Jillian Horton: You have been coaching physicians on performance for more than a decade. What are the most common issues that you see?
Jason Brooks: Fear of failure is a huge issue. When you consider the cost of failure in medicine, you can see how that manifests: you try too hard, you overextend yourself, you work yourself to the bone. Ironically, this puts you in a state that makes you more susceptible to failures and setbacks. Not setting boundaries is another big one. I hear so many people say, “I just feel like a pinball, I have no control over my schedule.” Once that mindset creeps in, we feel even more of a diminished sense of enjoyment and control. Helping people break through to set boundaries allows them to reclaim some of their life.
JH: What do you think about pursuing “balance” as a goal?
JB: This is not a 9–5 lifestyle. It’s not a job that’s conducive to the traditional concept of balance. To me, balance is more about being mindful of the time and how you use the energy you do have. When it’s time to work, be all in and focused. When it’s time to be away from work, you have to get good at learning to transition and shifting your attention and energy to be fully present. There’s so much fatigue in medicine that can be challenging. But it’s even more important for physicians than in many other performance realms because the downtime you have is quite short. So, being able to optimize the time you have by shifting your attention and energy effectively is critical.
JH: How should physicians approach transitions in day-to-day life?
JB: We have to prepare to transition. There are various things you can do. I know of people who don’t leave the office until they close all their devices and jot down a few things they need to do tomorrow. That cognitive offload allows them to detach from work until the next day. Another approach is taking 5 minutes to prepare before you step into the house. Small things like that help us create the experience that we want.
JH: How can physicians use rehearsal to achieve high performance?
JB: If you have better control of your emotions you have a much better chance of accessing all your cognitive skills. Doing some rehearsal inoculates us. We’re not eradicating feelings; we’re getting ready to meet those feelings in a way that allows us to quickly bring arousal down and regain focus here and now. So, the process would be to envision some situation in which it’s difficult for you to feel, think and perform optimally. Sit down, get relaxed, play it through, collect the data and observe. Play that scene through again with much more attention to detail. The mind doesn’t necessarily differentiate between what’s “real” and that which we are just perceiving. So, there is an absolute observable training effect just from rehearsal.
JH: We know that organizational factors drive burnout. What role do you think the individual plays in dealing with it?
JB: In spite of the system issues, how many people can really say they are absolutely doing all that they can from a personal responsibility angle? Nobody can. That’s not incitement. The challenge is that you’re in a field that needs you to be self-disciplined more than anybody. And it’s small things. If you look at elite sports — take the best hockey players in the world — what separates the very good from “exceptional”? It’s not much. A 1% difference in speed or accuracy at that level is magnified. This is not about doing more but about recognizing that engaging in certain habits, certain behaviours and routines, is the way to reclaim the things you don’t have enough of … time, energy, engagement.
Footnotes
This is an excerpt from a longer podcast. You can listen to the full interview here: cmaj.ca/medlife
JASON BROOKS, PhD, is a mental performance coach who works with high performers, including elite athletes, tactical law enforcement officers, musicians and doctors.
The interview was conducted by Dr. Jillian Horton, director of the Alan Klass Health Humanities Program at the Max Rady College of Medicine, University of Manitoba, Winnipeg. She hosts Med Life with Dr. Horton on CMAJ Podcasts.
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