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Cultivating Joy in the Journey in Medicine - Perspective

We are in a series on finding joy in the journey of medicine and avoiding the arrival fallacy. This week are on to the next approach: Perspective. I lump several strategies under this category - gratefulness, practical positive cognitive psychology, growth mindset, and self-compassion. 


I, along with many others, have written, taught, and coached on all these topics, so I suspect they are not new to you.  However, let’s harness these approaches to find joy now rather than waiting for the trip across the proverbial other side of the fence to experience greener pastures. 


A gratefulness practice is an excellent tool to find ways of seeing wonderful things that your blinders may be hiding. I personally love the Three Good Things approach set forth by Duke’s Dr. Brian Sexton. It’s been proven across many medical settings to decrease depression and emotional exhaustion and improve happiness and work-life satisfaction. And best yet – it’s free, easy, quick, effective, and long-lasting. 


For 15 nights in a row, you pause before bed and write down the 3 things that went well that day, your role in them, and the overall one-word emotion that best describes your feeling about those things. This approach leverages how your brain rehearses things subconsciously while you sleep. It also helps to reset the natural negativity bias we all have, which is even worse under stress. The first few nights, you may not have 3 things. But your brain LOVES answers. So now it’s actively seeking out what is going well to help you answer your nightly question.  And thus, the blinders start to fade.


It's interesting how this ties together with positive cognitive psychology. A resident and I were coaching around facts versus the story we tell about those facts (our thoughts). As he practiced during our coaching session, a lightbulb went off. He realized this was the crux of why the gratefulness practice he was taught earlier in the year was ineffective. At the time, he could find no positives in his life because his negativity bias painted every encounter in an unfavorable light. Uncovering the realization that he didn’t have to believe everything he thought was revolutionary for him. 


While we are moving toward the vision we have cast for our lives, including caring for patients, trainees, and medical teams, it is beneficial to develop the ability to reframe and consider other perspectives. A key to this is becoming aware of our thoughts about situations and how they are or are not serving us or those around us. When you think, “They look down on me,” you likely are assuming based on some facts.  Our brain has filled in the gaps automatically. What are other explanations for those facts? What do you really know is true? If you find a crack in your belief, what will happen if you begin dismantling that belief? What if you could get to a place of believing they likely don’t have strong opinions of you one way or another? How would it affect you? How would it change your emotions and actions? Even if you’re wrong, and they do look down on you, what is the benefit of holding on to that belief versus letting it go? Learning to challenge our automatic thoughts is a powerful exercise. And the great news is that once you examine it and see how it’s affecting you and your experience, you can decide to keep it or shift to something more neutral. Basically, you are taking back your emotional remote controls that you’ve doled out to everyone who has crossed your path. You can take back some agency in how you experience life.


A growth mindset is also powerful in enjoying life right where you are. So much of our stress as physicians comes from our thoughts about how we are doing. We often see so much at which we are “failing.” What would happen, though, if you began to reflect rather than ruminate? What is really true about what isn’t going well in that arena? What can you learn from the results you’re getting? What changes do you want to make and try out next? If we see each domain of our life as an iterative process in which we plan, act, reevaluate, make changes, and repeat, we will feel much more satisfied with who we are, knowing we are a work in progress while we strive toward our goals.  


We can enhance and genuinely leverage the growth mindset, positive cognitive psychology, and gratefulness principles by grounding it in self-compassion.  Kristen Neff, Ph.D., describes the critical elements of self-compassion as self-kindness, common humanity, and mindfulness. In other words, we can drop the self-judgment, realize that most of humanity experiences similar situations and emotions, and become aware of and accept our thoughts and feelings while not allowing them to control us.


"I found in my research that the biggest reason people aren’t more self-compassionate is that they are afraid they’ll become self-indulgent. They believe self-criticism is what keeps them in line. Most people have gotten it wrong because our culture says being hard on yourself is the way to be.,” Dr. Neff.


I hope you are building the skill of finding joy on your journey with the awareness, expectations, intentionality, and perspective strategies we’ve covered.  Next week, we will cap it off by discussing maintenance and language.


Until then, have a joy-filled week!  Tonya

Are you interested in the first three steps I recommend for increasing your joy now in your life and career? Click here for my free tips pdf


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