I created this slide as part of a talk I gave at the University of Saskatchewan's Emergency Medicine winter retreat. I thought that I'd share it and some reflections here.
During the talk I used my own personal experience as a burning-out PGY3 resident struggling with issues of fatigue and low sense of accomplishment, self doubt, compromised relationships, lack of wellness and a decreased sense of purpose. Sound familiar?
It's only a few years after the fact looking back on things that i realized that I was burnt out, unwell, unaware and living in a horrible environment! I wish I knew then what I knew now. The diagram above represents what in coaching circles we refer to as the 'Logical Levels of Self' [adapted from the work of anthropologist Gregory Bateson].
Struggling Nadim was stuck at the bottom of this pyramid - questioning the choices he had made to get him to this point. He was perseverating on the negatives and oblivious to how far he'd gotten off his wellness track. He was living in a noisy apartment with construction noise all day and into the night - impeding his ability to sleep. He was also struggling with the cultural expectations of being the eldest son in an ethnic family.
“I am stressed and exhausted. I feel like I can’t accomplish anything. I feel like a failure”
“I should be smarter and more efficient. I don’t have what it takes ... maybe I need to work more shifts so that I can get better | smarter | tougher”
Little did he know that he unwittingly built this basement that he was living in piece-by-piece with his beliefs, blindspots and lack of introspection and self-awareness.
While he had some idea of his skills and capabilities, he really didn't know his strengths or inner resources. He had never learned how to deal with his emotions or to have courageous conversations. He had never learned to deal with his inner critic. At some point in time he may have had a vague sense of what was important to him, but like most people he’s never really sat down and reflected deeply on this. Fast-forward to where he is right now – questioning his sense of self, his ability and role in life.
I wish I had the chance to coach this young man. I hope that all future Nadim's won't even need a professional coach, because this stuff will become 'baseline knowledge' in medicine. In order to build your life from the inside out ... you first need a 'home inspection' of your Logical Levels pyramid:
Get to know your basement:
Understanding your pyramid begins with spend some time looking at the basement you've created. You need to have a good realistic grasp of your environment. While it's important to understand some negative aspects [such as the ambient noise and how it was affecting Nadim above] I want you to shift the focus onto all of the positive things. Appreciate where you are and the good things you've accomplished. Get a good sense of the tasks in your life that require prioritizing. The most important of these is self-care.
Understand your capabilities:
Everyone I have coached is universally blind to some of their strengths. You got here somehow - reflect on what it takes to make you achieve. Look at other areas of your life where you have more agency - this will make you more aware your strengths.
Learn how to deal with your inner-critic:
Everyone I have coached is also hampered by negative self-talk. Your inner critic has served a valuable function in your life, but if you want to excel you need to be in the driver's seat. Acknowledge these thoughts, but choose to accept or refute them.
Learn how to deal with people - including yourself:
Read up on emotional intelligence and courageous conversations. Reflect on situations that made you emotional. Ask yourself why? What does it say about what you value? How might you do things different? [Hint: go easy on yourself - you're only human]
If you want a better basement start from the top:
You might not know your purpose in life, but you still need to ask yourself some tough questions. Understanding what you are about and what you value takes time. Sometimes what you think you value is just a 'surrogate' marker for something else. Think deeply. Strip away the layers so that you have a list of your core values. Challenge your firmly held beliefs - why do you believe these 'facts'? I read a book called The Four Agreements. The biggest pearl I found in there was that we inherit many of beliefs from our well-meaning parents. We never had informed consent about these. If you could clear the slate and go to an app store of beliefs today- which ones would you download? Your purpose should start to become more clear to you as you reflect on these things.
Once you've done all the mental footwork the rest comes easier - you just need to nudge yourself forward. Align your actions with the things that you value. Play to your strengths and start winning :)
Depressed doctor: www.medscape.com article
Call to action: www.overpass.co.uk
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As CLinician educator
This is where I share my experiences as a clinician educator.