Comparison:  The Thief of Joy

Comparison: The Thief of Joy

How much time do you spend on mental comparisons? Looking on Facebook and thinking everyone else has better relationships and is much happier than you?  Thinking that everyone in your peer group is smarter than you? Or fretting about how much fitter, thinner, smarter, or more successful you were at a different point in your life? Much of our stress, frustration, disappointment, guilt, and regret is the result of comparing ourselves to preconceived ideas about how we should be acting, how we should be looking, and how our personal successes are perceived by others. Theodore Roosevelt once said that comparison is the thief of joy. Indeed, comparisons often keep us in a mental hamster wheel of self-doubt and lack of confidence. To combat physician burnout, it is critical to decrease the tendency toward comparisons.

But comparison allows me to improve my performance

You may believe that comparisons keep you on your toes. Let’s test this out. Think about any times you’ve compared yourself to someone else in the past week. Did the comparison help you feel good about yourself and your circumstances or did it send you into a spiral of self-critical thoughts? Did you feel energized and optimistic about your circumstances or did you feel defeated, inadequate, and that your life would be forever deficient?

Like advertisements, comparisons hold us in the belief that if we only had product or service X, we’d be happier, feel and look younger, and be the king or queen of our world. While it’s always good to work toward life improvement, comparisons typically leave you unable to focus on the satisfaction inherent in your current circumstances. Comparisons push your focus onto either the past or the future, or simply what’s wrong with the present. Comparisons keep you from being content and perhaps more able to accept what is. Right now.

How to stop comparing yourself to others

As a physician coach, here are four steps I teach to overcome the pull to comparisons:

  1. Start tuning in to your own thought processes. Simply begin noticing when you are going into comparison-oriented thinking. Try not to judge yourself. Jot these instances down so you can begin to see how often this occurs.
  2. Once you’ve noticed that you’re making a comparison, name it to yourself. Say to yourself “there I go comparing myself again.” Doing this begins to create a distance between the comparison you’re focusing on and the reality of the situation. Having that distance and separation is vital in having choice and control over your own thoughts.
  3. Now ask yourself: What is the cost of this thought process? What would I gain if I spent less time on these mental comparisons? Journal about these questions.
  4. Now for the challenge. When you find yourself making a comparison and coming up short, push yourself to think of at least three ways you, your circumstances, your thoughts, and your actions are right and adequate just as they are. Your mind will call you back to the land of comparison and self-criticism. Your job in this step is to exert equal and opposite force in the other direction! Definitely take notes here.

These steps take a lot of practice. What you will gain, though, is the ability to see your own strengths and accomplishments. You’ll find yourself experiencing more calm and a stronger sense of your own self-worth. Harkening the words of Theodore Roosevelt, you may even find yourself experiencing more joy.

An Out-of-Balance Seesaw: Physician Burnout and the ABIM Apology

An Out-of-Balance Seesaw: Physician Burnout and the ABIM Apology

On February 3, 2015, the American Board of Internal Medicine (ABIM) issued an apology to American physicians for subjecting them to an out-of-date and burdensome board recertification exam.

The importance of this step cannot be overestimated. Of the ~850,000 active physicians in the U.S., over 200,000 currently hold ABIM certification, which is required of internists and most medical subspecialists. Starting in 1990 (the year I was unfortunate enough to complete Internal Medicine residency!), physicians have been required to take the exam every ten years to maintain their board certification.

While the ABIM cites data suggesting that the exam improves quality of care, this has not been definitively established, and questions have arisen from a number of quarters about appropriateness of content, the expense, and whether the exam is contributing to early retirement, a major concern in terms of the growing physician shortage.  The ABIM apology focuses on making the exam more relevant to the practice of medicine, allowing CME credits to be used in place of the esoteric MOC (maintenance of certification) modules, and eliminating the onerous practice assessment and patient survey requirements.

Board recertification is expensive, time consuming, and requires intensive preparation. In the setting of increased demands to see more patients in less time, decreased reimbursement, increased scrutiny, increased role definition by non-physicians, and the burdens of the EMR, board recertification is yet one more factor contributing to physician burnout.

Physician burnout is a complex phenomenon and yet it can also be summed up with a very simple equation.

X = all the things that buoy a physician up

X equates to things like positive patient encounters, good relationships with support staff and colleagues, intellectual challenge, or picking up a tricky diagnosis.  X also includes meaningful personal relationships, adequate sleep, and personal health, in addition to a sense of meaning and accomplishment.

Y = all the things that drag a physician down

Y includes an EMR that is frustrating to use and eats away at precious time, unrealistic patient loads, having more and more administrative hoops to jump through, inadequate staffing, or not having time to just focus on the care of your patients.

The math is simple:

When Y outweighs  X, you get imbalance and physician burnout, almost like two sides of a seesaw.

And board recertification is in the Y category big time. My own experience is telling. When I recertified in 2010, as a hospice physician out of touch with general practice, I prepared for over a year and a half, studying 3 hours a day for 3 months. I spent most “free” moments studying, I was completely drained, and my family was angry and alienated. Prior to that recert, my 13-year-old son had always proudly called himself Dr. Gazelle Junior. By the end of the experience, he said you couldn’t pay him enough to become a doctor. Now, at age 18, he’s planning on a career in engineering.

Many things can be done to decrease physician burnout. Not having to spend time that you don’t have studying for an irrelevant test is one important one, but it is still just one factor. Part two of this blog series will discuss the growing body of knowledge on other interventions.

Physician Burnout: Are You Engaged Yet?

When you wake up in the morning, are you ready to take on the day, or do you want to pull the covers up over your head and crawl into a cave?

As noted in a recent  New York Times  article, “Why You Hate Work,” a 2013 Harvard Business Review study of 12,115 white-collar workers revealed that 70% of workers do not have time for creative or strategic thinking at work, and 50% do not find meaning and significance in their workplace.

This problem of finding purpose or engagement at work affects all white-collar workers, including physicians in nearly every specialty and field. A pioneer in burnout research, Christina Maslach defines burnout as a three-dimensional syndrome made up of exhaustion, cynicism, and lack of sense of meaning and accomplishment. Does any of this resonate for you or the physicians you know?

As a physician coach, I have worked with many clients suffering from physician burnout who are not only dissatisfied in their work, but feel disillusioned and without purpose.

I recently worked with a mid-career neurologist who was frustrated by the never-ending changes in her workplace. It seemed as if the rules changed by the week, with hard-to-understand updates to the EMR, and rotating practice managers, one more challenging to work with than the next. My client became so lost in frustration and negativity that she wondered why she was even practicing medicine anymore.

Engagement is the antithesis of physician burnout, and is defined as a positive, fulfilling, state of mind characterized by vigor, dedication, and a sense of flow in one’s day.

The New York Times article points out that employees are more satisfied and productive when their foundational needs are met, including creativity, value, and a sense of connection and purpose at work.

When engaged, white collar employees are more motivated, feel more personally invested, and tend to become absorbed in their work. When they come up against challenges, they are inspired to find creative ways to problem-solve. In addition, these employees find greater work-life balance, and have an overall sense of optimism and happiness. This is critical for physicians, given that they experience levels of burnout of 30-60%.

Engagement is increasingly recognized as vital for self-determination and productivity in the workplace. Organizations that encourage employee engagement are experiencing higher profits, improved safety records, and higher retention rates. Simple workplace measure such as providing breaks and acknowledging hard work can go a long way in increasing engagement.

Through physician coaching, my neurologist client experienced renewed motivation to effect change in her workplace.  She pushed leadership to develop a wellness committee. We worked on many strategies to help her manage the changes and stresses of her position. Over time, she learned to focus more on her strengths, celebrate small daily accomplishments, and gradually re-engage.

If you find yourself overcome by disengagement and burnout, please check out my new FREE ebook, Building Your Resilient Self: 52 Tips to Move from Physician Burnout to Balance. I created this resource specifically for physicians. In the book you’ll find specific strategies to prevent and counter physician burnout.

The Impostor Syndrome Part II: What’s the Treatment?

The Impostor Syndrome Part II: What’s the Treatment?

Part I of this post explained this common disorder, which strikes physicians in their primes, leads to chronic low self-esteem, and contributes to the epidemic of physician burnout. What else do we know about it?

Many physicians have some form of the Impostor Syndrome (IS) but almost all suffer in silence and isolation. This isolation actually feeds into the syndrome, making physicians focus more on the belief that others are more competent than they are. And the vicious cycle repeats or even intensifies.

Furthermore, IS erodes confidence and sense of accomplishment. There are so many pressures on physicians, so many things that weigh you down. Given this, in order to survive you need to limit or eliminate anything that can contribute to the weight of these pressures. Walking around waiting to be “found out” is definitely in this category.

Here are a few ways to manage IS:

  1. Realize that many of your peers also suffer from IS. You can derive comfort from the knowledge that IS comes with the territory of being a physician. It is an occupational hazard, unrelated to your actual skill or expertise.
  2. Try not to expect yourself to be perfect! No physician is, so stop berating yourself for being human. We would have been much better served if we had been taught this in medical school.
  3. Remind yourself that you’re selling yourself short by comparing yourself to others. You bring unique strengths to your work.
  4. When symptoms hit, consciously shift your focus to at least one specific way you excel professionally.
  5. Regularly acknowledge that there is so much new information out there, you cannot possibly keep up with it all.

Like many treatments, this prescription will not take effect immediately. It must be practiced consistently. Old thought patterns are difficult to change. Take care of yourself in this way and you will promote your well-being over your entire career.

This week, if you experience symptoms of IS, try the methods above. Do they relieve your suffering?

4000 Clicks: The EMR Really Is Dragging You Down

4000 Clicks: The EMR Really Is Dragging You Down

We all know the advent of the electronic medical record (EMR) is slowing us down. While it’s leading to better care (although the jury is still out on this,) it’s adding one more headache to your over-extended days. The jury is in, however, finding that the EMR is worsening physicians’ quality of life and contributing to physician burnout, something we are in the midst of an epidemic of. A recent study in the American Journal of Emergency Medicine supports what other studies have found: physicians spend a greater percentage of time on documentation than they do on direct patient care.

From 6 mouse clicks to order an aspirin to 227
for a discharge summary after an ER visit for abdominal pain, this study found that physicians spent 44% of their time on data entry and only 28% on direct care.  This is 1.5 times as much time on documentation as on patient care.  A scary figure, yet pretty validating for physicians who find themselves overwhelmed.

Why is this important for you to know? Because you are not alone! Many physicians feel like there is something wrong with them personally for not being able to keep up with documentation, that sense of always running behind. As time pressures increase, physicians are more and more isolated from one another, so there’s less and less opportunity to, shall we say, “compare notes.” In addition, it’s always better to have validation that a problem you’re experiencing is real and external, not in your head or due to a state of deficiency on your part.

We can’t change the fact that the EMR is here to stay. Once you know what you’re up against, though, you’re less likely to let it weigh you down psychologically. It’s a small thing but, with physician burnout so rampant, EVERY small amount of weight you can shed contributes to your ability to survive.