#92 You Can Decide How You Feel?
Yes, even if you work in a medical clinic or hospital.
Arthur C. Brooks and Oprah Winfrey have co-written a book to come out soon and an excerpt appeared this week in the Wall Street Journal with the title, “The Power to Decide How You Feel.” The back story on this collaboration must be fascinating indeed. An alliance of these two thought leaders commands a reach and legitimacy that few people can command.
Oprah has long been an advocate for self-discovery and improvement. This essay reminds us that some problem or situation that arises in our lives, causes unhappiness or some other negative emotion, not by its very existence, but by the thoughts that we have about it. The afternoon rain storm is an event we cannot control. The bride and groom are disappointed about their soggy wedding venue. The gardener is elated that his flowers will get some much-needed water. Our thoughts about the storm or any other circumstance, cause our emotions.
By working backwards, Professor Brooks and Ms. Winfrey advise that by examining your thoughts and changing them, people can feel better. The authors term thinking about our thoughts: metacognition. I think and write about this as awareness of negative thoughts. If we can re-direct or guide our thoughts to be positive or at least neutral, the emotions that result feel a lot better to us.
Unsplash photo by Freddy Mishiki
Can the approach Brooks and Winfrey write about be applied to the medical workplace?
Yes.
I write about applying this concept to the strained relations that doctors, nurses, and clinical care professionals have with some (studies say 15-20%) of our patients and their families. Their disruptive behavior, unreasonable demands, nonadherence to our plans, or inability to keep appointments become situations or circumstances beyond the control of the doctors and nurses. The patients and their families get labelled as difficult. It would be lovely if folks followed the plan, behaved graciously, and thanked us at the end of every encounter. That delightful fantasy shatters rather quickly when young clinicians enter the real world of the clinics, hospitals, and emergency departments.
The way physicians and nurses feel at the end of their shifts is more than a matter of work dissatisfaction and unhappiness in the medical work force. This issue with difficult patient interactions is just one problem to be faced by workers in today’s flawed healthcare system. Feelings of guilt, shame, and hopelessness drives professionals to over-drink, abuse substances, and end their lives by suicide. The rate at physician suicide in our country is about one per day. This is a national tragedy. I believe that my colleagues are suffering more than they should.
Some clinicians choose to address the negative feelings that they have about some “difficult” patient interactions by deleting the relationship. Office based physicians can “fire” a patient and dismiss that person from their practice. Some nurses change their jobs so that they deal with a different sort of patient or cease to work in patient-care at all. In my lengthy career as an emergency physician, I was obligated legally, professionally, and morally to treat every person who presented to the department, no matter how problematic my interactions with them became.
The best approach, I believe, is to change the way we think about our difficult patients. I have made it my mission to write and teach about this concept to as many people who will listen. Changing our negative thoughts about some of our patients and their families will lead to more positive feelings of acceptance, empathy, and understanding. As Professor Brooks and Ms. Winfrey say, we have a lot more power over our emotions than we think.
To gain power over the negative emotions in our lives, we need to change the thoughts that cause them. The approach is used in cognitive behavioral therapy and in the field of life coaching. In their essay, Professor Brooks and Ms. Winfrey make some suggestions as to tools to use to achieve more emotional control in some general work and life situations. In my book, Changing How We Think About Difficult Patients: A Guide for Physicians and Healthcare Professionals, I take a deep dive into the specifics of patient care and the patient-clinician relationship. Those relationships are special because they are guided by basic ethical principles and legal codes. We take oaths to do no harm and to do what is best for our patients.
photo by American Association for Physician Leadership
Our patients have both typical and unique issues that prevent them from taking the medicines, making the appointments, or giving up the cigarettes. They have traumas and stressful experiences that we can never know or understand unless we consider them and ask. Clinicians get their back up about patients ignoring advice or defying them. Clinicians can get frustrated, intolerant, and cynical. It does not have to be this way.
So much of the negative judgements about patients that are baked into our healthcare system are so widespread, that we no longer see them as just thoughts. We think we are just observing the truth. For example, a thirty-year-old man who shows up in the emergency department intoxicated every weekend gets labelled as just another irresponsible drunk. Most staff members share the same terrible thoughts so it seems that this is the truth. It is not. The negative thoughts results in feelings of annoyance and disgust with the patient.
The very negative thought about the intoxicated man can be moved in a positive direction by remembering that he is someone’s son. By remembering that he is someone’s son, a change of thoughts, the staff can feel more curiosity and compassion as to why he keeps showing up and making sure he has no other injury. The first step to changing our negative thoughts is becoming aware that we are having them. And by the way, let’s not beat ourselves up about having negative thoughts. We are only humans and human clinicians sometimes have negative thoughts.
Doctors, nurses, and other clinicians find ourselves with other typical and unhelpful thoughts. We try to fight reality by wishing things were different and the patient should not have come to the emergency department. We believe that there is only one way to solve the problem or do the operation. We take on the role of the victim and villainize the patients, their families, the system, or the insurance companies. I discuss how clinicians can become aware of their unhelpful thoughts and begin to change them. Like starting an IV line or repairing a laceration, it takes practice to learn the skill of changing thoughts and beliefs held for a long time.
So, start with reading the WSJ essay and perhaps take a deeper dive into the book of Winfrey and Brooks. If you are a nurse, physician, EMT, or anyone who takes care of patients, you may find my book to be just the nudge that you need to start changing your thoughts and feeling better about work. I am pleased to announce that my book is also available in both Kindle and audio book format through Audible on Amazon. At under four hours running time, your commute time can be well spent improving yourself.
