Cultivating Joy in the Journey in Medicine - Perspective

We are in a series on finding and cultivating 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 based on Dr Martin Seligman's foundational work. 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.

Even without a formal daily method - you can begin to find sparks of joy, but looking for them actively. I once worked with a resident who wanted to believe she could enjoy her career but she was feeling a bit disillusioned. When I asked her about the last satisfying patient interaction she had, it took her a couple of minutes (very common as we often rehearse the unpleasant encounters but rarely replay and internalize the good ones). She remembered one actually from the week before. I asked her what made it satisfying, she began to unpack it and relive it a bit. I continued encouraging her to find more reasons. And then, she reflected - you know what - that was joy I experienced. It was buried like gold amongst the rest of the settlement. And those nuggets, are worth spending a few worthwhile quiet moments digging and panning for. 

This is a form of leveraging positive cognitive psychology. Gratefulness and the Thought Model go hand-in-hand. A resident and I once were coaching to separate out facts from the story we have 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. The practice alone left him unable to reset the negativity bias. The realization that he didn’t have to believe everything he thought was revolutionary for him. And then he was able to use the both tools to inform each other.   

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. 

Recognize assumptions and start to question. 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 (and energy!) 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 harsh 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 and then aiming toward growth and mastery.

"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 like to remind those I coach with that are thinking this that narcissists don't worry about becoming narcissists. 😂

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

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Original 6/2022, updated 4/2024.