Dr Tabitha Healey: Mental Health & Burnout in Medicine

Joining us is Dr. Tabitha Healey, a seasoned Medical Oncologist and successful business owner with over 20 years of experience. Dr. Healey is not just a medical expert; she's also a certified Executive, Leadership, and Life Coach, blending medical know-how with compassion and effective communication skills. With diverse credentials, including Clinical Hypnosis and certifications from the Institute of Executive Coaching and Leadership, Dr. Healey brings a unique perspective. As a Fellow of the Royal Australian College of Physicians, she eagerly guides individuals on their journey towards success and purpose.

Today, we'll uncover insights and wisdom from Dr. Tabitha Healey, exploring the keys to a purposeful and fulfilling life. Whether you're navigating your career, relationships, or health, Dr. Healey is here to share her expertise. So, let's dive into this enriching conversation with Dr. Tabitha Healey, as we discover the path to success, purpose, and well-being. Stay tuned for a conversation that promises inspiration and enlightenment.

Dr Tabitha Healey: Mental Health & Burnout in Medicine Introduction

Dr Tabitha Healey, a seasoned Medical Oncologist and successful business owner with 20 years of experience, understands the essence of a fulfilling life—built on strong relationships, good health, and a sense of purpose. As a certified Executive, Leadership, and Life Coach, she combines medical expertise, compassion, and effective communication skills to guide individuals towards success and purpose. Dr Healey holds diverse credentials, including a Postgraduate Qualification in Clinical Hypnosis, certifications from the Institute of Executive Coaching and Leadership, and “Dare to Lead” training by Brené Brown. A Fellow of the Royal Australian College of Physicians, she eagerly looks forward to working with you on your journey.

I hope you enjoy this conversation I had with Dr Tabitha Healey.


Podcast Transcript

 Dr Ron Ehrlich [00:00:00] Hello and welcome to, Unstress. My name is Dr Ron Ehrlich. I’d like to acknowledge the traditional custodians of the land I’m recording this podcast on, the Gadigal people of the Eora Nation and pay my respects to their elders past, present and emerging.


Dr Ron Ehrlich [00:00:20] Well, we have covered stress and public health issues and burnout before, but today we are visiting it from the angle of the medical practitioners that deliver our health care service. It gives us a little bit of an insight in an environment where we are constantly told there is an epidemic of preventable chronic degenerative diseases like heart disease, cancer, over 100 autoimmune conditions, diabetes, obesity, mental health, a whole range of issues. It is perhaps sobering to gain an insight into the health of health practitioners, particularly medical practitioners and nurses at the coalface. My guest today is a person who has experienced both sides of the fence as over 20 years as a medical… My guest is Dr Tabitha Healey and Tabitha has been a medical oncologist for over 20 years. Her medical knowledge and experience morphed late in her career, as she will share with you after reaching a turning point to become a certified executive leader and life coach, specifically focussed on those in medical practice, doctors and nurses. Yes, they are stressed and alarmingly have high rates of burnout. Apart from being a medical oncologist in training and coaching, she’s also a postgraduate… She has a postgraduate qualification in clinical hypnosis, a subject we also discuss in this podcast. I hope you enjoy this conversation I had with Dr Tabitha Healey. Welcome to the show, Tabitha.


Dr Tabitha Healey [00:02:00] Thank you so much for having me, Ron.


Dr Ron Ehrlich [00:02:02] Tabitha, we hear so much about public health problems and many of them are preventable, but we rarely hear about the health, physical and mental of those that provide health care. And I know you’re involved in this, you’re at the coalface of this, but I know there’s also something about your own personal journey that when I first heard it, I thought, “Wow, now that is a story.” And I wondered if you’d be happy to share that with us.


Dr Tabitha Healey [00:02:30] Absolutely. So my background is I trained as a medical oncologist. I’m based in Adelaide, went through the standard thing of medical school internship. I got into physician training because I knew I couldn’t be a surgeon because I faint at the sight of blood. Which was slightly unfortunate professionally, and then really headed into medical oncology for similar reasons. It was a speciality that really was based around talking to people and communication and relationships. Absolutely loved what I did. Incredible patient group that I looked after. So I specialised in the treatment of young women with breast and gynaecological malignancies. I had the pleasure of establishing my own practice. So things were pretty beautifully set up, but I hit a couple of hurdles along the way. So it was about 2007 and I had young kids that were 1 in 3. I was married to a doctor as often is the case. I was working 24 hours a day, seven days a week on call, running a busy practice, high needs patients, lots of distress in that space. And I really found that I was sleeping only a few hours a night. I was self-medicating with alcohol just to be able to switch off. I wasn’t particularly nice when I run into people that I, you know, that say, “Oh, I knew you when you were a junior consultant.” The first thing I always say is, “I’m so sorry for how I treated you during that time.” And I was really looking at checking out of oncology, checking out of my marriage, and instead, thankfully checked into a health retreat and in that space got watered, fed, learnt to meditate, learnt to look after myself and really transformed my emphasis on self-care and has allowed me to return to work to build that practice, to keep providing for my patients and then sort of did that for another ten years.


Dr Tabitha Healey [00:04:25] And then 2017, a couple of things happened in rapid succession. I forgot to pick up one of my children from football practice in the middle of winter. I got a call from a stranger to say that they’d picked him up and could I come and get him. So, I’m not doing so well as a parent. And then a couple of nights later, I was working late again and walked into the room of a young woman that was dying of metastatic breast cancer who was crying and I said to her, “I’ll come back when you finished.” And I walked out of the room and it was at that point that I realised I was no longer the doctor that I’m trying to be either. So I actually stepped out of medicine. Sold my practice started to be a coach and then grew that to being health coaching and particularly looking after health professionals. Along the way, I’ve spent some time working in hospice. Which gives you a beautiful sort of reflection point on what matters in life. But then my coaching practice just got too busy and I inadvertently ended up working over full-time again. So I pulled it back to just working in coaching. My clients are predominantly doctors at all stages of their careers, but I look after senior health professionals and other specialities as well at nursing and allied health. So it’s been inadvertently a fantastic way of retiring and reinventing myself.


Dr Ron Ehrlich [00:05:51] Well, what what a journey. And you said so much there that would sound familiar to many practitioners. Medical practitioners on call 24 seven. Interesting to me that you had to go on a retreat as a doctor who was probably at that point had, I don’t know, 10 or 15 years of study to get to the point that you were a specialist to learn about what was healthy.


Dr Tabitha Healey [00:06:19] And you’re so right, Ron and it still is such a tiny part of medical education with such a disease-based degree and it’s all about illness. It’s all about treating that and there’s so little about prevention and there’s so little about self-care, but it’s challenging. It was great Last week I was invited to speak to the six-year medical students at Adelaide University in their transition to internship. So I was speaking to them about burnout and well-being and what are the scaffolding that they can put in place to to protect themselves. Because I remember my first night as an intern and I was covering one half of the hospital, someone was covering the other half. And halfway through the night, they said to me, You’re going to have to cover the whole hospital because the guy that was doing the other half has just locked himself in a locker and he won’t come out. And that was the first and the last night that he worked as a doctor. So, he was just so woefully underprepared for what the reality was of looking after patients and being the person solely responsible for those decisions. So… But you’re absolutely right. We’ve got a disease-focused model and I knew so little about what were the things that I needed to do to protect myself in that space.


Dr Ron Ehrlich [00:07:40] Hmm. Well, I want to talk more about that a bit later, about how the… How that journey as a doctor prepares you, but also a bit about what it says about our own healthcare system. But I know that, you know, when I heard you speak at the Health Coaches conference in August in Brisbane, I mean, I just loved your presentation and I really was looking forward to this conversation and sharing you with our listeners. But you also, you know, came off the three year pandemic that we had. And if we thought health care was stressful before the pandemic and it was. The pandemic certainly threw up some challenges. What were some of the issues that were faced that you you observed, you know, on a personal level for for practitioners facing that Covid pandemic?


Dr Tabitha Healey [00:08:32] Absolutely. It was huge and I think what we’ve underestimated is the ongoing imprint of that trauma. We’ve sort of dusted our hands of Covid and said, let’s move on. But we haven’t really considered what that did to people over that time period and I’m seeing a lot of that now in my clients and Covid has been recognised as a mass trauma event. And so often we recognise that for large-scale traumas or really, really identify the stressful events. But what’s also been recognised is that repetitive small t trauma creates the same outcome for people and for doctors and many people across health professions. It was things like the workloads went up dramatically, the workforce contracted significantly. So a lot of people towards the end of their career got out. People who were thinking about it left. We lost our international workforce. We lost our transition across borders. People were either locked down or moved to where family were. Nursing profession took a massive hit, which increased workloads as well. And then that was the aspect of uncertainty. So when we think early on, so many doctors and nurses felt that they were potentially going to work to die, what we were seeing coming out of the US and Italy and China was that a disproportionate number of health professionals were dying in their line of duty. So many people actually felt that their own lives were at risk. They were concerned that they were threatening the lives of their families, particularly if they had elderly or sick relatives. And so they started cutting themselves off. It became sort of socially unacceptable as a doctor to go out because you couldn’t risk getting Covid and then not being able to turn up for work. And there were people who didn’t want to see their medical friends for fear that they were going to contaminate them.


Dr Tabitha Healey [00:10:23] That isolation was then made worse at work because we stopped multidisciplinary meetings. Ward rounds were trimmed down to the bare essentials. And so you lost that social component, the bouncing things off each other and really feeling like he was sharing the burden of care. Other factors uncertainty around finances, private practitioners whose practices were shut down overnight with no when they were opening up again with debts with staff to pay. Then the things that I’ve really seen hanging over are that people lost their appropriate healthy coping strategies. So they stopped going to the gym. They stopped having dinner parties. You know, dinner parties seem to be this thing of the past that people don’t have anymore. So they lost the social connection. They lost their fitness routines, and they’re also replaced with unhealthy self-soothing like doomsday scrolling, alcohol and those sorts of things are then being maintained. And it’s interesting how many clients I see now and I talk to the effect of what did you used to do when you fell at your best? What did your last look like? What were you doing? And then I recognise that they dropped off all of these things and had reinstated them. And then the saddest part that I saw about it was the moral injury pace. So people who, because of how they had to practice medicine during Covid, when not practising the best form of medicine, so patients were being kicked out of hospitals who needed more time, treatments that required inpatient hospital care. And this happened more outside of Australia, thankfully, than in Australia. But there were inappropriate substitutions being made and then talking to doctors and this was a lot of paediatricians had this a big mast up, gowned up keeping the distance and they lost that that physical connection to their patient group. And suddenly that made the process of caring so much more difficult, so multifactorial, really complex. But what I see is that the imprint of that trauma actually remains now. And I’ve seen increased stress levels, increased burnout, hypervigilance and almost a state of elevated threat that people carry with them now.


Dr Ron Ehrlich [00:12:38] I mean, I know I had an experience with my grandson who my son in law took him to the doctor locally in suburban Sydney, and the doctor said to him, “You can’t bring a sick child here.” I thought that, “Hang on. Did I just hear that correctly?” A doctor telling a father that he cannot bring a sick child here. And I mean, that’s the sort of thing you’re talking about.


Dr Tabitha Healey [00:13:07] Yeah, it turned medicine on its head. And so people and seeing people in car parks and those sorts of things at mandatory vaccination was really difficult for many doctors. So they were there were things that people really struggled with.


Dr Ron Ehrlich [00:13:24] Yes. Well, mandatory vaccination was a problem for many. But interestingly, trauma is often a catalyst for change. And you know, people you you will have seen this in your oncology practice where people have sometimes said, I’ve heard it said it was the best thing that ever happened to me. You know, I changed, you know, if I survived it, of course. You know, and similarly, we’ve done a lot of interviews on regenerative agriculture and the farmer going through a fire or a flood or a drought, you know, had to rethink their entire way. Has that been the case? Is that what you’ve observed? Do you see a real positive coming of this?


Dr Tabitha Healey [00:14:07] In those that have the capacity to see that. So… And perhaps they’re the people I’m not seeing. So I’m sure it’s caused a lot of people to reflect on how they work, where they work, the importance of family. But I think I’m probably seeing those that are at the the more extreme end that are so overwhelmed that they just can’t see a way out. And I find when I ask them, you know, where have you got control? What can you do in this situation? And their answer to everything is just I don’t know. And they cannot even see their way out to start to make changes in terms of the way they work, how they work, how they look after themselves. And so I think that’s been part of the problem. So I agree there has been fabulous things that have come out of this, but I’m probably not seeing them.


Dr Ron Ehrlich [00:15:00] Mm hmm. Look, I know we’ve discussed stress and burnout actually on a few different programs from a few different perspectives. But when it comes to the medical profession, how big a problem is this? I mean, you know, you’re seeing a cohort, but there must be a broader perspective of what the stress levels are and what the burnout is in medicine. What are the studies telling us?


Dr Tabitha Healey [00:15:23] So there’s a large body of work that comes out of the US every year with a group called Medscape. And they sort of surveyed over 9000 doctors across 30 different specialities and they was showing in the sort of released in 2023, so 2022 data that emergency physicians were sitting at 65%, closely followed by internal medicine physicians and then paedia generalist sitting in the highest 50’s.


Dr Ron Ehrlich [00:15:52] We talking about burnout here or stress level? Burnout?


Dr Tabitha Healey [00:15:55] Burnout. From there the definition of that in terms of Australian data there’s the Health roundtable data from a group called Brain Train. And those rates were sitting that was 2021 data. So height of Covid and the rates for doctors were sitting at 44%, the rates for nurses sitting at 60%. And then there’s a international group that was over 2021. So once again, heights of Covid. And those rates across 800 locations, over 20 countries was sitting at around 55%. So they’re high. Hopefully, they are going down somewhat post-COVID. But some of the challenges are that the biggest drivers of burnout is an organisational issue rather than a personal issue. And so from an organisational perspective, the things that are really featuring are the bureaucracy associated with medicine now. So electronic medical records, the defensive practice of medicine, that… Those things that take you away from the part of medicine that most people love, which is either the doing medicine, the being with patients. And so it’s those aspects, it’s the not having the ability to control your clinics, not having the ability to control the flow through in your workplace, the things that grind people down. And this partly comes from this tsunami of ageing, the contracting workforce, the financial constraints that we have. And medicine’s exploded. You know, what’s available to us now is changing at such a rapid rate in terms of complexity of drugs, life expectancies improving in that space. So and expectations of patients are much higher.


Dr Ron Ehrlich [00:17:48] What are… Just remind us about what defines burnout, because we’re talking about different from stress levels here. I mean, what defines burnout?


Dr Tabitha Healey [00:17:58] Great question. So Christina Maslach was a psychologist who defined burnout in the late 1970s, and that was in her work with people who worked in drug and alcohol centres. And she found that there were three criteria. And I always think of remembering it as dying on the inside. So D is for detachment, I is for ineffective and E is for exhaustion. So the detachment is that putting a wall between yourself and the patient because you just can’t take any more of the distress. And so it’s also the cynicism that comes out. So if you’re rolling your eyes or making inappropriate comments about patients or relatives then you’re probably developing that component. The ineffective is not that you’re not good at your job, it’s that you think you’re not good at your job. So you start questioning, you start ordering more tests, you start getting more referrals. And so it puts costs up. It slows down the process and it impacts on patient care and then the final one is exhaustion, which is the one that most people recognise for burnout. And that’s an extreme degree of mental and physical exhaustion. So stress is this situation is making me uncomfortable in that moment. Burnout is more pervasive the event may have passed and these three components persist.


Dr Ron Ehrlich [00:19:22] Well. So just with that definition, I think it’s worth repeating what you said before. I think it was the Banetree test that 44% of medical practitioners and 60% of nurses fulfil that criteria.


Dr Tabitha Healey [00:19:38] Yeah so that the American what I think that criteria are particularly tight. But my understanding of the Australian data was that they were more closely aligned to these criteria across those three segments.


Dr Ron Ehrlich [00:19:50] Wow. Well, that is sobering. That is sobering for I mean, it’s not surprising as a health practitioner, but as a patient listening to this and, you know, bombarded by public health, how bad public health is and da da da da da da da. But here we’re hearing about what’s going on on the other side of the desk, on the other side of the stethoscope. You know that this is a major problem. You talked about bureaucracy. And I know myself, you know, having been in practice for 45 years, when I started, my patient card was the size of a postcard. And I would write their name, address, phone number. And the day they came in, a procedure number and the fee that was charged, that was almost the full extent of notes. And as I left practice recently, I had to record every instrument’s tracking number, why I was giving an anaesthetic, why I was taking an X-ray, what I did for everything that I did. I mean, I could spend a good hour or two of my day filling out what was required of me.


Dr Tabitha Healey [00:21:05] Absolutely. And so many of my clients come to see me and we talk about how many hours they work. And then my routine question is, and yes, how many hours of shadow work are there on top of that checking results, writing reports, referrals, writing and editing letters. So there’s this enormous burden of work that goes unrecognised, usually unpaid and often out of hours.


Dr Ron Ehrlich [00:21:29] Mm hmm. And another aspect of work that goes unpaid and unrecognised is keeping up with the latest literature. And I heard some estimation that in order to you know, when I hear someone say “There’s no evidence to support that.” I kind of go and hang on. “That implies that you’ve read all the evidence.” And I know for a fact well, I have heard that say that it takes probably need around to 600 hours a week to keep up with every piece of research that’s been published. And as far as I know, there aren’t that many hours in the week for that. So it’s just simply impossible to keep up.


Dr Tabitha Healey [00:22:08] Absolutely. And that was my thing in oncology. So when I started to drug Cisplatin 5FU by the time I list extraordinary number of drugs, and particularly in the breast cancer space, that was evolving dramatically. And so you then had you say, absolutely adding this study in on top of that and you’ve got continuing professional development requirements about how you maintain that. And then that sense of if you’re not keeping up, that sense of failure associated with that are not good enough. And so many doctors are perfectionists. That’s how they got there in the first place. That’s how it got them through high school, gotten through medical training. So they hold themselves to this very high bar. And then if they don’t feel that they’re making that their self-talk is very detrimental. And the personality characteristic most closely aligned with burnout is perfectionism. And it’s that whole issue that burnout happens to good people because they care and they try and they keep pushing harder and harder. And so they’re the group that are particularly at risk.


Dr Ron Ehrlich [00:23:11] You know, you mentioned and I’m really excited to hear that you actually were going into the medicine faculty and talking to the six, you know, the final year students, because there’s something about the journey through university, a doctor’s journey from university into the hospital system that sets them up for exactly what we’re discussing here now. I think it’s worth sharing with our listener some of the, you know, some of the contributing factors at play here. When doctors go through their training, what kind of things are expected of them? You were mentioning you handled half a ward until the guy hid in the closet and wouldn’t come out. You know, I hope that’s not a stat. You know, I can imagine it happening. Tell us what is it like being a doctor, an early you know, you’re entering the hospital system.


Dr Tabitha Healey [00:24:10] So it’s challenging. So there’s the personality traits that are touched upon. So these young people have worked really hard to get there. Often what they’ve done along the way is drop off the things that give them some three dimensionality to their life. They might have stopped playing sport, was playing an instrument, dropped off some of their nonmedical friends and associations just to get the sheer load of work done that they need to do. Then it’s the hours so they can be very long. There’s been a lot that’s been done to make the work hours safer than they used to be. There’s been a lot done to change workforce issues so that there’s more senior members of staff on to support. But I don’t think anything prepares you for when you’re actually the person making a decision with the patient in front of you that could be life or death and the burden of that. Now, some people they’re confidence, they’re knowledge is such that they are exceptionally good at that. But there is also a large group that are filled with self-doubt and questioning and sort of symptoms of imposter syndrome and those sorts of aspects that really make it very hard. And then there’s the emotional component that people are scared, angry, and violence is on the rise in the hospital system against staff. There’s the challenge of bringing people together in a really stressful environment and how they treat each other. There’s a lot of work being done about civility in health care, and Chris Turner‘s done a lot of work in this space, which is beautiful around how do we be civil to each other. And that feeds into Amy Edmondson‘s work on psychological safety and that we need those environments, those cultures, so that people feel safe to admit they don’t know, to admit they’ve made a mistake, to ask for help. And part of what… You touch on there is, is the types of people that we bring through that they’re meant to be independent, confident, able to make decisions, you know, jump tall buildings in a single bound, and then it builds them up to be reluctant to ask for help or reluctant to say that they’re struggling. And so I think, once again, we’re getting better at that. The culture is changing, but there are still a lot of people who really, really struggle with asking for assistance or acknowledging that they are finding it hard, which is where the coaching actually fits in really well. So we’re not saying that these people are unwell, that they’re sick, and that they need a doctor, a psychologist or psychiatrist. And still, unfortunately, that carries some stigma when it shouldn’t. But the beautiful thing about coaching is it’s performance-based. So you’re going to see someone and talking to them about, okay, I’m here, but I want to get to there. What can I do that’s going to allow me to be the best I can be physically, mentally, emotionally and within my relationships professionally and personally. So I think coaching has a beautiful place to play in supporting our doctors to thrive.


Dr Ron Ehrlich [00:27:19] But just to just give our listener a bit of an insight there, because I know when I’ve heard of the hours that young doctors are working, it is quite frightening. What would be typically expected of a junior doctor in a hospital setting?


Dr Tabitha Healey [00:27:34] It really does depend on the unit that they’re on. So some units will have shifts and you shift and you go home. But the challenge is that you might be doing a late shift than an early shift and then check in a couple of nights and your body clocks out of order and you skip a sleep cycle because that’s the only way you can get back on track. So you can get sleep deprivation because of the variance of the hours. And you might be on a surgical unit where an operation just keeps going or the next patient keeps coming in, or that the volume of work is just so large. And so there’s a class action that’s occurred in the eastern states against about unpaid overtime. And there’s that’s starting to take place in South Australia as well. So there is a lot of unrecognised overtime, but it wouldn’t be unusual for people to work a number of 12-hour days in a row if they then got a weekend on-call. They might be working 14-plus days in a row without a break. So there is a lot of work being done. But at the end of the day, if there’s six patients that need to be cared for and looked after and work, that needs to be done and expectations, then it falls down to the junior doctors to keep producing.


Dr Ron Ehrlich [00:28:48] And I would imagine that without putting an exact figure on it, 40 or 50 hours a week would be aspirational. It would be…


Dr Ron Ehrlich [00:28:56] Absolutely. I mean, you know, most people 40 hours a week, I want to work more, 40 hours a week, 40 to 50 for a doctor in a hospital would be aspirational.


Dr Tabitha Healey [00:29:05] Absolutely. I think that’s a great outcome. Would probably be…


Dr Ron Ehrlich [00:29:08] Yes. But it’s not by any means typical. No, no, no. That’s interesting. I mean, yeah, the whole thing is it says something at a very fundamental level as we train these young doctors about our health system. Isn’t that it’s kind of… What does it say? What do you think it says about our health system? Tabitha? I could wax lyrical about this one, but I’m interested to hear you.


Dr Tabitha Healey [00:29:32] I think the challenge is, is that we simply can’t keep up with demand for the health of our population. So an ageing population where we haven’t invested enough in preventative care, where we have a very tertiary hospital based model of reacting to disease and illness. And we we simply can’t train doctors at a rate to deal with the need. And then the other problem is our woeful neglect of general practice, of appropriate remuneration, of recognition of the incredibly important role they play in our community. And, you know, this horrifying figures about the number of people going into general practice now, in comparison, I think it used to be about 50% and it’s now down to 17%.


Dr Ron Ehrlich [00:30:19] Oh, my goodness.


Dr Tabitha Healey [00:30:20] Trainees going into general practice because of remunerations woeful, hours are difficult. They are treated often as triage and referral services. They are not treated with respect. And so people don’t want to do general practice anymore. And so we’re not going to be able to get that primary prevention model in place. And it’s that tricky thing. Doctors are predominantly still trained in hospitals, and it’s having the funding and the space to be able to train them. And we just don’t have the capacity to do that.


Dr Ron Ehrlich [00:30:54] I mean, now, on a personal level, I’m really intrigued by your own transition from practitioner to coach. How would you define the biggest difference in that approach?


Dr Tabitha Healey [00:31:08] Well, I can’t use any drugs. And I can’t order any investigations. And it’s not disease focussed at all.


Dr Ron Ehrlich [00:31:18] Okay.


Dr Tabitha Healey [00:31:18] The thing about coaching is and it took me a long time to get my head around this because I was trying to give advice. I was trying to sort things out for people. And coaching is about putting all of that power and all of that responsibility back onto the individual. So my role is to ask questions, to allow people to lay the issue out on the table in front of them and examine it from a different perspective and then examining it from a different perspective they can find their own solutions. My role is to just guide, to nudge occasionally, to ask permission to give advice because I still love doing so but it’s… And then what we know with that is that from a compliance perspective, if people choose their own solutions and it resonates with them, they’re far more likely to undertake that. And really, coaching should be a foundational model that we practice medicine. You know, if we were saying to our patients, What’s important to you, why does this matter? How do you think your health is contributing to that? What outcomes do you think you could? You know, What changes could you make to achieve that outcome? And they came to that solution themselves then compliance rates would be so much higher and outcomes would improve, which is why health coaching is great. And I think an integrated model of medicine plus health coaching is the ideal outcome. It’s the knowledge of medicine adding in the fact of giving the client or the patient the autonomy and the control to create their own destiny. So it’s been a really fun and interesting journey and I just wish I knew more about coaching when I was actually practising medicine, and I think it would have made an extraordinary difference to my enjoyment and the quality of outcomes.


Dr Ron Ehrlich [00:33:03] How long have you now been, you know, focussed entirely on coaching?


Dr Tabitha Healey [00:33:08] So full time for just over two years. Part time for just over four. A fresh newcomer to the coaching space.


Dr Ron Ehrlich [00:33:19] Well, I’m even fresher, newer than you. And that’s why I’m so intrigued. And actually to hear you say, you know, the transition from giving people advice to facilitating a journey for self driven, self driven journeys is a really interesting one, isn’t it? So when you when a practitioner and… Comes to you, what… Can we talk about some of the you know how you would approach that, how you approach it? You know, your sessions with the practitioner?


Dr Tabitha Healey [00:33:48] So for mine, I send out intake forms beforehand, which is what brings you to coaching? What are the challenges you’re facing at the moment, if you could without having to worry about anybody else’s opinion, design your perfect life. What would that look like? What’s getting in the way of that? And then I have five words to describe your life at the moment, which is often fascinating and busy is number one for most of them. So they fill it in beforehand that the Wheel of Life, which is well known in coaching, is it’s the segments of your life and you write them from 0 to 10. And that visual imagery is often the strongest for people because they’ll go, Oh, I’m smashing out the money component, know I work 5050 and then they’ll often realise that they’re neglecting relationships or personal growth and they often come in with that going, Oh, okay, there’s some sectors of my life that I’m really not doing particularly well. And so, the intake form gives me a nice sort of temperature check on where people are at. And then I talk to them about what are the biggest challenges you’re facing at the moment and where would you like to go with coaching? What would you like to achieve through coaching? And then I do tend to bring it quite strongly back to a health and well-being focus because I feel that underpins people’s ability to think, to make decisions, to fully engage with their life. So I have quite a formalised structure that I bring people back to in terms of the pillars of health and well-being and how are they going in those pillars and what can they do to reconnect and change them. Because often I find that people sort that part of their life, that they can then have greater clarity. Their brain starts working again and they know how to run their practice better than I do. They know how to interact with their colleagues at work better than I do. And so they then have the energy and the clarity to make the changes that they know that they need to make.


Dr Ron Ehrlich [00:35:42] Hmm. That wheel of life. Incidentally, I hope that we will have a little hyperlink in our show notes for our listeners to go on to, because the Wheel of Life is really a circle divided up into eight segments with concentric circles from the centre to the outside on a scale of 1 to 10. And you literally do, you know, finance, family relationships and you get to score that and you see exactly how. So I would love I’d love to have that in my show notes so our listener can go on to that. But you mentioned to focus on some pillars of health and how this is relevant to all of us, whether you’re a medical practitioner or not, but seeing you’re advising top medical practitioners, this is probably just as relevant to our listener. What are some of those pillars of health that medical practitioners should be focussed on?


Dr Tabitha Healey [00:36:33] And it’s a fabulous thing because the medical practitioners all know this. But none of them apply. They’ve lost connection with it. So I work on a framework called Holding the Space for well-being and SPACE stands for Sleep, Pausing, Appreciating, Connecting and your Energy levels, which comes down to how you exercise and what you eat. So it’s prioritising sleep and I talk to them basically about the neurophysiology of what you need to clear your brain out of the accumulated debris over the course of the day. The pausing is really a strong conversation around their relationship with technology because that’s one of the incredibly common things that I see is the self-soothing with technology and then getting them to understand the impact on their neurotransmitters of what that’s doing for their sleep, their stress levels, that cortisol, their dopamine and their ability to focus and concentrate. So I spend quite a bit of time in that space and then I talk to them about breathing, which most doctors will tell me where to stick it at that point in time. And I have to remind them of the physiology of Breathwork to dial up their parasympathetic nervous system and get them back into the frontal lobes. And then I talk about mindfulness meditation. And interestingly, once again, they all know the data about how beneficial it is. But the common response is I tried that once and it doesn’t really work for me. I’m too busy. So talking to them about how to cultivate that practice, connections, about the importance of their family, their friends, because the busier people get, the first thing they often drop off is their social connections because they’re tired and they’ve spent the whole day talking to other people. And the problem with loneliness is that it puts your cortisol up higher than any other stress event, and it’s incredibly detrimental to your health and well-being. So it’s you know, it’s worse than smoking, diabetes or obesity in terms of mortality. It can take 10 to 15 years off your life. And so really talking to people about that importance of finding the people that give you energy and then the final phase is how do they energise themselves? What are they eating? And it is quite horrifying how bad doctors diets are, despite once again, they have a fundamental understanding about nutrition. Most of them seem to live on cheese and biscuits that are available in hospital fridges, which isn’t really food. And then the importance of exercise. So that and interestingly, exercise is the most significant protective intervention that you can take on a personal level to protect you against burnout.


Dr Ron Ehrlich [00:39:13] Mm hmm. The… You mentioned, all the breathing in mindfulness. Hang on. Was the breathing, mindfulness and meditation under the pausing?


Dr Tabitha Healey [00:39:22] That was all under pause. And you’re so right. I forgot my wonderful A for appreciation, which is the simple practice of gratitude. So noticing what’s going right rather than what’s going wrong and changing your mindset in that regard, learning to say thank you and learning to appreciate the people around you. And by doing that, you just change your neurotransmitters and you… I talk to people about the metaphor of a swimming pool. Let your you know, your body is the swimming pool, the structure. That doesn’t really change. Now, if you neglect the chemicals in your pool, then you quickly get a green, slimy pool. And if you keep the structure and the volume of the water exactly the same, but you just change the chemicals in your pool, you have a pristine clear pool. And that’s the way we need to approach our lives, is that there’s so often we can’t change the structure of our lives. We can’t change the hours that we have to work and the responsibilities that we have. But you have complete control over the neurotransmitters that you secrete, so you get to clean your own pool by implementing these well-being strategies. And for a lot of people that really resonates.


Dr Ron Ehrlich [00:40:28] Mm I love that acronym and it’s so interesting to hear you talk about technology because I think that is the biggest challenge, one of the biggest challenges for all of us. But you know, it’s so ubiquitous.


Dr Tabitha Healey [00:40:44] Absolutely. We need it to work. We need it to connect and to function. And then it just infiltrates our lives. And so the number of people who are checking emails before they go to bed now, getting up overnight to go to the toilet and just seeing if emails have come in, the first thing they do in the morning is back on to their phone and just getting people to recognise what that does in terms of dopamine depletion and then the irritability, the insomnia and the lack of concentration and focus that people get as a result of that and disconnecting them from people. So being on their phones around their children, being on their phones in front of their partner. And so it is hard because so many doctors are on-call. And so the phone is part of that being on-call, but encouraging them that the moment you’re not on-call to detach from that and to separate yourself from it.


Dr Ron Ehrlich [00:41:37] I’m also interested in breath and pleased to hear you talk about breathing like that and are not surprised to hear the response that you get from doctors. Like, come on, I’m alive. What more is there to breathing than that? Just you mentioned it very quickly. Go on. Give us a little bit more about what more is there to breathing than that?


Dr Tabitha Healey [00:41:57] Certainly. So the vast majority, particularly when we’re hunched over screens and computers, we’re bent over. And so we’re not fully expanding our lungs. And when we fully expand our lungs and flatten the diaphragm, it pulls on the vagus nerve. And the vagus nerve is like the cord up to the light switch in the brain and your parasympathetic superhighway. So as you breathe in and then breathe out long and slow, flattening your diaphragm pulls on your vagus nerve switches off, you’ll fight flight freeze response in your limbic system. And when you switch that off, it allows you to drop back into your frontal lobes and your frontal lobes are that part of your brain that differentiates us from humans, sorry, from animals. And in differentiating us from animals, it’s what allows us to connect with people. It’s where we form our memories. It’s where we retrieval of our information. So I describe it to people. It’s your public library. It’s where you filed away every experience, every piece of knowledge. Everything you’ve read is filed away. And now if you are distressed, the lot goes on your public library, you cannot access it. So that simple act of breathing allows you to open your library and allows you to then see your way through a solution. Because I do quite a lot. I’m also a clinical hypnotist as well, and so I do quite a bit of work with trainees who are struggling to get their exams. So, you know, they’re super smart. They’ve done their study, they know their stuff, but they head to that exam and they get so stressed that the library just shuts and they can’t access it. So in hypnosis, we teach them that ability to self-regulate and then open up their library so that the entire resources available to them.


Dr Ron Ehrlich [00:43:36] That is so interesting. I mean, you know, the fight and flight is very much survival and the rest and digest is very much in the front there. And I’ve heard it described that we can either cultivate the neural pathway as a dirt track or a five-lane highway going whichever way you want it to go. And we do have control over it. You know, I’ve been doing a course in positive intelligence, which may well ring a bell with you. I don’t know whether you have familiar with the work of Shazad Shamim and… At Stanford, but this is exactly what he’s talking about. And hypnosis. Now, it’s a little bit of a digression here, Tabitha, but I am fascinated about it. I, I did my first hypnosis course six months after I graduated and it’s so interesting. Tell us a little bit about the theory of hypnosis.


Dr Tabitha Healey [00:44:29] So it’s looking at the model of the brain similar to being an iceberg. So 10% of our brain is the bit that we can see above the ocean, and that’s our conscious mind and that’s our logical brain. And it can deal with about 2 to 3 pieces of information at a time. But the challenge is, is that most of our mind is our subconscious mind, which sits below the surface, and that’s approximately 90%. And it can deal with up to 20 million pieces of information in the time intensive regulating our system and driving our thought patterns and behaviours. And into that subconscious mind is our habits, our behaviours, our thoughts, our emotions. And they’re just rolling on in the background like the soundtrack to our life. And it’s this concept of cognitive dissonance that people will know that they want to change something they just can’t. And so their logical mind wants to change, but their subconscious mind is holding them to that old pattern of behavioural thinking. And we know that programming of that is thought to come from three ways. One is childhood so between the ages of about nought and seven. So things that were either said or done knowingly or unknowingly get laid down into that programming. Then there’s the element of a traumatic life event will drop a programming and then there’s the act of repetition. And that subconscious mind really only has two roles. It’s either there to protect you or to pleasure you.


Dr Tabitha Healey [00:45:55] And so hypnosis is about distracting your conscious mind, opening up the conduit into the subconscious mind and allowing people to do the work that they need to do in that space. I call it Marie Kondo-ing your subconscious mind. It’s about keeping the things that spark joy, but letting go of the clutter and the mess that you’ve accumulated over time that no longer serves you. So it’s cleaning that out. It’s it’s rewriting the narrative. It’s changing the soundtrack to allow you to then to change the things that you want to do. Now, I got into it on the basis of time when I was working in palliative care. So a pain, an existential distress was where I first started, but now most of the work I do in that space is either negative self-talk, anxiety. I don’t do a lot of trauma work because that’s a lot more complex, but it can be used in so many ways. In our dentistry it’s very commonly used for dental anxiety and relaxation. But I have just seen some of the most spectacular results for people. People have been so stuck for so many years of their life with a self-belief system that sabotages them and a few sessions of hypnosis, and it’s like the slates being wiped clean and they can start fresh. And it is such a… It is fun, it is fantastic. It’s often very fast. So it’s a fabulous a-jump. So I don’t actually advertise the fact that I do hypnosis primary goal, but it’s been really useful for coaching. So people who are really, really stuck and I desperately want to change, but there’s this block that they just can’t get past. Hypnosis is so useful for getting around that. So I find the combination of can be really useful.


Dr Ron Ehrlich [00:47:44] And when you say it’s fast, you mean it may only take a couple of sessions? It’s not like 5 or 10 minutes that we’re going to get this sorted out in…


Dr Tabitha Healey [00:47:52] Usually an hour, but 1 or 2 sessions might be all someone needs. And some people may have been talking about this issue for ten years. And then in 1 or 2 sessions, it’s done like a flying phobia or a needle phobia, losing weight, quitting smoking, managing chronic pain, dealing with crippling anxiety, things that they’ve battled with for a really long time that are destroying their quality of life. And then you can shift that for them with spectacular benefits.


Dr Ron Ehrlich [00:48:22] Mm. Yes, well, I know. And I mean, so many people have this view of hypnosis as this showman thing, which makes people do stuff that they would otherwise not do. But but what you… When you see that, what are your thoughts? What do you think of that as a…


Dr Tabitha Healey [00:48:40] Common worry that people have? So I talk to people about the fact that hypnosis is actually about increasing their control. It’s about taking back control and show hypnosis is about people who want to be up on stage, who want to be doing crazy things. Like if I go into a hypnotic show, I would never be up on stage because I would never allow myself to be in that situation, whereas I’m very hypnotisable but you would never have me up there doing something crazy. So those people are there is willing participants and they go up there with the intention of something unusual happening. So I do reassure my clients that I can’t do anything to them that they don’t want or is not appropriate for where they want to go to. And it’s actually about all hypnosis. It’s self-hypnosis. So it’s about giving them the tools to be able to manage their own subconscious programming so that they can then allow that to be functional for them to live a fulfilling life.


Dr Ron Ehrlich [00:49:46] Well we’ve covered so many bases here today and it’s been terrific, I wonder and finally, I want to ask you a question, taking a step back from your role as medical practitioners health coach, because we are all on a health journey through life in this modern world. What do you think? You’ve mentioned so many things. What do you think the biggest challenges for us on that journey?


Dr Tabitha Healey [00:50:08] I would say the obvious one is technology and how people interface with that. But in terms of what’s the most significant thing you can do for yourself in terms of your well-being, I would say it’s exercising outdoors in nature. So terms of the simplest thing that somebody can do to reset is to get outdoors and to be in motion and that will start to bring your cortisol down faster than anything else, and then you’ll have flow on effects into every other sphere. You’ll sleep better, you’ll make better food choices, you connect better with other people. So that’s how I start every morning for me is walking up in the hills of Adelaide and coming back down, and that sets up my day beautifully.


Dr Ron Ehrlich [00:50:52] Well for our listener. I start my day on the Bronte on a beach doing exactly that and I what a great note to finish on. Tabitha, thank you so much for joining us and sharing your knowledge and wisdom with us today.


Dr Tabitha Healey [00:51:05] My pleasure. Thank you so much for having me Ron.


Dr Ron Ehrlich [00:51:07] Well, that may come as a sobering episode for you if you haven’t been aware of how your medical practitioners and health practitioners are faring in this epidemic of preventable chronic degenerative diseases, It’s interesting because if you Google the worst jobs for your health, it’s a US Department of Labour study that looks at 950 jobs in America and it uses a criteria of exposure to microbes, exposure to toxins, exposure to radiation and being seated through the day. And it gives each of those criteria is a score. And from 950 jobs in America, the jobs which came up one, two and three were dentist, dental nurse, and dental hygienist. It is worth mentioning that doctors come there in the first ten as well. So it’s surprising because you would, you know, with 950 jobs, you cover almost every job there is. And what’s sobering about that is, of course, they don’t even factor in stress into that equation. So you can multiply that even more for the health practitioners that are delivering you your health care. So Tabitha mentioned the Maslach, MASLACH index burnout inventory, and you can Google that and do your own score. And I just repeat her little acronym of DIE. Rather sobering there to die. The D stands for being… These are the criteria for burnout. The D stands for being detached. The I stands for feeling ineffective. You’re not getting anywhere in your job. You what you’re doing is, you know, you don’t feel you’re achieving anything. And the E stands for being exhausted. And I loved the fact that she was asking her clients in health coaching to take up the SPACE and that acronym was S for sleep P for pausing from technology using mindfulness and meditation. Interesting to hear her talk about breathing and how many doctors approached that rather cynically. A is for appreciation and gratitude. That is an extremely powerful thing that you we should all be practising on a daily basis. The C is connection, connection is huge. The Harvard Study of Adult Development over 80 years finds that the greatest predictor for health and well-being is relationships and E is for energy, which is all about eating and exercise. Now, Tabitha mentioned the life wheel that is a will have that are actually if you’re watching this on YouTube, this is what it looks like. It is a circle which is divided up into eight different sections. You can divide it up even more, if you like, into the various life domains like your work, your family life, relationships, exercise, health, finance, etc., etc. So you then have ten concentric circles from centre to the edge, allowing you to score how you think you fare in each of those life domain. And it’s a very interesting and powerful tool which which we will have available on our show notes as well. Now I’d encourage you to join our unstress health community and subscribe to the podcast and the community. Lots of interesting curated podcasts. I go back over the 4 or 500 podcasts that I’ve done and curate them carefully and pick out the best of each episode, each topic, and we’ll be doing one on burnout and workplace well-being, Men’s health, women’s health, children’s health, mental health, regenerative agriculture, environmental issues, the whole thing. But they will be specially curated where I take probably the best of 3 or 4 or more episodes and roll them all up into one. So and then in our unstress health community, we are looking to run regular live Q and A’s and webinars workshops and draw on some of the wonderful guests. And on that, I have also on my advisory panel there. Hope this finds you well, until next time, this is Dr Ron Ehrlich. Be well.


This podcast provides general information and discussion about medicine, health and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences and conclusions.