Full Transcript Sponsor Messages and Podcast Introduction 0:00 This episode of the Burnout Recovery Podcast is brought to you by MIGA, your medical indemnity partner. 0:06 Whether you're starting out in your career or have decades of experience, Miga helps you thrive with support that goes beyond insurance. 0:14 Enjoy travel benefits like complimentary travel insurance and Qantas points on your membership, plus education, medical legal support, 0:23 access to career coaching and wellbeing resources. 0:26 Visit miga.com.au to learn more. 0:30 Insurance issued by Medical Insurance Australia, which has not taken into account your objectives or situation. 0:34 Before you make any decisions about our policies, please read our PDS and consider your needs. 0:37 Call us for a copy or visit migo.com.au. 0:39 Busy day, quick question, no time to dig. 0:42 Heidi Evidence brings the evidence to you. 0:45 Clear answers with citations you can trust. 0:48 Completely ad free, unlimited and region aligned. 0:52 Find evidence in the chaos. 0:54 Search heidehealth. 0:56 com. 0:58 Welcome to the Burnout Recovery Podcast, a guiding resource dedicated to healthcare professionals on their journey to overcoming burnout. 1:05 Spearheaded by Dr. 1:06 Joe Brain, certified professional coach and rehabilitation physician.
The Expectation Trap in Healthcare Burnout 1:12 Hello and welcome back to the Burnout Recovery Podcast. 1:15 This is episode number 182. I am Dr. 1:20 Jo Braid, your host, medical doctor of over 20 years, and someone who's spent far too much time trapped in the land of should. 1:29 Today we're diving into something that might be the most insidious contributor to healthcare burnout, the expectation trap. 1:37 You know what I'm talking about, those relentless shoulds that follow us around like shadows. 1:43 I should be able to handle more patience. 1:45 If you've ever felt crushed under the weight of what you think you should do, feeling or achieving, this episode is for you. 1:57 We're going to explore why these expectations are so toxic, what the research tells us about their impact, and most importantly, 2:05 how to break free from this exhausting cycle. 2:09 Let me tell you about Kate, one of my coaching clients, a brilliant emergency physician who came to me completely burned out. 2:17 In our first coaching session, she said something that stopped me in my tracks. 2:22 I should be grateful. 2:23 I have a good job. 2:24 Am helping people. 2:26 Make decent money. 2:27 Shouldn't feel this way. 2:30 And there it was. 2:32 Three shoulds in less than 30 seconds. 2:35 As we talked, more emerged. 2:38 Should be able to work these shifts without feeling exhausted. 2:43 More patient with difficult patients. 2:46 Keeping up with all the latest research. 2:49 The list was endless. 2:52 Now, I recognize this pattern because I've lived it myself. 2:57 Early in my career, in fact, not actually that long ago, less than 10 years ago I still carried around this invisible rulebook of expectations.
Personal Story and Research on Perfectionism 3:08 I should never need help. 3:12 I should be able to handle whatever came my way without showing any signs of struggle. 3:18 I remember having a particularly challenging week when I'd made a minor medication error, caught and corrected immediately with no harm to the patient. 3:27 But instead of treating it as a learning opportunity, I spent days berating myself. 3:34 Should have been more careful, should have double checked a good doctor wouldn't have made that mistake. 3:41 A colleague found me in the break room. 3:43 I was clearly upset and she asked what was wrong. 3:46 When I explained, she looked at me with such compassion and said, Joe, you're a human. 3:53 Humans make mistakes. 3:55 The fact that you caught it and learned from it makes you a good doctor, not a bad one. 4:02 And that moment was my first glimpse into how these shoulds weren't motivating me to be better. 4:08 They were slowly destroying my confidence and my joy in medicine. 4:14 So let's look into the research on this. 4:16 The research of expectations and burnout is fascinating and sobering. 4:22 A 2023 study published in the Journal of Occupational Health Psychology found that healthcare workers with high levels of perfectionist expectations were 2.3 4:34 times more likely to experience severe burnout symptoms. 4:39 But here's what's really interesting. 4:41 It wasn't just personal expectations causing the problem. 4:45 The study identified four main sources of expectation pressure in healthcare. 4:52 Firstly, there are our professional standards, the legitimate expectations of competence and care that come with our roles. 4:59 And these are necessary and appropriate. 5:03 Secondly, peer pressure, what we think our colleagues expect of us. 5:09 This is where things start getting murky because often what others expect isn't actually what they expect at all. 5:18 You never really know what someone else is thinking. 5:22 Third, patient expectations. 5:24 And this has become incredibly complex in our digital age. 5:28 We're not just dealing with traditional patient expectation anymore. 5:32 Now patients come in with AI generated diagnoses, having consulted chat or other AI tools before their appointment. 5:41 They arrive with printouts of symptoms, they fed into algorithms, convinced they know exactly what is wrong. 5:47 And when our clinical assessment doesn't match what their AI consultation has shown, you know, this can really be tricky for the doctor-patient therapeutic relationship.
Gap vs Gain Thinking and Self-Compassion 6:00 We also have to spend time explaining why AI is not a substitute for medical training and examination. 6:09 And fourthly, self-imposed expectations. 6:12 And these are often the most brutal. 6:16 Research from the Stanford Medical School shows that healthcare professionals consistently set higher standards for themselves than they would for their 6:24 colleagues doing exactly the same job. 6:26 Now, this is where I want to share something that completely changed my perspective on expectations, I was recommended the book called The Gap and the 6:36 Gain by Dr. 6:36 Ben Hardy and Dan Sullivan, and it was absolutely eye-opening for me personally. 6:43 The authors described two ways of measuring progress. 6:47 Firstly, living in the gap versus living the gain. 6:51 When we're in a gap, we are constantly measuring ourselves against an ideal, where we think we should be, some unrealistic goal that we've set really high 7:02 for ourselves. 7:03 This can sound like I should further along in my career by now, or I could be handling stress better than this. 7:11 But when we live in the game, we measure backwards from where we started to where are now. 7:16 So instead of focusing on how far we are from perfect, We acknowledge how we've come. 7:23 And this framework helped me realize that most of my should thinking was gap thinking. 7:29 I was constantly measuring myself against some impossible ideal instead Of recognizing my actual progress and growth. 7:38 Now, Dr. 7:39 Kristin Neff's work on self-compassion supports this beautifully, showing that when we're trapped in gain thinking that should mindset, 7:49 our stress hormones remain chronically elevated. 7:53 And this doesn't just affect our mental health. 7:55 It affects our decision-making, reduces our empathy, and ironically, it makes us less effective at the very things we think we should be better at. 8:06 So how do we break free from the expectation trap? 8:10 And let me share some tools that have worked both for me and my clients, organized around my framework of sleep, support,
Practical Tools to Challenge 'Should' Thinking 8:18 mindset, and movement. 8:20 So thinking about mindset tools, I invite you to do a should audit. 8:26 Notice every time you use the word should about yourself. 8:30 Make a note of it and at the end of a week, go through your list and ask, is this a professional standard or a perfectionist expectation? 8:39 Professional standards are specific, achievable and focused on patient safety and care quality. 8:45 Perfectionist expectations are vague, impossible and focussed on being flawless. 8:52 And then try the good friend test. 8:55 When you catch yourself in should thinking, ask, what would I tell a good friends in this exact situation? 9:02 We're almost always more compassionate and realistic with others than ourselves. 9:08 Support tools. 9:10 You could create what I call an expectation reality check with trusted colleagues. 9:15 Share some of your shoots with them and ask for their honest perspective. 9:20 you'll often discover that what you think you should be doing is far beyond what anyone else expects. 9:26 And for those challenging patient interactions where AI diagnoses come into play, I invite you to develop a standard compassionate response. 9:35 Something like I can see you've done some research and I appreciate that you're taking an active interest in your health. 9:41 Let's have a chat and do an examination and we'll discuss what I find alongside the information you've gathered. 9:50 Sleep and movement. 9:52 When we're well rested and physically active, we are less likely to fall into catastrophic should thinking and really exhaustion makes everything feel 10:00 more urgent and critical than it actually is. 10:04 So here's a powerful reframe technique. 10:07 Replace I should with I could or I choose to. 10:12 Instead of saying I shouldn't stay late to finish these notes, try I couldn't say late or could finish them tomorrow morning when I'm fresh. 10:20 This simple language shift moves you from obligation to choice. 10:24 And it's such a difference with having that edge of autonomy there. 10:28 Practice what I call gain thinking. 10:31 So this comes from the book I mentioned before. 10:33 At the end of each day, instead of focusing on what you didn't accomplish or where you fell short of your ideals, ask yourself, 10:41 what did I learn today? 10:43 How did i grow? 10:45 And what progress did make from where I was yesterday? 10:49 And this shifts you from that gap thinking, measuring against impossible standards, to gain thinking to measuring your actual progress. 10:58 Practice the good enough standard for non-critical tasks. 11:02 Ask yourself, what would good-enough look like here? 11:05 Not everything requires your absolute best effort. 11:09 Save that energy for what truly matters. 11:12 And finally, develop what I call expectation boundaries. 11:17 Just as you wouldn't let a patient treat you disrespectfully, don't allow unrealistic expectations, whether from yourself or others, 11:25 influence your mental health. 11:27 So let's bring this home with some specific action steps. 11:31 I invite you to try the should audit and just track those should statements you make about yourself. 11:38 Don't judge them, just notice them. 11:41 For your reflection, ask yourself, what is one expectation I'm carrying that's heavier than it needs to be?
Action Steps and Closing Reflections 11:49 Maybe it's the expectation that you should never feel tired or that should always have the perfect response to difficult situations. 11:58 And then practice one refrain this week. 12:01 Take that heavy expectation and ask, what would a realistic, compassionate standard look like instead? 12:09 Remember, you can shift from gap thinking to gain thinking simply by changing your measurement point. 12:18 So the goal isn't to lower your standards or stop caring about excellence. 12:22 It's to distinguish between standards that serve your patients and your profession and expectations that only serve to exhaust and discourage you. 12:33 I'd love to hear about your should discoveries. 12:36 Share one insight from the audit. 12:39 you do with someone you trust, a colleague, friend or family member. 12:44 Sometimes saying these expectations out loud helps us to realize how unrealistic they are. 12:50 And as always, I invite you to join my newsletter where we dive deeper into these topics and stay connected with me on social media. 12:58 You're not alone in this journey and you don't have to carry these expectation by yourself. 13:04 Until next week, be kind to yourself. 13:06 You're doing important work and you're going it well enough. 13:12 Ready to take the next step in your burnout recovery journey? 13:16 Visit drjobrade.com for free resources, all 150 plus podcast episodes and information about my keynote speaking. 13:28 Links are in the show notes. 13:30 Your wellbeing matters. 13:32 Protect the asset that is you. 13:37 You know those moments where you're between patients, everything's moving fast and you just want to double check something without falling down a rabbit hole? 13:45 Heidi Evidence helps you to get to a clear answer with citations you can see, pulled from trusted guidelines, research and even your own uploaded docs. 13:55 It's completely ad free, no sponsored results. 13:58 no weird ranking, and it's unlimited, region-aware, that fits into the workflow you're already using. 14:04 It supports your clinical judgment. 14:06 You stay in control. 14:08 Find evidence in the chaos. 14:10 Search HeidiHealth.com. 14:12 Be your best you. 14:14 Rely on MEGA for your protection and support, serving doctors for over 125 years through insurance, education, medical legal advice and member benefits 14:24 designed to help you thrive and succeed. 14:27 Insurance issued by Medical Insurance Australia, which has not taken into account your objectives or situation. 14:31 Before you make any decisions about our policies, please read our PDS and consider your needs. 14:34 Call us for a copy or visit migo.com.au.
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