A few months ago I had been getting emails from the pharmacy that a very important medication is due for a refill. But it wasn’t. I had already refilled it. Initially, I just ignored it, secure in this knowledge. Then, daily messages came, each one making me more tense. Eventually, I had to brave the phone tree from hell to straighten it out.

What started as a mere annoyance gradually escalated into a genuine source of stress. Despite knowing that I had just refilled it, getting daily messages telling me I wasn’t doing it right brought back memories of implied or overt criticism from medical school and training. 

Then a few weeks later, I had a conversation with a client. She was experiencing stress and potential burnout during her days in the office. As a dedicated physician, she usually enjoys seeing her patients (although charting is a different story.) But lately, that’s changed. 

She is Family Medicine and sees many patients with complex medical histories. In her previous independent practice, she knew her patients very well. But since becoming employed, she sees many new patients every day who often need or have needed lab work. imaging, and consultations. 

She has no control over where these studies and consults are completed. Nor is there a way to see where they were done and often the results are not yet in the EMR if done outside her system. It’s not easy or fast to get the information while the patient is in the office. Like many practices, short staffing during the pandemic has wreaked havoc, and systemic problems like this haven’t caught up.

She expressed the overwhelming feeling of “Oh crap! I should know all this stuff!” that hits her multiple times a day. She expects that information to be in the EMR and so do her patients. By day’s end, she’s exhausted and demoralized by all the times she feels her knowledge of the patient’s situation has failed her. In addition, she feels that her concentration is also lacking.

We explored some practical ideas to improve this situation, including leveraging the EMR, optimizing her staff’s support, and fostering patient involvement.

These practical solutions may help, but like a pill that only treats a symptom, it’s not treating the underlying problem.

The real problem is the critical voice in her head constantly berating her for not knowing everything. It interprets any knowledge gap as a personal failure, triggering an instinctive emotional response. 

Since childhood, not knowing has been synonymous with failure. Being incorrect is a failure. Anything other than an A+ knowledge base and performance is a failure. 

And failing is a trigger, if not THE trigger. The trigger that you are not enough. You haven’t been enough and if you only worked harder, longer, and more diligently you could be.

The trigger may be activated externally, like in my case. Or internally from the inner critic’s messaging. 

And when you are triggered, you respond solely from the emotional side of your brain. The immature emotional brain. Higher cortical functions, like logic and perspective, are unavailable. The ability to listen to reason is totally offline. The ability to respond is offline. You just react.

To get out of reactivity, you need to regulate your nervous system, which can be as easy as taking several deep breaths, listening to music, and talking with a loved one or coach who is already well-regulated. 

Have you ever experienced venting to a friend only to find yourself more agitated by the end of the conversation? Venting can be a way to relieve stress at the moment, but it’s best done with someone who isn’t having that same stress response if you want to restore equilibrium. 

The other reason self-regulation is crucial is that dysregulation accumulates during the day. One “Oh Crap” moment easily leads to a cascade of “Oh Craps” that build upon each other, intensifying the ease and volume of being triggered. Ultimately, this leaves you exhausted and emotionally drained at the end of the day. 

So what’s the long-term solution?

Firstly, develop an awareness of your triggers and recognize your triggered state. Then you can address it more promptly during the day to avoid the compounding effect. Determine what methods you can employ to regulate during the day.

Secondly, proactively address potential triggers in your daily life by devising creative strategies to address them before they happen. 

For instance, providing clear verbal and written instructions to patients regarding the information they need to bring in each visit. This sets mutual expectations. To paraphrase Jerry McGuire, “Help them help you.” 

While the system or EMR may fall short, you can teach your staff to better assist you by capturing vital information about what tests they had done since their last visit and where they were done.

It’s essential to remember that the burden doesn’t rest solely rest on your shoulders. And that you personally do not have to know everything to deliver excellent care.

You have help. You are part of a team. The doctor-patient team, the caregiving team, the hospital system team, the unit team, and the operating room team. Ask your team members for help. Empower their contribution and attention. Demand improvements in the EMR and how health information is entered and accessed. Talk to your colleagues about their processes and daily hacks.

By recognizing and addressing your triggers, seeking support, and utilizing your resources, you can regain your sense of agency and calm and avoid falling into frustration and overwhelm.

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