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Common Physician Thought Distortions, Should-statements and Polarization

Last week, I introduced the most common thought error patterns in physicians. This week we will look at two prevalent distortions.


I'll start with one of the most easily recognizable cognitive distortions. 


The should (not) statement. "Shoulds" pretend to be motivating, but in reality, they add more burden to our mental load. 


They can be self-directed such as, "I should call that patient." Self-directed should-statements often lead to guilt, defeat, frustration, anxiety, or feeling stuck. 


They can also be others-directed. "They should not have put this patient in this slot." Others-directed should-statements lead to additional anger, frustration, resentment, or disappointment. 


I mentioned that should statements are easily recognizable because the word is easy to pick out in our heads or when we are talking to others once we put it on our radar. You can also help your colleagues recognize how often they throw the word around.


The mental shift here is to recognize that iron-clad rules don't fit neatly into a world of human beings and complex systems. Try to ease up on the rules by adding some flexibility to your thinking.


Also, try shifting the language inside your mind or speech when you are self-directing the "should."

Compare the following statements to "I should call the patient.":

"I may call the patient."

"I could call the patient."
"I want to call the patient."

"I have the freedom to call the patient."
"I'm not going to call the patient."

"My MA can call the patient."

Can you feel the burden lighten a bit with any of those compared to what you "should" do? 


Another tip is tapping into curiosity. Why do I believe I should? Who would be most impacted if I stopped believing I should do x, y, or z? How would I experience it?


"I wonder why they put this patient in this spot?" Curiosity allows you to soften the rigidity of the "rules." It doesn't mean that the stress of a patient being in a less-than-ideal spot isn't challenging. Nor does it mean you can't address it or have it changed. It does lessen the anger, frustration, and resentment directed toward your team member. It also can lead you to healthier actions to prevent it in the future. We don't know. Did they feel threatened by the patient? Did they simply make a human mistake? Would a simple, written reference sheet for the schedulers prevent this in the future?


Polarization. This is also called all-or-nothing thinking – there is nothing in between. It's black or white; the gray is unrecognized. You and I see this all the time in our patients. Mr. Jones is going to start working out. He sets a goal of hitting the gym 5 days a week for 30 minutes. He shows up three days in a row. On day 4, he gets busy repairing his car and never makes it. He decides he's failed, so he gives up and never goes back. He's either all-in 5 days a week or not working out at all. He fails to see that exercising even 2 days a week is a significant improvement from his baseline.


All or nothing thinking leads to discouragement, defeat, overwhelm, frustration, and even depression. There is a high relapse rate. It sets you up for failure. An unreasonable standard can also interfere with relationships.


Tune in by noticing when you only see a binary choice. Ask yourself what a third or even fourth choice might be. I coached one senior resident who was torn between staying where he trained and had family nearby and moving to where his wife's family lives. When I asked what other options he had considered, he said none. He had an "aha" look on his face and thought of other possibilities – living somewhere in between, living in a bigger city with direct flights to family, or having family consider moving. Just by him allowing for other options, the negative pressure was decreased. He could then look at the pros and cons for himself and his family more positively.


Get good with "gray." Look for the balance. Look for additional options. Your brain loves to give answers. Ask yourself, "What are 5 other options?" Brainstorm and go crazy. Don't judge the choices before you finish the brainstorming activity, as it interrupts your creative genius. 


Next week, we will jump into two more thought distortions frequently seen in physicians.

Have a joy-filled week! Tonya

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