Resilience [Re-release] (05 July 2023)

SPEAKER_01 0:00

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SPEAKER_03 0:24

Hello and welcome to this podcast by the Training and Members Committee at the Royal College of Physicians Edinburgh. My name is Adelina McLeod, and I'm the chair of the committee. Here with me today is Dr. Paul Coulter, and this podcast today is focusing on well-being and building resilience. From humble beginnings growing up during the Troubles in Northern Ireland, Paul Coulter chose to devote his life to serving others in the NHS. His journey to become dual trained as a doctor and consultant in palliative medicine has not been an easy one. With a series of academic roles, he's also an inventor, and his invention to support the future direction of mental health was included in a TEDx talk and has already been embedded in an MSc at a UK university. He has also been taught to international healthcare students. So, with a warm welcome to Paul.

SPEAKER_00 1:17

Hello, Adri. Many thanks. Thank you for your kind introduction.

SPEAKER_02 1:21

So I thought we would start this podcast by listening to the four-minute audio from a video that Dr. Coulter made with patient voices on his journey and how he built resilience.

SPEAKER_00 1:33

Growing up in Northern Ireland in the 1970s, I had to learn a lot of coping strategies. I learned to assert myself, to hold my own with bullies in the playground. Spoken or unspoken. Eventually, my grandfather's head was turned down. A message was left in a body on our doorstep. We moved out of the city to the coast. Away from where my family had always lived. To a safer place. I got another way. I went to university. The first in my family. I became one of the youngest JP partners in the Scottish Islands. They were the best five years of my life. I enjoyed working autonomously. I loved and respected my patients. And they loved and respected me. I was named in the mail on Sunday for helping save a child's life. I felt proud. Around the same time, I was named for the Royal College of Channel Practitioners, Scottish GP of the Year. More messages. This time in metaphorical teaching. I felt isolated and chose not to collect the award in person. It was the best achievement of my career, and also my biggest regret. Again, I had to move to somewhere safer. I brought my family to England and changed my career path to retrained as a specialty medical physician. But now I struggled with the switch from training to training. My training constantly undermined my performance, my confidence, and me. I was only trained to practice as I always had. Without questioning, I felt I had lost my doctoral autonomy. Undervalued, diskilled, I lost my confidence. The hypervigilance of the belt engineers returned. This time searching for signs of different things. In this playground, with these bullies, the incentiveness that had served me so well in 1970's buildings was not working for me. I adapted my behaviour around others who did not see the world between my limbs. This time I didn't instead put the peace process in Northern Ireland has sidelined the bullying and intimidation that was rife there. Will there be a peace process in medicine?

SPEAKER_03 5:09

Thank you very much for sharing that with us today, Dr. Coulter. I suppose my first question is why you chose to do this podcast with us today and why you feel that it is important to share your story.

SPEAKER_00 5:21

Well, um, thank you very much, Dr. McLeod, um, for allowing me this opportunity. Um and it's something I feel very passionate about. Um I am currently uh a consultant in palliative medicine in Scotland, and I also work as an out-of-hours GP for the Northeast Ambulance Service. My additional roles in my career are that I am a CQC specialist advisor, a Q improvement member, and I sit in the Royal College of Physicians of Edinburgh's newly appointed consultants committee. I have academic roles, and that includes being a visiting lecturer at Birmingham City University, as well as holding honorary lecture posts at Newcastle and Glasgow University. I am a medical director at a research hub, and this is where my invention to enhance mental health was developed. I'm doing this podcast to share my story, really, which I hope can be used to show what can be done when faced with extreme challenges and why it is critical to increase self-understanding, to build resilience, levels where whether it be for personal or professional reasons.

SPEAKER_03 6:28

So let's talk about your story more. What experiences have led you to where you are today?

SPEAKER_00 6:35

Well, as from the audio clip, um, my story begins growing up in Northern Ireland in the height of the Troubles in the 1970s. I was surrounded by threats and violence and bullying, and I must say I was left with no option rather than to learn coping strategies to hold my own with bullies in the playground. I learned to become vigilant, aware of threats spoken or unspoken. My grandfather's shed was burnt down and messages were left. This was all to do because he worked across the religious divide. As a family, we decided that was enough, and we left Belfast where we had always lived and relocated to the coast. I really didn't know where to turn and I turned eventually this forced exodus into an advantage. I come from a working class background and I was the first in my family to go to university. After university, I underwent GP training in the Scottish Highlands. I must say they were some of the best days of my life, and I was very proud to be the Highland Medical Society president, and in 2006 was the youngest GP partner in the Scottish Highlands. I really felt then I was making a difference to the community, and as mentioned before, were the best days of my life. I was very blessed to be acknowledged in the Mail on Sunday for diagnosing a rare condition early, which saved a child's life. At that time, I was also named runner-up, Royal College of General Practitioners Scottish GP of the Year. You would think winning such an accolade would be a very welcomed reward. However, unfortunately, this resulted in other spoken and unspoken messages which suggested that I should reconsider and decline acceptance. These words reminded me of my early experiences in Northern Ireland. I did feel isolated and chose remarkably not to collect the award in person which was to be given in the Royal Mile by Nicola Sturgeon. This is something that I have struggled with in my life, that I never got the opportunity. I discussed my reservations at that time with the president of the RCGP, and he was very upset and felt that I had earned this reward and that he wanted me to come and even offered for me to come the following year with my wife. Despite his sound advice, I still chose not to. I was clearly hyper-vigilant, and this was because of the spoken and unspoken messages I was receiving. Instead, I resigned after receiving this award, and I uprooted my family to escape. I moved to England and completely retrained as a specialist medical physician. Now I had the biggest challenge of my life. I went from being trainer to trainee. I did find that some trainers undermined my performance, which hit my confidence levels. I felt I had lost my doctor autonomy. While I do have wonderful memories of growing up with my family in Belfast, being undermined by these colleagues brought back memories of the darkest times. Although these new threats were not physical, they were equally as damaging, and I would actually say more damaging. I thought I was going to lose my job, I was traumatized, and I considered leaving retraining altogether. At this stage, there were two factors that made a difference to my health and well-being. The first factor was the support I received from a few colleagues at that critical time of my life. This really did make a difference to both my personal and professional life, and I will never forget the compassion showed to me by a few individuals. As a result of that experience, I have lived my life trying to support my own trainees and colleagues in the same way. This is a core reason why I got involved with the Royal College of Physicians of Edinburgh. I wanted to influence the doctors and a wider community coming through. The second factor, however, was actually I went on a course on transforming leadership culture, which made me realize that I had been overplaying my strengths. I realized that the assertive techniques that I would use in Belfast growing up were clearly not working in this different environment. The course taught me about self-understanding and the understanding of others. I adapted my behavior so that I could create win-win outcomes with people who did not see the world from my lens. I grew in confidence and learnt resilience. This time I didn't move. I stayed put. This experience resulted in me wanting to make a difference to help other people in the medical profession. After a series of discussions with the firm that delivered the Transforming Leadership Culture course, they invited me to join as they felt my talents could make a significant difference in the future of health and well-being in the country. The company was in a process of developing a framework to increase confidence, resilience, with the objective to decrease anxiety using Eastern and Western philosophy. This was all a very new concept to me. And using my past experiences, I invented a concept called the roundabout theory, which is designed to help people get through negative past experiences that I had gone through. It was approved by the firm and was also approved to be included into an MSc module titled Understanding and Managing Behaviors of Self, Teams and Organizations. And this is delivered via Birmingham City University. It was a great moment for me when the framework was covered this year in a TEDx talk, and my roundabout theory was explained for the world to see. I am also a visiting lecturer at the university, and we teach this module to international healthcare students. Every time I read the student feedback, I feel immensely proud. One example that comes to mind quote from a student, I've completed over 40 university modules in the last 20 years, but I tell you, I got significantly more learning from this one module than in any of my previous. I've introduced the framework in my teachings of well-being, diversity, and inclusion. This is just one of many positive comments that I've received. And in recent times, I have seen comments from students who have said how this knowledge has helped their health and well-being throughout the lockdown and the COVID-19 pandemic. So, in summary, the reason I'm doing this podcast is to deliver an unmet need for those working in the medical world and the global community. The environment we work in is stressful, it's constantly changing, it leaves no space to pause, reflect, and care for our own health and well-being. In particular, 2020 has been a year which has challenged many NHS workers and others to the limit. I would like my colleagues throughout the UK and even globally who are feeling under immense pressure to recognise that there is a way forward and they're not alone. In the words of the poet John Milton, the mind is its own place and in itself can make a heaven of hell a hell of heaven.

SPEAKER_03 14:22

Thank you for sharing such personal experiences. I think sometimes we don't realise just what other people are going through or have been through to get back to where they are today. And I think for many of our listeners, hearing your story of growth through adversity and actually all of what you are achieving now is incredibly important. So thank you for sharing it. And you also have have shared it previously with Patient Voices, and I just wanted to know how you got involved with that project to start with.

SPEAKER_00 14:56

Thank you very much for that. Um is quite emotive for me. Um I uh it was very opportunistic, really, how I got involved with Patient Voices, and it was quite transforming in my career. I was actually at a Q improvement networking night where I met Dr. Pip Hardy from Patient Voices. Q is an initiative connecting people who have improvement expertise across the UK and Ireland. It's delivered by the Health Foundation and supported and co-funded by partners across the UK and Ireland. I was so impressed with her when she demonstrated her work that I thought, you know, I'm going to do one of these digital storytellings, which was a really, you know, something I had never really thought about. And I went on a residential course to make a digital story. You'll have heard the audio at the start of this podcast, and I would encourage anyone to watch the video, which can be watched via a link on the RCPE website.

SPEAKER_03 15:53

So it sounds like you had a fairly opportunistic meeting with this doctor at the Q Community um event that you went to. And it almost appears that you're um describing a mentorship relationship, uh if I will. So have you had mentorship relationships in in the past and how has mentorship helped helped you in your journey?

SPEAKER_00 16:17

I think this is a really important thing because, as I mentioned previously, it was very emotive. Um, and I chose not to share my digital story for a long time. You know, I'm still jewelry and I still work in in both primary care and secondary care. And I realized that a lot of you know out of the GMC uh survey, and there was a lot of people feeling stressed and wondering where to go, and it was very clear to me that mentorship was important, and I took it up with various people, but you know, it's a lot about getting a good relationship with the mentor, and I was very lucky indeed that I have been coached and mentored by a professor who's an executive in life coach. This has been ongoing now since about 2013. Um, I use the framework that we developed together, and as mentioned previously, it teaches teach it to the MSE students. It is very important to you know appreciate self-understanding. I did eventually, it took me some time, but I did eventually realize that I am very individual and I now have objectivity about my strengths and have realized how easy it is to overplay them. I mentioned that I was from a working class background, and a lot of the studies show that there is not many from a working class background in medicine. I know there's been a lot of uh talk about this, and universities are thinking about this, and I do think you know you need diversity and need to respect that. It I struggled as as is shown in my video, but I've I've come out of it the other end, and that's why I wanted to share this, and I couldn't have done it without mentorship.

SPEAKER_03 17:57

What advice would you give anyone who is struggling or or in any difficulty? What would what would you say to them knowing what you know now?

SPEAKER_00 18:05

Well, I mean, I think Dr. McLeod, you've mentioned it, you know, you're definitely not alone, you know, nobody's alone. I think that's one of the most important things. You don't know what other people are going through. And um the best advice I would give, you know, part of, you know, I I think people have a look at you know what we're building for the healthcare workers in the faculty of health, education and life sciences at Burman City University. You know, we do a lot of work on the holistic approach using the Indian Four Rooms philosophy. Owing to the success of our first MSE module, we are now building a full MSE dedicated to this philosophy. And as mentioned previously, it was passed for a TEDx talk. Everyone is an individual, that took me a while to realise. You might think that's easy, but it took me a while that other people didn't see the life through my lens. You know, what is useful for me may not be useful for someone else. The advantage that I found with the Four Rooms philosophy is that it was holistic. I could tailor it to specific and individual needs. I did this for myself and my resilience definitely improved. We all know those listening to this podcast will be sent on numerous leadership courses. I've gone on, I don't know how many in two decades, and you know, they just did not work for me at all. I apologize, but they will work for others, I'm sure they will, but it just didn't work for me. I hope that sharing my story today, you know, might be insightful of what can be done and what is possible by increasing self-understanding. It definitely helped my resilience. My journey was not easy. Um and as mentioned, I got out of the other end. However, it wasn't without that act of kindness. And I must say, I can't those the the person that showed me that kindness, I hope, is listening to this podcast because I wouldn't be where I am today without, and they know who they are. The most important thing to remember is that even if you do feel it, you're not alone, it is important to reach out. You can do that various ways, you know. You can go to your GP, your family, your friends, trusted colleagues, and various organizations that are well advertised. We have a list of these organizations and a lot of advice and of support, which can be found on the Royal College of Physicians of Edinburgh's website. And I always like to finish um with sort of some words, the words of writer Aldous Huxley. There's only one corner of the universe you can be certain of improving, and that's your own self. I do really appreciate you giving me the platform to share this. As it was as mentioned previously, it was very emotive. But if I if it and if this even helps one person, I feel I have done my job. Um, and I'm very happy for those that contact me if they ever want to discuss anything private. Um, thanks very much.

SPEAKER_03 21:03

No, thank you, and Dr. Coulter, I think your story is incredibly powerful, and also it's it's one of hope, really, um, to see that you have gone through this difficulty and developed a framework that works for you. If anyone wants to know more about the framework, the the four rooms, where could they get that information from?

SPEAKER_00 21:23

Thank you very much. Um, yeah, it's on the Birmingham City University website um of the Health, Education and Life Sciences. And the one if some people may wish to actually watch the TEDx talk, and that would be if you Google Professor Adam Krizzle, and that is the TEDx talk. I also can be contacted myself. Um I'm on Twitter, I work for the college, so those at the Royal College of Physicians of Edinburgh would be able to pass on my contact details. But I would encourage you to watch the video as it is quite powerful, and patient voices work uh closely with the NHS. So it's a very validated uh tool.

SPEAKER_03 22:11

Thank you. And if any of you have been affected by anything that we've uh discussed today, um feel free to email the trainees email. Thank you very much for your time, Dr. Coulter. Thank you for sharing your experiences. I think 2020 has been a tough time for lots of people, so I think it's really important to identify that the fact that you really are you really are not alone and your colleagues are there to to support you. I think the main point is to to share, to speak out, to ask for help. Um I know I've gone through tough times in the past, and the best thing I ever did was reaching out to my educational supervisor and just saying help and that really the support that I was able to access just through asking for help, which can be incredibly scary, but it's uh really important. And also reach out to your college community. We really are here to help. So thank you very much.