DTD 156
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This is the Drive time debrief, episode 156.
Hey guys, welcome back to the podcast. I'm Amanda. I'm Laura. I'm Kendra. And today we are diving into a topic that many, many, many physicians grapple with. which is excessive self-criticism. Being in the medical profession comes with high expectations, rightly so, from [00:01:00] society, from our patients, and often most partially from ourselves.
Today we'll explore excessive self-criticism in three sections. First, understanding its roots, then its impact on our wellness, and then practical strategies to overcome it. So let's get started. Okay, so to begin, let's take a closer look at where excessive self-criticism comes from. For many physicians, it's tied to the culture of medicine.
From medical school to residency and beyond, the environment emphasizes perfection, precision, and constant improvement. While this drive for excellence can fuel success, it also conditions us to be our own harshest critics. We internalize the belief that mistakes are unacceptable and that our worth is tied to performance.
This often leads to the imposter syndrome, that nagging feeling that no matter how much you achieve, it's never enough. According to a study published in the Journal of General Internal Medicine, imposter syndrome is highly prevalent among physicians. With estimates ranging from as low as 22% all the way up to [00:02:00] 60% depending on the specialty and population studied.
We've mentioned before, that Imposter syndrome isn't a disease, it's a normal variant. You're in good company if you struggle a bit with it. But excessive self-criticism isn't just about medicine, it can also stem from past experiences, perfectionism, or a fear of being perceived as inadequate.
These patterns become deeply ingrained and over time, they can easily chip away at our confidence and mental health. Yeah, and we've had podcasts on this before, at least one before, and really everyone has it at some point. It's completely normal to have imposter syndrome. So just know that the first time you experience it, it feels pretty lonely.
Yeah, all of this is very normal, very normal, very normal, chipping away at yourself. It's very normal. Yes. Okay, so what is the impact on physician wellness? Self-criticism is in many physicians' lives. Self [00:03:00] criticism is a constant presence. And while, you know, we had that voice that told us to do more, to do better, that helped drive us to success.
We have achieved having self-criticism constantly playing in the background really does have a negative impact. And, you know, we are the burnout survivors, burnout experts, and. Self-criticism really is one of the things that drives burnout. When we're self-critical, we only will see the mistakes that we make or where we're falling short.
We are less likely to celebrate when something goes right when things are going right all the time. We just look for them and we're not going to feel satisfaction in our work. Like we would. If we had compassion on ourselves and treated ourselves as normal and perfect, but amazing human beings, which we are.
So when we're focusing on what went wrong or what we could have done better, we're always going to be dissatisfied. [00:04:00] And that means. We're not satisfied. We're not happy with our work, ourselves, and ultimately our lives. There's been research done on this. In the Lancet, there was some research that highlighted that burnout among physicians is associated with a higher rate of self-criticism.
And I would suggest that it's probably not the burnout driving the self-criticism at first, But it definitely contributes to the cycle. So it might start with some self-criticism oftentimes because we've been actually criticized and then we internalize that and then it drives burnout into a horrible, vicious snowball of misery burnout.
So that self-criticism. Exacerbates our feelings of emotional exhaustion and depersonalization. It's interesting. I was having a conversation with one of my partners the other night. And he was like, we just do the same thing over and over again. It's not even a real job. [00:05:00] I'm like, not literally not doing anything.
And, you know, I'm looking at it and I'm like, you're definitely doing stuff. And the other day when. It was 2 a. m. and you told me you do the LP on my page so I could just go home. You definitely did something for me that day, but it's so easy for us to depersonalize and think that what we're doing isn't anything useful or good or putting good into the world when we're self-criticizing. Well, and just like with depersonalization too, it might not seem like a big deal to bandage up a wound or something on a person, but it matters a lot to that person. It's a human being that it might not seem like a big deal to you.
It is a huge deal to them. That's why they came there in the first place. Yeah. It was a big enough deal to go to your ER. That's a big deal. Right. So many people don't want to go there. Right? Yeah. Like, it's packed. Yeah, yeah, no, you're absolutely right. I [00:06:00] think that is true for some, for a lot of them. And it's funny.
I'm hearing him in my mind. He's like, yeah, they don't give a root. They're like, but yeah, they do sit there for 8 hours. Something's happening. We don't know exactly what that's yeah, something is happening there. It's not. A nonjob. It's not a, it's not that nothing is happening. We are affecting some level of change in the world.
So, yes, sure. But it does like, you can depersonalize and. Things can feel, it can feel pretty dissociated and be like, yeah, what is this? My life, right? So, yeah, this is it. Okay, architect it. Let's make it what we want. So, excessive self-criticism. Like, there, you know, some level of self-assessment and feedback to ourselves is obviously important for our well-being.
When we're excessively self-criticizing, we are going to be fueling [00:07:00] anxiety and depression. And when we're constantly questioning our abilities and replaying mistakes or perceived mistakes in our minds, it can lead to actual hopelessness. I'm sure many of you listening have seen this or felt this.
We've seen it a lot in our clients. And inadequacy, which you have done all the tests, you have checked off all the boxes to become a doctor, you are not inadequate, you're fully adequate, you're a great human being and doctor, and yet we can still, we can trick ourselves in that way. A study in JAMA Psychiatry found that self-critical perfectionism significantly increases the risk of depression symptoms among medical professionals.
So that's not going to help us. So. When we are perfectionistic when we're self-criticizing, we're more likely to be depressed and that doesn't help us, doesn't help our patients, doesn't help our families, doesn't help anyone. So let's not do it. Let's not forget how self-criticism impacts our [00:08:00] relationships.
When we're overly critical of ourselves, we might struggle to connect, to connect with colleagues, patients, and even loved ones. You know, what's interesting is that oftentimes when we are self-critical, we're going to be more critical of the people around us, too. We're more likely to isolate ourselves or become defensive and it's gonna, yeah.
You're just gonna be kind of miserable human beings. So, it's interesting how just these little sentences floating through our brains that are telling ourselves unkind and probably untrue stuff about ourselves can have such an impact on the rest of our lives and on other people too. Lastly, and this is probably going to be scary to a lot of us, excessive self-criticism is going to likely undermine our professional performance.
We might think that being hard on ourselves helps us improve. Research shows that it often leads to focus, decision fatigue, and even impaired [00:09:00] judgment. None of which are good for us or for our patients. Yeah, and when we are already having imposter syndrome and we're looking at our clinical performance And it's not Objectively what we would want it to be that's gonna just drive another vicious downhill snowball of misery I think it's going to be hard for some people listening to accept that, but we're going to say it over and over again, that your brain is telling you you got here because of your self-criticism.
That's not true at all. You're here in spite of your self-criticism. And the best way to improve and don't hear us that we're saying, Go straight to nihilism and you don't care about anything and you're doing a good job, even when you're just botching stuff all over the place. That is not what this is. Those amongst us who are the most self-critical seem to be married to this idea.
If they started to be kind to themselves, suddenly they would just stop caring [00:10:00] altogether. I would really question if you're even capable of that. Yeah, I know. I'm not. No, you're not. No, no. And so how much better would it be if you could? Yeah. Depersonalize the mistakes, depersonalize when things could have been better, and more like, you know, I do think that I could do better here.
That's not the voice that most of us hear. Most of us hear this voice that's like, I can't believe you did this. You probably shouldn't be here in the first place. You probably ought to just quit now because you're just a wreck over here, like incapable, and spirals into this whole, like, you can even start telling yourself that you're a horrible human because you didn't have a differential.
You know what I mean? Like nothing bad even happens to the patients half the time. And you're still talking to yourself that way. Yeah. So interestingly. You can look at that voice that you're hearing, and ask yourself if it reminds you of anybody's voice, is it the voice of a parent? Is it the voice of an attending?
[00:11:00] Sometimes it may be more than one. A lot of times this is going to be coming from something in the past. That created a neural loop that your brain just latched on to and thought it was going to help you and it's really not and it's not true. And when we're doing this to ourselves and we have kids are likely to pass it on to them.
So if taking care of yourself isn't a great enough motivation to fix it, then look at your kids. Do you want your kids to be thinking this stuff about themselves? Yeah. A classic question we ask of clients is like, if this same thing happened to your favorite colleague, would you ever speak to them in such a way?
I can't believe you've been so terrible with your finances. You pretty much are an idiot. Would you ever say that to anyone else? No, absolutely not. So if that's the case, it's not appropriate to say it to yourself either. Like, listen to the difference between, I can't believe you missed this, you suck, versus, hey, I wonder how I can set myself up to think of that the [00:12:00] next time, or it's a completely different strategy.
We want our docs to be the highest achieving, to get the best results they possibly can, not at the expense of destroying yourself. You won't get as good of, Results if you're destroying yourself. So let's talk about some strategies to overcome excessive self-criticism. We're just going to have to start uncoupling that self-criticism got us here is useful or is holding us to a higher level.
You're here in spite of that voice. So now that we understand the roots and the impact, let's shift what we can do about it. And so here's several, I think we've got like six things that you can start to do to start. Uncoupling that association in your mind and to cultivate ultimately a healthier mindset your career longevity depends on it.
So number one practice self-compassion start by recognizing that you are a human in a doctor's coat. Somehow we put this [00:13:00] coat on and for whatever reason we buy into this myth that you will never again question Your judgment that you will never again not know what the answer is that you know all things you'll never have to look something up we're human beings that put on this jacket and we've got to stop buying into this Mistakes are inevitable, they're not what we are hoping for, they're not what we're trying to do, but they happen because we're humans working with other humans.
And so, not always do things present as advertised, not always do things happen the way that they're written in a book. Mistakes will happen. Okay, it does not define your worth as a human being, and so when you catch yourself being self-critical, pause and ask, How would I speak to a colleague or a friend in this situation?
If you would not Insult them the way that you're insulting yourself. It's not appropriate. Treat yourself with that same kindness. Studies by Kristen Neff, the guru on self-compassion, show that self-compassion is [00:14:00] associated with lower levels of anxiety and burnout in health care professionals. And right now we can't afford to lose anybody else, right?
Oh my gosh, yes. Please start talking to yourself kindly. Positive reinforcement does so much more than negative reinforcement. Number two, reframe your inner dialogue. Instead of saying, I'm terrible at this, try reframing it as I'm still learning and that's okay. Shift your focus from flaws to growth.
It is wild to me that I did, you know, three years of residency and then truly expected that I would recognize every single disease entity that ever walked in when I have no control over what was coming my way. How would that ever be possible? Yeah, like I'm over 20 years in and I learn new things pretty much every shift.
Some things I didn't want to know. Yeah, I think a big point here with, like, melding of the 2 self-compassion and reframing your inner dialogue. I'm reading rising strong right now from [00:15:00] Brene Brown. And she says, you know, empathy isn't always just for our patients. We have to turn it inward. And so 1 of the ways that empathy can really stick with You know, stick and like land with yourself is when you stay curious.
And so one of the ways to really practice self-compassion is to be curious. Just ask yourself like, Hey, that was interesting. Like, I wonder why that was presented that way. Or I wonder why my brain didn't think of that. Or man, I wonder why I'm so annoyed by every flu patient that comes in the last three days.
Well, it's probably because I stacked my shifts, I'm not getting good sleep, like, other things are happening. Just asking questions and getting curious keeps you from the danger zone of blaming and pointing fingers at yourself and you know, just reframing that inner dialogue of like, Oh, now I see why I'm so annoyed.
I've worked eight of 11, like every flu patient is coming in right now. Everybody's sick. [00:16:00] Everybody wants to be seen. They're crabby. Like, you know, when you just start like, what else could this be? It really shifts the focus on owning. 100 percent of the blame or whatever you're thinking that you need to own and saying like, Oh, Hey, this makes sense.
And just stay curious and therefore you'll be empathetic to yourself. I mean, our patients need empathy, but we need empathy too. And making that a priority to just stay curious really helps not go down that shame spiral. Yeah, and I can't emphasize how important it is to start doing this for yourself because You know that people have said kind things to you like, oh you couldn't have picked that up You don't believe it because you won't let yourself, you can't receive it because that voice in your head won't let you and so You can't rely on somebody else to make you feel, you're gonna have to start talking nicely to yourself for this to start working Well, it's amazing too, when you're in this [00:17:00] mindset, is like, you also don't even hear it, like, it's that imposter syndrome coming up, well, like, even if someone were to say something nice, or like, empathetic or compassionate, like, you can't even hear it, and you'll either dismiss it as like, oh, I was lucky, or I just happened to blah, blah, blah, whatever you make up in your head, and that's kind of dangerous.
I think one of the most powerful things I've ever learned about this was from Rachel Hart, who's an over-drinking coach. And we heard her speak at a conference and she showed a picture of herself as like an eight-year-old. And she said if you would never talk to your eight-year-old self, like you're talking now, you need to reframe the way you're talking.
And that has been really, really powerful to me because That eight-year-old self is still in there and is like a real part of everything I do, or if you can't imagine that, if you're not going to talk to your own eight-year-old [00:18:00] child like that, like, would you ever say, oh, you just got lucky when your child had a success?
Not if you're not a psycho, like. No, you'd say, good job, you really prepared and you worked hard. It's helpful for me in that same way like, the version of me who missed that diagnosis or whatever. Well, why? Oh, I don't know. 30 people in hall beds, 17 critical patients at the same time, overhead pages nonstop, and interruptions, and 80 people in the waiting room, and labs were reassuring, and nothing was as advertised.
That's why I missed it. So did she really need to get beat up afterward? Or did she need a hug? Because she was traumatized by missing that. So maybe by the whole thing, like everything going on, like, it's kind of a miracle that this doesn't happen every single day, frankly. Yes, but was I kind to myself at all?
Absolutely not. For a bunch of stuff that [00:19:00] was totally out of my control, it makes sense why I miss that. I mean, so, so if I could, Give her some grace. That's what she needed. She already was learning what to do differently the next time. She'd already beat herself up. She doesn't need any more. She needs a freaking hug.
Yeah, you know? Yeah. So number three, we can go on forever because you guys are doing it too. We see it so much. And it is not helpful. If it helped you, we would say keep it, but it's not. No. It's making everything worse. Well, it drives you further down into your limbic system. And you can't think straight when you're down in your limbic system.
And so that's what it's going to create, all that snowball misery we were talking about earlier. Yeah. Alright, so number three is to set realistic expectations. Remember, since we are still humans and not robots on this earth, perfection is not going to be attainable. Because we're dealing with patients that are also human and don't always come as [00:20:00] advertised.
Perfection will not be attainable. So focus on doing your best within the limits of what's possible. And be realistic about that. When there are 30 people in a hall bed, you probably won't be as accurate as if you had a one-on-one patient for 24 hours straight. You would probably pick up some subtle things.
Right. Okay. So, let's do our very best with what we've got. It's going to be really important to celebrate small wins and progress, not just big achievements. But I'll say, we don't even celebrate big achievements half the time, too. We've become so numb to this. Actually, this is going to be a podcast in the future, so stay tuned.
Okay. Next, number four on this list is to seek feedback and support. Sometimes, as much as we're telling ourselves to be self-compassionate, our self-assessment isn't accurate. We just cannot get out of our own heads. And so that's when it's going to be really important to talk to a trusted colleague, mentor, a coach or friend to get a balanced perspective, they can remind you of your humanity, your strengths, what's lovable about [00:21:00] you, and then also help you see areas for growth more objectively. No one wants you to just give up and be like, well, I guess I don't have to try because I'm a human and I can make mistakes.
No, that's not what we're saying here at all. It's just focusing on a process and focusing on doing better the next time is a lot different from Just pounding yourself into the ground over something that's already in the past. And then number five, engage with mindfulness and reflection practices like mindfulness journaling or even a few moments of deep breathing can help you get back in your own body and out of your head.
That's the thing. Like if I get up in my head and start ruminating, it is off to the races. So sometimes it is helpful to take a deep breath, to listen to what the sounds are going on in the background to get back into your own body. And remember that this moment is the only thing that's real. Meditation will increase blood flow to your prefrontal cortex. Pull it out of your limbic system, which when you're down there in the [00:22:00] limbic system, that's when you're in these emotional spirals. So it's a. Very real neuroscience-based way to help get out of these situations. So it's just really powerful.
Yeah. Yeah. Renee Brown says in Rising Strong, she does what's called a S H I T T Y first draft. She calls it the S F D and her S F D. I mean, it really helps. Cause she says she'll just play that story over and over again, annihilating herself and getting it down. Like act one, act two, act three, like.
Write down the story and that can be six sentences. She said, you know, just getting it down actually interrupts that whole process where you can actually remind yourself to be present, but just writing it down. I mean, she said you can speak it. We talked about getting a mentor and seeking a colleague or coach or something to speak it out.
But there's something about writing it down in like six concise. Sentences and it's your first draft and it's an SFD, she calls it because it is, it's like we talk [00:23:00] about a thought download like you just get it out. She said, don't alter it. Don't censor it. If you want to cuss, eat Oreos, or hit somebody like you say that, like, like get it out and write it down.
And it actually helps you to then go back and be like, okay. And you see it and you're like, okay, I don't need to eat a bunch of Oreos. Let me let me think about what's a better thought that gets a better result. And it just helps. It's amazing. Yeah. Well, the writing. You don't use your limbic system to write, it does pull you up into your neocortex.
So it's another really awesome spelling words, practicing spelling words or math facts also will help get you out of the emotional spiral. Nice. So here would be something better to do would be to reflect on what you've learned from the challenges rather than dwelling on them. There's a good chance you're not going to do it the same way next time.
You've already learned something from this lesson. That's what you focus on rather than what a failure you are. You're already better for the next time. We forget that. [00:24:00] The only way to, I mean, the best way to learn is a mistake. We are so petrified because it's human lives. And yes, we are very cautious because of that, rightfully so.
But, again. There is no way to be perfect, and so when you, when something goes in a way that's unexpected, you've already learned something from that. You're already a better doctor because of that. Research in the Mindfulness Journal demonstrates that mindfulness-based interventions can reduce self-critical thinking in healthcare workers.
Just in case you wanted data on that. And then the last one is to prioritize self-care. Taking care of your physical and emotional well-being can help you build resilience. I'm convinced over and over that if you are not sleeping well, you are not gonna be at your highest capacity. First of all, prioritize your sleep, but if you can't sleep that night, give yourself some grace.
You won't be a hundred percent. Do your very best and it's going to be the best that you've got that day. Your 80 percent is going to be 100 percent that day. So please prioritize [00:25:00] exercise, sleep, and hobbies outside of medicine. It's not a luxury to recharge yourself. It's absolutely essential.
Yeah, I love that. That's a great way to close. Excessive self-criticism is a common struggle for all of us as physicians. Anyone that's in a very high-demand field or profession, really. It's not just physicians, but it doesn't have to define us. By understanding its roots, recognizing its impact, and taking steps to overcome it, you can cultivate a more compassionate and balanced approach to yourself and your work.
Thank you for joining us on this episode. If you found today's discussion helpful, please subscribe and share this podcast with your colleagues. Also, check out our free video in the show notes called How to Crush Physician Burnout for Good Without Cutting Back Hours, Quitting Medicine, or Sucking It Up in Silence. Remember, your wellness matters not just for you, but for the patients and loved ones who depend on you. Until next time, you are whole, you are a gift to medicine, and the work you do matters. [00:26:00]
