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Doctor Brain

Mar 07, 2022

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Being on high alert, looking for what’s wrong, constantly staying attuned to anything that could go wrong – those are typical tendencies of any physician. And that only gets reinforced as we go through our schooling and training. This programming results in what I term Doctor Brain, a condition that intensifies stress and anxiety when we need to remain calm and focused. Unfortunately, this nearly unbearable high level of stress results in physicians who quit or even commit suicide. Perhaps the most sobering part is that managing stress is achievable. And it all starts with retraining our minds to reframe stress.

“Learning to combat anxious, stressed-out thinking is what I believe actually makes us better physicians.” – Dr. Sara Dill

This topic is so important that, as promised in Episode 1 of my new podcast, Stress-Less Physician, I’m dedicating an entire podcast to defining and explaining Doctor Brain. I coined this term because, as a board-certified dermatologist, pediatric dermatologist and Life Coach for physicians, I live the stress-inducing physician life. But I learned how to think differently, and thus control my response to stress. I even wrote a book that talks in-depth about Doctor Brain.

If you want to learn more about my background as a physician and the journey I took to find the answer to dealing with stress, I invite you to listen to the trailer for my podcast. I’ve also added a little about myself at the bottom of these notes. Finally, if you missed any of my previous episodes, I encourage you to visit my website to listen to them. In episodes 1-3, I discuss how to feel better, I identify some myths about stress, and I give you insight on how to believe new things.

What You’ll Learn 

  • What is Doctor Brain?
    • Where did it come from?
    • Why it isn’t actually helpful
    • 5 programmed thoughts that result in Doctor Brain
    • Natural negative human bias
  • How to tame your Doctor Brain:
    • Step #1: Awareness and reprogramming your patterns
    • Step #2: Get it all on paper
    • Step #3: Separate fact from interpretation
    • Step #4: Practice the new you

Contact Info and Recommended Resources

Connect with Sara Dill, MD, The Doctor’s Coach

 

A bit about me…

 

I’m Sara Dill, MD, board-certified dermatologist and pediatric dermatologist. I went through life getting straight As, following the rules, and getting into the right schools (Harvard, UC San Diego, Brown). I believed the way to be a good and successful doctor was to work hard, always say yes, and put patients (and everyone else) first. 

But while I was successful, I felt perpetually stressed out, overworked and unhappy. I was always looking for that perfect work-life balance, which never appeared. So I became determined to solve this problem. I had worked too long and hard to simply accept being overworked and stressed out for my whole medical career! 

I took a sabbatical from practice and studied life coaching. I completed two life coach training programs, numerous other courses, read 100s of books, and used coaching to transform my own relationship to work.

What I learned was that stress is a symptom. It all has less to do with the actual hours you work than with your thoughts about your work.

With this knowledge, I took control of my life and stopped being just one more overworked and stressed out doctor. So can you! But you don't have to take years and read hundreds of books to figure it out. I did it so you don't have to. And I’m here to help. Using a combination of coaching tools and mindfulness, I coached myself back into a thriving dermatology practice I truly enjoy. With the rest of my time, I coach other physicians on how to stress-less and enjoy their work and life more.

Transcript

I’m Dr. Sarah Dill, and this is the Stressless Physician podcast, episode number four. Welcome to the Stressless Physician podcast. I’m your host, Dr. Sarah Dill, MD. Using my unique combination of coaching and mindfulness tools, I will teach you practical ways to reduce your stress level, feel happier at work, and create a better balance between your medical career and personal life. If you are a busy practicing physician who wants to design a life and medical career that feel good to you, you are in the right place.

Hey, everyone, welcome back to the podcast. I am super excited for today’s topic. This is something I first started thinking about when I wrote my book back in 2019, which for any of you who don’t know, I wrote a book called The Doctor Dilemma: How to Quit Being Miserable, Without Quitting Medicine. I’ll definitely put a link to it in the show notes. It’s on Amazon and Kindle.

So anyways, I first started thinking about this idea of “Doctor Brain” when I wrote my book. And it’s something that I still find super relevant to me, and to my physician coaching clients every day. I wanted to start by telling you that if anyone listening has met me or knows me in person, I think that sometimes I appear to be pretty calm and sort of a naturally chill person. Or maybe no one thinks this about me and I just think that I appear somewhat chill and calm. And maybe I’m fooling myself.

But I just want you to know that I’m not naturally that way. So, any calmness or chillness I might exhibit these days really is the result of coaching and self-coaching, my mindfulness practices, and meditating for the last few years. So, I just want you to know that I am much more calm and unruffled about many things now. And it takes a lot more to get me riled up and stressed out, and I still have to work on it daily. But coaching really does work. At least it’s worked for me. Thought work and tuning into my brain and noticing how I’m choosing drama sometimes, when I could choose otherwise, has been a complete game-changer for me. And that’s why I wanted to introduce this idea of Doctor Brain early in the podcast, and also talk about how we can tame it permanently.

So, what is Doctor Brain? Doctor Brain is what I would describe as— really are shared medical programming that we all, or at least most of us received as part of our medical school training. That as we made our way through the stages of being medical students, interns, residents, fellows and even as fully fledged attending physicians, what were the ideas, the beliefs, really this sort of programming, that we all took on, maybe consciously and maybe unconsciously?

And this programming, this Doctor Brain is a huge part, I would argue, of why so many of us doctors feel anxious, worried and stressed so much of the time. There’s a reason why we physicians have one of the highest suicide rates of any profession. Yes, part of it is knowledge of anatomy and access to medications. And yet, I really want us to think about why should being a physician, why should be in someone who’s dedicated to helping other people, to being of service to others be so stressful? Why should it be so hard? And so anxiety-provoking? Why do we have one of the highest, if not the highest suicide rates, and have for a long, long time?

So I want to suggest that Doctor Brain is the result of the culture of medicine that we all have taken on often without question, and I would say a lot of the time unconsciously or subconsciously. So, I want you to think back to medical school and to your residency. These were challenging times, right? At least for me. I often think about the person I was when I showed up to class on the first day of medical school. And if you’re like the physicians I know, you really did go 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 all of us got introduced to the culture of medicine. Or maybe you grew up in a family of doctors and you were already sort of familiar with it. But I think that it becomes very relevant and very personal when you’re going through it as a medical student.

       And despite a lot of the more recent changes for the better, by and large, I think it’s still a culture in many ways similar to that of the military. So, I grew up with a former Navy SEAL father, who used to frequently repeat his two favorite seal slogans to me and to my sister growing up. And those slogans were, “The only easy day was yesterday, and pain is just weakness leaving the body.” So, these scenes that were meant for soldiers preparing for combat, for Navy SEALs, came to mind frequently during my medical training. I think they totally apply to medical training, don’t they? Think about it, the only easy day was yesterday, and pain is just weakness leaving the body? I don’t know. I feel like it made a lot of sense to me in the moment, in a weird way, though, right? Why should military training resemble medical training, or vice versa? Why should our medical training be at all, like going through military training?

But like the military, traditional medical education, often does rely on a rigid hierarchy of rank and responsibility. In my experience, attendings, not all of them, but a lot of them sort of acted less like colleagues or mentors, at least in medical school, and maybe my internship, and more like disciplinarians. There was a lot of focus on figuring out what you didn’t know. And in many training environments, I found mistakes were not really viewed as opportunities for growth, but rather as opportunities for humiliation.

So what did we learn as medical students and as trainees and physicians? What are the elements that make up Doctor Brain? So, the first thing I really want to talk about is how in medicine, we’re taught to always look for the problem, right? We want differential diagnoses on everything. We’re always looking for what’s wrong, what could kill someone, what we’re missing? Maybe we’re thinking about what we could miss, or wondering about what we did miss. And then the question is to notice how many of us do this even in our personal life, or when we are with family or with friends? Maybe we do this at the grocery store. I noticed I’m always looking at people’s skin, and diagnosing them with things, even when it’s completely irrelevant, and not my job. So how good are you at turning off this sort of relentless need to identify and diagnose people, or problems or situations.

So I think this really is the key definition of Doctor Brain or maybe the key foundation of it, that our brains are so trained to look for what is wrong, and focus on the worst possible diagnosis or outcome, that we are sort of, in a way, programmed to worry and to ruminate. And to almost catastrophize, what could go wrong with the patient in front of us are with almost any scenario we can imagine? It’s like we’re always thinking about the worst-case scenario.

This might seem like it would make us a good doctor. But I would suggest that feeling worried and anxious and stressed, actually are much more likely to result in us engaging in overthinking, in maybe missing things, and in making mistakes. Learning to combat anxious stressed-out thinking is what I believe actually makes us better physicians. Additionally, I think Doctor Brain, which again, is sort of really this focusing on what’s wrong, looking for the problem, looking for worst case scenario, I think Doctor Brain has also added to and reinforced by the additional programming that most of us were all exposed to during our medical training.

This is a lot of different things—I’m going to highlight, I think the top five or six, the first one, I think, is this idea that mistakes are to be avoided at all costs. I don’t know about you, but in my medical training, mistakes were really not something that one was supposed to make or do. The other part is this idea of not complaining. We learn in our medical training, really to just suck it up, to take what we get, and to make the best of it. Another thing I think that most of us have learned is that when the going gets tough, the answer is to work harder. The answer to most problems is to just work harder; to do more, not to do less.

I don’t know about you, but for some reason I also have this belief, or I did, and I probably still do a little bit, even though I’ve worked through it, but I have this belief that doing things that hard way is somehow better, more valuable and maybe even more virtuous than doing something the easy way. I don’t know if that resonates with anyone else. I still notice this tendency to equate doing something that is hard with it being better than doing something that is easy. And that doesn’t mean that doing hard things isn’t rewarding, or that we should avoid doing hard things at all costs. I wouldn’t say that at all. Some of the things that we value most are challenging and difficult. Big goals can require a lot of hard work and a lot of us. And yet, I would just notice of letting things be easy when they are, seem somehow wrong or less valuable to you. It’s just interesting to notice.

Another part of our programming that I at least learned in medical school is to never show weakness. So this might include not needing to eat or drink or go to the bathroom for many hours, to function well on little to no sleep. Most of us learned how to tune out our body and its signals to us. And this includes maybe not asking for help, doing it ourselves. For me, really asking for help felt like showing weakness, like I was supposed to figure it out and supposed to be able to handle it all on my own. And this is something that continues to sort of run in the background for so many of us.

And then the last part of this Doctor Brain programming, and the golden rule that I learned as a medical student, was that the patient always came first. And this, I think, has so many repercussions and so much of a trickle down. It’s really interesting to notice if that’s something you still believe, and how that shows up for you. So, the other thing I’ve noticed in almost all the physicians I work with is that, in some ways, our natural caring tendency is frequently co-opted into a feeling that we are responsible for solving every problem, and that we need to fix our patients, even when what they have isn’t fixable, or they don’t want fixing.

So, I know when I was first seeing patients, I would often find it very frustrating and difficult to have patients who either didn’t follow my recommendations or didn’t seem to want to get better, or they didn’t want to be fixed. And I took it very personally. And it was very problematic actually, for me. It created a lot of stress for me.

And I think most of us began medical school as sincere and very hardworking individuals who probably already had an overdeveloped sense of responsibility. I don’t know if that sounds familiar to you. So, we tend to have this overdeveloped sense of responsibility that maybe we brought with us or also caused us to go into medicine, for fixing everything and everyone. And then this over responsibility, maybe now causes problems in how we show up in our personal life, as well as in our professional life. So no wonder so many of us physicians find so much wrong in medicine, and in our practice.

This Doctor Brain and our focus on what’s wrong, what’s not working, mistakes, etc. Looking at worst case scenarios, sets us up for overworking, for burnout, and for personal and professional dissatisfaction. And then, all of this, this whole Doctor Brain is simply amplified by the inherent negativity bias of humans and our human brain. As I mentioned in an earlier podcast, as humans, we have a brain with a hard-wired negativity bias. This negativity bias, basically refers to the fact that humans give more psychological weight to bad experiences than to good ones. And this means that we’re always looking for the negative for what’s wrong, for a mistake, for what we missed, for what might kill us, or kill a patient.

So this is just the natural human brain left on autopilot. It likely helped us survive as a species, but it does not help us thrive. It does not help us be happy, it does not help us feel fulfilled. So again, I love this quote from Rick Hansen, neuroscientist PhD, that our brain has a negativity bias that makes it like Velcro for the bad and Teflon for the good. So you can see why having Doctor Brain—so all of our doctor programming, or differential diagnosis running looking for worst case scenario looking for the problem, plus, the inherent negativity bias of our human brain, really sets us up for a lot of unhappiness, a lot of focusing on the negative, and a lot of just seen the problems out there.

And so again, this is really why it is so helpful to learn how to use our brain and not just let it run the show. So again, it likes to run on autopilot. Our brain likes to be efficient. Left to itself, it’s going to be a pretty negative narrative inside our head. And that’s normal, there’s nothing wrong with you, if you find that the conversation you have inside your head is pretty negative. But again, no wonder so many of us physicians find so much wrong in medicine and in our practice, and in our life. We see what we look for.

So, here’s some good news: it is totally possible to tame your Doctor Brain. You can actually use your amazing brain, our ability to think about what we’re thinking, to focus on what is going on inside our head. We can use our brain to deprogram these patterns, that we have to identify and deprogram them, and learn how to reverse our tendency to feel stressed out and anxious, and how to feel better, and how to function better, both in your professional life and in your personal life. Because often, when we are not at work and not taking care of patients, it is not helpful to show up in full Doctor Brain mode.

I don’t know about you, but my friends and family don’t like my doctor side, a lot of the time. My dad always used to call me a bossy and know it all doctor. And I don’t think he meant it in a good way. So, I don’t know if that resonates for you at all. But again, when we aren’t at work, it can be helpful to learn how to turn off our Doctor Brain. So, the first step of taming your Doctor Brain is always going to be awareness. So, can you start to notice how and when you are in Doctor Brain mode? When are you looking for what is wrong? When are you looking for what the problem is? And then ask: is a useful? Is it required? I would say when we’re taking care of patients, yes, absolutely focus on your differential diagnosis, right? sort of look for what’s wrong.

Look for patterns come up with different options. But notice, if you’re always thinking about the worst-case scenario, even when you’re not at work. I would say notice if you’re always thinking about the worst case scenario, especially when you’re not at work. Notice if you’re overly focused on not missing something on not making a mistake, or if you’re focused on making mistakes on doing it wrong. Notice when or if you’re worrying about making those mistakes. Notice if your answer to most problems, is to just work harder. Notice if you always or mostly choose the hard option, the hard way over an easier or maybe a more fun way.

Notice if you still prefer to never show weakness. And notice if somehow asking for help might seem like weakness. And especially notice if you’re always putting others first. How often do you prioritize you? What would be different for you to put yourself first, or to at least not put yourself last? The way I like to think about this is that I love taking care of other people. I love helping. I love being available. I love being of service. But my rule is to not have it be at my own expense. A great question to ask yourself, if you’re thinking about this is how can I show up as the best doctor, the best partner, the best husband or wife or girlfriend or boyfriend, the best friend, the best parent, the best whatever, and not have it be at my own expense? How can I take care of others in the way in which I genuinely want to when I want to, and also take care of myself in an equally loving way?

And lastly, I would notice if you’re holding yourself responsible for fixing things that are either not fixable, or that don’t need fixing. I think a lot of us do this. Are you holding yourself responsible for fixing your friends or family partners, neighbors, maybe the world? How many of us physicians feel secretly responsible for fixing the world? It’s sort of crazy. So, awareness is step one.

Step two is writing down what you’re currently worried about or anxious about, or stressed out about. Maybe what is the worst-case scenario you’re running through your brain, or write down where Doctor Brain is showing up for you, and maybe why. Just get it all out on paper. I think I talked about this in a previous episode, but it’s so helpful to see it in black and white, and then you get to work with it.

And then step three is noticing, what are the facts of the situation, and then what is your thinking about it? So separating the facts out from your interpretation of them. So I’m just going to tell you here, there are going to be very few facts, and lots of thoughts and interpretations. So again, whatever you’re worried about, or anxious about or stressed out about, or maybe the patterns of Doctor Brain that you see, and why. Again, separating out what are the facts? And what is your interpretation? What are your thoughts? What are your feelings? What is everything else?

And then the last step is to come up with a different interpretation, maybe a different possibility, a different future scenario. This is you coming up with new thoughts, new beliefs, new ways of showing up. You want to find ones that feel better, that are perhaps more neutral or more positive in their interpretation of whatever situation you were dealing with.

And then I guess there’s a step four, is to practice the new version of you, to practice how you want to show up and when, to practice thinking about what the best-case scenario could be. Practice thinking about all the things that are going well, and that are not problematic. Maybe practice thinking about how something could perhaps be accomplished in an easier way, rather than a harder way, redirecting your thinking, focusing on really the opposites of a lot of our habitual patterns of thought that create a lot of our dissatisfaction.

So I have a worksheet that you can download as well to help you build awareness of these patterns and start to tame your Doctor Brain. I’m going to put the link in the show notes as well. And I would love to hear back from any or all of you. Any feedback, any questions, any comments, feel free to email me at Sara, S-A-R-A, at Saradill.com or head on over to my website, www.saradill.com, and leave me a comment. Let me know what you think. So good to hang out with you. I can’t wait to be back next week. Hope everyone is well. Talk to you soon.

If you are a busy practicing physician ready to start feeling less stressed, enjoy work more and learn how to create a more balanced and sustainable medical practice and life, sign up for a consult call with me at www.saradill.com. That’s Saradill.com. It would be my privilege and pleasure to work with you.

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