What’s one of the biggest complaints we physicians have about the current state of our jobs? It’s that we’ve lost our autonomy, that it has been taken from us by a health care system more focused on profits than on the well-being of patients and ourselves.
As a physician, you know firsthand how dysfunctional health care has become. There is abundant evidence that the modern health care system is more than broken, and there is no question that autonomy over our working conditions has been vastly eroded. We spend hours on below-grade tasks, see dozens of patients in a day, and toil away charting when we could be helping people or spending time with our loved ones.
We spent 10+ years training for our white coats, and now that we wear them, the profession is nothing like we thought it would be.
The system is broken. But it isn’t changing any time soon. So to reclaim happiness, we have to focus on what we can control and let go of what we can’t.
How many times do you find yourself railing against the system, having an internal shouting match about how unfair it is that you have to spend hours catching up on charts or fighting with an insurance company to get your patient the expensive med they need?
How often do you find yourself thinking there’s no way you can be happy given the power that has been taken from you?
You’ll only be happy when the system changes and your autonomy is restored. Or when some other future event comes to fruition.
I call this the I’ll Be Happy When disease, or IBHW. It’s not in the ICD-10 (or the DSM-V), yet I’ve seen this malady afflict almost every one of the over 500 physicians I’ve coached in the past decade.
IBHW afflicted a physician I’ll call Lila, a forty-one-year-old pediatrician, who found herself stewing much of the time, experiencing so much anger toward her practice manager, Joanie, that her jaw tightened to the point that she was sure that she was developing TMJ. On top of the dysfunction around her, Lila multiplied it by handing over her happiness to the broken system.
A year prior, one of Lila’s partners had retired, and recently, another had developed long COVID and was out on extended leave. Recruitment efforts were in place but thus far had borne no fruit.
There were now only four doctors doing the work of six. However, the patients still needed to be seen, so her schedule was frequently overbooked. Lila was willing to accommodate the increased patient demand, but nothing had been done despite asking her practice manager, Joanie, to rearrange her schedule to make it more manageable. Lila railed in frustration and anger every night over dinner with her husband, a nurse at a nearby hospital. Her anger would fuel his, and their moods would spiral together. She was convinced that she would only be happy when Joanie left, or she did.
Lila felt a growing sense of acrimony toward Joanie. She found herself thinking, I can’t believe she isn’t changing my schedule! She’s treating me really poorly. If she’s not going to help me, then why should I be nice to her? When she’d pass Joanie in the hall, she didn’t make eye contact, wouldn’t say hello, and barely acknowledged her presence.
Unfortunately, Lila’s anger was not getting Joanie to do anything differently, and it was not improving her schedule. In fact, Joanie started becoming spiteful in her own right. The more Lila iced her out, the less sympathetic Joanie became. When working on the department schedule, Joanie went out of her way to discount Lila’s requests.
Reading about Lila, you likely noticed how much she let a bothersome coworker impact her mental state.
Granted, having a coworker you have difficulty getting along with, let alone someone who controls your work schedule, is challenging. At the same time, we can mindfully recognize that conflict with people we have to interact with regularly or who have power over us is an aspect of nearly all our lives.
What we see, however, is that instead of becoming more resourceful in dealing with Joanie, it was Lila’s very actions that were making things worse. Grinding her teeth and acting out with Joanie was only leading Joanie to react in kind. It was challenging enough having four physicians doing the work of six, but Lila’s mounting standoff with Joanie was digging her into a deeper and deeper ditch of discontent. Unknowingly, Lila had given over much of her contentment and power to someone she didn’t even like.
Lila’s anger and acrimony towards Joanie only worsened her situation. Let’s see how this plays out when the enemy isn’t a challenging administrator but the health care system. Railing against it and harboring resentment may not result in a direct backlash, but in the end, only serves to sap our energy. In many ways, the challenging administrator is a powerful metaphor for all that we can’t control in health care, yet we shouldn’t fall into letting the dysfunction around us control our happiness. And we definitely shouldn’t predicate our happiness on an event that may or may not occur (in this case, Joanie’s departure).
It’s no surprise that we’re conditioned toward IBHW. Throughout our decade-plus journey through medical training, we implicitly believe that each subsequent checkpoint will result in greater happiness. I’ll be happy when I finally get into medical school. I’ll be happy when I finally get to my residency. I’ll be happy when I finally finish training and become a full-fledged attending.
Unfortunately, the future is often quite different than we anticipate.
Think for a moment about times when you may have fallen into this very same pattern. Consider, for example, something you have been looking forward to yourself. Perhaps you’ve been struggling to manage the demands of your work and are telling yourself, I can’t wait to go on my vacation. I’ll be so happy once I’m there. You find yourself imagining how blissfully happy you’ll be lying carefree on the beach sipping a mimosa while your kids happily build castles in the sand. But once there, the weather is poor, the mosquitoes are out, your youngest has tantrums, and your mind is so absorbed with work that you can’t actually unwind and enjoy the trip.
As this example illustrates, we can be focused on an imagined ideal, sure that it is exactly this thing that will bring us happiness, but sometimes (read: most times) things don’t turn out quite the way we plan. Or we may reach the imagined ideal, only to feel dissatisfied and have our mind establishing a new guidepost that we believe will deliver the missing happiness. In truth, we can’t ever truly know what the future will bring, and we can’t know whether what our mind is telling us will make us happy will truly do so.
There will always be dysfunction and imperfection in our lives. Be it a broken health care system, a spiteful administrator, or a flawed vacation, we’re committing to being unhappy today as long as we predicate our happiness on some future conditional event.
So here’s the thing:
It’s up to you whether you hand over your happiness to a broken health care system or not.
You can spend your time in IBHW thoughts and beliefs, imagining a world different from the reality we live in today where the system is magically fixed (not coming any time soon), or you can focus on that which you can control. It’s an uphill battle. The system was not designed for your well-being. This is why focusing on reclaiming your autonomy and happiness through focusing on what you can control is what we all need to do.
You’ve invested over a decade and likely upwards of a quarter-million dollars in your career. This has the potential to be a wonderfully fulfilling profession where you impact human lives and are enriched mentally and emotionally. Don’t let all that fall to the wayside because of a broken system. Be mindful. Claim your happiness in spite of it.
Gail Gazelle is an internal medicine physician, physician coach, and the author of Everyday Resilience: A Practical Guide to Build Inner Strength and Weather Life’s Challenges and the forthcoming Mindful MD. 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout.