Optimizing Your Mindsets in Medicine, Step 2 - Fact vs Story

Your mind is a powerful tool for improving your day-to-day experience of your given situation. Last week, we discussed the first step of optimization—writing and reflecting on your thoughts. This week, we will use that download to move on to Step 2. 

By default, we believe our thoughts to be true. However, physicians, like most humans, have imperfect brains. Our thoughts, the sentences in our heads that our minds automatically produce, are colored by our experiences, the beliefs we grew up with, our culture, the media we consumed, and the influence of others in our lives. While all these inputs can grow us in unique ways, they also create an inherently flawed system open to misinterpretations, assumptions, judgments, and common cognitive errors.

Unfortunately, low-quality thoughts not entirely based on truth can lead to undue stress, mental energy drain, and actions that are not in our best interests (nor those of our colleagues, patients, friends, or families). I like the analogy that a mind left in default mode is like an unattended toddler running around with scissors.

Step 2 is to separate facts from the story you have about those facts - truth from thought. After unloading what’s on your mind onto paper, look for the area causing you the most distress. What is it that is most unsettling? Once you are zeroed in, we start the process. 

Pick out the facts. You can do this by circling them or rewriting them in a clean space. Now, for the purpose of this exercise, you need to use the following tips for defining what qualifies as a fact.

1. It contains NO adjectives. (“hard”)
2. It contains NO loaded words. (“dumpster fire”)
3. It contains NO assumptions. (“They’re avoiding me.” Maybe they are, but what exactly are you observing - did they cross the street after making eye contact, etc.)
4. It contains NO judgments. (“That’s messed up.”)
5. There’s NO room for a different interpretation or perspective. (“vaccine-hesitant”)
6. Everyone would agree. (Not just people who think like you.)

Once you’ve carved out the facts, you’re left with your interpretation of the circumstance—the thoughts.

This seems like it should be easy. In actuality, it takes a bit of work. We become very attached to our stories and oppose loosening our grip on them. “I have too much to do. Really. Everyone would agree.” Even now, as you’re reading those words, many of you are experiencing a visceral reaction in solidarity that there IS too much.

But, what is too much? Is it if you can’t get the boxes checked by the end of the day? Is it if you have 10 things left to do at the end of the day? Who defines “too much”? Would everyone agree on where the line is? No. So let’s break it down to where it is a fact via the definition above by listing it out.“ I have 10 notes to write, 45 in-basket messages, a grocery list, an appointment for a tire change-over, etc.” So, we are stripping it of judgment and adjectives and ensuring everyone can objectively agree.

Thoughts containing deeply held judgments, such as “He was rude,” can be very challenging in Step 2. However, we know various things seem rude in one culture but not in another. And something that offends your partner doesn’t bother you in the least. So, we wouldn’t all agree. We know rude is an adjective. Again, list it out – what factually happened to cause you to think that way? “He interrupted me, and the volume of his voice increased. He said, ‘You have no clue.’” Put the exact words down said. Now you are down to facts.

Sometimes, you find yourself holding tightly to your interpretations as factual. When you cannot loosen your grip, think of someone who would likely look at it differently. How might they view the situation? Even if you disagree with their perspective, the exercise helps wiggle it loose a little. There are many ways to think about each situation.

This exercise step aims to raise awareness and objectivity that everything we think isn’t necessarily fact. Even recognizing something as your interpretation of the facts and labeling it a thought lightens the intensity of the moment. 

I watched Cy Wakeman last year listen to an audience member's story about all she has put up with and how she's having a hard time deciding what the right thing to do is. Cy took notes as the emotionally laden story was told. Then Cy read the things on the right side of the paper (many) and said - "All story - it's drama." Let's remove it. She ripped the paper in half, crumpled it and threw it on the floor. Then she read from the left side. She said "Facts" and read the couple there. Then she asked, "Now, what do you want to do?" It was disarming to all of us as the collective anger that had begun to simmer cooled. The woman, along with all of us, was calmed. It was a powerful example. 

This coming week, utilize steps 1 and 2 together each day. The whole thing can take less than 5-6 minutes. Let me know what you discover along the way. 

Next week, we will cover a framework that can be utilized in Step 3. 

Have a joy-filled week! Tonya

Download the first three key steps I recommend to increase your joy now in your life and career. Click here  

Originally published July 2022, updated September 2024.