Our Thoughts Work (Until They Don’t)
Physicians are deeply accomplished people. If you’re already spiraling into thoughts of, “Yes, in principle, but I have a manuscript I need to submit, and notes I need to complete, and everybody I work with is way more accomplished than I am…” just put a pin in those thoughts for a second and stay with me. Compared to all humans alive on the planet right now, physicians, even those still in training, are deeply accomplished. We’ve accomplished as much as we have because of thought patterns that have moved us from step to step: from quiz to test, from semester to graduation, from gross anatomy lab to board exams, from the completion of training to our first faculty positions. Walking the academic path from pre-K through the end of our training means that we may have held onto very early motivations to keep going in our education. When we’re little, we’re motivated by gold stars (or their equivalents). We take that motivation with us and repeat the patterns that got us those first gold stars. The patterns range from putting all of our things away after being asked only once to being really hard on ourselves when we received a B+ instead of an A. A lot of physicians are deeply self-critical: have you ever sat for feedback and thought, “This person can’t be any harder on me than I am on myself”? I see you, lovely friend.
It makes sense that we hold onto the pattern of self-criticism because 1) we learned it when we were young, and it got us to where we are, so there’s not been motivation to change, and 2) medicine trains us to be deeply critical so that we can find the thing that might kill our patients and fix it. Examples of self-critical thoughts are: “I can’t believe I don’t know this yet,” “I should have prepared better for this day,” “I can’t believe I have to ask for a second opinion,” and “I have no business being a doctor.” If you have those thought patterns and they work for you, keep doing what you’re doing! But if you have those thought patterns and you’re not learning that one thing yet, are never perfectly prepped for your day, or rarely feel “good enough” to be a physician, it may be time to let those thought patterns go. You’ve outgrown them, and it’s time to think something new. Easier said than done? Yes. But let me show you why it’s important.
The basis of the life coaching that I practice is The Thought Model. It’s based on cognitive behavioral therapy, where, loosely, we examine our thoughts to see how they’re showing up in our lives. The Thought Model separates everything in our world into five categories: circumstances, thoughts, feelings, actions, and results (“CTFAR’ for short). Circumstances are neutral, objective things that everybody would agree on. For example, “I have 15 patients scheduled for clinic today.” A thought is one of the ~60,000 things our brain offers us daily, and it can be conscious or unconscious. Our thoughts give meaning to the neutral circumstance we’re in. For example, with the circumstance of “I have 15 patients scheduled for clinic today,” the thought that I have may be, “I should have prepared better for this day.” Our thoughts then lead to our feelings. Stay with me; this is not kumbaya or woo-woo. This is physiology. The neurons firing in our brains that give rise to a thought trigger the neurohormonal cascade of dopamine, serotonin, catecholamines and the like through our bodies to generate a feeling. The thought, “I should have prepared better for this day,” may lead to the neurohormonal cascade that makes my chest feel clenched, my stomach nauseous, and my brain kind fuzzy and disorganized, the combination of which I recognize in my body as “dread.” Our feelings then lead to our actions. Out of a feeling of dread, my actions regarding my clinic day may be: I ruminate and beat myself up, over-caffeinate to “get through it,” delay coming to the clinic so that I pull into the parking lot right when my first patient is scheduled to be roomed, defer writing notes in between patients because there’s not enough time to make the notes “good enough,” clean out my email inbox in moments of down time to feel productive and miss out on using those few minutes I do have to prep for the patients that haven’t been roomed yet. Our actions then lead to our results, which always provide data for our original thought: in this case, I’m not prepared well for anything I’m doing that day because I’m using all of my brain space to loop in things that do not allow me to act, only to react.
A lot of us life coaches will write clients’ thought models like this:
C: 15 patients for the clinic day
T: “I should have prepared better”
F: Dread
A: Ruminate, beat yourself up, over-caffeinate, delay coming to the clinic (preventing your having any breathing room before the first patient is ready to be seen), put off writing notes because of sliding into perfectionism, get quick dopamine hits by cleaning out email inbox (but not actually accomplishing anything other than deleting emails), miss out using the time I do have for the patients I have coming up for the remainder of the day
R: You’re not prepared well for anything that day because your brain space is being used in a way that does not allow you to act, only to react (probably leaving you exhausted at the end of the day such that you also won’t be able to prep for the next day’s clinic in a way that would serve you)
This is important because the self-critical thought that you used through school and training to get you to this place (“I should prepare better”) is no longer getting you a gold star; it’s getting you a result that you do not want (and adding insult to injury, it’s making you feel lousy while getting the result that you don’t want). If anything in this seems familiar to you, start playing around with the idea that self-criticism isn’t serving you anymore. Please do not beat yourself up for thinking self-critical thoughts. We don’t use CTFAR to self-flagellate; we use it to get curious. Examining your self-critical thoughts instead of dismissing them as “no big deal” or “just what we all do” is the first step. Is the next step generating thoughts of self-love so that we lose all motivation and drive and live blissfully cuddled on couches with Netflix binges and Uber Eats for days? Nope, lovely friend, it’s so much better than that. Watch out for next month’s email 🙂