A balanced assessment of our competence: physician coaching guards against burnout

We each have our addictions. Mine is the drama in human lives. I’ll stay up all night reading a book, unable to interrupt the story before its culmination. I can’t stand the Screen Shot 2016-07-21 at 9.35.13 AMsuspense of not knowing how the characters transcended their challenges or resolved their conflicts. So it’s no wonder that I’m hooked on the old TV series, Flashpoint, with its complex characters and riveting drama. One benefit of this addiction: it guarantees I stay on the elliptical trainer for 42 minutes, a good thing for my cardiovascular fitness.

What’s compelling about this series is the psychological tension balanced by the characters. In particular, Sgt. Greg Parker, the leader of a SWAT team, struggles to maintain his confidence in the face of the mistakes he makes. We see this difficulty over and over – Greg glosses over his many great calls and the positive impact he has on so many people and focuses instead on the times that his “best just wasn’t enough” and people died in spite of his efforts. Greg seriously considers leaving his position because of these doubts.

As physicians, our days are filled with decisions affecting the lives of others. While some are life or death, most decisions impact patients and their families, our families and staffs in less critical but no less important ways. Notice how many decisions you make that affect others during a day at work. My guess is that it’s in the hundreds.

How do we reconcile the inevitable mistakes we make over the course of hundreds of decisions with our belief in our competence, caring and our commitment to “above all, do no harm?”

One of the issues that create this tension, described by Valerie Young in Secret Thoughts of Successful Women, is our definition of success. Some of us believe we need to be perfect in everything we do. Does this sound familiar? If we fall short of this, we question our competence. Unfortunately, none of us is perfect. We all make mistakes, fail to integrate certain pieces of information, misunderstand our patients or colleagues. Other physicians believe they must learn everything without effort, know everything, do it all alone or excel in everything they do, or they don’t feel competent. These are impossible standards to meet.

We are taught to always ask ourselves, “How could I have done this better?” While this practice of self-examination, practiced personally and at institution-wide gatherings such as M&M conferences, is admirable and necessary, it is imperative that we also recognize our successes and make space in our minds and hearts for our inevitable imperfections.

Periodically reading thank you notes from grateful patients or keeping a journal of our successes can help us maintain a realistic view of our competence, especially when we feel we’ve made an error. Sharing what we appreciate about our colleagues helps them know that we value them. These simple practices to shift our focus away from our mistakes to a more balanced assessment of our worth can be career or life saving.

So let the last question we ask ourselves each night be, “What did I do well today?”

About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
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3 Responses to A balanced assessment of our competence: physician coaching guards against burnout

  1. Bassam Sinno says:

    I liked very much the posing of the question “What did I do right today”because it helps us tolerate the difficult job of our honest self assessment that occasionally ends up with “I could have handled it better”.To be fare to ourselves we should recognize that in the end the the term”I should have done it differently” should be replaced ,due to the benefit of experience , by ” From now on I will deal with it differently as I have already gained more understanding of it’s nature “of course.

  2. That’s a great perspective – to look to a future that is aided by greater knowledge and experience rather than criticizing ourselves for our past. Thanks for your comment! While it’s important to assess ourselves so we can learn and grow, we cannot let the source of our learning overshadow the many things we do that are already correct and the fact that we can always improve.

  3. eldersurf says:

    Hi, Helane,

    I found a nice article that you could extract to make a good article of your own since you are an excellent writer. It is from the dean at my med school, Jefferson in the periodic newsletter. I would be happy to send it to you by mail if you could provide me with your office address.

    By the way, I have signed up for PBL at UCSD although they may not have much opportunity right away for me to teach. I think you mentioned that you do some teaching when we met for brunch some months ago.


    Bob Bullock

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