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And we are good to go for. Is all yours, Dr Yeah, start recording. Yes, we're, we are recording. You're good to start kill everybody coming. Lovely to meet some many new people. Although they were sad about the circumstances that have brought some money off you to to this session. Um Those you have been to my session before we already know they'd be slightly uncommon central, a very, very exception because I just want you to be listening thinking uh is Dr uh we're having trouble hearing you because I think doctor we're having trouble hearing you. You're like your connection is bad. Um Let's try maybe um shutting off the video, maybe that might help the audio connection. Let me cried. Mhm Turning off my camera. Um Can you Yeah, can you, can you hear me at the moment? Just barely. Um Let's try turning after uh okay at petty uh let me see. Just barely. Okay. Is this better? 10 people? He better now this is okay. This if he's going to his uh the connection is still, it's still cutting okay. We're gonna try story. Uh Is that any better? Yes, good. Okay. I'm not a very prepossessing site anyway. Okay. So, um, so just to go back a little bit, my presentations and sessions tend to be, uh not based on a power point because what we do in our sessions is we think about things, we try to discover patterns and links rather than me just giving you lists of facts and information that you can perfectly well look up for yourself. Okay. So when I initially agreed to do this session, I asked for it simply to be called well being because I think self care is an element of well being, but it's not all it's about. And it's a subject that is very much talked about in medical schools. It's talked about when you're doing your junior doctor training and somehow it never seems to work very well. And, um, I got asked to do this lecture very short notice. I was actually in an airport waiting to board an airplane to go on holiday because I realized that I was burning out. So I made a proactive decision. Uh I was going to take time off work and I want is going to go on a very comfortable holiday, but somewhere where it was going to be very, very difficult for people to get hold of me and we'll talk a little bit more about that later. Not because I'm going to force you to look at my holiday snaps. Um, but because I had some very interesting experiences and learning and reinforcement for myself about maintaining well being in very difficult conditions. So, we're a big group today. There's 70 of you. So could people be willing to put into the meeting chat rather than calling out what or who as health care providers? Your highest priority is any suggestions? It's not a trick question. So the question is what as a healthcare provider or who is your highest priority? My mental health ourselves, patient's two votes for patient's three votes for patient's 45. Yeah. So the answers are majority in the majority but by quite a small majority patient life. Um but then also an acknowledgement that you are actually your own highest priority. Okay. When you're learning basic life support, you must all have done basic life support by this stage. What is the first thing you do on spotting a casualty, spotting someone who's collapsed? No trick questions. It's as easy as it sounds okay. Good. Make sure the environment is safe. That's the first thing you do, isn't it check for safety? And that's about your own safety. Yeah. Okay. A BCDE. Yes, that's what you're moving in to do. But the first thing you must do is make sure that you're in a safe environment. Okay? Why has the patient collapsed? Maybe they've just had a bit of a run of uh cardiac arrhythmia. Um And there is actually no external danger at all. Maybe they've managed to electrocute themselves. Yeah. When I was working in Sierra Leone snakes were a serious risk. No way would I weighed into the undergrowth to check on somebody who was unconscious or apparently unconscious without making lots of noise to encourage snakes to run away? Okay. So remember even though the medical schools may teach you either directly or indirectly that patient care and safety is your highest priority, they actually go straight ahead and contradict that when they teach you basic life support. Yeah. Another really obvious example who's been on an airplane? Lots of you expect when they're doing all the safety stuff at the start and they're telling you about oxygen masks. What do they say? Put your mask on first? Yeah, then help others. Yeah. So the airline industry is one of the industries that globally doesn't matter what country you're in, it doesn't matter what your role is in an airplane. They have probably the highest global safety standards. Yeah. So we can learn a lot from air safety and the idea is that they have to transfer not just into team working but into our own lives. So make sure you're okay. How long? There's a slightly aside question, how long can the human brain manage without oxygen before you start to get irreversible damage? Minutes? How many minutes? 53, three, yeah, three minutes. Okay. At three minutes you will have damage that can't be reversed. The brain may well be able to compensate for that damage. But the fact is that, that you will now have at least some irreversible brain damage. It's quite handy to, to think of, I, I think of it as the rule of three's okay. So it's three minutes without oxygen, three days without water, three weeks without food. So that's just a rough kind of rule of thumb of what the body can recover from. Okay. So after that period of time, the body may be, may be able to compensate, but there will be medically concerning damage. Okay. How long? This is a trickier question? How long without oxygen before the brain loses its ability to make well structured decisions? One minute, any advance on one minute, less than two minutes, any advance on less than two minutes, three minutes, it's actually a small number of seconds. Um It will vary from individual to individual. Um Yeah, by 30 seconds. Um our, yeah, you're not really making. If you're making good decisions, it's by luck rather than by good judgment. So the question was, how long can the brain go without oxygen before it starts to impair decision making? And the answer is a surprisingly small number of seconds. And that is why your first priority in an airplane must be to get your own mask on first because if you delay in any way, you will lose the ability to look after yourself as well as to look after others. Okay. Having so shifting slightly towards well being now well being and your own well being, it's not a fixed thing. There are some fundamentals of well being, food, oxygen, water, adequate, appropriate clothing and so on. But lots of aspects of well being very personal to yourself and will change as, as your life situation changes. Yeah. What so to, to choose, you know, obvious examples, your priorities for well being as a child are very different to your priorities of well being as an adult apart from those fundamentals. Yeah. And so there's, you can always think about Maslow's hierarchy of needs, which is easy for you to look up where Maslow sorted different sorts of needs for human beings into, into a hierarchy. That's exactly what it says with the really basic stuff on the bottom, food warmth, etcetera, usually shown as a pyramid with self actuation right at the top, you don't have to have 100% of every level to progress to the next level, but you need to have quite a lot of each level so that you have the ability to, to move up the levels towards self actuation. And so one of the things that I want you to do when we finish this session is I want you to really spend some time thinking about what's important to you for your well being because it's going to be slightly different for all of you. Okay? Because our living situation changes, okay. So going back to my holiday, I chose for the first time in my life. Do you go on a cruise for lots of reasons. Um, one of them to do something completely different. One of them that much as I love my friends, a lot of them have personal problems at the moment and somehow I end up being the person that they share with and look to for support, which is flattering and I'm honored, but sometimes I need time to think about my problems as well. So it was a very conscious decision to go and do this and it was a very good decision mostly because internet on board is completely rubbish. And so nobody could get at me, um, spot one of the things that I found really interesting because as you would have realized well being is a topic that very important to me. And I've done a lot of work around well being and creating and maintaining, well being for others as well as for myself is how hard everybody worked, all the staff on the cruise ship, whatever their role, how cheerful they all were and how they all seemed genuinely to be loving what they were doing. Now, I would be a terrible person to work on a cruise because I'm bad tempered and I wouldn't be able to put up with all the daft complaints and so on and so forth. I am not a very nice person in lots of ways and I kind of started to find out a little bit about what people actually do the staff on the cruise. So it's quite a small boat, 1600 passengers and about 700 crew. And I um I discovered that for example, if you're the first officer, so he's actually a member of the Merchant Navy, rather than one of the support staff. Your shift are from eight pm till midnight and then from 8 a.m. to noon. So eight hours split shift, not great, but on the other hand, only eight hours, and then you discover that he also has to be on the bridge every time the ship either enters port or leaves port until all the documentation, all the associated stuff has been done. So that actually means the ownership that most evenings sailed out of port at about six o'clock, that he would be on the bridge from five and probably wouldn't get back to his bunk until midnight. And that we entered port usually at about 5 36 o'clock in the morning. And so he'd be back on the bridge by about four o'clock in the morning. So suddenly that doesn't look like such an attractive shift. And I met him and he's lovely and he loves it. And so I contacted, um, they actually on this ship, they have a member of staff whose job is staff well being. And I met up with her and she arranged to take me on what they call the VIP tour of the ship. And that meant I had chances to talk to different members with the crew. So those of you are thinking cruises, what a great way to see the world know most people on the ship will not get ashore. They just don't have time. Cabins are serviced at least twice a day and cabin staff are on court 24 hours a day. If you're rude enough to demand a new bottle of water. At three o'clock in the morning, most people share space. They have their bunk and that's their private space, but they will be in a shared room. So I was really interested to see how they managed to maintain this very high level of professionalism. And the answer is they're breaks. One thing about the VIP cruise is that you go into two parts of the ship that would normally only be crew members. So no photographs, obviously because it's private space and also terrorist risk. But what they do have is they have really excellent break facilities. It's a big space well below the regions of the ship where passengers can go, they have a bar, they have a restaurant that serves food as good as the food that is served two passengers. And when they're on their break, they swipe I/O and when they're in the break room, they are not disturbed is their responsibility to end their break if they're on shift. If they're not on shift, they can stay as long as they want and they are actively encouraged to take part in that fully. There are other small things which are probably big things if you're on a boat for nine months and never set foot ashore and certainly never go home. So there are, at the moment the boat I was on has 40 different nationalities accrue. And one of the things that the kitchens know is that they must prefer, must provide homely food on a regular basis for everybody, whatever their nationality. And I have to say that the food I ate in all of their restaurants was very, very good. And those kitchens also supply stuff off. So breaks, who here is good or bad at taking breaks? Who feels they're good at taking breaks horrible at taking breaks? Say somebody bad at it bad at taking breaks tend to pre crash. 01 person says they're very good at it. Well done. Seriously. Well done. We know that it's important to stay breaks. What prevents those of us who are bad at it? What prevents you from taking breaks? Good people. You'll get a chance in a minute if you're a bad at taking breaks. What's the barrier? Okay. Getting back into work mode. What about when, when you're at work in the hospital? Are there barriers to taking breaks when you're actually at work? Feeling empty prevents me from taking a break? It's interesting. Procrastination makes me overthink. I feel I'm useless. Who's a, carried a bleep or has been with someone that is carrying a bleep or a mobile phone. Lots of places I work now don't believe they use mobile phones. I can't concentrate because I'm thinking of tasks and responsibilities. So you're not actually taking a break at all. Hospital, I can't take a break until I leave. Is that because that's a hospital rule or is that something that you impose on yourself or that your colleagues impose on you? Thank you. It's tricky, isn't it? Doctors are notorious nurses quite rightly say that they must take their breaks because if they don't have a break that impacts patient care. And in Britain, that is strongly supported by a royal College of Nursing. And that is what they are taught when they are studying and learning their job. Doctors for some reason, our representatives in the UK, the British Medical Association and the GMC says that if doctors have protect protected breaks during the working day or night, that this will impact negatively on patient care. So it's quite interesting. This is complete opposite approach from nurses and doctors. If you try and interrupt a nurse, when they're on break, you'll be told where to go. Sometimes, not very politely. If it's not the first time you've done it. But nurses will ruthlessly interrupt doctors on break and doctors will ruthlessly interrupt doctors on brain. We our, our own worst enemies. So one of the things that I want you to think about and take away with this from here is the idea that part of your self care is to take your proper breaks. If your work in, in England, Britain, you are entitled to a 30 minute break for every four hours worked. Different contracts may specify slightly different things, but that is actually a national legal employment requirement. Okay. And it's never like these people working on the cruise ships who once they've swiped into the rest area cannot be disturbed, whether they're on shift or off shift. Mhm. There is this idea that doctors must be available all the time and it's very damaging. How many of you? I wonder when you've had unexpected hot weather or you just live somewhere where it's plain hot have been actively encouraging patient's to drink water to take fluids orally, but haven't stopped to have a drink yourself. Why do our patient's deserve more care? And we do? And the answer is that there is this culture that the patient comes first and that in some way, doctors don't deserve the same amount of attention care. Yeah. Feeling responsibility for their lives. But you're also responsible for your own life. Yeah. Yeah. So it's an interesting problem. So, and there are some times of course, when, when you just can't leave, you know, if the patient is arresting, if you're in the middle of a complicated surgery that isn't going quite well you know, we suck it up, we deal with it and we carry on. But anybody who's done any work in theaters or has observed surgery knows that between operations, the surgeons again, they have a good rest room. Usually been in one or two places where it's not great but a separate place for the surgeons to go and see it and have a cup of tea, coffee, just chill out before they put on a fresh set of scrubs and go back into the theater. So surgeons have this feeling that it's very important that between cases they rest very few surgeons unless there's an emergency between surgeries will go back on a ward. Okay. So in lots of ways, we our, our own barrier to maintaining well being. And one of the reasons that I didn't want the words self care included here is that well being is not just about the individual, it's about the team. So one thing you can do, especially when you reach a point where you have others under you is you lead by example, you do a ward round, everybody's tired. You've got a long job list, sit down with your junior for 15 minutes and a cup of tea, a glass of water somewhere quiet and just take some quiet time. What's very interesting in Scandinavian countries which have the, the highest ratings of happiness overall in the world is that it is very common for all sorts of businesses. To set aside 20 minutes, half an hour in a day where people just sit together and have coffee, a biscuit, a small snack, something like that. It's not work. You don't talk about work. It's social stuff that ability to step out of your role just for a few minutes is very important. And they found that it massively increases efficiency. Their businesses, they're not going to do stuff that doesn't increase efficiency. So well being is about the whole team and you can lead by example, if you're thirsty when you're on shift, when you're on the ward, you can just ask other people around you, your colleagues around you. I'm just going to get a glass of water. Can I bring some water for anybody else? Even if everybody says no, what's the impact of that kind of offer? I'm thirsty. I'm gonna danger a glass of water. Can I bring water for anybody else? Silence. Mhm. Very positive impact. Thank you, Hassan. It's about caring. Yeah. And this is a topic that we're going to spend a few minutes on in Britain. As you head up towards graduation, we have a hideous examination called the situational judgment exam. And a lot of people object to it because the subtext is always that the right answer is the one that puts the patient's interests above yours. Okay? And they will ask questions like you're on the way to the airport and hr ring you up to say they can't cover your shift. Are you going to come back? Uh No, but that's the wrong answer. So I actually wrote a complaint about a question the year that I did it. The question was you're on the ward, you're doing something or other and you over here two of the patient's complaining about a doctor colleague being disheveled and looking a bit crumpled, bit smelly. You know that this doctor is usually somebody who's very smart and on the ball, what are you going to do about it? Now, in this exam, you get five answers that you have to rank in order of best to worst answer. So what I want you to do is I want you to think about what some of those answers might be. So you over here patient's complaining about a doctor who has become scruffy and malodorous and he is your specifically told him the question that he is not someone that this is the usual presentation. They're usually smart and professional looking. What sort of offenses for? What are you going to do? Confront him? Yeah. Ignore it. Yeah. Defend them or ignore them. Yeah. Call his friends or loved ones. Yeah, that wasn't one of the potential answers. Um But it's a good option. Report to hospital management. If you're evil might not be your first step. If it became persistent, then I would seriously consider ask him to take a break. Yeah, the answer that wasn't there that I felt very strongly is the best answer is ask him if he's okay. How has he been feeling lately? What's going on? It's actually happened to a colleague of mine who had a really horrible break up with his partner and after a couple of days he clearly wasn't looking himself on the ward. And so I just said, you know, what's, what's going on? Are you all right? It's not like you. And it turned out he was so unable to cope with the, the situation. He'd lost his home, he lost almost all, almost all of his property and so on. And he'd been living in the doctor's mess, kind of sleeping on a sofa and sneaking into to the, um, surgery, surgery showers when he had a moment. So to my mind, there are lots of ways to approach it. But the first step, if you feel one of your colleagues isn't quite themselves should surely be. You're right. And listen to the answer. You think of yourself on a, on a day where you're not having a great day, you're just mildly put out by something. Perhaps you've got a bit of a headache and so on. And someone says to you, you, you all right, how many of you I would say yes. And how many of you would say no. And I bet in the real world and especially in the workplace, you tell people you're fine, even if it's not true. And so. Yeah, I'm fine. Don't worry about me. Yes, I'm fine. Go away. Leave me alone. I've got enough problems. Go away. Yeah. So, when you think someone is not quite right, people hide their true feelings, make sure that you're somewhere where people can tell you what's going on. Yeah. Ask them twice. I know you said you're okay. But you don't look yourself today. Do you want to just go and have a cup of tea? Some? You know, let's just take a few minutes off the ward. Give people space to tell you what's going on. And you, when you're asked, there will be times when you don't want to say, but at least ask yourself and just as if you ask someone else, listen to the answer because we do that to ourselves, don't we? It's like I'm really grumpy today. I need to pull myself together. There's nothing wrong with me. Uh Well, you're really grumpy. You've got a headache. Maybe you're not okay. So remember to be kind to yourself and then extend that kindness to your colleagues. Okay? And there are things going back to that glass of water. You offer someone a glass of water. It's, it's what I call a love token. Okay. So this is not a romantic kind of love food and drink is something that we share with people we love. Yeah, who doesn't like it when a close friend or a close relative, it says to us gosh, you look tired. You sit down, I'll get a cup of tea. Yeah. So that's a love token. You are doing something. It is a gift of your time and effort. And it can be as simple as somebody's got a new pair of shoes and it can be a love token to say, wow, loving the shoes, goodbye. Yeah. So, be kind. Kindness is a very difficult thing to teach at med school. They teach you lists to memorize, they teach you routines, they don't necessarily teach you to just be kind and that's for yourself as well as for others. The other big thing that I noticed in the cruise team, so it's a team of 700 people. So by hospital standards, it's quite a small team is that there was a very strong sense of them all being on the same team. So the guy who cleaned my cabin twice a day is on the same team as the captain of the ship. The guy who looks after waste disposal on the ship. And that really pleased the inner nerd because that's actually really interesting and complicated, but not for today. Um He is as much a part of the team as the weight uh in the sushi restaurant. And so just because somebody has what might be considered one of the less skilled jobs than being a doctor, they are part of your team, treat them as part of your team and they will treat you as part of their team. Hospitals cannot do without cleaners, we cannot do without administrative staff, we cannot do without nurses. We cannot do without students. We definitely can't do without patient's in lots of ways. If you really start to think about all the stuff that needs done in hospitals, you start to realize the doctors are actually probably the least important element of the team in a hospital. We have our place, we have our role. But actually people would notice the absence of cleaners or the absence of kitchen staff much quicker than they would notice the absence of doctors. So b team aware, I had a lovely colleague a few years back, but I thought they were lovely. And then I discovered that they were horrified and told me I was being subservient that when I made myself a cup of coffee in a shared clinic that I did with one of the consultants, I also made him a cup of coffee. So I don't know. And they said to me know, make him make his own coffee. So like it's not because he's my consultant. It's because he's my colleague and we're working together. So it goes up as well as down. Yeah, it's not just about being kind to people who are lower down in the hierarchy than you are. You can extend that kindness upwards as well. But most important of all, never ever forget to extend kindness to yourself. You are the most important person in your life. I'm sure every nationality that I'm talking to here today has an equivalent saying to the English saying you can't pour from an empty pot. Yeah. And so take time, take breaks. If you know, you've got a tough run coming up, plan a little treat for yourself. At the end of it, it doesn't have to be a big thing going out. I've just been out for a cup of coffee and started off reading a new book because I've had a busy few days of it and I knew that I needed a little bit of downtime, little treat for myself. Your idea of a little treat for yourself may well be something completely different but have in the back of your mind, it's going to be tough. I've got this exam coming up. Some of you have been displaced from your own homes. You're living in foreign cultures, you're living in difficult conditions, make sure that there are those little personal pleasures in there to help you through the time. Okay. So I will be giving more sessions on psychiatry later through the term and we'll be lovely if some of you decide to come to those. But remember if you're tired, if you haven't had anything to eat or drink before you come to a session, then take a break. There's never any overheads in, in my sessions. It's all talk like this. Bring a cup of tea. Sit and listen or go out and have a cup of tea. Do what works on your well being because when you're well, you're in a position to help all of those around you. Okay. So we'll finish a few minutes early. It's been a long day for people who have gone to all of the lectures. Well done for listening. Well done. If you're still here, spend some time thinking proactively about your own well being, what well being means for you, what barriers are there for you to maintain your own well being. And once you've identified those barriers, then you can start overcoming them. Okay, if any of you want to contact me, uh my full name, Phyllida Row Roe. You can find me on Facebook. Uh Don't send me friend requests. Um I never ever look at those for all sorts of reasons. Uh But you can send me a direct message if I don't answer you immediately, please be patient. I am a working psychiatrist. Um And I'm sure you know how hard doctors in the NHS are working at the moment. So it there may be delays but do feel free to get in contact if it would help you. All right. So you are all bloody brilliant. Okay. I have no doubt at all about that and I hope that I'll see and hear from you again. Usually I have smaller numbers at my sessions and I make you join in. Don't say you haven't been warned. All right, my lovelies. Go and enjoy what's left of your day. Thank you doctor. Thank you so much. Bye. Um, everyone. Just a quick reminder, your um, certificate is in the chat. You can download it and you can put your name in. That is for you to keep, um, all of the recorded sessions will be on the link tree link that is also in the chat for all the metal lectures. It's all in the chat. Um, can you guys confirm, uh, the certificate, you're able to download the certificate so we can move on from that? Uh huh.