Exit Stage Right, Helping Physicians Drop the Persona

The more I coach, the more I see a theme emerging. The theme of portraying a character that fits the mold, earns praise and is accepted.

We are socialized early in the education process to perform for the approval of others.

You are standing on stage. The spotlight is on you. The critics are in the back with their pencils, ready to scribble harsh judgments with any slip or nuanced infraction. So much rides on the published review.

“Pass, Honors, High Pass, Fail?” “Highly recommend without reservation.” Are we accepted to the “right college?” Do we get the right recommendations? Do we get into medical school? Do we pass the rotation? Do we get pigeonholed into a reputation, good or bad? Do we have to remediate? Do we earn public kudos? Do we get nominated to be chief? Do we get the job we desire? Are we accepted? Do we fit in, belong? Are we up for promotion? What will be said at the annual review with the chair?

It happens in a variety of settings.

-You walk up to present in front of peers.

-You grab the list of labs to reference as you report out on rounds.

-You sit in front of the clinic preceptor.

-You have a new resident plop down in front of you in the preceptor room.

-You pop into a colleague's office to run a case by them.

-You present findings or a proposal in a meeting.

-You run the meeting.

-You call a specialist for a formal consult.

-You see patients while a medical student shadows you.

-You meet the patients’ extended family members in a team meeting with the social worker, case manager, and specialists.

-You present at M&M.

-You interview for a promotion.

-You present and defend your cases for oral boards (thank goodness I’m not a surgeon!)

When we are in performance mode, the focus is on how we come across. We become overly concerned with others’ opinions. Instead of showing up as our unique, authentic selves, we put on a persona. Then unconsciously, we begin to tie our self-worth to others’ thoughts about us. Intense fear of judgment grows. We become approval addicts. The satisfaction from approval, when it comes, is short-lived. Anxiety, self-doubt, guilt, and shame grow. The inner critic gains access to your internal PA system. Uncertainty abounds. You never feel you’re enough.

Pause. Breathe.

What would it be like to show up as your favorite, more authentic version of yourself?. (Shout out to Dr. Melissa Parsons for changing the verbiage from “best self” to “favorite self” to add flexibility and self-compassion to the mix.)

In the words of one physician that I coached – “I’m here to take care of patients the best I can and to keep learning.” The same set of circumstances, but the focus has shifted.

The spotlight is on

1. The patient, what do I know, what do I not know, how do find it out to give them the best care, trouble-shooting, goals of the meeting, or how the department needs to advance.

Instead of,

1. I hope Dr. X thinks I’m doing a good job, Dr. Y approves of my plan, the Chair is impressed, my colleagues don’t realize I don’t know everything about this topic, or Dr. Z doesn’t think I’m an idiot.

It’s an important internal alteration that takes the locus of attention from what others are thinking about you, to the task or person at hand. Doing your best. Learning from the rest. Accessing that growth mindset.  And knowing that whether you’re accepted or not by others, you are proud of how you’ve shown up. Getting comfortable knowing that you might not be everyone’s cup of tea. And allowing others to be wrong about you or even (gasp) not like you.

It's a shift that removes unnecessary internal stressors. It takes you off the emotional roller coaster of others.  We know that so much of what is said, how it’s relayed, and even how things are perceived have much more to do with the individual who says it. It’s more about their life experiences and their stressors and has less to do with you personally. Plus, you really can’t control those things anyway.

So, what if by showing up as your favorite self, minus the theater makeup, costume, and stage presence, you are seen most accurately and, therefore, given the best opportunity to grow into the physician, academician, colleague, or leader you want to become?

Less performing. More being and becoming. Less unnecessary stress. More internal validation and growth. More ease.

Next week, I’ll walk you through a series of questions to slowly move off the platform – exit stage right.

Until then, Have a joy-filled week!  Tonya

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