Beyond Burnout: Moral Injury, Purpose & Provider Well-being – with Prof. Dorothy Breen

Welcome to the Transforming Stress with Dr Ash podcast. And today I am delighted to welcome Professor Dorothy Breen from I from Cork, Ireland. Professor Breen, thank you so much for joining in on my podcast. And let me introduce you to the listeners. Professor Breen is a clinical professor in the University, University College of Cork. She's a senior lecturer. She's an independent qualified coach and mentor for consultants, GPs, and trainee doctors. Her career spans more than three decades across Ireland and Australia. Between Professor Breen and myself, we have got, I think it's reasonable to say, six to seven decades of experience in the healthcare. Professor Breen, first of all, it's I would like to congratulate you for launching the service for stressed-out and burnt-out doctors. This is such a timely initiative. I know in the HSC in Ireland and the NHS UK, the problem with burnout in healthcare is huge. And I assume that this is the same situation in HSC. it is my vision that to deal with this problem, every physician, every doctor should have a coach. This is my vision that every doctor, every physician should be provided with some kind of coaching, coaching support. And your timely initiative for creating this kind of service is really heartwarming. So, welcome to the podcast. Really grateful for you to take out the time and would love for you to introduce yourself to the listeners.

Well, thanks very much, Ash, and thanks for inviting me. It's a real privilege, actually, to be to be here, I must say. so yeah, so you covered the main points. my name is Professor Dorothy Breen. my background is as an intensivist and ethnist, and I've worked as a consultant both in Ireland and Australia. but throughout my career, I've had a really big interest in leadership and quality and safety, and that sort of weaved a thread throughout, and I've done some leadership roles around that as well. and I lecture in leadership and quality and safety in the Royal College of Surgeons in Ireland. So, and strangely, that is how I came to coaching because you know, as part of leadership, I actually did get coaching at various points along my career. and I found it hard to source, and I found it hard to get a coach that was a peer. in fact, I didn't have a coach that was a peer, but I just found it so useful. And, you know, of the things that I've done throughout my career, many of those have been from coaching sessions and you know, real introspection that allowed me to kind of develop myself along those lines. But I suppose how I really came to set up for doctors.ie is essentially through patient safety, which may sound a little bit circuitous, but I think the evidence is sort of overwhelming now that patient safety is strongly linked to provider well-being. And really, we're at nothing with these levels of high, you know, burnout, if that's the terminology that we want to use in both the HSE and the NHS, we're at nothing trying to improve patient safety until we can improve provider well-being significantly. We know it impacts all sorts of poor patient outcomes from a patient safety perspective. If people have high levels of burnout and poor satisfaction at work, disengagement, all those things.

Yeah, I fully agree with you that it is not only patient safety, but also patient and family experience. One of my mentors, Dyke Drummond, physician executive coach in the United States, says that you cannot give what you don't have. So if the providers are burnt out, they do they do not have emotional energy, they do not have empathy, they cannot give it. And it usually affects the entire practice of medicine. I mean, we know that with patient complaints, two-thirds of the complaints are related to communication. Lack of lack of empathy, lack of empathy, lack of emotion, emotional energy, lack of engagement. So this is such so paramount that we try to solve this problem. So we are completely on the same page that this is a really huge problem. And where do we start? Where do we stop?

Yes, well, I suppose where to start indeed. I suppose, you know, we all know now that burnout, if we're going to use that word, and you know, there is some problems with using that terminology in itself because it tends to, you know, land poorly on people, I think, you know, in that it sort of implies a level of personal failure. but we kind of know that burnout is not due to that now, it's predominantly due to organizational factors. we know that doctors are actually more resilient than the general population, so it's not a resilience problem.

It is absolutely true. And apologies for interrupting you. it is not a resilience problem. You might have heard about the cannery in the coal mine. Canary is a bird which the coal miners used to see what was the level of poisoning in the when they were going for mining. So if you keep increasing the temperature around, and we'll come back up to the boiling frog analogy, at some point of time, as the stress is increasing, there will be a breakdown. So it is not a resilience problem. And the WHO, the World Health Organization, has defined burnout as an occupational phenomenon. And it is it is related, it is related to the work environment. So then where what do we do? Where do we start? Now, why don't we start in start with defining what is burnout and how the healthcare workers and physicians and doctors would be experiencing it? How will they even know? Because there is so much lack of an awareness, an awareness that many times, because if we would agree, the conditioning of doctors and many healthcare professionals is really very stoic, that they will keep going on and on, they are not aware of their emotions, what's affecting them.

So I think the first point is to recognize on a day basis. Absolutely, you know, and I think that comes from you know, many of us seeing medicine as a calling, you know, and there's many ways to view your job, career. You can view it as a job, a career, or a calling, but I think a lot of us went into medicine as a calling. and that's a bit of a trap, actually, you know, because that can become an excuse for the organizations for one to take advantage you know, of people's overriding sense of duty of care. and it can become a trap for individuals as well to abandon themselves. So it's not just organizations that, you know, can abandon them, it's also themselves who can abandon them because of the overriding sense of a feeling of calling or duty, which is not entirely a bad thing, but it can lead to you know real harm. And you know, even if you go down right to the bottom of Maslow's triangle, you know, we're kind of taught to neglect ourselves, we're taught to neglect our own physiological needs around sleep and eating, safety, all those things, not even to mention the tip of the triangle, and because which is self-actualization, but because we are high achievers and high performers, we keep going through all of that, and so it is hard for us to recognize that about ourselves because society, the system, and even our own sense of self is telling us everything else, everything otherwise, because of this vocation calling, which isn't entirely bad, as I say, but that's that's where the trap is. It's a sort of a double harm.

Yes, yes, absolutely. And you mentioned earlier about the organizational issues, and I'll be really blessed to have you today because not only not only are you a clinician with experience across the Australia, in Ireland, but also you have been an academic because you will be able to talk about the evidence that this is this is the issue. You are seeing this problem here problem at work and how it is affecting patient safety, how it is affecting patient and family experience. Now, let us talk about the organizational issues. Professor Breen, have you heard about the boiling frog analogy?

I have Ash, but I think for the listener's sake, it would be good if you explained it to us.

So the boiling frog is analogy which is which is commonly used in different settings. So if you throw a frog into hot water, it is immediately going to jump out. But if you throw a frog into cold water and slowly increase the temperature, that increase of temperature might be outside the awareness, and the frog slowly adapts and adapts till the time it completely loses that capacity and it is charred to death. The chronic stress which can be insidious every day, micro stresses can have a similar effect. We are seeing our healthcare colleagues in their 40s, in their 50s, present with heart attacks, present with stroke, present with mental health issues.

I mean, we've had loads of evidence from Ireland. Like last year, the Medical Protection Society published a report on Irish doctors showing that 64% of them were burned were burnt out and that over.

64%. Now in the United States, you know, United States, there have been studies for five to six years, and that is the percentage, which is in the 50s and 60s, and I guess there will be similar amounts of figures in the UK, in the NHS UK.

It seems to be a consistent figure, actually, because the Irish Medical Organization did a survey in 2021. Now, granted, that was in the pandemic, and that was again around 70%. So around that sort of 60 and up to 70% seems to be the level of dissatisfaction that there is amongst medicine. I mean, that's actually, I think it's incredibly sad.

It's incredibly sad and it is incredibly concerning also. So if I toss a coin, if a toy is if I toss a coin, the chances that I will be meeting a colleague who is burnt out is quite high. Every second colleague I'm meeting is but is suffering some symptoms of burnout. Now, on a day-to-day basis, how do these colleagues come across you? How is their engagement? Do they smile? Do they have energy? Do they communicate? And how does that affect our own selves? And how does that affect the patient care? No, it's a very challenging environment because remember, we are not working in isolation. Yes, so we are working in teams, we are working with nurses, we are working with the therapy teams, and I guess with the nurses, with the therapists, there is a similar percentage of stress in other professionals. So when we are dealing with the entire system, is a boiling frog system. How then do we start to work on it? How then do we manage?

Yeah, just before we do that, I sort of suppose I just wanted to say that, you know, how do how do you find people? Like, you know, well, how do you find them in those circumstances? And I suppose I kind of think, you know, I mentioned earlier that, you know, your work can be a job, a career, or a calling. and I find people kind of tend to go into different ways. Some people, you know, when the demands exceed the resources of themselves, just say that's it, it's a job, and I'm not doing anything extra. I show up and I go home, and they're definitely not bringing the best selves to work. And then there's another group of people that actually I saw a lot, actually, and you mentioned it from academia, is who undertake like quality improvement, that type of work, and they lean into the dysfunction as much as they can. And quality improvement will lean and all those sort of technologies and you know skills are great, but actually they can there's a there's a dark side to them because there's a group of people who will continue to push the rock up the hill and to their detriment because these systems are huge. We know healthcare is the most complex of systems, they are the most complex organizations of all organizations, and to try and change it from to use that expression, the bottom up without assistance from the top down is really pushing a rock up a hill. And you know, there are a group of people who will throw everything that they can to do that, and to some extent you can make change that way, and not all of it is bad, but it does, it doesn't have a dark side. The dark side is that it will take these systems, they will take everything you've got to give and more. and they're very hard to change, they are extremely hard to change, you know, and we're not going to be able to do that as individuals.

Are you are you are you are you saying trying to say that this is a bottomless pit? The more you give, the more you give, the more it will take.

Exactly. Yeah, and I think you know, definitely for people I see it a lot in people who are involved in quality improvement, they come very altruistically to it. And it's great, you know, don't get me wrong, there's there's a good side to it, but there's also a dark side, you know, and I think I think that's actually really where coaching can help is to know yeah, well what is within my control, what's not in within my control, you know, and how much am I giving to the detriment of the myself, my family, you know, my own career actually, because that's not sustainable. And if you want to be effective in the long run, you know, you can't burn it all up in the first 10 or 15 years.

Yes, yes, very, very true. Well, if you don't mind me sharing my journey in very brief, Professor Been, I would love to share. And 10 years earlier, I went through about a burnout, and that was on the background of a lot of challenges. I did a lot of soul searching, connected with great mentors, including one I mentioned, Dike Ramond, was a physician executive coach in the United States. And I met him in his meeting, he was speaking to around 4,000 plus doctors about stress in healthcare, and that's where I started. And I realized that you know, to be a doctor, I mean in the United States it costs around a million dollars. In UK, it is in several hundred thousands. And if at the end we have doctors who are burnt out or who are unhappy, I think we have paid a very high price for high price we have paid for being miserable and unhappy. So I then decided that either I should solve this problem or I should be a taxi driver. Because wherever I go, wherever I travel to the world, I would sit in the front seat because I feel taxi drivers have got huge wisdom, they have got autonomy, they can start and stop work when they want. They have got control of their environment. I came to the realization that I need to solve this problem. That started a decade's journey into leadership, into coaching, and I have to tell you, I have to share this with you that in the last 10 years I've had my cake and eaten it too. I have had my cake and eaten it too. The answer has come out of coaching. The power in coaching is recently I've started reading this book, tremendous book. I have developed my own system of the boiling frog coaching. Because another thing, Professor Breen, that there cannot be one size fits all approach. Absolutely. Yeah, people have to know themselves, they have to diagnose their own blind spots, their own emotions, their own challenges, their own issues, and they have to manage self-management. Then they manage, then they see what's going in the environment, and then they manage the environment. So there cannot be a one-size-fits-all approach. And that's where coaching is so important. And coaching really helped me. And like you mentioned in the beginning, that you've had a lot of coaching, you have invested a lot into coaching, and that has really brought a lot of values. So, do you think it is it will be good to talk about how coaching helps us turn this environment into better? I call this, I call this the jacuzzi effect. That now I know that there is heat. You know, a colleague walks in and I know I can feel some level of toxicity. How do I take a stock? How do I manage my emotions? So I temper down the temperature, I temper, make that heat into a manageable, comfortable world. But it starts with self-awareness that what are my emotions? How are my emotions being affected on a day-to-day, hour-to-hour, minute-to-minute basis? So I would love for you to share with the listeners about your coaching journey, where you started, how it benefited you, and then what inspired you then to start this lovely services for the coaching services for the doctors. I think this is a great initiative.

Yeah, well, just before that, I suppose what really resonated with what you said there was the word autonomy. And I think that is a huge attraction of coaching. and I think it resonates with doctors hugely, who are, you know, high performers, independent thinkers, you know, and a lot of the feeling of helplessness sometimes comes from a feeling of lack of autonomy. And I do think coaching can help you, you know, re-establish your sense of autonomy. And in my colleague actually Mia Pumphries in the College of Surgeons, who does a lot of work on immigration of doctors from Ireland, which is huge by the way, and she speaks about three core work needs, and one of those is autonomy. and I think that really is kind of the striking aspect of coaching. And I suppose some of the things it can certainly help with, besides the you know, the sort of concept that everybody has, which is you know, to realize your personal and professional goals, which actually, after all, it's what we want to do as doctors, isn't it? Like we really do want to, you know, we're high achievers, we want to self-actualize, you know. We put as you said, we put lots of money and lots of lots of money, lots of resources into this.

And I'd say, I sorry to interrupt you, I'm so excited with what you have just said. I can't miss this. Work is a vehicle to fulfill all our six needs: the need for certainty, the need for variety, the need for love and connection, the need for significance, the need for growth, the need for contribution. These are the six human needs from Maslow's hierarchy of needs. Now, work is supposed to be a vehicle to fulfill these needs. Now, this vehicle now is causing burnout, severe exhaustion, mental health issues, that you are just living, you're not able to even fulfill the lowest strongest wrong, exactly. That is really ironical, and that is where the journey of leadership and coaching brought me here.

And I've been I think it's important to remember as well that sometimes we might think that's very self-serving, actually, but we can't actually serve others until we have met all our own needs, otherwise, that's coming from a place of harm, and actually it only causes harm, you know. So it's not self-serving to look after your needs, certainly the basic needs at one, but as I say, to move to that higher level that you've just described there, Ash, and in doing that, that's how we serve people the best anyway. So for anybody who's struggling with this might be a bit selfish. it's the way to serve your patients the best anyway, which is how I got to it. I got to it through patient safety, and I really honestly believe you know, we can't change these massive complex systems as individuals. We can't, but you know, we have some autonomy over ourselves and often more autonomy than we actually think we have, you know, and even getting a sense of that back, even getting a sense of your own agency back, it is it's so relieving actually, because you know, it is it can be a harsh feeling working in these organizations and feeling totally out of control, you know, and you're not actually you do have some level of agency. Now I'm not painting it as kind of you know the answer to all life's problems, you know, and it's as simple as that, it's not, and it's not simple as you outlined, Ash, because every solution is individual, and that's that's the benefit of coaching, and even more that every solution actually comes from within the individual because they know actually what is best for themselves, you know. and no corporate wellness program is ever going to do that for you, you know. yeah, and I'm not saying I do find it extraordinarily gratifying work because of that. I mean, I don't know, is that how you feel as well, Ash?

Yeah, absolutely, absolutely. And I would like to add one more thing to what you have said, and that is many times the individuals might not be aware or might have forgotten their strengths. Many times they have to be reminded of how far they have come. So, you know, some sometimes things might be outside our realm of awareness, and that's where a facilitated self-reflection with a coach can be immensely, immensely useful. And that can be a really good starting point that look how far so you have come. And absolutely you are spot on, and you've got to be self serving to start with because if you're not able to have strong boundaries to protect yourself, how can you serve others? Because you cannot give what you don't have.

100%, you know, and we're not trained well on that. Concept to be fair, you know, we're trained on the opposite, you know. and also kind of speaks to like a lot of what a coaching, I think, you know, really does well with, which is this whole concept of self-leadership, you know. and we can't lead others actually, unless we can effectively lead ourselves, you know, that's where it starts, isn't it? You know, and then all other sorts of skills, you know, of a sort of more transactional nature, if you like, you know, the time management skills, the performance skills, and even communication skills all tend to flow from that sort of work that you know you do in coaching, isn't it? so yeah, I think it's gonna be an incredibly powerful tool, you know. yeah.

We spoke about coaching and how coaching can be such an immensely powerful tool in understanding and managing the challenges. We cannot fix these challenges. We have to simply like if you're driving a car in a bad weather, you don't have any control of the weather. I mean, what I say that I've been in Ireland for many years and also in Scotland. If you are going to complain about the weather, six months out, six months out of the 12 months, you will be in the complaining mode. So, what we got to see is that okay, I'm going out, I got to solve these problems, and how what is the way I navigate through these challenges? So now can will it be okay to talk about the culture, the environment we work in a little bit more detail because okay, we talk about the organizational issues, but the culture of medicine the culture also has to change. You know, it's not going to be a slow process. What do you think about? I see things like basic things like saying thank you, saying having gratitude to people who are contributing in our in our team, like saying thank you to the therapist, thank you to the nurses, thank you to our colleagues who are helping us lead an effective. I feel that it can be much, much better. There has to be more culture of gratitude, more culture of courtesy and respect, and mutual respect in the profession.

Yes, absolutely. You know, I mean, my husband is not medical actually, but you know, in the very early days, I would be describing, you know, various people shouting at you as a junior doctor, or you know, being called here and there and wardsapping, grumpy with you, you know. And he couldn't believe it, you know, from the corporate environment because exactly he was like amazed, like how are people getting away with speaking to each other like that? It just becomes the norm, doesn't it? You know what I mean? I have a phrase I use in quality and safety a lot, which is normalization of the abnormal. That's the biggest barrier there is actually to quality and safety is that you know we don't recognize abnormal stuff because if we recognize it at least we can do something about it, you know. So I think the first stage is actually just recognizing that, you know, right. And it is it's kind of a little bit sort of worried about this whole compassionate leadership thing a bit as well, because that can be a bit gaslighty, like you know, and it like be kind stuff.

I mean, it's true, you should be kind, but you know, but you are but you but you are doing this for yourself, yes. If you are grateful, if we have gratitude, if we are polite, if we say thank you, if we say please, that's it. Yeah, if we are respectful, we are doing this for ourselves. Absolutely. Also, yeah, we are living in that vibration of joy and gratitude. That's not everybody might reciprocate, and that's fine. Because one of the things I have come to learn, and this has come over a period of time, learn with some with some teachers that in every environment, this is the law, basic law of physics, Professor Breen. That in every environment, in every system, there are equal and opposite factors, the positive factors and the negative and the challenging factors. What you focus on becomes your reality.

Yes, that's true. I mean, we all have limited time, energy, and attention. And you know, if we put our time, energy, and attention, whatever where we put that, that becomes our world, you know. Yeah, so I mean, that's where the agency comes in, actually, in autonomy, isn't it? We all control our time, energy, and attention. we can do that, you know, for ourselves. And I suppose getting back to the kindness culture and all that, you know, we can feel a bit, I don't know, off when people are telling you to be kind as if you're not kind anyway. But it does start with yourself, you know, it starts with yourself to you know, be kind to yourself, like you know, yeah.

And are we allowed to have are we allowed to have bad days? Because part of being kind of part of being kind to yourself is that one can have bad days. So suppose I've not slept well, I will let my team know that guys, I'm having a bad day today. I've not had very good sleep for whatever reason.

Yeah, yeah, yeah, absolutely, 100%, you know. and that comes down to the communication thing as well, isn't it? Realizing, you know, go back to those core needs I mentioned earlier on, you know, one of them is connection. You know, we don't function as isolated people in a very complex healthcare system, do we? In fact, like we've got multiple connections with many people in those organizations. So, yeah, we don't. And we're all leaders, we're all leaders of ourselves and leaders of teams. Like, you know, you don't get to be a doctor and not be a leader, you know. So it the sort of you know, reflection on that is that we need to develop those leadership skills, you know, and that's all around recognizing as well when you're having a bad day, you know, when you know that you can communicate that, and other people can probably communicate what they need from you. so yeah, plus we are enormous example setters as doctors, you know, and we have I think we should never ever underestimate the power of our voice. I think so I think sometimes we do, you know, we feel like we're beating our heads against a wall, but actually, you know, we can be the advocates of ourselves, you know, and really the power of voice should never be underestimated. Power of voice should never be underestimated. But I think what is even more important is when you don't use your voice. Like there's a cost to that. There's a cost to you, and there's a cost to everyone about around you. And I do feel people feel increasingly a sense of being silenced, you know. and that's a very sinister feeling, you know. so yeah, I would never underestimate the power of your own voice, even if it's only just speaking your truth. You said it, you know, you don't have to put it anywhere, you know.

Yeah, it has to be done, it has to be done in a polite respect. Yeah, absolutely. That is that is so important. Professor Been, I would like to also discuss another important aspect with you, and would love to know your thoughts on this. No, we have got listeners in India, Ireland, the United Kingdom, and the United States. high level of challenges, high level of challenges and problems in all these systems, but different, different, different kinds of issues. But one thing which is becoming more common, and recently I've read some papers in the United States, you know, this huge challenges around the insurance and all is the concept of moral injury. Yes, yeah. Would you like because how moral injury can lead to burnout or how it can be detrimental? I would love to know your thoughts about it.

Yeah, and I think you know, it tends to get all mushed together, but you know, and I think possibly like a lot of what people are referring to burnout is actually moral injury. and I suppose you know, moral injury is where like we see or participate in or fail to act in an act that is against our deeply held moral beliefs. You know, and I guess you know, I worked in intensive care a lot. There was never enough ICU beds, you always had to discharge people before they were ready. You know, there was always a challenge that could not be met by resources, you know, and I suppose that reflects on a bigger scale than what everybody else does. GPs have only got 15 minutes to see their patients, they can't, you know, really truly hear some of the you know issues they'd like to hear, or hospitals or emergency departments. So we're all working in that conundrum, actually, and that has a has a price to pay in the longer term, which may be manifesting as well now. There's sort of a muddle in the middle, I guess. But you know, I think a lot of what is happening can be lumped under, you know, that you don't feel that your mission is aligned with the organization's mission. and it comes down a lot to meaning and purpose, I think. Yes, meaning and purpose, yes. Yeah, and I think in coaching, actually, a lot, a lot, whatever you start with, it a lot of it can unravel to meaning and purpose, and that's where we're all feeling a little bit asunder because we don't feel perhaps that the organization that we work in, you know, our mission is aligned with the with the organization's mission, you know. yeah, but I think moral injury has a huge part to play in that. Huge part to play in that.

Yeah. Our own inner core values are not being served in an environment, or in fact, they are being antagonized in an environment. Absolutely, yeah. How do we navigate that? First of all, we need to diagnose that. We need to be aware of our own core values. That's where coaching comes in. That's where coaching comes in. Then we need to diagnose the environmental values. Now, one thing I would like to ask you, both as a clinician as well as an academic, now there's a huge values written in organizations and business on paper, but on the ground level, you see what is being practiced is different values.

Absolutely. And I like that can be even hurtful, I think, actually, if you see like the mission and values written on the wall as you go in and you know that's not the mission and values, or you're not getting your basic, like, you know, HR requirements met by your hospital or something like that. You know, that can that can actually be hurtful, you know. So it's not what's written on the paper or on the walls or any of that. And I suppose, you know, like I think we're increasingly seeing that the structures of our organizations are not fit for purpose, you know. we're gonna have to, this is a bigger question beyond U and B, absolutely, but we will have to sit down and look at that, you know, and what that involves is actually really deep listening to everybody involved. I mean, and I have heard, you know, suggested that among multiple solutions that you know we do need to prioritize staff satisfaction and that you know, maybe we even need to financially incentivize that because that's how we're gonna get to go care, you know. Unless we take care of the people taking care, we're never gonna get there, you know. And we unfortunately in today's world, the only thing that people understand is money. and if that's what it takes to incentivize it, maybe that's where we have to go, you know, and then there will be deep listening out of that.

But if the system is drying up with money, then what do we do?

Yeah, I know, but it's a question of chasing its tail, isn't it? Like it's like you know, I always think that about quality and safety as well, is you know, people say, Oh well, we don't have the money or the time for that. When we sort out the trolley crisis, we will get to that. But it's the car before the horse, you know. If you start with quality and safety, all the other problems solve themselves, all the efficiency and timeliness and all that solves itself. If actually you start with patient experience, believe it or not, everything else flows from that. And actually, we're the citizens, we're all going to be sick at some point, we're all gonna have a family member in the hospital. You know, that's what we want for ourselves and our families, you know. We want an organization that cares because I do think increasingly we're seeing organizations are hostile to the people they're serving, and they're hostile to the people that work in them, but nobody is being served by them. So I think we're gonna have to look at that again. And I honestly believe you start with both the patient experience and the staff experience, you prioritize those two, everything else will flow from that.

Professor Brina, I have to say something. You know, I've had a deep love for Ireland all these years, of friends in Dublin, to Donegal. And I just love the Irish light-heartedness, and the way you're bringing this light-heartedness to this very serious problem is really, really, really inspiring. It is a serious problem. But if we are going to sit down and if we are going to wait, that systems will change, it could be too late. What we want, what you have done with your coaching services, what I have done with the boiling frog system, is that we are trying to empower individuals. We are trying to empower individuals that you guys, you have spent a huge amount of money, hundreds of thousands of pounds, high cost to pay for being miserable, unhappy. You got we got to take our own control, we got to take our own control, our get back our own autonomy, agency, have better boundaries, have better communication. I have done this, and I have to say I'm very grateful to all the coaches who have been in my life. And also, you see, medicine, in essence, there are lovely people around. If we can come in, people are generally coming to work with a good heart. A hundred percent. And if you can find out a way that in we are all in this together, it just helps in tempering down the temperature of the heat and making it. It is it is a challenging situation, we know that. What do we do? Either we boil to death or we find out super strategies, super skills, a growth mindset, shift our perspectives. You see, Prof. Breen, if you have heard Man Search for Meaning, Victor Frankel. Frankel talks about survivors in the Holocaust. There were people who could do it in the Holocaust. If they could do it in the Holocaust, can we not do it in the healthcare system?

Absolutely. And that's where the that's where he speaks about of meaning and autonomy. Meaning autonomy is how I mean it's Marvel's book, is one of my favorite books, but yeah, absolutely those two things together. And I think you know, we feel that sense of overwhelm, and I think actually people are feeling that in the world in general, not just at work and in hospitals and healthcare settings. The only thing you can do is control your reaction to it and how you're showing up for that, you know. And don't forget how powerful we are as doctors. That really, really matters, actually. And first of all, it matters to you. You deserve actually to be happy at your work and you know and have positive and have positive emotions, exactly, and to feel fulfilled and have joy at work and all those things that the Institute of Healthcare Improvement talks about, which sounds nice and fluffy. But actually, people do deserve that. They've put long and arduous hours, they give a lot of themselves, they deserve to be happy at work, and they don't need anybody's permission. Is that reasonable to say? Absolutely.

You know, yes, absolutely. Yes, Professor Breen, I know we are coming to the end of the conversation, the end of the hour. We have covered a long, a lot of things. It's a huge topic to discuss, but what we discussed about what is the problem, understanding the problem, and seeing what are the things which we can control. What are the things which we can control, how we can shift our perspective? And thank you for sharing all your perspectives. In the if there's any final message you would like to share with the listeners, the top tips. There are any top tips you would like to share.

The top tips. I just want to make an observation is that you know, I will say that in coaching, and it speaks to what you were saying earlier on, is you actually see the true honesty, and I call it loveliness, actually, sounds of yourself, but you see the true honesty and integrity of people, it's just it's actually very humbling, you know. And I know that like that's going to be powerful in the world, even if it's just one, two people, you know, but it won't be, it'll be many more, you know. It yeah, it's it's humbling, actually.

Yes, very true. And earlier, what you said that this problem of stress and burnout is not only in healthcare, according to the Gallup studies, the 60 to 70 percent or something like that, huge proportion is across the professions, across the continents, all the countries. It's a huge problem. And I think it we need to take more and more control. And for me, this has become my purpose. And we've got the boiling frog system which I've created, not just for doctors or healthcare professionals, but it's coming from me as a doctor, as a healthcare professional, to be able to find out what is causing stress in us, and then finding out what are the strategies, what are the strategies we can take because all of us as a basic fundamental need and a right, we have the right of fulfillment in life.

100%. And I was just speaking to what you were saying there, you know, it is avoiding medicine that we don't have coaching like widely available, specifically from peers. And I do think a peer coaching, as in and other doctor coaches do is real value. And I think that's part of the problem why it hasn't taken up, is there hasn't been you know availability of coaching from peers. But there's no doubt other high performance industries have been onto it for a long time. I mean, obviously, and they invest a lot of resources in that exactly, you know, could why because it works, you know. so like I think as doctors, we sort of owe this to ourselves too, you know. And I think Atoga Wande, I think many people will be very familiar with him. He's very much a promoter of coaching in medicine, you know.

So many of his books, including Being Mortal and the checklist manifesto.

Yeah, yeah. So that's the last thing I was going to say is just that you know, pretty much every other high performance industry has coaching. We've got to ask ourselves in medicine, you know, what can it do for us?

Well, well, that is my vision. that is my vision that every doctor should have should have a coach, should have coaching resources. And I congratulate you once again on your initiative for starting this service for doctors. It's been a real joy, real pleasure to have you on Transforming Stress with Dr Ash. Thank you so much for joining me. And if the listeners would want to reach you, what would be the best way they could reach you properly?

Through the website, really, which is called DoctorS.ie.

So that's F O R I'll put a link to that here if you don't mind.

Yeah, that's great. Thank you very much. And thanks for asking me, Ash. Really enjoyed that conversation.

Thank you so much. Well, it well it was one of my Irish friends. It was one of my Irish friends who's an entrepreneur, and we are going to talk about entrepreneurial stress next week. He told me about your services, and I thought I have to get you on the podcast. So thank you.

I need to listen to that podcast next week.

Whenever I think whenever I think of Ireland, I can only smile. It's such a lovely country, lovely people. I think we should get some more Irishness to the healthcare system.

Yeah, certainly the sense of humor, maybe. Yeah, sense of humor is important. Okay, thank you so much. Thank you so much for joining me. And until we meet again. Exactly. Thanks again. Bye-bye.

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