The Doctor Dilemma

How to Quit Being Miserable Without Quitting Medicine

Sara Dill

• Publisher: Morgan James Publishing
• Year: 2019
• ISBN:
  9781642792461
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

• Burnout is an epidemic in medicine right now for physicians (>50% report burnout) with no end in sight.
• Sara Dill offers a unique perspective as a physician and life coach to help address the unique stresses experiences by physicians today.
• Contains real-life solutions and self-coaching tools that busy physicians can start implementing right away.
• Most career books currently in print are not relevant to highly-trained and specialized professionals like doctors who have spent decades training for their career and then are unsure what to do if they are unhappy in it.

CHAPTER 1

Telling Yourself the Truth

“There are no mistakes in life, only lessons. There is no such thing as a negative experience, only opportunities to grow, learn, and advance along the road of self-mastery.”

– ROBIN SHARMA

I want to congratulate you on having the courage to acknowledge that you are not happy and that you want more than the career and life you currently have. It’s not easy to admit to yourself that you might have made a mistake in choosing your current job or, worse, in even becoming a doctor. Allowing yourself to ask these questions, even if you tell no one else, can be very frightening and unsettling. It may make you question your judgment about anything and everything.

This is okay. This is normal. It may not feel okay, but I promise you, it is.

I’ve been there. I’ve worked with many other doctors who felt exactly the same way. And I can help you figure out what to do about it.

What do you think being courageous feels like? Many of us have this idea that being courageous must feel good. It doesn’t. Courage is defined by the Oxford Dictionary as “the ability to do something that frightens one.” Courage is being terrified and doing something anyway. Courage is asking yourself the hard questions whose answers you are reluctant (or afraid) to discover. It is acknowledging that although your life might look good or even amazing on paper, it doesn’t feel good to you. It is asking for help when you need it. Courage is taking action even when you aren’t sure it’s the right thing to do. You are courageous. Really. And I want to help you see that in yourself.

The recognition that you aren’t happy is the first step toward having a life that does bring you happiness. Isn’t it odd how we pretend to ourselves that we are happy? As if we can keep how we are feeling a secret from ourselves. What other secrets are you trying to keep yourself from knowing about your career and life? Creating any type of lasting change in our lives starts with being honest with ourselves. The process begins with gently turning toward what we know to be true and allowing ourselves to acknowledge what is not working in our lives. You don’t have to tell anyone else. Just yourself.

Whatever you are feeling right now is totally normal. I don’t know about you, but no one ever told me that life was going to be so hard and confusing for so long. Sadly, our lives don’t come with a manual or cheat sheet. I mean, really, we humans need a user’s guide! I thought the hard part of being a doctor was getting into a good college, and then getting accepted to and completing medical school, and then surviving residency. I thought once I finished residency my life would be so much better. And in some ways, it was; but in some ways, it was worse. I thought being an attending physician would be so much easier than being a resident and that I would be so much happier. I think having expectations like this is why it can be so confusing to find yourself a practicing physician and yet an unhappy one. And why it’s way more common than we might think it is.

When I decided to take a break – I called it a sabbatical – from practicing dermatology, I was uncomfortable telling people, especially other physicians. I worried a lot about what they might think or say. I worried they would think I was being foolish, selfish, stupid, and short-sighted. I worried they would think I didn’t know how good I had it, that I was making a big mistake, that I would regret this decision forever. Basically, I worried they would not understand what I was doing and judge me for it. (Of course, since then I have learned that whenever I am afraid of what someone else thinks or says, it is because a part of me is already thinking or saying that about myself. More on that later.)

However, what I discovered – and what I think you will discover too – is that almost all doctors I spoke with confessed to wishing they could do what I was doing. They all told me of their dreams of time off, travel, more time for hobbies, more time with family and friends. Many of them sincerely enjoyed practicing medicine, but every doctor I spoke with also wished for more freedom and more time to do everything else they wanted to do in life.

What I began to realize then, and what I know for sure now after working with many unhappy physicians, is that we all have doubts. We all have thoughts about the life we might have had if only we had made different choices. Maybe some of us have more doubts than others. Maybe there is a rare doctor out there who has never doubted her choice of medicine, or type of practice, ever. Even on a bad day. And I am so happy for her. That’s wonderful. But I haven’t met her yet.

These days it is harder to find a completely happy doctor than to find an unhappy one. Right? You’ve probably seen the articles. You’ve talked to your colleagues. The burnout rate continues to rise across all medical specialties. Yes, even in my specialty, dermatology. Physicians no longer have only to contend with the inherent stress of caring for patients; we now have to deal with EMRs, insurance companies, declining reimbursements, increasing administrative oversight, loss of autonomy, and so on. Physicians everywhere are feeling this squeeze.

So, I encourage you to start right now to treat yourself as you would a scared or confused patient. Speak softly to yourself. Ask questions kindly and gently. Be curious. What’s going on with you? You probably keep telling yourself “I don’t know.” The voice in your head might sound like:

“I don’t know what’s wrong with me.”

“I don’t know why I am so unhappy.”

“I don’t know if I made a mistake taking this job or becoming a doctor.”

“I don’t know what to do.”

That’s what I mean about telling yourself a lot of “I don’t know.” But “I don’t know” will keep you stuck. “I don’t know” is a dream-stealer.

I want you to see if you can discover what you do know to be true for you right now. Keep asking. Maybe try journaling. You don’t have to do anything with the answers. So much of the time, I think we don’t want to know what is true because we are afraid of what it will mean; we are afraid of what we will have to do about it. You don’t have to do anything about it until, and unless, you want to. Acknowledging that you hate your job (and maybe the whole medical profession) and that you don’t know what to do about it is enough for now. You don’t have to know anything else right now. You’re just taking a history of the present illness right now. You aren’t ready to formulate the diagnosis, let alone the assessment and plan.

If you don’t even know how to start identifying what’s wrong, and what you do know, writing prompts and coaching exercises can help. You may need to do them over and over again. Sometimes we uncover one layer of truth, and only later can we go back and discover something else we couldn’t see before.

Go ahead and grab paper and pen. Take a few minutes and ask yourself the following questions. Feel free to repeat this exercise as often as you need to.

What do you like about your career and life right now? Can you make a list?

What do you dislike (or hate) about your career and life right now? Write it all down.

What are you afraid to admit to yourself about your life? Why? What else? Repeat these questions for five minutes. Just write it all down. Get it out of your head and on paper.

Why did you become a doctor? Spend some time on this. Go back and remember when you were applying to medical school or learned you were accepted. Reflect on that first day of medical school. What were your reasons, your hopes, your dreams?

Did you do the exercise? If not, don’t worry about it. Maybe just spend a few minutes thinking about the answers. You don’t have to write it all down right now. But it is interesting to see if anything surprises you about your answers. Maybe the only thing you really like about your job right now is the paycheck. Or maybe you still enjoy seeing patients, or certain kinds of patients, but dislike everything else about the practice of medicine these days. Or maybe there is a lot you like about your career, but you simply want to work less. This is all really good information to have.

A lot of my clients find this exercise challenging to do honestly. It’s common to find yourself judging your answers or making things sound not so bad. This is normal but can get in the way of your progress. Again, this is just like taking a history from a patient. Can you step into that same curious and compassionate role you assume with patients? You need to know the facts of your own particular case to be most effective in finding the solution to your career unhappiness. And as you’ll see in the next chapter, doctors are especially at risk of finding themselves in this position of being unhappy, burned out, and miserable in their careers – through no fault of their own.

CHAPTER 2

How You’ve Been Set Up for Unhappiness

“Human happiness and human satisfaction must ultimately come from within oneself.”

– 14TH DALAI LAMA

It’s helpful and important to understand the very good reasons you are so unhappy and dissatisfied as a doctor right now. After all, just like with treating an illness, the more we understand the cause of the disease, the more likely we are to be able to cure it. Otherwise, the best we can do is simply treat the symptoms and hope it improves with time. And that may be what you have been doing. Perhaps you have been treating the symptoms of your unhappiness rather than understanding the cause of it. I did this. I was unhappy in my first job after residency, so I got a different job. I didn’t love that one either, so I did a fellowship. Then I got another job. And another job. Each one was better in some ways than the previous one, so there was improvement. But I was only treating the symptoms: my unhappiness, having a job I didn’t love, worrying about making mistakes at work and in life, and being dissatisfied.

The first very good reason you are unhappy is that it’s normal not to be happy all the time. I know, right? What kind of self-help book tells you that? Don’t stop reading yet. This is actually good news! It means you are a normal human being who is experiencing some negative human emotions. In spite of what popular culture, self-help books, social media posts, psychologists, counselors, and even life coaches would have us believe, it is normal to experience a wide range of emotions, both positive and negative. Right? Hasn’t that been your experience so far in life? Perhaps Byron Katie, Eckhart Tolle, and the few other fully enlightened individuals experience a constant state of contentment, but that is not my experience. Not yet, at least. Is it yours? Is there some part of you that believes that you really should be happy all the time? You may notice that you actually feel better just knowing that feeling unhappy is okay and normal and totally to be expected at times. Telling yourself you should feel happy when you don’t sets you up for feeling even worse. So it can be a relief to understand that it is totally normal not to be happy all the time. And, yes, you can do things to feel consistently happier than you do right now. (If you are impatient to get started, check out the Two-Minute Happiness Hacks at the end of this book.)

Perhaps you have read something on the negativity bias of the human brain? It is the fact that humans give more psychological weight to bad experiences than to good ones. Research by psychologist John Gottman, as discussed in his book Why Marriages Succeed or Fail, reveals that it takes five positive interactions to overcome any one negative interaction. (1) This supports Dr. Rick Hanson’s statement in his book Buddha’s Brain that “the brain is like Velcro for negative experiences but Teflon for positive ones.” (2) It makes sense that, to survive, it is way more important to avoid negative (and potentially lethal or dangerous) situations than it is to focus on positive experiences. Basically, if you think about how we evolved as a species, it makes sense that we evolved to be fearful. Looking for danger and focusing on potential danger very likely helped keep our ancestors alive. The fact that you are here today means that your ancestors were pretty good at spotting danger (real or imagined).

Yet now we live in a world in which most of us are not regularly in physical danger. Barring illness or accidents, for most of us the world is not nearly as threatening as the one in which we evolved. And yet our brain has not caught up. Our brain does not really care whether we are happy or not. It cares that we are alive, that we survive, and, from an evolutionary standpoint, that we pass our genes along. So when we have urges and instincts and irrational fears and stress, thank evolution and the human brain. Yes, they have gotten you here and have kept you alive. But at what cost? Left unsupervised, our brain and our thinking default to looking for problems, looking for what is wrong, looking for danger. This is sort of a bummer for those of us who want to feel happier, isn’t it?

There is good news. Happiness is something we can foster. As a species, we need to learn how to cultivate happiness. Understanding why our default mode is one of fear and worry and looking for everything wrong is good to know. It means nothing is wrong with you. You are a normal human with a brain that is doing what it is supposed to do. But these hardwired tendencies are certainly not helping you find happiness and fulfillment in your job and career, or in life in general.

There are also personal and professional reasons why you are experiencing such dissatisfaction and unhappiness as a doctor. Some of these are what cause so much burnout and dissatisfaction among doctors these days. I like to call it “Doctor Brain.” We all have it. It is the programming we got as we made our way through medical school, residency, and beyond. It’s the culture of medicine that we all have taken on, often without question.

I want you to think back to medical school and to your residency. These were challenging times. Right? Especially when you remember the person you were when you showed up to class on the first day of medical school. If you are like the physicians I know, you went to medical school out of a deep desire to help people, to ease suffering, and to make a positive difference in the world. And then we were introduced to the culture of medicine. And despite some changes for the better, by and large it is still a culture in many ways similar to that of the milita...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Table of Contents
• Introduction
• Chapter 1: Telling Yourself the Truth
• Chapter 2: How You’ve Been Set Up for Unhappiness
• Chapter 3: The Path Forward
• Chapter 4: Begin Where You Are
• Chapter 5: You Have to Believe it to See it
• Chapter 6: Feelings are for Feeling, Not for Fleeing
• Chapter 7: Live Your Life, Not Someone Else’s
• Chapter 8: Self-Care Isn’t Selfish
• Chapter 9: Dream, Baby, Dream
• Chapter 10: Lights, Camera, Action!
• Chapter 11: What If Becoming a Doctor Was a Mistake? How to Know When to Quit
• Conclusion
• Bonus: Two-Minute Happiness Hacks
• Acknowledgments
• Thank You
• About the Author
• References