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Common Physician Thought Distortions, Overgeneralization

We continue to look at common thought distortions affecting the entire population that do not spare us as a physician community. And some seem to be more prevalent for us. This week we will review overgeneralizations.


Overgeneralization. This is when we take something with a negative outcome and generalize it to include everything with similarities. Its' equivalent in a scientific study would be an underpowered one (in which the sample size is analytically too small to extrapolate), but the authors draw conclusions for the larger population nonetheless. You can often clue into absolute words such as "all, none, always, and never."  


Using generalizations in our day-to-day experiences can cause a cycle of continual feelings of defeat.


For example, maybe you rotated through a private practice and observed a lot of animosity between the front and back-office staff. Based on your n of 1, you conclude you'll never work in private practice because there's too much drama. 


Or perhaps, you have someone give constructive feedback about your presentation, and you think, "I'm never going to get the hang of academic medicine."


Or maybe, you consult a urologist who cuts you off mid-sentence and asks you to get to the point. After listening to your narrowed-down clinical question, he says, "this does not require a surgical consult," and hangs up. Overgeneralization can first lead you to believe he's a jerk. (And while the behavior isn't excusable, maybe he's a really nice guy who has been up 48 hours straight covering three hospitals.) And worse, it can feed into negative stereotypes of urologists (or any other specialty or allied health team member). Now I know we love to look and laugh at patterns of personalities that go into various specialties (I mean, who doesn't love Dr. Glaucomfleken?). When they go beyond a bit of humor and cause an adverse reflex reaction, it's time to address it. I am also not saying you should tolerate abusive or unprofessional behavior. The warning is only against overgeneralization. Though, I have seen some wonderful physicians act out of character when deprived of sleep or under tremendous stress.


Overgeneralization not only increases your anxiety but impacts your motivation and self-confidence. It can also have negative consequences for your team and patients. Perhaps the next time you feel you need a urology consult, you shy away from it and hope for the best. You make generalized comments to the medical student with you to perpetuate the stereotype. You can see the potential consequences here.


After recognizing overgeneralization as a typical pattern of thinking for yourself, begin to challenge it. Using "what are five other possibilities" may be helpful. 1. Maybe it's an unusual day for the practice you rotated in. 2. Maybe there was an isolated incident that caused some temporary drama. 3. Maybe this office has dynamics uncharacteristic for most private practices. 4. Maybe you misinterpreted the undercurrent. 5. Maybe they need a more experienced office manager.

You also can point your brain in the opposite direction. What were the positive things said about your presentation? Or, when did you give a presentation with the majority of positive feedback? When has that urologist helped you or your patient? What urologists do you know that excel in their skills? When was the last time you were thankful your community had urologists in town?


Ladder thoughts can also be helpful, not just for overgeneralization but for many others. When these beliefs are ingrained, it's hard to shake them loose, and the ladder can be useful.


What are ladder thoughts? Well, you are on the bottom rung of the ladder, "All urologists have poor bedside manner and are hostile toward primary care physicians." Maybe you'd like to get to the belief that urologists are amazing humans that help you by helping your patients." That would be the top rung. And so, you recognize you will not develop that belief overnight. Your brain is focused on too much evidence to the contrary. Thinking the opposite didn't help you. Considering other possibilities didn't help you. So, you take one step up the ladder. It can be a slight shift. "I'm open to believing that all urologists aren't (insert description here)." You practice it every time you have your bottom rung thought. As it becomes more accessible, you move up a rung. It could be, "I believe that the urologists in my town have good technical skills that are needed." Then, "I am considering that I only see one side of urologists when I phone them on call. Perhaps, that's not when they show up as their best selves." You get the picture. You work your way up until you do find some belief that will begin to open your mind to find evidence to dissolve away the problematic fixed stereotype you've bought into. 


Every human has their own unique patterns of cognitive errors. By identifying your top ones, you can become more aware in the moment. Look for triggers so you're prepared. Is it when you're tired, hungry, in a new situation, or around certain people or locations? Remind yourself, "I'm in a state with a high prevalence of my thought distortions." You can catch them earlier.


Look for what you actually know is true to ferret out the speculations from the facts. Remember, you're not a mind-reader. Look for binary thinking, labels, and tune into words "should," "never," "always," "all," and 'none." Challenge your thinking by looking for the overlap or the gray. Dig into curiosity and find five other possibilities or even evidence for the opposite. Change up the language to "I may consider," "I want to," or "I'm open to believing." Be careful not to dismiss the positives. Actively look for them.


Okay, I hope this has been a helpful series. I'll see you next week in our new series.


Have a joy-filled week! Tonya 

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