BMJ. So it's the closest we get to sort of solid evidence in this world and this past from the Oxford. No, London Deery. Um, just recognize these 77 features of, well, in her case, they were trainees who were under pressure. I think we see them and everyone's under pressure. Well, just running through them, they're disappearing out. You know, there's some people just not around. Yeah, they're, they're not present in hospital. I guess they didn't answer their bleed in general practice. This was sort of a trainee who would do her visits and then he had to come for hours, didn't know where he was. Er, so we, uh, I don't know if you recognize that low work rate, I would say coupled with a high attendance rate, these are people who come early, stay late are totally unproductive, are usually caught in some little bit of detail. Uh, that really doesn't matter, but they can't move on until they've, I don't know, I summarized all the notes of everyone they've seen in the last six months or some, some low value task. So they're there or not, but really have lost sight of what's, what the goals are and what they should be doing about it. Ward rage, irritability. Very common. Under stress of all kinds rigidity that, that has the pressures on. We start to get more. What, like it says in my job description, um, poor tolerance of, I'm not prepared to make an effort to understand what you've been told. You know, can you fash that thingy and what thingy do you mean? It's quite clear what the thingy was. So that's sort of rigidity and er, not bending bypass syndrome. Absolute nightmare. If you're working with someone with this, you know, there are some people, uh I just make it incredibly difficult for them to be approached, uh who were just, just not there, who they might be there, but they're psychologically absent and they make it so difficult for junior colleagues or nurse to ask them a question. Um And if you've got, you're working with someone of that, you'll be ta you'll be dealing, you'll be fielding all their requests from, from other members of the team. Very hard not to get irritated with them, except just to remember, it's actually, it's a huge stress reaction and one step off burnout and the whole business about medical identity we see in career problems. Um I run this coaching service for doctors in the Thames Valley and people often, very rarely when people come to us with a career dilemma. Is it about the career? It's things are not right. The I know the twins aren't sleeping, the car needs four new tires. Um, my wife and I are getting on and I'm drinking too much. 00 God. I think I'll be a history pathologist. I mean, that's, it's a career problems are sometimes often just markers for distress and the final thing. And this is like a little joke at the one time that you really need insight and, and to see what's going on around you, that's the hardest to access. A nice little little joke. Next slide, please. W right. Burnout a few years ago. Burnout be that was code for, to co can't do it, can't hack it. Uh Whereas now I think it's, it's recognized and it's totally rehabilitated. I put at the bottom that it's an ICD 11. That means I think that American insurance companies will pay out on a diagnosis of burnout. There's still a little bit of stigma about it. But, er, there is absolutely no doubt this triad of emotional exhaustion and I would add physical exhaustion. Um, but this particular exhaustion, feeling of emptiness, you're not just tired, you drain depersonalization, you're not really in the world, it's kind of happening around you. You're not there and sense of reduced personal accomplishment. Um, often I'm no good but sometimes, oh, what does it matter? They're all gonna die anywhere. Um, so if I could see you, I would say hands up anyone who's had one of those or more. Um, actually, no, we have a, we have a pole so you can put your hands up digitally. Uh So remember that, that triad of symptoms, emotional exhaustion, depersonalization, cynicism, and seeing the world go around you and a reduced sense of, er, personal accomplishment. Uh Isn't that worrying? There's the poll result, I'm seeing 84%. Yes to one or more. Um, 15%. So that's, that's five out of six people have, if not been burnt out, been CED, being too close to the sun. Uh, and that's what makes you being here today and what we're going to talk about is so important and in case anyone still thinks that burnout is for Wimps. Actually, two things I would say. The first thing is um if you look at the literature, um not being a wo being a high performer puts you at greater risk of burnout. And secondly, next slide please. It's a MRI, I guess functional MRI. They purport to show differences in the burnt out and normal brain. Now look, I was a GP, I don't do this stuff, but I've included this because you guys are surgeons, you need evidence. These are photographs of burnout, the burnt out brain is different. Uh And I hope that makes anyone who's feeling better, actually better in a way. I'm scared actually it's doing things to your head. Uh So why, why do people get burnt out? Next slide, please? Michael. These are er recognized risk factors for burnout and you can, you can have a read of that and when I see that list, I just think that just looks like a trainee's job description. Uh, and almost anything, everything there is just part of everyday life as being a trainee in the health service for many jobs anyway. Um, so we shouldn't be surprised but, um, somehow we still managed to at least managed to do this to people. Um, and does it matter just a few people having a bit of a stressful work? Yeah, it does. Actually. Next slide, these are the suicides, the standard mortality, mortality rate for suicide in doctors, er, and doctors kill themselves more than the average population. Uh, and some people say, when I, when I say, ah, well, that's because you've got the means or the knowledge, I don't believe that. I think everyone knows where the, our buildings are, everyone knows where the electricity is. Everyone knows where the drug cabinet is and it's nothing to do with, uh, availability of noxious substances or trauma. Anesthetists always come out hives on every survey you do. This is one survey I picked up from the States actually, but anesthetists are always, always top of the list. And I think that's a feature of the sort of people who go into anesthetics. No surgery. And second, huh, there is a Facebook group for doctors with the autistic spectrum and the biggest single specialty representative is the test and I think it's people who, like, control. It's very complicated but it's kind of logical. Uh If this dial does that I would need to twist this knob and give this drug. Um It's complicated but there's a sense behind it unlike life, which can be complicated with no logical pattern, no sense behind it. And I think for people who need very highly structured worlds, um the defense makes them crumble. You can quote me on that, but there's no evidence behind it. Just my observation. I noticed too that surgeons are in second place. Surgeons actually choose more violence ways of committing suicide typically. So you can work out why that might be for yourself. I thought it would be good to um ask our audience um a part of what specialty they are in uh currently. So, uh let's do that now. Um No. So see the pole on the uh what sort of specialties are you currently in? Ok. OK. So I thought this was a surgical audience. So I might have to turn down what I was saying. I also thought I'd be the only GP but clearly there are some hired spirits out there. Thank you. OK. Next side, please. That's a blank side. It's just a, a break so far. It's been pretty miserable. I mentioned all sorts of things that, that, that the stresses of medicine will do to people ending up with that we're at risk of killing ourselves. So, and what we really need to hear is what can we do about it? Um And I have no answer. I have no quick answer. I have no easy answer. I probably had no answer. You hadn't worked out for yourself. But I have been working all right, coaching and counseling doctors in. We don't call them doctors in difficulty, but doctors in need of support for it is now 13 years. Um And that's my full time job now. I don't see, see patients, I just see doctors in distress. Um So my observations which are I will share with you, there is just a tiny bit of evidence. Next slide, please helping ourselves. Again, this is er Clare Gerard and people from her um practitioner health, fantastic organization. Um And again, it's observational that she found that people with these features of staying interested, um which actually I think the risk factors is for doctors in later life, doctors in their fifties, they've seen everything, done everything, there's no recess, there's no events that is too traumatic for them. Done it scenic boring. Um And they're just hanging on for their pensions and they are at huge risk, I think and they've got so much to offer, they should be doing the audits and writing the protocols and doing the teaching. So stay interested, self-awareness, I'll talk about some more time management. I think the world's pretty equally divided into people who have no problem with time management. Can't see why and you're inefficient or you lazy if you, if you can't get it together or if you're always late and people who just struggle, struggle to keep a die, struggle to get all these things done. And it's hugely stressful when you're always trying to catch up. But it's one of the few areas I think that, er, with good help and advice, you can't cure it but you can control it and you can, you can manage it, uh, and just take away a lot of the stress support. I don't know what support is actually. Um someone to be nice to you or er, having good group of friends. CPD that plugs into the intellectual interest. So you're staying interested and mentors and this is more widely recognized than a lot of the royal colleges and now have mentoring schemes. Um But you don't need a form one. If there is someone who you would be able to talk to, you would be able to trust, who makes sense to you, then I would see if they would act as all mental hugely beneficial. So, next slide, please. Yeah, most of all, I don't know if you're familiar with Victor Frankel and a book he wrote called Man Search for Meaning. Victor Frankel was an Austrian psychiatrist who was in AWI and he observed um that people who had something to live for, people had a purpose just didn't die as much in our pictures. Um The people who were just, just there and didn't have a purpose. So what is the life I want to lead? And that's a question I have asked every one of my coaches over 13 years I did. The first thing you have to do is actually convince people they have a choice. Um, and that usually takes, takes a bit of time. Yeah, you can choose, um, medical training is such a treadmill. Uh, that you, you feel that you've just got to keep doing it and then you do this and then you do that and then you get sent over there and you do a year's research and a fellowship and then you, your prize is, you become a doctor in the NHS. Um, no, you have a choice. And what is the life you want to lead and everyone bar one, it eventually comes down to work life balance and then you have to unpack that and then clearly some people want more work and less life and vice versa. The one person who said something different said they wanted lots of money was American and I just wonder whether that's a cultural thing and that's code for, er, enough money to live a good life. Um, so I cannot stress enough knowing why you're doing it and being in control of your lives. I was talking about this to a dean in the northeast. Uh, you know, in he, yes, yes. Why does medical training have to be such a sausage factory? Why can't it be an artisan? Bakery. So I leave that with you. Go out there and become fruit tats of your own choice. Getting slightly off peace. Now, um, back side please. This I really want to, er, make the point. Oh, medicine guideline. Medicine E portfolio has become so much cookbook, medicine that we're losing some of the, some of the magic. We're losing some of the things that a, I can't do. A, I can follow a, I can read the literature and follow the protocol and do a guideline and all that sort of stuff. What it can't do is pick up the nuance, the, the, the hidden meaning, um the, the, the body language. So, for instance, I mean, you can say, I love you in 1000 different ways with different meanings. And if you saw it written on a page, the words are the same, but it could be a joke, it could be cynical, it could be deeply romantic. Um And, and that's just a huge example of, of the context and the book called para Language, of what we hear. Um And I would really want to bring that back into medicine um because I think it lives with humanity and to really finding out what people are about. And, er, it's not necessarily the answer to the question that you just posed. Um and A I is so far behind and ultimately, it may be able to, to distinguish nuance and true meaning and emotional content but not in my lifetime and I doubt in your lifetime. So, uh next slide, please. Yeah, if I could see you, I would say that, you know, does anyone know this picture? And if you're a typical audience, maybe one or two hand goes up, usually none. Um, and then I would say, um, do you like it? And a few hands go up? So, yeah, it's quite interesting. Few bits and Bobs stuck around and the rest of a load of rubbish. My six year old. Terrible. But um, so let me tell you about this picture. Uh It's by the Catalan. Well, he was an abstract painter but he hates being called abstract. And he said that I paint what I see shack bit worrying. Um I call Juan Miro spelled Gene Miro. Uh and this is called Hunter in a Catalan landscape and I don't know if you can see my cursor if you can. Ok. You, if not up towards the left, there's a, a obvious pipe, a beard, a mustache, an eye, an e uh no, John Me, not, not Danny. Interestingly. Um Danny came from just down the, down the coast, um, from, from where row did, but also Dy, and I think what was happening in this area that all these, these, these great sort of surrealists er, came to the fore at once anyway, back on track. Ok. Can you see if someone in, in the, I can, I can read the chat, if you could say yes or no, whether you can see my cursor, it would be helpful. Otherwise we have a, a guy's face, he looks like a hunter. To me, he's got a heart legs. We won't mention he's ok, thank you. Um, he's holding a sort of black triangular thing that could be like a fire stick. It's a gun. Ok. Let's call him a hunter. Oh, look, he's got ammunition with him. So, er, if you screw your eyes up and give your head a wobble, you can s make that into a, into a person. The castle and landscape, very sunny, but the earth is very red like Herefordshire. So there's your Catalan landscape, there's your hunter and, er, these other things, I mean, hunt, is it a fish? Is it a rabbit? Who cares? It's the sort of thing a hunter might be after. So we have a hunter, we have game, we have the landscape. Um, if you look up on the top left, there's a sort of thing in the air. Um, a, a ladder thing symbolizing maybe upward, er, a propeller type thing. And about the time this was painted, um, they started to overfly Catalonia, um, from Marsa to Casablanca. Um, and if you look, there are the Catalan and the French flags there. So that could be some representation of a overfly airplane, right? Can we have a pole, please? What I, what I'm trying to, what I'm trying to say here is, it meant very little to most people to begin with. I have told you four facts. I've given you four interpretations about that. Uh, painting. Do you see it differently now? Uh, and what I'm hoping is that people can see the analogy to awareness. You just need a little bit of insight, a little bit of self knowledge and you change the whole picture. It would be real. Actually, I'd like to know that who did and who didn't? Er, and, and why anyway, but that's, that's for another day. So I, I hope that's an interesting way of demonstrating that a little bit of awareness, a little bit of insight, a little bit of knowledge changes the whole picture. So, yeah, these are a few random bits which I just stuck on. We're going to the end here. Um, the three worst words, a trainee can hear from a trainer or consultant, senior doctor is in my day, in my day. It was all different. And what we have to realize is that the current cohort generation Z is different and why shouldn't it be? And why isn't it? And, and so what, uh the, the social rules of the people we are training to be doctors are the clay with which we have to make our pots. Um, so what evidence have? I got to say that there are generational differences. This is some of the best, er, the University of San Diego um has been giving out personality inventories to the freshman intake for years and years and years since the eighties. And I just picked out this, this is the narcissistic personality inventory. Not necessarily a bad thing. If it, instead of narcissism, it said self esteem and we feel better about it. But lo and behold, there is a statistically significant increase in narcissistic scores over time. I don't know, let's call them self esteem scores over time. I don't think that's a bad thing. Um, except that we're still using Victorian medical education methods on people who are just so different. Uh So dili the future, the future is coming faster than we ever thought. Er, one of my little side hustles is I sit on the faculty of the changing face of medicine which recently caused a great storm, quiet wrong. I think um the idea being to think about what medicine is going to be like, not next year, not in five years time, but in the distant future way things are changing. Uh And there are huge paradigm shifts and what medical education really ought to be about is not teaching you the anterior relations of the inguinal nerve as it goes through the femoral canal or the other way around. But to stay plastic, stay interested, stay thinking. How can you keep up with changes that will happen both in medicine but in society and we're seeing it already. Um, you always on society people, you know, if I can order a toaster, I could have it by tomorrow morning. How come I can't see a doctor for months, er, and three little quotes there. If I Henry Ford, if I'd asked my customers what they want to, that as the past the horses, it's actually not gonna be a horse at all. Uh, it's gonna look totally different and it's no good just putting, go faster stripes, uh, on, on your horse. And there's a, a very early um horseless carriage, but they couldn't think of horseless without it having looking like a horse. Next slide. Ok. This is a slide about community emotional response to disaster. It predates COVID and it's from an American disaster relief organization. Normally dealing with floods and fires and terrorist stuff. And you see AAA waning of emotional wellness, which I would relate to sort of March when we were hearing about COVID in Italy and Spain went into lockdown and then it hit and there was a, actually people felt their own last had a job with meaning. And there was a huge sunny honeymoon period. Pizzas being delivered to A&E departments, people out clapping and then the disillusionment started and I think we're still having trigger events. We're about to see another COVID and I like this. This is an anniversary reaction. So, so even for a single, I know a day's fire, you can expect that you're nowhere near where you were pred disaster emotionally as a community a year later. And, uh I was talking to the guy who's leading the ee response to education and COVID and he's saying it's going to take a minimum of seven years to, to get over COVID emotionally and that's without all the, the things that are backed up and the waiting list and your log books and everything else. So, next slide and then my final slide, which is really my, how can you improve things? Actually, it's not my five, next slide has got my meaningful slide. Anyway. Ok, I think you have to acknowledge that you're in an at risk group, both for the reasons that got you into medicine and what medicine means now and all the things I've been talking about. So, would you manage a patient without thinking about why now what's causing it? What are the risk factors? Would you take a history, do an examination and have a plan? Uh And why am I saying that? Well, of course, you wouldn't because I think we need to check in with ourselves. We need to take a history from ourselves. Um How am I doing? God, I'm tired, irritable. We need to examine and that will be our behaviors, stress reactions, you know, eczema in the day and all flare aches and pains, behaviors. I recently got spooked by someone riding on the pavement behind me and I swore at her. No, I it's not what I do I don't normally go around swearing a cyclist. And if I swore it people highly on the pavements in Oxford, that would be a full time job. So that was a, a clue to me. So, go home and see if you can clear your diary. Take tomorrow off, you're on the edge and that's what I recommend. You do take a history, it's an active, active process, think about how you're doing. Um, and then above all, have a management plan and that's going to be personal to each and every one of you. There's no point in my saying, I'll go and play your elbow. I bet they hard, any over players in the audience. So, whatever it is that works for you. Exercise, not exercising, reading, drink, whatever. No, not too much trouble. Um I'm a big, big component. This will keep you going. This will lead you a long and happy life. But it, it's a discipline check in next side, please. Yeah, if you guys want to take a picture of that, er, link, that's the BM. They use that particular burnout questionnaire and it's quite interesting and the questions they ask are, are quite telling. Um, and I, I will recommend everyone have a look at this and final slide, please. That's me. I'm very happy to get, that's my NHS email. Uh Very happy to be approached. Um, very happy for you to disagree. Very happy for you to agree. Very happy for you to steal my slides, pass them off as your own. I don't care as long as the message gets out there. So, thank you. I hope we've got time for some questions. Thank you so much Richard in for talk tonight. And um there are two questions from the audience. I think there questions from Edie and uh he was asking and how could we um reduce the demanding shift while still fulfilling our professional duties to provide patients care? And um and uh and also to reduce risk of burning out as well. Very was physical collapse. What uh what's your thought? Well, what I want to, I don't want to do is I put in the trap of legitimizing the system. I clearly, it's not right for me to say, you know, stage of revolution. Uh But I mean, we can do two things at once. We can actively work to try and get a bit of humanity into training. And at the same time, I, I try not to use the word resilience because it's so tainted. But actually, if you can be more resilient, if you can uh accept more stress than you might otherwise, if that's what resilience means, I, I think if anyone else can hear that but some of the dogs get bruise or something. Um So I have no magic answers but two prong change the system, change yourself gone violently. Both. Mhm um The second questions that we have from the audience is from Kayleigh. And um do you think um the helping ourselves area should be focused in work or out of work? And how do you find balance in between these two? Yeah, interesting. Uh because, because lack of balance is, is, is a, a key feature of medical life. Um And I think, I think we should find it both. I think if you love what you're doing, um if you can see the, the joy, the benefit, the good that you're doing in your work sometimes hard and sometimes huge moral hazard as you're doing a secondary job because that's what the system demands. Um, but also have a life outside medicine and a, being outside medicine. Uh, and a belief in, I believe in yourself. It is important, isn't it? Enjoy it ourselves. It is in cause I was, uh, just one more last questions from, uh, due to the time factor from Camilla. And, um, she was wondering whether if, um, how to ask for help and, uh, I mean that you would need help and it's struggling for doctors to, I mean, um, the weakness and how do you approach that? It, it's just a, one of the biggest problems is that the, when I speak to established doctors, they say, oh, well, you've all got your educational supervisors. They should be where you go for help. Actually, that's the last person you want to take. I don't know, you've got a gambling problem or a drink problem or you had, you know, a bad experience or something, the person who's going to sign you off, it's not the person you want necessarily help you. And that's a huge confusion in role. So there are lots of other things. Um uh I've never this self help. All the stuff I've been talking about. Meaning informal health, your friends, your colleagues mentors, um the sort of secondary care, the, sorry, the primary care type things GPS are very good actually at diagnosing and helping people some GPS are anyway. Um And finally there mental health services outside that you've got things like practitioner health, you've got er um medical professional support units like the one I uh you um work for and they are nothing to do with the trust, nothing to do with the GMC. They are totally confidential. Um So um it is there and it can be confidential and actually there are a lot of good people around in medicine, a lot of good consultants who, who would not, I know plenty who would be helpful and generous with their time and their feelings. Yeah, I'm very sorry that, that you cried out and you given a bad time. I it's a story I hear too often. Yeah, I it's not um it's important that we support each other and um and there are, helps out there, find a good mentor and reach out to others and look after each others. In difficult times. All right. Um Our time is up for today's webinar and um thank you so much, Richard for your time. Such a privilege of um having you and think about something that's great, dear to my heart and uh being a wellbeing um elite of my academy and hope you all have enjoyed the uh wem today and um please don't forget to fill in the feedback and uh certificate issues with today's events. Thank you. Thank you again, Richard. And it's been a really, really good webinar. Can you hear me? Ok, thank you. Thank you again. Um Just before everyone logs off, I just wanted to um plug our in December. Um It's going to still the last two minutes. But thank you again. This has been really, really powerful, really great start to our webinar series. And uh Richard, your, your advice has been really invaluable and I'm sure you know many people who've logged in will, will appreciate it. So, thank you. Thank you again. All right. Hopefully, this doesn't create an infinite loop. OK? And hopefully we will have more of wellbeing ser of wellbeing related series through mo academies. And thanks for thank you everyone for joining in and um take look after yourself and do take care. Yeah, thanks and thanks Michael. I don't know if uh you can see my screen. Yes, I can see that link. Can you see my screen? Uh Yup. You can see my screen No. Ah, great. Can you see that? I can see a, a link. Ok, fine. Um, if everyone joins the link, that's our GS weekend. Um, and it's broken up into different sections, pre mcs and Post mcs. I think I'm the only one, Michael. Ok. Chest screen. Um, ok. Yeah. Can you see this? Yes, we can see that. All right. There we go. Yeah. So just, er, oh, any stop show and screen now. Uh, so just a little plug for our EGS weekend. We've got, er, as Ro and Jukes all joining us. It's a real big educational um, er, event and we would love to have you all there. Er, again, Michael really are done for putting this together and Richard, thank you so much for, for your presentation. It's been really, really appreciated. Um, and on behalf of the Mohan Academy, I'd like to thank everyone for attending and, uh, thanks as well to me, all who supported this event. Thank you. Way. Have a good evening, everyone.