Managing Stress With Coping Strategies For The Perfectionist-Driven Physician

As doctors, we are taught the art of assessing our patients through the doctor-patient relationship. We learn a series of open-ended questions to gain insight into our patients’ values and thoughts regarding their personal health. We learn how to evaluate lab values and make diagnoses. Through all of this, we strive to make optimal decisions for our patients to avoid the legal ramifications of medical errors and because physicians thrive to be the best at what we do. After all, this motivation to help others has propelled many of us through medicine’s demanding training trajectory. Medicine has cultivated the perfectionist mindset in many of us. However, there is a problem with the culture of medicine including feelings of stress, burnout, and physician suicide. This matters not only because it affects us as individuals, but also because caring for ourselves has ramifications for our patients.

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Though our unique skill sets and personalities arguably make us great doctors, these same factors can also be detrimental to our own personal wellbeing. We don’t expect doctors to know how to be doctors before attending medical school. By the same token, medical students should be taught coping strategies and healthy habits. Resilience, or the capacity to recover quickly from difficulties, is something that can be taught in the same way as the art of diagnosis. Many of us, however, lose ourselves in the practice of medicine. We are so focused on taking care of others that we fail to intentionally pay attention to ourselves. We need to learn how to know objectively when we are stressed. There are some great assessment tools to help evaluate stress levels, such as the Perceived Stress Scale or the Maslach Burnout Inventory. Mindfulness meditation, and the recently popularized coaching movement, can also be useful skills to help physicians recognize their thoughts and adjust their mindsets.

For instance, let’s consider a scenario where you are in a job that you absolutely hate. Let’s consider all of the possible scenarios for responding to this situation.

Response one requires problem-solving. Let’s say you are in a private practice position, but you realize that you really miss the ability to teach trainees. Instead of leaving your private practice job, you could instead seek ways to precept trainees from a local academic center or mid-levels in your practice. Though this response may require some upfront work on your part, these creative changes may positively impact your job outlook and career longevity and help fight against feelings of burnout.

Response two involves adjusting your thinking. This type of response requires you to observe your thoughts with the intention of changing your feelings over time. Meditation is a great tool to help you to learn the art of noticing negative chatter in your mind. Meditation teaches us to pay attention to the present moment without getting caught up in past or future events. Though more randomized controlled trials are needed, a meta-analysis found that mindfulness mediation programs can improve anxiety and depression at 3 to 6 month intervals. In the scenario of hating your job, this type of a mindful observation practice could help you feel decreased job stress over time.

Response three describes a skill proposed by Martha Linehan, the creator of Dialectal Behavioral Therapy, called radical acceptance. It is a skill that encourages you to accept reality as it is. You still do not have to like your job, but you can acknowledge that you dislike it without needing a solution to improve it. Perhaps you have other reasons for not wanting to move for a new job (i.e., your kids’ schooling), and you realize that this is the best situation for the current time.

Response four involves leaving the job to find a new one. A pivot such as this can be a fresh start, but it does not address mindset. If you are not clear about the stresses that you are trying to avoid, you could end up with similar thoughts and feelings in the new job.

The final choice, and one that I do not recommend, is response five: Continuing to be miserable. This type of mindset can leave you feeling “stuck” and can result in continued negative thinking and worsening stress over time.

I think it is important to review why perfectionists, including many doctors, are so vulnerable to getting “stuck.” First, as doctors, one of our main attributes is thinking critically. We are smart, and we are taught how to think about complex medical problems, but oftentimes we are so thoughtful that we allow our patients and their problems to occupy our minds. We ruminate about our difficult cases, and our mind is constantly working on overdrive. Without the proper coping strategies, our thoughts can consume us, and we can lose ourselves in the process of doctoring. The second reason why I believe that doctors are particularly vulnerable to stress and burnout is that we are taught throughout our training to never give up on our patients. We are excellent problem-solvers when it comes to advocating for our patients, and we actively fight against failure, often refusing to accept any standard short of perfection. This can cause a significant amount of internal stress when expectations do not match reality. Feelings of shame and failure can become overwhelming and debilitating for the stressed-out physician.

Overall, we need to acknowledge that many physicians struggle with stress and burnout, which can have societal ramifications for all of us. If the pandemic has taught us anything, it has taught us how stressful life can be and how important it is for physicians to be able to cope with changes quickly and resiliently so we can continue providing optimal care for the sick. We also need to be proactive in medical training and teach physicians how to care for themselves, just as we teach them how to care for others.

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