Stress and self-doubt in practice - a post from my recent talk at Primary Care 2022
Back in 2020 I was asked to talk at Primary Care.
It was meant to be the second year in a row that I stood on a stage (I say “stage” but the first year I was on the same level as everyone else 🤣).
I first came to the conference in 2006 as a student podiatrist, sitting in the audience learning from the speakers, so to be able to return and be one of those speakers is a really cool thing.
You get given your title, with a quick conversation asking if you are able to speak on that.
Of course, I said yes.
The title I was given was “overcoming stress and self doubt in practice”.
It’s a subject that I could totally resonate with, but also one that is so important - not just in healthcare, but across the whole landscape of humanity.
And when we finally got to speak on stage, two years after the original date, the conference feel on mental health week, so speaking about something that essentially feeds into mental health was humbling.
I had a plan for the 2020 version, involving some research, but in that 24 month gap it became a different presentation.
My delivery was different.
My approach was different.
I was different.
I had originally put out an online questionnaire to get people’s views of stress, self doubt and overwhelm via social media and foot health forums.
I asked about workplace and whether they had stress, self-doubt and overwhelm, and what they did to manage each of those areas if it was present.
287 people responded and I took the results and at the NEC and I delivered the data, which you can see below.
Stats from my 2020 online research.
Looking at the quantitative data and it’s pretty clear that people on the whole rated themselves as having stress, self-doubt and to a lesser - but not insignificant - degree overwhelm.
That fitted in with my thoughts on the subject and my my subjective experience in both NHS work and private practice.
Moving onto the qualitative data there was a range of management strategies proposed and I put these into a word cloud generator online to do a rudimentary analysis of any themes that occurred.
It’s pretty clear that people have strategies to help with stress, self-doubt and overwhelm and when I looked a this data, there was one word that felt right to describe it all - wellbeing.
Defining wellbeing is pretty hard as it’s ultimately a subjective thing - what wellbeing is to one person is totally different to another, but for the purposes of the talk I found this by Ruggeri et al (2020):
“Wellbeing is “the combination of feeling good and functioning well; the experience of positive emotions such as happiness and contentment as well as the development of one’s potential, having some control over one’s life, having a sense of purpose, and experiencing positive relationships”
Personally I think that covers everything, and when I dug deeper it was pretty clear that when wellbeing is poor, there are some clear things that happen.
Stress occurs, and when this becomes chronic it leads to burnout and further down the line in a healthcare setting this can lead to reduced patient safety.
Not good, right?
Obviously improving wellbeing is massively important, and in theory if you improve wellbeing then the negative effects (stress, burnout and reduced patient safety) should improve.
(I say “should” but it’s not always that easy, right?)
For good wellbeing there are three components that we need to consider:
Meaning & Purpose - having something greater than “just coming to work” to motivate and drive us. This could be a work thing, or it could be something personal outside of work.
Authenticity - knowing your values and then being able to express these in everything you do (including your job role).
Control - having control over your working activities, For example: who you work with, when and how.
If you take these three things and positively influence them, then wellbeing “should” increase.
So how do you do this?
Well, that’s a good question and I’ll give some of my thoughts shortly, but before that…. A bit more research.
I posted another online survey, but this time asked specifically how participants rated their level of meaning/purpose, authenticity and control, gathering numerical data and quality data to provide more context and feedback.
The results are below:
Qualitative data from the second piece of research.
Qualitative extracts from the second piece of research.
Reading some of these I felt sad, and was also aware that my biases may creep in.
I also remember looking at these and feeling a sense that the data didn’t make sense - on one hand there is data showing significant level or stress, self-doubt and overwhelm, yet people rate themselves fairly positively in having meaning/purpose, being authentic and control. That seems strange, but the data is the data and poking around isn’t going to change what is.
Being critical of my approach - as I should be - there were many questions Idid not ask, the biggest being why.
Why did participants rate their level of stress, self-doubt and overwhelm the way they did?
What led them to choose that score?
And why did they choose those methods to help manage these things?
Maybe that’s the next bit of research…
Towards the end of the presentation I showed the audience a chart called the Performance/Pressure curve by a duo called Yerkes and Dodson.
It shows a number of zones relating to stress bookended by a two zones - bore out (the low stress/low performance zone) and burnout (the high stress/low performance zone).
The game is to increase the gap between these two - the ideal zone - and maximise this giving you the space to manage the day to day stressors and pressure and not slip into one of the outside zones.
Yerkes and Dodson Pressure Performance curve from 1908.
But what about those things that can help?
I proposed six things that people could use to improve their wellbeing.
1. Find meaning a purpose.
What is it that gets you up in the morning?
That feeds not only your wallet but also your soul?
Yeah, that sounds a bit cheesy, but having some meaning and purpose to what you do is important. That may be something in work - a cause bigger than you - of or something outside of work, and work is the vehicle to get you there.
Often in healthcare there is a bias towards “I want to care for people” (ask anyone in healthcare why they trained to do that job and you’ll get that back a lot) and that may be enough for you.
2. Have people you can talk to.
I can’t emphasise how important this is. Having someone to share where you are in life and having an objective and supportive conversation is worth it’s weight in whatever currency you value.
This could be a friend, a family member, a partner, a coach - someone you can trust and who has your back.
3. Understand your values.
Your values are the lens by which you see the world, and by which you communicate with the world.
They are an essential component of authenticity, allowing you to live through your values each and every day.
I have four - Love, Learning, Freedom and Fun - and when I worked these out it helped me to see where I had made decisions in the past and helps me to make decisions in the present.
There are some great ways of doing this and I work with a lot of my clients around this as it’s such a key thing.
4. Practice mindfulness.
Well, I was going to say this really, seeing as my current area of study is, well… mindfulness and compassion.
For me it was a game changer and allowed me to observe my emotions and state in the moment, and make changes as needed.
It opened up a huge amount of compassion for me, which is something I think the world needs.
5. Create a success journal.
We have a bias towards negativity. Ask anyone about their successes and they will often fall short - ask about failures and sit back with a cuppa as they reel off a long list.
I’ve had a wall of awesomeness in the past, and in those moments when I felt a bit crap, I could look at that wall and be reminded that actually I am pretty damn good.
6. Get good at self doubt.
This is a biggie.
We often look at self doubt as being something to get rid of or remove, yet it’s actually a great barometer as to when we are growing and developing.
Like a muscle - use it too much and you get an injury, but use it too little and it wastes away.
Get good at self doubt and be mindful of what it is really saying.
Some of those activities above will resonate with you - some won’t, but I would love to know how you get on if you try them.
There are many paths to wellbeing and often it’s an individual path laced with trial and error, with occasional wanderings off the path where you find the stuff that doesn’t work.
That could even invoke a trip into burnout or bore out - because often we only learn by making those mistakes.
(That’s been me quite a lot)
But with practice, time and mindful reflection things become easier and clearer.
Let me know if anything in this post resonated with you and if I can help.