Episode 1 - Stop calling it soft skills!

Hello and welcome to The Imperfect Clinician.
This is the first episode of our podcast and today we want to discuss soft skills and why
we do not like calling them that.
My name is Mike Grudzinski and with me there is Yuen who are going to look after quite
difficult questions and definitely even harder answers about fears, about looking at ourselves
and where we can develop to prepare us for being better.
And also looking into the futuristic AI world in the near or not so near future.
Thank you for joining us.
Keep listening.
Hello and welcome to The Imperfect Clinician.
This is Mike and my co-host with me is Yuen here.
Hello, and today we are talking about soft skills, or are we?
Yeah, the title of the podcast, Stop Calling It Soft Skills.
So I think before we even start, what is soft skills?
Soft skills is such a bad name for skills that are really important in a way.
And I am categorically refusing to call them soft skills.
Okay.
So what would you prefer to call them?
Well, I divide the skills in that respect into the analogue skills and the digital skills.
Okay.
So then let's start with what are digital skills for you?
For me, digital skills or, you know, if you make it a reference into hard skills, I think
it's a little bit wider than hard skills.
So digital skills are those that are in a way clearly defined and necessary to perform
certain professions.
In our case as clinicians, we have our clinical knowledge.
There is a diagnosis that is a digital skill because there's either diagnosis or the reason.
Sometimes it may not be clear, but that's beyond the point.
Medication, that's something digital.
It is or it isn't.
Usage of it, outcome research for, for example, evidence-based medicine.
This is something that's digital.
It's solid.
It exists.
It's something we can learn and it's something that these are skills that we acquire through
learning from available resources, textbooks, guidance, uni lecturers, people who are organising
trainings, postgraduate trainings, and even, you know, any training that we have in, it
develops our digital skills because these are zero one numerical skills in a way.
Something either exists or it doesn't.
But I disagree in terms of what you said about research, because I feel research will inevitably,
you will have to come across some people skills in research because it's very rare
that you work in isolation.
Of course you can, but a lot of the research you have to involve studies, people's group.
Yeah, but absolutely.
I agree that in a way, when we go and talk about the analogue skills, then we're going
to see what leads to this research.
But when it comes to the structure of it, so you have thesis and there is research,
you have some data analysis, and there is some logic to it.
These are digital components that everything has to adopt.
With regards to analogue skills, that's something slightly different.
I would class critical thinking that is considered as a soft skill, I would put it with the digital
skills because it allows us to be logical and methodical about things.
Whereas the analogue skills is anything but, anything in between.
These are the people skills, these are skills regarding leadership, team building.
So things are not as straightforward then.
So I would agree in terms of research, you'll have the analogue skills involved, especially
in planning.
But when you do your data collection, when you interpret the data, when you look at the
statistics, the number needed to treat, those are hard skills, those are digital skills.
And linking in with the studies and the percentages, these will be hard skills that you've mentioned.
Okay.
Correct, yeah.
In a way, yeah.
When it comes to what are the analogue skills, it's those that are not clearly measurable,
not clearly defined in terms of, you can't put the percentage of it.
When it comes to the data, you have some sort of, oh yeah, in so many percent, we can heal
that disease, we can control the group.
In here, this is much more fluid and a bit less obvious.
You can't really measure empathy, you can't measure emotional intelligence or the level
of your assertiveness.
These are the skills that are considered soft and I refuse to call them that.
Why do I refuse to call them soft skills?
It feels they're not important when you call them soft skills.
Soft means not relevant, not something that is easy to go for.
And they're actually harder skills to acquire and they are much more precious in terms of
personal growth because hard skills you can learn, you can redirect yourself and learn
different things and you constantly develop yourself in terms of your hard skills.
You learn new services, you find out new guidelines, you grow in that respect.
When it comes to analogue skills, for individuals, when you focus on, for example, communication,
communication is a fantastic example of analogue skills.
So correct me if I'm wrong.
So based on what you're telling me, I feel that, so for example, let's pick an easy case.
A patient has got a blood pressure of X reading.
When you look at the X reading, this is a digital skill because the guidance says this
reading is within this range of this age and if it's raised, what's the step in terms of treating?
Step one, step two, step three.
And this is hard skills.
Exactly, you have guidelines to follow and it's the craft where you're doing it in a way.
And so how you would increase the dose, those are digital skills.
But the analog skills is how you engage the patient into why your blood pressure is raised
in the first place and having the communication skills for them to be fully on board with you
in that discussion.
Does that sound right?
Absolutely, and it is very important how you engage with the patient and treating them
as a partner in a conversation and not giving them tasks to do.
So you can't just tell them, right, this is a prescription, off you go.
Yeah, and I think everyone learn about communication skills in university, especially in any healthcare setting.
But how do we link it into our day-to-day communication skills?
Because a lot of the time we are aware we need to show empathy, we need to understand the patient,
we need to reach a shared decision-making process.
But how do we link to communication skills in a personal level?
Well, this is the wrong way to put it in a way, because what we learn in the uni is directed
towards certain tasks or digital skills.
So it's trying to accommodate those digital skills around those analog skills,
empathy and communication skills, whereas it should come the other way around.
We should be able to learn the communication skills at home in a way, okay?
And then it has a direct impact on our practice, on what we do at work.
So communicating with patients doesn't start in the uni.
Communication with another person starts much earlier with others, with ourselves and within our families,
within communities and everything that leads up to the point that you are privileged to speak to the patient
is a lesson of communication.
So we should use all those lessons then to impact on other people's lives.
And we should do it in a very skillful way.
And it's not always easy.
Okay, so because the purpose of this podcast is for us to delve deeper into our why,
let's talk about communication skills failures, maybe.
Yeah, the breakdown of communication.
Or learning opportunities that we've had on the personal level.
So what's the first thing that comes to mind for you?
Well, when it comes to breakdowns of communication,
it's sometimes those misunderstood intentions that we might have during our conversations.
Sometimes when we are trying to discuss more personal issues.
Yeah, let's be open and honest here.
Let's mention a topic that has caused us to argue because we misunderstood each other's intention
or not made it clear enough.
Not communicated the intentions clear in the first place.
So when we're talking about something very important,
I sometimes like to throw a joke just to try to look from a bit wider perspective in a way,
but also to release the tension a bit.
And that is often misunderstood by you.
I want to give the listeners something that they can relate to.
So we had recently an argument that led to a productive discussion about chores.
So we were talking about chores that needed to be done at home.
And you made a joke along the line of you should know what needs to be done at home.
You can see it clearly.
And I was taken aback because for me, I don't see that.
I see what needs to be done in a different context.
And I took it personally and thought, oh, he thinks I'm not helping out enough.
And we had a discussion about it, an argument first, where we both got really defensive,
where I said, do you not think I've done enough?
And then you say, no, that's not my intention.
And then we had to iron out the argument by then putting our expectation.
So my question to you was, first of all, you might not think I'm seeing the whole perspective
of chores that needs to be done throughout the week.
Can you help me understand better?
So this is what I did, which I can't show you at the moment.
But I've actually got a table written Monday to Sunday about what tasks need to be done
on a daily basis.
So for example, Tuesday is the day where we order our vegetables from our farmers.
And this is, now I know Tuesday is the day where we have to sit down and talk about vegetables.
Because this is something that is day to day for you.
If you don't say it, I am not aware.
But you assume I am aware.
And I assume you would tell me.
And this is where miscommunication happens.
And when it comes through as a joke, I then take it very personally in terms of, have
I not done enough?
Do you think I'm doing?
Well, you see, I stand in a position that there are certain things that grow over time
that need doing.
That's part of the routine, of the weekly routine.
The weekly routine is something that's a bit more tangible, but a weekly one is something
that for me might be obvious, but I've not made enough effort to communicate it because
I assume that you would pick it up.
And yeah, there are certain things you do, certain times of the week that just need done
when you do the washing, when you do, I don't know, shopping, whatever.
And very often, most of the things around the house is these other things that I tend
to look after.
And I think it's worth to mention for the listeners that I'm not quite sure whether
anyone knows how to operate iron.
Yes, because I have never bought a top that needed ironing.
Well, because I'm ironing your tops.
But even when I did try, I have to say, I'm getting defensive here, but I did try and
he said, no, that's not good enough.
And I said, okay, fine, you do it.
Well, there is that.
Yeah, well, you know.
So I think by giving this very relatable experience, people can see how on the day to day
basis interaction with family, how important managing expectation and be very explicit
about your expectation is.
So I'll give you an example that.
Before you go in there, I think that in this context, making a joke or referencing to it
in a way that I try to distance myself from it is a way of asking for help that leads
to both getting frustrated in a way.
Yes, it becomes difficult to communicate the feelings.
It's difficult to make them clear to another person.
And it takes time to work out as long as you decide to work on it.
Because I'll give another example and we can talk about why joke can be seen as something
that is vague or a barrier.
So I've had so many experiences where I talk about something that I'm struggling about and
Mike would then make a joke and I'll just feel that he's not taking me seriously.
And now I've got a few ways of looking at it.
One, it's an armour because he gets affected by it, but he's trying to make light of it.
So I think this is the same issue with the washing that he's mentioned.
He's making a joke of it because actually he wants my help, but doesn't know how to put it in
a way that is clear enough for me to understand.
So then the joke becomes his armour that he falls back on.
So when I mention about something important and Mike makes a joke out of it, I get very upset.
And we have a discussion about why do you think the timing of this joke is correct now, at this
moment? I don't think it's helping me at all.
It's not helping with the situation.
And so after a lot of arguments like this, I've come to the conclusion that I've not made my
needs clear enough for him at the start.
So now I try to, sometimes I feel like yesterday, but I tried to start the conversation with, I
need you to just listen.
And it's a rant.
I don't need you to give me any suggestions.
I just need you to listen and empathise.
And then you know where to go with this.
I feel that pouring a bit of humour into it is, it is a reaction.
It's definitely not a proactive way of looking for help or for understanding.
It is a reaction because I care about it.
So I react in a way and sometimes, you know, it is definitely not a proactive approach.
It is a reaction.
And because proactive approach would have been better if I communicated things a bit
clearly, because it's not a constructive way of dealing with it.
And maybe there is a bit of fear in each scenario where you're asking for help or you are
about to ask for help.
There might be a bit of fear that, you know, should I, should I not, and there's this
hesitation, how is it going to be read?
So I feel that lightening it up makes it a little bit, make it a bit less scary and less
risky for you.
Yeah, it just softens the blow.
It's not putting yourself out there as much.
Yes, definitely.
I think the fear is what drives a lot of our reaction because we operate on feeling.
So I love this quote from Jim Collins that says, we do not fundamentally operate at the
level of thoughts and analysis.
We fundamentally operate at the level of feelings.
And I think reflecting on what I feel and how I react, a lot of it comes from the feeling.
So when I feel that you're not taking me seriously, I am scared that I am not being listened
to, I'm not being heard, my thoughts are not being valued.
And so my reaction is to lash out and say, why did you do that?
Why are you not listening to me?
And this is like you say, a reaction instead of a proactive approach to say, actually what
you're saying is not helping.
I would like for you to listen to me because when the feelings are involved, the personal
side of things comes in and we lost track of distance with the issue.
Would you agree?
Yeah, at the very basic level, it's not our brains that decide about things.
We think it does, but ultimately we make decisions on how to communicate things with our
feelings because feelings and what sits in a way in the heart is what comes out from your
mouth.
I mean, you can think many different things.
People know that drugs are bad for you, but then still do it because of the feeling.
It's not the head thing that drives people in a way.
So we know that certain behaviours are bad for us, but we're still risking it because it
feels right at the moment.
Comfort eating.
Comfort eating, we're talking a dangerous drive, you name it.
I mean, even the good reactions and the good decisions that we make, they always come from
the feeling.
We have to truly feel how we want to do certain things in order to proceed with it.
The brain has got an impact on it, but only to a certain extent.
Yes, I agree.
I think, like you said, the good behaviours, like people who exercise as regularly, like that
feeling of endorphin rush after, the adrenaline rush after or in the process of doing it.
And because they enjoy that feeling, they continue to do it.
And the same with any behaviours that we choose and any reaction that is happening.
But then look at people who do not exercise.
And most of us are fully aware of the benefits of exercising and we choose not to.
So the brain tells us one thing, but we have a feeling to do other things.
We choose and this choice is made by our inner feelings and not by our brain because our
brain knows that it's better to exercise.
So how do we bring it back to communication skills that we're talking about?
Because I feel it's such a big part of our daily life, both personal and professional
life, that we don't see the importance of it.
So how can we help the listeners to reflect?
Because I think the situations and the examples of a glimpse of our arguments, really, for us
to be so vulnerable in talking about it, will allow a lot of people to relate to those
experiences and think, actually, I haven't been able to communicate my thoughts and my
needs very clearly and doing it in a more proactive way.
The best example of communication is a communication breakdown.
Always.
Well, always in most circumstances.
Let's talk about the communication breakdown network.
So for me, a clear example of something like breakdown of communication, breakdown of
conversation is not giving correct instructions to your team, staff, colleagues, whoever it
is.
There is a problematic, you know, managing your own expectations and frustrations with
poor results or outcomes.
So you're asking people to do certain things without putting enough effort into explaining
how you want it done.
And then you get frustrated that it doesn't get done right.
Then it leads consequently to the thought in your brain that, right, I shouldn't have
delegated it because I know I would have done it better.
But in modern world working in team, we rely on others and others rely on us.
And we have to be able to learn how to impact, how to give instructions that would
enable others to cause less work for us, ultimately.
Yeah.
And I think for me, it comes from, I feel that I've lost control of the situation.
So for example, the day is extremely busy and I've delegated some to somebody in the
team.
And when they're not doing it to a level, like you said, that created extra work, the
first thing that I would go for in terms of my own armour that I'm working on, especially
when I'm stressed, is resentment and blame.
So why aren't you doing it properly?
Or maybe I shouldn't have delegated.
And I think that is coming from because we don't know what to do with that situation.
And so we lash out.
Similar to what we talked about in a personal setting, because I feel that I'm under attack
almost, then I lash out at you because that might make me feel better.
But really when I reflect further, is it a more superficial fear of the day's job not
getting done, but is it an underlying fear of my own inadequacy in teaching or coaching
or delegating clearly?
And when I get to that reflection, it really scares me because I realised that I can't do
everything, nobody can, without an expense to your own wellbeing.
And it directly reflects on how I am as somebody who is mentoring.
And so I think the importance of our why, especially when we're reacting in a situation,
really allows us to give ourselves some time to do some introspection at the end of the day,
to say, why did I lash out?
And we probably have to ask a lot of whys to get to the actual fear that's underlying it.
Because when we get to that fear, that's when we know how to first of all identify it and
second of all be aware and do something about it.
Well, I think it's easier to react to the outcome rather than predict the initial setup of the
conversation and prepare for it.
This is why often the blame goes onto others, like blaming lack of time, assumptions people can
do things not as well as we would do.
And this is where I think it's important to reflect on it in terms of trying to invest the
effort, not necessarily time, because time is something that's always scarce in our
professions to decide on where to set up the right conversation before the task starts,
rather than to deal with the consequences of it if they are poor.
That really reminds me of one of Daniel Kahneman's book, Thinking Fast and Slow.
He said, it's easier to recognize other people's mistakes than our own.
And I think, especially when I get into the defensive mode, I'm not even aware my defences are
up.
It's so easily done now, it becomes second skin to me until I allow myself to reflect and pull
down my own barrier.
Then I realize how I've been reacting from a position of fear.
Does it make sense?
It does make sense.
And you mentioned that it's the scare of own inadequacy of teaching skills, of conversational
skills.
Do you think it's the laziness that leads to loss of control, that we cannot do everything and
we're too busy, that we become lazy to communicate our thoughts clearly?
I think if you talk about laziness in any healthcare setting, you'll get lots of arrows
pointing at you because everyone is so stretched.
But I can see where you're coming from because I would put it as our own way of prioritizing
because we don't prioritize the time to explain our expectation clearly.
And by not putting the time to do that, it resulted in less time for ourselves.
By not allocating time, we're taking time away from ourselves.
Does that make sense?
That does make sense.
Yeah.
Well, with regards to laziness, I was more referencing to not the fact that we sit doing
nothing, it's just that we make certain shortcuts, tasks that need doing, you say, right, just
get on with it and then you deal with the consequence.
So ultimately it does take longer to correct all the problems that's happened alongside.
You are operating on the assumption that people know what you want, people are on the same
level of thinking as you are, and all these assumptions are not helping.
Yeah, this is the shortcut that you're making.
This is the laziness.
This shortcut is not helping basically in the long run.
I agree.
Because if you don't, because I think when you talk about laziness, I get very defensive and I
think probably a lot of our listeners might go, I'm not lazy, but I see where you're coming from.
It's not the laziness in terms of...
Twiddling thumbs and not doing anything.
It's the laziness in terms of the thought process.
That doesn't go alongside the fully explain, fully commit to organise others workflow in that
respect.
And also your own, because sometimes you just say, oh, I'm just going to dive into it and, you
know, without preparation, get things done.
And sometimes it's not the most economical approach.
It's not the most desirable approach in a way.
And do you think people look at the short term result rather than the long term results?
Because a lot of people do firefighting.
So people are looking at getting the job done.
Yes.
Getting the job done in like today's job done.
Today's job done is important.
Tomorrow's job done is important.
But what about taking some time out today and tomorrow, maybe for the next two weeks to invest
the time on somebody.
So in the long run, you can share the load together because having the ability to invest the
time in somebody to get a return that you won't see straight away, but a return that is further
down the line, it's much harder for a lot of people to see.
And some people might not think it's important.
Some people might not think it's worth it.
Similar to training students or new people in new jobs, it's the same setting.
Any new people in the team, regardless of their job title, being a leader in any setting, you will
have new people coming in.
You will need to invest the time.
Whereas if you have a really busy day and you go, right, today's not the time, but tomorrow I'm
going to schedule in time for you, that is you showing your willingness to invest in them and
hence giving you the results in the long run.
And that's where the being organized works.
It's just like they say, if you want somebody to do something for you, make sure you fit somebody
who does many, many things because they will be always able to find a better time to fit into their
schedule because they are planning ahead.
And this is where the individual organizational skills are so, so important.
So going back to our discussion about analog and digital skills, why are those analog skills overlooked?
I think because with digital skills, everything is measurable.
You can mark it in the exam because everyone will look at the same case study and have quite similar
results, whereas analog skills are quite open.
Everyone will have different thoughts, different processes.
There is no one size fit all or 10 size fit all setting.
And would you say it's less palpable?
It's definitely less palpable and less, you know, it's not something that you can test in a multiple
choice question test.
So soft may mean easy and like it's disregarded as a priority.
It's not something that brings to mind as the most important thing for the job, but I think it comes out
of fear of, or lack of understanding or how to learn those skills.
And I don't think that schools or uni or any courses teach communication levels to the degree that
would address the fear and all the internal fears.
And just, you said to me once that creates like a smokescreen.
Yes.
Can you tell me more about that?
Yes, I think I would agree because a lot of, now there are more and more information out there
about self-development, but I'm trying to make the link between self-development and professional
development and how it's both interlinked because we look at professional development a lot of the
time in isolation and not alongside self-development.
So I will have students or new people in the team saying, I want to be more clinical.
If I'm more clinical, then I'll be more confident.
And I'll be better.
Then I'll be better.
You know, I'll feel better about myself.
And what we work on is, yes, you need the clinical skills, but that is not the only thing that makes
you better.
That is just a small part of it.
I've had people who've qualified and say, I've qualified, but I'm still not better.
I thought when I was a student, I thought if I qualify and get that certificate, I'll feel better.
I'll feel more confident, but why do I still feel the same?
I've got people in their jobs for years and years and say, why do I still not feel confident?
I know what I'm doing, but what is stopping me from being confident in the first place?
Do you hear that around your workplace or anyone that you talk to?
If people are willing to say that, then yes.
But sometimes you see that, you see that people are choosing the easier ride because they are at
certain level and some professionals do not really like to be questioned in a way.
And they create that smokescreen of inaccessibility and they become arrogant in a way.
And I think that even if they have the knowledge and clinical skills, sometimes they just cannot
convey well to the team or to the patients.
I think the smokescreen is there because it's hard to, what Brené Brown said in her TED Talk
about vulnerability, it's hard to rumble in vulnerability.
It's hard to take risks and talk about how you're feeling because the risk is there for you to get hurt,
hurt for you to be judged, for you people to see you differently, for you to lose your sense of
identity, that you've defined yourself in that fixed box.
And because of that fear, we don't have the courage to delve into the unknown.
And because we don't have the courage to delve into the unknown, we can't grow as a person.
So I'll give you the example of courage and confidence.
It can be, it's very scary to start driving.
But when you have the courage to keep practising, you slowly get better.
But you have to overcome a lot of your fears when you're starting to drive.
When you do the exam, same thing about a child learning to walk.
It's a lot of fear in falling, but they have the courage to keep trying.
Yeah.
Yeah.
And I think with courage to communicate, it's about practising, but still the practice on its
own still requires a little bit of effort to make it work better for you because, you know, we
can talk for many, many hours without making a lot of sense and a lot of value.
And I think it's very important to understand where we can improve that communication and where
we can make the listener richer with what we're trying to tell them.
How do we develop them?
Whether we develop our teams, whether we develop our colleagues.
I mean, I try to learn every day and I always say, try to learn something every day to the people
around me.
Same with patience that I see because it is important for people to grow.
If we don't grow, we're going to move backwards.
It's inevitable.
And so what you said reminds me of what Debbie Millman said about courage is more important than
confidence because you need to be brave to take the step into the unknown because that's what
propels you forward.
So I am reflecting on my own journey in my professional life.
And a lot of the time, all the things that have brought me to where I am now is because I step
into something that is of unknown.
I try different things that I'm doing now.
I've got a few hats on, but these are unknown territories that I have to open myself up to when I
step into these places.
But you step into them with a certain level of confidence or courage.
Both, but I want to say courage because when I first started, I want to say for everyone who's just
starting in a new job or who are training, you would feel you lack in confidence.
And for me, what compensates it for me is the courage to be okay, to get things wrong, to be
okay to ask a stupid question, to be okay to put myself out there for anything that will help me
grow or not, but I need to know.
And the only way for me to know is for me to try.
So I want to say the important here is having the ability to address your fear and then having the
courage to embrace the fear and deal with the situation by acknowledging it.
Okay.
So, so what are the risks of not growing, of not trying to get better, more proficient in those
analogue skills?
I think you, it's, it's a whirl of impermanence, nothing stay permanent forever.
So you either move forward or you move backwards.
Yeah.
But what are the actual consequences?
Is it you're going to lose interest?
Is it you're going to burn out?
Yes, both.
I think from a personal perspective.
Or is it you're just going to stagnate and you're just going to get old and die trying?
But you're trying, it takes courage to try.
So from a personal perspective, I think when I don't take the courage to say, this is actually what I
need from you, or I'm afraid I'm not being listened to, then it, what does it result in?
Constant argument, constant frustration.
You think the relationship is, it's not a two way street and then it festers, it sits and it festers.
It never goes away and it builds because something else would happen and it will just build on what
happened previously without you dealing with it.
So if this is a personal perspective, from a professional perspective, I think when you don't work
on your communication skills or you work, because as a clinician, you would have work on it to some
extent, the level of impact that you would have would be limited.
So this is me reflecting on my practice seven years ago.
And now because of how I worked on my communication skills, the impact I've got, not just on my
patients, but on my team and the wider people that are involved is bigger, wider, and I'm able to
have a bigger impact and I'm able to be of service to a wider group of people.
So how did you break down your fears?
Because ultimately, you know, if we are discussing an analogue skill, which is communication, and we're
saying that the barrier to developing is fear, how do you break it down to progress?
Do you just address them or is there anything else that you need to undertake to change it?
So I think the most common thing for me that I've seen, it's a theme that is across everybody, but
this, I really relate to it and I'm going to share it because I know this is putting myself out there,
but this is the promise that we gave the listener that for us to be open and raw about it.
So this is a fear that I always struggle with, but the difference now is how much I let it affect me.
So the fear of being perceived as, so I am worried about how I'm being seen.
So even as a student, when you want to say something or when you, even when you want to say
something in a social setting, you think, oh, should I say this?
Should I not say this?
What if I'm perceived to be incompetent?
What if I'm perceived to be too harsh?
What if I'm perceived to be too straightforward?
And this comes through from a personal and professional setting.
And when I realised that actually, why am I scared about what other people think of me?
And I then realise I am scared of what I think other people are thinking of me.
So it's not what they're saying.
I'm just putting my projection into somebody else's.
And this comes from self-doubt.
This comes from lack of confidence.
And this comes from how much weight I am allowing people's words to have on me.
And so I had to delve into why, which we'll cover in the next episode, where is it coming from?
Why and how do I deal with it?
And for me, understanding this fear, allow me to be mindful in any situation.
So now when somebody in the team say something, I would go, right, am I reacting?
So I slow down in my response.
Now I take the time to think.
I don't mean slow down as in like, I won't speak to you now, I'll speak to you three hours later.
I mean, I'm giving myself to take things in, pause it and think about where is it coming from?
Because I think we'll never get away from that thought of, I don't care what other people are thinking, full stop.
I don't think that is possible.
Not for me anyway.
I think we will care to some extent what other people are thinking of us, especially people that we care about.
But how much are we letting what they say have an impact on us?
And I call this a sticky thought.
So how much is their impression is going to stay with you and stick with you for a period of time or for longer than what you would like it to be?
And the difference now is I have the ability or I've grown to develop this ability to make the thoughts less sticky, to make those words less sticky.
Well, I, whenever I was probably a bit younger, but to some extent, probably still in certain roles, I guess, I was always quite happy to dive into certain things and being quite brave going into things.
But then it was a bit like imposter syndrome.
So I thought, well, I go for something.
And then what do I do here?
I'm not good enough.
I'm not, whenever I went to high school, my high school was a really decent one.
And I just thought, well, I'm really, really average.
And I'm, you know, I don't think I have anything to add in terms of value to the, to the place.
And then similar things happen in uni and then at work.
You just, you don't know whether you are actually relevant in a place.
And, but then it, you just sort of work through it and you have to, through gaining experience and through trying to be in tune with how you feel about yourself, you get better, I guess.
Yes.
And I think you, you brought it back to what everyone would have felt at any point of their life.
Sometimes even now is the fear of inadequacy.
You know, what if I'm not good enough?
What if I'm not good enough in my job?
What if I'm not good enough as a clinician?
What if I'm not good enough as a person?
What if I'm not good enough as a parent or a podcaster or a partner or a daughter or a friend?
And we have this self doubt in our head that's constant, but I think this is stemming from a lot of being critical to ourselves.
And we'll cover the, the self critical in our next few episodes, but it's something for you all to think about and reflect on.
I hope, because I want to take this opportunity to talk about what it's like, because when you talk about the digital skills, what it reminds me, which I've seen at the moment already starting, and it freaked me out when I read this book from Yuval Harari in Homo Deus.
When he talks about a world that is almost overrun by AI, and we see that now, even we have apps in different parts in the US, for example, where they are able to diagnose things.
What happens when the digital skills are being taken over by algorithms, by apps, by the digital world?
What are the roles do we have as clinicians that can contribute to that world?
We don't know how long it's going to be.
It can be us now, it can be the next generations of students.
What are your thoughts?
Well, I think that we see it now that our digital skills, our knowledge is, you know, we can always refer to whatever website we can find, whatever app we've got on the phone to support our clinical decision making skills.
The clinical decisions that we make in our practice are going to be less relevant on our knowledge, but more relevant on how we feel we can convey it to the patient.
And algorithms are going to replace, in my opinion, quite a lot of what we currently do.
And I think that by building resilience and developing those analogue skills, we stand a chance of finding ourselves in the new world of healthcare, maybe not fully prepared for the challenges, but at least able to respond to it.
Able to proactively have the strength and energy and skills to find things to do that are going to be beneficial for us and therefore for our patients.
So what do you think, so with the current state of AI, what do you think we can do as clinicians that AI can't do at the moment?
Don't know what's going to happen in three years?
Well, we still have the link with the patient, with another person that can impact their decisions, their lifestyle decisions, their choices regarding their healthcare, their treatment, their care.
And I think that this is a big role of our communication skills to try to implement those analogue skills into our practice to impact people's decision making a bit better.
So for example, we are less relevant or necessary with regards to setting up the treatment for hypertension, but we can still tell people about what is safe drinking.
What effort do patients need to make in terms of their physical activity to benefit them?
Because everybody can read everything about it, it's not that.
But I think that our experience and the unique position we are in, where people are for the time being still listening to us,
that we have this amazing and very intimate opportunity of dealing with a patient and impacting their decisions about their own health.
Because nations are not getting much healthier and we need to address their everyday struggles to make them feel better physically and also mentally.
The mental health is a big thing where we can make a huge impact because algorithms are going to be rather poorly equipped for the time being in addressing mental health needs.
So what happens, this is me being very futuristic now, what happens when you have smart watches that tells you how many steps that you're doing, how much you're drinking.
The future will tell you how much alcohol you are drinking, how much cigarette you've got for the day and what is your next step and linking this to the biomedical side of what's your blood pressure like and what do you need to achieve.
When those are in place, where do you think we stand?
People still are people and we are faulty to some extent.
Imperfect.
Imperfect, like our podcast, it's not very perfect.
But I think that we are still going to be human beings that are vulnerable, that are making a lot of shortcuts in how we address issues we come across.
Just want to put a keynote here. Vulnerable not in terms of vulnerable adults, like safeguarding adults, but vulnerable in terms of have feelings and open up.
Yeah, and we see a lot of people, at least I see a lot of people in my practice that come for advice, for comfort.
They often know the answers, but being able to discuss their problems with somebody who is not directly connected to them in terms of family or friends, it allows people to be more vulnerable in that respect.
To be more open and honest and the barrier of being scared but being judged or considered as troublemaker in a way by the family is taken out of the equation.
So when people come to us, they have this amazing and very precious, intimate opportunity to delve into the problem that they're facing with somebody that can, through their communication skills, really support their struggle or really allow them to give advice, reassurance, whatever we're doing.
Can I just say that it also takes them a lot of courage to come in and talk to you? Because it's an unknown. They don't know how you're going to react.
It is very, very brave and they usually come to us clinicians when they've tried all the other ways of dealing with it.
People often go because they've been on the internet searching for solutions and finding more problems.
And trying to sift through all those information, all the data overload that people have got, I think is going to be our role. I think we're going to be, as clinicians, we're going to be a bit like funnels.
We're going to take all the information that there is and try to funnel it for the person.
What if AI can do it better to an individual level? This is just me thinking very, very, very far ahead or maybe not so far ahead at all.
What if they can say to an individual person, they can have a conversation like now we have with Alexa, a full on conversation about how they are.
Hello Alexa, how's my blood pressure today? Your blood pressure is X, Y and Z. You need 15,000 steps today and this is your menu for today.
It's already in the smart kitchen for example. And then they go through conversations about their preference and their imperfection and the AI has everything included in them.
So just for example, when you read in your Kindle, for example, what if Kindle has the ability to know when you're pausing?
Where are you spending more time? Which books and when do you stop from your preference?
And from this forming your own preference for each and individual person because they're monitoring you almost 24 seven, which I don't think any person will be able to do, even with years and years of relationship.
This is a collection of all the data in the world and I'm pretty sure that a lot of big companies can fully draw a picture of you that's much better than you standing in front of the mirror internally and externally.
But I think that algorithms might be perfect, but we're still going to be flawed in a way of how we approach the information given to us.
Unless we have impulse or something that leads us towards the goal that we set up or the algorithm set for us.
It might be incentive set up, I don't know, reward base, reward base.
So, for example, your insurance company is going to reduce your charges because you're going to lose weight, lose weight, for example.
Or you're going to reach the blood pressure level or you're going to have frequent blood tests or whatever.
So there is this incentive and where our role is, I think, is to make sure that we don't create into our targets.
Yeah, but where do you stand then as a clinician? What is our role in that world? Because I struggle to see where would clinicians...
Somebody's got to develop those algorithms, but I don't think it's not going to be all of us.
So I think what I'm trying to get to is I don't know. I don't know what it's going to be like. I can't prepare for it. It's scary to think of that.
Can you or can you not prepare for it? It is a way of... you can prepare yourself as a person for change, but not necessarily for what exactly is going to happen.
Yes, so I think I feel that what you're getting to is to develop the resilience for change. Yeah? Would you agree?
Yeah, to be prepared mentally, being able to do other things. I mean, I've in my career have been doing different things because the opportunities were there.
I was lucky enough to choose to go for certain things, but we might be in a position that the choice will be taken away and we'll have to make it a choice for us.
Either we stay in the profession and develop, go follow the opportunities that are available, or we're going to, well, branch out to do other things.
And can I just say every time you make a career change of sort, or I would call it pivoting, any change of direction, it involves a lot of fears because there is a lot of what-ifs question.
So it's going back to dealing with the fears and having the courage to step into the unknown because you never know what it's going to be like.
And I think the resilience to change will then allow you to find alternatives that work for you because when the hard skills are taken away from you, it can feel a loss of identity.
That is very true. And I think it can happen quite involuntarily. You can be a magnificent swimmer that loses legs in an accident.
But I have a better example of a guy who used to play a guitar. He was really good, rather proficient at it. And in an accident, he lost his fingers.
And he became one of the really good luthiers. He stayed within the profession. He overcame his fears of the unknown because the only thing he could do, really, was play the guitar.
And then he started making the guitar.
What is a luthier for people who don't understand?
He's a person that makes guitars or makes, in general, musical instruments of wood, especially.
Ah, so he's not able to play, but he's able to make instruments.
Yeah, and he stayed within the industry in a way. And he developed to be a really, really skilled craftsman who makes beautiful instruments.
Through the involuntary change, because it was an accident, he had to quickly develop resilience and quickly develop an alternative solution to the problem that would have never existed if the accident wouldn't have happened.
So it feels like these people that you've mentioned in terms of examples and also your personal experience, we link it into addressing the fears.
How is it linked to a sense of self? And how do we develop the flexibility and the ability to pivot?
And so by doing that, it allows us to adapt in a world of uncertainty. Would you say that is a fair summary?
I think it's fair. I mean, I by any means have no answers. I can only guess or try to answer rather than find the answers for everybody.
We're all different and we all have different struggles. But I think it is a really fair assessment of potentially everyone's future in a way.
Yeah, it reminds me of Dr. Maya Shankar's podcast, A Slight Change of Plan. And she was telling her own story. She used to be a classical violinist.
Then she hurt her hands and she's not able to play at all. She completely lost her sense of identity. And then she had to find out why she loved violin in the first place.
For her, it's connecting to a lot of people using, in her case, music. But how can she do that now?
She has done work in the White House under Obama administration. Then linking in with her fears and linking in with her why,
she's able to pivot into something that she is doing now for the greater good, but connecting with people at the same time.
So I think having the awareness and the courage to delve into the fear, first of all, is something that I want to say the hardest for me.
Because for you to face the fear of fears head on, it's very daunting. It can be heart-breaking. It can be scary and it can be disappointing.
When I sit in that and I do the work on addressing the fears, it allows me to see my reaction in a different lens and allow me to be a better mum,
be a better clinician, be a better person in any way. But I feel that it has to come from the developing yourself as a person first.
It's absolutely true and I think that we all could look into the initial why. Why we are where we are and where has it all started?
Ultimately, these are the questions that will make our future or struggles in the future a bit less relevant.
And we go into the point again of deciding with feelings, how we feel about the whys, how we feel about what initially drove us to what we're doing now,
or whether we found the whys on the way, because that could have happened. Sometimes you just jump into something and you grow to master it and love it.
And this is important to understand that most of those decisions we make less with our brains, but still with the feelings.
And I think probably a lot of us haven't really delved into our why in terms of what's the purpose and our intention of what we're doing.
Because a lot of us will say we want to help people, we want to help patients. But perhaps a lot of the why, we probably have to do a lot of digging,
like what we're going to do in the next few episodes. Any final words?
And that's what we're hoping to do. No, it was a good chat and I hope that our listeners can relate to it or find a point of interest that would allow them to introspectively look into where they are,
what they want and how they're going to, or if they're going to change in a way. I am changing every day. I'm trying to change for the better and I'm trying to reflect.
I'm trying to see if I can contribute better to not only my professional work, but also my personal work. I've noticed that over time I became more understanding.
I mean, I always thought that as you get older, you become less forgiving because you just think that people should harden up and just, oh, this is nothing.
You know, you haven't had problems. I had problems passing you. And I become more understanding to people I work with, to people I talk to and to the family, to everyone around me, really.
And I think this comes from the understanding of where I'm positioned between other people. And this is this analogue skill that I believe has the direct impact on where I am personally as a clinician.
I don't treat my job as a chore. Of course, I work to earn money, but I'm a clinician, a proud clinician to listen to others and to make a difference.
I want people to feel just a little bit better after seeing me than before. If I achieve that, this is it. And I think that this is the value that we can bring.
So I've just thought about this, a way to end our podcast. So I hope everyone who's listening can relate, reflect and rise. Thank you all. Thank you for your time.
Thank you all. It's been Yuen and Mike, and you have been listening to the Imperfect Clinician podcast.
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