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Optimizing Your Mindset in Medicine, Step 7 - Overcoming Common Obstacles

This week we conclude the guide to optimizing our mindsets as physicians by discussing three common roadblocks and how to work through them. But first, I’d like to review the steps briefly:


  1. Brain Dump - We must be aware of what is happening in our minds.
  2. Thought vs. Fact - Boil situations down to bare facts (by removing adjectives, loaded words, assumptions, and judgments) and the story we have about them.
  3. Automatic Thought Model - Use the framework to see what your thoughts are creating.
  4. Intentional Thought Model - Use the same framework to find a believable thought that serves you better.
  5. Decide and Explore - Exercise your agency by deciding if you like the original thought of a situation and what it’s creating for you or if you’d like to shift your perspective. If you want to change it, move on to Step 5.
  6. Tips for Intentional Thoughts - Use these thought forceps to wiggle loose the strong attachment to a story you'd like to shift.
  7.  Overcome Roadblocks - The subject of today’s blog.


Over the years, for myself and my clients, there are times when we go through the steps above and honestly want to gain a different perspective, but we feel stuck. Even after we find a believable thought, our brain often snaps back to the less helpful automatic one. What is happening in these situations? 


  1. Rushing.

The entire process of loosening attachment can't be rushed. For many weighty situations, it takes time for the shift. We'd all love to wave our magic wands and "Poof!" shift the automatic perspective.  

Patience is vital, especially for those deeply held beliefs such as impostorism. Two helpful things that will take some time are visioning and exploration.


Visioning creates the beginnings of a new neuropathway. Your brain doesn’t distinguish between real and imagined; therefore, you can leverage neuroplasticity to your benefit. I love the exercise I do with groups, residents, and faculty alike, in which I have them picture themselves as fully capable, confident, and fulfilled in their careers. I then have them imagine what it feels like to get up in the morning. What are they wearing? How are they walking as they enter the office, hospital, or surgery center? How do they speak to their team, patients, and family members?


Exploration of all that underlies your automatic thoughts is illuminating. What is good about your original thought? What makes you believe XYZ? What could you be missing? What other circumstances has the belief served you well? What about times it didn’t serve you well? What’s the difference? Get really curious. Many times, you’ll make discoveries to move forward.


  1. Resisting or ignoring the emotion.

When you are living an experience that includes intense emotion, it can at times prove impossible to shift your perspective to anything else. Even when you really want to. Even when you have a believable thought that will serve you better. Even when you wish to exercise your agency in this manner. Denying the way you are experiencing a situation is not helpful. The emotion can be like the toddler pulling on your arm to tell you something. The more you ignore them and pretend it’s not happening, the louder or more destructive they get.


Processing the emotion is the solution here. 1. Acknowledge what you are feeling. “I’m feeling frustrated.” We know that just labeling the affect alone can disarm the amygdala. 2. And then, we want to leave the cognitive focus that we as physicians excel in and move into the somatic (which many of us are not well-versed in). It’s just noticing the sensation of the emotion in your body and allowing it to be there. Just like nervousness can show up as butterflies in the stomach, each emotion can be pinpointed in the body. It takes practice to tune in and feel it. 3. Then you describe it. “A hot expanding mass in my chest about to explode. Also tightness in my jaw…” 4. When your brain wants to offer up more thoughts, allow them to pass and tune back into the body vibrations as the observer. It’s a fantastic process that allows the emotion to lose intensity and pass within seconds to minutes. It can come in waves affiliated with returning to the cognition that brought it on. 5. Once it’s lessened, you can move on to view the situation in a way that serves you better if you’d like.




  1. Self-Judgment

If you find yourself still unable to shift your perspective despite exploring the model, finding a believable thought you would want to turn your focus toward, and processing any emotions involved, then look for sneaky self-judgment: “Ugh, I’m such a terrible person thinking that about a brand-new MA in training.” “It’s such an illogical thought; why is that the first thing that comes to mind?” “I SHOULD be better and think x, y, z.”  Do you see the blatant and subtle judgments appearing in those statements? It’s even sneakier when it’s in your own head. One thing I’ve continued to find accurate as it plays out is that self-judgment keeps you stuck in so many ways. Many of us are afraid to “go easy” on ourselves – what if we become complacent or accept mediocrity? And yet, that is a false belief.


Become the compassionate observer of your own mind. “Isn’t that fascinating that it’s the first thing that pops into my head?” “Of course, I’m thinking x,y,z because I’ve been conditioned that way.” “I’m thinking x,y,z right now, and that’s okay.” Dr. Kristen Neff has done much research on how extending yourself compassion moves you forward in a powerful way.


Okay, the take-homes today involve being patient and compassionate with yourself and allowing emotion, instead of trying to ignore or resist emotions. (There is another concept involving ladder thoughts. You can read more here.) 


This work is empowering for physicians. I hope you make it part of your daily self-investment. 


Have a joy-filled week! Tonya


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