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Optimizing Your Mindset in Medicine, Step 3 - Thought Framework

Over the last two weeks, I’ve laid out two fundamental steps to optimize your frame of mind. If you do nothing else, that alone is beneficial.  This week, I’m ratcheting it up a notch to a more advanced step. This is the Thought Model Framework, developed from positive cognitive psychology by Brooke Castillo, master certified coach.


It’s essentially a framework for those of us who are not behavioral science experts to up-level our mindset.


The model is made up of 5 lines:

C (circumstance line – these are those stone-cold facts about the situation)

T (thought line – this is the overriding thought we have about those facts – a short sentence or phrase works best)

F (feeling line – the one word emotion)

A (action line – includes inactions)

R (result line – this is your result, not someone else’s result)


We have an overriding Thought about any set of Circumstances. That Thought leads to a Feeling. That Feeling ultimately drives our Actions – the things we do or don’t do. And those Actions create our Result.


Let’s take a look at an example I used in May when demonstrating this with a new group of residents:


C: 54 degrees in Alaska, no wind, the sky has no clouds, weather forecast states “Full Sun,” 16 hours of daylight

T: It’s a great spring.

F: Excited

A: I smile a lot, I get outside and walk, hike or run, I reconnect with friends, I eat bright, colorful foods, I don’t veg out on the sofa binging Netflix, I make camping plans, I don’t ruminate on how awful Alaskan weather is.

R: I create a fantastic spring for myself.


Contrast that with what some of my family from Florida may have created:

C: 54 degrees in Alaska, no wind, the sky has no clouds, weather forecast states “Full Sun,” 16 hours of daylight

T: It’s a miserably cold spring.

F: Disappointed

A: Sit around and mope, eat comfort food, complain any chance they can, sigh at their closet of fun summer clothes they won’t wear, don’t go to outdoor events

R: They are miserable.


Same circumstance – different thought. 


It’s enlightening to throw your facts and overriding automatic thought into a model. It’s an awareness tool for what your mind, left unsupervised, is creating. 


I presented this recently in another resident group. One person volunteered to give an example of a patient encounter so we could demo it.  Then she second-guessed herself. She didn’t think her example would work because her thought was not “negative.” We tried it anyway, and this is it:


C: 32-week OB pt said “No” to vaccines, said “No” to blood products in the labor plan, said “A blood transfusion may have the vaccine in it”

T: She’s a fun challenge

F: Energized

A: Remember the positives about the patient, recalls previous good interactions, talk to her in a supportive, kind way, don’t ruminate about how hard she is, doesn’t dread going to see her

R: She’s having fun seeing the patient


And that, my friends, is the power of our minds. Who here may have thought differently about that patient? How might it have impacted your day in preparation for seeing her, during, and after the visit? See what you may have created for yourself. So, this volunteer case was actually perfect!


Okay, I would love to hear from you if you begin to trial this advanced technique. Some subtleties can come up I can help you navigate.


Next week, we will unpack one last advanced strategy and close out the month with some Helpful Tips and Caveats to be aware of.


Until then…

Have a joy-filled week!  Tonya

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