I’m stuck in assembly-line medicine. I’m not smart enough. I have no power. I’m burned out ... do you recognise these negative thinking patterns?
Pamela Wible: I’m sitting here with Sydney Ashland, an expert in physician mental health, who has worked with doctors for decades helping them overcome negative thinking patterns. And we’re going to dive into the top 10 lies that physician’s tell themselves.
The number one thing that I hear over and over again from doctors is: “I’m stuck in assembly-line medicine.”
Sydney Ashland: Yes. I hear that all the time, too. I’ve worked with hundreds of physicians, and it doesn’t matter if they’re a general practitioner, if they’re a family medicine doctor, if they’re a specialist, they all believe they’re stuck. I’m here to tell you, and I’m going to use an example of a specialist who thought she was stuck in middle America, a child psychiatrist, and she discovered that this was not true. Even though she had had a challenging fellowship and then ended up in a very big hospital, where she was told, “There’s absolutely no way as a child psychiatrist, as a pediatric psychiatrist, that you can work outside of the system.”
Yet she was so over burdened, and in such a compromised position with the demands that were placed on her, that she felt like she had to explore other options. When she decided that she was going to go out on her own, she was pleasantly surprised to discover that she wasn’t stuck. Not only was she not stuck, she could thrive. And she has a thriving practice where she sees many, many, many children each and every week. And has a waiting list.
Pamela Wible: And never even put up a website, right?
Sydney Ashland: Never put up a website. And doesn’t even take credit cards.
Pamela Wible: They have to bring cash and a cheque, right?
Sydney Ashland: Right.
Pamela Wible: And the other thing about her, is that these CEOs at the hospital system—the administrators that were hassling her so much about how she was gonna fail and this would never work—they actually bring their kids to see her. How about that!
Sydney Ashland: That’s a wonderful ending to that story.
Pamela Wible: Number two is: “I’m not smart enough.” I hear this all the time. Don’t you?
Sydney Ashland: Yes.
Pamela Wible: And I just tell these medical students, these physicians, “Are you kidding? You’re in the top 1% of intelligence, compassion, and resilience on the planet. You’ve been valedictorian, president of all these clubs. The smartest one in the room. Why don’t they feel smart enough Sydney?
Sydney Ashland: I think they lose their confidence. In fact physicians report that their number one issue is self confidence that gets eroded through the process of being trained as a physician. Often we embrace perfectionism in order to make up for that which we feel insecure about, and perfectionism does not help us feel smarter. It just helps us become controlling. Then we feel insecure and not smart enough. You’re absolutely right. You are in the top 1%. You’re not only intelligent. You are brilliant.
Pamela Wible: Number three. “I have no power.”
You’ve got a mortgage to pay, you’ve got administrators down your throat. Family, spouse, kids. You have a lot of obligations. You start to think that your life is not your own, but you do have power. I felt the same way. My contract was up, I was the only breadwinner. I finally decided, “I don’t have to put up with this shit.” And I took my life, and my career into my own hands, and opened my own practice. This was 12 years ago, or 13 years ago now, and it was a simple change in overhead. I changed the structure, I cut out the middlemen, and I literally got my power back by removing all the people in my business life that were sucking my power from me. They’re like little parasites and you’re supporting them with the revenue you’re generating per minute. Sometimes upwards of 85% is going to them. Why not cut them out of the formula? Which is what I did. My overhead went from 74%, to about 10%. I was suddenly making as much as I was earning at my full-time job, working part-time on my own and having the time of my life. What do you think about this power issue?
Sydney Ashland: I think that you absolutely nailed it. It’s responsibility that we tell ourselves that we bear, that makes it impossible for us to have power. And the truth is your responsibilities are lessened when you take your power back.
Pamela Wible: And remove the disempowering people from your lives and also the disempowering thoughts that you have of constantly have to serve all these other people.
Sydney Ashland: Whether it’s the administration, whether it’s your family, whether it’s your community. Take your power back.
Pamela Wible: Number four. The thing that gets under my skin more than anything in the world. The thing that I hear more frequently than anything else is: “I’m burned out.” You are not burned out. You have been abused, manipulated, and you have experienced human rights violations in your medical education and training.
Sydney Ashland: That’s right. We are so conditioned to blame the victim because if I tell you, “You’re burned out. It is your problem,” then I am victim blaming, and I refuse to participate in that. I agree. You are not burned out.
Pamela Wible: The problem with this, the reason why this gets under my skin, is that people start to think that they’re defective when they hear the word, burnout, right? And that defectiveness leads to additional negative patterns of thinking in which you feel like you don’t belong. You’ll never make it as a physician. You don’t even belong on the Earth. You’re not even helping your family. You might as well kill yourself. This leads to—it’s like a gateway diagnosis to suicide. So please, I am begging you all to use proper terminology. To stop calling yourself burned out, when you’ve been abused, neglected, manipulated, and have literally survived years of human rights violations.
Sydney Ashland: Hear. Hear.
Pamela Wible: Number five.
Sydney Ashland: “I must overwork and overextend myself.” I hear this all the time. Workaholism, alcoholism, self-medicating. These are the top coping strategies that we, as medical professionals, use to deal with unrealistic work demands. We tell ourselves, “In order to get everything done that I have to get done. In order to meet expectations, meet the deadlines, then I have to overwork.” And this is not true. If you believe in it, you are participating in the lie, you’re enabling it. Start to claim yourself. Start to claim your time. Don’t participate. Don’t believe that there is a magic workaround or gimmick that’s going to enable you to stay in a toxic work environment and reshuffle the deck. What happens is in that shuffling process you continue to overcompensate, overdo, overextend yourself—and you’ve moved from overwork on the face of things to complicating your life. This is common. Liberate yourself. You can be free. It’s not about overwork.
Pamela Wible: And here’s the thing that really is almost humorous. What physicians do when they’re overworked, their solution for overwork—is to overwork. Right? They’re like, “Okay. I’m exhausted. I’m tired. My office isn’t working. I’ll get another phone line. I’ll get two more receptionists. I’ll add three more patients per day.” Your solution to overwork, if it’s overwork, is probably not going to work.
Sydney Ashland: Exactly. Exactly. That’s craziness.
Pamela Wible: And number six. “I can’t get confidential mental health help.” Yes you can. There are so many off-the-grid options. Even locally. Many psychologists and counsellors do not even use an electronic medical record. They keep paper charts, and they’re 100% confidential. You can always talk to your pastor, your massage therapist, your friends without worrying about anything going into an EMR. Plus there are therapists, even psychiatrists, who do phone and Skype sessions. I’m here. I’ve been running a suicide hotline for five years, and Sydney, you have same-day emergency sessions for anyone in the world, right?
Sydney Ashland: Right. Skype or phone.
Pamela Wible: And how do people get a hold of you?
Sydney Ashland: All they need to do is type in SydneyAshland.com and right there is my schedule, right there are my types of sessions, and what the fee is, which is incredibly reasonable.
Pamela Wible: I think your 15-minute sessions, which people can have between patients, right, and same-day Skype and phone sessions, I think they start at like 30 bucks?
Sydney Ashland: Exactly. Because I don’t want financial restrictions. I don’t want financial barriers to hold anyone back. I want anyone to be able to reach out for help.
Pamela Wible: Including premed and medical students?
Sydney Ashland: Absolutely.
Pamela Wible: They are often wondering, should they even go into this field, right? You have a lot of information that would help them avoid a whole lot of hassle later on in life.
Sydney Ashland: Yes. Which takes us into the next . . .
Pamela Wible: Because you cannot afford not to get help, right?
Sydney Ashland: Exactly. “I’ll go broke.”
Pamela Wible: Number seven.
Sydney Ashland: Believing that in order to pay off debt, maintain your medical license, you have to stay in assembly-line medicine or your big box. I visited, several times recently, with an OB/Gyn who believed this, thought she couldn’t leave her practice because of the tail insurance on her malpractice insurance. She had loans to pay off. She was the breadwinner. Didn’t think she could support her kids and spouse. And guess what? She discovered when she started exploring what it might take to get a small space, to get rid of all of the administrative, middlemen that you talk about, Pamela, in her office, and just provide simple health care for women that her overhead dropped dramatically. From 70% down to 15%, that she got a very reasonably priced space, that actually her risk for malpractice went down because there were fewer people interacting with these patients Fewer people taking call. In fact, I don’t think she has anyone taking call. You don’t have to go broke to go out on your own, or at least to change the way you’re practicing medicine.
Pamela Wible: And number eight. “It’s the system.” We spend so much time vilifying and demonising insurance companies, pharmaceutical companies, clinic managers, hospital CEOs, that we don’t take our own lives back. Once you realize that you have the power to practice medicine on your own terms, you end up way more successful and financially secure. You sometimes realize, along the way, that you are the problem. You have been the main obstacle to your success.
Sydney Ashland: Yes. And you know what? Some people end up embarrassed when they realise that the way they chart, that they have for years been chastised at work about how much time charting is taking. Then they go out on their own and think, “Oh my word. I’m free.” They realise that they are spending an inordinate amount of time. They’re writing books. Or that there are other systems that they aren’t utilising that could so help them.
Pamela Wible: They end up just making things more difficult for themselves. It is not the system. We can blame the system, and stay captured, and captive, and disempowered by the system, but frigging take your own life back. It is not anyone else’s fault if you’re not happy.
Sydney Ashland: Or another thing that I hear a lot is, “It’s the system that promotes the types of patients that I get.” I have these needy patients, or these patients that keep exhibiting behaviours that I am not fond of, and it’s the system that attracts that.” Then we go out on our own, and we find out that the same needy, entitled patient show up. Guess what? That means that we’re trying to over-deliver, that we’re over-accommodating, we’re enabling, and when we look at ourselves, we no longer have to blame our patients, or the systems. We can change ourselves and then our practice changes.
Pamela Wible: And number nine: “Nobody cares.”
Sydney Ashland: This is another lie. Because there are so many people who want to share your vision. They just need the invitation. So much of the time when we isolate and we don’t communicate, we tell ourselves that nobody cares, because we’re in our little isolated bubble. Once we start to poke our head out, and we start to talk a little bit about our vision, and we get brave enough to invite others to join us, we discover that there’s power in collaboration. That more people cared than we’ve recognised. Those are the small communities where people start taking up donations in order to help someone who is really sincere and honest build their practice. We build alliances. We build a network. And we discover that not only is that a lie, but there are a lot of people that care.
Pamela Wible: I just sent a $10,000 check to a woman who inspires me in North Carolina. She’s opening up a clinic in her farmhouse this July when she finishes residency. There are so many people that want to help you. Mary Ellen got a $100,000 cheque from a philanthropist in upstate New York to open her clinic.
Sydney Ashland: I know.
Pamela Wible: People will jump out of the woodwork to help you. You have to believe in yourself first and realize that people care. And what I want to say that is truly important for me to say right now is you do not have to wait until the next physician suicide to care. I want you to take the doctor in the next cubicle out to lunch. Do not wait to care until you’re at his funeral, standing next to his children. You can care now. You are a health professional. You know how to care. It’s in your title. Why are people not doing this?
Sydney Ashland: Because they’re afraid. Because they’re isolated. Because they’ve started to believe the lie that nobody cares.
Pamela Wible: And number 10.
Sydney Ashland: “Nothing will ever get better.” I’m here to tell you, you are not terrible. You have not screwed it all up. It doesn’t matter if you’ve lost your licence, made unethical or illegal mistakes, or missteps. It can and will get better. You just need help in strategic planning. You need to be willing to embrace change, instead of resisting it. And when you do that, through acts of courage and bravery, usually that start by telling yourself the truth. Not participating in the lies that we tell ourselves, you begin to personally and professionally experience what it’s like to have things get better, not worse. You absolutely can create for yourself, what you want your practice to look like.
Pamela Wible: Absolutely! You can have whatever you want in medicine. We are totally living in a time when huge disruption and innovation in medical practice delivery is happening right now. Don’t miss out. You can get involved in this. People are launching medical clinics in yoga studios, with juice bars, and teaching patients how to garden from their farmhouse clinics. You can literally break free and design whatever your heart desires, whatever you want, and engage your community to help you. So please stop isolating. Ask for help. You are not alone. Your community cares. Your loved ones care. I care. You can call me 24/7. You are a brilliant, capable, amazing person and stop selling your soul. You went into medicine with high hopes and dreams and you can absolutely be the doctor you described in your personal statement when you entered this professions. Please stop waiting for the system to change. A system is just made up of people like you. Now is the time.
Do you recognise any of these lies? Let’s go through these one more time. What are these lies? I’m stuck in assembly line medicine. I’m not smart enough. I have no power. I’m burned out. I must overwork and overextend myself. I can’t get confidential mental health help. I’ll go broke. It’s the system. Nobody cares. Nothing will ever get better. If any of these sound like things that are circulating through your mind every day, you may be lying to yourself. If you recognise these lies, I am inviting you, and Sydney is inviting you, and encouraging you, to stop lying to yourself today and become the person you were truly born to be.
