No sleepless nights

Welcome back. It's season two of The Imperfect Clinician. My name is Yuen Toh.
And it's Mike Grudzinski.
Today, we are talking about No Sleepless Nights, where we talk about decisions and regrets,
how we try to avoid it, and what can we do to learn from it.
No Sleepless Nights
No Sleepless Nights.
This episode, we are hoping to discuss what does that actually mean? Where does it come from?
And yeah, what are our thoughts on what does it mean for us personally?
You mentioned about No Sleepless Nights before. Tell me a little bit more about where it came from.
So it's essentially about decisions and regret and decisions how it impacts us.
And how did I come about it?
When I got my training working for ambulance service or for more emergency services,
during the training, one of the guys say,
we have one policy and one policy only. We have only one phone call with the patient.
And it essentially cuts off us from the further decision making process.
And the patient is directed or helped in one way or another.
So you want to make sure that you get enough data to make the right decision.
So that later, when you go back home, when you're laying bad, and you think,
I should have done something differently. I should have said something else.
I should have referred. I should have checked one more thing.
So this is the matter of making sure that we have enough data, enough information to make right calls.
But then when I was thinking about it, I thought that it has much wider relevance to our professional life.
Not only as clinicians, but also as people who are in charge of others who run the teams
and who may be facing making decisions on every step of their career and every day
to make sure that there is no regrets when they retire to rest.
So it feels like you're talking about risk assessment. Is that right?
Well, yeah. Essentially, we're looking at making sure that our decisions are informed,
that we establish our own private framework for risk assessment to prevent causing the problem
or to get what we want from the decision or from the circumstances around us.
For the context, for international audience, we want to make sure that how do we risk assess our decisions?
How do we set boundaries for our professional expertise?
So do we know enough to make judgment? Do we need any more information?
Or is it outside of our remit of our experience, of our knowledge?
And we have to refer to somebody that can address it better.
Or maybe we need more time to assess it if it's not urgent.
We have to establish the urgency of it and we'll have to establish the weight of it or the seriousness of it
to make sure that the decision that we ultimately make can be easily explainable by us.
But also when we reflect on it, it says, right, this was the best decision that we could make.
And don't get me wrong, we make mistakes when making decisions.
It's just trying to prepare, trying to think about the process where we can harness this idea.
And it feels that we can learn transferable skills from work to personal life.
Okay. So I can see where you're coming from in terms of risk assessment
because what I see in primary care, when I see new starters from another sector,
the risk assessment skills are not fully developed.
So how do you balance between risk assess accurately to being risk averse?
Well, this is a hard call because if you as a medic follow the all good rule,
the primum non nocere where we don't want to cause harm to anybody in the first place,
we often like to delay the decision, delay until we know more, delay until we have more data,
delay because we need the time to think about it, maybe because we need to consult it with others.
And in my opinion, being risk averse means being scared of making the call
despite having this information available to you.
So everything is there, all pieces of the puzzle, but you're scared of putting the puzzles together.
That's for me being risk averse.
When you assess the risk of any problem, any decision, assess how, as I said before,
how urgent it is, what is the severity of it, how does it impact others and myself
and what would be the possible benefit of it for the person you're making the decision for
or for the team or for the group or for the family, whoever you're making the decision,
whether you're buying a car or crossing the road,
you need to make sure that you don't make mistakes, but you still do it sometimes.
So just based on what you're saying then, I'm reflecting in comparison to when I speak to students.
So I mean medical students, nursing students, pharmacy students.
I see quite a significant difference between risk assessment of different profession.
So I always tell my pharmacy students there is no black and white anymore.
It might be that this is the black and white that they were taught
and in primary care it becomes different shades of grey. What do you think to that?
It might be even more than 50 shades of grey in primary care.
In my opinion, being a pharmacist myself but also having experience from other clinical branches,
I want to say that yes, for pharmacists there are things that are wrong or right
and either something happened or didn't happen.
Either this is the, I don't know, medication, treatment, procedure or it is.
There isn't an area for any ambiguity.
When you're making clinical decisions, there is different takes.
Despite having all the guidelines and everything else, we may have different experience,
different backgrounds and different routes that lead us to this patient in this particular moment
and these decisions can vary between clinicians.
Clinicians may disagree on the assessment of the situation.
When I was working in the community and assuming more clinical roles,
I noticed that it sort of put me out of my comfort zone
because often you can be both right or wrong at the same time
or not 100% right or not 100% wrong and that initially didn't sit quite well with me
because you have this greater potential of trial for your theories and guidelines
which is not the case in the community pharmacy.
So in the community pharmacy you expect there is very definite right or very definite wrong.
Either you sign something and it's correct or sign something and it's not correct.
How do you see it from your point of view?
So I think in primary care it's right as long as you're able to defend your clinical judgment
and it's right if you're able to communicate it clearly to the patient.
So your thought process might be more digital
but your communication skills to the patient will be analogue.
In a different context, if you have something in your head and you want to engage your team,
the thing in your head that you want doing might be more digital
but the analogue skill is more the influencing of the people,
making sure that they are on board with what you are doing.
These are the things that are within our control in terms of what we do,
how we say it to other people.
But what are your views when you're dealing with issues out of our control?
You mean like coming across issues generated knowingly or not by others?
So you wake up in the morning, you go or you replace somebody on a shift
and there are some problems that were led by your predecessor or person that did a handover to you
and you have to deal with it.
Or none at all.
Or none at all, yeah.
Well this is again, I think that starting by others requires you to do your own.
Do your own due diligence and you have to make a decision from the very beginning.
You have to make sure that it sits right with you and that you have got enough information to do it right.
I mean to whatever the problem is, answer the query or commit to something.
I think there is one thing that I need to mention which is called Dunlop
and with all the regards and respect to the company that makes all the motor equipment.
Dunlop I've come across this a while ago which is a delay until no longer our problem.
And it appears to me that some team members or sometimes, I don't know, even ourselves probably
try to avoid making a call or try to avoid doing something
because we don't like it, we're not in the right frame of mind, we don't have time.
There's many reasons.
And then the next person comes to something that should have been done yesterday.
That we should have considered much earlier.
And now within your work it's not part of your task that you were meant to do but you still have to do it.
And I would urge all the leaders, managers and any clinician to make sure that you try to work to your best ability
to make sure that you respect the next person that comes after you.
I think I want to say majority of the people do that from an avoidance perspective.
Not because they don't want to deal with it, maybe because they don't know how to deal with it.
And because it becomes the hardest thing that they have to deal with that becomes the last thing that they put in terms of priority.
Because that can be crucial in teams other than from the clinical setting that we talked about.
So for example, I come into work today and I realize team member A is not okay.
But the workload today is tremendous.
I am going to be flooded so I will check in later.
And then later becomes never and I miss that window of opportunity to be present for others when they need it.
And I'm hoping that we can give ourselves a little bit of leeway where even if I'm not able to speak to person A straight away,
I'm telling that person I will speak to you in 30 minutes let's say.
And then scheduling time, five minutes of my time to check in.
Because I feel it makes a huge difference to be listened to, to feel that you are cared for.
If this is me having a problem and somebody realizing it and taking their time to listen, it would matter a lot to me as well.
So you would say, how would you rate in that respect, urgency of making a call?
Is it more important to deal with a team member, for example, over some work issue?
I think you prioritize, don't you? I think as clinician in every setting that we go in,
we go in first of all assess what the day brings and then you prioritize the workload.
And I think the priority of checking in on a team should not be the last priority.
It should be your top three for the day.
I think so. I agree with it. I think that making sure that the health of the team is sustained in that respect,
that you don't allow any issues that they last longer than they should.
I think this is quite important.
And I think that it demonstrates how you lead with your heart instead of your head.
So you don't get carried away by the workloads and the delegation and completion of it.
You put caring of the team in front of your leadership priorities or as a matter of one of your, as you said, top three priorities.
I think it's important to understand that our decisions bear weight, especially in somebody else's heads other than ours.
I think in order to maintain a clear head, you need to ensure that you minimize the risk of regrets.
That is where I think kindness comes into play.
You want to make sure that you're kind to people you work with because ultimately it's the group effort and the brand of your department,
of your company that will suffer in case something goes wrong.
I absolutely agree. I think the last thing I want to do is to regret at the end of the day that I should have checked in with Person A.
I know he or she was not okay. And if that was me, I would have wanted an empathetic ear to lean on.
And you see this situation quite a lot, especially when you, let's say, walking from one place to another in your workplace,
and you overhear somebody being upset, or you can see somebody deep in their thoughts.
It sometimes takes only a moment to pause and say, I am giving space. I'm providing space for you to open up.
When you walk past somebody in the workplace and you realize that they are crying or upset or deep in their thoughts,
I would like all clinicians and all leaders to have this eyes and ears open moment and actually take the courage to say,
are you okay? Because a lot of the time I think we don't pause, not because we don't care.
We don't pause because we might be thinking about something else or not being present in the moment.
We might be thinking, oh my goodness, there's so much work to do. Or we might be thinking, what if I ask and I don't know how to deal with it?
What if I ask and I make them even more upset? I think it's those fears that might be stopping us from having that conversation.
Or you delay until no longer our problem. I think also even acknowledging it is quite important.
You may not have time. There's hundreds of things going on at the same time.
Even if you say, right, I will be with you. I want to talk to you. You are important.
Just like you say to your kids, you are important to me. We'll talk about it.
Sometimes it's not possible to have this conversation right away.
But I think acknowledging it is very valuable from a person who may be affected by it.
Because clearly they are more affected by what happened than you because you're not personally involved in it.
I agree, I think. But I have to add, in terms of acknowledging, you have to follow through.
Absolutely, yes.
Because sometimes myself has experienced the, I will check in with you and that never happens.
And that can lead to disappointment when that happens repeatedly.
And perhaps the intention is there, but you as a leader have the responsibility to follow through with what you promise to create that space for that person.
I agree. And I think that this is what our reflection for the day, when the day is closing, I don't know, for an end of play or whatever you do at work, you reflect on it.
And you, even if you don't want to, you still think about those especially significant events to try to learn from it.
Try to see how you can solve it in the future maybe.
Whether you need to go back to it. So the better the process earlier, the better due diligence, the less situation that you need to fix in the future.
Because that takes up the energy from you.
And I think those significant events can be a good learning point for us regardless of whether we made the right or bad decision.
Do you think that being surprised means not being prepared? If you're surprised about the event that is happening in front of you, is it something that you should have anticipated in a way?
I'm not keen on being prepared all the time. I think a lot of risk averseness comes from wanting to be prepared.
And I've seen people being paralyzed because they didn't have time to prepare and they're not able to be spontaneous to the level where they need to risk assess.
They need to gather information from patients and decide the next step.
So when I say being paralyzed, I mean not able to even have a conversation with a patient or a team member to at least have some foundation of understanding before taking action.
I don't mean paralyzed from taking action because it might be sometimes you have to pause, gather more information or speaking to other people before you can.
But when you want to be over prepared and say, I need to know everything I'm going to say before speaking to person A, let's say when you check in, or I need to be over prepared before I speak to patient A,
it makes the, I don't know whether it makes the margin of error little, but I can see a very slow growth from that process.
Okay. But in the past, we were talking about how sometimes it would be easier for us to do things ourselves rather than delegated to others.
I think it comes to some extent from the fact that other people might be more risk averse than yourself.
So in that respect, how do we support someone who is risk averse more than us, for example, to go ahead and commit to making the decision?
So I can share an example where I notice the inability to risk assess actually comes from fear.
And myself and that person, we had to sit down and delve into where the fear is coming from, find out what is paralyzing the person and what can be done to address it.
But prior to addressing it, we, first of all, I said, me as a person who asked the question and provide insight,
but the person who's actually doing it with me needs to be aware of it before they can do something about it,
because it goes back to our conversation to fear being in the driver's seat.
Yeah. I think that the fear is one of those factors that sits in us, either fear of not caring or lack of care.
I can tell you about my experience with my dad. So whichever decision I made, it would be bad.
I think this is just for him to make a point. And I think it's a point of control.
If you're criticising every decision, it can take you to that point where people stop caring.
Yeah. And I think because every time you make a decision, you are essentially risk assessing and making that leap.
Whereas every time when, if you, unfortunately growing up, haven't had a chance to be able to train that muscle,
haven't been able to be constructive and supported when you're doing any decisions,
because again, like we said, we always will make mistakes. It creates a lot of fear around it
because your brain automatically links making decisions or potential making mistakes equals negative feelings.
Yeah. And being criticised.
And being criticised. And so in order to avoid the criticism, in order to avoid the negative feeling,
the brain will then automatically create the escape route of avoidance.
If you don't want to feel that way, don't make a decision. If you don't want to feel that way, don't risk assessing, make that leap.
And so from your case, understanding where it's coming from,
I wonder how were you able to be aware of it before you do something different about it?
I think you sort of have little choice but to play into it, you know, with your parents.
The relationships are a bit different than at work, I suppose.
So to some extent you could do the DUNLOP.
So you delay until the problem is solved because whatever you do is going to be wrong anyway,
and you're prepared for it. The decisions will be taken instead of me or for me by my dad in this case.
But in your case, there might be different routes here, but I can see two clear ones
where you stay in that situation and you lose the autonomy to make that decision or that decision
or any decision yourself because you leave it in somebody else's hands, so you never needed to risk it.
Or in your case, you've learned to make that decision-making in other areas.
So how do you learn to risk assess without the safety or control provided by your dad?
So I think there are two options to this. So you either fight it or run away.
So you can argue and, I don't know, diverge your world to prevent overlap into people that can have control in your world.
And it depends, I guess, on your strengths and opportunities.
Or you run away and you just don't make a decision just to calm things down, I suppose.
Is there a third option where you just resign yourself to it because you've lost the will to fight?
Yeah, I think this is the runaway in that respect. It's running away from the decision.
You just go with the flow and that's how it goes.
Okay, sorry. So I meant when I thought about the word runaway or the term running away,
I would be under the assumption that you are running away from the situation.
So you are avoiding coming into that situation again where the...
The less opportunity to put you in a position where you have to make a decision that's going to be bad
or that you're assuming that it's going to be bad, the better chance of, let's call it, peace in inverted commas.
Okay. Pretend peace to please the other person.
Yeah. I mean, it's just for the peace of mind of everybody, just to make sure that there is no fighting and arguing, I guess.
But not for yourself. So you are pleasing people around you, but you're sacrificing yourself in the process.
I think so. When it comes to dealing with the families, in my opinion, there are no winners.
You only realize that you can minimize the losses. You try to minimize the losses.
I think that when you have a possessive, abusive or in one way or another controlling member of the family
whoever that might be, there is no winning. No one's a winner. Okay. And no one's happy ultimately.
So when I hear you say that then I feel that that's perhaps where you develop your own risk assessment skills
because you scan your options and you risk assess based on losses. Like you said, different levels of losses
but losses that have been risk assessed. Would you agree?
Well, yeah. When you still see the decisions being made, you are just passerby in that respect
and you sort of still learn from somebody else's making the mistakes. Of course, you are a little bit detached from it directly
because you don't necessarily bear the consequences. But for you, the benefit of it is that you don't have the immediate negativity around it.
So from a team perspective then, if you have a leader who's controlling, you then with time created a team
that's not going to be empowered, not going to step up for themselves, not being able to risk assess and make decisions.
Correct. Unless you're like enjoying being a slave.
Yes. And so in terms of the options that you've mentioned, you'll have people who stay on
but with time getting dejected, getting feeling really helpless because they can't do anything about it anyway
because they feel that they're not in control and maybe getting resentful. And the other option is people leaving.
So that sounds like a toxic work culture to me.
Yeah, it does. And now you can look at this running away in a different perspective where people just say right now
that I can't fulfil my aspirations, I can't be an active member of the team and somebody who can contribute to it
because the decision making process is taken away of you. Because then when the control is less prominent,
less dominant in the team or in the relationship between parents, children or husband, wife, then when there is no control
or jurisdiction, you have no choice but to be autonomous and effectively fend for yourself.
Even if you are under the influence of a manager or boss, nothing is stopping you from thinking about the choice
and also as a consequence of decisions. They might be right or wrong and you can always learn from people around you
especially if they are making mistakes. As Brandon Moore I believe said, smart people learn from their mistakes
but the real sharp ones learn from mistakes of the others. And I think this is one of the mechanisms where you can learn for the future
but you ultimately can't run away from making all the decisions.
And probably that's why collective growth comes quicker compared to individual growth because if you're only looking at mistakes
done by yourself and learning from it compared to let's say 10,000 mistakes that you've seen people doing and you learn,
you learn much quicker as a team, don't you?
Absolutely.
And I want to quote, one of my team members said this when we talk about control and jurisdiction.
So I've been told my way of leadership, this is recent feedback, is I don't micromanage but I provide the railings, the support railing.
So there is a bridge and I am the support railing. So I don't hover. However, I am there if they stumble.
I am there if they come across a challenge and they need to lean and hold on to the support railing for more guidance.
So it's good old German rule, trust but double check.
So I want to, I am trying to give my team the space to grow, the space to empower them but I am always there to set the boundaries.
I think that is important, leaders in any perspective, whether you are leader of your children.
As a parent, you always set clear boundaries and the same thing with the team.
You set clear boundaries and then you go from there.
That's why the micromanaging, the controlling side of leading, perhaps it's not my cup of tea.
Okay, so who has more sleepless nights?
Let's assume the situation where you have people who are just overseeing others.
Do you think that the team members then have got more important decisions to make they have to bear with and they have to bear the consequences of?
Or in that case, the manager or the leader who is allowing others to make decisions to be independent, autonomous and you're just overseeing the whole structure.
Or when you have the controlling leaders who are wanting to micromanage everything, do they sleep better?
I want to say the controlling leader will sleep least out of three.
Because I think based on what my team members' feedback was, when you create a workplace that has psychological safety,
people will feel that they have the space, they are given the space and the time to talk about what is of concern for them.
So then they don't take their concerns back with them, hence the sleepless nights.
And if you as the leader are checking in, like we talked about checking in, you are aware where they're up to because they want to keep you in the loop.
But you are also there when they need you.
So there is a clear two-way communication.
However, with a leader who is controlling, I want to say that stems from fears and insecurities.
And when it's driven by that, generally, I doubt that they will sleep well.
I think they wouldn't sleep very well for other reasons as well.
It's because they seem to be the ones that bear the weight of the world on their shoulders.
And this is what ultimately they feel like they are delegating things to others.
But they're controlling them to that respect that they don't allow any movement, any capacity for feedback.
And it's just a collapsing world of everything being dependent on one person and say, oh, I would have done it better.
Yeah, but you're not given a chance to your team to deliver.
Yes. And I don't want to sound as if I've got it all figured out because I haven't.
I sometimes still struggle with how much to delegate, especially when I know everyone is stretched.
And sometimes I do that by preventing overstretching of others.
I don't put myself as priority.
And in that case, I'm overstretched because I've got too much on my plate.
But it's having the awareness of going, right, where is this coming from?
How can I deal with it? Because any overstretched leader or person, anyone, really, it's not going to function.
It's not going to function at their optimal level, whether I'm not going to be reacting as well as I would have liked or whether things get to me a bit easier.
So I am, I'm still learning, but having feedback like this allows me to reflect on how I am and where I want to be, not just me, but us as a team.
So do you have any sleepless nights?
Sometimes, but I want to say less and less.
So the reason, usually, for my sleepless nights is because there is so much things in my head.
I tend to, that's why the meditation is absolutely crucial to me, or writing it down.
I just need a place to let it all out and to organize it in a way because all the things in my head can be very jumbled.
Whereas if I write it down or sit down for meditation for as long as I need, it's almost giving myself some time to reorganize my thought and have a fresh perspective of where I am now and where am I heading.
What about you? Do you have any sleepless nights?
I used to have more sleepless nights than now.
In my practice on a daily basis, I want to say that over the years I developed a little, well, system.
It's not system, it's nothing ultra-special, but I try to leave all the home problems before I start work and then try to stop all the work problems before I go back home.
You compartmentalize a bit better.
Yeah, you make sure that you put them into the right box so they don't turn crouch.
In the past, I used to have this very strong belief that if there's a problem, something serious or the decisions to be made or something happened that you need to digest, I always could think about it clearer after a sleep.
And I say, right, what now has to happen is I need to go to sleep and start a fresh sort of take on it.
And that worked for me for some time, but sometimes there are those things that you can't delay.
Yes, and you talked about last time as well where sleep becomes one of your avoidance or a strategy, really, where if you don't want to deal with it, sleeps become a way out.
It is avoidance, but it also a delaying to give you time to look from a distance, to look from a different perspective.
Because I'm always hopeful that, right, maybe there's something I don't see.
Maybe I need to look at it from a different perspective, think of something else that can contribute to it, to shine a different light on it, to make it into your decision.
You're making like into a structure that has got different legs to support on.
At the minute, this decision is like very wobbly based on only one pillar that I am thinking because you're channeling your thought in one direction.
If you give yourself a little bit of time or a little bit of a runaway or try to avoid it, I always were able to come back with another pillar to support the decision.
And I think this was very helpful for me to be more informed and also in that respect, try to avoid being risk averse.
I don't think I was ever particularly risk averse.
I think I was quite quick to establish where the risks are and where my limitations are.
Okay, so how would you summarize this no sleepless night today?
So I think it's reflecting on your risk assessing skills, both clinically, perhaps we do more off and use that skill in our day to day work life and personal life because we learn during challenges and mistakes.
And I think checking in with yourself and checking in with others because I'm sure everyone would like to be heard.
So do the same for others and you as a clinician, you as a leader, realize the power you have in you when you create the space for people in need.
I hope our experience you can tap into and learn from and you can reflect on that and rise. Thank you for listening.
Thank you very much and thanks for joining us for the second season. Thank you. Speak to you soon.
Welcome to the new segment of Yuen Reads.
So I thought of doing this because I would like to share what I'm reading, but also curious about what you are reading.
So please let us know and let us know what you thought of the new segment. Thank you.
So for this week, the book is called Untamed by Glennon Doyle.
I had so many recommendation from speakers, from friends saying, you've got to read this book.
And I thought, really, is it just a popular one?
But no, I was wrong. So this book shook me up in a good way.
One of the things, one of the biggest thing I took away from this book was the analogy of a drawbridge.
So essentially I'm paraphrasing here, but she's saying family is like an island and the drawbridge is what you put down or up, depending on who you want to let in.
And the biggest thing about the drawbridge that I took back was actually you can say no to anyone that can inflict hurt, even if it's family.
So out of this book, it came at a brilliant time.
My parents came after COVID and before they came, I wanted to set some boundaries and I never really know how to do that properly.
So in the past, this is what used to happen.
Someone said something, one of my parents, I get frustrated mainly with myself because I didn't set the boundaries in terms of what's okay, what's not okay.
And then I just get angry with myself.
So this time, surprise, surprise, I wrote a list on a full paper, essentially listing my boundaries.
So in there I talked about what's okay, what's not okay.
It's not a lengthy document, just a one pager.
And the reason for that, so for example, it's quite common in the Chinese culture to talk about, to comment on physical attributes.
And I said, I wouldn't like that to happen in our home.
And the list goes on shortly.
So then I sent it out to my parents and it was radio silence.
I was thinking, are they mad? Did they read it?
And I then very briefly sent another message.
I've sent you an email and you have a read before you come over.
They're like, yeah, okay, we've read it, nothing else.
Anyway, so they came over.
They did try their best to follow the boundaries.
It's been helpful.
I shared it with my sister.
She was supportive, which was great.
And that was a good another story, I guess, but this is what I got away from it.
So that we can let you know directly about any news and free exclusive content for subscribers.
If you review us on Apple podcast or podchaser, there is a chance we can reach more people seeking support and encouragement.
Reflect on how you are now and let us know about one thing you would do differently after listening to us.
We love to hear from you.
So please keep the questions coming via direct message, email, comment or record a voicemail on our website.
We will do our best to answer you either directly or via the podcast.
Bye for now and until next time.