Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / The Self-Compassion Tax — Moving Beyond the Inner Tyrant
Transcript
- Santina Wheat: Welcome to The Hidden Load. I am your host, Dr. Santina or Tina Wheat. If you are listening to this, you are likely someone who has spent the better part of two decades being the absolute best. You got the grades, you survived the residency or other training hours, you climbed the academic or clinical ladder. And now, ⁓ You are one of the people that others look to for answers. But there is a specific kind of hidden load that high achievers like us often carry. That is one that does not show up on a productivity report, and it certainly doesn't show up on a teaching evaluation. It is what I call the self-compassion tax. It is the constant high-frequency hum of self-criticism that runs constantly in the background of our minds. Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. We will tackle the hard topics and help you conquer your chaos and get to calm all by starting to acknowledge and remove that hidden load. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. and it runs like an app that we forget to close that is slowly draining our battery. Now in our culture, especially in medicine, we have been conditioned to view self-compassion something that is soft. We often confuse it with self-pity or heaven a lack of ambition. ⁓ This podcast is a space for us to name the things that are common, but not normal. Each week, we'll look at the invisible weight you're carrying and explore practical coaching-based tools to help you find more calm, better boundaries, and a sense of purpose that doesn't require you to run on empty. I'm so glad that you've carved time out for yourself today. Let's get into the episode. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. that's almost unheard of in medicine, right? We believe that if we are not our own harshest critics, we will somehow slide into mediocrity. We think the inner tyrant ⁓ the only thing that is keeping the wheels on the bus. And we think this because has worked to get us to where we are right now. You can find information on how to reach me in the show notes. don't forget to hit subscribe so that never miss an episode ⁓ and leave me a rating so that others can find too. Now, there have been so many times I did this to myself. I see a patient, I would all of the things that I was supposed to do, and still there be an that I hadn't hoped for. Maybe they didn't choose the treatment that I wanted or was recommending. Maybe they made the decision that I wouldn't make. and take care of yourself because you deserve to be held up too. And I'll see you next time. Maybe despite all my good recommendations, their A1C was still 13, they were struggling to take their medications, or, or, or. are so many times when I could tell you these specific stories, but there was a time when I really felt like I failed. There was a time when I had a patient ⁓ who elderly, I really wanted to decrease the amount of medications that they were taking. I was trying to diarese their pills, if you will. I wanted the family to have an honest conversation ⁓ ⁓ advanced directives would be. I tried to lay out all of my arguments and about what I would want myself or what would do for my own parent once they were in their 90s. and I was absolutely not heard. And then day, ⁓ two months later, across my EHR inbox, I word that she had passed. And it wasn't just that she had passed, but she had undergone multiple rounds of compressions the hospital. And the paperwork that I received, expressed all of the that she'd received from those compressions. When I read that, my initial response was, I and truly failed. I didn't protect my patient from this experience. I kept thinking about it. It was racing through my brain. I thinking about I could have had the conversation differently. Maybe they just a better doctor. Maybe I should have them again later and asked them to have the conversation again. I couldn't sleep because of decision or because of this information. ⁓ And really, the conversation replayed in my head less than 30 times. Until I ⁓ it one of my colleagues. I told them horrible I felt. And they stopped for a moment they said, but why do you feel horrible, Tina? And said, well, I feel like I failed. I didn't protect my patient from this. And they but that wasn't your job. Your job was to present them with all of the information and to allow them to make the choice that was right for their family. You did the good thing. You were the good doctor. You let them have their decision and you were okay with that. You knew that it wasn't the one that you would choose, but you knew it was their family's decision. And it wasn't until that moment that I was able to be okay with myself, that I was able to see that being the best doctor didn't always mean my patients doing what I had hoped they would do. It didn't mean them always choosing the choices I would make. It just meant showing up for them and allowing them to have that information. But that self-doubt that I had, that inner tyrant, it certainly didn't help me. And today, I want to argue that this inner tyrant isn't making you any better either. It is making you tired. is making you rigid. And it can actually be a liability for your team and learners. ⁓ So let's talk a little bit about why this inner tyrant is bad for you. is this a load? Well, ⁓ is biologically expensive. When you criticize yourself, you weren't just thoughts. You're actually triggering a cascade. Your amygdala, the brain's alarm system, ⁓ registers that self-judgment as threat. ⁓ It doesn't know the difference between your patient coding and you telling yourself that I'm an idiot for getting that meeting. In both cases, are getting a surge of cortisol ⁓ adrenaline. Your heart rate variability is going to drop. Your prefrontal cortex, the CEO of your brain, is losing its grip. This ⁓ the of the perfectionist. The more you beat yourself up to perform better, more you physically disable the parts of your brain that are required for high level clinical reasoning and emotional intelligence. And those of us in healthcare, we need those parts of our brain ⁓ single day ⁓ we see our patients and when we support our teams. And then there is also the shame loop. Now shame, it is different from guilt. is I did something bad. Whereas shame is ⁓ am bad. So in my story, I feeling the shame. I was feeling that I was a bad doctor, that I wasn't good enough. ⁓ which was worse than I didn't do the best conversation I could have. In medical education, we often operate in a shame-based environment. When we internalize that, our focus, it shifts from, how can I fix this problem? To, How can I hide the fact that I am imperfect? And this right here is where the hidden load dangerous. When we are a shame loop, we stop being curious. We stop being innovative. and we just try to survive the day being found out. When we do that, we have the opportunity to learn or to grow or to make sure that we're being the best leaders or providing the best care. This right is a massive tax on our leadership capacity. So do we dismantle this? How we get rid of that inner tyrant and that inner shame loop? Well, we a framework that feels as rigorous as a clinical protocol because most of us understand that. I use three pillars of self-compassion, but I want to look at them through the lens of a medical leader. The first pillar that I use is mindfulness. ⁓ or the vital signs check. In medicine, we check vitals to see what is actually happening before we intervene. It allows us to have better context and lets us know if something is an emergency or not. Clinical mindfulness is checking your internal vitals. is noticing ⁓ thought spin. before it becomes a behavior spin. It's the ability to say, I am noticing a feeling of an inadequacy. I am noticing a feeling of an inadequacy right now. When you're able to name that, takes the power away. There are plenty of times when I've been leader where things didn't go as planned. There are times when I realized a conversation was going off the rails. There times when people weren't responding how I hoped they would. And in many of these moments, I've noticed brain begin to spin. And before, it would just spinning and I didn't know how to stop it. ⁓ But now, that I use this vital signs check, I can notice that the spinning is happening, and I can take a pause, a tiny moment of mindfulness, even if it's just deep breath, to focus on happening in the room, to stay focused ⁓ on the goal, rather than ⁓ on the fact that losing control. When I can focus on what's happening in the room and re-center on those shared goals, even the most difficult conversations longer cause me to spin. So then there's pillar two, which is common humanity. This is the inner peer group. One of the biggest lies of the hidden load, and one of the main reasons why I started this podcast, is because many of us feel like we're the only ones that feel this way. We feel like we're the only ones who feel like a fraud. We look at our colleagues and we see their highlight reels. We see their grants, their publications, their successful clinics, their polished presentations, their positive evals. And we compare our behind the scenes footage their highlight reels. But common humanity the radical realization that that respect this building is also carrying a load. They also have their own behind the scenes footage. Suffering and mistakes, unfortunately, are not outliers. They are the true statistical norm of a career in medicine. And when we can realize that we're not the only ones that have that, then sharing that experience can feel better and helpful. And then there's pillar number three, which is self-kindness and hopefully becomes the standard of care. We all know that we have a legal and ethical standard of care for our patients. But I'm going to ask you, why don't we have a standard of care for ourselves? If I saw you treating a resident the way that you treat yourself in your head, I'd probably have to pull you aside for a conversation about professionalism and good communication skills. is simply holding yourself to the same standard of professionalism and decency that hopefully you are affording everyone else in the hospital or in your clinic. And now, you think about self-compassion for yourself, I to share something that's really critical for the educators and leaders who are listening. When you self-compassion, it is actually a public service. Our learners and teammates are hyper-attuned to us. They watch how we stress. If you were a leader who was perfect on the outside, but clearly white-knuckling it on the inside, then you're sending a message. probably not the message that you want to send. You were teaching them that the only way to be a leader ⁓ to sacrifice your own humanity. And you were inadvertently teaching them that mistakes are small deaths. But instead, we need to model the vulnerability. you practice self-compassion openly, ⁓ able to create psychological safety. When a learner sees an attending say, ⁓ really struggled with that interaction and I had to take a minute to be kind to myself. so I could come back and be a good doctor or some version of that sentence. You have just taught them more about resilience than any one hour mandated wellness lecture ever could. As a program director, I often have to see moments when the residents feel like they're failing. And sometimes when they're receiving the feedback that they aren't doing as well as we would hope. And that means that they're often scared to come to me with a mistake. By the time they get to me with mistake, they are often beating themselves up. or at least being pretty hard on themselves. They usually come with their head down or in tears worried to talk about whatever that challenge is. ⁓ And so what I try to do is instead of giving them advice on how they could have handled that specific clinical scenario better, because that's certainly what not, that is certainly not what they need in the moment, instead, try to share with them how I have beat myself up in the past as well. I share with them my own struggle with self-criticism and how I'm working on being better at giving myself grace. ⁓ I tell them about the mistakes that I have made. Usually when I share with us, there is a realization that they aren't alone. And usually there is a realization that they aren't the only ones that have to work at being kind to themselves. By doing this, it shows that it's really a clinical skill and something that we all have to practice. Now, by putting down your own hidden load of self-judgment, effectively lightening the load for everyone who reports to you. You're creating a kindness return on investment, ⁓ ROI, where the team can become more efficient because they aren't afraid of their own shadows. They afraid of sharing those mistakes ⁓ because know that you'll be gentle and show them how to be gentle to themselves. ⁓ It doesn't mean that there won't be accountability. It just means that there is a safe space to process to look forward to the next steps. Now, we have just spent chunk of time ⁓ about something that usually gets zero minutes in our medical training. We've looked at the tax of self-criticism, a framework for a clinical reset, and the way that our internal dialogue can shape our team culture. Self-compassion not about letting yourself off the hook. It is about staying on the hook for the long haul. It is about making sure that the educator or leader that you are today is still there 10 years from now, of being burned out by the weight of your own judgment. And this week, I'm asking to perform a self-compassion audit. I want you to pick one task that usually triggers inner critic. Maybe it is your in basket. it is your feedback or precepting sessions. And the inner judge starts talking, I want to say, I hear you. But that is not a clinical skill I'm using today. I want you to treat yourself with the same dignity that you would give your most complex patient. You absolutely deserve it. ⁓ and your team absolutely needs it. Thank you for listening today to The Hidden Load. If this resonated with you, I hope you'll to the podcast and I hope you'll share it with ⁓ one colleague who you know is being a little too hard on themselves. ⁓ This is how we end up lightening the load together. and I hope to see you next time.