Amanda: Hey guys. Welcome back to the podcast. I'm Amanda.
Laura: I'm Laura.
Kendra: And I'm Kendra.
Amanda: And today we are going to talk about judgment within medicine. First of all, don't forget to leave us a review. Please just scroll down and hit the five star button. But also I was gonna share with you another review. Thank you very much, AppSarnic “Love these episodes. Taking real life and offering tools that are easy to start implementing into life. Thank you”. Thank you, AppSarnic. Just another reminder, we are not associated with Lumos whatsoever, however, we are very much interested in solving this problem of shift work in our coworkers. So if you regularly work night shift rotations, have access to an iOS device and are 18 to 65 years of age, scroll down to the show notes if you'd be willing to participate in their study on night shift workers.
Kendra: Okay, so we recently got back from a lovely conference where we got to experience lots of lovely lecturers, up to date, medical pearls, and all the goodness. Always good to sit in a room of your colleagues and be a part of that kind of think tank. But something came up while we were in the conference that we had a discussion about and thought, man, this would be a great podcast episode. So just to set up how we got here. We were listening to a lecture and the physician that was giving the lecture was fantastic. He is a well-known educator and lecturer and the lecture he gave was amazing. Just some really critical wellness pearls and just some really good nuggets to take home about how we can manage this fast-paced burnout, moral injury that we're all headed towards, and how we can turn it around almost immediately. So, very, very thought provoking and well received. But he used an example in his lecture about going through a experience as the patient instead of the patient, it was actually about his children and he was the father of the children going through it on that side as opposed to being the physician side and actually delivering the news. His message was one of the things that he thought was important for us to know is not to lose our empathy, and so if we cannot lose our empathy, no matter what kind of like dreadful news or maybe very directive news that we have to give, if we can come from the shoes of compassion and empathy that it's received well because he was on the recipient side of it this time and just wasn't received well according to him. And so how he portrayed the conversation though was he just really felt like this physician had lost his empathy. And so what got us thinking was, well, like maybe that's not how it went down and how do we know this other physician was even at his best day or his showing up his best self. And so this topic is very useful to dive into and we just ask that you would open your mind to thinking about how quick we are to judge not only our colleagues, but even our patients we take care of. We go in sometimes with some prejudgments that may not serve us very well when we're coming up with a plan. But definitely when we talk about judgment and medicine. The programming that we get when we go through training is just like always looking at everything through a critical eye.
And just like he said, never lose your empathy. We could always consider having empathy for even our colleague that is on the other end of the line when we call them at 3:00 AM or is going on his sixth night in a row. And may be ready just to check out. So they may not be showing up their best self. And so when we judge, we tend to dehumanize each other and we can also do it in our, in our own patient care. But really, we have to normalize this conversation and we have to be able to kind of take a step back and consider that. Hmm. I wonder what's going on today. We talk about in coaching, like maybe try to be a little more curious than furious. And so maybe just taking a quick second to just be like, Hmm, I wonder what's going on, instead of just really quick to judge. And what we considered as Laura and Amanda and I were talking was we felt like immediately kind of 97% of the room went there and we're like, oh, how could he say that? Just like that and how, how could he walk off and then duh, da da da da. Like, and, and it was easy for us to even go there, but because we have been in coaching, because our eyes have been opened up, we tended to take the other side like, Hmm, I wonder what that position was going through. He has a rough job. He sees death and dying all the time. He's really had his hopes and dreams for patients he thought were gonna do well and didn't. Like all of that throughout his career. Probably played into the fact that he has just developed a sense of like, it's better to be direct maybe cuz I'm talking to a colleague versus just a parent that has no medical background. All these things, they're taken into consideration. And so what we were considering as we were talking amongst ourselves was, man, we are just so quick to judge. And really it's been a part of the programming, but now I think it's time to maybe bring an awareness to like, let's challenge this a little bit. Let's just see if we can bring the human back to humanity and think about there's always more to the story. We like to say that. There's a blog by Shola Richards and she mentions “We usually judge others in areas where we feel the weakest.” So for example, we call a consultant at 2:00 AM. He's very short. He actually probably puts up a front, doesn't wanna admit the patient or makes you do two or three more things before you admit. I don't know any, any number of things I'm sure y'all can think of and what you're thinking on the other end is like, or what I love is when the consultant tries to punt the patient and like, oh, this is not a cards patient, or it's not a cards problem, it's a pulm problem or something, and tries to punt it and it's like, oh, I'm taking care of your patient at 3:00 AM so you don't have to. I think you need to know, you're just really quick. I have all kinds of thoughts that come up, but translation is. I don't feel certain that I always come across with empathy and concern, but I'm a little bit better than that guy. Like at 3:00 AM I'm actually here boots on the ground awake and taking care of your patient. The least you can do is give me good advice or something like that. So somehow we find some sort of relief in considering that, oh, well, at least I'm not like that guy, or at least I didn't treat you like that on the phone at 3:00 AM with your patient or whatever. She goes on to say, “and usually we harshly judge others because we do the same to ourselves.” So no one judges more harshly and viciously than we do. And so it kind of starts with that vicious cycle of we hold ourselves, it's that perfectionism, we hold ourselves to a very high standards. And if we forget something, if we miss something, if whatever we really turn inward and judge ourselves very harshly. So in turn, we're just gonna naturally hold someone else to those high standards and judge them for X, Y, or Z. And I think that we could challenge that. And you know what if we were actually able to stop for a second and if, and extend just a moment of grace and consider that, Hmm. I wonder what's going on there?
Okay. I'm gonna stay neutral cuz I'm in charge of my emotions and the emotional environment on this phone call and I'm just gonna consider that, hmm, something must be going on. There's more to the story. State the facts, get this stuff done and, and get off. Instead of creating a kind of a moment where the conversation goes really south really quick.
John Mark Green says “The self-righteous green judgements against others to hide the noise of skeletons dancing in our own closets.” Boom. So that's really touching. I take that right into my soul and let it burn there for a minute. I'm like, oh, okay. So, this judgment thing definitely starts with ourselves and what we've ingrained in our brains through med school and residency and training. Man, we hold ourselves very harshly and we don't allow for very much great grace for ourselves. So how can we extend that grace when it comes to others, especially our colleagues, we're all on the same team here. We're all trying to take the very best care of the patients that we are given, and we just need to keep that in mind that our goal is the same.
Amanda: Yeah, this came up because again, our medical training sets us up to judge each other so harshly. Think of M&M’s and just all of the shame and judgment that comes along with those. It's natural for us to just instantly judge people. And that is the thing. Now that I've been a coach for a while, I know sitting in that lecture room, I would've been, in fact, pretty much the entire room was ready to go to fist to cuffs against the other physician who had delivered the news in. I mean, I think that it is quite possible that most communication experts would say that that conversation could have been better. Okay. But a bunch of doctors were ready to just basically go fight another doctor because he was on an off day. That's something now that I recognize that I judge myself sometimes so harshly because I'm so judgy of others. How many times have I been like, “this is just a dump.” Or like, “I can't believe they sent this.” Like, they must not be working at all in whatever office. Like, so funny, right? And so then when I screw up, I extend it back to myself because I'm putting it right out there in the universe. So this is just a conversation just to start bringing awareness because I would argue it would be a much better culture if we could start being allowed to be vulnerable, if we could stop going instantly to judgment, because we weren't even there in the room, this conversation these two doctors had, and yet we're just assuming. Everything is as presented and ready to fight, right? So how do we start to change this instant judgment that we have? Number one is to remain in curiosity. This is again, from Shola Richard's blog judgment shuts us down. Curiosity keeps us open to the possibility that there may be more to the story. And that's just like even just mentioning that like, yeah, what I mean patients all the time say the doctor told me this. You go look in the chart. It's nothing like that. You know what I mean? We hear what we're listening for, and so who knows how that conversation went down, but curiosity keeps us open. I wonder how many families that attending had talked to that he gave them hope and then they were crushed. I wonder if that attending had any sleep. I wonder if there's something else going on in his life. I wonder if he was criticizing himself even as he walked off. I mean, it's just impossible to be perfect 100% of the time. But just being curious about what was going on with that guy that he delivered this news so poorly helps us have a little bit of empathy because I'm certain I've probably botched a patient conversation before and not even been aware of it, or was aware of it later, and then there was nothing I could have done about it.
It's hard to take back words even when your intentions might have been pure and it just didn't come out right. The other thing that she does whenever she's noticing people judging others and being particularly nasty is she tries to make it right. And just a tiny way, like intentionally sharing a smile with a person who's being judged. Just to let them know that. It is quite possible that they are being judged harshly by others, but she will not be one of those people that are participating today. And I think that's a nice thing. Like you can't necessarily, like telling people that they're being judgy necessarily won't always come out productively, but the person who is being judged, you can, you can intentionally make a meaningful, positive connection with them in order to try to make it right a little bit. So now we're moving on to Brene Brown, her Atlas of the Heart book, which we've referenced several times with our pursuit of emotional granularity. She relays a story of when her life changed. She has been sober for many, many years now, and at one point at least, she was going to AA meetings and during one of the meetings, Someone said, “part of my sobriety is letting go of self-righteousness, but it's really hard because it feels so good like a pig rolling in (another term for feces).” And she immediately thought to herself, oh God, I'm not exactly sure what that means, but I think I roll around in it too. And I know I roll around in it, like it does feel good. Like, and it's that relief that we're talking about before, like, well, at least I'm not that bad. It's real addictive to get in there. But from that day on, she started thinking of self-righteousness as a threat to her own self-respect, her wellbeing, and even her own sobriety.
Laura: Yeah. It's like that relief that, hey, at least it's not me being shamed today. It's somebody else who is being shamed.
Kendra: And that's just a big fat deflection.
Amanda: And it's not our both selves, and that's what we're saying is like, Truly coming from our best selves. Doesn't look like that.
Laura: No. Well, and it's funny too, like when you mentioned telling someone they're being judgy, like that in itself is also being judgy. So really this is about what we're doing ourselves. This is between me and me and how I wanna show up and I wanna show up as the most empathetic, non-judgmental person that I can. Realizing that my brain's default is going to be judging. So Brene again says, “self-righteousness is the conviction that one's beliefs and behaviors are the most correct. It's our old friend, black and white thinking. Self-righteous people tend to be closed-minded, inflexible, intolerant of ambiguity, and less likely to consider others' opinions.” And again, it's trying to control other people's experience in life. We're in charge of ourselves. That's who we get to be in charge of. We're slightly in charge of our children and employees if we have them, but mostly we are just in charge of ourselves. So self-righteousness is different from righteousness. Righteousness is interested in trying to do the right thing. Self-righteousness is feeling morally superior to others and trying to convince ourselves. We are doing the right thing, so it's where we are judging other people. A term from recovery, Brene says, is terminal uniqueness, that you're different from everyone else, that you're the exception. Your struggle is unique.
Amanda: Ouch. Oh boy. We are all special snowflakes.
Kendra: And yeah, we're from Oklahoma and we'd say to those people “bless their hearts, gosh, bless their hearts.”
Laura: Bless all our hearts. Yeah. Bless all of our hearts. The more we do this, the more we realize we do all have our own experiences, but we all have the same struggles. We all have the same. Issues that we're dealing with to one degree or another. So Brene admits she had to take on more humility and less thinking. She was more right, better than, and an exception. She had to stop assuming that people who disagreed with her didn't care about people or issues as much as she did. Okay. So, look at the world we're living in right now and people's ability to even tolerate. The opinions of others that are not their own. It is striking and does not speak of a lot of curiosity, I'll say it like, oh, but he's curious, curious about why other people think the way they think.
Amanda: On both sides. There's so much self righteousness, like the other side as a group is a horrible set of people. It doesn't matter which side you pick. The other, they're, they're both saying it, so somebody's wrong there. If we can just assume that people are coming from a good place, so much judgment falls down from the wayside and it helps with curiosity. Like, I know my neighbor who has differing opinions from me is a good person, so I wonder why he's thinking that way. There must be something I haven't thought of.
Laura: Yeah. To me, as I look at these people in groups who are demonizing other huge groups of people, some of whom are like super pro-social people doing really, really kind things and helping other people have a better life. And not having any curiosity about what is going on with these people. It's just not gonna produce the results we all want, which is sanity. And so it's just close-minded. And I like, I used to be very into politics and now I'm like very, like, what the heck?
Amanda: Well, the problem is you're fed what you wanna hear is the problem. And you have no tendency to question any of that. If it's what you wanna hear, then you don't question it anymore, and that's the problem.
Laura: Yeah. So Brene says, “it's funny how thinking “I'm better than”, can slip into, “I'm worthless” in mere seconds. Ooh, yep. Does that sound familiar? Any people who work in medicine.Letting go of the first, so letting go of “I'm better than”. Slowly releases us from the second. So letting go of this charade that we think we have to be a certain way and realizing that we can be a little vulnerable and we're not gonna die. Suddenly helps us to realize that we're never worthless. We always have this innate eternal worth just by being human. So and this is where I think so many physicians do get hung up, is because we do spend so much time on judgment and it spins back on us. If we can just pay attention to the way we look at the way other people are practicing medicine and try to be curious and try to increasingly seek understanding, we will find that we, by doing so, become kinder to ourselves. That will produce the best results of all in our lives because when we can love ourselves, that is, that's really when we've got it going on. So many of us equate our worth. So many of us doctors equate our worth with our performance as a physician. And this was never the case. We are infinitely worthy already. We are born a special treasure. Not a special snowflake, but we are born like magic. We are magic. And we can not lose any of that just because we make a mistake at work or maybe don't deliver news the best way we could have. And having compassion on ourselves and having compassion on each other. Bringing curiosity to as many situations as we can muster. Hopefully those will increase over time and then choosing to do the next right step. This is what we can do. This is, this is showing up as our best self. This is doing our very best. We don't have to do more, be better than that , or strive harder than anyone else, we just need to do our best and that is going to include not always looking for the worst in others, but maybe looking for how they're doing their best as well and extending grace and love to them for that.
Amanda: Going back to the lecture, one of the main themes was always strive to be excellent. A lot of people when they think if they have compassion for themselves or give themselves grace, that they will suddenly stop trying. We would offer, that's not the case, but striving to be excellent knows that there will not be perfection. So strive to be excellent every day. Being okay is not good enough as a doctor, being excellent is what we wanna strive for, but also know that there will not be perfection. And the funny theme about the original lecture was don't lose your empathy, but also have empathy for each other. We are judged by so many metrics that we have no control over, but we don't need to be sucked up in part of that by judging each other even more. And it lets us be less judgy of ourselves too.
Kendra: Yeah, and can I just offer that, just like Laura said, that next right step just may be that curiosity. Guess what that might lead to? Letting go of resentment and bitterness that maybe you have for that colleague for the rest of the time that you work with them. Maybe that next right step, instead of being judgmental, is actually being curious, and that way you don't allow your brain to develop a memory for that person so that every interaction from there moving forward is definitely cold or negative or bitter or something like that. Maybe let's just, I don't know. I just wanna offer that up, that maybe that is the next right step is instead of being judgmental, we're curious and then you don't harbor bitterness and resentment for that colleague. I don't know. Anyways, what a great discussion this has definitely even just talking about this when we did bring it up in our little group and then now on the podcast just helps to remind me daily. Just to think about what else could be going on and asking questions instead of being quick to judge and having a little bit more empathy for myself in allowing just a little bit more grace on the days that I'm not feeling a hundred percent or not showing up a hundred percent.
Until next time you are whole. You are a gift to medicine. And the work you do matters.
