Common Physician Thought Distortions, Jumping to Conclusions and Catastrophizing

This week we are moving into what I classify as the assumption category of thought distortions. We will look at the first two of four - jumping to conclusions and catastrophizing.

Jumping to Conclusions. This pattern of thinking automatically assumes the worst. It's not intentional but a well-worn pathway that lights up. People with this knee-jerk response often get labeled as "negative" or the "Debbie-downers." But remember, it exists for reasons. It is often a response to how we've experienced the world. It often serves as a defense mechanism to attempt to protect against the emotion of disappointment - or even pretend to be "preparing for the worst."

Paradoxically, by trying to avoid being disappointed, we start feeling negative emotions ahead of time. Making a negative interpretation without logical facts that support the conclusion can lead to frustration, anger, suspicion, and defensiveness. And you start feeling those almost as soon as you jump to the conclusion. Preparing for the worst is much different than assuming the worst. 

Conclusion jumping may show up in small things. Like when you left your unopened yogurt and granola on the call room table, and it was gone after returning from a nursing call. You assume someone had the nerve to eat it.

It could be something a bit weightier in appearance. The APD wants to talk to you about your curriculum. You assume they are going to take away your favorite curriculum. Or you "know" that they will criticize your inability to get something done promptly within your area.   

The way we grow out of that imagined outcome is to recognize when we are doing it. It can take some practice. When you get the pit in the bottom of your stomach. Ask yourself, what may I be assuming?


Then we must leave room for other possibilities. Practice on the small things and extrapolate to the larger ones.

What are other explanations for your yogurt no longer being on the table? Perhaps someone put it in the refrigerator for you. Or your teammate thought you went down to the lounge and left it behind, so they were taking it to you. Lean into curiosity. I wonder...

What are other possibilities that the APD could want to discuss? Maybe they want to give you positive feedback, ask if you need support, or give you a new resource they found on the list serve. We experience negative feelings by anticipating things that don't come to fruition. So, what's worse for you, unnecessary negative feelings in advance that may never surface or only experiencing disappointment when you have the objective evidence?

Catastrophizing. This is Jumping to Conclusions on anabolic steroids. We take it one step further to the worst possible conclusion and magnify it as a disaster. Sometimes catastrophizing leads to anxiety, sometimes it is a symptom of anxiety, and sometimes there is a vicious cycle between the two.

To be fair, in medicine, we are trained to be on the lookout for the thing that could kill a patient if missed. But we also have tools to ground our thinking in reality. What's the Well's score or the PECARN score, etc.? And even when there isn't an evidence-based algorithm, we think through things logically. With catastrophizing, we don't challenge our thinking. We don't step back and ask what's rational and what's not.

This leads to fear, insecurity, indecision, inaction, overreaction, anxiety, and depression. 

Let's say the Chair of the Department has asked to meet with you on Monday for an unexpected "Check-in." When your brain has a well-rehearsed catastrophe pathway – your weekend will be ruined. You'll be anxious and restless. You'll think of all the things that could have been misconstrued or things that you never wanted her to know. You'll think through what you'll do as the next step in your career. Will anyone hire you after you're fired? Your sleep is off; you don't enjoy your friends and family.

Again, we need to be "on to" our brains. "Oh, that's so interesting. My brain just automatically blew things out of proportion." If your brain is really stuck – acknowledge bad things do happen. You aren't trying to pretend it could only be a celebratory meeting. 

Then check in with yourself. What is rational? What is irrational? Write it out with arrows and see how convoluted it may be. What do you actually know?

Consider less negative, neutral, and even positive reasons for the meeting. "I wonder if she is checking in with everyone since it's been a rough year." Or "maybe there are some changes she wants input on."

Allow yourself to get comfortable not knowing. You're a family physician – you are good at uncertainty. Ruining your weekend will not change the outcome.

Consider practicing having no expectations. "It will be what it will be. Right now, it's the weekend. I have x number of hours to focus on the people, tasks, and self-care at hand. I'm going to make it count and be fully present." 

All of this, as always, is done from a position of a patient and compassionate observer. Adding judgment to your automatic thinking keeps you from shifting. You are human and have a human brain. And it takes time to shift. Give yourself some grace.

Next week we will take on the next two closely related assumptions – Personalization and Mind Reading. 

Until then, have a joy-filled week! Tonya

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