Transcript
Sophie Shephard: today we're actually going to focus a little bit more on the clinicians who are delivering care.
Ollie: Thank you.
Sophie Shephard: And this episode is going to be all about clinician wellbeing, what supports it, what might erode it and how we can help create systems and cultures that genuinely care for caregivers. We know that working in healthcare, particularly in areas like chronic pain, fatigue and complex conditions, can be really rewarding, but it can also be really emotionally taxing at times and sometimes quite isolating.
Sophie Shephard: Many of us do carry quite a heavy load, not just in our patients' stories, but also in the weights of the systems we work within, productivity pressures and a lot of tensions that exist between our values and the structures we work in.
Sophie Shephard: today we're really going to pause to reflect around what does wellbeing mean for clinicians in these spaces, what helps us stay connected, regulated and resourced, and what are some of the things that can get in the way.
Sophie Shephard: So I'm very, very excited to be joined, my co-host, Ollie, as well as our very special guest, Jen.
Ollie: Jennifer is an exercise physiologist and director of Invisibly Brilliant, a telehealth clinic specialising in the management of invisible chronic illnesses such as ME, CFS, lung COVID, POTS, EDS and fibromyalgia, particularly where they intersect with neurodivergence.
Ollie: Her treatment approach focuses on validation, problem solving, pacing, education and embodiment, trigger management and appropriate movement guidance. In addition to lecturing in exercise and sports science, the amazing Jen also lectures in anatomy and physiology, health science, and has presented at the Australian POTS Foundation, EDS Society, and Genesis Cardiology.
Ollie: She's also the co-founder of Connection Medicine, where we were lucky to meet her, which provides education and self-care support for healthcare professionals in the field of managing and treating chronic invisible illnesses.
Ollie: Welcome to the show, Jen. We're really lucky to have you here.
Jen Smallridge: Oh my gosh, thank you both. It's a bit of a pinch me moment. I, as you know, adore the both of you. So I think there's a real three-way appreciation happening here. Thank you.
Ollie: ye
Ollie: What led you to this space in the first place, Jen
Jen Smallridge: Well, often say that this space found me. When I graduated from uni, there wasn't much talk about invisible illnesses. And I was working at like a few different private practices and in the life insurance space. And as as it happens, you know, people with chronic fatigue and depression,
Jen Smallridge: not so much POTS back then, but just fatigue and pain-related conditions would kind of get into the diary and I would really enjoy that work and then on they would go or on they on I would go to a different clinic, workplace, what have you.
Jen Smallridge: So I was working at a multidisciplinary health clinic and I feel like we can't talk about connection medicine and myself without mentioning the wonderful Florence Kelly, exercise physiologist.
Ollie: Yes.
Jen Smallridge: And she started at the clinic and she was really renowned for being, you know, the fatigue EP and the POTS EP. And when she started, I'll never forget, I had this feeling of like, ah, like that is amazing what she does.
Jen Smallridge: And she's that EP. So I better find like, another version of EP to do. Cause it just felt like at the time it wasn't that common to receive these referrals unless you were known for being that clinician.
Jen Smallridge: So I watched the way she worked and I admired it and we'd share some clients together and have some really good chats. and And then eventually it turned out that she would be mentoring me and that I would be stepping into this space. And that came with a whole host of imposter syndrome type feelings and feelings of uncertainty, of readiness, of do I know enough and am I enough? And Florence being the amazing mentor she is helped me.
Jen Smallridge: embody the fact that I am and I can listen and I can care. And then on it went that we both stayed clinicians in this space. We went to different clinics. We founded Connection Medicine Co to educate other health professionals, which is how we found both of you.
Jen Smallridge: And now Flo and I both work for our own businesses on telehealth in this space. And I wish I could just go back and tell myself like the pie is big enough. It's actually too big.
Jen Smallridge: ah
Jen Smallridge: There are, there is more than enough to do in this space. And if anything, we just need more and more clinicians to assist. So yeah, it found me, but I just, I've never looked back because this work is just the best as you would know.
Sophie Shephard: Yeah, it's huge.
Jen Smallridge: just the best.
Sophie Shephard: and And I think like what you mentioned there about there just being so much there, you know, it's competition is not an issue because it's such an underserviced area.
Ollie: Totally agree.
Sophie Shephard: And I think, you know, particularly given the context of the topic in which we're keen to chat about today, i think it raises this really interesting point. And I'd be really keen to hear your experiences, both of you.
Sophie Shephard: around this. But I think one of the the most common things I hear from people, almost in response to, you know, when people you're talking to people about the area you work in and it's like, oh, what do you you know what area of practice are you in?
Sophie Shephard: Sometimes the response that you get when you tell people, oh, I work in chronic pain or I work in complex invisible illness, it's almost like this visceral distancing that happens almost. it's And and from I think part of that, at least from the conversations I've had, comes from I think a lot of clinicians do tend to steer clear of this area and a lot of it comes down to concern about maintaining their own wellbeing and the fact that it is quite a demanding, challenging area to be working in as a clinician who cares about people.
Sophie Shephard: and Have either of you had experiences in some of these discussions or does is yeah your experiences different? What have you heard about working in this space from that end?
Jen Smallridge: how about you Oli I definitely have thoughts and feelings but you go
Ollie: i I just get this blank stare sometimes, like a huh.
Sophie Shephard: Okay.
Ollie: So it's either like I didn't even know that those people existed, which breaks my heart in a way because I'm talking to, you know, know different different people from other, they're just not familiar with that, like be sorry family members who are farmers and they just go huh.
Ollie: And then otherwise it's health professionals going, yeah, like Soph said, but yeah, So that's a minefield. Why would you go into that? Or how do you even help people over telehealth? And it just makes me laugh. i had a conversation like that last week with a really, really capable clinician, but they just didn't see the, yeah, how it would all work.
Ollie: Yeah. what What about you, Jen? Yeah.
Jen Smallridge: Oh, yeah, this is reminding me that like a lot of my life, I'm actually talking more to just like and people in the community rather than health professionals these days, which is just such a funny contrast because I so like, let's say i was at a wedding on the weekend, like I'm so forthcoming with I'm an exercise physiologist.
Jen Smallridge: But I work predominantly in invisible illness, like fatigue, POTS and pain. I really just like put it out there now because inevitably someone would be like, my best mate has that or my friend's sister or my hairdresser.
Ollie: Yeah.
Jen Smallridge: And we can make that connection and have a really open chat. Or if someone's like giving me the glazed look, I'm like, that's okay. Like I can stem it there. That's fine. So I love like just being rogue and chatting about it.
Jen Smallridge: out in the wild, but then you're right. I have forgotten about that interclinician kind of the sound that you made, Ollie, like ah
Sophie Shephard: Yeah.
Jen Smallridge: so like
Ollie: yeah
Jen Smallridge: what do you do? what do you do? Or like that nearly hands in the air. Like, what do you do with them? Like really,
Ollie: Yeah.
Jen Smallridge: uh listen be with probably the same way that you do your craft like I yeah I I don't miss that layer of skepticism or like good for you vibes yeah yeah which then heightens my passion for this area of like oh no people who get it
Ollie: Exactly.
Ollie: Yeah. A loose judgment.
Sophie Shephard: yeah
Jen Smallridge: We're here and I'll never refer to you kind person for this stuff.
Sophie Shephard: yeah it's it's it's so interesting isn't it and I guess like one thing that's jumped out at me is the amount of people that I've run into that I've been chatting about that do seem or express that they're kind of interested in the area and they're actually fascinated clinically by a lot of this stuff but
Ollie: Yes. Yes.
Sophie Shephard: they've actually said to me, you know, I just don't think I could work in that space for long. Like i couldn't I couldn't do more than a small amount of it because I would be concerned about burnout.
Jen Smallridge: Hmm. Hmm.
Sophie Shephard: Like and I think at least from my experiences talking to people going through – I guess some of the pain training and and doing a bit more mentoring with people in the pain and fatigue space. From what I've seen, it seems like that's often a big concern, I guess. Is that something, because Jen, I know you guys have been running courses for clinicians around invisible illness for a while. in In your courses and in the discussions you've had, does that seem to be a common thread that comes through?
Jen Smallridge: Yeah, yeah. And I feel like even when I started, I know Flo was so aware of the occupational risk of burnout and really encouraged me to keep my, if I put in quotation marks here, healthy pops, like to keep my general EP caseload and start to gently add and add and add the invisible case illness caseload, which now I look back and that is a form of pacing.
Jen Smallridge: Like it's genius.
Sophie Shephard: Yeah.
Ollie: yeah
Jen Smallridge: And
Ollie: Masterful.
Jen Smallridge: It was just gorgeous. And I think it was really well-timed advice because the demand, as we know, is so there. So you could open up your books and you could fill up if you don't have any systems and structures in place to protect you. So I felt that my alternate roles and like lecturing and seeing general population or taking clinical Pilates was a bit of a buffer for me.
Jen Smallridge: And then in our courses, because we attract a whole range of different health professionals, like hands-on to hands-off to movement to mental health, I guess that we would still carry that same advice of like, keep a diverse caseload maybe even just initially and then we can decide if you're tolerating that amount, like any good intervention, like check, reflect, how's this being tolerated?
Jen Smallridge: And with the full caveat that your life outside of your clinical work inevitably will impact your energy and your the way you show up within your clinical work.
Jen Smallridge: So i think there is a bit of like a healthy fear factor
Sophie Shephard: and
Jen Smallridge: around burnout. And I'm so happy to speak today about the time I got burnout.
Ollie: Thank you.
Jen Smallridge: Such a big like bookmark, I guess, in my story, because it was just so blindingly obvious in hindsight. But it like all things, just so multifactorial. So I, I would encourage people who are feeling like curious, i guess, to get to know that feeling of like fear of burnout. Well, with the people who you see who don't have invisible illness, like, are you working harder than them? Are you trying to solve problems for them and not really being empowering are you enjoying being the fixer healer helper because we have to drop that in the invisible illness space there's no 12-week program there's no true cure I suppose they've got to be really uncomfortable with outcomes not swimming along at a lovely acceptable pace for everyone
Jen Smallridge: so Yeah, I'm keen to hear from both of you if that resonates or like is bringing up things that you've heard or experienced yourselves too.
Ollie: Big time. I, I really resonate with that, that the meta principle of pacing, even within your own professional journey and how it's always comical to me as to how pacing pops up as just one of the challenges of many, many of i think within many of life's challenges, even if it's not clinical, like in any, any aspect. And so particularly as you, as we've transitioned, you know, as I've now,
Ollie: work with Soph and that's most of my week and obviously now mostly with this it's been interesting how I'm glad that it took time to get there but also it's it's quite enjoyable to me now that I've never been so well or been so you know there's always the chaos of life but but in that kind of confident, steady place of helping people, i looking after myself, the dance continues, but the challenges are probably greater than they were years ago.
Ollie: So it's good.
Jen Smallridge: oh my gosh.
Ollie: Yeah. what What do you notice with, because something I experienced, thankfully, after I did your your course, which was wonderful,
Jen Smallridge: Hmm.
Ollie: was like one of the biggest challenges around a fatigue flare, or we can call it so many different things, but a multi-week month extended period of reduced capacity.
Ollie: that there were perhaps signs earlier on that i I could have paid attention to, but I didn't until I learnt some of these different ways of seeing these issues and managing them like we learnt at the course.
Ollie: What do you notice in other professionals and clients and maybe yourself with your own story that are these early warning signs, the canary in the mine shaft, so to speak, where it's saying, hey, we're getting to our edge here, we're potentially pushing too much?
Jen Smallridge: Oh my gosh. you can probably tell. that I love this question and it like simultaneously takes me back to a time where I wish I listened, but I also see, I wish I listened to my body and I simultaneously see the socio-cultural economic factors that I chose to just press snooze on those signs and symptoms.
Ollie: yes
Sophie Shephard: Thank you.
Ollie: think
Jen Smallridge: Like, I hear you, but also like not right now. And like purely objectively,
Ollie: yeah
Jen Smallridge: I had an Apple watch on and I'd be sitting in a cot and consult and it would be like, you have a very high heart rate. Like actually sympathetically. And I know I have the propensity to be so sympathetically driven.
Jen Smallridge: And like, you know, as we all know, we're always trying to work on that autonomic flexibility ourselves.
Ollie: Yeah.
Jen Smallridge: But work was like invigorating me, but it was also in an environment where at a like clinic level that was very pro getting stuff done and the hustle and no rest, let's go.
Jen Smallridge: and it was working for the people who were like taking Pilates classes and getting those runners back to running. But like you can't really apply that embodied feeling in a session with someone who is basically housebound because of their chronic fatigue. So there was a mismatch of culture with the work I was doing. And then, yeah, my heart rate was just going high all the time. I was like, ignore, I'm fine.
Jen Smallridge: oh I did like cry in the shower quite a lot. That was a pretty, it was pretty profound. And then my husband said, haven't heard you laugh for a while.
Jen Smallridge: And that was like, oh, oh, like talk about a canary in the mineshaft.
Sophie Shephard: Mm-hmm.
Jen Smallridge: Like
Ollie: Mmm.
Jen Smallridge: That's suddenly not okay. And I started to toy with the idea of stepping away, but kept finding all the reasons why not to. And I will say, you know, all those little signs and symptoms were there. And it took my GP saying, I think I went in.
Jen Smallridge: because I was like, oh, just not feeling good, not feeling good, something I just need. like To be honest, I think I wanted like sleeping assistance from my GP. I was like, I'm not sleeping. What can you do to help?
Ollie: Yeah.
Jen Smallridge: I thought I would get some sleeping tablets, which is not my style.
Jen Smallridge: I've never had a sleeping tablet. So that was not good for me. And she actually called it and she was like, you can't, you can't, you can't go back to work. And I was like, okay, I'll give my notice period. Like, well, this is big.
Jen Smallridge: And then two days later i went back in and she's like, I don't think you can go back at all. And it did take someone kind of taking the lead because as we all know, is I had a caseload. Like I had a list of people.
Jen Smallridge: We had appointments in the diary. Like integrity is my thing. i said I'd do it, so I'm going to do it. And it just challenged everything I knew to be true about looking after myself because yeah, you actually, i hope no one listening kind of gets to this point.
Jen Smallridge: And I wonder if either of you two have, but like saying no or like pressing pause suddenly and someone needed to say it for me.
Sophie Shephard: Mmm
Jen Smallridge: But then when it was decided, was like a massive flood of relief in my body of like, I couldn't, even if I tried, like, even if there was a fire and they're like, you have to see this client to get out of the fire.
Jen Smallridge: I think my body would have, well, I guess that's freeze, isn't it? Like,
Ollie: Yeah, so true.
Jen Smallridge: Immobilization. i think I would have been like, well, here I am in the fire, like so different to anything I've ever experienced, but I would never say it was the nature of the work I was doing.
Jen Smallridge: i mean, this was Melbourne 2020
Ollie: Oh my gosh.
Ollie: Yeah.
Jen Smallridge: I felt like the violin player on the Titanic, like just let's keep on playing while everything is falling down around us. So many, many like factors but it just eventually the body as they say the body keeps the score and it was kept for me so yeah I I wonder like I guess I'd like to hear also like your signs and symptoms Ollie but mine were just like an a sense of not me and have to follow that
Ollie: Well said.
Ollie: well said
Ollie: my My one that I learned that I'm still continuing and I'd be fascinated. I don't know if I've actually had this conversation with Soph, this is going to be really interesting to hear what she says, but I noticed my mood is like the biggest indicator. I'm very terrible at hiding. get grumpy really quickly. So my poor partner was very supportive, still is.
Ollie: And I noticed I was just, yeah, it was like, it was it was became an obvious depression.
Jen Smallridge: Mm-hmm.
Sophie Shephard: Thank you.
Ollie: but not one for the reasons I had been conditioned or taught that depression would come from. And it took a while, probably honestly, and in hindsight now integrating the – stuff I learned on your core course and working and learning with Soph over this last year to go, it was actually an exhaustion, physiological exhaustion and and these signs earlier on were talking to you and that's now what I'm so curious about because it's often what is most pertinent to help people with and go, oh, we can listen to this and we can prevent this and change this and and maybe that, you know, that mood shift that's been going on for three weeks is telling us something.
Jen Smallridge: Whoa.
Ollie: so what did you notice like i know you've you've been through different experiences but what's been pertinent or helpful to you
Sophie Shephard: Well, I mean, i think I actually still, even with all the discussions we've had, i think I still sometimes struggle to untangle some of my experiences because I think there are probably so many overlapping facets to what I experienced that it's sometimes hard to figure out, okay, what's what and what's contributing here.
Ollie: and
Sophie Shephard: I guess to think about a previous experience I had, You know, I've had the experience where a few years ago i was feeling just, I guess, probably kind of similar to what you described, Jen, just very off, not right, overwhelmed would probably be the the word I would use if I was to sum it up.
Sophie Shephard: But it it sort of wasn't like conscious, anxious thoughts. It was just this general feeling of of overwhelm, and I can't explain it beyond that.
Jen Smallridge: Mm-hmm.
Sophie Shephard: And it got to the point where I actually, you know, I thought, right, I'm going to actually do the thing after ignoring it for quite a long time. I was like, I need to suss out some help. And I went through the Black Dog Institute, for those of you who aren't aware, anyone listening,
Sophie Shephard: They have a really fantastic program for health professionals and they actually offer free sessions with psychologists to help deal with occupational burnout. So fabulous resource. I'll link it.
Sophie Shephard: But I actually engaged with them and it was this really weird situation where when I was going through their questionnaires, like like everything, and when I described what I was kind of feeling,
Sophie Shephard: it sounded very burnout-ish. But then when I went through their questionnaires that were specifically looking at occupational burnout, my scores were like normal. Like, you know, it was still like, you know, i wasn't hating turning up to work every day.
Sophie Shephard: i still really loved what I was doing.
Jen Smallridge: Thank
Sophie Shephard: So the psychologist at that point was like, I don't really, this is a bit weird. are you sure? Like, I'm sure her brain was sticking over going like, are you sure you're not lying to me on these questionnaires? Like, did you misread or flip the scales or like, you know, the zero to 10 is now the 10 to zero or whatever.
Sophie Shephard: And that was really weird. And maybe six months later, i was diagnosed ADHD and autistic. And so it's like, oh, okay, there was that was more going on than just what was happening in the workplace.
Ollie: and
Sophie Shephard: But I think for me, it was this really interesting moment of realising that you know Often when we talk about burnout, it is very centred on the work. and And I think my experiences have been very different in that I've worked pretty much exclusively in the persistent pain space, fatigue space, invisible illness space for now quite a few years.
Sophie Shephard: And during that time, while there are definitely challenges and and it can sometimes be a lot when you're sitting with people who are in distress, I've never felt like it was the work itself that drained me and i don't I've never dreaded going to work. I've never felt oh like I need to get out of this.
Sophie Shephard: For me, it was so many of the other contextual things around it and the the workplaces I was in and other factors at play that would impact it for me. and And I think that's where it's really fascinating. I would say more recently because I also have a lived experience chronic fatigue syndrome. So probably in the last few months after, after joking on our very first episode about how I'm pretty much in remission, I think I jinxed it because the last few months have been kind of awful.
Sophie Shephard: And so for me,
Jen Smallridge: Thank you.
Sophie Shephard: It now shows up more recently as I guess probably the actual physical symptoms, like somatic symptoms of of fatigue and illness. And that's how I tend to feel it.
Sophie Shephard: But it's always kind of felt very different, I guess, to your typical experiences of burnout. So I think but i don't think that's just for me.
Ollie: and
Sophie Shephard: I think that's also a lot of people is that everyone experiences it very differently and it kind of takes tuning in and really unpacking what it is you're feeling and actually being present in your body.
Sophie Shephard: enough that you can actually appreciate that that's what's going on as a starting point before you can start to really work it out.
Jen Smallridge: Yes. Oh, my gosh. Firstly, I'm sorry to hear that things have not been as remissiony as you would have liked them to be. and I so agree with what you said around like I would never say it was the client work and the actual like relating and doing the doing that still maybe it was protective in a hindsight to do something that really lit me up.
Ollie: Thank
Jen Smallridge: in a multifactorial system where I wasn't thriving. and it did make me think, I wonder what both of you would ponder about this. In my experience, like, yeah, the body whispers first, like, here's some fatigue, here's some sleeplessness, the things I could cope with pretty well.
Jen Smallridge: And then symptoms just started to, in my experience and maybe some of my clients, like, I feel like the body takes away the thing you really actually needed to do to meet that demand. So,
Jen Smallridge: when I've pushed it way too far, like it's in my eyes, it's in my ability to focus, which is so much of my job and it used to be my voice, my throat. Like, I just feel like the faculty that got taken away was finally the last thing for me to like do the work. And I just wondered if that, like we spoke about mood, Ollie, like was that the last thing that the body was trying to do to get you to stop or they just the one that was the most uncomfortable or and same for you, Soph? Yeah.
Ollie: That's a really good question. and Yeah, this gets me so excited and fascinated about this whole broader allostatic theory. like with how it all connects, how it's such an integrated system and how different things are more important for each of us. For me, i think what was obvious and still is now is that my primary coping mechanism and source of joy, one of my biggest sources of joy is movement.
Jen Smallridge: Yes.
Ollie: And that that using that, became a problem. Like it it actually, the the medicine became the poison as I've often say to to friends and clients, like the very thing you're using to help yourself then starts to make you worse.
Ollie: It was like, oh, well then now what? Like I'm exhausted after doing the thing that usually helps me get ready for the day and I've still got a day to do and people to help.
Sophie Shephard: Mm-hmm.
Jen Smallridge: yeah
Ollie: oh And it was, yeah, it was just that plus the mood. And then I was, which is probably a classic ignorant male thing where I'm like just going to push through and ignore my body and keep going and not, not listen to the subtleties of what my body's telling me, which is an ongoing journey.
Jen Smallridge: Hmm.
Ollie: But that, that exercise thing was a big one, still, still big one.
Sophie Shephard: i think I think that kind of speaks, though, Ollie, to the fact that, like, i think what comes through in most of the discussions we see around burnout, I think when we're whenever we're talking about, you know, self-care and sometimes, you know, theres there's nuance even in talking about self-care within these big systems too.
Ollie: yeah
Sophie Shephard: That's a whole conversation i'm sure we'll get to. But, the you know, even when we're talking self-care, I think it just highlights that, having sort of a breadth of strategies that that we have and really building that toolkit can be of use because like you said, if you've sort of got one thing that you're relying on, becomes hard when maybe that isn't a viable strategy as it was or or things change.
Ollie: And
Sophie Shephard: Coming back to what you asked, Jen, around, you know, at what point, what tips the scales for for where things impact, I do wonder how much of it is that so many clinicians, I know it's certainly been my experience and also a lot of clinicians I've spoken to where, know,
Sophie Shephard: there are so many pressures both externally but also internally as a you know a personality and and a sort of self-compassion thing that it's like we have to power through because there's no alternative and so it's it's really only when we're physically forced to stop sometimes like where it's like okay we can actually no longer continue this that choice is taken away similar to what you were describing before and I and I do wonder how much of it is that because
Jen Smallridge: Hmm. Hmm. Hmm.
Sophie Shephard: you know, i think sometimes it's really hard as as health professionals, particularly those who end up working in these, some of these more complex spaces, generally very, you know, empathic, very compassionate people who are there because they want to help other people and they carry the the weight of that and the gravity of that because they know what people are living with and they know that they have the skills to help.
Sophie Shephard: And so there is this, sometimes I think it feels almost like this moral imperative that, well, we have to be showing up because we, we, you can kind of see the impact and the assistance you could provide.
Ollie: Mm.
Sophie Shephard: And so it's like, yeah I don't know, there's this tension of like, how much of yourself do you give before we actually start prioritizing ourselves?
Jen Smallridge: Yes. Yes.
Sophie Shephard: And I think that's often not helped by many of the systems we work in either.
Jen Smallridge: yeah
Sophie Shephard: But yeah, I mean, it's, it's tricky. I think, coming back to that idea of, I guess, having different strategies, Jen, I'd love to hear when you're talking to clinicians who are in this space or Even conversations with, like, I don't know about you, but many of my patients who I'm seeing as patients are actually health professionals. Like, it does seem that, you know, health professionals themselves are maybe more susceptible to developing some of these sort of chronic health conditions, or maybe it's the other way around. Maybe they gravitate towards health because they've had lived experience.
Sophie Shephard: I guess, what would be some of the things that, if you were talking to someone about maybe the things that they could consider or some of the ideas around, structures, systems, processes, you know, things that might actually help with maintaining wellbeing while working with complex caseloads and making sure we can still show up in the way that we need to, what would be some of the things that you would sort of talk about with people or recommend?
Jen Smallridge: m I think this is powerful and maybe we'll make the assumption here that someone's not drowning like you and I and we have all drowned and that therefore the answer to that type of burnout is put everything down and get to the ground and rest so let's say like we're fortunate enough to be having a conversation far earlier in the piece and the body's starting to give some whispers i
Ollie: Thank
Jen Smallridge: suppose knowledge about yourself and your nervous system and your neurotype, if that's applicable, and your chronic health history or your health history, think is priceless.
Sophie Shephard: about yourself and your consistent and your chronic health history or your health history. I think it's quite clear.
Jen Smallridge: Like if we're going to be talking to people about their invisible illnesses, maybe we need to get reflective on what our body has been through and the different responses it has had.
Jen Smallridge: So the way that you described like being drawn to helping people or being drawn to healthcare
Jen Smallridge: I've heard that framed as like we get our dopamine from assisting other people. And if I look back at my work history, I was at Kmart for my first job and I felt so lit up on register eight helping people because that was my scope to help people.
Jen Smallridge: And then now I get to help people with invisible illness, but like the joy is still the same. And when I've been in work environments where I haven't had a direct impact or I can't see the impact or feel it, or I'm not in the right setting to assist, or I'm not getting that feedback.
Jen Smallridge: I felt depleted, not great, amotivated, a bit apathetic.
Ollie: Amen.
Jen Smallridge: So knowing yourself and knowing what actually does like feel good on a very simplistic level. but then I think then helps you make some decisions around, okay, this thing feels really good. It feels really good to help people.
Jen Smallridge: I then need some limits and some boundaries and some, if I get elevated when I'm talking to people and I'm working in this way, or I have a thousand thoughts at once, I actually need like structures in place to ameliorate that.
Jen Smallridge: So if I were to work with someone and and maybe anyone listening to this around that preventative pacing picture. I guess you would firstly have to go on a journey of discovery with yourself to notice what your nervous system enjoys, does not enjoy, where are the bits of compression in your day, where are the bits of expansion?
Jen Smallridge: And on a very like practical level, shout out to ai
Jen Smallridge: AI has helped me feel more expansive in healthcare care because I can be here and I can be present.
Ollie: Thank
Jen Smallridge: And when I used to type and listen at the same time, I would start self-auditing the note that I was writing through the lens of, I don't know, NDIS, Medicare, what if I get audited?
Sophie Shephard: Thank you.
Jen Smallridge: What if this person requests a clinical note in five years time? Have I correctly captured their experience? Like, yeah, we can multitask. Arguably we can't, we're just constantly switching, but,
Jen Smallridge: I actually have noticed my own energy and my own tolerance to seeing, let's say, a new patient or to seeing multiple clients in pretty short succession of time. I feel more expansive because I am more single tasking and focused and present. But that took me knowing myself and also then hearing from other beautiful health professionals that they were utilizing good quality AI for this purpose. So I guess like there was a real philosophical chat there about knowing yourself and then also a real like practical, whoa, what strategies already exist? What tech geniuses have worked on this so that I can do my job?
Jen Smallridge: whatever that dopamine wired brain of yours likes to do
Ollie: Thank you.
Jen Smallridge: How can I do that in a way that is paced and supported? So I guess on another just strategic practical level, i i have to get pretty clever with how I open up my diary and also how I close it off. So putting in blocks of unavailable time physically stops other people from booking into it and mentally stops me from over offering that to many people or over offering it to myself as having lots of tasks that I'm just going to fit in that one magical hour because, my gosh, it's an hour.
Jen Smallridge: So I just, I guess like that's taken knowing myself and I'd be so keen to hear your approaches too of like, I probably used to get away with a lot more, a lot more cramming, a lot more adrenaline. My capacity now is so different to what it was then. I've had two kids in that time. I think that's very healthy, normal shrinking of the bandwidth because it's been allocated elsewhere. So i yeah, I had to update my systems to match the the version of myself that was meeting the challenge.
Jen Smallridge: But if you work in like private practice or for another person, maybe no one's having those challenges updates and system chats if we're going to call them that like
Sophie Shephard: I was going to say, just the hearing you talk about this, like when you're talking about systems, something, I don't know whether it's been a good thing or maybe if it drives Olly nuts at times, because I feel like like I'm like, I genuinely, i feel like there has been so much change in processes.
Ollie: I admire it.
Sophie Shephard: I mean, and part of it is because we're, and I'm a newer clinic, like we've been open, coming on three years now but I mean in that time Ollie started and obviously when you go from just you to multiple people things change we went to telehealth in that time so it's like there's been a lot of evolution and one of the big things that I spend a lot of time thinking and working on is like how can we actually make systems more efficient because think that's a bit that we often miss and I maybe touched on it before but you know mentioning about
Sophie Shephard: maybe how the idea of self-care sometimes can become a little bit problematic because it it's it's an important part of of clinician well-being definitely but I think sometimes it's thrown around and held up as like the be-all end-all as a way of basically putting all of the burden onto the individual and kind of neglecting the role that the systems and the workplaces we work in play and you mentioned some of the financial and
Ollie: and then
Jen Smallridge: Mm-hmm.
Sophie Shephard: social cultural influences. And I think like, that's a huge part of it too, that underpins it. And we, we actually, if we want to be serious about looking after wellbeing, we need to be able to take that bigger look. I'm i'm interested though, Ollie, because I know you've had a lot of different experiences and obviously you've been, you know, with us now, like how has it been for you? Not necessarily specifically with my clinic, but like just in terms of the, the impact of different processes and streamlining and that sort of extra appointment,
Sophie Shephard: you know, outside of the appointment sort of stuff? How has that impacted on your experiences?
Ollie: Massively, massively. Yeah, I think it's one of the groans that each one of us have, allied health professionals, I think in particular, but, you know, medical professionals, GPs probably have it far worse.
Ollie: Is this, yeah, is this pressure of workload that is outside the fee-for-service model that most of us tend to exist in.
Jen Smallridge: Mm-hmm.
Ollie: And, know, It wasn't until I had a model that I transitioned into community care physio when I left the the classic private practice industry that wasn't suited to me and I wasn't suited.
Ollie: Yeah, we weren't suited to each other. That I realized, oh, there I could have more affordances. andt it And it, I think, speaks to what why i now work for Soph and I think what were saying before, Jen, is this... the impact of the context on our agency that that when we've when we've lost and when we don't have the agency to change things where we see problems, either our own problems or bigger problems in the systems we exist in, then we can very quickly have that learned helplessness and the physiological consequences of it.
Jen Smallridge: Mm-hmm.
Ollie: Whereas what I've noticed and really admired about Soph is even being a you know just insanely productive person with the things she's doing is to go, no, you know what, actually this thing that we're doing right now is is you know not as effective or as helpful as it could be for us or for our clients. Let's change it. Let's talk about it. And there's always open to it. And I think what that's allowed for, even with the AI stuff we've just talked about, that Soph and I, I mean, my life's been completely changed by it. Like i as you said, can now completely focus on the person in front of me and listening, knowing that that detail is usually pretty well recorded.
Ollie: Yeah. getting better so i like my experience has just been been yeah i'm really grateful in hindsight because now those pressures and the affordances i have to have that time better better integrated into work are are improving and i think the industry still has has constraints that we all have to operate in but i think seems to be upward trajectory in our little silo
Jen Smallridge: Yeah. Okay.
Jen Smallridge: yeah
Sophie Shephard: think I think coming back though, what's what's jumping out at me from both of what you're saying is the, I guess, the workplace side of things. and And, you know, Jen, you were talking about even just things like.
Sophie Shephard: being able to rule out time in the diary where it's like, hey, like I need to block this out. I need time to do admin. You know, I was honestly kind of horrified to have conversations with some people. Like I've been relatively lucky in the scheme of where I've worked in the past, but some of the, I would say, horror stories of people who have worked in really – I would say toxic private practices who where it's basically the expectation is you're doing 20 minute appointments back to back.
Jen Smallridge: Well.
Sophie Shephard: There's back and you're expected that your notes are pretty well done in that 20 minutes as well. And people just end up doing massive amounts of hours of unpaid overtime to do clinical notes and to catch up on all the stuff that inevitably has to happen if we're doing good care, you know, letters and reports and all those sort of things that aren't often paid, which is a whole issue in itself. And, you know, of course, like we should be valued for the time that we need to take for this. And that speaks to some of the broader health system funding models. And there's a lot to unpack there, but the, I guess it, it sort of speaks to the idea that, you know, the workplace and the culture has a huge role. And I think,
Sophie Shephard: what you were saying about having the affordances, Ollie, of being able to practice in the way that you need to. You know, I think I really liked a few years ago when they were talking about burnout, I think it might've even been in the midst of COVID when this was really becoming apparent that this was a huge issue.
Sophie Shephard: And this idea that we need to stop maybe calling it burnout and actually call it what it is, which is in a lot of cases, it's moral distress. And a lot of it comes from not having autonomy to be able to practice in a way that's consistent and coherent with your values and the way you want to practice.
Jen Smallridge: Okay.
Ollie: Yeah.
Sophie Shephard: and And a lot of that often does come down to mismatch in the clinical setting or to external constraints and pressures that mean that we're not able to show up and deliver care in the way that we feel we need to.
Sophie Shephard: And that's hugely demoralizing. When I think back to the times where I have felt more strain with work, it's been in those situations where I've actually felt the circumstances weren't right for me to be able to show up in the way that I felt I needed to, to do a good job for that person.
Sophie Shephard: I'm interested in your thoughts though, Jen, if that's something, thinking back to your experiences with the clinic you're in, is that something that resonates with you?
Jen Smallridge: Yeah, you can probably see and hear and feel me vigorously nodding because it's fast. That is a really great encapsulation of the moral distress. And I remember at the time, earnestly reading a Harvard Business Review piece about burnout. And it and because I was like, I think I have burnout in Google.
Jen Smallridge: And it it spoke about like these multi, multi-layered factors. But the thing that like got someone in the end was like the faulty, printer cartridge or like everything like all these layers all the time but every time they went to go print they're like oh the printer cartridge again like someone needs to fix that like it's as we said before like it's never just one thing and it's not often the body of the work that we're here to do but it's layered and multi-contextual and
Jen Smallridge: I'm so glad to hear that you two have an open communication between processes and visibly seeing that they can be altered. Like there's nothing like giving all this feedback around organizational change, which often like I'm, I was talking about things that would have taken like 30 seconds, but they never got done.
Jen Smallridge: So then you're just yelling into the void and
Ollie: Yeah.
Jen Smallridge: that probably speaks to management being under-resourced and clinic being under-resourced. Like it's so tricky, but it did and does, it did impact me from like being fully present with a person. And I think when you are somewhere, but you're not they're there, there,
Jen Smallridge: the cost of that like in terms of autonomic and psychological distress of not being fully where you are in your body at that time it's so it just ends up with people falling out of the business and and moving on but I with regard to like paid versus unpaid notes and admin sometimes I just think like What if you just, you know, had that little portion allocated to each clinician so they felt loved and seen and valued versus the cost of losing someone, rehiring, advertising, onboarding.
Sophie Shephard: Yeah.
Sophie Shephard: Yeah.
Jen Smallridge: I'm not in economist, but I think I could have ran the numbers of just what if I just had a little extra 15 minutes on that day?
Sophie Shephard: that's
Jen Smallridge: No, no, no, no. no
Ollie: No, the unseen costs. From someone who was doing economics before physio, it blows my mind that what you just said there is not there. It's the same thing as, I mean, so many businesses and humans have this problem where it's like what we can see seen cost can be easily like over controlled and shaped.
Ollie: Whereas an unseen cost that's bigger that we don't look back and go, Hey, actually, yeah, the cost of losing and hiring a person is enormous and perhaps multiple thousands of dollars. Whereas the $30 a console, maybe twice, three times a day where you let this person catch up.
Jen Smallridge: Yes.
Ollie: Yeah.
Jen Smallridge: And breathe.
Sophie Shephard: Well, it just comes down to, you know, and I think particularly when we're talking about chronic pain, chronic fatigue, and and I totally appreciate like obviously running a business that you've got overheads to meet.
Ollie: Yeah.
Jen Smallridge: Wow.
Ollie: yeah
Sophie Shephard: and And in many ways, we're in a very privileged position because we do run as a telehealth clinic. So we don't have overheads of rent, you know, where we're in a good spot from that end. So in some ways, we're not under the same level of pressure as many clinics would be.
Sophie Shephard: But it it is amazing to me that like the extent to which we'll we'll hyper focus on like, oh, every single like bookable hour needs to be booked in and like there's no allowance for things like notes or anything like that.
Sophie Shephard: But yet we'll continue as a clinic to run with the most inefficient system that like costs us hours of admin time a week. Like just, just stuff that like, you don't, again, it's exactly what Ollie just said, but it's like the unseen stuff.
Jen Smallridge: I'm sorry.
Sophie Shephard: And like, you could be really cutthroat about it, right. even if we weren't decent human beings and we actually, you know, if I, as a boss, Ollie, you know, didn't care about you as a human being and literally just saw you for the dollar figure over your head, it doesn't, there's not even a good business case for not, for not putting this stuff in place.
Ollie: No, no, it's bad business.
Sophie Shephard: but Like it goes beyond that because obviously I do care about you as a person and I think it's problematic that we have businesses that don't see their workers as as humans and see them as the dollar value. And I think, you know, capitalism does have a lot to answer for when we're talking about a lot of all of these things, but it comes back to just not,
Jen Smallridge: Hmm. Hmm.
Sophie Shephard: yeah like we need to take care of our clinicians who are caring for others. Like you, we actually have a responsibility. And i my personal opinion is if we can't be, if you're a business owner and you can't run a business without driving your staff into the ground, you shouldn't be running that business. Like no business should operate at the cost of its employees.
Sophie Shephard: And I don't know. I like that. I know. Thank you for clapping. Anyone that can't see Ollie was sitting there clapping, but,
Ollie: Bravo. Yes, a agreed.
Sophie Shephard: I actually, that makes me sad that that is like a bar to clear. Like the the bar, to me, that bar is on the floor. Yeah.
Jen Smallridge: Yes.
Sophie Shephard: like yes Yeah,
Ollie: Really when it's had like that, because it seems so obvious. It's like we wouldn't, you you know, we we wouldn't get, know, if you're incredibly cutthroat, right wing business person running a corporation, it's like, yeah, we can't afford this, this will cut it off, the business doesn't work. And yet, yeah, we do. So otherwise, it's funny.
Jen Smallridge: yeah
Ollie: but Perhaps actually, this is a good sort of interject, also like diagnosed ADHD, which has has helped me understand my pacing a lot more. But now seeing that this very journey that is represented in our learning as clinicians,
Ollie: I'm gonna hate that I'm even saying these words, but about, it feels like a spiritual existential evolution in itself, that like we're figuring out how to be better humans to do this job, like, and and to to help people in the ways that they need to be helped.
Jen Smallridge: Yes. Oh, well, firstly, just mike mic drop at that phrase.
Ollie: thoughts Yeah, sorry.
Jen Smallridge: just well i And let us hope, I suppose.
Sophie Shephard: Oh.
Jen Smallridge: Like we spoke about AI and we spoke about systems. And then, you know, I've seen Florence take a yoga class at our retreat for health professionals.
Jen Smallridge: And she made a comment at the end saying everyone was like, wow, like that was amazing. And she was like, it's the oldest technology we have. Like, I'm loving systems, but I do have to come back to the technology within me and in all of us of nervous system awareness.
Ollie: Mm-hmm.
Jen Smallridge: And as you said, Ollie, like understanding ADHD to understand pacing, how it works for you. and then what if you then happen to match with a fantastic ADHD a patient who has the same like capacity for rest and activity and you can talk about that and suddenly then work is like,
Jen Smallridge: an extension of the growth that you've been doing in yourself. And that's not to say like treat everyone as though you've been treated. Like I think our job is to help guide people to what works for them, but from a really grounded a grounded place of confidence, not jumping through hoops for people because that would lead us to burnout anyway.
Ollie: Yes.
Jen Smallridge: But yeah, that and notion that like business,
Jen Smallridge: is kind of healthcare business is kind of hopefully a reflection of where we're going to do this sustainably. And I can only wonder what it would feel like, because I don't think I have been, but like to be a patient at a clinic where people are getting quite churned and burned, i only got the feedback.
Jen Smallridge: from my patients who have followed me, which I'm so eternally grateful for, of like, that people actually notice this and their nervous systems are having an experience in these surroundings that people just give you a look like, uh-huh.
Ollie: Totally, yeah.
Jen Smallridge: Yeah. like you're leaving okay like I how conducive is it to health care and healing if we're yeah maybe there's a bit more responsibility there for clinics to actually like be regulated in order to then help people yeah it's like an ethical responsibility when you put it like that
Ollie: its time totally yeah the the power of context now. And I've been grateful to like, obviously now with, with how Vives set up and and I'm sure with yourself with the telehealth, people who access from home, but even a previous clinic where the owner puts so much attention into the,
Ollie: the experience knowing those things and it was one of the first times I had it shown to me like minimal stimuli coming in safe like that it was facilitating the embodied safety that we were hoping to provide with our interaction with it the clients walking in and it and it was the first thing to go oh this is important it needs to be there on every layer of the context rather than the burden on the clinicians
Jen Smallridge: Wow.
Jen Smallridge: Yes.
Jen Smallridge: Yes, to do more self-care, which you've touched on.
Ollie: yeah
Sophie Shephard: Yeah.
Jen Smallridge: Mm-hmm.
Sophie Shephard: Yeah. and and And so on that, I'm going to ask more about self-care because we, you know, we we do know that, yeah, you know, there are lots of systemic layers to it and we can't ignore those when we're talking about this.
Ollie: yeah
Sophie Shephard: And at the same time, in many ways, we've got clinicians who are still having to show up, live and work in these conditions.
Jen Smallridge: Mm-hmm.
Sophie Shephard: And so having the capacity to have skills and tools that they can use to regulate iss really important. We've spoken about some really good things already, Jen, you know, what you mentioned about just tuning in and being able to know yourself and maybe some of those warning signs, some of the practical things like having, you know, just looking at your workload and setting boundaries and sort of knowing, okay, well, I need to actually block out time for what this is going to take and make sure we're not, you know, ballooning out or things like being able to rule out time where we can, if you do just need a bit of a decompression.
Sophie Shephard: Are there any other practical sort of strategies or things that either you use or that you've heard people use just in terms of sort of general sort of self-care strategies or things that jump out?
Ollie: Thank you.
Sophie Shephard: And even for you, Ollie, maybe some of the other things that you've used in the past.
Jen Smallridge: Yeah, definitely. guess like we've really gone from the macro, this is like micro pacing and I love it so much, but getting really curious about like, what does it feel like to hold space in a consult and then having a bit of playing with like sitting back, like where is the back of my body? Where is the back of my chair?
Jen Smallridge: Cause I'm like a lean in person. I could lean right into my screen if it would let me. And that has been a really cool practice of like just
Ollie: Yep.
Jen Smallridge: pendulating that awareness between my anterior and my posterior body. So that is something like if you're listening to right now and you're driving, like, or you're walking or you're with a pet or something, like just noticing what it's like to gently draw back some of that energy and and your physical awareness. I think that's a really cool one we can do when we're listening to someone or we're spending time with them, whether it's person face-to-face or telehealth.
Jen Smallridge: are they cool like somatic I guess I don't want to use the word hacks because that's so like capitalist because there's no rush to get to this regulated state but
Sophie Shephard: You can be as hacky as you like. Ollie's already branded his balance, his inclined board and, you know. and
Jen Smallridge: oh I love it let's get hacky then it is a good it's a good word to get to where we want to go really
Ollie: and
Jen Smallridge: I quite like, you know cold water on the pulse points. Maybe even if my hands are a little bit cool, like touching around my, as I said, my eyes are my, they tell my story all the time.
Jen Smallridge: So I can just gently feel some cold compression or I've got like a like a wheat bag that I keep in the freezer that I pop over my eyes to have a brain break.
Sophie Shephard: you
Jen Smallridge: If I take out my vision, I find I can have a bit of rest.
Ollie: It's nice, wonderful.
Jen Smallridge: legs elevated if you're a POTC person or even even if you're not, like why not just get some extra blood flow coming back into the central circulation. And i never thought of it this way until I like reverse engineered it. But I noticed that I felt quite good if I was holding a cup of tea.
Jen Smallridge: when I was working with people. And of course, there's that tactile, like soothing, sensory, safe, warm, I can see you taking a sip there.
Sophie Shephard: Mm-hmm.
Jen Smallridge: But there was also the sense that if it was a bit hot, and you're blowing on the tea, like what a great extended exhalation in a time where you might not be taking any super deep breaths.
Ollie: Then
Jen Smallridge: And if you're with someone, and it's appropriate to like, sip while they're speaking it's a good way to take a pause without wanting to jump in and we have the propensity to do that I feel because we get excited finding ways to slow down the somatic experience of being with people because particularly it depends on the story that they bring our nervous systems are dancing together and sometimes we don't know what's happened until afterwards where we're like oh
Jen Smallridge: we lost track of time or didn't ask this question or yeah, what leaves you with that feeling of a bit discombobulated. So anything that your nervous system likes to just come back into the present moment is, i guess that's a real wide way of saying there are some narrow strategies that you can try on.
Jen Smallridge: I also like to shake it off like in between.
Sophie Shephard: yep that's nice
Ollie: yes.
Jen Smallridge: That's just a nice little resetty thing. but you you may not enjoy that. So you do have to try these things on and see what sticks.
Sophie Shephard: yeah for sure what about you Ollie is there anything I could see you nodding to quite a few of the things that Jen was yeah but are there any anything else that you can think of that you maybe you use in the day or that you've experimented with
Ollie: I
Ollie: love it.
Ollie: I just want to reaffirm everything there. I'm definitely team shake off. I had a conversation just this morning with someone about how when, and this is something that's like going to be an ongoing career. I think research interest for me is what's the best embodied experience
Ollie: practice for what particular context. and and if we're feeling a bit little heightened and a little bit upregulated, then yeah, shake off, jog, hop to the toilet and back between between clients. Whether it was here at home or back at the clinic you know in-person clinics I was at was definitely a big one.
Ollie: Legs up, elevated, lying down is is a big one. And I don't even think I have POTS or an orthostatic issue, but it's always been a really helpful way to to drop into deep rest quite quickly.
Ollie: And I think for me, it's anything out of curiosity, it's almost like a creative exploration, like you said, Jen, we're always testing to these things as to what works for us. I've learned from Soph that, you know, just taking out auditory stuff and having some earplugs or like sitting, standing in different contexts, these these small things can have a big impact. But For me, it's always the sense of safety in the present moment in your body as as is is the biggest canary to to listen to but in the Mindshaft analogy and feeling into the back of your body.
Ollie: Just the ability to feel into your body, I think, is one of those key points that if you forget the complexity of all of these tools, that's the one thing is can you feel your feet on the ground?
Ollie: As my meditation teacher says to me, can you feel your buttocks on the cushion? Then yes, it's working. If you're off somewhere else, you probably can't feel your buttocks or you you know you're you're in that too lent forward or too heightened or whatever state.
Ollie: So that anything that brings us back there, there's many roads to roam, so to speak. Cool.
Jen Smallridge: Amen.
Sophie Shephard: I think what what's coming out from hearing both of you is is it's almost, and and I think what probably resonates with my experience too, is when we're when we're thinking and when we're working and we're under the pump, we are often in our heads a lot and we kind of do lose that awareness and connection.
Sophie Shephard: with what's actually happening in our body. And so, and I know for me, and I know a lot of other neurodivergent autistic ADHD people, it already we're operating with a lower degree of interoception than most other people are.
Sophie Shephard: That's something I've had to be really conscious of because it's so easy for my brain to just basically switch off from what's happening in my body completely. And suddenly it'll be like 12 hours later. It's like, oh,
Sophie Shephard: Like I had to laugh. I think I might've sent it to you, Ollie, but I have a close friend who I talk to a lot about work. He's also a physio. He's great. And I felt very attacked by him the other day because he sent me a video, like a meme. And it was basically like, he sent it to me with just no context either. It was just that and like left it with me to sit with. And I'm like, oh, good.
Sophie Shephard: It was like, my most toxic trait is telling people to take care of themselves while I'm running on three hours sleep, enough caffeine to kill a bear and a cheese stick. And I'm like, yeah.
Jen Smallridge: Not the cheese stick.
Sophie Shephard: like
Jen Smallridge: I'm so sane.
Sophie Shephard: I know. I was just like, this is just so like accurate, right? Cause I'm like, I'm the, I'm, I'm like the queen of like, please do as I say, not as I do, because this is so bad.
Jen Smallridge: yes
Sophie Shephard: Cause it's hard, right? Like, and I think that's the other thing is like intellectually, we can know that there are lots of things we need to be doing, but for many reasons, a lot of them can actually be quite challenging to put in practice. And yeah,
Sophie Shephard: I mean, I think particularly when the systems aren't set up to support them, that's one aspect of it. But part of it is sometimes the awareness and the habit and and breaking sometimes a lifetime of of just like pushing through.
Sophie Shephard: And, you know, again, the the the value we place on ourselves as being, you know, the that we are our value in being productive is a huge one.
Jen Smallridge: Thank you.
Ollie: share
Sophie Shephard: I think sometimes like we're not, I know for myself, that was a huge thing was acknowledging that like I deserve to exist as a human being, even when I'm not actively productive. in service to someone else or producing something. And like, that seems like such a basic thing, but I think there's actually a lot of people who haven't quite internalized that. And we, we sometimes do have that sort of thought process sitting in the back of our heads.
Sophie Shephard: If it and that sits there unchallenged, we just don't ever question it. And so i think unpacking that so we can have self-compassion is, was a huge thing for me.
Ollie: So good. Yes.
Jen Smallridge: Yes.
Sophie Shephard: But I really liked, yeah, all of your suggestions because I think that that resonates a lot with the things that I've found. The other one that I find, you know, it's often used as an insult when you're talking to people who are like chronically online and everything.
Sophie Shephard: But, you know, the whole idea of like going outside and touching grass, like, you know, but it's used as an insult.
Jen Smallridge: Yes.
Ollie: i good
Sophie Shephard: But I actually think sometimes that's the best thing. And yeah. Even Ollie, what you were talking about before, just with the change in posture, like there's something physiologic in that, I think, like getting up and changing position, like whether it's moving to a standing position when you've been sitting or doing something to disrupt or change your physical state, I think is in a form of reset and and getting outside.
Jen Smallridge: yeah
Jen Smallridge: Hmm. Hmm. Hmm.
Sophie Shephard: If you're someone like us who work from home, like it's really easy sometimes when you've been working from home to go, Oh, I haven't really left the house in like two days. So just like getting outside and actually spending time outside fresh air, even if it's just a few minutes, like if you're in a clinic, being able to step outside for a few minutes,
Sophie Shephard: It's hard when you're really busy, I think, too. Like I used to find when I was in private practice and we were back to back and if I was running late, it was really stressful. And coming back to what you said, Jen, about, you know, when you walk into a clinic and it feels very dysregulated because you can tell everyone's rushed and everything's chaotic.
Sophie Shephard: Like I think one of the most helpful things that I ever started doing was even if I'm running late, awfully late, which sometimes would happen because the complexity of of people I was working with and that's time that I needed to spend.
Sophie Shephard: Even when I'm running really late, giving myself permission to pause for 30 seconds and just pause and stand there and take some deep breaths and drink a cold glass of water. Because the difference that would make for how I would then walk into my next consult rather than just steamrolling in made such of a difference.
Jen Smallridge: Yes.
Ollie: yeah
Jen Smallridge: yes
Sophie Shephard: And even for me, the mental break of just feeling like you're disrupting that constant, I'm on the go all the time, It was huge. And so even if you are someone, I think, who's working in a clinic where or any other system where you might not be afforded the luxury of being able to rule out huge chunks of time or, you know, things are a bit more chaotic, even just taking those micro breaks through the day, even if it is just pausing to take some deep breaths or have a glass of water.
Sophie Shephard: What you were saying about temperature, Jen, I really like too. I'm a big fan of like tip strategies from DBT. So temperature,
Ollie: yeah
Sophie Shephard: intense exercise, progressive muscle relaxation, and my brain is not going to do the thing. What's the third one temperature?
Jen Smallridge: I think you had three. Oh,
Sophie Shephard: Yeah, there's it's double P
Ollie: One moment paced breathing.
Jen Smallridge: oh
Sophie Shephard: Face breathing. There we go.
Jen Smallridge: Oh, that's cool.
Sophie Shephard: Yeah, tibber doesn't work very well. That's why I was getting confused.
Ollie: but
Sophie Shephard: um like And I found that actually works really well for me because one of the challenges I had when I was actually seeing a psychologist was i found
Jen Smallridge: yeah
Sophie Shephard: what didn't gel for me, and I think I've heard a lot from patients, is that a lot of the very cognitive heavy techniques, like the CBT sort of, if you're having an anxious thought, take it out, unpack the thought, is there evidence for a guest?
Sophie Shephard: And I'm like, when I'm already feeling burnt out and overwhelmed, the last thing I want to do is add more cognitive load. I just do not have the energy for that.
Jen Smallridge: Yes, absolutely.
Sophie Shephard: And so so having strategies that actually aren't
Jen Smallridge: Yes.
Sophie Shephard: top down like that that you can actually tap into bodily sensation I found really valuable so temperature is exactly what you were describing Jen you know it being able to go out and have a cold compress that you can put over the eyes or the back of the neck intense exercise is relative so you know it could be something like either shaking it out, jumping jacks, that sort of stuff. If you're able to, you know, even doing a like a quick like run as fast as you can on the spot for 30 seconds.
Sophie Shephard: I've had patients who have had pain who aren't able to do what we would typically consider intense exercise, but even if there's an area of their body they can, you know, say shake or or tap sometimes like really quick tapping. I think even stimming, you know, if someone is neurodivergent or has the proclivity to to want to stim, actually letting yourself stim is a huge thing. Fidgets and things like that can be great.
Sophie Shephard: But yeah, I think a lot of it comes back to this idea of like shifting state in some ways and like where is our attention focused and how can we change and disrupt that? So lots of commonalities, but really good ideas from everyone, I think.
Jen Smallridge: Definitely. And they're making me think even like, yeah, they get out and touch grass. I'm actually like, Hey guys, like that is a good thing to do, but sure we can say that to each other.
Sophie Shephard: Yeah.
Jen Smallridge: i will actually literally do it.
Sophie Shephard: Yeah.
Jen Smallridge: But it does like, there's nothing like nature in particular, I guess, to show the impermanence of all things so like if you're outside and there's a cool breeze and then there's not and there's a cloud and then there's not it I think it really reminds us of like we can be really really full of tension and then we cannot be or that that client may be a difficult interaction one day and and not another so nothing can be too well we can get fixed when we're heightened into believing the myth that this is how it always will be
Ollie: It's true.
Jen Smallridge: so
Ollie: like true
Jen Smallridge: Yeah, I love all those strategies. Sometimes I never thought about, I always thought about them as somatic and bottom up, but actually i didn't realize that they also had a sense of transience about all.
Sophie Shephard: and Yeah, it's interesting, isn't it?
Ollie: This
Sophie Shephard: And I think, Ollie, I'm keen to get your take on this too, because I know it's something that we have spoken about in the past as well. But even coming back to thinking about, I'm so sorry, my two brain cells just decided to go completely two opposite directions in the middle of that sentence.
Sophie Shephard: It was so well formed. And then they went, nope.
Jen Smallridge: me
Sophie Shephard: Oh, that's annoying. That's really going to annoy me. Sorry.
Ollie: happens to me all the time.
Sophie Shephard: a
Ollie: but
Sophie Shephard: That's really going to irritate me because it was something we've spoken about, Ollie.
Ollie: Is it around this regulation stuff? Throw me some topics.
Jen Smallridge: Permanence, sensory...
Sophie Shephard: a
Ollie: Yeah. Nature, grass touching.
Sophie Shephard: Oh, sensory stuff was part of it, but this is really going to irritate me if it doesn't come back now.
Ollie: I have this theory that whenever we forget this, that we've got like our our hippocampus or our memory cortex cortices are like full of little oompa loompas. And like one of them might have to go down into the depths of the archives.
Ollie: And then like, that's why you wake up at 2am going, it was Bob.
Sophie Shephard: yeah
Ollie: and bob river dies It's because the leprechauns found it and come back.
Sophie Shephard: yeah yeah yeah I love that accurate I love that so much unfortunately i think mine all might be slightly drunk and and unmotivated just
Ollie: Here it is.
Ollie: but
Ollie: AWOL now.
Ollie: It's just going down to level 456. It'll be a while. There we
Sophie Shephard: Yeah, dude dude still hasn't worked out how to operate the elevator.
Jen Smallridge: be back it'll be back get back
Sophie Shephard: It's a whole thing. I'm sorry.
Jen Smallridge: i
Sophie Shephard: I remembered what it is. Thank you. did i just needed the time.
Ollie: and we go. He's back.
Jen Smallridge: yeah
Sophie Shephard: Yeah, he was just on his way back. Oh, that's funny. Sorry. So i'm I'm actually really interested to get your take on this, Ollie, because I know it's something that we have spoken about before and Jen, very keen to hear you talk about this a bit more too.
Sophie Shephard: You mentioned earlier in our discussion that sometimes part of the the pressure and the burnout can really come from holding on to this real like fixer approach to care basically do you mind maybe talking a little bit more about that and and I know Ollie that you've had thoughts on this too so maybe after Jen has said if you were happy to jump in on maybe your own experiences with that too
Ollie: Yeah, definitely. That's a good point.
Jen Smallridge: me Yeah, I, I, I'm an exc exercise physiologist. So we pretty much got taught at uni that and patient has problem exercise fixes problem.
Jen Smallridge: And if, if, the exercise doesn't work, it's because they haven't done it in enough or they haven't done it the right way, or you didn't cue that tiny, tiny muscle in the arch of the foot. So that was your fault. Like there was just a lot of reductiveness. And also I have to like make room for the fact that exercise is a poly pill that does work for a lot of health conditions in conjunction with other strategies and whole person support.
Jen Smallridge: So like and we don't want to swing the pendulum too far either way, but
Ollie: then they're
Jen Smallridge: Then imagine coming into the invisible illness space and realizing that, oh, exercise doesn't only not heal and cure these people, but it has actively harmed them in the past.
Sophie Shephard: Mm-hmm.
Jen Smallridge: And it is a complex dose response relationship. And what other tools in the toolkit do we have? So my sessions move from being far less like Thank you for telling me your problem. Here is the evidence-based exercise program and I'll see you in a few weeks to see if you've done the thing or not without any consideration for the...
Jen Smallridge: Context and lifestyle. I mean, I'm being very generalist. Of course, we ask those questions, but there was a safety in the in the guideline care and then in invisible illness, not so much.
Ollie: Hmm.
Jen Smallridge: So I'd be really curious with other health professions, what that is like. Is there a fixer, healer, helper mindset where you have the knowledge and the tool and it's up for the person to enact it or receive it?
Jen Smallridge: invisible illness has turned that on its head for me but then it made me wonder so invisible illness I guess I'm thinking how can I help this person create the conditions for their nervous system and body to be how it wants to be in all sorts of conditions that we can kind of gently change across time And then I thought back to classic like knee OA and ankle sprain and all your really typical uni assignment level of conditions.
Jen Smallridge: But like maybe exercise was also just creating the conditions for that body and the dietitian was also assisting and rehab or whatever it might've been. So we can like impart the knowledge about the conditions it takes for the body to change, but we can't like do it for them and we never could.
Jen Smallridge: And so i think in theory that should soften our load. And I really think it has changed the way that I practice of like, I can,
Ollie: Yeah.
Jen Smallridge: listen and I can give advice when it's asked for or when it feels appropriate and there's consent to do that. But then most of the time people come back when they've got chronic fatigue and chronic pain and life has happened in between our sessions and we need a totally different plan. And like, we just get to roll with those punches. And I know that that's nonlinear and people get frustrated and that's extremely fair as in like patients can get frustrated because life is so not smooth, but I've learned as a clinician to stay really like,
Jen Smallridge: a bit like shrug, like i care deeply, but that life circumstance happened. So let's work with what is here and and what what can we use from many, many sessions ago that we didn't get to use at that time, perhaps.
Jen Smallridge: Can we revisit a strategy that didn't take off? So yeah, I feel a lot more grounded as a clinician now because I don't feel like it's my responsibility to help heal, fix,
Jen Smallridge: and discharge and see you never. That was probably a very more traditional model of EP. And I, yeah, I feel really grateful not to have to do that.
Jen Smallridge: But I also know that that is an expectation, not so black and white, but like it is a bit of a thing in healthcare of like find, fix, discharge.
Ollie: Totally.
Jen Smallridge: Yeah.
Ollie: Yeah. It's really inspiring to hear say that. And I think it's because of having fellow clinicians, mentors like yourself and Sophie, that those imperfect ones of us out there that still really fall back into that fixer mindset quite strongly. And and for reasons I'm still learning about, like whether it's our own you know healthcare care experiences, you're right, the expectations of clients and the and the and the desire to provide value and help them. And sometimes that you know you're you're constantly chameleaning in many ways to their
Ollie: yeah, to their needs and context. And sometimes those preferences and and and expectations are tricky, not so coherent with how things are in reality, which is complex.
Jen Smallridge: Thank
Ollie: But I think also just like the the costs of it, as you said, like you feel a lot lighter, but that was something that was really obvious. is that when you sit back and appreciate the reality of it, which is this dynamic complex systems, thankfully, you know, a bunch of physicists over the last 50, 100 years have done some work to explain a lot of this and it seems to be useful in all different contexts, who'd have thought, that it helps you go, even if you had all the money for all the RCTs in the world and you were the smartest, best person that you ever could think to you still wouldn't get it right all the time.
Sophie Shephard: Yeah.
Ollie: and i can
Sophie Shephard: Yeah.
Ollie: so like so says that to me a lot whenever i'm falling back into this mindset that it's like can't control everything and and like i've even seen evidence to say that those who try but you know make poorer decisions the research and doctors discharge or diagnose prematurely and and and burn out faster what we've all wrapped for so it's yeah it's uh it's it's an
Sophie Shephard: yeah
Sophie Shephard: That's a huge thing. It's a huge thing. And I think, you know, yeah it comes naturally as as well. We can intellectually know that that's not a good thing, but it's sometimes a really hard thing to break ourselves out of because we want to be helping people.
Ollie: Oh my God, yeah.
Sophie Shephard: And I think the complexity is the key thing. Like i I genuinely think if there was one change that we could make across the board that would collectively help clinicians mental health like across the board would be being able to shift from linear to complex thinking because baked into that is a comfort with uncertainty that the way we're currently taught doesn't doesn't have that we are taught that if we have if we are sufficiently knowledgeable and skilled that we will have the answer that will fix people and that's just not how health or humans or life works ever and
Jen Smallridge: Hmm.
Sophie Shephard: the research around sort of burnout, particularly for people who work in these complex areas, shows that it's actually not the nature of the caseload itself. It's how people respond to the uncertainty of it.
Sophie Shephard: And actually it's the comfort with uncertainty that is often the the <unk>icin predictive sort of factor in that.
Ollie: Mmm.
Sophie Shephard: And so... I think that says a lot that actually even if you are someone who's working in a complex area, that that's not you doomed to burnout inherently. It's just maybe we need to shift the way we view and see ourselves and how we position ourselves within this system and moving from fixer and expert to coach who you know can still provide the expertise and the knowledge that we have and share that but actually acknowledging that things are really complex and every single person is going to have a non-linear perspective
Jen Smallridge: Thank
Sophie Shephard: response to things and it's kind of like, right, let's work together to work out what is going to work for you and drawing on our collective knowledge to help chart that way forward. And I think for me, that was honestly one of the biggest things that made an impact the second I took that pressure off myself and I i dropped the ego of of being the health professional that's going to fix everyone and is the expert in these conditions and just actually approaching it from that lens.
Jen Smallridge: Yes. Yes. Yes.
Ollie: They come.
Sophie Shephard: I think that single-handedly made the biggest shift in how I was feeling overall. So I think that's a huge one.
Ollie: come
Jen Smallridge: yeah
Sophie Shephard: Really... conscious of time here and I'm so appreciative that we've been able to have you join us Jen I guess before we finish up is there anything that we haven't spoken about that you'd like to end on or maybe is some parting advice if you could tell the clinicians who may or may not also be patients who are listening what would be I guess maybe one key takeaway or some keynotes from today if you'd like to see them take something away
Ollie: then
Jen Smallridge: Oh, can I have two?
Sophie Shephard: You can, I'll allow it.
Jen Smallridge: Thank you. When you spoke about shift yourself shifting away from the fixer, healer, helper, it made me think about just lately, this has happened like quite organically, but the phrase triggered to act comes to mind of like, as a clinician, am I being triggered to act here on a nervous system level, as in triggered to help heal, fix, give that one piece of advice that would change your life?
Jen Smallridge: Or is it coming from a more regulated place where I have actually a really nice bit of information to share or I'm thinking, and I often just say it out loud of like, oh, I'm having two thoughts at once, or I'm feeling really torn between, do we give you some exercises to explore or do we actually talk more about pacing and just like calling it out and letting them digest and make choices from that. So that has like firstly, just freed up my practice so much and it becomes then really explorative and responsive rather than like, hmm, process, digest, here is the one answer for your complex, in that word, system.
Ollie: Yeah.
Jen Smallridge: so
Sophie Shephard: Thank you.
Jen Smallridge: there's that. I'm really like slowing down time and and being very frank about how I'm feeling and if I'm having two thoughts. But then I guess because we like to tie things in a little bow for people who are listening what would I suggest?
Jen Smallridge: i
Jen Smallridge: I think I would look at pacing both your work days of like noticing where are the nervous system escalations, where is the exertion, is it cognitive, is it physical, is it environmental? Like really what we work on with people with chronic invisible illness and pain gets so curious about your week, your day, your hour, your minutes.
Jen Smallridge: And then just gently picking one thing at a time to soften, to expand, to reduce, to delegate, to remove. I wouldn't do a massive overhaul all at once of your whole entire work week and life and partner and living situation and diet like and exercise routine. like Just pulling on threads really slowly, really gently,
Jen Smallridge: And I guess to share like that in real time, it took me probably running the connection medicine course, I'd say a good three to four times to every time I would think, why didn't I take tomorrow off?
Jen Smallridge: yeah And to be fair, I was working for a private practice where that wasn't the norm to preemptively rest and to take care. If you weren't sick, then why i wouldn't why wouldn't you come in?
Ollie: Yeah.
Jen Smallridge: It was a weekend course, recover, come back. So now that I work for myself, but even if I was working for someone else, I would really look at my annual pacing and see the big blips of activity courses, running them, being at them, big events, and just being so kind with plonking that day off afterwards because you're never...
Jen Smallridge: really regret it would you so it's like a big annual pacing tip from me today in addition to everything we spoke about but yeah no more diary regret there for myself
Ollie: but Great advice.
Ollie: thank you so much, Jen. It's been a real pleasure and privilege to have you join us and and impart your wisdom. For the people listening who might not be as familiar as they should be with your work, where can they find you?
Jen Smallridge: Great question. I'm extremely inactive on social media, which, you know, with good and yay, but also like there's this's content there.
Ollie: good yeah
Jen Smallridge: It's just not frequent or, yeah, I'm reducing my exertion in a few different ways, as you can tell.
Ollie: Yeah.
Jen Smallridge: So, but the basics are there. We've got Connection Medicine Co, which I'd really say is for clinicians in this space or who would like to be more in this space. Yeah.
Sophie Shephard: Very highly recommend the course both Ollie and I have been and it's fantastic. So strongly, highly recommend it to anyone who hasn't done it. Just going to jump in and interject there, Jen.
Jen Smallridge: Thank you.
Jen Smallridge: That is such, such kind words, but I feel like I can really accept that like, and say thank you because like Flo and I have just really created it for that intent to help people, help people in this space.
Jen Smallridge: We also, so we're running a course at the end of June this year in Melbourne, and we're also doing a retreat in Daylesford in October for more of that clinician self-care piece. And, it's just always like so warm and fuzzy and, uh,
Jen Smallridge: Ventral vagal and happy. So that's Connection Medicine Co. And then my own private practice is called Invisibly Brilliant, also available to search on Instagram.
Jen Smallridge: And if you pop it in Google, my clinic comes up where there's online bookings and a bit more about what I do.
Sophie Shephard: Thank
Jen Smallridge: And very excited to share that I'm bringing on my first colleague in Jade Brody, who is a physiotherapist in this space, particularly in the EDS space. So same as yourself, Soph, like looking at my systems and processes and like, how do I replicate the essence of what I've tried to how I've tried to work and make things really streamlined and gentle on the nervous system for everyone involved. So yeah, they're the two main branches to find me.
Jen Smallridge: But I love, love, love connection as you can tell. And so, yeah we very welcome everyone to come and join either of those communities or both. Maybe that's your jam.
Ollie: Wonderful. Thank you. i highly recommend.
Jen Smallridge: Thank you both so much and keep up the amazing work with this poddy Love.
Sophie Shephard: Thank you so much.
