Getting rid of manuals to reduce stress.

Today, we are talking about manuals. You've likely not heard of this concept, but stick with me, and you'll understand.  We know stressors are everywhere in medicine and, sometimes, we have more control than we realize in improving our experience.

Here's a scenario. Let's say you are checking your inbox before clinic starts, and you see a refill request with a lengthy explanation of why it's needed early. But you had only seen the patient once 18 months ago. They have seen your partner twice in the last year, and your partner is the one that prescribed it. You likely think something like. "Why is the medical assistant sending this prescription refill to me? This isn't my patient. My name isn't listed at the top. I'm not the original prescriber. I have enough of my own inbox messages. Ugh." Then you decide if you refill or not or if it’s someone else’s decision and send it on. You likely mumble under your breath or maybe even out loud or perhaps even make a scene.

This is a common scenario for many of us. And there isn’t anything wrong with the initial reaction. You’re human. It’s natural. But can you spot the unnecessary suffering here? Okay, now let me first explain a concept called "The Manual," and then we will relook one more time. 

Manuals are like the instruction manuals we get with our appliances that have all the information needed for ideal operation of the machine. Manuals have embedded rules. We actually have this type of manual for just about everything, (although they exist solely in our minds) including, about how people should behave. How the world should work. How the grocer should bag your groceries. How your best friend should act when you tell her amazing news. How your spouse should act at the end of your stressful day. You likely have expectations for scenarios you’ve never even encountered or thought of encountering. For instance, if a small aircraft appears to be making an emergency landing on the road that you and others are driving on, everyone should… what?

 (…pull off to the nearest shoulder as far as possible. …speed up to get past the dangerous landing zone. ... pull off to the same side to leave maximum room).  Who knew we could even have rules on what others SHOULD do in a situation that most of us never have and will never likely encounter?)

So, what’s the big deal about our manuals? One, we each have rules about people and situations that are only known to us. Even our loved ones don’t know all the many rules we have. Second, if people knew what our rule book said about them, they may disagree– they have their own manuals. Third, the amount of distress we experience when people don’t follow our manuals is much higher than we must experience.

So, let's go back to our scenario above. The number of legal arguments we make from our own manual in this one situation is many: 1. I should never get a refill on a patient I don't consider mine. 2. If I didn’t start a prescription, it’s not my responsibility to refill it. 3. Medical assistants should know how to figure out the ‘right’ physician a Rx refill should go to. 4. Medical assistants should never make mistakes.

What would happen if we decided on purpose to let go of those unspoken rules? "People make mistakes or do things differently than I would, and sometimes I get Rx refills for patients that see my partners". A natural reaction to letting go of our many rules is "people will continue to take advantage of me.” However, the truth is no matter how many rules and expectations you have, you can’t control what people do. So, what actually will happen if you decide to let go of them in this situation?

I’ll tell you; you stop arguing with reality and work from a place of acceptance. You allow people to be who they are. “Rx refill for Mrs. X." You still get to decide if you refill or not or if it’s someone else’s decision. The very same steps above but minus the mind drama, the mumbling, and the frustration.  Imagine how that feels. From that place, you can even discuss brilliant system changes to help medical assistants. And when it happens after that, because it will, you can choose to remember “people make mistakes.” Either refill or not or decide it’s someone else’s to address.

Now, when you're a parent or a boss, you can still have standards but by dropping the manual, you still suffer less. It's defining what's above the bar or below the bar sort of speak. For instance, you can have a rule to help develop your child's sense of responsibility: "You rinse your dish and place it in the dishwasher when you're done." But, when they don't do it (because they're human!), you don't have to be angry. You can just remind them and/or do it yourself. And if it becomes a pattern without improvement, you as the parent (or boss), can have consequences - but there doesn't have to be the personalization and additional frustration. 

Watch this quick video about manuals. Take this week to see where your manuals are frequently in play. Decide if they are really helping in any meaningful way or if you’re just getting frustrated by arguing with reality. Trial out how it feels to drop one or two. Be on the lookout for next week's blog which contains a corollary - boundaries. 

Have a joy-filled and manual-dropping week,

Tonya

Our 12-week course for individual physicians walks you through detailed steps of ditching unnecessary suffering, protecting and increasing your energy, and fostering your ideal future AND now it provides up to 12 AAFP Prescribed CME Credits.