How to manage your overwhelm in the moment

A short story, featuring:

Dr Totali Pistov, consultant physician

Magli, the fearsome neurosurgeon - also Dr Pistov's wife

Sasha, FY2 doctor

Ronan, Dr Pistov's loyal Physicians Assistant

Kwame, the charge nurse

An angry patient's relative

Dr Pistov is a brilliant diagnostician but known also for his incredibly long ward rounds. Infamous as a teaching experience, they are also exhausting. Dr Pistov is actually eagle-eyed at diagnosis, however he is easily distracted and loses track of time due to his slight neurodivergent tendencies. His favourite topic is neuroendocrine tumours (he has a small band of loyal patients whom he diagnosed and gathered around him over the years). His second favourite topic is football. He can easily spend ages talking to a patient about last night's result, unless his loyal physician's assistant, Ronan is there, who has the skills to move him along.

Unfortunately, Ronan is away today, on a one-day fast-track course to train him in management of major variceal bleeds. Instead, Sasha, the FY2, is organising the ward round. Sasha is not in control. In fact ,she uses Dr Pistov's Arsenal chatter time to look out of the window and plan her post for that evening on Junior Dr Reddit - probably on the unreasonable length of these wards rounds plus all her problems with Ronan.

Of course the round has run now well past 1:30 pm. Everyone is starving, exhausted and in a state of dehydration.

Suddenly it dawns on Sasha: Disaster! There are another six patients on an outlying ward that she has forgotten about. A crucial last page of the list has not printed out due to yet another IT failure at the Trust.

?Dr Pistov off is normally extremely mild mannered, however exhaustion and impending burnout has made him increasingly ratty these days.

He begins to enter a negative thinking spiral.

Let’s look at what happens next, using the A to F model:

A is for Activating event

It’s safe to say that Sasha announcement about the six extra patients has left Dr Pistov feeling pretty activated.

B is for Belief

Dr Pistov is now experiencing a variety beliefs about the situation - both real and imagined.

Now his day will run in impossibly late (possibly true), and he will be in a foul mood for the rest of the day (something he actually has a choice over).

In his mind he is blaming Ronan for not being there and planning how he will tell his wife Magali later that juniors are universally useless these days (a massive over-generalisation).

Now he’ll have to review all these patients otherwise he’ll be totally culpable if something happens ('all or nothing thinking style', with with an added element of catastrophe).

Consequences

Dr Pistov conducts the rest of the ward round in a matter he will later admit to himself was 'half-arsed.' He makes passive aggressive comments to Sasha only the lines of, 'Well, if only I had more time for this patient or that problem' etc.'

Sasha is now feeling tearful and already plotting how she will be straight on Junior Doctor Reddit later to 'slay' his reputation. Meanwhile a patient’s relative who has been waiting for five hours for Dr Pistov is agitating the situation with Charge Nurse Kwame.

Kwame tells Dr Pistov he has to speak to the relative to avoid a complaint.

D stands for Disputing irrational beliefs

Dr Pistov remembers what his wife Magali would do. Magali has a coach, which Dr Pistov dismisses as woo-woo unicorn time, however he has noticed a difference in Magali and has started secretly coping what she does.

He takes a deep breath does activating his parasympathetic nervous system. With impending catastrophe on all levels, he begins to dispute some of his thinking.

Yes his clinic will start late but it will all get done in the end. He doesn’t have to see all these six patients now. Instead he asked Sasha to tell him of any immediate issues and he will pop back and see them later in the week. He reflects that all not all juniors are bad and Sasha does have a good points. He will talk to her later about her organisational skills when he’s next has an opportunity instead of issuing the dressing down he has been orchestrating in his head.

It is his choices to whether to remain in a bad mood. To Kwame's relief, Dr Pistov decides that speaking to the relative is a priority.

Exchange

He decides to adopt a new belief that his clinic will get done in its own time. Adopting the stance enables him to see Sasha in a more positive light with strengths and areas that need building up. He is still grumpy and allows himself to be so after the ward round has ended but not for too long, so he can start his clinic in a reasonable mood.

Future steps

In this way Dr pissed off has both created some solutions and avoided burning off all this bad energy and stress and anger all afternoon.

His workload is still enormous but he has a useful tool to help him think his way out of overwhelm.

He may have even avoided becoming the topic of a very toxic thread on Junior Doctor Reddit.

A free conversation about working together is bookable directly into my diary here https://zcal.co/drclairedavies

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