A Doctor's View

Perfectionism, Burnout, and Productivity: A Deep Dive into Healthcare Challenges and Solutions

August 14, 2023 Dr Paul Polyvios Episode 55
A Doctor's View
Perfectionism, Burnout, and Productivity: A Deep Dive into Healthcare Challenges and Solutions
Show Notes Transcript Chapter Markers

Ever felt the weight of perfectionism bearing down on you, be it personal or professional? Join me, Dr. Polyvios, as I engage in a profound discussion with Dr. Samantha Anthony about perfectionism and the corresponding burnout it can provoke, particularly in the healthcare field. With a personal touch, Dr. Anthony uncovers her own struggles with perfectionism, highlighting the often-overlooked traits such as persistent guilt, fear of criticism, and a compulsive need for excessive preparation. From this enlightening exchange, you'll discover how accepting our limitations and recognizing the elusive nature of perfect outcomes can moderate perfectionism and kindle productivity.

Steering the conversation towards the darker side of perfectionism, we expose the specter of unrealistic expectations and the storm of guilt and fear it can stir. Unpacking the importance of downtime, we spotlight how career interruptions are not just breaks but opportunities for personal growth and development. Drawing inspiration from nations like Australia that have mandated time off, we dig into how such strategies can ward off burnout. Listen and gather valuable insights on the significance of reliable support for those who step back from work to reclaim their wellbeing.

Wrapping up our discussion, we consider the broad-ranging impact of perfectionism across various professions, acknowledging its role in fuelling creativity yet also recognizing its potential to lead to burnout. Our dialogue circles around the stress perfectionism can engender in the workplace and the strategies to support those wrestling with its weight. We stress the importance of open communication in recognizing burnout signs and promoting a safe space for these crucial conversations. Listen in to gain actionable ideas on balancing perfectionism with creativity, navigating career decisions in medicine, and supporting mental health in the workplace.

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Dr Sam Anthony:

The idea that we are on this continuum for our entire working life, at this rate and with this intensity, with the responsibilities we have, which are quite different not to every job but to a lot of jobs, surely, surely there should be some understanding that it's only healthy and would enable retention of staff and good physical and mental health in the healthcare system in this country that we are given permission to have a break every single day.

Dr Polyvios:

Welcome to Doctors View with me, Dr Polyvios. Join me as I discuss everyday topics in health and medicine and provide the insights into everyday hospital life. Sit back and enjoy the show. Hello everyone and welcome to Doctors View. I'm Dr Boulivios. Joining me today is a long-time friend of the podcast and Doctors in Distress advocate, Dr Samantha Anthony. Sam is an associate specialist in dermatology, principally working as a skin cancer surgeon for the last 14 years and previously as a general practitioner too. After being diagnosed with cancer in 2005 and when reaching burnout in 2017, she created Permitted to Pause, an organisation to reach out to doctors and healthcare professionals to encourage positive changes to their well-being and also to share their understanding of why self-care is so important and often a low priority amongst our profession. In this episode, we discuss perfectionism and the problems it can cause in the workplace, as well as some ideas around a solution to the burnout crisis in the NHS. Before we begin, I have to thank Sam for her patience in the recording of this episode. We were absolutely plagued by technical faults on the day and, for all those who are podcasters or are thinking about starting a podcast, you can never underestimate just how many things can go wrong when trying to do something so so simple, but thankfully we managed to piece the episode together and I hope you enjoy our conversation. Hi, sam, can you hear me?

Dr Sam Anthony:

Hi, Paul, I can hear you.

Dr Polyvios:

Oh my goodness, that was quite an ordeal.

Dr Sam Anthony:

We got there, I know, as we always will.

Dr Polyvios:

Due to various various reasons, we've been trying to meet in person for a long time, but we are back to Zoom or virtual phone conversation, which is absolutely fine. We will meet in person one day, I'm sure.

Dr Sam Anthony:

We will, paul, we will get there. My concern was never getting this done. If we were trying to get to be in person, we'll do it.

Dr Polyvios:

I know, I know how have you been?

Dr Sam Anthony:

I've been well. Thank you and you.

Dr Polyvios:

I've been good, I've been good. A few changes and new setup as well here and yeah, all for the good.

Dr Sam Anthony:

A new job I heard from you and settling in.

Dr Polyvios:

Settling in. It's got its challenges, as everywhere it does, but getting used to it.

Dr Sam Anthony:

Yeah, you'll embrace it like you do everything.

Dr Polyvios:

Thank you. Thank you. We had a very quick chat before, when I posted something on perfectionism and you commented on it, and I think you mentioned something with regards to your own practice and your own philosophy, as it were. So what was it that made you think about perfection after that post?

Dr Sam Anthony:

Well, paul, I think as soon as I saw that it was that you were talking, you, in particular, also were talking about perfectionism. It's something that is a topic that strikes me quite deeply because it's something I know that I have had and still have traits of, and but I would say my wish to learn about it and this opportunity to talk about it and to share experiences and to share learning about it. It is so important, actually, for someone who I would say I've talked about it before where, just with friends and family, that I feel like I'm a reformed or reforming perfectionist. I think there will always be things about me that will be perfectionist, but there's so many things that I have thought about it before and wondered why I have these traits, why they impact upon me, how that affects my practice as a doctor, how that affects me as a person, how it might impact on my work-life balance, all sorts of those things. And again, this opportunity to talk about it, read a bit about it, think about it, I think is like therapy in itself as well, which I know you say with a lot of your podcasts. Just talking about these things sometimes is really helpful and getting other perspectives on it.

Dr Polyvios:

Yeah, it's interesting I've said this, as you said, I have said this before and there's something very therapeutic about listening to your own voice. So, for people that don't know, when you're on the whole, when you're podcasting, you may have seen people wear headphones and wondering why? Because they don't do anything for the sounds it wear, but they allow you to hear what's being said and so you can hear any noises or anything like that, so you can adjust audio levels and what have you. But the thing that I found very strange was listening to your own voice in real time. That took a lot of getting used to and it actually became a very nice way of actually consolidating your own thoughts in a weird way, because we all have a sort of internal monologue, but actually hearing it as you're saying it and thinking it does make you think a little bit more sometimes. So yeah, at least for me, but you know.

Dr Sam Anthony:

I think that's part of externalising what we all hold inside. We've only got our own brains that ruminate and tell us and talk to ourselves and sometimes we can just sit with that and we don't really get another perspective because it's all internal. But expressing it and externalising it, whether you have someone else you know working with that or you know communicating that with you. It still comes out, and I think that's just healthy.

Dr Polyvios:

Yeah, no, absolutely. And what were the traits you said that? You said I definitely have these traits. What is it? Is it similar to some of the things that I've spoken about? Or what is it that you have noticed that the perfectionism traits?

Dr Sam Anthony:

I mean, definitely, I hear where you're coming from and that's why some of that resonates with me. I mean, my personal take on perfectionism has always been what everyone would think like, that definition of wanting to do something almost beyond what is best. You know, perfectionism in itself just is completely. It's just a nonsense actually, because how can anything ever be perfect? There will always be something else. Surely you can do to it to make it even more perfect and even more perfect. It's kind of a limitless upper end. Yes, you can't. How do you contain that? But I've taken a long time to understand that for myself personally, and my traits would definitely have been I would say they are diluted somewhat these days, whilst I've kind of taken time to consider perfectionism affecting me personally, but it's definitely been the trait of making sure that I do everything to the absolute maximum that I can possibly do, and actually not necessarily in the time that I've got. So one thing is definitely it's time consuming and the idea that if I haven't done it, if I haven't spent enough time on it or more time than what I have, or I haven't looked at every possible outcome or option or you know how it might look, how it might, what the outcome might be for that other person, then I haven't done my best and the feeling that I the fear of the consequence of not getting something right or, you know, being criticised for it or just not delivering it in the most perfect way and requiring a lot of preparation. So that's where the time consuming side of it has come into my life as well. And then when I sort of really go out and read about or learn about perfectionism, all those other things, so something that you know it'll be feelings of guilt if I haven't spent as much time as I think I should have. So who's setting that bar? I am setting that bar. It's only me who is saying I am the one being self-critical or criticising that piece of work that I've done, or criticising myself after I've delivered that presentation, and actually most of the time no one else has even noticed that. But it will be those little things that I've gone away and gone. That was imperfect. I could have done that better, but that's my internal narrative again. And sometimes no one knows how much somebody else has, but that was excellent or that was good, or you know, I never thought of that. And then, if you even raise that little internal doubt, the guys didn't even notice that. So there are those aspects that I do recognise in myself, and I suppose I'm talking about the wider aspect of working as a doctor, where you do have to do things in detail and you present and all of this. But then there's that whole other thing of how many exams we've always gone through right from school. You know where you were expected to have a certain level of. Well, your grades have to be a certain level to go to medical school. If you put that in your horizon, then you do that, and if you're not in that sort of group, then how would you get on to do that? So you'll, you know, do medicine. Then you get to medical school and then you'll face the whole other lot of people who are just brilliant and you're thinking, well, there's a bar set there. So it's almost like it's an ambition, but it's also the perfectionism I feel has sort of developed with me a bit, because I think I've got to be a certain level to be enough, and if I'm not and I don't reach that grade and I don't reach that level and I don't pass at that level, then I'm not going to make it. And then this goes on. It's like a self-perpetuating thing. Certainly it has been for me. But then I have achieved and I have achieved and I've had how I needed to get 100%. No, I haven't, and I've not been aiming for that. In the end you come to a point where you go well, I can't be, I can't be perfect at that. I'm just going to have to accept I can pass, I can pass well, or I can just pass everything, that's okay. So that sort of studying level, that's one thing. But then in my practice as a doctor, I think one of the things I commented after your little piece on perfectionism was have I gone into medicine because I'm a perfectionist or have I become a perfectionist by being in medicine, either through studying it with all these brilliant people or in the work that I do? I do surgery in dermatology, having gone through a lot of different things in my career training in surgery, training in general practice and then doing surgery in dermatology. But therefore, what I do with all of my experience, it's quite a lot of very detailed facial work, and whilst it's not aesthetic, it needs to be aesthetic from my perspective on one hand, but clearly I also need to present function. I also need to take the cancer out. I've got to think of all these different ways of putting it back together, and so there is the detail in what I specifically do that actually every doctor in every realm will be seeking their own perfect in what they do because of that huge thing at the end of it, which is the patient's outcome, which is what we are all so central to.

Dr Polyvios:

So yeah, it sounds very much at the beginning where you were talking about all the different things, targets, wise, it sounds. Part of the perfectionism is setting unrealistic expectations to some extent, not only in terms of the outcome, but actually just in terms of the targets that you're setting yourself for I've got to do this in a certain time frame, or I've got to achieve this by this point, and even it's almost a double-edged sword, because you've got unrealistic time frame and you've also got unrealistic expectations of each thing in that time frame. So you want to do each thing in that time frame perfectly. You want a perfect outcome, and there's also too much to do and it can be quite, not even quite. It can be very overwhelming, and I think that is one of the. I think it's a trait that isn't really talked about too much, actually.

Dr Sam Anthony:

I mean, yeah, I'm really putting it out. There was how living with it really can be. But I suppose it is quite important to say that every doctor, every healthcare professional is still your outcome, is still for the best outcome for the patient. No one is thinking anything less than that. But I think it is very well written about healthy versus unhealthy perfectionism, and so that healthy perfectionism is where it's accepted that those outcomes may not be perfect, despite everything that you put into it. There is an understanding and an acceptance that there is a complication rate, that there are going to be times you cannot, no matter how hard you try, get the outcome that you and everybody else would wish for. And whilst that doesn't take away any of the emotion or feelings of fear and maybe guilt, I think it's just augmented and magnified in the unhealthy perfectionism but then also might drive that need to I've got to do it better again next time. Well, I thought I did everything I could, but maybe I didn't. Therefore, I've got to do it more and more, again and again, and so that is where it just continues to build, and again it's that. Self criticism is that, and I think if you keep that to yourself, that can be where the overwhelm and the burnout come. And of course we know perfectionism and burnout are very, very connected and very linked. In fact, I read, I did read something I'll read it out to you because it was. I read it in time one magazine, but online in January, and it was just a sentence about the link between perfectionism and burnout and it said plant the seed of work related stress in the soil of the perfectionist personality and burnout is likely to sprout. And it's almost like you're watering that soil where we always say, oh, water your soil and let your seeds grow. That's kind of general growth and you know managing life and let yourself move forwards. But actually in a perfectionist, if it's the wrong thing that you're planting and then you know nurturing, actually that can lead to something quite negative and I would almost replace plant the seed of work related stress in the soil, plant the seed of doubt in the soil of a perfectionist, and I think that is equally, you know, sort of well defining it Just propagates all the all the problems, isn't it?

Dr Polyvios:

And you start, I think self self doubt, it is a catalyst, I think, and I think that's the one thing that we've spoken a lot about burnout in the past with Doxin distress, and we've had group discussions as well. And there's one thing which I was trying to work out because, you know, and it's one of those things that feels impossible to work out, we've spoken so much about it. We know what causes it, we know the different traits that certain people may have with regards to it, or at least we've got certain predictors that I think we've we can all testify to when we see it in, either in ourselves or in colleagues. And to this day, no matter how many years we've been talking about it, either ourselves, between us or as a profession, the solution has never really happened. Now, yes, that's an extent of how big the problem is, of course, but it also feels like I just feel there's going to be an epiphany moment where we're sort of asking the wrong questions or the solution is something perhaps there, I say, more simple than we think. I can't, I don't know, it's just thoughts that were going into my head. And the one thing I did think about and I think we have touched on this before is one of the things in medicine is you don't get and I think this is where your channel and your website's name permitted to pause is so relevant to this. You actually don't get any point in your career where you can just literally hit a pause button and there's, there is a thought of you've got your annual leave and whatever. But can you imagine how, how different the vocation was be as if you were allowed a four to six week break every so often? Not penalize for it, not not. You know, not have paid doc to a big extent, or you know I know this is a wishful thinking, it's something you know everyone would love to have unpaid, paid, paid leave all the time. But just in terms of you know different levels of intensity, in terms of different specialties or different hours that you've put in equate to just this extra little bit of time where you can go off and have time to revise for exams or have time to go and do a placement. You know, in another place, in a different specialty, that you might want to have a look to see and gain some experience in just something that that gives you that opportunity to have a little bit of a break every now and then in a in a block and just time away from the hospital. You know, sometimes people say what you're doing on your annual leave and and often I hear people say, actually I'm not doing anything, I'm just not being here and that that's actually more. You know, people get more of a rest from and respite from just not being at the workplace rather than actually having to go away on holiday or or whatever. So it was just a thought and you know not sure what your thoughts are on that, but I know it's slightly unrealistic.

Dr Sam Anthony:

But but I 100% agree with that pool. I think there has not to date been a culture, certainly in the UK, of enabling that accepted time out. That you know. I know, for example, after after doing some work with permitted to pause, when I first sort of set it up and that was after a career break which you know it's probably well known now that I had that career break entirely opportunistically, when I hadn't realised I was quite at the brink of burnout and it wasn't, it wasn't all work related, it was. It was life and work colliding, which is why you know definitely think is a thing I know the WHO brought out their definition of, you know, burnout being a occupation related kind of chronic stress. But I do think that is isolating the fact that we are human beings and life does impact and life will overlap with work and work will overlap with life. You cannot separate the two. I mean we do, that's what we do our best to do, but actually in reality humans are not built like robots, they're not built to separate these and put these things in boxes. But we do a job, we make a jolly good job of it Because that's what we're trained to do and you know we've got a job to get on with and impacting our external stuff to work. It's not okay, but I think so. The vision of a medics, healthcare professionals, doctors, nurses, being human, having the same worries and anxieties and stresses, and all of that on top of the job is, is slowly I think extremely slowly getting recognised. But how, you're right, how is that dealt with? So, with the work, as I say, very early on during my career break, which I did, I did not work through. So I went to Canada. My husband had a job there for a year and I had the support to go out there. And that's when, a few months into it, I thought I permitted to pause because I thought this is all actually about my ability to give myself permission, and a perfectionist does not give themselves permission for a lot of self. You know, that's another thing. You know that idea of self care, it's just it doesn't sit well and belong well to a perfectionist. Well, certainly this one, because you, just you could think you can always do more for that thing you need to do. That's not about helping yourself, it's about helping another, and that's been certainly the thing for me. But again, that totally impacts on your work life balance. And that time out showed me some balance, although it was very skewed as well because I was doing no work, but of course I was still having to contain, continue my CPD, which I had to find in America to go to, you know, a dermatology course which was all very good and I had to do some reading and you just have to keep up your hours. So it wasn't nothing, but it actually was nothing in the sense of I don't have the responsibility of patients for this many months and responsibility is very heavy, definitely, and what we do, we talk about that a lot and that's never going to go. If we're talking about burnout, that's all. That's part of what we do, is part of our jobs. So I think that permission thing is important to kind of really sit with. What I learned was that places like Australia I learned from a couple of people when I put my first article out in the BMJ blog about my career break and just the idea that actually this should be considered more. If you compare it to something like maternity leave, which is really well structured, it's really well done and with planning it can be done and it is, it's often done and it can be done more than once for an individual. Whilst it's not the same, obviously, as a career break, it is still possible to do this. And so then I heard from a couple of people an old friend in Australia who works in A&E there, who reflected and said you know what? I've just had a career break and it has absolutely changed my life. Then another person came in and said we have this in Australia after X number of years I can't tell you the definition after X number of years we have a mandatory amount of time off. They say go and do something else, go and travel, go. And you know I may or may not be right with that fact, but that definitely came to me five years ago as something I didn't realise. So there are ways that it can be done. It's just having the right support to do it. And I genuinely don't know where that comes from. Does it come from the Royal College, sort of the Royal College is giving permission. Does it come from the institutions, the hospitals? Individually we work in giving that permission. How does that become a rule? I'm yet to know. But if we can find out and approach the right people, then the idea that we are on this continuum for our entire working life at this rate and with this intensity, with the responsibilities we have, which are quite different not to every job but to a lot of jobs, surely, surely there should be some understanding that it's only healthy and would enable retention of staff and good physical and mental health in the healthcare system in this country, that we are given permission to have a break every so often.

Dr Polyvios:

The difficulty with it and is that, well, it's self perpetuating, in that the numbers of doctors and nurses and healthcare staff is dwindling by the day and you're not going to attract new people unless something is done, and or you're not going to retain people that you already have unless something is done. And at the same time you can't we can't implement some of those things like career breaks and all the rest, because there's not enough people to actually do that at the moment. You can't, you know, and if we did that and said, ok, every few years you can go and take a few months off, it would as much as that would be great for everyone and I completely agree with it. I have to sympathize to some extent with the hospitals or with the people running everything saying you know we can't do that now. I think they should be working harder to try and make it a reality personally, like they have done, like, as you say in other places. And it's interesting when you say the WHO, the WHO definition, saying that burnout is a, is a workplace thing. I am not sure how I feel about that as a, as a conco, you know, as a formal definition of it, because I really think it, it's all aspects of life that, yes, we do talk about burnout as a as a workplace scene, because that's genuinely when it manifests and it's genuinely the thing that gets impacted the most and because, on the whole, people don't care when people go have burnouts, when they're not employed. Really no one cares. That's why you have so many forgotten people suffering alone in their, in their apartments, in their, in their flats, if they're in their house, if they're lucky to have somewhere to live, and whereas people and government and institutions only really take notice when it actually affects their workforce. So you know, so you can, you can see how, yeah, burnouts defined as a workplace thing, but I don't really agree with that. I think there's so much that contributes to burnout in the workplace and part of those things are external factors, be it your personal life, be it all the, all the little things that, all the little challenges that we have each day. Sometimes it doesn't take much to push you over that edge and unfortunately, the workplace has a, especially in medicine, has that wonderful ability to push you over those, those edges on a on a very regular basis. And the other thing I've noticed within medics and this is a very biased view, of course, being being a medic, and it's very skewed view, because I tend to see a lot of medics in my day-to-day life. But because of that perfectionist nature that a lot of medics tend to have, because of that very competitive nature that a lot of medics tend to have and medics on the whole are relatively they are risk-takers on the whole because, you know, at a young age we did put all our eggs in one basket trying to get into medical school and and you didn't leave much wiggle room for much else to be fair, and so you did put everything into this one thing and there are people that they do go to different countries to try and practice medicine, and that's that's. That's a difficult thing to do, to just get up and and move to a different country to practice your job, and that's, that's a risk, and a lot of people do this. And so one of the things I say is sometimes because of our personalities and because of our nature and characteristics in medicine, our personal lives also tend to be slightly more complicated than other people that I've, that I've met, just because of our very nature, and so you've got this whole melting pot of things and yeah, so that's why I'm not. I'm not entirely in agreement with the burnout being a specifically workplace phenomenon, but that's my humble opinion on that, you know so.

Dr Sam Anthony:

I agree, I agree, and you know, as I said earlier, I just think these two are not mutually exclusive, they will overlap. So, yes, I'm also not. It's good, it's been a recognised thing and that may make steps towards the fact that, ok, there is a responsibility of institutions and our employers, and you know, to care for the people working in that workplace to, you know, help to prevent that. So so a definition coming out like that does, I feel, need to be followed up with something that continues to support preventing it. And you know, and obviously trust some sense of pandemic. You know all those, all the fragility within we all know this all the fragility within our institution that is the NHS, has just been exposed by the pandemic, I think, and so it's great that a lot of wellbeing is now being introduced. It's being talked about so much more. That is a great thing. But, as you say, what is the solution? And just going back to what you were saying about the fact that you know, obviously retention of staff is already a really difficult thing. I mean, that was a difficult thing even when I was on my career break thinking about this, writing. You know about this quite publicly. But my point about that is, if you had planned breaks. That is way better than having sudden loss of staff through stress and burnout at a very short notice with no backup, with no plan. And actually you could, you could. There is no, you know, there's nothing to say that there's a plan of when someone will have a baby. Once they find out that they need that maternity, that just comes. But there is still some months of planning for that because there is a known amount of time with that gestation period. So this can be done, I, you know, and it can be done. People still go on annual leave. They still take the leave that they are required to take and with the amount of notice we manage In teams, we manage, you know. I think another thing we all have a massive duty of, you know, duty of care to our patients, but also to our colleagues, and so that's another big thing. So if you imagine there's a group of colleagues who might all be perfectionist, you know we've got to support each other out of that as well. And again, recognizing when a colleague is burning out, when a colleague is, you know, focusing and ruminating on something that actually it's okay, it's not that bad, or I didn't see that I think that that goes a long way as well. So there's so many factors involved in here. Clearly there's just there is no easy answer and we can keep talking about it, but it's like, how do we, how do we do something about it? I think that whole the scrutiny that we have as medics as well, you know we are kind of on a stage with patients. You know the whole public in general, the execs, within all you know trust and on our boards, you know, maybe some colleagues, maybe there's there's a lot we have that there's. There's a huge expectation of us and so you know that whole idea of the fallen hero. If you don't achieve what it is you're expected to achieve, then there are so many consequences, you know, not only to the outcome but actually personally. So again, it's all about our self perpetuation, but it's those expectations that are put upon us as medics as well. So, my goodness, what if we did take an extended break? Of course I didn't feel comfortable with that at the outset, but I thought you know what, just go, I was supported to do it. I just went and did my department fall apart? Of course not because they don't rely upon me, they don't. I came back and you know I'd support the next person to definitely.

Dr Polyvios:

It's interesting. You say that I had one job about eight years ago. It was one of the and to this day, probably probably the busiest job I ever had. I didn't have any real seniors. I had consultants, but they were the few and far between, but there was no middle grade person. So for people that aren't medics, it was, it was you had. I was still very pretty junior and there was no, there was no one sort of at say, the level I am now kind of thing is in between, and so you were doing everything and it was so, so busy. I and I made I feel like I made the job more busy than it should have been. Looking back at it, maybe, but I always used to think, if I, how's this place going to run when I'm on leave or when I'm, you know, because there's no one else, there was literally just just you. And but it did, you know, and you came back and you're thinking you know, place hasn't burnt to the ground, as it were. And and then you, then then you start thinking am I, am I doing something wrong? You know why am I? I'm putting all this effort in, I'm leaving three hours later than I should be. For what reason exactly, you know, am I being inefficient and you actually question your own work ethos in a way, or your own ability in your workplace when that happens? But it is true, the place carries on. They don't rely on you as this one person to run everything. It's not possible at all. And I think we, we have to sometimes take a step back and realize, actually, it's like the place will go on, things, things go on. You know the day will end, there will be a, there will be some, something, someone, something will help to to carry, carry things on when you're not there. You know, as in the same way that we know, when we go to work and there's been a, a sickness, or in in recent cases, you know, with lots going around, there's been two, three sicknesses all at once, and even with the strike action where it's like how, how are we going to cope with with so many people away? And we find a way, and I think COVID did that. We, we learned so quickly. I mean, I, I saw pop up intensive care units come up. You know we turned wards into intensive care units and the things that we did in in in a period of a week, two weeks was was nothing short of phenomenal, I mean yes, it was to the denture. it was to the detriment of facilities and lots of other departments, but we did manage to achieve a lot with with COVID in terms of what we can do when we put our minds to it.

Dr Sam Anthony:

Absolutely and incredible ways and, as you say, very, very swiftly. There is a which just shows, doesn't it, the tenacity of everything that we are all capable of as a team and when all these brains come together, and what you can do with limited resources as well. And you know, I think we are very, I think we're very recognized for thinking on this. You know we have to think off the hoof. That's what we're there for. Something comes in front of you. It's risky. We have to make a decision. You just just do it and there will be consequences for better or for worse. But if you didn't make a decision, you didn't do something about it, there's only going to be a worse outcome. Yeah, not only. But you know that's. That's obviously what we're. We're always trying to sort of weigh up. But I would say one thing about the fact that, yes, look at what we can all do with when we really are pushed to and have to with with very little very little time is that there is a danger there in that we can just be seen that we are just like really coping because we're just managing the input, the throughput, the output, and actually what that does to the people on the cold face maybe is not fully visible and understood. The pandemic has shown it. But if we continue to just cope and react so well that that could be too well, you know, certainly not to the detriment we hope for our patients, but but certainly to us working in it. But anyway, that's just another viewpoints. But I was sort of reflecting a little bit back to perfectionism and the sort of burden of the work that we have as medics. So just to go back to that theme again, you know, the one of the visuals I have of the job itself that we all do is a bit like carrying an elephant on our back. It's a really heavy weight of burden with responsibility, with volume of work, with duty of care, and we're just, we're just holding that most of the time. And the way that I sometimes see perfectionism is, hard as it is, whether it's inherent within us, as we've talked about traits, or whether it's sort of from external pressures. I sometimes see it as sort of inviting a second elephant to come on top of the first elephant, knowing that it's going to be really heavy, even heavier, and almost you're just crumbling under the double weight. It's not only just the job itself, which is which you're burdened with, but but then this other sort of extra. It's the extra being extra and adding extra to what you're already trying to do, and trying to do to the best of your ability. So it's just a visual I sometimes have thought about with my moments of perfectionism and a way of saying how do I get this, this second elephant off my back is hard enough, and that's been part of me coaching myself almost through not needing to be quite so perfect at everything. And then and then I've also often thought to myself what would I say to my juniors? So if, if I see those traits in them and there I'm supervising a procedure where I see something that might not have been done perfectly, could still be done slightly better or slightly different technique, and then when I hear them ruminating about it to me, I'm the one that's reassuring them, saying it's okay, it wasn't. You know, this is not going to have a negative outcome in in to the magnitude that you think it will. If it were, I would have helped you, or I have corrected you, or you know, it's almost like putting the perspective back in sometimes, and I think perfection can sometimes remove perspective in a healthy way. And whilst I talk about permitted to pause, I think my, my charm from here will have to be permitted to part of perfectionism, because it again it's just part of working through, yeah, taking the more difficult aspects of perfectionism out of what we do every day.

Dr Polyvios:

It's so much easier said than done, isn't it? To take away the, the thing that we've been practicing for so long in terms of all our lives? We no one's ever told us that this is, this is an unhealthy thing to do, you know, and so, and so only as we, as only now, as we're getting into I want to say, adulthood, because it feels like it feels like these are traits from, from, from childhood, you know, but it feels as we, as responsibilities, are growing and as we're seeing the repercussions of having this personality trait more and more, it feels like it's almost we're finding out about, about our own characters, maybe sometimes too late, and it's well too late. It is in. You know, I'm with is never too late to find out things, but you know what I'm trying to say in terms of it's, we're finding things out after they've produced. There's been repercussions as a result of being a certain way and, unfortunately, burnout is one of those things that it seems to manifest.

Dr Sam Anthony:

Yes, yes, and I agree, it's never too late. I mean, like I say, I'm very proud to say I'm reforming. I think I would always be a perfectionist, but certainly not. I'm taking that second elephant off a lot of the time. But you know, it's not just in medicine. I see people around me and other professions and you know, I can, you know, even just looking at my own two brothers. So I have a younger brother and older brother and all three of us, without a shadow of a doubt, our dominant thing is creativity. We are all very creative individuals. I definitely haven't gone into medicine because I think I'm a scientist or I just I am very we're. All three of us are very, very colorful and I mean that in every sense of the word, with creativity, with artistry, and we all have very different professions. So I'm in medicine. My younger brother is a very, very talented filmmaker, has been in the sort of technical side of CGI and special effects and all of that, and is making films now and some of the you know some of the detail required in his work, very, very creative. But I will remember right back to when we were very young, he had a saying on his wall in his bedroom that was off the back of, I think Leonardo da Vinci originally said something of it that art is never, is never completed, it is only ever abandoned. And there is that. So again, it looks at that limitless sort of you know where do you finish it, where do you end? But I know I'm not definitely not defining myself and my two, you know, should I say, shouldn't be defining my two brothers as perfectionist. But I totally see some of those traits as well in part of what they've gone into and how they've been so successful at what they do. My older brother, he's a photographer, but he's also a qualified pilot, and the sort of necessity of absolute perfectionism when you've got a plain foot jumbo jet full of, you know, passengers is a bit like having patience. So, again, like we've all required elements of perfectionism in what we are doing. But I've also again seen how, you know, I see my traits in them and I'm sure they see theirs in me. So it isn't just medicine. It's really important to remember that. You know. Clearly it's saying that there are things within us that make us the way we are.

Dr Polyvios:

I mean, the ironic thing is it does, it does make you sometimes very good at your job. Because when, if I'm an anesthetizing a patient, for example, I think the patient wants me to be a perfectionist in a way, and they, you know, or if you're an anesthetizing someone's child or whoever it may be, the parent or patient or relatives they kind of hope that you know you haven't got someone, that's just this, it's okay, you know, even though you know everyone's way of practicing is very, very different. You kind of would want the pilot that's a perfectionist, you know. You do want the photographer that's a perfectionist. You do all these, all these things. You want it. And it's when you, when you think to yourself that actually not only are you expecting it of yourself, but you realize that patients or your clients or your passengers or all the people around you are also expecting you to be a perfectionist as well, you really do propagate this, this massive cycle of of of just expectations versus reality and versus what's what's actually achievable, and it really can make things a lot worse. But you can see where, where people and where we may struggle as a, as a profession and or perfectionist in general, may struggle because you have got so many people who you think in your mind. If I, if I do something not so perfect, I've not just felt myself, I felt the people that I'm serving or people that are paying for this service. And, yeah, it's a, it's a difficult thing to get your head around, but I guess one, one message is it's it is impossible to be perfect all the all the time, and we, we learn this the hard way and actually, when we don't allow ourselves to have this permissible imperfection, for once, the better phrase we really do, we really do lend ourselves open to to burn out. And it creeps up on you, I would say, probably a lot, a lot faster than than we'd like to think. And and and it goes back to sort of our very early conversations I think that we were having, maybe even a couple of years ago now, and when I was chatting to other charity members in in Dr St Distress as well, it almost feels like the telltale signs are. They're there early, but but they get noticed far too late and, as we know, the impact that this has and and the increasing suicide rate in in medicine as well, which is which sadly doesn't seem to be on the the increase at all. You know it's the way it manifests, is is it really is? It's tragic there's no other word I can use to describe it and I just I don't know. Sometimes I just wish people listening to episodes like this, or I think I just hope that they can realise that there is so much support and just I think the first step is actually just saying to someone it could be a friend, a colleague, a senior, whoever it may be, or even, of course, the doctors in distress charity themselves but just to say I'm feeling run down and all, or even just a simple I know if anyone at work came to me, for example, and said you know, I'm just not feeling myself. It doesn't, you don't have to talk about depression, you don't have to talk about burnout per se, but just giving that little signpost, signposting and we're taught to notice signposting with patients when they want to say something to you and they don't quite know the words to say it or they are struggling to get it out because of embarrassment or all these things. But we're taught to pick up on these things and I like to think that we can do that with our colleagues as well, and sometimes you just need a subtle, subtle signpost and we've said before that sometimes just asking the question twice or three times are you okay it does trigger this. You know this thought process to say actually do you know what I'm not, and you can actually have a conversation and hopefully help someone and hopefully someone can help themselves in that way.

Dr Sam Anthony:

Absolutely. I mean, I think it is maybe easier to see it or identify it in another. It's harder to see it in yourself and therefore it's also really important to listen to those people who are pointing those things out to you. You know, we've said it before and we'll say it again the people who often need it the most aren't necessarily the ones reaching out for the help. So it's really identifying them, but then it's really easy for them to just sort of get hidden away in the hustle and bustle of every day if no one is checking in. And that's quite an important thing. I mean, I did something, you know, last month only with my own team, which was I volunteered to, because I've been wanting to do it for ages. I volunteered to present, do a presentation at our clinical governance, which is normally a fairly clinical meeting, on burnout, and I finally got the opportunity. Very supportive team just said yeah, we'll give you, you know, half an hour for that, and it was quite an eye-opening session really, more because I was sat there watching my team. It was a safe place. That's what I wanted it to be. I'm bringing it to them. You know we're all talking about it, but I'm bringing it to them and I'm saying this is okay, it's okay to talk about it. You know that this is what we should identify in each other, in ourselves. This is how we might be able to help each other. You know, not maybe reach this point there's a lot of this about and it just was I was seeing everyone's faces. They were only seeing mine, but I was seeing everyone and it definitely was resonating with everybody in that room and afterwards I literally had such an overwhelming response, just with individual sort of reflections. I thought this is a really important thing to do. I've done this with my team. Now I've been very prepared to do it with every other team in the hospital. Is it something that other teams can embrace? Yes, this, you know, talking about risk registers and patient complaints and all of that is really important, and the educational stuff and clinical governance. But all I'm saying is let's just reserve, even if it's 10 minutes every three months in these meetings where everyone is together, to bring a well-being thing, to bring something that reminds everyone that it's a safe environment, to do it in Just raising that awareness again. But also, I think, important to signpost and important to remind and important to just reassure people that there are things that can be done. You know, and even with perfectionism, you know, I've sort of been thinking how okay, what if you asked me? So how do we deal with all of this? Yeah, very well that we know what it is and we recognize it. But I think part of it is about self care, self reflection, but also sharing. We said right at the beginning, just externalizing some of what, which is the hardest thing actually to externalize what you're really feeling. But coaching. There's a lot of coaching out there, you know, which is really positive, I think you know almost learning what those tipping points are for you and maybe recognizing or thinking where you can place your own boundaries, because maybe that's another thing it's hard to put a boundary on time, it's hard to put a boundary on all of those tasks. How do you stop that list getting longer? Well, it then is about prioritizing and some of those things. That bottom of the list actually didn't really matter anyway. They were there but they've come and gone now and it doesn't matter. But again, sort of just communicating as an individual, as a team, getting support from managers, support which we always say, you know, support from some of the higher levels, from the institution. You can go right up there. But actually, just this is on a maybe individual to individual basis to start with, and I suppose that goes for everything, not just facing for perfectionism as a trait, but you know all those other things that are causing overwhelming burnout.

Dr Polyvios:

Yeah, I try. Whenever I'm given or whether I'm being shadowed by a medical student, inevitably our conversations do tend to go towards what made you choose anaesthetics or where did you study, and we talk about medical school and we talk about choosing a specialty, and this happens actually more often than not. And I left surgery to do anaesthetics and it wasn't a decision I regret. I missed certain aspects of surgery and I explained to them. When students find this out, they actually they talk to me a lot about this and you can see why because they have this idea in their minds when they're starting medical school. I want to be a neurosurgeon, I want to be a, you know, a plastic surgeon, or I want to. And they come up with all these wonderful, wonderful specialties, usually very, very highly competitive specialties. I found this happens quite a lot the students that know exactly which specialty they want to go into despite never having experienced it, despite literally being in year one, for example, they know which specialty and these specialties are always highly competitive ones, always, like every specialty is competitive, but these are sort of the hyper competitive ones. They'll say something like ophthalmology or cardiac, where you get like one job every you know in a blue moon. And so you're thinking, gosh, this is quite a big commitment and quite a big amount of pressure that you're putting yourself on at the very early stage. And they usually are competitive, highly driven people. And when I tell them that I left surgery to, I said I was exactly like you, I left to do this. They're very interested because you can start to see that there's an element of self-doubt, not an unhealthy amount, not like I can't do this, but just the thought of what if I don't like it. And it is going back to sort of putting your eggs in one basket and all the rest. And when you give yourself this amount of pressure, just and I just say to them, it's okay to change your mind, you know you don't have to be like this is my career path, this is going to be my trajectory and and that's it. It's like it doesn't, doesn't quite work like that, because you might find, like, as I did, I loved being in theater, absolutely loved being in theater, loved assisting with the operations or doing some minor procedures myself, and that was, that was great. But the life outside of the operating room and the work outside the operating room, I didn't really enjoy as much and it wasn't as fun. And so naturally, I progressed towards the other side of the table, as it were, and you know where I could have. It felt like to me, the best of best of both worlds. Theater still had the ability to use skills and and what have you. But and yeah, I just find students when they hear that you can actually change your mind and that you're not going to be not just not criticized, but it's not going to be a detriment to you you know, actually enhances your work life balance. Yeah, I don't know how things would have turned out if I just stuck with a specialty that I. Just that I wasn't particularly happy with was making me unhappy, because a career is a long time to be unhappy.

Dr Sam Anthony:

Yes.

Dr Polyvios:

And yeah, you know so.

Dr Sam Anthony:

Yeah, just just, I completely resonate with that because I've changed career more than once and I've done every exam, going for each of them as well, and each time, therefore, because of the amount of commitment that went into progressing in down each channel and getting almost, you know well, getting to the end of those exams and then just saying like it's not. For me, actually, that probably was, they were the best decisions I made, but they were also the hardest decisions. There's still a weight of expectation and actually at that time, probably that was the expectation for myself. But we have to carry every experience with us and every single bit of surgical and general practice training I have done still is used today in a job that I'm very happy in. And, yes, I've just come, I have found that place, but it can take years to find that place. It's what have found me, but yes, and obviously I had a life threatening illness in the middle of that as well. So there were definitely paths in life that you sometimes just have to let it carry you as much as you are doing your best to carry it and you you'll find it, you'll get there. And if, at the end of all that you don't, I think you still have to, unfortunately. Yeah, you have to get the help required to really make an informed decision about changes in career, especially in medicine. And once you know that we shouldn't, we must remove the stigma of wanting to change, needing to change, seeking another direction.

Dr Polyvios:

Yeah, Thank you, thank you, and before we wrap up, just let me know what what permitted to pause is doing next. I saw you are selling some mugs as well, and other projects as well, so just let us know what's going on.

Dr Sam Anthony:

So, yes, I mean I'm most of what I do or attach sort of with permitted to pause is on my Instagram at permitted to pause. I always support doctors and distress as a charity, through many different guys, as I have, and you seem to have got me on at the beginning of May, which is the 5k a day in May sort of program that they do and they encourage people to run, cycle, swim, skip, hop, whatever you can 5k a day in May. I've done this two years in a row. The idea of me coming around every year fills me a little bit with anxiety. I haven't done my 5k yet today, but off the back of it, really, I'm just trying to raise a little bit of money and awareness and I have some permitted to pause mugs which the sale of each one will, I hope, contribute to doctors and distress. That's the idea and, yes, I'm working with them, with my hospital trust as well imminently, and the wellbeing team there. So that's really where where I'm at with permitted to pause, always putting my little reflections on Instagram in the hope that people sort of resonate as well.

Dr Polyvios:

That's great. I will leave. I will leave links to the mugs in the podcast description. If there's anyone that would like to buy one, please do and just click on the little. Thank you, paul. Thank you, sam. Thank you so much for taking the time to chat today and I'm so sorry again for the technical problems, but we finally got there, I think.

Dr Sam Anthony:

Thank you so much. You've been super patient and it's been really lovely talking to you, as always, and I hope we can do it again soon. Yes, definitely. And to meet in person.

Dr Polyvios:

Yes, finally, that would be lovely.

Dr Sam Anthony:

We will do it, we will.

Dr Polyvios:

Thank you, Sam. Good luck for the 5k.

Dr Sam Anthony:

Thank you, take care.

Dr Polyvios:

That was my conversation with Dr Sam Antony. If you're a healthcare professional and you believe you're being affected by burnout, please seek help. Doctors in distress is a charity which is dedicated to supporting healthcare workers suffering within the NHS and prevent suicide within the profession. I've left websites and social media links to both permitted to pause and doctors in distress in the podcast description, and that's it for this episode. If you're enjoying the show, please do leave a review on your podcasting platform and follow the show so you don't miss future episodes. As always, please look after yourself. I'm Dr Spolivius. Goodbye.

Perfectionism and Burnout in Healthcare
Perfectionism and Self-Criticism in Medicine
Negative Impact of Perfectionism, Need for Breaks
The Importance of Taking Time Off
Understanding Burnout in the Workplace
Challenges and Solutions in Medicine
Perfectionism and the Burden of Work
Perfectionism in Different Professions
Mental Health Support in the Workplace
Navigating Career Choices in Medicine