The Expectation Trap: When ‘Should’ Becomes Your Worst Enemy

Sponsor Messages and Podcast Introduction 0:00

This episode of the Burnout Recovery Podcast is brought to you by MIGA, your medical indemnity partner. Whether you're starting out in your career or have decades of experience, Miga helps you thrive with support that goes beyond insurance. Enjoy travel benefits like complimentary travel insurance and Qantas points on your membership, plus education, medical legal support, access to career coaching and wellbeing resources. Visit miga.com.au to learn more. Insurance issued by Medical Insurance Australia, which has not taken into account your objectives or situation.

Before you make any decisions about our policies, please read our PDS and consider your needs. Call us for a copy or visit migo.com.au. Busy day, quick question, no time to dig. Heidi Evidence brings the evidence to you. Clear answers with citations you can trust. Completely ad free, unlimited and region aligned. Find evidence in the chaos. Search heidehealth. com. Welcome to the Burnout Recovery Podcast, a guiding resource dedicated to healthcare professionals on their journey to overcoming burnout.

Spearheaded by Dr. 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. This is episode number 182. I am Dr. 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. Today we're diving into something that might be the most insidious contributor to healthcare burnout, the expectation trap. You know what I'm talking about, those relentless shoulds that follow us around like shadows. I should be able to handle more patience. If you've ever felt crushed under the weight of what you think you should do, feeling or achieving, this episode is for you.

We're going to explore why these expectations are so toxic, what the research tells us about their impact, and most importantly, how to break free from this exhausting cycle. Let me tell you about Kate, one of my coaching clients, a brilliant emergency physician who came to me completely burned out. In our first coaching session, she said something that stopped me in my tracks. I should be grateful. I have a good job. Am helping people. Make decent money. Shouldn't feel this way. And there it was.

Three shoulds in less than 30 seconds. As we talked, more emerged. Should be able to work these shifts without feeling exhausted. More patient with difficult patients. Keeping up with all the latest research. The list was endless. Now, I recognize this pattern because I've lived it myself. 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 3:06

I should never need help. I should be able to handle whatever came my way without showing any signs of struggle. 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. But instead of treating it as a learning opportunity, I spent days berating myself. Should have been more careful, should have double checked a good doctor wouldn't have made that mistake. A colleague found me in the break room. I was clearly upset and she asked what was wrong.

When I explained, she looked at me with such compassion and said, Joe, you're a human. Humans make mistakes. The fact that you caught it and learned from it makes you a good doctor, not a bad one. And that moment was my first glimpse into how these shoulds weren't motivating me to be better. They were slowly destroying my confidence and my joy in medicine. So let's look into the research on this. The research of expectations and burnout is fascinating and sobering. A 2023 study published in the Journal of Occupational Health Psychology found that healthcare workers with high levels of perfectionist expectations were 2.3 times more likely to experience severe burnout symptoms.

But here's what's really interesting. It wasn't just personal expectations causing the problem. The study identified four main sources of expectation pressure in healthcare. Firstly, there are our professional standards, the legitimate expectations of competence and care that come with our roles. And these are necessary and appropriate. Secondly, peer pressure, what we think our colleagues expect of us. This is where things start getting murky because often what others expect isn't actually what they expect at all.

You never really know what someone else is thinking. Third, patient expectations. And this has become incredibly complex in our digital age. We're not just dealing with traditional patient expectation anymore. Now patients come in with AI generated diagnoses, having consulted chat or other AI tools before their appointment. They arrive with printouts of symptoms, they fed into algorithms, convinced they know exactly what is wrong. 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. And fourthly, self-imposed expectations. And these are often the most brutal. Research from the Stanford Medical School shows that healthcare professionals consistently set higher standards for themselves than they would for their colleagues doing exactly the same job. 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 Gain by Dr.

Ben Hardy and Dan Sullivan, and it was absolutely eye-opening for me personally. The authors described two ways of measuring progress. Firstly, living in the gap versus living the gain. 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 for ourselves. This can sound like I should further along in my career by now, or I could be handling stress better than this. But when we live in the game, we measure backwards from where we started to where are now.

So instead of focusing on how far we are from perfect, We acknowledge how we've come. And this framework helped me realize that most of my should thinking was gap thinking. I was constantly measuring myself against some impossible ideal instead Of recognizing my actual progress and growth. Now, Dr. Kristin Neff's work on self-compassion supports this beautifully, showing that when we're trapped in gain thinking that should mindset, our stress hormones remain chronically elevated. And this doesn't just affect our mental health.

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. So how do we break free from the expectation trap? 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 8:12

mindset, and movement. So thinking about mindset tools, I invite you to do a should audit. Notice every time you use the word should about yourself. 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? Professional standards are specific, achievable and focused on patient safety and care quality. Perfectionist expectations are vague, impossible and focussed on being flawless. And then try the good friend test. When you catch yourself in should thinking, ask, what would I tell a good friends in this exact situation?

We're almost always more compassionate and realistic with others than ourselves. Support tools. You could create what I call an expectation reality check with trusted colleagues. Share some of your shoots with them and ask for their honest perspective. you'll often discover that what you think you should be doing is far beyond what anyone else expects. And for those challenging patient interactions where AI diagnoses come into play, I invite you to develop a standard compassionate response. Something like I can see you've done some research and I appreciate that you're taking an active interest in your health.

Let's have a chat and do an examination and we'll discuss what I find alongside the information you've gathered. Sleep and movement. When we're well rested and physically active, we are less likely to fall into catastrophic should thinking and really exhaustion makes everything feel more urgent and critical than it actually is. So here's a powerful reframe technique. Replace I should with I could or I choose to. 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.

This simple language shift moves you from obligation to choice. And it's such a difference with having that edge of autonomy there. Practice what I call gain thinking. So this comes from the book I mentioned before. 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, what did I learn today? How did i grow? And what progress did make from where I was yesterday? And this shifts you from that gap thinking, measuring against impossible standards, to gain thinking to measuring your actual progress.

Practice the good enough standard for non-critical tasks. Ask yourself, what would good-enough look like here? Not everything requires your absolute best effort. Save that energy for what truly matters. And finally, develop what I call expectation boundaries. Just as you wouldn't let a patient treat you disrespectfully, don't allow unrealistic expectations, whether from yourself or others, influence your mental health. So let's bring this home with some specific action steps. I invite you to try the should audit and just track those should statements you make about yourself.

Don't judge them, just notice them. 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 11:48

Maybe it's the expectation that you should never feel tired or that should always have the perfect response to difficult situations. And then practice one refrain this week. Take that heavy expectation and ask, what would a realistic, compassionate standard look like instead? Remember, you can shift from gap thinking to gain thinking simply by changing your measurement point. So the goal isn't to lower your standards or stop caring about excellence. It's to distinguish between standards that serve your patients and your profession and expectations that only serve to exhaust and discourage you.

I'd love to hear about your should discoveries. Share one insight from the audit. you do with someone you trust, a colleague, friend or family member. Sometimes saying these expectations out loud helps us to realize how unrealistic they are. 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. You're not alone in this journey and you don't have to carry these expectation by yourself. Until next week, be kind to yourself.

You're doing important work and you're going it well enough. Ready to take the next step in your burnout recovery journey? Visit drjobrade.com for free resources, all 150 plus podcast episodes and information about my keynote speaking. Links are in the show notes. Your wellbeing matters. Protect the asset that is you. 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? 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.

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Before you make any decisions about our policies, please read our PDS and consider your needs. Call us for a copy or visit migo.com.au.