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It Is All Your Fault

By Jimmy Turner, MD
The Physician Philosopher

There’s one fundamental truth that can change your perspective when you feel like medicine is burning you out. This truth can help you turn the tide to claim the life you want and deserve.

Today’s thought is this: If you want to take back the autonomy in your life, you have to stop giving the control of your feelings and actions over to someone or something else. 

So let me just get it out of the way right now. Here’s a fact. How you feel about your current situation at home or at work is completely determined by you and your thoughts. In other words, any feeling you have about work is up to you. Not your spouse, not your boss, not your chair. It’s up to you and only you. 

So having heard that it’s all your fault, do you want to punch me in the face yet?

Let’s dive into this a little bit more, so that you can understand exactly what’s going on here and what I mean by all of this. If you hang around, I promise you it’ll be worth it.

How This Fits CTFAR

So let’s say that the circumstance is that you took care of a patient on Friday. Now you go about your weekend with no other thoughts on your mind. You’re probably thinking, “I’m pretty happy, peaceful, maybe relaxed, not a lot going on.”

But on Monday, after having that weekend, hopefully peaceful relaxing weekend, you find out that the patient you took care of on Friday died on Saturday while you were doing all of those things.

Now prior to you learning about coaching, you may have said something along the lines of, “I can’t believe she died. She was doing so well when I last saw her. That makes me so sad that she died.” And is that really true? Is it the patient dying that makes you sad? In other words, was it really the circumstance that produced your feelings in that situation? 

And the answer, as strange as it seems, is no. What causes your feelings in this situation are your thoughts. The second that you found out on Monday that the patient died on Saturday, you probably had some thoughts. “Man, I remember meeting the patient’s husband. They were so nice. I can’t believe she died. Maybe I missed something. What could I have done differently?”

And the second you start having these kinds of thoughts, you start to realize one unshakable truth. Your circumstances do not cause your feelings. If you’d gone on and you never knew that that patient died, which happens sometimes. 

In my line of work, anesthesiology, I might take care of you and you might die seven days later, and I would never have any idea, because no one told me. In that situation, I don’t lose any sleep at all. It’s not because I don’t care. It’s because I just didn’t know. And so I can’t have a thought about the circumstance of the patient dying.

So your circumstances do not cause your feelings. Our thoughts about our circumstances are what causes our feelings. 

How Your Past Impacts the Way You Think

One of the most powerful examples, though, of this truth, that your circumstances don’t cause your feelings, is your past. I cannot tell you the number of people I talk to who will come to me and say, “I hear what you’re saying, but like you don’t understand. Like when I was younger, I went through X, Y, and Z. My mother did this. My father did that. They’ll say, “That’s why I am the way that I am.” We all have various circumstances.

But the problem is that when we say that those circumstances determine how we feel, we’ve just handed the keys over to the other person. This sort of flawed thinking extends to other areas of our life. That includes our feelings about being burned out at our job, getting mad at our spouse, or really any other situation.

How This Impacts the Burned Out Doctor

For a burned out doctor, they’ll often say things like, “I feel stuck. There’s no options for me. My hospital doesn’t care about me. They treat me like a number.” These are things that I will hear doctors say about their situation. And those thoughts produce very powerful feelings that then lead to the actions and results in your life and how you show up at work. So all of these things are because of your thoughts.

Now at this point, there’s going to be a group of you who are listening that really want to punch me in the mouth right now. You can’t wait to meet me in person, because everything that I’ve just said sounds like I’m blaming the doctor who was burned out.

In fact, I remember writing a piece. It’s called You Are Strong. It’s a poem that was trying to encourage people and remind them of how strong they must be to get to where they are today. I had 70% of people reach out and say, “That was beautiful. I needed to hear that right now.” They read it in the light that I meant it in.

And then I had another 30% of people that reached out or commented on the post and said, “How dare you blame the doctor for not being strong enough,” which is ironic, because at the end of the post, I literally talk about them being strong enough. It’s not about them. You are already strong. But I still got those responses.

Burnout Vs. Moral Injury

The reason why is this. Burnout is not the same as moral injury. Burnout is kind of the common colloquial term that people use to describe a really common phenomenon in medicine. The three common features of a burned out physician are a perceived lack of personal achievement, emotional exhaustion, and the depersonalization of the people we care about. We start treating patients like objects.

In recent years, there’s been a foray into a different term called moral injury. Moral injury refers to an injury to an individual’s moral conscience and values resulting from an act of perceived moral transgression, which produces profound emotional guilt and shame, and in some cases also a sense of betrayal, anger, and profound moral disorientation. 

We know what to do. We’ve gone through all this training. We know how to diagnose these problems. But, the situation and the circumstances in which we work will not allow us to take proper care of patients. You are sitting in a situation where you feel like you have no control to help somebody. That is called moral injury. 

The people that prefer moral injury as a term will say that the reason that they don’t like burnout is because burnout implies that it is on the physician to fix. You are blaming the doctor who is burned out, not the system that caused it. 

There is this distinction between moral injury, which causes or happens to a doctor, and burnout, which is experienced by the doctor and is being blamed on them for being that way. So people have preferred moral injury to burnout for that reason.

The System Needs Fixed, But You Can Help Yourself Out

I just want to be fundamentally and unequivocally clear about one thing. Coaching can help burned out or morally injured doctors. But that does not mean that I think that moral injury or burnout are caused by the doctor.

I 100% still believe that medicine needs to be fixed. I think our culture needs major change. However, despite that, I still think that there are individual solutions that will help doctors feel empowered, while not blaming them, but helping them own responsibility for the piece that they can control. 

Both of these things need to happen. We need to teach our doctors how to reclaim autonomy in their life, to change their thoughts, so that they can change their feelings, actions, and results. I think coaching is the best way to do that. I also think that the system needs to change.

Final Thoughts

You can take that autonomy back. You can control that autonomy, and take back the power over your life in doing so. And once you’ve done that tough thought work, then you can even change your circumstance. You might decide to go work part-time or to go work at a different hospital. You might decide to open up your own clinic. The options are limitless.

TPP

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