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Hello, everyone. Them to the weekly mindedly. Pleven, are, um today we have a very, very exciting session. That was just part of a serious off. Prepare for enough one. Um, we're going to be talking about the well being and one for advice today on be joined by the representatives from the MG as well as the BMA. So it's going to be very exciting session. We're joined by Dr Carlin, Fran, Daniel Taylor, Lasagne Stevenson and clear James. And the session is going to be run by John Grisham. Um, just a brief introduction before we start at please remember to Santa for the weekly webinars at the mind oblique dot com slash webinar registration. I'm going to post the link in the chance section and all of the materials are going to be recorded S O P. Sign up to make sure you don't miss a few discussions as well as, um ensure t you get that you to get actions to Desprez it a shin before we start. Just a quick shots. I t I was sponsored. Dandy. Please don't forget tee and sign up for the end. Even Dacian membership before you start your shadowing because unless you failed in a foundation application form, your student membership will cease to exist in the summer. So it's essentially they have indemnity cover s. Oh, please check out And the sign up for that. Then I'm going to leave the link. Any comment as well? Um, and night with I'd for GE. I'm going Teo 100 a The to doctor John Grisham. He's going to Teo ran the session on the welfare and wellbeing. I hope everyone is going to enjoy it. I thank sorry for that wonderful introduction. So my name's Janhvi and we're joined by our crashes. Well, from the mind, the sleep team. So we're gonna be running the webinar on welfare and wellbeing today. We're really fortunate we joined by with the B M and M D U. On it's rare that you get the wonderful opportunity to have both of them the same time and ask all the questions you want. Please make sure you ask anything you want to on the chat, and we'll be sure to reply to it right at the end. Eso just quickly what we're gonna cover today. So we're going to start with the M D u covering medical legal support when things were wrong or might Then we're gonna move on to the BMA toe, well being burned out and services to help. And then finally, within end, we're dealing with the foot colleagues and really in an information on roto and maximum hours that could be worked. So without play the reduce, uh, pass over to the M D U s. If you want to share your screen and we'll get started. Thank you. You cases I can show my screen while someone else's sharing. So I don't know if some the other person can stop sharing him. Then hopefully I can no shot my screen yet. I have no enabled most people to share, so that should be okay. Perfect. Lovely. And I'll just check that everybody can see my slides. Yeah, Okay. So welcome to this evening. I'm dots. Caroline Fryer. I had a the advisory team here at the MD You So we're going to cover support when things go wrong or night. I would say at the outset that although we're talking about when things go wrong, actually, ideally you seek support before they do a pre emptively onda. Just by way of an understanding as to what that might look like under silliest who we are. So my team comprises mainly doctors, and there are over 30 office. We range in specialties. I'm a GP by background, but I have a niece tests neurosurgeons, diabetologist and the chronologist. So you name it. We tend to have people from most specialties on. We're spread all over the U. K. Which means that we can get out and support you when you need it locally. That's your trip. Stunned indeed. We work very closely with the BMA in in doing that in terms of what we do, we have over 20,000 calls a year to our medical legal advice line on we open about 10,000 new cases a year, and as I say, we prefer proactive. We prefer to help you before it's problem, and this just gives you a breakdown off cause to our advice line. In the last 12 months, I've run into October 20 because if we run exactly the last year, coated, coated coated is basically the flavor that you get on just to give you a slightly broader understanding of the normal range of things we get. This is a a mixed range, but you'll see that general advice is on most common thing. What does that look like? Well, it's always tricky. There are so many different things that were contacted about but by far the most tricky. Waller's fall into these common themes off confidentiality on consent complaints are course off bread and butter. Um, certainly after ethical medical legal queries the most common. But in terms of proactive things, these are what we see. Public interest is coaches, so the please turn up at your hospital once information about patient that you've seen. Can you give that information? Obviously, doctor patient relationship SAR confidential. But there are occasions when you come breach that. So that's one of the common wearies we deal with and also requests for access to medical records. One of my staff has just been dealing with a complex issue today in terms of the police wanting access to somebody's medical records, and these are rarely straightforward. Often the request span not only the patient, but perhaps their relatives as well, so that's a common sort of thing. We deal with the most common reason that I get woken up in the middle of the nights on. I don't often get woken up in the middle of the night on call anymore. Those days are happily gone. But when we do, it tends to be to do with issues in treating patients who are lacking capacity. Or particularly, patients in the emergency departments who taken an overdose and have questionable capacity under are refusing treatment. So there's the source of things that were there. Four. Um, well, what I would say is, over the last year or so, I think we found that anybody we speak to you is just more stress than normal. And that's entirely understandable. But anybody who gets involved with any sort of medical legal issue, it's effectively the tipping point. There's so much going on already, and that's additional stress is just too much. So we're finding that so many of our members are really struggling and needing a lot of support and in terms of our support, clearly the bulk of that get falls when things do go wrong. So this is a fictional case example off something that has gone wrong. We've seen many cases like this. This is not unique But if you imagine that you're the F two in this occasion and you're looking after a lady who's post elective hip replacement, a known diabetic and the nurses are concerned that she sounds trustee and has lower two cents, you go to see her. Um on. Do you think it's probably a chest infection? Could be heart failure. I'm sure, will be familiar with that sort of difficult decision between the two, Um, or, if not now, certainly give it to a three months and working on the ward's you will be so the F to arrange is some bloods in the chest X ray. And then it's a question of what what's actually to do and rushes off the consultants in clinic. So finds the consultants in between patients and clinic, has a quick discussion and follows the request off. The consultant for those IV antibiotics quickly prescribes those on the ward whilst bearing in mind lots of other things to do lots of the patients to see brushes off to deal with another call about patients who's on another ward and stable BP. Clearly urgent on that of the war, they hear the rest sleep, go out to the world. They were just on initially think nothing of it. And then, of course, the horror of horrors. This is the patient that you just prescribed those antibiotics to a few moments ago on there. Contraindicated. There's an allergy. Whenever I talk to people about this, a lot of people will say, Well, of course, that won't happen. The allergy will be written in the notes. The patient will tell you they're allergic. Drip cardiacs will say that analogy. They may well even have a marking about the allergy on that bracelet. Absolutely. All of these things are there, and they're they're a good reason to try to prevent these things from happening. But these things do still have, um, not as often as they did, but they do still happen. I'm really what this case is about is illustrating the range of things that can happen in terms of investigations once you're involved in a technical incidence. And to my mind, these are the things I would have perhaps wanted to know about when I was at your stage, because knowing that they might happen means that you can put yourself in the best position to deal with them or to preempt them if they do so I'll just give you a little bit view of my top tips in terms off what we can do by way of support or what you conducive, um, if something goes wrong. So those things first in terms of claims, they are indemnified by the NHS at the stage that you're working at. But you would become involved in a claims process in terms of giving statements, reviewing expert witness evidence. The issue with claims is they can be brought a very long time after the incident, at least the three years in normal terms after the date of the incident. But for Children, it's a until the 21st birthday. For adults like in capacity, there is no time there. It's so what this really means is, Well, can you really remember that patient that you saw on the ward three weeks ago exactly what you did? Exactly why you did it? Probably not given how many you're seeing. So really, the thing about planes is making sure that you make good notes if you haven't realized this already. Any thought from the medical depends organization will always refer to the new to bite good records. Okay, fine. Seems obvious on a suppose. In an ideal world, you'd write reams and reams and reams, and that would be fine. But you're not working under that situation. You have got a pressure of time. So good notes really mean making sure you've got the salient features. Who was there? What was your working diagnosis? What were the red flag symptoms or more? Relevantly. What? What weren't the red flag symptoms? What was missing? If somebody has chest pain, you know, have you excluded the corners of a DVT? And do your notes show that so some relevance red flags, but also safety netting go. A plan on making sure that plan is followed out to be. Do some blood tests, chest X ray, whatever. But make sure there's a plan to actually follow that up. You're finishing shift. Make sure that you have that over to your colleagues. The next one. The criminal investigation. Now the case. I've just given you the example off is right for criminal investigation Ball Gross Secretary. It's manslaughter. The issue with that is twofold. One is incredibly stressful to be called the police station and have to give an interview and a caution. But to even if it doesn't progress, it can drag on for a huge amount of time on that. Hanging over you is so very, very difficult when you're trying to progress your normal day to day job. So the only top tip I can give you on criminal investigation is call your MDO. Don't attend any sort of police interview without us. That is what with with that for. But it's a much lower level because in most incidents don't run the risk of criminal investigation. And I don't want you to scaleable but thinking about it a lower level if I'm the medical director. Faced with the scenario we just discussed, my role on behalf of the trust is to make sure that you are safe to continue working, and that really comes down to your level of insight. Somebody who says, Well, it wasn't my fault. It was the consultants fault. They gave me the wrong idea. Who? The antibiotics. It was a nurse's falls because they didn't check properly. It was the votes, his fault, because I was being pulled in too many different directions, absolutely all of these things old, valid. But to blame everybody else but yourself means you're inside is probably somewhat lacking. And I, as the medical director and then quite concerned as to whether I can have those dots of continuing to work while Simvastine Gatien goes on. So it's important to try to show insight when you've been involved in at first incidents. That's any level. And the sorts of things can be personal reflection. Thinking about your own knowledge base, all the gaps. Can you change that all their protocols in the hospital that could be changed to the benefits of everybody? Is it worth presenting this case anonymously to colleagues so they can also learn from the same areas? Is there any online learning you can do modules. You can do certificates you can get to show that you've done your reflection. That you have insight into this, and the reason reflection is so important links the GMC as well. The GMC doesn't investigate a huge number of cases, but those that it does in terms of their ability from stopping you practicing it's incredibly stressful on what the GMC is looking at is your ability to reflect and your fitness to practice today. So if this arm first incident had happened today, it may not reach the GMC for a number of months, or possibly a year or so. In the meantime, you've got that opportunity to learn and reflect. And that is what will stand you in good stead at the GNC as an organization in those except that things will go wrong. But it's how you deal with those that puts you in me to the absolute best position. Complaints what the patients want. Well, on apology, an explanation on the reassurance It's not going to happen again. How do you do that? Well, if you've done the things we've talked about by way of reflection in sites you can help on, that reassurance is not. Pains happen again on the openness and the apology. You don't need to wait for the complaint. If something goes wrong, you can apologize. It's not an admission of liability. So if you feel that you would apologize in the same way that if you've been paying somebody when you're walking on the street, you say somebody. If your natural reaction, when faced with an instant is to say sorry. Say sorry. Don't be afraid of that. But we can help you in terms of wording complaint responses to stop you from admitting simple of liability when you're saying sorry. More formally inquests. Really? Haman, um, much more common now than they were becoming more adversarial, although they're not supposed to be, um, but Coroner's office is. Do tend to quiz families on whether they have any concerns about the treatment that's being provided, and so that does tend to raise the stakes some warts from point of view of the inquest, that's best thing to do is all about the statement. It's making sure that you do one statements, and you do it once and you get it right. So if you're ever asked for a statement about your involvement in anything and not even just the death of a patient, but much more minor things, anything at all, don't be tempted to just draw it out a few lines by way of the mail off your and night fifth, take some time and get some advice. That is what we're here for. And in terms of support, I think it's one of the most important things we can offer for you because if you put something out that isn't quite right or is going to get yourself into difficulty, it's very, very difficult to go back from that. We can always offer supplementary information, but you can't really get away from what you said at the outset. So do it once and get it right on. We've done tens of thousands of these, so we we can help you. CQ see, I'm just a minor. Nor that's more of an issue for the trust, but survives to say if they end up any with difficulties to do with breach notifications, something having gone wrong and you're involved, they're not going to be delighted. So again, important to work with the trust and do what you can to avoid that and media attention. I think you'll know that it goes without saying the newspapers love a good story about the doctor doing something wrong. You see it in their day in, day out awful on just has to be left and hopefully it install, read loses interest in a day or two. But we do have a press office and that's what they're there to help support you So just in summary, those are the top tips as to what you might do. But I think the most important thing I would say about sports when things go wrong is support one another. Don't be afraid to talk to your colleagues and your friends and family. You need to give a sleep. I don't Bible information about patients, but in general terms, talk to people about what's happened and why you're feeling like that. We've had many cases over the years where people haven't been able to do that. Even people who have been suspended from work but not able to tell their families and still left the house at 6 30 every morning and returned but 7 p.m. each night is if they've been at work. But they haven't, and that is an awful situation to be in. So nobody wants to get involved in an adverse incident. But if you are, be brave and raise your head above the parapet. Andi, talk to your friends about it, about how you're feeling because you won't find them saying, Oh goodness, when I can't believe you did that, how did that happen? Far from it, they will be supportive. And as time goes on, if you're talking to more senior colleagues, they will have bean there. Then it experienced it all. But whether Andre, four hours a day, every day of the year, we do have a swell uniquely amongst all the embryos. A PS fault network, which allows you to have the opportunity to speak to another MD. You remember who has been there and done that, got pretty shirts on. So we find that's really helpful and it's not there. That's not about the nuances of the case and the specific running off it. That's what my advisor for that. This is about how these people coats where they sort support the best things to do to try and put things to the back of your mind when they're dragging on on. I've put a link here. If you need to go on our website to other sort of support. I know in the B M. A is indeed one of those areas. We 0.2. We do also have just finally add, because I know and that's 20 past bang on time. We do have an online wellbeing module, so you might want to access that I can probably try and put be linked to. It's in the chats and whilst the BMA are speaking, but that's based on our experience of stress and burnout, and people who have done it have found it very helpful. So there are lots of areas of support out there, but the first thing to do is ask and don't wait until something goes wrong. I'm not. I'm going to finish that. I think we're going to do questions at the end. But I hope so. Um, the helpful Thank you. Thank you so much, Doctor Prior. That was so useful. It's really good to know the support networks that are available. I think we'll pass over to the BMA now if they want to share their screen on Continue with that. Any questions for Doctor Brian? Just pop it in the baby book. Chat on will be short to answer them all at the end. So just just being a bit slow my straight Can you see that? Okay, Yes, that we can also see your notes so we'll see my notes. Okay, But we've made for a second. Thank you. Sorry. Mrs. Shed the wrong screen that uses a mess. Sorry, I'm normally on normally on teams. It's Trey. That's Do you see the white sweet now? Yes, thank you very much. I just for a sec to see if we're not going to your notes. Because sometimes as the gays No, that's good. That's good. That's perfect. Right? Okay. Thank you. So, Hi, everybody. And my name's Claire James and I work in the well being support department at the British Medical Association, helping with the day so running off the well being support services that we provide. Doctors and medical students know Talk a little bit more about those later. Okay? Eso First thing I need to say that I'm not a doctor. So I come sense know everything about being one or the wellbeing challenges that your face saying. But I have been working in this role for 2.5 years and have learned quite a lot about doctors well, being during that time. And I've been asked to come along today still, but doctors wellbeing, but specifically about burnout. So I would start by briefly setting so context of doctors wellbeing. But I'll focus on burn out. What is the science has prevented what to do if if you see yourself struggling with it and so one and then I'll end by talking very briefly about the services that the BMA providing some other sources of support as well. So just a very briefly give you some insight. Doctors Wellbeing was facing a huge problem before the pandemic hits a Z, you can see on that slide back in 2018 2019. The being made it a big mental health survey on thousands of doctors responded, and off those 80% of them reported that they were at a very high or higher risk of burn out then, throughout the pandemic, the being may have been running monthly track of surveys. And in our in our February track of survey, just over 40% of our respondents said that they're currently suffering from any of depression. Anxiety stress, but announce emotional distress. Well, the mental health conditions relations here would be made worse by by what your work in Sunday's. So what exactly is burn out? The World Health Organization defines burn out as a syndrome conceptualized is resulting from chronic workplace stress that has not been successfully managed on. They characterize it by three dimensions. So feelings of energy, depletion of exhaustion. So by that they mean emotional exhaustion. That feeling of unable to being able to give any more increase meant to distance once job or feelings of negativism or cynicism related ones job so depersonalization and not in the usual. I can't trick sense, but it says they mean by sort of cynical. Ask you is to what your patients and colleagues on then, lastly reduced professional efficacy. So lack of lack of feeling, of personal accomplishment and a tendency to evaluate ones work negatively. There were so many causes and contributing factors would burnout, especially for Doc says. There's the statistics that you're seeing on the screen front of you are from a Medicaid piece UK survey last year on that the top of their list from that survey and think that was about 2000 people would respond it. On the top of that, the top contributor for Been Out for those respondents was a lack of respect from administrators, employers, colleagues starting. So, um and we know that that's ever since from the service, civilities saves lives, movement that instability can affect the person on the receiving end. I'm, um, causing 61% less cognitive ability. But it was so, impacts anybody. The witnesses, that instability as well on they result in 20% less cognitive ability and are linked linked that research at the end. In a parliamentary report that was published last month on Workforce Burnouts and Resilience in the An HS and Social Care, the authors conclude it's that chronic excess workload is a key cause of burn outs and doctors, and that better workforce planning is required. I'm sure that for all of you that won't come as a surprise. It certainly wasn't a shock to me. Onda doctors Like drummers, he's also known as the Happy MG It has I sent, if I'd on additional five main courses of burn out in Doctor's on them, one being energy requires to be a doctor. So if you think about what you have to do every day and they're dealing with that stress and the distress and suffering and death every day, and that's without the pandemics, to contend with all of that takes a lot of energy is quite with it every day. The conditions of particular job a sweet know from the parliamentary report that I just mentioned. Chronic access workload is the biggest. We should research to burn outs. It's not just about the pressure. It's also about the workforce and how you're working together. And if you're not working well together than that can contribute Teo towards burn out as well. Your home life can be a cause of burn ounce or a least contributes to it. If you're not finding your home life relaxing or you're not having that time to be charged when you're not at work, that can contribute to burn out as well the leadership qualities of your boss or supervisor. Eso. You may have heard about compassionate leadership, particularly over the past year, and we know the compassionate leadership is linked with psychological safety of staff say that you feel able to speak up. And for most compassionate losers, it means they're paying well attention to their staff, really listening, really trying to understand the challenges there facing rather than imposing some kind of understanding on then, lastly, the programming of your medical education. So if you think about my school sorry, medical school on personality traits, such a perfectionist in that come with it actually kind of come with people who are trying to be doctors. And then there's sense through medical school, it's drugs into you that you should be able to cope with the situations and you should be invincible, like superheroes on all of these things contribute towards your identity as a doctor on the same schedule as a right. In her book Beneath the White Coat, which was published last year, she regained something of patients once told her, which is that a doctor is something you are not something you do on all of these things can contribute. Teo, you feeling burnouts on then last. They just wanted to highlight this emotional energy matrix. You may have come across it before. There's a really brilliant webinar that I watched last week from Dr Michael Xavi, and that's where this has come from, and this is his summary of The Matrix on. So essentially, I I haven't got time and in my talk to go through it all in detail. But let's say his weapon out. The answer. You can watch it when you have time pretty good. I am essentially here saying that they say, if you've got the energy levels in the middle and then your emotions on the horizontal line and he is suggest saying that really needs to spends all about time on that right hand column. So thriving, reviving You need that time to revive, to be able to continue to thrive. If you spend too much time thriving, you're going to find yourself surviving. And that left that top left corner. That's what left corner. Sorry, but you find yourself surviving for too long, then you're going to end up burning out. If you're not getting that time to revive that. Can Lisa what to what? To both burn out as well. He's like, So it's some of their science for burnouts. Some of you might have been able to read the text that was with the my previous slide, but I'll make sure that I get the sense of humor and the sleep. Um, afterwards say that they can send it to you, taking see it more clearly. But these signs are from very well mind alienation from what related activities so you might be sensitive to your job is increasing. The stressful and frustrating might be going cynical about your working conditions or the people that you work with. You might be finding yourself emotions a distancing myself from your work, who are beginning to feel numb about your work. Physical symptoms can happen if you're starting to burn out. Well, no, you chronic stress from the physical symptoms such as headaches, stomachaches, intestinal issues, increased heart rate and so on. Emotional exhaustion so you might be feeling drained on labels cope. You might be feeling tired and you want really liking the energy, so get your work done and lastly, reduce performance. So, um, you might be finding that your everyday tasks they're taking you longer than they normally words. You might be feeling negative about doing certain tasks you might be having difficulty concentrating. You may find that you're lacking creativity and unable to think of the box and problem self. And so some of you may be aware that some of these symptoms are quite similar to depression on other mental illnesses. So it's important to remember that with burn out with specifically thinking about what I relates to your work life and not all aspects of your life. But there was a survey on the B m, a website, which can see how this you are off, burn out on which the date that new fill it out and it's for your eyes. Only way. Don't see any data from that. And again, all expire at the end. In terms of preventing burnouts, doctors like Drummond again hospital other. This burnout prevention matrix, which Doctor Kate Little he runs a physician burned out website has some arose, has reduced your stress at work. Reduce your stress at home, increase your ability to recharge at work and increase your ability to recharge at home. All right, so some of these things are going to quite difficult today. Um, but it works, for example, and you could try and recharge it work If, for example, your hospital has a double room. I know that if you have been, stress is over the last year and a half, just a space. We usually just escaped the chaos of the wards for a few moments and just really great for a little bit and just have a breather. But I will talk to your colleagues if you feel comfortable doing so on decreasing your ability to recharge at home. Just try and make sure that your carving out time for you as well. And it's really easy to get caught up in chores and home life and looking after the Children if you have them and all of these things, but just it's really important as well. Teo, Have some time for yourself, too. So what do you do if you are feeling better out saying if through listening to this or even before you came to this talk here? Oh, I'm thinking that some of it resonates in your starting to think that maybe maybe you are feeling burns out. You just want to know future reference. And it's really important that you recognize that you're feeling that way and and six support, Really, there's There's either support out there. Mice Trust now have some some some kind of support, but a sale sign place to some as well was the end of my presentation. Um, as we saw on the emotional energy matrix you need time to revise to really do make sure that you're finding that time Teo Rest and Republic lawyer itself to do that's really important on. Then make sure you're doing activities that completely different. She'll work today, so you are finding that you're blue to a screen, put some poor, then make sure that when you do finish work that you're getting out in nature or you're going for a swim or your going out for dinner, which is something that isn't completely screen based. Um, just just try and give your brain that. That's a bit of a break from what you've been doing all day. I appreciate that. A lot of that will be completely out of your control. You might be thinking, I can't do any of that. So I thought that I might share this model with you as well. It might just find it helpful just to help manage buildings of uncertainty. How you manage your wellbeing a little better as well. So I have heard this from Doctor Lee David. She is the founder and director of 10 Minutes CBT dot com and the mental health course director at Red Whale, and she's accepted it for healthcare workers from Los Harris's The Happiness Truck, which is based on acceptance commitment therapy. And she's adopted it as a way to face Kobe 19. But let's say. I think it's applicable to face uncertainty as well, so I thought I'd share it with you. Hopefully, you'll find it helpful. So F is the focus on what's in your control so we can't control the pandemic or whether or not people are playing by the rules. We can't control the government's response. We can't control around beings for certain extent, but what we can control is our own actions and our own behavior. So focus on what you can do. Well, you know what you can't A. It's acknowledge what's inside, say take a moment and acknowledge your personal reaction to what's going on with something. And if you're able to put the labels that emotion it can be really helpful in to bring it is perspective, helping you want to stand yourself that little bit better. And so when that could just help you feel, uh, more able to cope with. What's going on, see, is we commit to a plan, so plan to actively do things that are important to you and choose actions based on what really matters for you. And that looks really closely with a which is engage with your values by that we mean to engage with your core values. So what you really care about so that could be your family, your friends, fun, humor, professionalism. Whatever it might be. Just make sure that whatever it's, it's pretty important to your appointment times to engage with that in your life and then just quit clears and punches of a minute couple of minutes provided. Have lovastatin you'll, um, just what it very briefly talk through the BMA services and then highlight another source of support you might find helpful. And then, um, I will handle your birthstone. You'll s o. There's been most main support. Substances are counseling and peer support, and these are free to any doctor or medical student. Cross the UK You do not have to be a member of the BMA to access them. Our counseling service is such a what it says on the tennis counseling. Get in the moment support, or you can get a structure course the counseling of up to six sessions mainly over the phone or by BJ. But we have recently launched face to face and are both. The face network is increasing a Z. The Kobe restrictions starts to lift and we get more copay secure. Been using place on the counseling services also available to partners. Independence. So just 16 to 24 off stocks is a medical students in the UK as well. On up here, support service is a confidential space to talk things through with another doctor, so it's not clinically they can't diagnose you with anything. I can't prescribe you with anything, but what they can provide you is emotional support. So you can talk things three with somebody who's not necessarily immediately in your world. But I understand your world. So it means that you've got somebody to talk to. You kind of gets what it's like to be a doctor on. Got support. I'm going say some people feel better after one call. Some people need much more than that and that that's fine. Whatever works either way on, then Doc Half is our face to face confidential psychotherapy service that we run with the Royal Medical Benevolent Fund Before the pandemic. It all of our appointments were taking place at the end of a house in London with Skype appointments for people who were brother field or couldn't get to be in my house easily, but all of our appointments are taking place virtually at the moment on. Like all of other other services, you do not have to be a member of the Bumex access talk health. But unlike them, that is be attached. So Virginia doctor is at 65 lbs per session. But there was financial assistance available, if you need it. And then, lastly, just wanted to highlight the well being paid on the B m A website. It has got lots of different resources on there that you might find helpful but particularly wanted to highlight the sources of support page at the bottom there. There are lots of different resources on that page. Assess how in finance, legal counting, mental health and so one on the majority of them are just purely for doctors and medical students. But the top that page will also finds a directory of wellbeing support services and across the UK that are specifically productive and medical students. You can click on your region and see what's available locally to you as well as the U K Y services on. Then, as promised, I have links to Barry ESIs and Bernard resources here, including the pressure that I mentioned that's going to be in my website, the webinar, that I mentioned from Dr Michael Xavi and, um, the report as well from Parliament, in case anybody would like to get that a raise. So thank you for listening. I'm aware that I shared a lot of information on Brussel through that, but I hope you found it useful. Anyway, I am also aware that there's a huge range of issues which can affect your wellbeing. So if you're looking for a particular type of support, but you're finding it difficult to like eight, then please, by all means contact us, and we'll do our best to help sleep place. Gee, the main message I'd like to pass on along with all of this information is, please reach out for help. If you feel you might need it and encourage appears to do the same, it's really important. Thank you very much listening. I'm now great. Hands over to my colleague Daniel, who talked to you through a little bit. About what else did they make an offer? You? They think you listen and I'll hang around at the land. If anybody's got any questions? Thanks a lot. Bye. Thanks There. So you should be able to see my screen now. I think should be or get s. Oh, yeah. Ah, Ralph. Remind it very quickly because I don't want to ever run. Um, so yeah, Thanks. Thanks to care for again for the talk. So I'm down. I'm going to talk about being a membership quickly. I'm sorry if you've heard me avoid over the different mind beats over the past few weeks, but this time I come bearing and you give which is the offer that you see on the screen s Oh, this is very red. It's comes around, but you can join the BMA now, and you ain't painted thing until October. So So that basically covers you through, um, through inductions and get your contract getting your rotor. So use that kill our coat on the screen, or I put the I put the links in on the Facebook comments that while you're watching on Facebook, So yeah, that that you are currently also be in the top corner for the presentation. So if you're not remember, joined get a free introductory bed and after October, hopefully you do stay on but very, very pivotal. Time to be a member for sure. So, yes. So you've already will know this with that Will even trade union on depression associated doctors. So we act as the voice the voice of you guys representing you on an individual local national basis. Eso So, while it's your job to be your job to look after patients, it Zaroxolyn to look after you. Um, so way often get this. But we're knowing indented companies say we do. You get confused at home to use sometimes, but we're we're no arrivals were very much friends, eh? So? So we don't do with patient complaints. We are your union. So So we're here to look after you. You're working dishes that things like pe contracts where so we negotiate the contract. That going on too. So So we know what should be in it. Your freshman home. And also, of course, your wellbeing with with services like the ones that the class mentioned. So we understand sort of things you might encounter, particularly when you become become enough one. Give you advice, a support, anything you might face system and being from racing really ships have seen your staff to responsibilities they don't quite feel comfortable with. Eso just keeps the mind. We can take any pressure off you. If you're facing anything you need support with and and you drive or not speak to anyone, trust I will come to us. We've seen most things before. Um, and we've got relationships, and we've got people on the ground every single trust in the UK on. But we know that people in, in, HR and and elsewhere so so we can handle things for you. Um, see, uh, I've briefly mentioned the contract Exert this, um but but it's It's probably that the key tool to to use this year this month, maybe ever being remembered to be any so it protects attention. Quite save you quite bit money. As I mentioned, we we negotiate the contracts so we know what should be in them. Beside the 27 the contracts we checked last year were wrong. So one in five s o. If you remember the BMA, you can get your contract centers will check it in five working days. And if there's any issues week again, touch with the trust and get erect. Fight best to do. This is quickly as possible so you don't have any issues down line. If you've already signed it, that's fine. We can still check it. If it's wrong, it's wrong. Um, also, it's were saying that we've also got a similar tool broke checking tool. So that one you put in put your rotor on your flag up to his room. But the roads should be pretty standard. It's just the contract we did. We do worry about the one of five just too high number. Um, so, yeah, you're so please be a part of being being a member. You get the BMJ every week, so you get the doctor vision. Now, if you already remember, you're not getting the BMJ the doctor version every week in the moment. Just get in touch with because we may have an old address for you. Um, so, yeah, you may be sick of learning now after finishing the school, but you've got access to a lot of clinical, non clinical learning tools. A zombie. You're continues to learn from your career, so you have you have full access to be mg a learning which has over 1000 finish kind of corn on clinical modules. Um, and this could be really helpful when it comes to completing your evil folio. Um, so being a library 1000 of the books and and he Jones, you can access instantly from anywhere on. Also, we've got webinars that you could watch for of the year on be viewed on demand. Um, and wrapping up very, very great quickly. If you think about your specialist, the options already you can use especially explore it'll which helps you get a better picture of what's suits you best, based on the answers that you give. So, yeah, it takes about 20 minutes complete and our score source of work, life balance questions and you really personalized report. Um, according to notes that you've given says it for me. I'll wrap up so again, you know, remember, definitely join. Now it's it's free introductory. Ever get your contract? You get a row checked and just have peace of mind. I'm going to, um for your year the everything set and you won't have any issues. Have don't like now is it very whistlestop for me. Thank you, Dan. And clear that was really useful. I'm going to quickly move on to my bit. But at the end of this, everyone's gonna be around questions to please everyone. We'll distract. This works, please Everyone put all your questions and comments in the Facebook a comment section, and we'll be sure to answer them at the end. Eso I'm going to talk today about dealing with difficult colleagues and billion, which unfortunately is still quite a common thing that we come across with controlled and the, um, be, um, a while back. So why is it important? So this number of reasons it's it takes an emotional and a professional told on us It's very challenging, and quite often we're not really sure how to deal with confrontation or how to. There's a kind of a culture that f ones are at the bottom of the pile, and we need to change that and make it more acceptable to talk to everyone about this. It has a massive impact on your mental health. If you're having a bad time at work and you're dealing with difficult people, it can impact you professionally and personally like are saying Oh yeah, and finally, not only does it impact you, but it also impacts patient care. A team that isn't working in an ideal way is, of course, going to impact how well the patient has looked after and the treatment off them. So just quickly before we go into some cases, I'm just gonna go through these different styles of communication. So if we look at this first of all, whenever you're communicating with anyone, you need to think, how am I feeling? And how are they feeling? Um I feeling okay and do I think they're feeling okay? Are we communicating in an open and honest way? So aggressive communication is when everything goes your way, you get the job done. But of course, you're not gonna build relations like this on your making someone else potentially feel awful passive aggressive Communication is kind of when no one gets what they want and you know, the you're not getting it on the person. You're speaking to it and getting it. The advantages of this are that there is no confrontation. But of course, the team can't continue to work like this, And there are gonna be problems further down the line. Submissive communication is when you don't get what you want, but someone else gets what they want, Not course. Sometimes you do have to use this style of communication with sets in aspects of medical care. But again, this should be avoided as it causes problems within the team. And finally, what we should all in for is assertive communication. This is where everyone gets that point of view across. And everyone feels good after the conversation that we had. And now we're gonna go through some cases to see how we can apply these things. So the first case, and if you have any thoughts in these cases, obviously put it in the comments section. The worst case is something that's happened to me quite a few times. So a patient presents with the domino pain and you Consultant has rejected and Ultra Sense is requested an ultrasound scan, and unfortunately the radiologist has rejected it. So what happens after this? You're consultant shots that you were not getting the very urgent and important scan. Now, this can unfortunately happen quite often, and I think the first thing to think about is that you need to keep your emotions and check. Of course, that is upsetting, but you can't let it get to you. Also, we need to appreciate that the consultant on the radiologist are potentially going through their own issues. They could be having problems at work at home. We need to think about this is well, So how do we approach this? Of course. First of all, we need to say that this is completely inappropriate. No one should be shouting at your work, and it's not bad if they do. This is a quote we got from anonymous F one saying being an F one is about being shafted up. Since I started an F one, I've been shot after that every day. Now this is restroom. Hurry on. It's just a one off case. But this is again unacceptable even once is not okay. And we need to make a culture that it's fine to raise our voices and say that we're not okay with this. So how do you approach this? The first advice we can give you is to speak and tons of feeling. So instead of saying you're being rude, you're being obstructive to me. You can say things like when you speak to me like this, It makes me feel like I'm being doesn't dismissed. Are you aware of that? Now, if you talk in terms of your own feelings, no one can say that you're wrong. No one can say no. That's not how you're feeling. And it sometimes a good way to get your point across. If this doesn't work, of course, if you're feeling overwhelmed, then you can escalate as we've heard it from both the M, D U and B M A. There are loads of places to go to. So, first of all your tea, then your educational and your clinical supervisor, and then you can go even higher to the TPD. The director medical education on. Like we said, the MD you on the B m A. So why is this important? Of course this case in particular, you want something similar to it impacts patient safety on also increases bone out. So we need to make sure to tackle this early on rather than focusing on it later. As related to this. Make sure you supported sugar. If you go through cases like this, talk to your colleagues. There's no need to do it in a rude way, of course. Don't need to blame people, but it's always good to talk about your experiences. Case number two. So Mr Andrews is 86 year old male who presents with her pox ear. You think this is pulmonary edema, but your registrar things it sepsis on recommends IV fluid. Now, this is again something that happens quite often on. I think it's difficult when you're so junior to step up and say, Oh, no, I think I know the right answer. Of course, someone with years more experience than you, you would think they know it, but sometimes it's easy for them to miss it or you could be in the wrong. But the main thing is, it matters that the patient gets the right care. Even if you're wrong. No one's gonna get angry at you for saying, Oh, what about this? Why don't we think about this now? If you feel uncomfortable saying it like that, we don't want to use as we're talking about before on aggressive communications style. So we recommend using something on at clinical pace. So first of all, start small, so probing, So just say, oh, do you eat? Do you Why do you think this is a good idea? Azzan, can you explain it to me for my education? I would like to understand more about this. If that doesn't work, then we go to the next stage, which is alert. So this is telling them. Oh, this is what the chest X ray shows. Why would you go with this option rather than this? Still, you're keeping it nice and polite, but just making the register, aware of what you're thinking next is challenged. So this is saying No, please. I think this is the wrong thing to do when you think about something else. And of course, you don't want it to get to this point. But if it's a life or death situation, the final thing is emergency. This is actually putting your hand up and saying Stop, I don't think this is right. Please, can we discuss this further? Obviously, we want to stop about probe or alert on most people. Nearly everyone that I've come across is happy for your education to explain to you why their way of thinking is this on. Most actually, senior doctors prefer if f once do raise their voices and it just brings a new viewpoint to the team, which is always a lot better and the same people talking about the same things. So keep points from these cases that we've learned so bullying harassment should never, ever be tolerated. Be aware that there might be something else going on in people's lives and finally, be very careful with your emotions. You don't want to come across as being either too angry or too upset. Cry. Keep your most emotions and check on. Then you go afterwards to think about it, either with your colleagues, your friends and family or or the support services that we talked about today. Just very quickly we're gonna talk about information on break allowances. Maximum working out was like Daniel saying earlier. It's rare now that there's a problem with your Roto, but it's still worth checking eso the BMA, like we had earlier office a row to check er. So if your b m a member, you can look at this and make sure that your rotator's okay for more specific rules and have a look article cause that's quite a few like nit picky rules on. It's difficult to cover them all online. But we're happy to answer any questions, and I'm sure the BMA would be a swell. So just briefly, we should be working less than 40 hours average no more than 72 hours and any seven days, no more than four long days or no night. You should not be working more than seven days in a row, and that should be a minimum of 11 hour gap between shifts with breaks. This is, of course, very difficult on it. Unfortunately, it's not possible always to take a break. If there is a very unwell patient, you can't leave the, uh, if you do desperately need to get away, then make sure you hand over to someone and don't leave everyone kind of high and dry. So you should have a 30 minute break in every five hours to and every nine hours or three during the night shift. But like I said, just make sure you ask for them sensibly and don't pressurized people into that. If these rules aren't fuller than you must exceptional report on this is key lows of people are scared to do it. But under the new contract, we are allowed, so please make sure you do. Um, and I think that is it from me. So I think we'll go through some questions. But just before we do that, he is a link to our feedback. We really great. But if you follow this out because no, only is it good for our portfolios and to know how we can improve. But also, it's good for you. So, you know, for future webinars what to do differently and you'll get a certificate is well of attendance. Um, so thank you to everyone. I'm just gonna pass over to a crash toe, ask any questions that we might have High s. So we have been sent quite a few questions in advance of this talk from people that wanted to attend but weren't able to. So I'm just gonna go through those questions while so we wait to some more questions come up live on the video eso. The first question is that I think this is a model. The MD you. At what point should we contact our defense union? If we contact too many times, does the indemnity costs to go up? Sure. I would say contact us is early as possible. Know the indemnity cost does not go up slowly for seeking advice from us. It would be rather silly of us to do that because we've much prefer that were involved really on. And we genuinely believe we have a positive impact in being involved. So discouraging members to from contact it goes only for them again in in for the difficulty would be rather foolish. So it doesn't impact your indemnity. Fascinating. Lovely. Thank you so much. The next question is, I think, predominately end of the MD You again if I'm going through mental health issues or burn out well, people question my fitness to practice. Yeah, that's a difficult one, because, of course, these things are on a A spectrum. Obviously, it's not for the MG youth question. You're finished practice, but we are involved in a number of health cases for doctors, either locally at the hospitals or at the GM. See, I think the most important thing if people are going through burnout stress difficulties, is to be open about that and seek the appropriate support and not concern themselves about fitness to practice issues that arise on the reason I say that is actually the GMC is very supportive of doctors with health issues. It calm, for example, a raise. Doctors strike doctors off because they have health issues. It does occasionally into him. Suspend doctors if they are extremely unwell. But I'm talking about is a very severe end of the spectrum on that would have been done in a with advice of treating psychiatrists, for example. But for the normal run of the mill situations that people find themselves in, everybody is going to experience some difficulties and and burn out issues at some points on that, they rarely hinge on fitness practice. But if they do, it is a very supportive home model with the GMC, as opposed to if you notice is But thank you so much. Um, the next question is being at the BMA, which is what do the BMA counselors help with what common reasons that people would use them. They're just had a sticky mike there. I'm really great question the top reasons for us that we I'm getting later from our help in the service every month and the top reasons for accessing it are Lomu's stress and anxiety on the other one worked for later. So yeah. Um, sorry. Low made. What? Related stress on a relationship. Issues of the top three that we see. My circular? No, thank you. So what? Oh, and that was sorry. There's a second part of that question was in there about what cancers been helped with. So pretty much. If you want something that you want to talk about that can they can talk you through it. And if they if it isn't something that they can help you with that, be able to help you get to somebody who can help you with it. Um, the next question is again that the MD you How common is it for cases or complaints to get resolved? It's a local level. Yeah, very common. I would say. The vast majority are I think the way we find that works is that as I talked when I was talking about there being impotent and honest at the outset, apologizing, I'm recognizing when things haven't gone perfectly on. But, you know, and trying to make changes, people want reassurance that things that won't happen again. They've often think something's happened. It's gone wrong. They accept that but they a lot of the time they complain it's because they want to think it's not going to happen to somebody else. So if you can adopt a positive attitude, it is possible to a complaint. Then the vast majority are resolved locally. Yeah, that don't have exact figures, but not setting my my impression. Lovely. Thank you. I think the next question is in. Get both the BMA and do you have about the same time? Um which is what should you do if you're chronically short staffed in the ward on Should you include this in your documentation? Uh, I want me to go first, since I'm a meeting. Um, I think should you include it in your documentation, I presume that means in the patient records. I'm not sure it's relevant to the care off the individual patient, and one has to bear in mind that the patient has access to their records, and so I don't see that that's necessarily the right place to put it. But should it be involved in documentation per say absolutely yes. If you have concerns about staffing, then you must raise those. Normally, that's done with your line manager to begin with them. Your educational supervisor will your consultant. Usually you're not alone in those concerns. And so if your other colleagues seven then getting together with them and putting the case forward can be helpful again, it's helpful to have a specific example. So rather than just wear short staffed some objective evidence, You know, on this particular day on this ward, I was the only doctor doing whatever. So it's, um you know, some concrete evidence effectively that you can refer to, but yes, and I would suggest that that is raised assay joint me where possible on always in writing. So there is that evidence trail, but I just don't think it goes in the patient records. But a little cloud would say on that, um, I come in, you can get in touch with the B m, and this is certainly something that, um, we can get involved in. If you raise it of us, we can take it forward to the trust. Um, you you may not necessarily be brushed off, but if you if you'd like us to step in and talk to if it's something that's happening a little too often, week we can, we can get involved like that. We have industrial relations, Office is based at the trust and this is this is really what they do day today. This is the kind of issues that they get involved in. So again, it's not being being with the BMA isn't just about getting your contract using the BMJ. It's it's issues like this. You can use us for you have people that the here to the hand of those kind of issues. Yeah, so I would completely agree with the exact same sentiments that it's really important to raise again. Nothing. The notes in the right place to put it. There are lots of other avenues where you can raise it. You can let the rotor coordinators or all the status managers know about the short starting on on the ward. You can also raise it by an exceptional. But I think the most important thing is natural that there is some some trail saying that you did having a verbal discussion, just just telling something. Oh, by the way, we need a little bit more help. Say, um, does that I caught it and that it's quite important that you raised not only for future patient safety, but also for yourself. Because then you always have a trail saying Well, actually, I did raise the fact that there was understaffing on this particular day and that, and I was concerned that best would lead Teo lead to potential issue. So if it doesn't even issue in the future, does come. Sounds like then at least you have a record to say. Well, that that was something that was very worried about Certainly certainly acceptable. Boring, definitely, definitely Great. Start exceptional, Pull it straight way and then once once we're involved, we have that trail as well. So we can say this is just started now. This has been something that we hope we hope hasn't been ignored, but but it believe it it has been. Then we've got trails like I said on gyno, that from from my own experience that exception importing in chronic understaffing to be really frustrating because you feel like your most exceptional porting every day. But it's really important because it highlights and then go nation. But also you can get in touch with you regarding your safe working because they will ensure that you, uh, have that opportunity to basically voice exactly what what's happening. So if it's a problem going issue, that's might be to continue to be on guard and raising it directly with your body saying why we're waiting for them to, um, during their during that, unfortunately, reports when they're equal to monitor the exception of what's going through that and then trying to in for you meant by the details that you included contacting them. Invest Instance they may get that set on. Somebody's asked about feedback. We will be posting the feedback on in the comments. The link in the comments also the QR code is, is at the moment you to be able to read it on the next question. Um, I think it's probably again. And at the end, do you think many people are very worried about starting at one on getting into Yes, you trouble is documenting that you set up to someone enough or do you need them to write a new engine in the notes? Presume Thank you. Have this relates to riveting advice from somebody about a patient thing I would say is, don't be worried about starting your foundation years. It's really exciting time and actually most the time things don't go wrong. You are quite well protected by your colleagues. So, you know, cleans. Don't worry. And I think the purpose of me raising all of these things that might go wrong is so you're aware of thumb because being aware of them and what could flow of the state puts you in a much stronger position in victors. But on the whole, it doesn't do you write it in the notes. When you spoken to somebody, yes, that I would write whom you spoke to on when. But at the end of the day, the purpose of these discussions is for patient care. It's not about defending yourself when something goes wrong. It's about what's what's best for the patient at the time. And it's simply, in my view, not practical to start saying you know, a little sign here, Doctor Vaccine know you've given me this. Advise that canoe signs confirm that school about Faisal, whatever it might be. So I think just a clip notes in the records, to who you spoke to and when when and what they said is fine not to say There's never an issue where one person says something happened in somebody else disagrees. Of course these things do happen, but, you know, 99 times out of 100 they don't on the best way. I think to avoid those sort of disagreements anyway is to summarize at the end of the discussion you've had with the colleague and say Right, so you know, they some what we said our plan is to do A B and C Is that right? Is that what you think? And assuming they confirmed, that is the plan than simply documenting. That should be fun. I think the real take a message of all of that, particularly, is to have that discussion at the end because they're so many situations where I have seen documentation and then I was smoking to the person who made that made that advice I directly from a registration registrar, and they said that's not exactly what I said Whilst it's not really effective patient care and it's actually just being a minor and Europe's or yeah, I know I do think this is quite likely basses mean this is probable. It's not that like me. It does impact impact things just to some degree. So I think it's really important to have that discussion and say, This is what I'm going to essentially be documenting a Z. The advice you've given to make sure that the whatever points they've made to you have have actually come a prospect is no only for documentation, not really for the defense it but actually predominant the patient care and do confirm that fine with them. It really does. It does make things safer. Yeah, What? What I would add actually is, Well, I cash is about when you start working for new consultant. So as you rotate around through your placements, it's always worth checking with that particular consultant, especially if you're documenting things on ward rounds, etcetera. How they like things writing, because everybody has a different where they want things doing. And so, for your first few days, just saying, you know, asking, could it's that Is this Okay? Is this the level of detail that you would expect me to write on? Taking that constructive feedback at that early stage is always helpful as well. Onda At the end of the day, given, it's usually our name which is right at the top of that walk around entry. We want you to do that. So any F one out there do not feel bad checking in with us about your condition. But it's not something about anything, because at the end of the day, it's important because we are the ones who ultimately responsible actually becomes the consultants ultimately responsible on the war ground if it's needing them, gamble to be responsible. But also it's really important for patient care that we get it right, because we we want to make sure that they get the best level of care that they can. So that means make sure you interrupt me and tell me, um, whether you think, think I'm making in the state because I'd rather be told on down for us to get them, get it right rather than it's It's not about you go, Um, And the other thing is to make sure that, um, check in because ultimately working as a team rather than just working a sense teacher shit almost was going to be safe. If the medication, um, the next question, I think it's aimed at generally, um, what do you do when seniors tell you that you can't Exceptional. Okay, Yeah. We get asked this question quite a few times. Um, on that, Like I was saying earlier, you do have a garden of safe working in every hospital, so it's definitely worth talking to them. It's not really something that should happen in theory, because it is part of our kind of legal rights. According to our contract, eso if there is a problem on it, unlikely to be a problem, to be honest. And remember that if you raise that, not only is it good for you, but you're also making it okay for the rest of the team to exception report as well, which is great for everyone. So don't be afraid of speaking out about it. Talking to your garden you're safe working on. Obviously, if it's still an issue like down was saying earlier, you can always contact you be, um, a kind of want to contact your trust, and they can take it further for you, but it shouldn't be a problem monthly. And so we just have one more question left. So you please, do you take the opportunity to ask him any questions you can on the comments. Uh, if you if you don't get an opportunity, we'll be watching. This is, as I know, past 80% of the people watching the watching them. Even at that point, you could still comment yourself. Email us, um, so in mind Home. Please do let us know because way love talk to your questions on the last question is again aimed at the MG. Sorry, it looks for I like way. Always get lots of questions. They will, um, will the MD you help if the incident raised occurred before I was a member? If I remember when the issue is raised normally not know. It really depends on exactly what the issue is. But it would be little bit like to use the best analogy we can, driving your car without insurance, crushing it and then asking for the insurance company to pick up the issues so on. We're not an insurance company. Birds, you know, in general terms. That's how it works. So we ask that you'll remember at the time of the incidents lessons here and can tell you the price of membership. I don't think it's a huge amounts of money. So I'm not here to do a sales pitch, but some lasagne might wish to, but some I think you pay pay the small amount. Is it 10 lbs or something like that? Was, um it's time for the year for you. Okay. To my mind, the 10 lbs well spent, Hopefully hopefully it's 10 lbs that you feel you wasted because you don't need it. But for rather be in that position then to give you an idea. GMC hearings cost generally speaking well north of 50,000 lbs criminal cases, couple of 100,000 to defend. So hopefully you don't go there. Hopefully you never need this, But some? Yeah, I think spend the money on. Do you haven't got that issue. You don't You can't degree anymore. I mean, it's 10 lbs. You have a free Well, you do I just after that, if that's okay. Cash. So there is a thing, though, that if the incident happened while you were a member and then you left, you could come to us a swell. Okay. And that's something called a current spaced. A membership. Okay, So you other instant had to happen while you remember right. Or like I said, if you have now retired and you not remember anymore if the incident happened 10 years ago when you were remember, guess you can still come to us. Yeah. Is that my friends? Yeah, that means absolutely. Since I think that's really important. Because then you know, not you. If you if you do leave, you still cover it. If if the incident did occur, I and so you should you should know that you definitely even if you go the entire year, you don't don't find that you mean that issue of being raised, at least, you know, issue. Because I'm as, uh, look to fry a pointed out these instance get raised a long time on the on the actual issue. I I think they question related to that is that. But I have seen whilst they're suffering, registered very Southern site is if some people in that one take out both m d u on D MPs membership, essentially trying to get free gifts. Um, let's noticed that that happened. Nothing wrong with that, because I would be like one of the concerns that they raised on on the four room was What if they argue, saying the other person should cover us on. Therefore, it reaches a situation where you grew them. Cover us. Yeah, that shouldn't happen. We work very regularly them PS and um and other indemnify IRS. And, yeah, I totally understand that people often choose to be members of both on normally would speak to me 50 50 if there was another indemnifying involved. But yeah, it's it's no, not a situation where we say, Oh, well, you know, if you've joined based, that's that's that's out. That's not how we were. I was sure that was the case, the home just so I would I would just put it out there. I think that covers very one sec because we do have one more question on the Facebook comments or it's just come up asking, How do you suggest dealing with anxiety? But the first few shifts I'm going to quickly away and before ever anyone else has to say anything, I think a little bit of anxiety when you first start your job is probably a good thing, and it's helped being away on. I think the make anything to do is to remember that everyone starting at one, is anxious and ulna doctor there with have been through that. So everyone knows how anxiety provoking it is on. That's normal. I think the main thing for you to do to deal with that is speak to your colleagues. You'll have an induction or you'll meet all the other F ones. Speak to everyone else. Don't be afraid to kind of stay in your corner and say, Oh, I'm worried about this just voice and say I'm worried that this is gonna happen or this might have happened. And what should I do about it? That's absolutely fine. Even speak to, you know, adjust your peers, but also your seniors will have F two Zs. It shows even the register. It will really friendly. If you're feeling some anxiety, speak to them and we don't want to get to the point where you're feeling any sort of level of burn out or any mental health issues like severe mental health issues. So obviously all the services we've talked about earlier today are available, but honestly, don't worry about it. I know this is a little bit of a scary talk at times, but it's actually nothing to worry about, and we're just giving you the information at the worst case scenario, and it's better to have it. But it's unlikely that any of this will happen to you. Did anyone else wants to add anything? I agree, absolutely. And I think the most important thing naturally is to yeah, except you're going to be anxious. But this is an exciting time and be many times in your career, that slightly anxiety provoking because you're you're always progressing and you'll often being things for the first time. But the most important thing is not to think that you're expected to know everything. Know. I remember starting. My rollers had about five minute the end of you, which was seven plus years ago. Now, having gone from being in a senior position, but not this position and thinking about, I haven't suddenly develops a new level of knowledge overnight. I don't you know, I went to bed last night doing one thing, and today I'm doing something else. But the key is, you know, asking for help. Not being afraid to say, I just don't know, but I'll try and find out on try to work out early on. Who the best people are to go to for help? Mr Is don't be second police, slightly senior colleagues. A rock him really helpful appears. But don't be afraid to ask. No one is surprised. If you don't know the answer is on. That's true sacral great. So there's not two times where I don't know the answer, and it's not tender right along the anxious. When, when I see somebody particularly well, even very, I'm sure about what's going on. Um, it's all about keeping a systematic way and discussing with your colleagues. Because if you work together as a team and lean on each other to support, then it's That's a limitation is best for you. Sorry. Yeah, I was just going to add, um, that if you are finding anxiety of your exam anxiety a bit much, you want to talk about it with somebody. It's one of the top reasons that people access both our counseling and off his support services as certainly the top five. Both of them, I think so. They are counselors and are possible. Doc says that most use her helping people through that situation. So Azzam Jar said, do you seek out that support, I'm not necessarily from ourselves. It's true. But there's there's a lot of support out there, so just I could just encourage you Always talk to somebody. That's it. Lovely. Thank you so much. Everyone. I think that's a lot of the questions that so far, um, a couple of people have asked what kind of sign up linked to the M D u P M. A day at all in the comments. Otherwise, if you don't get them, if you don't see them in the comments, I will be sending out and email to your view with the link to watch the video and also looks a sign up to the service it's on on Do. That means that the session is recorded and it will be available through metal one you choose. I'm also on basic like it's like a lot of different places, so I won't say the opportunity to thank you so much. Every single person from this amazing panel you wanted so many questions on, honestly, the inside and advice you give that I think one week before before were these that one's starting. It's absolutely amazing, absolutely essential. So I'm sure this will be watched many, many times as as the days go through get go forward to getting closer and closer to the day of them stopped. Are there any final take home message? Is that do you want to? I think just enjoy it. I'm hoping the purses are asking the anxiety question. It's more about anticipation than than actually. When the day comes, you'll find the anxiety isn't there on it's, It's more exciting than anything else. But the anticipation is the thing that's a little sketchy, so enjoy it. Enjoy it. So I say it's great. Price is a wonderful affections. Keep ourself and, you know any got so many colleagues who were there in it with you. So yeah, absolutely is, as Daniel said, enjoy it. Sees the opportunities on book forward to it. And then, yeah, this is the start of your your Korea's so fantastic, Very exciting, I said, Good luck. Everyone, um, enjoy as every else's said and the cost yourselves and definitely good luck from all of us. A swell my great eso just that you know about the upcoming sessions next week. On Tuesday, we got a session about student loans on Tuesday. Am uh, just giving you a little bit of advice, because we know that all of you will soon have to repay your state roads. Allergy? Yeah, on. So we're giving you some advice and support in terms of how that works From an accountant who was also Nephi One is that I understand it in both perspectives. We've also got another session on two sessions on Wednesday. Seven o'clock, 18.1 on interpreting imaging. So ideology for F. Y once on the other session is on top tips. Or, um, essentially starting at my one on the day that you start that one. Ready for when you saw on salt your placements from that Wednesday for the longest eso it will be sorrow. And then who will be running that session? I'm sure they're getting amazing sides. Amazing discussions. Ready? So please do send again a lot of your questions in advance if you'd like to. If you're unable to watch the session because we love to answer questions. Well, thank you so much. I will hand over back to sorrow. Too close. Thank you very much. Everyone, um, for the lovely session on. Thank you. A cash for inviting every one for the session next week. Um, I think we have answered all the questions we have fell in the feedback for and we have posted all the links. Um, So unless there's anything else anyone would like to add, I think we're ready to and decision. Thank you. Bye. Thank you.