Learning to Hold the Tension
The majority of us in medicine are in it because we care. But sometimes caring means saying “no.”
- We say no to one more initiative when our team is already stretched.
- We say no to a patient’s request when it’s not in their best interest.
- We say no to ourselves when we know we can’t do it all.
And even when it’s the right call, it doesn’t feel good, because no one likes feeling they’ve disappointed people.
I wrote a quote down a few years ago that captures the paradox perfectly. I wish I remembered who said it:
“I can support them in their disappointment with compassion.”
That sentence holds meaningful weight. I don’t have to to try to fix their feelings. I don’t have to change my decision. I don’t have to wallow in unearned guilt or regret.
It allows, in this case, three to be true at once:
- They can be disappointed.
- I can feel I did the right thing.
- I can still care for them.
That’s the courage we need more of in medicine and leadership, the ability to stay connected through tension instead of trying to erase it.
If you want to read an excellent Op-(M)ed about it, you won't be disappointed: https://opmed.doximity.com/articles/can-we-accept-refusal-without-abandoning-care
Navigating Tensions: A Simple Reflective Tool
One of the most useful frameworks I’ve learned for navigating these polarities comes from Peter Hawkins’ systemic team coach training. It helps name the polarities that that feel like mutually exclusive choices or values.
Here’s how it works:
- Name the polarity/tension. For example: caring for your family & yourself and caring for patients & your career.
- Explore both sides. What are the good that emerges from focusing on each side? What are the downsides the happen when focusing on each site?
- Notice your early warning signals - how do you tune in? What are your signs when you lean too far toward self/family, neglecting the work? What are your signs when you lean too far toward career/patients, neglecting self & family?
- Adjust intentionally. What small actions will help you re-center when you notice the imbalance on the one side? What about the other?
The goal isn’t perfect balance; it’s awareness, agency, and harmony. You don’t have to choose between being a good doctor, leader, or parent. You just have to notice when the tension starts to pull too hard in one direction.
Reflection: What tensions are you navigating? What are your tells? What tweaks could you make?
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