The hidden reason you struggle with your charts and what you can do about it

For most clinicians, this will sound familiar:

I can feel the resentment bubbling up as I sit down to chart on a beautiful Saturday afternoon. I’ve got dozens of charts hanging over me, and if I don’t get them closed, there will be yet another miserable head thrashing with my practice admin. My kids are clamoring for my time, and every fiber of my being is resisting getting these charts done. The minute I login, though, I hear the familiar self-critical voices shouting inside my mind:

You’ve never been very good at this, anyway.

Everyone else is so much efficient than you.

Why can’t you just get your charts done like everyone else?

What is wrong with you anyway?

It turns out that many physicians have these painful inner messages. We can be our harshest critic, saying things to ourselves that we’d never say to a colleague or friend. For one physician I coached, it was the voice of an attending from his intern year, telling him that he’s not shaping up. For another, it took the form of a harpy looking over her shoulder, wagging a finger of blame and shame. Sometimes so prevalent that we don’t even notice it in the background, and at other times, it’s like there’s an inner bully constantly judging and finding us at fault.

This inner chitchat wears us down. But many of us believe we need to be harsh with ourselves or we won’t achieve anything, that we have to berate ourselves, we’ll devolve into a slothful mess. But does this negative messaging truly help us get through the load of charts more effectively, or does it just drag us further down?

Criticism or kindness: Which motivates you more?

Let’s try a brief exercise to find out. Visualize yourself sitting down to chart. Bring to mind your computer screen and where you would be working as if you’re there right now. Start by telling yourself that:

You don’t have what it takes to get them done.

You are nowhere near as efficient as others.

You’re  not as smart as your peers.

You’ll be lucky if you ever get on top of your charts.

Now rate your level of motivation on a scale of 0-10, where 0 equals no motivation, and 10 equals “Let me at it!” Write down your number.

Now, visualize the same charting experience. This time, tell yourself that:

You are great at charting.

You level of efficiency is just fine.

You are an outstanding physician.

You have exactly what you need to excel in charting and in your career.

Now re-rate your level of motivation on the same 10-point scale and see if your number went up, down, or stayed the same. Most physicians see an increase in their level of motivation.

In other words, those negative inner messages do the opposite of motivating you to improve.

Self-compassion can reverse the cycle

Another approach is to treat ourselves kindly, just as we would a close friend. This approach is now well-established and has a large body of research to support it. Numerous studies show that people who practice self-compassion cope better with difficult situations, experience less fear of failure and have greater overall life satisfaction. Self-compassion also benefits our physical health, including decreased severity of chronic pain, decreased alcohol consumption, and increased regular exercise. In addition to these benefits, self-compassion improves our ability to practice productively, increases joy in caring for our patients, and builds resilience to our careers’ pressures.

After all, you likely have quite a bit of compassion for your patients. If you don’t have it for yourself, there can be a sense of separation from those around you, as if others are worthy of compassion and we are not. Over time, this depletes our inner well of resilience and contributes to burnout and exhaustion.

With self-compassion, we see that suffering is occurring. Ours. We remind ourselves that suffering is part of everyone’s existence. We learn to greet our own suffering with kindness.

And while we might consider self-compassion too soft, weak, or selfish, none of that is actually the case. In fact, it may very well be the opposite.

Take a self-compassion break

You can build compassion for yourself with what is known as a self-compassion break. Employ it whenever you’re having a difficult time, come up short on a task, or notice something you don’t like about yourself.

1. Bring to mind whatever difficulty you’re currently facing and see if you can actually feel the stress and emotional discomfort in your body.

2. Put your hand over your heart and feel the warmth of your hands. Say these words to yourself:

  • This is a moment of suffering.
  • This is hard.
  • This is how it feels when someone is going through what I’m going through.
  • Suffering is part of life for everyone.

3. Now say the following to yourself:

  • May I be kind to myself in this moment.
  • May I give myself the compassion I deserve.
  • May I learn to accept myself as I am.
  • May I care for myself just as I would a loved one or dear colleague in need.

If you find it difficult to direct compassion towards yourself in this way, imagine what you would say to a good friend or loved one is going through what you’re going through.

This practice can feel very foreign, almost contrived, and artificial. If it felt uncomfortable, that’s likely because you’re used to being less than kind to yourself.  Yet, it is a muscle we can build, bringing ourselves the same care we so readily bring to our patients. Perhaps you can try it out for yourself and see.

Gail Gazelle is an internal medicine physician and the author of Everyday Resilience: A Practical Guide to Build Inner Strength and Weather Life’s Challenges.

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