The problem

How can we achieve our goal? Identifying the underlying causes

Many medical students live their lives on "full speed", leaving little time for reflection. We rarely question our routines, because they are exactly that - routines - and we become complacent in following these patterns. We don't leave time to question what we are doing or why we are doing it. We follow the path that others have paved for us. Without realizing it, we adopt unhealthy habits that become detrimental to our own health, and ultimately our medical practice.

First, we outline examples of maladaptive habits and highlight the distinction between lifestyle and thinking.

Informally, when we asked our colleagues to identify their problematic habits, many listed those related to lifestyle. These shortcomings are tangible, simpler to identify and easier overcome by making concrete adjustments to our daily lives. For example, if you judge that you aren't exercising enough, you can do a 20-minute home-workout video; if you find that you are eating in too much take-out food, you can limit yourself to one less meal per week. Unfortunately, these "quick fixes" are superficial in nature. We enter a cycle of constantly trying to improve ourselves and fail to address the underlying issue inherent in these so-called problematic lifestyle habits. Thinking that what we are doing is either too little, too much, not enough reflects a constant desire to strive for perfection, which we believe lies at the forefront of physician burnout. No one is perfect and aiming to fix everything at once is not only unconceivable, but unhealthy. Rather than critiquing our lifestyle, we emphasize the need to identify maladaptive aspects of our cognition.

What are some maladaptive thought patterns?

"Cognitive distortions are thoughts that cause individuals to perceive reality inaccurately." In simpler terms, cognitive distortions happen when what is true (reality) is altered by our own cognition (thoughts).
Psychiatrist Dr Aaron T. Beck has worked for numerous years on cognitive distortions, and is currently an undergirding basis of cognitive behavioural theory.

This website inspires itself of Dr Beck's work, applying it to medical students.
Here are examples of some of the commun maladaptive thought patterns found in medical professionals.

These cognitive distortions lead to negative emotions, which symptomatically express in maladaptive behaviours.
Thus, a maladaptive behaviours/lifestyle is the consequence of our cognitive distortions. While it is easy to address and 'fix' these lifestyle 'issues', we would not be addressing the real challenge at stake.

So, why is it helpful to identify our maladaptive thoughts?

As physicians, a big part of our job revolves around identifying a constellation of symptoms and labelling them. We take the subjective description that the patient provides and turn it into something more concrete: a diagnosis. But why is it so important to name these diseases/syndromes? For our patients, it provides an explanation to their experiences, which can provide a sense of relief after a long investigation process. From a medical perspective, a diagnosis dictates our treatment plan and allows us to act with greater confidence.

Now, we will apply the same principles to our maladaptive thinking. First, we identify a pattern in our feelings (similar to identifying our symptoms). Consider this example: “Every time I watch TV instead of studying, I feel conflicted about my decision and therefore loose pleasure in watching TV”. Next, we label our emotion – a term coined by psychologists as “affect labelling” (similar to naming a diagnosis). In doing so, we can acknowledge our feelings, and consequently, find the tools to manage them. Using this same example, we identify "guilt" as the prominent emotion and can therefore find ways to lessen this emotional burden.

Why do we struggle to identify our emotions?

Although we are trained to be good diagnosticians, we often struggle to correctly name our feelings. Being seen as emotional comes with its own share of stigma, especially in the context of medical training. While we are taught in medical school notions such as empathy, and we are boasted for our altruistic tendencies, we are also taught to be stoic in front of our patients, and show strength in the face of uncertainty. Unfortunately, many physicians find it difficult to let go of this deeply ingrained principle in their personal lives, and far too often suppress their emotions. While it may be adaptive in the short term, it becomes problematic in the long run. Failing to connect with our own vulnerabilities can lead to failed connections with others, especially our patients – in other words, it may hinder our capacity for empathy.

Now that you have the information, try out this exercise!

Set a timer for 10 minutes, grab and pen and paper and answer the following questions:

§ Name 5 things that bring you happiness or motivate you

§ Name 5 things that make you feel sad, guilty or angry

§ Do you have recurrent emotions that you feel are unacceptable?

§ Free style write until the timer goes off