Two of the great pieces of advice from the WellVet were; “Bridge the intention gap” and that you can only ask for what you need when you know what it is that you need.
I am sure we are all familiar with having good intentions especially after hearing a great speaker or reading an article or book that really resonates with us. And then returning to everyday life we are swept away by the tsunami of demands and deadlines and to keep our heads above water we cling to the life raft of familiarity and routine to get us through the day. The good intentions are left behind and are soon forgotten as we persist in doing what we have always done. This is the intention gap.
The intention gap arise as we tend to be stuck in the “doing mode” of living where we are always focussed on the next task, of other demands that we have on our time and we feel like we will never get to the end of what we need to do. The (better) alternative to this doing mode is adopting the “being mode” of living. In the being mode we develop an awareness of what we are doing at any given minute, giving it our full attention and note how we are feeling and how what we are doing is affecting us. It is only the moment that we are in that we can interact with, and it is only by getting the most out of every moment that we can improve on what we do next. In the being mode of living we give ourselves the opportunity to incorporate the great ideas and advice that we have been given and give them a chance to help us. If we find that we can achieve better results we can continue to use the new approaches that we have learned and if we find they do not work for us we can understand why and become curious about what it is that we need to help us get more out of life.
This is another benefit of the being mode of living, we can discover what it is that we really need to help us. We stop assuming that the present way of doing things s the only way. We become curious. We can start to see what is helpful and what is not to us as individuals. Knowing and recognising what works for us, what excites us, what brings success to what we are involved with brings us so much more satisfaction and success as measured by our improved wellbeing. When our wellbeing improves our interaction with others improves and everyone develops. When we truly know what it is that we need than we can ask for help in obtaining it. This will probably not be an overnight success, but rather a continuous personal journey where we feel confident in asking for help, explain why we would like this help and to be able to communicate what the benefits that this will bring to us and to those around us.
If we can all start to think about stopping just being and accepting that what is here and now is the future and starting to develop the being mode of life we will all benefit.
“Why fitting your own oxygen mask is key” was the title of one of the talks at WellVet Weekend 2019 delivered by Dan Tipney a former athlete, coach, now a pilot and founding member of VetLed. Although the title refers to what to do in a mid-air emergency its message holds true when we are talking about looking after ourselves- if we do not look after ourselves we are not in a position to help others.
I was asked during the weekend how can we help others? I think that it is a challenge to give appropriate advice to others without proper training in counselling. However, by looking after our own physical and mental health we build up our own resilience and by adopting a non-judgemental approach as discussed in previous posts we put ourselves in a position to be able to listen to those in difficulty when they feel able to talk. Being there to listen to people when the feel ready to talk is quite possibly the most helpful thing we can do, and puts us in a position to “fit their oxygen mask” by advising them where to get help for example at Vetlife.
Another way of helping others is for those of us who have experienced health issues to be open about them and what measures have helped us, demonstrating that life can get better with the right support. This where initiatives such as the WellVet Weekend and Vetled are invaluable and we can build resources to help all within the profession, but remember each and every one of us is responsible for our own wellbeing.
Sometimes it can seem selfish when we give ourselves time for ourselves but in reality it helps everyone. By being well, we encourage others to be well too.
The WellVet Weekend 2019 has been an inspirational event full of positivity showing that there is a growing movement of change within the profession. I was a member of the panel in the first plenary session where we asked the questions how do we learn to identify our emotions and their causes and how we can manage them for ourselves and in our teams. Here are my thoughts, not a word for word presentation of what we discussed, on this subject.
WellVet 2019, Learning to accept, acknowledge and manage emotions in practice.
Why is this important?
Emotions are an important part of being human, they help us appreciate what we like and what we do not.
In our everyday working life we experience a wide range of emotions, from happiness to a successful treatment outcome, to sadness when a patient has to be euthanised, anxiety when faced with a busy consulting session or anger when a client complains.
These emotions create thoughts which will lead to feelings which in turn lead to impulses and reactions within our bodies.
Strong emotions are often associated with the generation of negative thoughts which if allowed to can lower our mood and increase our stress levels. Left unaddressed this can lead to more stress.
The thoughts that arise as a result of the experience of emotions will largely be based on our past experiences and not necessarily on the reality of the situation in front of us and can lead us to impulsive actions which will not necessarily be the best way to deal with that situation.
Giving ourselves time to accept our emotions gives us a chance to identify what is the true cause of the emotion can help us deal with situations more effectively. It will also help us identify areas of stress and anxiety and with practice this gives us the opportunity to understand what the stressors are and how to manage them for the better.
Let us look at examples of how emotions can affect us in practice and some ideas of how we can deal with them.
We cannot avoid emotions and we must not be tempted to ignore them.
It is vital that we become aware of our emotions and the thoughts that lead to these emotions. This is best done by taking a little time out, creating a moment of quietness and looking at how we feel, what made us feel this way and how these feelings are affecting our bodies. If we can do this and incorporate it into our everyday lives we will become better able to identify what enhances our mood and what affects it negatively and importantly allow us to identify negative thoughts before they start to spiral downwards dragging us down with them.
This is one of the cornerstones of mindfulness, something you will hear more on this weekend, but I want to talk about two aspects of mindfulness which have helped me deal with emotions.
First of all treat all clients the same. Offer them the same gold standard treatments, never make a judgement on their ability or willingness to follow your advice. Listen to your clients carefully, be empathic towards them, be interested in their pets and don’t jump to conclusions without discovering all the facts required.
The benefits of this approach are that you will develop a better relationship with you clients, they will be more likely to take your advice, they will come to you for advice more readily and they will build up a feeling of trust in their relationship with you. This trust is particularly important when you are unsure of what the problem with their pet is, you will be more able to have an open discussion about the options available. I firmly believe that this trust extends to the relationship we have with ourselves, it gives us confidence to not be correct all the time and to admit when we need help.
Secondly, treat your colleagues with respect. Never make judgements on their actions, especially in the situation of second opinions. You may think that they are way of the mark, but you do not know the full facts of their dealings with the client, or indeed what is going on in their life that may influence their decision making. Rather approach the patient and client without any preconceptions and make your own recommendations. If you see a that a colleague is making lots of questionable decisions have the courage and compassion to have a private word with them, never berate them as this will always be counterproductive both to them and to yourself.
Thirdly, don’t be judgemental on yourselves.
Live in the moment.
Undoubtably this is the cornerstone of mindfulness. Simply it means exactly what it says, developing an awareness of what you are doing at any moment, fully concentrating on what you are doing. Although I use the word doing in that last sentence, mindfulness encourages us to be rather than to do. Adopting the “being” mode of life means paying attention to what is happening right here right now. With practice this allows us to become aware of our thoughts and emotions and their effects on our bodies. Importantly this applies to the positive emotions thoughts as well as the negatives because all too often we give the negative emotions more attention than the positives. Being aware of the positives helps us by allowing us to build up the resilience we need to deal and cope with difficult and challenging situations.
Emotions are part of life.
Learn to be aware of your emotions and the thoughts associated with them both positive and negative.
Observe what thoughts and events are associated with your emotions and accept them in a non-judgemental way and be kind to yourselves.
The second big concerned raised by respondents in the “Time for Change” survey was a lack of support from when things do wrong. Things will go wrong from time to time, it is inevitable, and it is important that there is a supportive environment to understand why things went wrong and what can be done to stop the same thing happening again.
This process is vital for veterinary practice to develop. We must look at how we can improve the quality of service that we deliver to our clients for their pets. I would encourage the profession to ensure that a robust Quality Improvement programme is in place in all practices, there is plenty of information on the RCVS Knowledge website which can be used and adapted for individual practice use.
Members of the profession will benefit by feeling able to talk about mistakes and cases where there has been an unexpected outcome. If we continue to feel that we need to be perfect or that we cannot talk about problems we become more stressed, we put more pressure on ourselves by setting unrealistic expectations, we become more anxious about making a mistake and our ability to practice effectively suffers.
Practices will benefit by ensuring that treatments and recommendations are effective, and when they are not steps can be implemented to improve. With regular discussions areas of weakness and strength can be identified in all members of the team. Areas of strength can be shared and areas of weakness can be strengthened through mentoring and CPD.
Our clients and patients will benefit through the practice of Quality Improvement as our clinical skills will develop.
By adopting the process of Quality Improvement we will show our clients that we take their concerns seriously and that we are proactive in taking steps to improve the level of service that we offer. This also has the potential of improving the trust between the public and the profession.
It may require something of a culture change in many practices to embrace the idea the mistakes can happen and it is important to discuss them, but it is only by allowing free discussion and accepting that it may be necessary to change existing protocols and adapt to new information and circumstances that we can develop.
I have been reviewing the results of my “Time for Change Survey” and they are similar to a number of similar surveys. One of the major causes giving concern to respondents is dealing with owner’s expectations, so how can we manage this?
I firmly believe that the key to success in managing owners’ expectations is communication.
If we start with a “non-judgemental approach” we can create an environment where we don’t jump to conclusions, we listen to what our clients are telling us and are better able to understand their concerns.
If we then use the techniques outlined in “the mindful consultation” we give ourselves time to fully examine our patients, formulate a treatment plan and discuss this and the costs with our clients.
I am confidant that these steps will improve the service that we give our clients which will instil confidence in them which in turn will improve compliance with our advice. This will also give us time and space to appreciate the gratitude that our clients have for us and for us to appreciate the good work that we are doing, and will be in a better position to manage the expectations of our clients and ourselves.
I appreciate that this may sound like a simple solution to a big problem, but sometimes we lose sight of how we can make things better for us. Give it a try and see how you get on!
&me aims to encourage senior people within the healthcare professions to come forward with their stories to show that we all have mental health, and that a mental health problem does not exclude people from achieving leading roles in healthcare. I have previously shared my story at the Wellvet Weekend and more recently at the BSAVA congress as part of the Mindmatters stream and am now presenting here.
I qualified as a vet in 1985 and have spent my entire career in small animal practice in a variety of practices including the charity sector, a 2 vet practice, a large multi-branch practice and the corporate sector. I have held a number of positions from assistant to clinical director but throughout my career I have found the stresses of everyday practice difficult to deal with. I particularly found being on-call very difficult and had a constant feeling of not being good enough and that every other vet knew more than me and was more skilled at everything. However, I felt that it had been my choice to become a vet and that there was nothing else that I could do and just had “to get on with it”.
For me “getting on with it” meant accepting the stresses as normal and my coping strategy was to try to supress emotions. I ignored the fact that I did not feel happy but took on more responsibility in my professional life thinking that was what I should do but all it meant was that I experienced more difficult situations and more stress. I was also increasingly anxious and my mood was low, but it is only now that I recognise this. Even when I consulted with my GP and found myself crying during the consultation, not knowing why, I still did not recognise that I was depressed.
When you do not address stress, when you suppress emotions, when you do not recognise the warning signs your body is giving you it is inevitable that something will give. For me it was finding myself shouting in a consultation, pent up emotions and stress have a tendency to burst out in unexpected and inappropriate anger. It was at this time I realised that I needed help. It had only taken me 25 years to come to this realisation.
So, I went back to the GP who got me to fill in the questionnaire that is used to assess levels of depression. I scored well, but in this test the higher the score, the worse the result, so perhaps the first lesson in recognising perfectionism is not a good thing. I was prescribed medication, signed off work and was recommended to undertake talking therapies. Fortunately, I had health insurance and there was a Priory hospital close to home and took the decision to get myself referred there.
After an initial assessment my psychiatrist recommended three half day sessions as an out-patient. I was asked how I felt about group therapy. I had no idea how I felt about group therapy but approached treatment with an open mind putting myself in the hands of the experts and see what happened. Group therapy was interesting, as I listened to other people’s stories I thought “you thought that?”, “you do that?”, “that’s not going to be helpful”. But as I reflected on what I was hearing, I realised that I did the same things and I was able to recognise problems in others but not in myself.
Talking therapies are surprisingly tiring, at the end of the sessions I was exhausted, but I stuck with it and did my homework which was lots of self-reflection and understanding my unhelpful behaviours, how thoughts affected emotions and in turn mental and physical health. Through the combined treatments of cognitive behavioural therapy and mindfulness I learned how to monitor my thoughts and recognise they are just thoughts and how to recognise the voice of my inner critic who would constantly tell me that I was not good enough, that everyone else knew better than me and that my opinion was not worth a thing. Over time I have learned to ignore my inner critic which has increased my confidence and self-esteem and opened a whole new world to me of new opportunities. I am getting more from my professional life, and genuinely feel that I am a better now than I ever have been. I also have allowed myself to explore other interests as well, particularly in producing fine art photography and poetry, and this creative outlet perfectly balances my work life.
I do not believe that I am cured of depression and anxiety, but with the toolkit mindfulness has given me I can ensure that I remain in remission and get more out of my life now than at any other stage. So if you are feeling low and cannot see how things can improve ask for help, it may be the best thing you ever do.
Yesterday, along with 2 other colleagues I presented my story of how mindfulness has helped my mental health and has made me a better vet (and a better person) at the BSAVA congress. The session involved us sharing our stories followed by a Q&A session chaired by Lizzie Lockett, CEO of the RCVS.
The session was well attended and I was humbled by the number of people how said how helpful my presentation had been and how it resonated with them. I will share my story in a later blog, but today I would like to share a few bullet point take home messages.
Mental health issues affect 1 in 4 people BUT, being a vet does not mean that you will be affected.
However, mental health issues are common within the profession
Every individual member of the profession has their part to play in improving the mental health of the profession
We are talking more about the issues which is fantastic
We must ask for help if we are struggling and Vetlife is available to all 24/7. Please use this resource.
Now we are talking about the issues, we must make changes
I feel strongly that there are some simple changes that we can make which will really help.
Create and open, non-judgemental environment where everyone can discuss issues.
I would suggest that by having regular meetings based on the RCVS Knowledge Quality Improvement resources will play a vital part in this process. It will create a blame free culture where clinical issues can be discussed and when handled sensitively it will identify where there are any issues that need to be addressed in a supportive manner.
Put structures in place to manage the workload throughout the day which includes regular breaks and lunch/meal breaks, 15 minute consultations and managing operation lists sensibly.
I believe the above points will go a long way in improving our clinical care, our health and our overall service to our clients and patients.
As I said above, we all have a responsibility to take ownership of our mental health, we must not fall into a victim culture as a profession where we think that mental health issues are inevitable and that we are powerless to avoid them. There are good resources to make use of especially the ones above and the Mind Matters Initiative and with everyone making use of these I believe that the profession will flourish.