March 2017 - Gail Gazelle MD

How much time do you spend on mental comparisons? Looking on Facebook and thinking everyone else has better relationships and is much happier than you? Thinking that everyone in your peer group is smarter than you? Or fretting about how much fitter, thinner, smarter, or more successful you were at a different point in your life? Much of our stress, frustration, disappointment, guilt, and regret is the result of comparing ourselves to preconceived ideas about how we should be acting, how we should be looking, and how our personal successes are perceived by others. Theodore Roosevelt once said that comparison is the thief of joy. Indeed, comparisons often keep us in a mental hamster wheel of self-doubt and lack of confidence. To combat physician burnout, it is critical to decrease the tendency toward comparisons.

But comparison allows me to improve my performance

You may believe that comparisons keep you on your toes. Let’s test this out. Think about any times you’ve compared yourself to someone else in the past week. Did the comparison help you feel good about yourself and your circumstances or did it send you into a spiral of self-critical thoughts? Did you feel energized and optimistic about your circumstances or did you feel defeated, inadequate, and that your life would be forever deficient?

Like advertisements, comparisons hold us in the belief that if we only had product or service X, we’d be happier, feel and look younger, and be the king or queen of our world. While it’s always good to work toward life improvement, comparisons typically leave you unable to focus on the satisfaction inherent in your current circumstances. Comparisons push your focus onto either the past or the future, or simply what’s wrong with the present. Comparisons keep you from being content and perhaps more able to accept what is. Right now.

How to stop comparing yourself to others

As a physician coach, here are four steps I teach to overcome the pull to comparisons:

Start tuning in to your own thought processes. Simply begin noticing when you are going into comparison-oriented thinking. Try not to judge yourself. Jot these instances down so you can begin to see how often this occurs.
Once you’ve noticed that you’re making a comparison, name it to yourself. Say to yourself “there I go comparing myself again.” Doing this begins to create a distance between the comparison you’re focusing on and the reality of the situation. Having that distance and separation is vital in having choice and control over your own thoughts.
Now ask yourself: What is the cost of this thought process? What would I gain if I spent less time on these mental comparisons? Journal about these questions.
Now for the challenge. When you find yourself making a comparison and coming up short, push yourself to think of at least three ways you, your circumstances, your thoughts, and your actions are right and adequate just as they are. Your mind will call you back to the land of comparison and self-criticism. Your job in this step is to exert equal and opposite force in the other direction! Definitely take notes here.

These steps take a lot of practice. What you will gain, though, is the ability to see your own strengths and accomplishments. You’ll find yourself experiencing more calm and a stronger sense of your own self-worth. Harkening the words of Theodore Roosevelt, you may even find yourself experiencing more joy.

On February 3, 2015, the American Board of Internal Medicine (ABIM) issued an apology to American physicians for subjecting them to an out-of-date and burdensome board recertification exam. The importance of this step cannot be overestimated. Of the ~850,000 active physicians in the U.S., over 200,000 currently hold ABIM certification, which is required of internists and most medical subspecialists. Starting in 1990 (the year I was unfortunate enough to complete Internal Medicine residency!), physicians have been required to take the exam every ten years to maintain their board certification. While the ABIM cites data suggesting that the exam improves quality of care, this has not been definitively established, and questions have arisen from a number of quarters about appropriateness of content, the expense, and whether the exam is contributing to early retirement, a major concern in terms of the growing physician shortage. The ABIM apology focuses on making the exam more relevant to the practice of medicine, allowing CME credits to be used in place of the esoteric MOC (maintenance of certification) modules, and eliminating the onerous practice assessment and patient survey requirements. Board recertification is expensive, time consuming, and requires intensive preparation. In the setting of increased demands to see more patients in less time, decreased reimbursement, increased scrutiny, increased role definition by non-physicians, and the burdens of the EMR, board recertification is yet one more factor contributing to physician burnout. Physician burnout is a complex phenomenon and yet it can also be summed up with a very simple equation. X = all the things that buoy a physician up X equates to things like positive patient encounters, good relationships with support staff and colleagues, intellectual challenge, or picking up a tricky diagnosis. X also includes meaningful personal relationships, adequate sleep, and personal health, in addition to a sense of meaning and accomplishment. Y = all the things that drag a physician down Y includes an EMR that is frustrating to use and eats away at precious time, unrealistic patient loads, having more and more administrative hoops to jump through, inadequate staffing, or not having time to just focus on the care of your patients. The math is simple: When Y outweighs X, you get imbalance and physician burnout, almost like two sides of a seesaw. And board recertification is in the Y category big time. My own experience is telling. When I recertified in 2010, as a hospice physician out of touch with general practice, I prepared for over a year and a half, studying 3 hours a day for 3 months. I spent most “free” moments studying, I was completely drained, and my family was angry and alienated. Prior to that recert, my 13-year-old son had always proudly called himself Dr. Gazelle Junior. By the end of the experience, he said you couldn’t pay him enough to become a doctor. Now, at age 18, he’s planning on a career in engineering. Many things can be done to decrease physician burnout. Not having to spend time that you don’t have studying for an irrelevant test is one important one, but it is still just one factor. Part two of this blog series will discuss the growing body of knowledge on other interventions.