Shoulds and the Paradox of Self-Motivation

I was coaching a physician recently who was struggling to start an exercise regimen. To protect her anonymity, I’ll call her Jamie.

Jamie had started and stopped exercising many times in the past but had never stuck with it. I could well understand this as she’s a mother of three with a busy career — her days are anything but quiet and full of free time.

Like many, Jamie had put on weight with her pregnancies and struggled to lose it. She also had a family history of diabetes and was worried about the extra weight increasing familial risk.

She’d tried everything from the Whole30 diet to Noom, from working out at her Y to shifting to an elliptical in her basement, and from having her husband push her to keep her accountable to app upon app, but nothing stuck. She just couldn’t get herself to stay motivated, no matter what she tried.

Like many others, Jamie didn’t know why she couldn’t do regular exercise. She just knew that she couldn’t. Having never gotten below an A- in her life, Jamie felt that, with exercise and self-care more generally, she was getting a big fat F.

So, Jamie and I got deep into discussion, and I asked her a few questions to help her understand what was getting in her way. I first asked her to share her thoughts on exercising. Here’s what she said:

  • I should get up at 5:15 every day and get on the elliptical.
  • I should be able to stick to my exercise routine.
  • I should be better at this.
  • I should be like other physician moms who figure out how to fit exercise into their busy lives.

Unfortunately, none of these thoughts improved her ability to sustain an exercise program. Something was still missing. 

Could it be that all these “shoulds” were actually getting in her way?

I’m wondering how you approach making a lifestyle change, developing a new habit, or getting some demanding task crossed off your to-do list. If you’re like me, Jamie, and many others, you may approach the issue by telling yourself that you should make the change. You should improve, you should become a kinder, more efficient, better person, you should just do whatever it is that you’re wanting to do. 

Unfortunately, all this “shoulding” may actually be stealing your motivation, rather than building it. As I discuss in my 2020 book, Everyday Resilience, these inner ‘should’ voices are ones we all have, yet without proper tools and skills, can really erode the inner resilience we all possess. At times, this voice of should can even become one that is punishing, harsh, and shaming, can’t it? It can even creep into our thinking around all kinds of things.

  • I should get out of bed early and get on the exercise bike.
  • I should be able to stick to my diet.
  • I should start meditating.
  • I should be nicer to my spouse.
  • I should be more patient.
  • I should get that work done.

Before you know it, all these shoulds then lead to a whole other level of self-judgment:  

  • What’s wrong with me not getting out of bed early and exercising?
  • Everyone else seems to be able to know how to manage their weight issues, but not me.
  • If I don’t get it together, I’m going to end up a fat diabetic sloth.
  • Why am I so unmotivated? What’s wrong with me that I don’t have the willpower everyone else has?
  • Why can’t I just suck it up and do better?

All of this begs the question: Have your shoulds motivated you? Have they helped you make the changes you want?

There’s a reason why so many of us can answer with a resounding ‘no.’ The fact is that telling ourselves that we should do something takes us away from the intrinsic or internal motivation that is what truly motivates us to do anything. The should takes us to an external source of motivation, one that is less likely to get the job done. The should leaves us trying to motivate ourselves because society says so or your parents told you to or how you think you should be doing something or other. It takes us away from what truly drives us in life — our desires, our passion, and what’s in it for us to take the action we want to take. We may believe that an external entity like money, keeping up appearances, or receiving praise from others will get us there, and they might for a brief while, but rarely in a sustainable way.

Let’s take a deeper dive into what it is that will truly provide the motivation you need. When you think about why all the shoulds actually erode our motivation, you can likely see the answer. After all, we humans tend to do things when there is something in it for us to do so. The old WIFM, or what’s in it for me, is an important truism.

The key is to make sure you’re aligning with your WIFM as opposed to the internalized voice of parents, teachers, and others which actually only serves to tap into our brain’s threat-defense system. Recall that this is the fight/flight/freeze system that our primitive brains developed to protect us from danger. Thank goodness our brains evolved in this way to ensure that our species rose up the evolutionary ladder! But in the modern world, this system is activated by threats of a psychological nature, ones that tell us we’re not good enough, smart enough, thin enough, or, in Jamie’s case, fit enough. And once the threat-defense system is activated, we’re operating in survival mode, small, withdrawn, fearful, and only focused on getting by. All too often, the result is procrastination, distraction, or avoidance.

For true self-motivation, we can go to an important psychological theory. One of the most influential theories on human motivation, in fact, is self-determination theory, which originated from the work of psychologists Edward Deci and Richard Ryan, who published Self-Determination and Intrinsic Motivation in Human Behavior in 1985.

The SDT informs that we tend to be driven by a need to grow and gain fulfillment. One of the core assumptions behind the SDT is that developing mastery over challenges, learning, and growing is essential for our sense of self.

SDT also points to the fact that while we may be temporarily motivated by external rewards (money, prizes, societal messages, recognition or validation by others), internal sources of motivation fuel the most desire and commitment toward our goals. Also, tapping into our intrinsic desire to achieve a goal can be a powerful motivator and keep us going when external rewards aren’t enough. While the idea of intrinsic motivation may seem like a new concept, it’s something we’ve known about for quite some time. Many studies confirm the truth of SDT, bolstering the fact that intrinsically motivated people are more able to reach their goals – resulting in happier and healthier (and more motivated) people.

Tips to self-motivate

Reading this, you may be wondering: what’s the alternative?

SDT helps us understand the true ways we can motivate ourselves. What’s key is getting in touch with the “why” behind the change you want to make. That will take you to your WIFM and help you move forward toward your goal.

When I asked Jamie about her WIFM, she readily identified that exercising was important for her so she could avoid diabetes and have the longevity she wanted to be there for her family. Her WIFM also meant how good it felt to fit into some cool clothes she had worn before giving birth. Instead of beating herself up with a litany of shoulds, when she focused on what was truly in it for her, she felt more of a sense of ease about exercising. In our next coaching session, she proudly told me that she had stayed on her exercise program for the entire prior month, a first for her. Of course, it was still challenging to fit this into her busy days but now she was able to do so.

Since I’m all about pragmatic approaches, here are 5 tips to self-motivate and reach your goals.

    1) Pay attention to the voice of the shoulds. Honing this type of self-awareness is always the first step in effecting any change. And guess what? This type of self-awareness is also known as mindfulness. After all, mindfulness is about getting to know what is going on inside and around us. We pay mindful attention in a kind and friendly way, not by adding more “shoulds” onto the existing pile! Why is mindfulness so important? The simple answer is that it helps us to be more present and aware in our lives. And this can make a huge difference in how we feel and experience both ourselves as well as the world around us.

    2) Now that you’re aware of when the shoulds are present, broaden your awareness by noticing how you feel mentally and physically when you experience them. Do you feel uplifted and excited to move forward? Alternatively, perhaps you experience a sense of dis-ease, a downward sense of gravity that pulls you back toward the shoulds. Get in touch with how different the extrinsic and intrinsic motivation feels to you. Since the latter likely leaves you much more uplifted, this will also contribute to greater motivation.

    3) Now ask yourself: what is in it for me to make this change? What’s important about this? How will it help me? If it’s still unclear, try to identify the consequences of staying in the situation versus making a change. What will happen if you stay? What will happen if you change? Again, focus on what is important about this—not what other people might think or how they will react to your decision, but what’s in it for you. To enliven this, take a few moments to try on the desired state. Just like trying on a new sweater, notice what this will feel like for you. Notice how your body will feel. Perhaps there’s a sense of relief, a release of physical tension. You may also find that you’re feeling lighter, more energetic, or clear in your mind. Perhaps there’s a feeling of confidence, certainty, and freedom.

    4) Replace the should with “I want to because ___”. Fill in your reasons at the end of this sentence. Whenever your mind takes to a should, go back to this key sentence. Make it a mantra for what truly has meaning for you.

    5) Lastly and most importantly, be kind to yourself. Be patient with yourself. If you fall off your path, avoid the temptation to add more shoulds (and shame) to the situation. Remind yourself that establishing new patterns takes time and the willingness to keep starting anew. Remind yourself that you are an imperfect human amongst other imperfect humans.

    A little self-kindness and self-acceptance go a very long way.

    In conclusion, changing and establishing new habits takes work. Motivating ourselves is something we all have to work toward. But if you want to reach your goals, you’ll motivate yourself by focusing on what’s in it for you to do so. This is the surefire way to build true, lasting, and successful change. With the right combination of factors, it’s more than possible to stay motivated and achieve any goal you may have. 

    Practice these 5 tips and you’ll free yourself from the tyranny of shoulds.  I can almost guarantee that you’ll soon be the one moving forward on whatever goal is truly important to you. The more you practice, the better you will become at creating exactly what it is you desire. And the better you get at creating your desired states, the more successful and happy you will be in life, in every possible way.

    It’s a VUCA Time in Healthcare

    I don’t have to tell you that these are complicated times in the world. The pandemic. Global warming. The war in Ukraine, and violence in many other parts of the globe. Inflation. Growing levels of inequity. The Great Resignation.

    In healthcare, in particular, these are very complicated times. The pandemic has brought to light many of the problems that were already brewing below the surface. Under resourcing. Shortages in staff. Negativity and discord. Burnout.

     It’s no surprise that the term VUCA is being used more and more to describe what’s occurring in healthcare. It’s a term that first arose in the military following the 9/11 attacks, and the same term is all too applicable to healthcare, everywhere on the globe.

    What Is VUCA

    We can think of VUCA as a big, tangled mess. A mess that is occurring in healthcare and elsewhere.

    V is for Volatility

    Upon an already stressed healthcare system, the pandemic brought with it many rapid and challenging changes in healthcare. Volatility is at bay in many ways but is most evident in the high levels of attrition and turnover we’re seeing — in physicians, nurses, technicians, therapists, and even in those who clean patient rooms.

    Indeed, a recent article in the Mayo Clinic Proceedings shed light on this issue. Looking at more than 20,000 respondents at 124 institutions, the study revealed that one in five physicians are planning on leaving their position in the next twelve months. For nurses, intent to leave was present in 40%. For advanced practice providers, 33%. This means a great deal of turmoil in hospitals and outpatient medical settings. It also raises questions about the sustainability of the entire enterprise.

    This “Great Resignation” in healthcare is something I was quoted in earlier this year in over half a dozen major news venues. While I was happy to be involved as an expert on the topic, I, like others in the field did not have a lot of tangible solutions to stem this tide.

    U is for Uncertainty

    With all this change, there is a massive sense of unpredictability and uncertainty about what will happen next.

    When will the pandemic end?

    What difficulty will come next?

    How will we do our jobs without adequate staff to support our efforts?

    What will the new normal be?

    C is for Complexity and Chaos

    The level of complexity in healthcare these days is almost inconceivable. So many moving parts. So much dissatisfaction and burnout. So much chaos. And the complexity and chaos have contributed to what can only be thought of as a giant vortex of negativity pulling all of healthcare into its hold.

    Additionally, there is so much change occurring that it has the makings of a dark joke:

    You work in a major urban area where you are in competition with the other major medical practice across town. You leave for a well-needed vacation on a Friday and return a week from Monday only to find that your health system has been acquired by your that practice. Guess what? Now you have to work side-by-side with the clinicians who were just 2 weeks ago, your biggest adversary.

    I hate to say it but, it can seem that, with all this VUCA, the joke may be on all of us in healthcare…

    A is for Ambiguity

    At the end of the day, we don’t know what all the changes in healthcare mean.

    What does all of this mean for my current situation?

    What does it mean for my future?

    If this continues, who will be left to take care of me and my loved ones?

    It is truly an ambiguous situation.

    Since many of us are experiencing a VUCA reality, it’s important to understand the impact it has.

    Certainly, a VUCA environment is both a disrupted and a disruptive one. It impacts all of us, doctors, nurses, technicians, therapists alike. Patients are certainly not spared. It can leave us:

    • Feeling unstable and ungrounded
    • Unsure of how to react to all the changes that are occurring
    • With lack of clarity on what our role is in a rapidly changing system
    • With reduced motivation to take actions that contribute to the greater good

    Most importantly, living and working in a VUCA environment can leave us fearful, reactive, and feeling out of control. This means that our limbic system is frequently activated, taking us into a fight/flight/freeze state. Unfortunately, in this state, we’re trapped in survival mode. And survival mode means that our world narrows, and that we are reduced to looking out for #1, ourselves. When we’re looking out for #1, we invariably have less left over to give to others. And yet, perhaps VUCA times require a greater degree of leaning into connection and shared community than ever.

    So, what can you do? 

    Let’s Look At 4 Ways To Overcome Uncertainty

    While the challenges of a VUCA world can seem inescapable and insurmountable, there are a number of steps you can take to manage yourself so you still show up in ways that you feel good about. So you can look back and feel proud about yourself and your actions.

    A mindful approach can help you hold steady amidst these challenging times. Here are 4 mindfulness strategies you can employ.

    1. Embrace uncertainty

    When you stop and think about it, uncertainty and change are the only things that are certain. Impermanence is one of the basic laws of our world.

    After all, everything changes. Our relationships change. Our kids grow up and change. Our bodies age and change. Our environments change. Our planet changes.

    All too often, however, we forget this basic truth. We somehow expect things to be predictable and stable.

    The problem is that this expectation sets us up for difficulty. It leaves us struggling unnecessarily when something shifts. It adds a layer of suffering above and beyond that caused by all the VUCA around us.

    What I’m getting at is that we have a choice. We can meet uncertainty with reactivity or we can meet it with mindful understanding.

    More than meditating on a remote mountainside, mindfulness helps us have the calm, steadiness, and clarity we need to work constructively with all the change and uncertainty.

    At the same time, while we can find ourselves resisting change, we can remind ourselves that it does not have to mean something bad! Just take a moment right now to think of all the difficulties you have faced in your life and work that are now resolved and far behind you. This can help you see how change has actually been quite the positive.

    1. Respond to complexity with compassion

    Even knowing that change is the only thing that is certain, it can still be difficult to weather. Living in such a VUCA time is difficult. You deserve compassion for managing all the challenges.

    With mindful awareness, we can bring ourselves compassion for what we’re going through. There is increasing evidence that self-compassion is a powerful antidote to stress and even burnout. From where I sit, I think that it is actually one of the most powerful medicinals available to us.

    How to Respond to Physician Burnout in a Colleague

    Physician Burnout in a Colleague

    Dealing with physician burnout in a colleague

    Two hours of administrative tasks for every hour with patients. A proliferation of non-physician administrators deciding how the day is going to run. Little in our training about how to cope with uncertainty and change. It’s no surprise that physician burnout rates are approaching 60%. Despite being so common, when we see a colleague struggling with physician burnout, we may not know what to say. Responding appropriately can bring someone back from burnout and may even save a life. Here are some tips to help with physician burnout in a colleague.


    Approach the situation with compassion

    Burnout is often referred to as erosion of the soul, and for good reason. With it comes a great sense of despair, hopelessness, and isolation. We lose our perspective.

    Often there is no better remedy than the kindness of a colleague, someone who has walked in our shoes and knows what we’re experiencing. Approach the colleague with the empathetic aim of letting them know that you care about them, you’ve noticed that they are struggling, and you’re there for them. Afraid of saying the wrong thing? Here are some ways to convey your concern.

    “I can see you’ve had a rough week.”
    “I’m concerned about you.”
    “I get why you’re feeling this way.”
    “I don’t have answers but I want you to know I’m here and I care about you.”
    “You deserve to feel better.”
    “I know these feelings will pass.”


    Normalize the experience

    With burnout comes a sense of personal inadequacy. Everyone else seems to be coping with all the stress. What’s wrong with me? Tell your colleague that what they’re experiencing is normal and that many physicians are having the same feelings. Let them know there’s nothing wrong with them. Make it clear that these harsh feelings do not mean that they are a failure. And, no matter what they’re thinking, that experiencing physician burnout is a normal response to the stressors of modern practice and doesn’t mean they’re in the wrong career.


    Don’t problem solve or give advice

    As physicians, we’re conditioned to fix whatever problem the person in front of us has. It is quite literally what we are trained to do. But with burnout, we need to suspend our desire to problem-solve. Instead of doing something, we need to focus on simply being present with a colleague’s suffering.

    On that same note, we also need to avoid giving advice. Giving advice sends an implicit message that the person doesn’t have the inner resources to solve their problem. Not only that, but the last thing someone wants to hear when they’re low on energy, overwhelmed by demands, and disconnected from any sense of meaning is “I know how to solve your problem, here’s what you should do.”  Simply listening without suggesting any action can help someone in burnout begin the critical step of gaining perspective on their situation.


    Help them connect with their accomplishments

    When we’re in burnout, we’re focused on everything that’s wrong, with the workplace and with ourselves. We’re disconnected from meaning and purpose. Positives slide off us like Teflon and negatives stick as if attached by Velcro. Whatever our strengths and accomplishments may be, we believe we have none. It’s critical to find a way to reconnect with the things we are accomplishing.

    Ask your colleague if they’d consider keeping a running list of three things they accomplish every day. This simple exercise can provide ballast against the pull to inadequacy and negativity, and potentially help relieve some of the symptoms of physician burnout.


    Let them know seeking help is not a sign of weakness

    We learn early in training that seeking help is a sign of weakness. We’re the head of the team and we’re supposed to have all the answers. Yet, we can’t solve every problem by ourselves (no one can.) Reassure your colleague that asking for help is a sign of health, not weakness. Recommend that they speak to loved ones and other colleagues. Encourage them to seek coaching or other professional help.
    While you can’t change the external landscape, know that applying these tips can make a big difference in a colleague’s ability to see a way forward.

    In summary, remind yourself to listen compassionately. Normalize their experience. Avoid the temptation to give advice or problem-solve. Help them see their strengths and accomplishments.  Let them know that seeking help is often vital and is not a sign of weakness. Reassure that they can find a way to meet the intense demands of practice with much less anguish.

    Get more resources on physician burnout.

    Physician Burnout: Are You Engaged Yet?

    When you wake up in the morning, are you ready to take on the day, or do you want to pull the covers up over your head and crawl into a cave?

    As noted in a recent  New York Times  article, “Why You Hate Work,” a 2013 Harvard Business Review study of 12,115 white-collar workers revealed that 70% of workers do not have time for creative or strategic thinking at work, and 50% do not find meaning and significance in their workplace.

    This problem of finding purpose or engagement at work affects all white-collar workers, including physicians in nearly every specialty and field. A pioneer in burnout research, Christina Maslach defines burnout as a three-dimensional syndrome made up of exhaustion, cynicism, and lack of sense of meaning and accomplishment. Does any of this resonate for you or the physicians you know?

    As a physician coach, I have worked with many clients suffering from physician burnout who are not only dissatisfied in their work, but feel disillusioned and without purpose.

    I recently worked with a mid-career neurologist who was frustrated by the never-ending changes in her workplace. It seemed as if the rules changed by the week, with hard-to-understand updates to the EMR, and rotating practice managers, one more challenging to work with than the next. My client became so lost in frustration and negativity that she wondered why she was even practicing medicine anymore.

    Engagement is the antithesis of physician burnout, and is defined as a positive, fulfilling, state of mind characterized by vigor, dedication, and a sense of flow in one’s day.

    The New York Times article points out that employees are more satisfied and productive when their foundational needs are met, including creativity, value, and a sense of connection and purpose at work.

    When engaged, white collar employees are more motivated, feel more personally invested, and tend to become absorbed in their work. When they come up against challenges, they are inspired to find creative ways to problem-solve. In addition, these employees find greater work-life balance, and have an overall sense of optimism and happiness. This is critical for physicians, given that they experience levels of burnout of 30-60%.

    Engagement is increasingly recognized as vital for self-determination and productivity in the workplace. Organizations that encourage employee engagement are experiencing higher profits, improved safety records, and higher retention rates. Simple workplace measure such as providing breaks and acknowledging hard work can go a long way in increasing engagement.

    Through physician coaching, my neurologist client experienced renewed motivation to effect change in her workplace.  She pushed leadership to develop a wellness committee. We worked on many strategies to help her manage the changes and stresses of her position. Over time, she learned to focus more on her strengths, celebrate small daily accomplishments, and gradually re-engage.

    If you find yourself overcome by disengagement and burnout, please check out my new FREE ebook, Building Your Resilient Self: 52 Tips to Move from Physician Burnout to Balance. I created this resource specifically for physicians. In the book you’ll find specific strategies to prevent and counter physician burnout.