Do This Every Morning To End Stress, Stop Laziness & Heal The Body | Dr. Rangan Chatterjee

1. 0:00 – 1:00

   Why waking up earlier can reduce stress: your personal stress threshold

   1. RCDr. Rangan Chatterjee0:00

      Could it be a possibility that actually doing this and getting up early might change your life? It's changed mine. I know it can change yours. But you've gotta be willing to give it a go. Now, I wanna explain a concept that I think is really, really important to understand, to truly get why getting up early can help you. And it's what I call our own personal stress threshold, where we've all got one. I've got mine. You've got yours. In fact, our personal stress thresholds are gonna vary between people. Right? Mine's gonna be different from yours. And actually, from day to day, they may also be different, but they're unique to us. And here's the thing about a stress threshold, right? When you are far away from it, there's no real problem. You've got loads of headroom in your day, right? You've got, you

2. 1:00 – 5:32

   Micro stress doses (MSDs): how a reactive morning stacks stress before you even leave bed

   1. RCDr. Rangan Chatterjee1:00

      know, resilience really, a form of resilience. You can actually deal with the stresses and the obstacles when they come up. But when you are living very close to that stress threshold, well, that's where it becomes a big problem because you don't have much headroom. Now, remember Alexandra from the start, right? Think about what she's doing first thing in the morning. She's accumulating what I call micro stress doses or MSDs. I would say that this is one of the most useful concepts that I talk about with my patients. Like time and time again, they'll feed back to me and say, "Oh, I get it now. Oh, I totally get it now." So what is a micro stress dose? A micro stress dose is a small dose of stress that in isolation you can handle no problem. But if they keep accumulating and building up one by one, they get you closer and closer to your stress threshold. So let's think about Alexandra's morning, right? Micro stress dose number one was her being jolted out of a deep sleep because she went to bed so late the night before because she was unwinding in front of Netflix, right? Her alarm clock goes off, boom, micro stress dose number one. Then because she presses snooze, six minutes later again, she gets woken up again, micro stress dose number two. Then first thing she does, picks up her phone, looks at her email, sees all the work emails she hadn't replied to yesterday, gets another hit of stress, micro stress dose number three. Then she goes onto social media, sees a snidey comment from someone, micro stress dose number four. Goes onto the news and sees the latest tragedy that's gone on in some distant part of the world, micro stress dose number five. The point I'm trying to make is, right, this is the key point, that by virtue of the way she starts every day, even before she's got out of bed in the morning, she's probably accumulated about 10 micro stress doses, and before she's even got out of the house and gone to work, she may be on 15 or 20. But that is real. Why don't you just take a moment to assess in your own life how many of those micro stress doses are you taking a hit on every morning? Because here's the problem, if you have zero micro stress doses before you leave the house, and we think about your stress threshold, right? You leave the house a million miles away from the threshold, which means you have got loads of reserve to deal with all the hits that are gonna come throughout the day. But if you've accumulated 15 or 20, you're already here. You've probably only got a few hits left. That's why on those days, that email from your colleague at 10:00am starts to bother you. Whereas on another day it might've been that email at 4:00pm. Because at 4:00pm, yeah, you've got closer and closer to that threshold, but at 10:00am, you're absolutely fine. The problem with the stress threshold is, is that when you get to it or near it, that's when things start to go wrong. As I mentioned, that's when the email starts to bother you. Probably a neutral email that if on a Monday morning you'd slept well and you'd had a relaxing weekend, you'd be totally calm about. But because you're so close to that threshold, it really starts to bother you. Well, I, I kind of know that feeling, honestly. Like I've sometimes in the past, I think, you know, you, you see that email at the end of the day and, you know, you get wound up. Why has this person sent it like that? You know, you, you can feel it inside your body, the frustration, but it isn't actually the email that's the problem. And we think it is. No, it's a state of us. It's a state of our nervous system, right? We see the world through the lens of our own stress state. So if you're near your stress threshold, you're gonna get triggered. You're gonna get annoyed. You may well take that next step and reply in that stress state, which compounds the problem. But if you can do things each day that keep you away from that stress threshold, you're gonna find you've just got more headroom

3. 5:32 – 10:10

   Stress spillover into relationships and evenings—and the case for an intentional morning

   1. RCDr. Rangan Chatterjee5:32

      there. You've got more self-awareness, and you'll find you just don't get that close. Like, that's honestly what's happened for me. Over the past years of getting up at 5:00am, having a precise morning routine that I can change from day to day, but I have a kind of broad framework. I've found that I just don't feel stressed as much as I used to. I feel calmer and more present with my colleagues, with my patients, um, more present with my wife I mean, you know those days where you, you've had a busy day at work and, you know, you get home, maybe traffic's been bad and, you know, someone's cut you up and, you know, you, you feel all these emotions kind of building up inside you, and then you turn up at home and, and it kind of spills out. It affects how you interact with your wife. You know, you may ... You know, you may have a little row or, or snap, or snap at the kids. You know, that's really common, isn't it? It's very rarely the situation that you're reacting to that's the problem. It's the buildup of what I'm calling micro stress doses throughout the day, especially if you don't take a lunch break, especially if you have no time in the day to pause and allow things to settle, which is the case of many people. Many people start off the day in reactive modes. They continue all day in reactive modes. Is it any wonder that your relationships are affected late afternoon, early evening? And it's not just that. It kind of bleeds into your entire evening. It affects the quality of your daily life. It affects the experience of life. And it may sound slightly trivial to say, "Well, what's waking up early gonna do here?" Waking up early is gonna do a lot here. It's about living an intentional life where you're the driver. You're in control. You're saying, right, that, "No matter what's going on in the world, no matter what's going on in my own life, no matter what I have to do, I'm still prioritizing myself. I'm saying that I'm still worthy of 10 minutes or 20 minutes or 30 minutes," whatever you can manage in your life, "I'm still worthy of that." And that does something really quite powerful. If we think about behavior change, and this is something that James Clear talks about in Atomic Habits actually, this idea that every time you do something proactive for yourself, it's a vote, right? It's a vote for the kind of person you want to become. So I think it's a pretty good point to ask you, you know, what kind of person do you want to become? Do you wanna be that person who's always reacting to life as a passenger in their own life, or do you wanna start to feel as though you're in control, right? You can be the architect of your life. You can help to direct your life and what you're gonna end up doing. And although that may seem like quite a tall aim from where you currently are, it's actually not. It starts small. It starts with setting an intention that I'm gonna get up. Pick your time, right? For me, it's 5:00am. Why? Because for me, for many years, my son would wake up at around 5:30. So for me, it was important that I get ahead of that 'cause if I can get ahead of it, I can do some stuff for me, right? I can move my body a little bit. I can meditate. I can have a cup of coffee. I can read something uplifting, right? I'm gonna get to my framework shortly. Hopefully, it will help you create your own framework. But that's why 5:00am worked for me. Doesn't mean it's gonna work for you. Maybe it's 6:00am. Maybe it's half 6:00, right? It doesn't really matter. It's what you do with that time and it- and it's also what that time says. What

4. 10:10 – 16:16

   A skeptical single mother’s 5-minute routine and the ‘3M’ morning framework

   1. RCDr. Rangan Chatterjee10:10

      vote are you giving yourself? What you end up doing is that you start building up the identity of someone who really values themself. Now, I just wanna tell you a story about one of my patients from a few years ago because many people, when I talk about this, if I, if I post about this online, which I do sometimes, you know, some people will push back straight away and go, "Ugh, doesn't work for me. I've got too many things to do. I'm, I'm a mom. No way will that work." So perhaps this patient of mine might speak to that, right? 42-year-old lady when she came to see me. Single mom, two kids. Had really bad skin. Now, she tried all kinds of things, creams and various things with some effects, but it was still bothering her. It was still affecting the quality of her life, and it was really clear to me from talking to her that stress was a big player here. Huge player, right? When she would get stressed in life, her skin would flare up, and this is pretty common for all kinds of conditions actually. Yes, a lot of skin conditions, but even beyond that, we see all kinds of things. Our perception of pain is worse when we feel a lot of stress. Uh, our gut symptoms. You know, gut symptoms are really common. There's this... There was this kind of survey done in the UK a few years ago of UK adults this says, which showed that about 80% of UK adults suffer from at least one gut problem in any given year. I mean, that's huge, isn't it? 80%. That's nearly the entire adult population, and everyone's always jumping to food. You know, what foods are causing that? And of course, food plays a role, but I can tell you in my experience, stress is the number one player- Because the stress response affects every organ system in the body. It affects your guts. Hugely affects your guts. So I'll get back to that shortly. I wanna explain what exactly the stress response is and how it affects the gut. But let's get back to my patient, right? Complaining of skin problems, single mom, two kids, working hard. I say, "Well, listen, what about getting up a bit early, doing something before the day starts to give you a sense of control?" She says, "Doc, I do not have time. No way is that gonna work for me." And, you know, I made all kinds of other suggestions. I always try and work with patients around what they want to do because it's, I think, the only way really, you know? Instead of trying to enforce what I think they should be doing, it's like, okay, in the context of your life, what can we do? But I, I, I did always have this feeling that there was gonna be a way to help her in the mornings. And I think it was a few weeks, maybe a few months, where we finally got to the point, I said, "Listen, come on. Hear me out. What about if you had a five-minute morning routine, right? Can you get up before your kids do, or even whilst they're getting ready? Five minutes. Can you give me five minutes?" And I walked her through what I call my 3M framework, the three Ms of a morning routine, mindfulness, movement, mindset. You don't need to do them all. But she thought, "Within five minutes, I'm gonna do this 3M." So what did she do? So for the first minute... Well, no, let's just back up a minute. She'd get up, she'd get down to her kitchen, I think she'd put the kettle on from recollection, but then her, her kind of five-minute morning routine would start. She'd do one minute of mindfulness. That happened to be a breath that I taught her called the three, four, five breath, where you breathe in for three, you hold for four, and you breathe out for five. Right? Now, it's a simple breath that I've been using with my patients for years, but an important thing to understand is anytime your out breath is longer than your in breath, you help to switch off your body's stress response system and you help to promote the relaxation part of your nervous system. So it's a very relaxing breath, okay? So one minute of three, four, five breathing. Super easy, super quick. Then two minutes of movement. Now, for me, it doesn't really matter what movement you wanna do, right? Moving your body first thing in the morning is a fantastic thing to do for a variety of different reasons, right? It can help lower anxiety, lower stress. It can help change your mood. It can help you feel happier. You can feel calmer. It can make you more creative, more productive, right? All kinds of things happen when we move our bodies, so it's a really good thing to do first thing in the morning to get you set up for the day. But she used to practice yoga years ago, and she really liked the sun salutation sequence, so she basically did her version of that for two minutes. Again, so let's just back up. First thing in the morning, she's in the kitchen, she's putting the kettle on, and then she's doing her five-minute morning routine. One minute of three, four, five breathing, two minutes of some yoga poses that she really likes, and then for the final two minutes, this is the kind of mindset part, she took my recommendation of reading. I said, "Listen, I'm not talking about reading an entire book, an entire novel, an entire chapter." I shared with her how I love to start the day by reading a few pages from a kind of uplifting book, right? And what I like and what you like is probably gonna be different, so it's not about choosing the books that I read. It's about, what are the books that make you feel good, right? Do you have any? Why not have them kicking around? And she would literally for two minutes

5. 16:16 – 22:54

   The ripple effect: small morning calm leading to bigger behavior change and symptom relief

   1. RCDr. Rangan Chatterjee16:16

      just maybe read a page or two pages. Now, it's so small, but she got up early, five-minute morning routine, and it kicked into effect what I call the ripple effect. Now, before I explain the ripple effect, let me just say something head-on. She was skeptical. Like, really skeptical. She thought, "How is this going to help me?" Right? "I get it. I, I, I'm desperate, so I'm gonna do what you, what you're recommending, but how's this gonna help me? I am busy. I have got two kids. I don't have any help. I don't have a partner. I've got to get to work, and my skin's bad." And what was amazing is within a few days, I think I got a call. Yeah, I don't think she'd come in to see me yet. I think it was a call at my clinic where she basically said, "You know, I'm, I'm starting to feel better. Like, I feel less anxious. I feel calmer." Right? And then about a week, week or two later when she did come in to see me, she said, "Yeah. And, you know, because of that, because of these new feelings, I then stop at lunch and go for a 20-minute walk," and all kinds of other changes on the back of that. You know, what, what was incredible is it was almost as if instead of being in reactive mode all day, every day, by having just a little window of calm, like a five-minute window of calm each morning that she was intentional about, it almost showed her how she could feel, what emotions it was possible to experience. And so she started going for that walk at lunchtime, not because I asked her to, but because she wanted to. Now, that's a really key point for me. Like, you know, in all my experience of seeing patients, I always wanna get to that point where I'm simply used as a guide to help point someone in the right direction. But I always want at some point my patients feel empowered that they're in charge now. Like, "This is what I want. When I do this, I feel better. When I don't, I feel worse." That's the secret to long-term behavior change, honestly. That really is one of those key secrets, because no one is ever gonna do something because somebody else told them to. It- j- just, just think about it in your own life. I know I wouldn't. Right? You know, we don't. You know, in the new year, in January, often people do. They think they're gonna manage. They think, "Right, I'm gonna follow this plan now." But whilst a plan remains someone else's plan, you're always a little bit removed from it. You'll, you'll follow it for the first week, maybe the second week, maybe for three or four weeks, but if you're not engaged, if you don't take ownership of that plan, like, "That's my plan. I'm doing it because I feel good," you're never gonna do it. You're never gonna do it in the long term. And that's what I love about this particular lady, is that she started to make changes 'cause she wanted to do them. She felt good. She experienced it. It wasn't 'cause I asked. Right? So what was the upshot? The upshot is she's feeling better, but her skin starts to get better as well. Remember, she had tried loads of creams, loads of medications and as I said, I strongly felt stress was a big driver of those skin problems. And she basically had about 70, 80% reduction in symptoms and flare-ups, and it all started with getting up early and having a five-minute morning routine. And that's why I'm so passionate about this. Right? This is not just for CEOs who might have personal trainers and have time to block off the first hour of their morning. Right? We've all seen those videos of, you know, the top performers, the big business guys who get up, win the day, they attack the day. You know, while the rest of the world is sleeping, these guys are getting ahead in whatever way. And I wanna be clear here, I'm not against that. Honestly. I think certain messages work for certain people, and for many people, that's the right message for them to hear. It helps to motivate them. They get up early. They spend an hour on a morning routine, then they start working. Right? Great. I'm not criticizing that. I'm not being condescending about that. You know, I very much respond to approaches like that, if I'm honest. But what I can tell you is that morning routines are not just for top CEOs and business people. They're not. They're for everyone. Right? They're for absolutely everyone. Let's just bring it back to Alexandra, right? Right at the top. Alexandra's life was reactive. Micro stress dose after micro stress dose. She's already starting her day with very little headroom. Of course she's a passenger in her own life. Of course every little thing is gonna start bothering her and she's gonna feel out of control. I would if I started the day like her. That's the truth. But as you can see, by intentionally starting the day differently, you're gonna kick into gear a ripple effect which will have profound benefits in many aspects of your life. And that particular patient, over time, there were all kinds of other benefits, right? She started moving a lot more. She started journaling, right? She got into a really good long-term relationship a few months later. All kinds of things. And can I put them all down to that five-minute morning routine? No, of course I can't. I can't prove that to you. Right? I can't. But I have recommended this with so many patients over the years, and it always

6. 22:54 – 32:04

   Pushback and practicality: “What about busy parents and sleep?”

   1. RCDr. Rangan Chatterjee22:54

      makes a difference once you find the right approach. Now, I posted about this last week, about my own morning routine. You know, it was a little clip from a conversation I had on another podcast where the host asked me, "What do you do each morning?" And I shared what I did. And like with many things these days, you know, a lot of positive feedback, a lot of people liked it, a lot of people took it as inspiration to go, "Oh wow, I'm gonna take some elements of that and I'm gonna see what's gonna work for me." But I got one message. I've, I've got it here. Right? I'm not gonna read the, the entire message. And she said a few things. "I challenge any mother with kids to have the time to meditate, read, or exercise before getting our kids to school. Maybe getting them earlier will cause us to lose vital sleep. These messages are unhelpful. They're gonna make most of us fall at the first hurdle. Please stick to science and advice for all, not for those who can afford an iced coffee and have too much time on their hands." Now, while I don't know this person personally, but, you know, as I reflect on the message- I have no doubt at all that what she is saying reflects the feelings of loads of people, right? There's a genuine need there. Life does feel out of control for so many people. Like, I've felt this. Like, honestly, I've felt it. I have ... I know what it's like to get up a little bit late, be rushing around. You're trying to get things done, trying to get the kids off. You're on the motorway. You're looking in the mirror. You're looking at your watch thinking, "I'm gonna be late, I'm gonna be late, I'm gonna be late." And then even if you do make it on time, what state are you in when you get to work, right? You're not in that calm, present state where you're gonna make good decisions, where you're gonna be that present with people, that kind of kind and compassionate ... You're just not gonna be your best self when you're feeling like that. So I get it, right? I understand it. But one of the reasons I wanted to speak to you is to say that this really does work. You know, I challenge any mother to do that and get their kids to school. Well, I'm not a mother, right? So I can't speak to that. But I have been a doctor for over two decades, and I've seen thousands of mothers, and I've just shared an example of a mum who was able to do that, who didn't think they were able to do that. Very much like the person who sent me that message, they thought, "That's not applicable to me." So if you're pushing back, I want you to just ask yourself, have you got five minutes? Do you have five minutes in the morning, right? Have you got 10? But maybe 10's too much. Start with five. What might you be able to do in those five minutes that gives you a headstart on the day? Like, I get it, right? I understand that message. I understand that that person is probably struggling, and they genuinely feel this is not relevant. But as I've already said, there is always a way to make this work, always. And if for whatever reason you can't make it work, then sure, maybe another time of the day is gonna work. But if you literally cannot find five minutes at any part of the day to do something for yourself, it honestly is time to ask yourself, what kind of life am I leading? Am I really that busy where I can't create this five-minute period at least where I could do something for me? What about the point she made about this interfering with sleep? That's a great point, right? That's a great point [laughs] because I'm always talking about the benefits of sleep. Not just me, loads of people now. Uh, there's some fantastic books, podcasts. It's out there in the media, right? Sleep is really important for our physical health, mental health, emotional health, right? We're all kind of getting that message. And so that's a valid point. If I'm asking you to get up earlier, let's say 5:00am, right? If I'm asking you to get up at 5:00am ... Or let's say Alexandra, right? Let's say I'm asking Alexandra to get up at 5:00am. Can she still stay up late on the sofa watching Netflix or past midnight? Well, no. Or if she does, there's gonna be a consequence to that. Now, here's a key thing about change. You're not gonna suddenly click your fingers and overnight everything's gonna change. You're gonna wake up at 5:00am, feel fresh, feel ready to go, have the most blissful morning routine, have a calm, non-stressed day, and go to bed early. That's not gonna happen, right? This is gonna be small, incremental changes. But if Alexandra decides she's gonna get up at 5:00am, or let's make it more realistic, her alarm was going off at 6:00am. So let's say she was gonna get up at 5:45am, just a little bit earlier than she currently does now. I would say, well, let's work back from that. How many hours of sleep do we ideally wanna be getting? Probably, you know, let's at least aim for eight hours in bed, right? In bed. Doesn't mean you're gonna be sleeping the whole time. What we call a sleep opportunity. A lot of the time when we're thinking about sleep, seven hours sleep or eight hours sleep, we think about, oh, then I need to be in bed, let's say for 9:00pm, waking up at 5:00am. But being in bed or being in the bedroom doesn't mean you're gonna be sleeping that entire time. But let's go for an eight-hour sleep opportunity, and let's say you might be sleeping for seven hours of that. If she's gonna get up at 5:45am, right, what does that mean? That's kind of 9:45pm she really wants to be in bed for. Currently, it's midnight. So that's quite a big adjustment. She may not be able to do that immediately. She may have to make some compromises in that transitional period. That's okay. You know, Rome wasn't built on a day. You're not gonna completely transform your life overnight. But even if instead of midnight you went to bed at 11:00pm and got up at 5:45, man, you're still in bed for six hours and 45 minutes. Is it optimal? Probably not. I've been a doctor for over 20 years. I've seen tens of thousands of patients, and I have to say that journaling is one of the most powerful habits I've seen with all of my patients. When people journal regularly, I see improvements in things like focus and productivity. I see improvements in their mental health, their decision-making, but also in their ability To make healthy change in their life. And the reason is, is because journaling helps you get to know yourself better. If you ask yourself the right questions, you'll get the right answers. And I've created my very own journal called The 3 Question Journal. In that journal are three of the most powerful questions I believe that you can ask yourself each morning and each evening. Now, these are questions that are tried and tested with my patients over the past two decades. These are busy people with busy lives. And the reason I've created this journal is to help people with a very simple practice that doesn't take any more than five minutes that can immediately start to have a huge impact. Now, there's many ways to journal. You have to find the right method that works for you. But if you're interested in trying something new this year, I think the three question journal that I've created is very, very powerful. It's simple, it takes minutes to do, and I genuinely believe it will transform your life. But is it better than what it currently is? Yes. So that little bit of progress is gonna start making a difference. Right? And what you will soon find if you just start to slowly make adjustments to going to bed time and waking up time, your body will start to adapt. You're not gonna wake up feeling fresh at 5:45 AM if you haven't done it before. It's gonna take you a few days, maybe over a week, two weeks to start to get used to that. Just imagine when you go

7. 32:04 – 35:05

   Night owls, screens, and circadian adjustment: changing light and routines to shift sleep timing

   1. RCDr. Rangan Chatterjee32:04

      on holiday, right, and you're going somewhere where they're on a different time zone. Even if it's just one hour or two hours, it still takes a bit of time to adjust because we are governed by these internal clocks, what we call our circadian rhythm. You know? It, it sort of goes on cycle. It's influenced by light. It's also influenced by food, but light is a big one. The point is, we can adapt. You know? If you go on holiday somewhere or you go away somewhere for work, you can adapt. It just takes time. Now, what about night owls and morning larks here? That's a big one, isn't it? People say, "Yeah, but I'm, um, I'm a night owl. I can't do mornings." And I just wanna make something really, really clear. These chronotypes do exist, so we know that some of us are kind of genetically predisposed to being night owls and staying up a little bit later, and some of us are genetically predisposed to being morning larks, you know, getting up earlier. But I think we, I think we kind of overly lean into that research and we use it, many of us, as an excuse to go, "No, I'm a night owl. There's nothing I can do." Well, many night owls [laughs] are simply night owls because of the way they're living their lives. Light is a key determinant, right? It's a huge player in what time our body thinks it is. It's a huge player in what time melatonin, the darkness hormone, the sleep hormone, gets released in our bodies. It does many things, but one of the key things it does is help determine at what point you're going to fall asleep. So you may be telling yourself you're a night owl, and you may be. You may have that, that sort of leaning. But even if you do have that genetic kind of underpinning, it doesn't mean you need to go to bed as late as you currently do. If you're looking at light, screens, right, late into the evening, it's gonna keep you alert. It's gonna push back melatonin release. You're gonna feel sleepier later, so you're gonna tell yourself, "Oh, I'm a night owl." Funny thing is, is when you take a lot of people camping without these devices, very quickly their bedtimes become a lot earlier. You may have experienced that yourself. Now, I just wanna be really clear. I'm not saying this has no bearing at all, but I think we overegg it. Our patients who would consider themselves night owls, who very quickly if they stop looking at screens late into the evenings, if they start eating their evening meal earlier, right, it helps to reset their clock so they can actually go to bed

8. 35:05 – 44:47

   Eliminating unnecessary choice: reducing decision stress to protect cognitive capacity

   1. RCDr. Rangan Chatterjee35:05

      earlier and get up earlier. The next tip, which I have seen be profoundly transformative for my patients and for myself, is eliminating unnecessary choice in our lives. Now, this may sound a little bit counterintuitive. Why would you wanna eliminate choice? Isn't choice a good thing? Isn't more choice even better? I get to choose what I want to do. And first of all, I wanna just recognize here that some people are living lives where they have no control, they have no autonomy, they don't have enough choice. I do understand that. If that's you, then this tip may not apply. But if that's not you and you are feeling stressed out, overwhelmed, anxious, you find that you're procrastinating, you can't make decisions, you can't move forward, you feel stuck, I bet that too much choice is playing a role. We have to make decisions on everything these days. Studies suggest that we're making over 35,000 choices a day. Other research says that we make over 220 choices a day on food alone It's overwhelming. And one thing we really have to understand is that every time you're making a choice, it's taking up some of your cognitive capacity. You may have heard me talk in previous podcasts or in previous videos about something called micro-stress doses. Right? These are little hits of stress in isolation we can deal with just fine. But when those doses go on top of one another, they build up, they mount up, they get us closer to our own personal stress threshold, and when we get to our threshold, that's when things go wrong. That's when we fall out with a work colleague. We have a row with our partner. Our back goes into spasm. Our neck starts to ache. And we often think it was the last thing that we did that was the problem, but it usually wasn't. It was the build-up of these micro-stress doses throughout the day. Every time you make a choice that doesn't matter, that's a micro-stress dose. You're getting yourself closer and closer to that personal stress threshold where things start to go wrong. And a simple way of keeping you away from that stress threshold is to make less choices, especially on the things that don't matter. You know, President Barack Obama, Mark Zuckerberg, these guys are famous people who are well-known for wearing the same thing every single day so they can save their cognitive capacity for decisions that matter. Eliminating choice from your life will have so many benefits. You make better decisions when you don't have to choose on everything. There was some more research showing that for food companies, if they offer 28 flavors of a food product compared to five or under, sales go down. When they offer just three, four, or five flavors, sales go through the roof. Because if you've got choice, if you've got infinite choice, you're always wondering, did I make the right one? Would that other choice have been better? And often you then procrastinate and end up doing nothing. I mean, I can't tell you the amount of times in the past when my wife and I, on a Saturday evening, once our children were in beds, would sit down on the sofa, put on Netflix with a view to watching something. The amount of times an hour later we still can't decide because of all the choice. Our moods are a little bit off, and we decide to forget it. Too much choice, especially today, it is real. I'm not saying never choose. I'm saying choose when it matters. Look, I'm a doctor, so people's health is something that's very, very important to me. Now, let's take something like, I don't know, exercise. We know that moving our bodies more is better for us. It's better for our physical health, and many people now realize it's very good for our mental well-being as well. But what often happens, and I've seen this with so many patients over the years, what often happens is this. Let's say people are online. Let's say they're on Instagram, and they follow someone who says that yoga's amazing. They follow someone else who say Pilates is amazing. They follow someone else who says, "I run. I do 5Ks each week." Someone else does strength training. And it's overwhelming. They're like, "Yeah, God, that yoga sounds good. Pilates sounds good. Running sounds good. Walking sounds good. Strength training sounds good. Which is the best one?" And they try and weigh up the decisions. In the meantime, they're not doing anything. They're not moving their bodies. The truth is they all have benefits if you do them. Most of us are better just picking one and doing it consistently, regularly. I honestly believe that variety is overrated. You can simplify your life in so many different ways by eliminating choice. In my patients, one of the commonest sources of stress for people who are trying to be healthy is asking themselves, "What am I going to cook tonight?" In this world of endless choice, what I'm gonna cook the family tonight, well, one way out to that is to have a meal planner. Have the same meal Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday. Have a different meal and just repeat it week after week. You know what you're having. You don't have to decide at your weekly shop. It's simple. You know what you need on which day. Again, I wanna emphasize that may not be something that's relevant in your life, but I'm pretty sure that too much choice is adding to your stress load in some way. So some simple things you can think about are, yeah, write a meal planner. Wear the same clothes every day. If you listen to podcasts, as I do, if you go on a podcast app now, right, and try and decide what to listen to, you've got limitless choice. There's something like two or three million podcasts there. How on earth are you meant to choose? It's actually quite stressful to look at them and go, "What am I gonna listen to?" I've been in that boat before. Some of my favorite podcasts are, "Oh, that episode looks good. That one looks good. Which one am I gonna do?" And even if you choose a good one, you still feel like you're missing out. So what I do now, I have three podcasts that I subscribe to. Just listen to them. I don't look at anything else. I've got three podcasts I subscribe to which give me the content, the quality, and the variety that I want, and I just stick to them. They are good enough Of course, there are other great podcasts out there, but those three work for me. If you're someone who also can't decide what film to watch on a Saturday evening, well, one thing I've started doing over the last years is when I get a recommendation from someone, whether it's on a podcast or a friend, I open up my Notes app, and I make a list. So if I'm ever sitting down in front of the television with time with my wife, I have a ready-made list of films that I want to watch. Now, these things, they sound really, really simple, but they are very, very effective. They simplify your life in so many different ways. I promise if you start eliminating choice, unnecessary choice from your life, it's gonna improve things. But if you're someone who likes to go out and eat in restaurants, do you have a favorite restaurant that you go to? I do. There's a cafe in my local town that I like going to. You know what? There's one meal there I really, really like. I just have it every time I go. Now, you may be someone who really values variety in your food. Okay, fine. That may not be the right choice for you, but for me, it is. For me, I don't even look. I go there. I say hi to the staff. I say, "Just the usual, please." If you're somebody who drinks wine, let's say, and you go to a restaurant, do you spend ages trying to decide which one of these wines shall I have? Well, if you're a wine connoisseur and that matters to you, that may be a choice that matters. If you're not, and you just like the odd glass of red wine, maybe you make a rule. I always choose the second cheapest bottle on the menu. Whatever it might be, you've got to find what works for you. And we're now living in an era where there is infinite choice wherever we go, and it's causing us huge problems. The next tip that I wanna share with you

9. 44:47 – 49:50

   Seek out social friction: reframing conflicts and ‘making everyone a hero’

   1. RCDr. Rangan Chatterjee44:47

      is truly life-changing. Arguably, this is the tip that's had the most impact on me over the past few years, the most impact on my health and also my happiness. And the tip is this. Seek out friction. What does that mean? Friction is something we usually want to avoid. We want a calm, nice, relaxed life without any friction. But friction can be your most powerful teacher, and I'm talking about social friction. How we interact with others plays a huge role in our health and our wellbeing. And a lot of the time we allow our interactions with others which don't go the way in which we want, we allow it to affect us, overly affect us. If someone says something to us that we don't like, it then ruins our day. We take it personally. We generate emotional stress, and then we engage in behaviors like sugar or alcohol or doom scrolling that really we're doing to neutralize the emotional stress that we created. But there is another way. You can use every moment of social friction to learn something about yourself. You can use every bit of social friction you come across as a teacher, and when you do, you will feel empowered. You will feel in control of life rather than life being in control of you. Now, one of the tips I have for you to do this is to think about making everyone a hero. What does that mean? It means when something happens, let's say you're driving to work, and someone driving another car cuts you up in traffic. Now, you could react negatively. You could get annoyed and start going, "Wow, that person shouldn't have a license. I can't believe they did that." Whatever it might be, whatever narrative you want to create. But how is that narrative helping you? It's not. It's generating emotional stress. You, by the way in which you are reacting, are generating emotional stress. And once you realize that that is a choice, you're empowered to change it, and that's where make everyone a hero comes in. What story do you need to create in your mind to make that person a hero? What could be going on in their life? Maybe they're a dad whose child was up last night with a cough or with earache, and they're exhausted, and they're just trying to get to work. And they're worried that they're running late, and if they get to work late, they're gonna lose their job, and so they then can't feed their family. Maybe they were just being unmindful. They didn't sleep well. They're worried. Maybe their parents are sick. If you were that person, you'd probably be doing the same thing. But you have a choice, and when you exercise the power of that choice regularly, you get better at it. Five, six years ago, I would have struggled with this. I would have felt that the way I feel is because that person behaved in that way. But I've learnt since then that my response is down to me. I can change my response. And by practicing every day, by, let's say in the evening, you reflect on your day and you think about a bit of social friction What happened today where I got a bit annoyed? What might have been going on in their life? How might I be able to make that person a hero? It sounds simple, but it's very, very effective. If you think it's gonna be hard, try it. It's honestly not as hard as you think. Sure, in the moment, you may find it difficult. You may be in your car getting frustrated. Fine. We're all human. But maybe later that day, maybe in the evening, maybe at the weekend on a Sunday, let's say you're having a slow, relaxed day, reflect and go, "Wow, okay, I did react. I did generate emotional stress. I did have an extra glass of wine that evening because of that. How might I change that? How might I make that person a hero?" You can do it. I've done it, whereas now usually my default is to do it in the moment, and it's very, very empowering. You know, one of the most powerful conversations I've ever had

10. 49:50 – 56:55

    Edith Eger’s lesson: mental freedom, reframing, and limits of the approach

    1. RCDr. Rangan Chatterjee49:50

       in my life was with a lady called Edith Eger. When I spoke to her on my podcast two or three years ago now, she was ninety-three years old. When she was sixteen, she was getting on with her life. She was at home with her parents and her sister. She grew up in Eastern Europe. They got a knock on the door, and they were put on a train to Auschwitz concentration camp. Within two hours of getting there, both of her parents were murdered, and later that day, because she was a dancer, she was asked to dance for the senior prison guards. Now, there's so many things about that conversation I remember, but the first thing was that she said to me, "Dr. Chatterjee, I never forgot the last thing my mother said to me. She said, 'Edie, nobody can ever take from you the contents that you put inside your mind.'" So she said to me, "When I was dancing in Auschwitz, I wasn't in Auschwitz. In my mind, I was in Budapest Opera House. I had a beautiful dress on. There was an orchestra playing. There was a full house." In the hell of Auschwitz, she managed to reframe things in her mind. She chose a story that empowered her. Now, that's pretty incredible. When she said that to me, I hadn't heard anything like that. Then she said to me, "When I was in Auschwitz, Dr. Chatterjee, I started to see the prison officers as the prisoners. They weren't living their life. In their minds, they weren't free. In my mind, I was free." It was really, really powerful. And one of the final things she said to me I have never forgotten, I pretty much think about it every single day. She said, "Dr. Chatterjee, I have lived in Auschwitz, and I can tell you the greatest prison you will ever live inside is the prison you create inside your own mind." That's what we all do. We go around the world. We get on with our lives, and someone maybe at the coffee shop steps in front of us in the queue. They probably had never even seen us. It was an accident, but we create a mental narrative that they were being inconsiderate and they should have known, but we generate emotional stress within ourselves. We do it everywhere. What about an email from your boss that you don't like? You get frustrated. "My boss should know better. I've worked for this company for years. They should know better than to email me like that. I know what I'm doing." Whatever it is, you are generating emotional stress, and you can actually reframe that situation with practice. Now, I wanna make something really clear. I'm not saying that you should put up with poor behavior. I'm not saying that. I'm saying if you can develop the skill of staying emotionally neutral and really understanding that your response comes from within you, you will start to change your life. Let's say you don't react to that email. Let's say that email comes, and you take a, a beat and you go, "Wow, isn't that interesting? My boss doesn't normally send me an email like that. I wonder what's going on in their life. I wonder if any of their relationships are under strain. I wonder if my boss's boss is putting pressure on them." If you approach it with curiosity as to what might be going on, how can I reframe this to tell myself a happiness story rather than a story that causes me harm, you're gonna be better emotionally regulated, your lifestyle behaviors are gonna be much better, and you're gonna be better able to change things. You're gonna be better able to not send a rash email back that you then regret, and the following day you're gonna be able to go up to your boss perhaps and say, "Hey, listen, you know, yesterday you, you sent me an email. Is everything okay? Like, it came across as quite rushed and as though you didn't value me. I don't know if that's just what you meant." Your boss may say, "Hey, look, I'm really sorry. I was in such a mad rush. I didn't mean any of it. I just fired it out quickly before a meeting. I'm so sorry." Or it may be that your boss really did behave poorly, but you can then say, "Listen, I think I work hard. I don't think that that was called for." Whatever it might be, but the key point I'm trying to get across and why this has transformed my life and the lives of many of my patients is because so often we feel as though we're a victim to life We think that the way we feel is down to other people, and when other people start behaving better, I'm gonna be okay. The problem is if you're waiting for the world around you to behave in a certain way in order for you to feel good, you could be waiting a very long time. Now, I know this may sound scary, it may sound challenging. I promise you, if regularly you ask yourself, "What bit of social friction came up in my life that I reacted to? How might I react differently?" Over time, you will start to change things. And really, what has helped me the most is that conversation with Edith Eger. If ever I'm stewing over something in my own life, if ever I think, "No, I can't reframe that. That was really bad. They shouldn't have done that," you know what? I think about Edith in Auschwitz, and I think, "Rangan, if she could reframe things in Auschwitz, you can probably reframe this in your own life." So I've used that as inspiration. Now, just a quick note. I understand that many people have got really tough lives, and there's a lot of toxic behavior out there. This whole idea about reframing things to help you, I'm not really talking about serious traumatic events such as domestic violence. I just wanna make that really, really clear. I'm generally talking about the things that come up in day-to-day life that we allow to affect our inner wellbeing and our emotional states. And if you can master this, even if you get 10% better at this than you currently are, you will start to feel much more in control of your life. That, in turn, is gonna help your health and your happiness. The final tip I

11. 56:55 – 1:04:01

    Talk to strangers: sociometer, ‘vitamin S,’ and why brief connection improves mood

    1. RCDr. Rangan Chatterjee56:55

       wanna share is talk to strangers. We know that the quality of our relationships is important, with our friends, with our family, with our loved ones. Those close, intimate relationships, yes, are a very, very important predictor for our health and our wellbeing. But it's not just the relationship we have with the people close to us. It's also the relationship we have with that wider social world. We're all part of this big, broad human family, and sometimes we forget that. Psychologists have found that we have a network within our brain called the sociometer, and what's the job of the sociometer? It's to constantly scan our social world for threats. So if we're not getting positive social feedback from our social world, we can feel anxious, we can feel afraid. Our self-esteem starts to go down. But when we get positive social feedback from the world around us, a smile from the person we walk past, a thank you from the barista in the coffee shop, a nice word you exchange with the supermarket attendant, whatever it might be, when you get those positive signals in your social environment, that sends a message to your sociometer in your brain that everything's okay. You feel content and in control. There was this really great study I remember reading in 2021 by the psychologists Paul Van Lange and Simon Columbus, and they found that positive interactions with strangers help us serve basic needs such as feeling connected, appreciated, along perhaps with the realization of personal growth in ourselves. And their advice was for people to initiate brief interactions, even a smile to strangers, because doing so supplies us with a critically important social nutrient that they call vitamin S. But isn't that great? We often talk about taking our vitamins for our physical health, but this is about vitamin S, the social vitamin, because that's who we are. We're social animals. Many of us are realizing more and more in our modern world we're becoming more and more isolated. I mentioned before about being in a coffee shop and not looking around, looking at your screen. Yeah, I mentioned the default mode network, the impacts of screens on our sleep. What about the impact on loneliness and isolation? What happens when these micro moment opportunities for connection are being lost? The more you can interact with strangers... And I'm not talking about a deep and meaningful chat. I'm simply talking about looking at people, looking them in the eye, smiling at them. Sure, if you're an extrovert like me, it's gonna feel easier. Sorry to interrupt. If you're enjoying this video and you want to learn more, then do check out my free special guide, which contains the six crucial steps you need to take in your life to not only build healthy habits, but also to make them stick. If you wanna get ahold of this free guide, all you have to do is click on the link in the description box below. But the research shows us that even for introverts, if you can talk to strangers or interact with strangers in some way, you're going to feel better. In a coffee shop, can you start saying hi? If you feel nervous, can you smile at the barista, say thanks? It gets easier the more you do it. But what's really interesting is how our brains work against us. Social interaction, whether it be with close friends and colleagues and family, or whether it be with strangers, is very powerful. But often our brain is trying to talk us out of it. There was some great research done in Chicago by Professor Nick Epley where he studied commuters and he basically took these commuters into three groups. One group were told to keep themselves to themselves, not interact with others. One group was asked to do what they would usually do. And the third group was asked to do something quite shocking and radical these days, reach out to someone, say hello and start a conversation. Now, before the test began, he asked all of the participants how they would feel if they were asked to do the third option, to reach out and say hello and strike up a conversation, and they basically thought they wouldn't like it. They'd feel less content and less happy. Interestingly enough, afterwards, every single person in that group who did reach out, they felt better, they felt happier afterwards, and that happiness lasted for the duration of the day. But also really interestingly, they were asked how many of the people that we reach out to are going to enjoy being reached out to? And they predicted that only 40% would actually enjoy it. Afterwards, when asked, it was 100% of them. People liked reaching out and talking to others, and the people who were spoken to enjoyed the fact that that had happened. Now, that was just one study in Chicago, but it's been replicated in many different cities around the world, including in London. Now I get it, you've got to be respectful. Some people will not want to be disturbed. Some people will be using their time on their commute to catch up with some work or listen to some music. But we can start to read these social signals. The point I'm trying to make is as we're becoming more and more isolated, more and more insular, we go outside, we put our headphones on, we don't look at others, we don't interact with others, and we wonder why so many of us are struggling with anxiety and depression and low moods. We're social animals, right? We need to interact with other people. Of course, in a safe fashion. I'm not saying go up in a dark street to someone you don't know and make conversation with them. But in a coffee shop, on a train, at work, when you're out for a walk, these are opportunities where you can practice interacting with strangers. So really, I want you to consider taking this seriously. I know you may feel a little bit scared, a little bit apprehensive, but like with anything, you can start small. It could be that later on today or tomorrow, if you go to a café to buy a coffee, if you feel nervous, could you just look at the barista in the eye and smile? Could you just say a thank you? When you're in a queue in a café, instead of getting frustrated

12. 1:04:01 – 1:09:06

    Sleep and daily recovery: morning light, caffeine timing, and evening ‘campfire time’

    1. RCDr. Rangan Chatterjee1:04:01

       that you have to wait, could you reframe it and go, "Wow, this is an opportunity for me now to practice a bit of positive social feedback. It's an opportunity for me to send my brain, my sociometer, a powerful signal." There's all kinds of things I could say about sleep, but let me just walk you through some of the commonest things that I see and the commonest things that you can do that will start to make a difference. And remember, you don't have to do them all, but the more of them that you can do, the better. Number one, right, when you wake up in the morning, try and expose yourself to natural light, right? If it's a cloudy day, you really want twenty to thirty minutes of natural light outside if you can. On a sunny day, you might get away with five to ten minutes because that helps to set your body's circadian rhythm and that's gonna help you sleep better that night. It's a really important point. People are thinking about their evening routine when they're thinking about sleep, but a good night's sleep starts in the morning. Second thing, caffeine. I get it. Many of us enjoy a cup of coffee or a cup of tea. I love my coffee, right? I'm not saying give it up, but the problem is in burnout is that you get stuck in a vicious cycle where because you feel tired all the time, you're using more caffeine to keep you going, which in turn is making it harder for you to sleep at night. So I always say enjoy your caffeine in the morning. Now look, the truth is we all have different sensitivities to caffeine. It depends on our genetics. It also depends on how much stress is going on in our lives. And if you're on the road to burnout, by definition, you've already got a lot of stress in your life. Your stress load is very, very high. And I have found time and time again that with people like this, with patients like this, you gotta be really careful with your caffeine intake. So I would say enjoy your caffeine, but keep it to the morning. The third thing I want to say about sleep is if you're gonna form into a deep, relaxing, restorative slumber, you have to start winding down about one hour before bed. One of the big problems these days is that our devices are our work devices and our pleasure devices. You know, you may have a laptop or a tablet and you may do all your work on it, but you also do all your chilling out on it in the evening. And what a lot of us don't realize is that our brain is an associative organ, right? It associates certain things and certain places with certain activities. So if, for example, you are used to doing emails on your bed on your laptop, your brain starts to associate your bedroom with work and emails. And that's one of the big reasons why people really struggle to switch off and fall asleep, because their brain has been conditioned for a certain activity in a certain environment. So that's one thing to pay attention to. You know, can you change your environment? Appreciate not everyone has space, but if you are working from home, are you able to work outside your bedroom? This is something that not enough people do, not enough people think about, but it makes a really big difference. The other thing to focus on in that one hour before bed is sending your brain a signal that you're no longer working. This is basically campfire time. Right? If we think about us, you know, tens of thousands of years ago, hundreds of thousands of years ago, the evening is campfire time. It's for storytelling, it's for fun, laughter, dancing, connecting. So if you are not giving your brain that signal, if you're still on your emails after dinner, right, you've just got to be really careful what signal are you sending your brain? So one thing that I find helpful, and many of my patients find helpful, is you have a cutoff time in the evening, right? Maybe you want to set an alarm. You know, we're used to the idea that we set an alarm in the morning, but maybe you should set an alarm in the evening. Like, let's say you want to go to your bedroom to fall asleep at 10:00, maybe you set an alarm at 9:00 PM or even 8:30 PM, and that's a signal to shut the laptop. Don't look at emails anymore. And then you can do some more relaxing activities, like, I don't know, have a bath, read a book, you know? Talk to your partner. If you do want to watch television, and I understand the temptation, find something relaxing to watch. You know, if you're watching the news just before you go to bed, whether on TV or online, and you can't sleep, is it really that much of a surprise? The news is, by its very definition these days, negative, right? All news channels are competing with other news channels, so you're gonna see negative stories. If that's what you are infusing into your brain and

13. 1:09:06 – 1:38:35

    A 10-step burnout/stress action plan: daily joy, boundaries, rest, movement, food, and values

    1. RCDr. Rangan Chatterjee1:09:06

       mind in the minutes or hour before bed, it's no surprise really that your mind's gonna be racing and you're gonna be thinking about the worst possible outcomes, right? So pay attention to what are you consuming. If you want to watch something, watch something uplifting, relaxing, that makes you feel good. The fourth thing I want you to focus on as part of this 10-step action plan is to do something that you love every day. Now, what a lot of people don't realize is that regularly doing things that you love makes you more resilient to stress. But at the same time, being chronically stressed, particularly work-related stress, means that you find it harder to gain pleasure in everyday things. And remember, that's one of those key seven signs of burnout, an inability to get pleasure from those simple things. So one way around this is for five minutes a day, right? If you could do more, great, but even five minutes a day will make a difference. Five minutes a day you're doing something for you, not for your boss, not for your work colleagues, not for your partner, not for your children. This is for you. This could be reading a book, okay? Could be listening to some tunes or some music that you really like. It could even be going onto YouTube and watching your favorite comedian for a few minutes, right? It's so, so powerful. If you give yourself a daily dose of pleasure, you will find that little by little, day after day, you are gonna start to feel more resilient, more engaged with life. It's gonna have such a powerful impact, and all I'm asking for is just five minutes a day. For me, what do I do? There's all kinds of things I love doing. I love reading, I love listening to music, but I love playing my guitar. And so often in the evenings, especially if it's been a stressful day, I'll just sit with my guitar for a few minutes and sing, and it makes all the difference. If I go for a week or two without doing this, I can absolutely feel it. So what's it gonna be for you? What is that thing that you can do each day for only five minutes, but something that you're really, really going to enjoy? It's really easy to underestimate just how important doing something each day that you love is. But let me just tell you briefly about a patient I saw a few years ago. Right? He was in his 50s, CEO of a company. He was married, had kids. He was doing well at work. He used to love his job, right? But he got to a point where he didn't really enjoy his work, he didn't really enjoy spending time with his wife, he didn't really enjoy doing that much with his kids. He felt flat. He came to see me, and he was worried. And there's all kinds of things I could share with you here, but the essence of the story is, is that I asked him if he ever did anything he enjoyed, and he said, "No, Doc, I don't have time. I really don't have time." I said, "What about weekends?" "Weekends, I'm just taking my kids from event to event. I just don't have any time for myself." I said, "Well, do you have any hobbies?" He goes, "Doc, I don't have time for hobbies." I said, "Okay, did you used to have any hobbies? Maybe when you were a child?" And he said, "Yeah, I used to love playing with train sets." I said, "Okay, great. Do you have a train set?" And he said, "Hey, Doc, you know, I, I do, but it's in my loft, it's in my attic. I haven't looked at it for years." So I said, "Listen, what I think would be really helpful for you is to go into your loft, get it out, and start playing with it." And again, I didn't see him for a few months, and three months later, I remember I bumped into his wife in my clinic car park. And I said, "How's he getting on?" And she said to me, "Dr. Chatterjee, he's like a different person. He's got his mojo back. He comes home from work each night and he's tinkering around on his toy train set for hours." And then a few months later when he came in for a well man check, I actually spoke to him. I said, "How are you getting on?" And he said Everything feels different. I'm happier. I feel I'm closer with my wife. I feel I'm more engaged with my children. Again, I feel like I've got my vibe back. And again, for him, it all started with his train set. So what's your equivalent of that train set? What hobby or passion have you let fall by the wayside, and which one do you think you can bring into your life right now? The fifth step to start introducing into your life is about learning how to say no. Now, this is easy to say, a lot harder to do in practice. It's something many of us struggle with. I've struggled with this for much of my life. Right? We have to be able to say no, and often we're doing things that are helping other people, but it's coming at the cost of ourselves. Now, listen, I get it. It's nice to be there for other people. It's good to do things for other people. But if it's happening all the time and it's coming at the cost of your physical, mental, and emotional wellbeing, I think it's time to ask yourself some questions. What's going on? Now, the truth is that for many of us, the reason we struggle to say no is because we're people pleasers. Often we don't feel good enough in who we are. Often this started in childhood. We feel that in order to be liked and loved, we have to do things for other people's approval, and if we're not careful, that continues into adulthood. We put our own needs last and everyone else's needs first, and as I say, this often comes from insecurity. We don't feel good enough in ourselves. We feel that we need that other person's validation in order to feel good, but this is toxic, and it is very, very problematic. So you're not gonna change this overnight. Again, simply being aware that you may have some people-pleasing tendencies which is getting in the way of your ability to say no is really, really powerful. Another thing you may find helpful when thinking about saying no is weighing up the consequences of your decision on both sides. Now, a lot of the time we just look at things from one side. Okay, I've been asked to give a meeting or let's say give a presentation at a weekend, and we might think this is a great opportunity for us. Okay, this is wonderful. But when you say yes to something, you're also saying no to something else, and what you're saying no to you often don't think about. You just think about the pros of what you're saying yes to. "Oh, if I do this, it will help me with my job. My boss will like me." Look, how does that play out in my own life? I get asked to speak at events a lot these days, and I used to say yes to a lot of them. I wanted to help. I wanted to go there. I wanted to speak to people, help empower them with information. But I realized a lot of the time this is happening at weekends, and, you know, I'm married. I've got two young children. They're at school in the week. Over the past years, I've realized if I say yes to a weekend speaking invitation, I'm saying no to time with my children. I'm saying no to time with my wife. And again, look, we're all different. We've all got different pressures and different requirements with our work. Sometimes taking that weekend invitation is gonna be the right choice, right? But for me, at this stage in my life now, at this stage in my career, I've decided that I will not do weekend speaking engagements, or I won't regularly do them at least. It would take something really, really special for me to decide, yes, I'm gonna do that. And so for me, I now have a rule. I don't speak at weekends, and that has simplified my life. If a weekend invitation comes in, it's almost certainly no. See, another thing you can think about here is make your default decision, at least in your brain, no. When you get asked to do things that are outwith what you are required to do, make no the default, and then say to yourself, "Can I make a case for this to be a yes?" It's just slightly tweaking things, and perhaps that's a strategy you may find useful. The other thing to say about setting boundaries and saying no is that if you've never been able to do it before, it's gonna feel hard at first, right? You're not gonna feel comfortable doing it. But what I'd really ask you to do is think clearly about why you're saying no, and then try and be honest. Don't try and overexplain. Just be really clear, to the point, explain your reasons, and you may be surprised at how well received they are. Maybe two years ago now, I got an invitation in July by a friend of mine to speak in August, and at that time, I had decided that I'd been working too much. I'd been neglecting so many important things in my life, and I decided in August I'm not gonna work. In August, I'm taking time off. I'm gonna spend time with my family. Again, I appreciate not everyone has the luxury of being able to do that. At that time, I did. And the speaking invitation came in. Now, the only reason I even considered it, because this lady who invited me was a friend of mine, but I thought about it, and then I very clearly said to her, "Hey, listen, thank you so much for the invitation. It sounds wonderful, but I'm not taking on any work in August. I'm spending it with my family. I'm really sorry. If you'd like me to promote your event for you, I'm happy to do that, but I can't take part." And do you know what? At that time, I was a bit nervous about telling her. I was wondering, what's she gonna think of me? And she didn't think anything bad of me. In fact, she really respected that I was honest and told her the truth. And it also felt good for me. I feel I didn't lie. I didn't tell a white lie. I didn't make up some excuse. No, I just told her the truth. And actually, I find more and more being able to say no in a truthful, authentic way is a really, really good skill to acquire, and it's something you can work on and get better at with practice. The sixth thing for you to focus on is to schedule rest. Now, this relates a little bit to the last one, right? If you get better at saying no, putting up boundaries, you're gonna have more time for yourself, but what are you gonna do with that time, right? You need rest to fully recuperate. Remember what I said about that elastic band and burnout, right? You get these little doses of stress. They're gonna come. They're not gonna stop, right? The stress helps us. It helps us perform better. But then if we intentionally have enough time to rest and recover, we grow back stronger, right? We become more resilient. With burnout, what happens is because we don't have that time to rest and recuperate, the elastic band starts to change shape. You know, we start to change shape internally, which is what causes all those symptoms and signs that I've already been through. So if you can put in the right amount of rest, you're gonna find that you can deal with stress because you're recovering from stress. Now, one of the best things to think about doing is put it in the diary. You know, in step number two, when I spoke about intentionally engaging with another human being, I shared that story about my friend in America who has Man Thursdays. It's in the diary, so it's gonna happen more often than not. What can you put in your diary? Maybe it's a, a yoga class midweek on a Wednesday night after work. Maybe it's a relaxing Epsom salt bath every Tuesday and Friday evening. Put it in your diary. See, that's the interesting thing, isn't it? We put our work commitments in our diary because we're prioritizing them, and we know we have to do them, but you also have to do rest. And let's just think about it for a minute. What does it really say about our priorities in life when all our work commitments are in our diary, all the commitments we have for other people are in our diary, but most of us don't think to put a walk in our diary or a bath in our diary or maybe our yoga class in our diary? It's a very simple move that can be really, really effective. Now, I just wanna quickly mention something about walking because I go to a lot of companies these days. I speak to a lot of people about burnout and stress, and one of the most useful and effective things I recommend is a 15-minute walk at lunchtime with no technology. Why is that so powerful? Well, if you have a walking break at lunchtime, you're gonna come back, be more creative, and better able to solve problems. That's the thing a lot of people don't realize. Burnout affects us at work, right? Our work performance goes down, and when we're feeling like that, we've got a problem to solve, we, we get stuck. We wanna work through lunch. We think if we plow through, it's gonna solve the problem. We don't realize that there's something in our brain called the DMN, the default mode network. And what does that do? Well, it does many things, but two things it does is it helps us solve problems, and it helps us be more creative. Now, the DMN only gets activated when you switch off, when you stop focusing on a task. This is why some of us have our very best ideas when we're out for a walk or when we're in the shower. I know for me, some of my best ideas come when I'm in the shower each morning because you've switched off. You don't have your emails. You're not focused on anything, so your brain tries to solve those problems for you. So again, diary in that 10 or 15-minute walking break every lunchtime. In the moment, it will feel like nothing. But if you do that five days a week, even seven days a week, you will very quickly start to notice a big, big difference. The other thing I want to mention on rest, let's say you like to watch documentaries, for example, as part of your relaxation. I'm okay with that. I'm not saying don't do that. But start to pay attention to how you feel after particular genres, right? If you watch quite an agitating one with a lot of anger and judgment and cynicism in it, how do you feel afterwards? Do you feel as though you've rested, or do you feel kind of agitated in your body? And then contrast that to when you're watching something relaxing, maybe something with nature in it, maybe a feel-good story. How do you feel in your body then? Because then you'll start to educate yourself on what the right kind of rest is for you. Now, I just want to mention something here that's relevant to some of the things I've just been talking about. I recently spoke to a chap called Steven Kotler. He's a human performance expert, and he co-founded the Flow Research Collective in Canada. And him and his team have done some research, and they have shown that it is almost impossible to burn out if you do three things Number one, if you get seven to eight hours sleep a night. Number two, if you access flow one to two times a week. So what's flow? Well, flow is an altered state of consciousness. It's a state you get in when you're fully concentrating. You'll feel as though your perception of time is changing. Some people will say, "Time just stood still." And it's usually those activities that you enjoy that you're fully immersed in, right? Usually it's when the focus that's required to do it is a little bit more than your ability level, so you have to stay focused, but it's not so hard that you think this is unachievable and you switch off. And if you're struggling to know what your flow activities are, think about the sorts of things you used to enjoy as a child or as a teenager. You know, common examples are playing musical instruments, skiing, rock climbing, could be reading, all kinds of things. But again, Steven says if you can access flow once to twice a week, it really helps prevent burnout. The third thing he says that really helps you avoid burnout is regular active recovery. But what does that mean? Well, passive recovery, as Steven puts it, is a glass of wine and a TV show. That's very different for your body than active recovery, which is more like yoga or a walk in nature or an Epsom salt bath. So just remember that. Those are three things that if you do regularly, make it very unlikely that you're going to burn out, and I think that helps to bring some of the ideas I've already mentioned together in one place. The seventh thing I want you to think about is movement. One of the problems when people are on the road to burnout, or even when they've got all-out burnout, is that they don't move. You know, I've already mentioned that one of the signs of burnout is when we start to neglect our self-care, and because people feel lacking in motivation, low in energy, you know, they're procrastinating, they can't make decisions, they end up not moving their bodies. They often think, "Oh, I don't have energy to move." And the interesting thing about movement is that it will change your state, guaranteed, right? Sometimes if we're feeling stressed and agitated and anxious, getting out there and moving our body, let's say with a walk or even two minutes of skipping or jumping jacks, will calm everything down. You'll burn off that stress. But it also works the other way. If you're feeling low energy, if you're struggling with motivation, sometimes movement will give you energy. Just think, think about the last time you couldn't be bothered going to the gym, or perhaps you procrastinated for an hour, "Shall I go for a walk? Shall I not go for a walk? Oh, it's raining. Not sure I've got time." But then you actually went. How did you feel afterwards? Did you regret it, or did you afterwards feel, "Wow, man, I'm so glad I went"? I don't think anybody has ever regretted going for a walk. We always feel better afterwards. So this is all about making sure you're moving your body every day. Even a 10 or 15-minute walk will make a big difference. Step number eight, pay attention to your food intake. Again, this fits the theme of the last step, which is about movement. When people are feeling close to burnout or on the road to burnout, they stop looking after themselves, and food, your nutrition, is absolutely key here. If you're feeling bad and you start to have more sugar, more ice cream, more highly processed foods, you start snacking more, you're eating late at night, it's simply not gonna help you. It's gonna make matters worse. And I know in that moment where you can't be bothered to cook, the easiest thing in the world is to phone for a takeaway or go on an app on your phone, depending on where you live in the world, and actually get something delivered to you. But please try and make healthier choices as much as possible, and make sure you've got healthy food at home. Make sure you've got things that you enjoy that are gonna support your health and wellbeing at home. If you've run out of food, it's gonna be easy to go and order that takeaway. You know? Try not to snack late at night in front of the television, because we know that late-night snacking for some people can really impact the quality of their sleep, and, you know, getting better sleep is on this 10-step action plan. We want you to get better sleep, and eating late will often get in the way of that. Also, do pay attention to comfort eating, right? I get it. In those moments where you've got no energy and you feel low, you just think, "Ah, I'm gonna eat something to make myself feel better," and I get it. In the moment, it does make you feel better, but it comes with a long-term cost, and if you're doing this all the time, it's gonna keep you locked in a vicious cycle. So the next time you have that urge to open that packet of crisps or those biscuits, why don't you just try this? Just take a quick pause and ask yourself, "What am I really feeling here? Is this physical hunger or emotional hunger?" You know, a lot of the time that we turn to food- It's 'cause there's something emotional going on. Maybe you feel lonely. Maybe you wanna say hi to your partner or give a friend a call instead. Maybe you feel like you've had no time to yourself all day, right? And you've just been working, so this is your treat for you. Okay, but maybe you can treat yourself in another way. Maybe you can run yourself a bath and kind of enjoy being there for 20 minutes looking after yourself, right? So pay attention to the foods that you're putting into your body. It's gonna make a big difference to your recovery. Step number nine is to define the end of your workday. Now, this is a really, really important step that I actually think you can start to implement immediately. Our to-do lists are never done these days because of modern technology, because of the way that we work. There's always something else to do, always. Let's say you miraculously clear all the new emails in your inbox, right? I don't know if that's possible, but let's say you manage to do that. The minute you've finished, and let's say you go off somewhere for a walk or, you know, make yourself a cup of tea, there's a very good chance that other emails have started to arrive. You can't control that. Emails are always gonna come in. This is just one example, right? So you can constantly be working, and I've seen this in so many patients. They don't put up boundaries, so therefore they're still working after dinner, right? You couldn't do this 20, 30 years ago. You'd have had to have stopped and switched off, spent time, if you've got a family, with your family, if you don't, spent time doing something enjoyable for yourself. But now you don't have to do that. You can keep plugging away. And of course, you keep doing this month after month, year after year, this is gonna put you on the road to burnout. So a really helpful tip here is to say, "What does done look like today?" And this is actually something that I discuss in a wonderful conversation I had on my podcast with Greg McKeown, who I've already mentioned, right? Greg's got another phrase that I really, really like: "If you don't prioritize your life, someone else will." In fact, I like that phrase so much I've got it up on the wall in my house, and that's what this tip really is about. You've got to define what done means for you. Maybe it's, "At 5:00 PM, I'm gonna stop working," or maybe it's, "I've got these 10 tasks to do today, but once I've done these six important ones, if that's the end of the day, that's the end of the day." If you don't do it, nobody is gonna do it for you. It's about setting boundaries. It's about taking a moment to go, "No, this is important today." Everything's not important. You may think it is, but it isn't. So why not at the start of each day define, "If I get these things done today, that's good enough"? And this is something that's really simple but really, really effective. And the final step, step 10 on this action plan, is a bit more about the bigger picture. A lot of the time we end up on the road to burnout and getting burnt out is because we're not living a life that's in alignment with who we really are. Our daily actions are not aligned with our values. We're often in jobs that we don't really enjoy, and there's elements of those jobs that don't really sit right with us. And I think it's really important for me to say here that I get it. Sometimes you have to do a job that you don't particularly like because that's how you feed yourself, that's how you feed your family and put a roof over your heads. I understand that. So this advice is gonna be different for different people at different stages of their lives. But even if that is you, it's still worth having a think about, "What are my values? Is this still the job I want to be doing in two years and three years and five years?" And I'd encourage you maybe once a week just sit down and write down, "What are some of the core values that encompass who I am and who I want to be?" Doesn't need to take long. Even just one value will start to help you. You know, I've done this many times over the years. What I would say right now is that my three core values are integrity, compassion, and curiosity, and those are the three values that I like to bring to every aspects of my life, my personal life, yes, but also my work life. And if I look back on my career at times when I was getting frustrated and overworking and getting quite resentful about work, often one of those values was being violated. I think this is one of the most important things that you can spend time with, yes, for how you're feeling right now, but also for your long-term health and happiness. You may not be able to change everything straightaway, but if you've never spent a moment to think about what it is you truly want out of life, you're gonna find yourself falling into the same traps over and over again. And if you're struggling with this, why not do this exercise of writing down some of your core values with a friend or maybe your partner? Some examples of values or things that you value, right? This is not an exhaustive list, but just to get you thinking, things like solitude, nature, the environment, creativity, curiosity, compassion, honesty, integrity. You know, maybe you're hearing all of those and go, "Yeah, I like all of them." That's fine. Just pick one, two, or three just to get you started. And maybe every Sunday you sit down with them and go, "How much of my life this week did I live in accordance with those values? And how much of my life was in conflict with them?" And I think you'll be surprised at how much you learn about yourself, because these are the really, really important lessons that will help you get out of the jam that you're currently in, but will also help you with your long-term health and happiness. I know that if you start to implement that action plan into your own life, you are going to start seeing results immediately. Remember, you do not have to do all of them at once. Pick one thing, start small, and build up with time. You know, the, the, the conversation around health, I feel gets overly polarized regarding

14. 1:38:35 – 2:49:41

    Stress as the root driver: why behavior change fails without addressing what stress is doing

    1. RCDr. Rangan Chatterjee1:38:35

       food and movement. Now, I am not for one minute saying that these things are not important, but I think there is far too much focus on them personally, at the expense of other factors. And here's the funny thing about stress, right? And this is what I really figured out as I was unpacking the book and writing it. Often our food choices, often our movement habits, often why we do certain things is because of the stresses in our life. So what happens in January? Every January in the US, in the UK, new year, new you, time to get healthy. Right, so what are the two commonest things that I see people doing in my clinic? I wanna reduce sugar, or I wanna reduce my booze. Right? Those are the two commonest things. So what is the pattern that I see is this. For a week, for two weeks, maybe for three weeks, willpower gets them through. It's like, "Yeah, getting sugar out the house. I'm not gonna have it. This year's gonna be different. It's not gonna be like the last few years. This year I get on top of things." Same with alcohol, you know? "I'm now not gonna drink. Yeah, I've, I've, I've overdone it over Christmas and New Year. That's it now. I'm in. I'm sorting my life out." One week, two week, three weeks, then those habits start to creep back in. And my view on that is, in a lot of cases, it's because the sugar or the alcohol was serving a role in someone's life.

    2. SPSpeaker1:40:00

       Of course.

    3. RCDr. Rangan Chatterjee1:40:00

       Uh, of course. I know it's-

    4. SPSpeaker1:40:02

       Mm-hmm

    5. RCDr. Rangan Chatterjee1:40:02

       ... it's super obvious to say it, but what they're doing is they're... And I, the reason I'm explaining is I think people will be listening to this, and somebody there is gonna go, "Uh, yeah, that's me, actually. I do that every January, but I, I can never get past January the 14th." And if you are using sugar, or if you're using alcohol, or if you're using anything to soothe the stresses in your life, I think many people are gonna be very limited in the change they're gonna make unless they address the underlying stresses. Address the underlying stresses, then you no longer need to engage in the same behavior. I'll give you another example. I had a patient who was a, I can't remember his job. He was sort of some sort of managerial position in a company. And he came to see me for, you know, a whole variety of different reasons. The point was is that when we looked at his lifestyle, it was quite clear to me what was happening. So he would drink a lot of alcohol, and it was affecting his relationship. It was affecting the, um, his sleep. It was affecting his performance, right? But he wouldn't, you know, he wouldn't drink every day, but what would happen when you looked at his week is he would start drinking on a Wednesday. So what happens when you unpack his life? Wednesday, just after lunch, he has to present a team meeting. He finds it incredibly stressful. So by the end of Wednesday's work, he is super amped up. He goes straight home, and he wants to unwind, so he opens a bottle of wine, has a glass. One glass turns into two, two turns into three, and before you know it, Wednesday, he has a whole bottle of wine. Therefore, doesn't sleep well. Wakes up tired, feeling a bit angsty. Needs more caffeine to get him through. By default of that happening, he's quite anxious throughout the day, feeling stressed throughout the day. Because he's drinking caffeine all the way into the afternoon, you know, he then drinks more alcohol on Thursday, affects his sleep, and this pattern continues whereby come Friday it's two bottles of wine. Come Saturday, it's two bottles of wine. And Sunday he spends just recovering for the week ahead. Now, what did I do? Of course, as you well know, Rich, there are multiple things at play here. But in this particular instance, I helped him. We sort of unpacked his week, and I helped to say, "Hey, look, you know what? It seems that on Wednesdays things start to go wrong. So is there something else that we can maybe think about doing to de-stress?" And he said, "Well," you know, we looked at a few options. There was a yoga class.

    6. SPSpeaker1:42:27

       I was just gonna say you should go to [laughs] yoga class right afterward.

    7. RCDr. Rangan Chatterjee1:42:29

       Well, again, man, you should, we should swap places, man.

    8. SPSpeaker1:42:31

       [laughs] Yeah. Go.

    9. RCDr. Rangan Chatterjee1:42:31

       In fact, you go to my clinic.

    10. SPSpeaker1:42:32

        Go ahead. No.

    11. RCDr. Rangan Chatterjee1:42:33

        I, I'll come and live in-

    12. SPSpeaker1:42:33

        Come on

    13. RCDr. Rangan Chatterjee1:42:34

        ... sunny California.

    14. SPSpeaker1:42:35

        Keep going. Keep going.

    15. RCDr. Rangan Chatterjee1:42:36

        So what happens next is that he goes, "Okay, fine." So Wednesday, straight after work before going home, what does he do? He goes to yoga. Now, he was a little resistant, but again, he was seeking help, so he came to see me. So he goes to yoga. Within weeks, everything changes. When he comes back, he reports what happens. On a Wednesday now, he relieves that stress at yoga. He goes home feeling calm, feeling present. Changes his relationship with his wife. He still has a glass of wine on a Wednesday night, but it's one glass. Doesn't affect his sleep as much. He feels good on Thursday. Again, he'll have a glass of wine on the Thursday, not the whole bottle. And, you know, ultimately, over the course of a few weeks, it completely transformed things. So that was the trigger point for him in the week. So I hope that people listening to this, someone's gonna identify in their own life and go, "Yeah, wait a minute. Ah, yeah, this is, that's like a similar pattern for me. Maybe if I can manage my stress in a slightly different way, maybe those knock-on consequences will be different."

    16. SPSpeaker1:43:39

        Mm-hmm.

    17. RCDr. Rangan Chatterjee1:43:40

        And so, look, these are individual cases, but they apply to all of us i- in many aspects of our life.

    18. SPSpeaker1:43:45

        Yeah. I think- Basically, what you're doing is you're telescoping up on the, on the, on the whole situation and trying to get at the root causes of, of these things so that the solutions that you're implementing are taking into consideration the downstream impacts of these behavior. So instead of just saying, "Well, don't drink a bottle of wine," you're looking at what is causing the person to t- make that choice in the first place. And then you see the domino impact either way, either positive or negative to what happens to that, which I think is... I mean, that's, that's the way to address these things, you know?

    19. RCDr. Rangan Chatterjee1:44:25

        This has come from experience because what, what is all public health messaging? It's, you know, eat less of this, move more. You know, you're drinking too much alcohol.

    20. SPSpeaker1:44:35

        Mm-hmm.

    21. RCDr. Rangan Chatterjee1:44:35

        You know, doctors over and over again tell me, um, "This stuff is all great, Dr. Chatterjee, but, um, you know, patients just don't do what we tell them to do." I would argue that that phrasing in itself needs shifting. I gen- generally get really good compliance from my patients. Like, I, I do not say that to boast. I say that because I really think that when you communicate effectively with them, right, people wanna change. People don't wanna come in and not follow your advice. People don't wanna take half a day off work to come and sit in a waiting room, wait for 20 minutes whilst you're running late to come in and see you so that they can ignore your advice. People wanna feel better. I... That is my number one belief in my job, is that people fundamentally want to feel better. They don't really wanna be there, so let me help them feel better.

    22. SPSpeaker1:45:25

        So what is leading to that idea that patients don't take the doctor's advice? Is it in the delivery, uh, in the w- in the manner in which these practitioners are trying to advise the patients? Like, where is that communication breakdown?

    23. RCDr. Rangan Chatterjee1:45:41

        Look, I think conventionally, if we look back over the last 30, 40 years, there has been a certain tradition in medicine, this very paternalistic relationship that I have a problem, I come and tell the doctor. He's gonna, he or she is gonna figure out what the problem is, give me a diagnosis, and then give me some form of prescription, usually a pill to take, to get rid of it. And again, I would make the case that maybe 30, 40 years ago, that worked super well. Like, if you c- were coming in with an acute problem like a pneumonia, and, you know, you're coughing, you can't sleep, you've got sweats. "Hey, doctor, help me." You know, they listen. They might take some tests. "Hey, you have got pneumonia. That's the overgrowth of this bug. I've got a pill for you that is gonna kill that bug, and you will be better." Right? That approach has worked and still does work. Of course, there are unintended consequences of that in the example I gave. But that approach, I think, does work, and the whole medical system, as you've alluded to already, is set up around that model.

    24. SPSpeaker1:46:36

        Mm-hmm.

    25. RCDr. Rangan Chatterjee1:46:37

        We are not set up, A, to look for root causes. People online will say, "Yeah, we are. This is all nonsense. You know, all doctors look for the root cause." I'm sorry, but I disagree because I know what our training is, and we're not really trained to look at it, because I don't think we had to in the past. So, A, I don't think we're trained to do it. B, I don't think the system is set up in a way that allows us to do it. And look, if you are a busy, tired, stressed out doctor, and you have... Like, in the UK, a NHS GP will see between 30 and 50 patients a day, right? I get it, right? You're sitting there. You've got five people waiting outside. The easiest thing in the world, A, is to give a prescription, because you can get that done quickly and run on time and start to build through your backlog. But also, I think the way we're taught and the way, often, in that rushed setting that we deliver this information is, I think it's, I think it's destined to fail. Like, if you have a patient, right, who comes in... Type 2 diabetes is the obvious example to use, right? The patient's in front of you, and, um, you've got their tests, right? Let's say they're coming in for some blood tests. They're trying to figure out what's wrong with them, why they're so tired. You run some blood tests, and they've got, um, type 2 diabetes, but they don't know this. So I actually do this role play at the end of the course that I teach to doctors to demonstrate just how different these things can go. So the conventional one is this. Patient comes in, knocks on the door. "Hey, Brian. How you doing?" "Um, yeah, Doc, you know what? I'm feeling knackered. I've got these, uh, blood tests. I wonder if I could get the results." "Yeah, yeah, sure." So without looking at them, looking at the computer, so looking at the screen going, "Yeah, you know, you have got something called type 2 diabetes, right? That's a chronic illness. Um, it's a bit of a problem because if we don't get on top of it, it may lead to heart attacks. It may lead to, uh, amputations in your leg. It's the commonest cause of blindness in this country, so we really need to get on top of it. Now, the good news is we've caught it. I've got some drugs for you. We're gonna start you today on metformin. Normally, within a couple of years, we need to add a second drug. Um, sometimes we then have to go to insulin, which are injections. But don't worry. We've got it all under control. I'll get you seeing the diabetes nurse, and we'll get this stuff licked." Okay, Brian's in shock. As he gets up and walks out the door and is like, "Hey, but also, Brian, you know, if you can lose a bit of weight and go to the gym, that would help as well." Okay, so Brian walks out. Yes, you've given lifestyle advice, but what does he take away? He takes away that, oh, well, 99% of that conversation was that we didn't mention lifestyle. We mentioned this drug and that they've got this under control for me. Cool. Well, I can keep going, doing what I'm doing. If you... That sounds like I'm, I'm making this up, that that's an extreme example. I can guarantee you that is how some of these consultations go down. There'll be people listening to this who have been in that consultation. Now, I'm not having a go at the doctor, 'cause I do recognize that things are challenging. But what about the same scenario where Brian comes in, you make eye contact with him. You don't look at your computer screen. You have a conversation with him, find out what he's concerned about, and then you say, "Hey, look, something actually has come up, Brian. Um, do you know anything about blood sugar?" "Well, a little bit." You explain, "Hey, your blood sugar's a little bit higher than we would ideally want. Now, it's actually gone into the range of something that we call type 2 diabetes. Do you know what that is?" "No, Doctor, I don't know what that is." "Okay, look, it's a condition that actually it doesn't develop overnight. You have not just got this in the last week or the last few months." This has been going on in your body for maybe five years, maybe even 10 years this has been building up. Now, look, there are a couple of options. Yeah, there are some drugs that we, we, we sometimes need to use. But if you are open to this, I can help you look at your lifestyle and try and figure out with you what are the various factors that may have led to this. Are you interested? "Hey, Doc, yeah, if you can let me know what I can do, that'd be amazing." And if you go down that road, and you spend the time connecting and spend the time explaining to them what they can do and what they feel is achievable, I think even within 10 minutes you can get good results.

    26. SPSpeaker1:50:40

        But this is communication.

    27. RCDr. Rangan Chatterjee1:50:42

        Yeah.

    28. SPSpeaker1:50:43

        Right? So why aren't medical schools training doctors to better communicate with patients, particularly if compliance is an issue? It seems like that should be part and parcel of what it means y- you know, to be trained as a, as a doctor. Like, you're gonna be... You're gonna spend your entire career communicating with patients, telling them what to do, what's wrong with them, et cetera. Shouldn't there be a... There's a s- There's a skill to that, right? To do it effectively.

    29. RCDr. Rangan Chatterjee1:51:17

        Yeah. You know, one of the things I'd say from certainly when I was going through med school applications, and from what I understand it's not really changed that much, although they have tried to evolve, that is not, uh, anywhere in literally how you are assessed. It is, what are your grades, right? What is your interview like? Now, I guess an interview on some level-

    30. SPSpeaker1:51:37

        Mm

Episode duration: 2:49:42