Get Out of Your Own Head

StockSnap_SWRREC0K3A copyBy: Carlos Chan (c2020)

At McMaster University, we prize the ability to engage in self-reflection and learn from our experiences so that we can become better physicians. We dedicate an entire morning to it every week in pre-clerkship (professional competencies), we have required writing assignments centered around the idea (our reflective physician portfolio), and it’s been touted as a tool to guard against burnout in medical practice. As someone who tends to live in his own head a lot of the time, I personally think that self-reflection is a great practice as well. But I got some very interesting and unorthodox advice from my preceptor during my first week of clerkship, which sort of turns that idea on its head.

This surgeon mentioned that he often sees that clerks get into their own heads too much and become neurotic about things that ultimately don’t really matter. In the grand scheme of things, it really shouldn’t matter if we slipped up on terminology in front of a patient, unintentionally slighted a colleague, or made any other mistakes that are easily repairable. But it often is difficult to keep our eyes on the big picture when we’re all tunneling towards the goal of matching to our preferred residency. Indeed, it is almost impossible not to go insane as predominantly type A personalities obsessing over every little detail and then retreating into our own heads when doing so. Despite all of that my preceptor’s point was that it does a disservice to the team you are a part of to retreat in this fashion. You have to remember that while you are there, you are present to care for your patients, to learn from the team and to assist them in the goal of creating the best possible outcome for the patient.

I found myself slipping into my own head one night on call when the surgical team had to tell a patient in the emergency room that he had metastatic colon cancer and that there was not much they could do for him from a curative point of view. In that moment, I found myself thinking how horrible I was feeling about the entire situation and how it felt rotten just to be there in that room, even though I wasn’t even the one breaking the news. I was only a spectator.  The patient didn’t even seem to see the rest of the team in the room, his eyes remained fixed on the senior resident talking him through the news.

However, beyond that I cannot remember all of the details. Maybe I was too tired or perhaps it was because I avoided looking at him due to my own discomfort about the entire situation. But my feelings regarding that event still linger, like formalin that stays in your nose long after you’ve left the anatomy lab. And I do remember one other thing, the only thing he said in response to the resident’s monologue detailing the news which he must have been dreading.

“Shit.” Repeatedly.

Truthfully, I don’t remember much else about that consult. The night was still young and there were other surgeries to participate in and many other consults to attend to. But as I reflected on that experience, I felt badly about the fact that I had made that entire experience about me in that room. I was predominantly centered on how bad I felt about the situation, and how much I wanted to leave. My preceptor’s advice about getting out of my own head lazily wandered back into my mind, and I realized that I had disengaged from that moment, and I was not centered on the needs of the patient. I realized in that moment I had done exactly the opposite of what he had said that I should do. As I thought more on that situation though I realize now that perhaps it would have been unreasonable for me to not focus on myself and what I was thinking in that moment since it was my first time witnessing such a situation and I’m not sure I would have been capable of attending to the needs of both the patient and myself . But now that I’ve had this patient encounter and worked through my feelings on the matter, I know that I will be better equipped to engage with this type of situation in the future.

I’m sharing this because it has been useful for me at the start of clerkship. I’ve since told myself to get out of my own head repeatedly whenever I encounter something new and scary or when I make a minor mistake that really does not deserve a second thought. Although this advice has been useful, I still think that there is a role for reflective practice. However, as with most things in life, balance is the key. It does not pay to stay in your head forever burning a circular track in your own mind. Stay in your head to figure it out but don’t stay too long. Your team and your patients need you. Get out of your own head and engage.

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