Rest first, with Dr. Adam Sandell

Practicing physician Adam Sandell, author of the Great Work newsletter, shares how to manage intense schedules

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Episode Transcript

Speaker 1 (00:02):
Welcome to Before Breakfast, a production of iHeartRadio.

Speaker 2 (00:08):
Good Morning, This is Laura. Welcome to the Before Breakfast podcast.
Today's episode is going to be a slightly longer one
part of the series where I interview fascinating people about
how they take their days from great to awesome and
any advice they have for the rest of us. So
today I am delighted to walk up. Welcome doctor Adam
Sandal to Before Breakfast. Adam is a physician working in

(00:31):
rural Canada. He teaches at the University of British Columbia
and writes the Great Work newsletter on Substack. So Adam,
welcome to the show.

Speaker 3 (00:40):
Thank you so much. I'm delighted to be here.

Speaker 2 (00:43):
Yeah, I'm decided to have you as well. Why don't
you tell our listeners a little bit about yourself.

Speaker 3 (00:47):
Sure, I've had a fairly crazy life, so as anyone
sharped can hear. I grew up in the UK with
mixed British and American parentage, trained as a doctor and
worked as a doctor for about twenty years in the
UK before moving to Canada right at the beginning of
the pandemic. I've also the craziness, you know, I've spent

(01:13):
ten years while working as a doctor, also working as
a human rights lawyer. That was in the UK, and
I've also spent quite a lot of time in other
parts of the world, helping to develop healthcare services in
places like Africa and India in the Middle East. But
I now I am now in Western Canada and rural
Western Canada, where I work on what Americans call a reservation,

(01:36):
what Canadians call a reserve with an indigenous population here
in British Columbia.

Speaker 1 (01:42):
And you are off on a tiny island, I understand, correct.

Speaker 3 (01:45):
That's right, kind of tucked into Vancouver Island and in fact,
and I love telling people this. At the moment, my
commute to work involves me getting in a kayak and
kayaking across the small channel.

Speaker 2 (01:57):
So that's your company vehicle, that's right, You're exactly right.

Speaker 3 (02:01):
And it's my first company vehicle.

Speaker 1 (02:02):
I was very proud when I bought it. Yeah, so
that's true.

Speaker 2 (02:06):
I mean, rural healthcare does not tend to come with
company vehicles, I suppose.

Speaker 1 (02:10):
But maybe I can tell people what that's like.

Speaker 2 (02:12):
You know, many of my listeners probably have more the
suburban or urban sorts. You know, they think about just
going to the doctor or hospital for healthcare? How's that
different in rural Canada and especially with indigenous populations.

Speaker 3 (02:23):
You know, it's something that I didn't when I moved
from the UK. I didn't even know still existed in
high income countries where you've got doctors doing what I think,
you know, doctors were doing fifty years ago, in the
places where many of us live now, many people live
now just doing everything. And in fact, for several years
here I worked in an even more remote community than

(02:46):
I do now, where we did do everything until things
got beyond our expertise, and then if we could, we'd
fly them out to a bigger center. But it is.
It's a kind of medicine, a kind of healthcare that
I think in so always people still yearn for, where
you have a doctor who deals with pretty much everything

(03:06):
for you. They see you in the emergency room, they're
the family physician that you see in the clinic, and
they're doing everything in between, insofar as you're capable of
doing that.

Speaker 2 (03:17):
And now we're going to talk about time management in
a minute, because you had told me that you thought
you were not so good at time management.

Speaker 1 (03:24):
But it tells me, you know, you're dealing with you
never know going into a day what is going to happen.

Speaker 2 (03:31):
I mean, you're dealing with every single ailment that could
befall a community or people's regular run of show health needs.
So how does one even think about time when a
day could bring truly anything.

Speaker 3 (03:48):
It's such a great question that and I think you
know some of it. In really reactive jobs like that,
all you can do is figure out what the most
important thing to do next is and then do that.
You know, and there's always the most important thing to
do next, and you just do one of those after
the other after the other, and you hope that at

(04:09):
some point you come up for a and have got
through your responsibilities that day or that night or that
or that shift. But there's a you know, there's there's
a skill to doing that, it seems to me, because
you can get so submerged in it that you stop
being aware of who you are and how you are doing.

(04:31):
And you know, when I was a resident, it took
me a while to realize that actually you have to
go to the bathroom and if you're you know, if
you're working really long shifts, you have to have breaks
and eat because because otherwise you are going to start work,
You're going to feel terrible, and you're going to start

(04:51):
working really and effectively, and actually you're going to have
a much worse day than you otherwise would be. So
there is this thing of kind of maintaining kind of
higher out tude view of how you're doing and thinking, no,
even though there are still people waiting, I have to
stop now, and I need to drink some fluids, and
I need to just pause and not think about the
next thing I'm worrying about, just for a few minutes

(05:12):
so I can get my head straightened out.

Speaker 2 (05:15):
A very important lesson for sure. Well let's talk about
time management. Though.

Speaker 1 (05:19):
What if you found hardest about time management?

Speaker 3 (05:22):
Yeah, I mean I think there are a bunch of things,
and one of them for me was thinking that there
was one change that I could make which was going
to fix everything. And I'm you know, I love reading,
you know, listening to podcasts like this one and reading
books about how I can improve my life, and when

(05:43):
you do, you have this kind of honeymoon effect of
thinking that everything is going to be You've solved the
problem and everything's going to get better. And it took
me some time and then it does for a little bit,
you feel more in control, and then a few weeks
later things are not that much different. And it took
me some time to realize that this is a life's project.

(06:04):
You know, you haven't failed by not solving the problem
overnight by reading someone's fantastic book. And these are fantastic
books and you know, and podcasts and advice advice that
people have, but there isn't one solution. This is a
you know, this is a process that you learn and
you gradually get better at it. And I've been doing
this for you know, nearly thirty years now, and I
am so much better than I was. But that wasn't

(06:27):
That wasn't you know, one big jump that I suddenly
made when someone's brain, you know, wonderful idea change transformed
my life. It was a series of small, incremental things,
you know. So that's one thing. And then another thing
I think for me has been recognizing that this isn't
it's not just about techniques, it's about perspectives. So you know, you, yeah,

(06:51):
you can learn how to time box, and that's great,
and that helps you if you're a time boxy kind
of person. And I think if you're not a time
I am a bit. If you're not a time boxy
kind of person, then it's terrifying and awful. But but
you need to understand why you're doing that and have
have that kind of perspective shift that goes with it,

(07:13):
and one that you know you You make this point
I think in several of your books, including Big Time,
which I've just read and I love, which is that
you have enough time. The problem is not that you
don't have enough time. And I you know, fundamentally agree
with you about that, but it took me a long
time to learn it that if you're you're fretting about

(07:35):
not having enough time, you are fretting about the wrong problem.
That that's not that's not how you need to solve
your time management problems.

Speaker 2 (07:43):
Well, we're going to take a quick break and then
we're going to think about how we do solve our
time management problems. Right after this, well, I am back
talking with doctor Adam Sandal, who is a physician practice
thing in rural Canada.

Speaker 1 (08:01):
He is also the author of the Great Work newsletter
on Substack.

Speaker 2 (08:05):
So you mentioned that in your time management journey there
had been a lot of small incremental steps that were helpful.
I wonder if you can share one or two of
those that were helpful for you, and that might be
helpful for other people who are listening to this.

Speaker 3 (08:20):
The biggest one for me has been recognizing how important
rest is, that how important breaks are, and making sure
that I adequately prioritize them, because my instinct always when

(08:42):
I feel as though I have too much to do,
is to do the stuff that I feel like I
need to be doing. And you know, there's a bunch
of problems with that, one of which is that there
are always more than you can ever possibly do, so
you have to prioritize. And the second is that if
you don't, if you don't make sure if rest and

(09:05):
breaks and things that allow you to feel better and
then in fact make life meaningful aren't in there, then
they're not going to get done. So so that that
that piece of advice, which to me feels like permission
to do what I actually want to do, which is
to sit on the deck and read a book, or
go for a walk, or spend time with my partner

(09:27):
or you know, whatever it may be, that that recognition
that actually that's at least as important as all of
the other things that I'm worrying about getting done. That's
been a huge transformative thing for me.

Speaker 2 (09:40):
Well, and that's interesting that you refer to those as rest,
because those are activities. The three things you just mentioned
that reading a book, yep, going for a walk, spending
time with a loved one. Yeah, that's that's not lying
on the bed watching TV. I mean, those are all
active choices. So I'm curious if you can talk a
little bit about this idea of rest as a category

(10:03):
that's about rejuvenation and not so much about just doing nothing,
if it were even possible to do nothing.

Speaker 3 (10:09):
Yeah, And people use all kinds of terminology for this
and distinguish between rest and leisure, and you know, and
I think it's easy to get a little bit kind
of hung up on that. I guess I'm talking about
doing the things that I most want to be doing
that don't feel like obligations, you know, because there's a

(10:30):
sense much I love my work, and I you know,
I love doing stuff like this, but it's it's you know,
it keeps me alert and active and having to think
hard about it. And I guess the things that are
most important to me, and I think to all of us.
We need to have time to do this are time
to allow our minds to wander into daydream or to

(10:51):
think the big thoughts, so you know, and that may
that definitely does include you know, watching We're watching six
feet under It at the moment, which I've never seen
before and I'm loving and that, you know, I get
a huge amount from that. And that's one of those
things for me. Going for a walk, Yeah, is it
an activity? I suppose so, but it's not a chore.

(11:11):
It's something I just love doing, you know, and or
you know, or reading, reading, reading a good book, or
you know, even sometimes I can find just doing stuff
pottering around in the garden, you know, mowing the lawn
that you know, that actually just gets me outside and
it's a little bit physical and that feels good. So
what it is for you and what it is for
me are probably going to be different. Although interestingly, when

(11:33):
big surveys are done on this, we they it often
boils down to you know, half a dozen or a
dozen things that most of us would identify as things
that you know, make us feel better. But the key
thing is to you know, it's not scrolling Instagram. You know,
that may be a break. But it isn't. It doesn't
leave you feeling invigorated and energized and that the life
is good when you finish doing it. You could just

(11:55):
kind of feel slightly dirty and ashamed of yourself.

Speaker 1 (11:58):
Sometimes we are deer.

Speaker 2 (12:00):
So another topic you talk about, you said, it's the reaction,
not the stuff.

Speaker 1 (12:05):
What do you mean by that?

Speaker 3 (12:08):
So I'm unashamed to say that I have often found
my work stressful, and I think that goes for many
of us, you know, no matter what what your job
may be. And and there was a you know, this
was one of those perspective shifts that I was talking
about a moment ago that was, you know, part of

(12:31):
this kind of cumulative life changing, life changing thing that
that often when you are getting stressed about something, if
you look at your reaction the stress first, it will
it turns out that whatever you are getting stressed about

(12:53):
is much less of a thing than you were thinking
it was. And you know this is you know, there
is strains of this in Buddhist and Stoic philosophy. There's
that quote from Hamlet, which I think I can get
away with because of my accent. There is nothing either
good or bad, but thinking makes it. So it's you know,

(13:17):
you find it in a lot of modern day thinking
about about how we can live our lives better, including
cognitive behavioral therapy that you know, that most effective, most
evidence based form of psychological therapy that you know, if
you are worried that you have done something wrong and
you are going to get in huge trouble or this

(13:37):
is going to have an enormous impact on your career
or on the people your work serves, and you're losing
sleep over that, Actually unpicking that and figuring out whether
that is really accurate and thinking about how helpful to
you the reaction that you are having to it is
being can often be the most helpful thing you can

(14:00):
do in that situation.

Speaker 1 (14:03):
So tell me how you started the great work substack.
What led to your decision to try and share your
ideas on you know, time and management with other people.

Speaker 3 (14:13):
This crazy career that I have had has taken me
to an awful lot of different work settings of one
sort or another, in medicine and in law, and in
different continents and just very different approaches to doing things.
And I, you know, after some years, began to realize

(14:34):
that the struggles that I have with my working life
are struggles that lots of people have with their working
lives and that and I have got this kind of
engineering mindset where if I've got a problem, I kind
of try and figure out ways to fix it, and
I'm interested in evidence based ways that actually do work.

(14:55):
I'm one of those people who gets put off by
wo and pseudoscience, but I want something practical that I
can do that makes a difference. And there came a
point where I felt that I'd figured out enough of
these people and increasingly had enough of these problems, and
increasingly had helped enough for other people to figure out
solutions to their own problems that I thought there's something

(15:16):
here that I want to start sharing with people, And
so started the sub stack and working on a book
about the same stuff, and have been delighted to discover
that this is things. This is information that people really
want to hear and seem to find useful if it's practical.

Speaker 2 (15:33):
Absolutely, people always like practical things. We're all about practical
here absolutely. And another thing we also like here before
breakfast is morning routines. And I understand that you have one.

Speaker 3 (15:44):
Yeah, And I'm slightly obsessive about it and get a
little bit stressed if I am unable to follow it
and then tell myself, no, it's the reaction, not the stuff.
Today is going to be fine. Yeah, I mean, and
this is kind of slowly evolved, and it will probably
continue to involve to evolve. I get up, and I'm
pretty disciplined about not switching on devices or checking anything

(16:05):
for a while, just so that I have a little
bit of mourning before I start to get consumed. I meditate.
I do some mindfulness meditation literally for maybe no more
than two or three minutes. Sometimes it's significantly longer than that,
but two or three minutes makes a huge difference to
my day. Recently, because I'm in my fifties now, started

(16:26):
doing again just a few minutes of yoga every morning,
and that makes me feel way better for the rest
of the day too. And two or three times a
week we'll lift some weights. All of this is just
for a few minutes. The whole thing is just, you know,
it's brief, it's easy to fit in there. And then
I sit down and I have this quite formulaic process

(16:48):
that I go through. I start by writing just a
few pages of I don't know, it's a cross between
diary and what people call morning pages, just getting stuff
out there. And I do find, as people who do
morning pages do that if there's something that if there's
a decision that I've been struggling with, often just a

(17:09):
few sentences on the page and it's figured out for
me in my mind. And then you know, I have
a task management app on my phone and my computer
and I have a look at what's popped up today
and sort them out and cross off a bunch of
things or postpone them and have a think about how
my day is going to go. I also look at

(17:31):
a list that I keep, just a short bullet point
thing of my big priorities in life, and I look
at that every morning. And the reason I do that
is that it is so easy to get off track,
especially during busy or stressful times, and I just find
it helpful each morning to look at that list of

(17:51):
what is my life, what do I want my life
to be about, and make sure that things are as
on track as they can be, and if not, think well,
what am I going to do about that today? How
am I going to fit in an hour of whatever
it is that's most important to me today? And that's
and By the end of that process, I feel like
I'm ready to get going with to.

Speaker 1 (18:11):
Day for sure.

Speaker 2 (18:13):
Well, it's always good to look at our goals and
refamiliarize ourselves with them. We're going to take a quick
ad break and then I'll be back with more from
doctor Adam Sandal. Well, I am back talking with doctor
Adam Sandal who is a physician in rural Canada, teaches
at the University of British Columbia, and writes the Great

(18:35):
Work newsletter on substack.

Speaker 1 (18:37):
So you've seen a lot of time management.

Speaker 2 (18:39):
Advice, You've seen you've read a lot of productivity and
self help books over the years. I'm curious if you
tried something that most definitely did not work for you.

Speaker 3 (18:48):
Oh wow, what a good question. Let me think that through.
I mean the things that the things that I find
in the hardest are things that just come across to
me as too tree hugging and pseudoscientific. And I mean,

(19:13):
I'll give you one. I'll give you one example. I
was involved in a great team building session led by
an external facilitator recently which suddenly dove into the world

(19:35):
of polyvagel theory. Now, I don't know if you've heard
of polyvagel theory, but it's big out there in in
kind of work performance kind of psychology stuff, and it's
made up. It's pseudoscience. And what it does is it
slaps a fancy sounding scientific, key sounding label on some

(20:01):
kind of basically good advice and makes it way more
complicated than it needs to be. And I can't stand
that because I think it's dishonest. I think it it
doesn't actually help people to it to attach labels, and
it warps the advice away from what might be the

(20:23):
most useful to make it sound like this kind of special,
fancy kind of science y thing, and I find it
very difficult to engage with that. And goodness me, I
had to bite my tongue because actually this was a
really good session and I didn't want to undermine that
or the facilitator, but that that stuff I find really
And I know I'm coming at this as a doctor,

(20:43):
you know, as someone as someone who is a bit
sciencing myself, but that really turns me off.

Speaker 2 (20:48):
Yeah, well, I think the group facilitation right there probably
turned me off. I'm really not into any sort of
forced group bonding activity, but good.

Speaker 1 (20:58):
For you for being part of it. So Adam.

Speaker 2 (21:01):
I ask, oh, my guests, what is something you have
done recently to take a day from great to awesome?

Speaker 1 (21:06):
We know that this.

Speaker 2 (21:07):
Pseudoscience group facilitation stuff was taking a day maybe a
little worse. What's something you've had a good day and
made it better.

Speaker 3 (21:15):
There's I mean, there's two things I want to say,
and one I'm just going to say in passing because
any day in which I can walk in nature for
the purposes of walking, so I'm not getting somewhere necessarily,
but just for the purpose of walking, that is going
to be a great day. But from from great to awesome.

(21:36):
And I thought about this a little bit because I
knew you were going to ask me this. From great
too awesome. I think any day where I have spent
time with someone else helping them figure something out. I
cannot tell you why that gives me the buzz it does,
but research tells us that actually that gives all of

(21:57):
us a buzz. There's wonderful search on this and I so,
you know, I do a bit of coaching and mentoring
of other health care providers in British Columbia, and you know,
there was a recent day where I spent an hour
with someone on Zoom, helping them figure out an approach
to clinical problems that they needed to have, and I

(22:19):
just felt for days afterwards. I felt good about it
because I knew that something, something useful had happened there
and we'd done it together.

Speaker 2 (22:26):
Yeah, helping other people and being useful is amazing, and
I'm sure one of the upsides of being in a
rural physician is you do that every day, right, I mean,
you are clearly solving people's problems every.

Speaker 3 (22:39):
Day, and I'm sure that's why I chose that as
a career. I didn't know it at the time, but yeah,
I get it. I get every every day I go
into work, I get energized by that. And it's great.
And it's weird for an introvert because actually I really
love spending time on my own, but there is something
very meaningful about that kind of one on one helping
people fix things.

Speaker 1 (22:57):
Absolutely. What are you looking forward to right now?

Speaker 3 (23:02):
I am. I'm loving doing the writing and connecting with
people who are interested in this stuff. So that's really
that's really exciting for me, and I'm just continuing to
enjoy that this time of year for me, you know,
part of the reason I'm in British Columbia is it's
one of the most beautiful places in the world and
this time of year is just fantastic. The nature and

(23:25):
the wildlife and the views and the scenery and the outdoors.
What else can I tell you that I'm excited about
at the moment, I guess the biggest excitement in my
life is I'm trying to turn all of this into
a book, and that feels like it's going really well,
and I'm excited to see how that may unfold.

Speaker 1 (23:41):
Wonderful, absolutely well. Let people know where they can find you.

Speaker 3 (23:45):
So the best place to find me is on my website,
which is Adamsandal dot com Adam Sandel l dot com
and you can connect with me there. You can also
sign up for the substack, and if you prefer that
as a podcast, then that's embedded in the substackle. You
can find in the emails, or you can find it
in all the places where people find podcasts.

Speaker 2 (24:05):
Wonderful well, Adam, thank you so much for joining us,
Thank you to everyone for listening. If you have feedback
about this or any other episode, you can always reach
me at Laura at Laura vandercam dot com.

Speaker 1 (24:18):
In the meantime, this is Laura.

Speaker 2 (24:20):
Thanks for listening, and here's to making the most of
our time. Thanks for listening to Before Breakfast. If you've
got questions, ideas, or feedback, you can reach me at
Laura at Laura vandercam dot com. Before Breakfast is a

(24:47):
production of iHeartMedia. For more podcasts from iHeartMedia, please visit
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