Working with Your Worst Enemy - Tips for Taming Your Inner Critic

What would you do if you were completely untethered by expectations? 

How would it impact your decisions? 

What other passions would you pursue? 

All too often, we put internal constraints on ourselves that prevent us from being our best. We are often our own worst enemy. Thoughts like “that’s not realistic” or “I could never do that” pop up and squash unrealized opportunities in our careers and personal lives.  

In this article, we are going to share some simple tips and tricks for taming your inner critic.

Awareness of Your Inner Critic

Before you can take any steps to managing your inner critic, you need to recognize that it exists and increase awareness of when it creeps in. Start training yourself to recognize your inner critic when thoughts like the ones listed below pop into your head:

  • “You can’t do that, are you crazy?”

  • “You can’t be successful at work and have quality time with family.”

  • “You always screw up!”

Copy of Copy of Youre not GOOD ENOUGH (2).jpg

Make Your Inner Critic Personal

Inner critics can take different shapes and sizes. Your inner critic may sound completely different from my inner critic. A strong voice that pops up less frequently for me says “not good enough.” This inner critic leverages my perfectionistic training and stifles my creativity and getting projects done. I feel pretty strongly that this inner critic served me to get into medical school and even in driving many of my surgical skills. I am also aware that it holds me back from doing some pretty amazing things. That’s why it’s important to identify the nature of your personal inner critic and how it is serving you. CEO coach Shirzad Chamine has developed a great tool for identifying the specific types of inner critics. Take his free Self Sabotage Assessment here to find out yours.

Learn How to Manage Your Inner Critic

Once we have increased awareness around our inner critic and personalized it, taming it becomes much easier. We can learn to snuff it out, or harness it when it is serving us. Leah Weiss, PhD and I talked about the inner critic with regard to showing Self-Compassion on a mini-podcast. Leah highlighted just how important it is to recognize when it is holding back from our success.  I found it pretty difficult when I was first working on self-compassion and my inner critic, so I only did this in a very safe place - my growing yoga practice! When I got more comfortable with my kinder, gentler voice, I began to manage my inner critic in more challenging environments.  

The trick was developing a personal statement to replace or respond to the inner critic. Here’s what I say…

“I am amazing! I offer Love, Hope, Care and the Best of my many growing abilities.”

What is YOUR personal statement? 

Don’t have one? Write one!

It will change over time, as mine has several times. It will serve you and your patients

For more tips on how to manage your inner critic, join the SurgeonMasters mailing list. If you want assistance or coaching to make it happen even faster, contact the SurgeonMasters team today.

CHARMed - Signing On to Improve Physician Well-Being

Whatever term we want to use - burnout, passion killer, sick-and-tired-of-this - we’re feeling it in the medical community. Some studies are even finding a majority of US physicians report symptoms of burnout at any given time. We at SurgeonMasters talk a lot about physician wellness and burnout prevention from the perspective of the individual in the system, don’t be fooled! 

We fully recognize the larger role the system plays in creating burnout and the conflict with our personal values. However, SurgeonMasters are not waiting for the system to change. We are creating the change.

Other physician advocates are not waiting around either. In April 2018, the American Medical Association and members in the Collaborative for Healing and Renewal in Medicine (CHARM) put together a “Charter on Physician Well-Being.” This charter was intended for organizations to use as a model to reduce burnout and promote well-being in the workplace. (list of early adopters)

Charter Jeff Smith 2.PNG

Impact of Burnout on the Physician and the System

The charter cites over 10 years of research on burnout compiled by Mayo Clinic and others. According to their research, roughly two-thirds of physicians report feelings of burnout, depression, or both – with female physicians being more impacted than their male counterparts.

On an institutional level, the research shows that burnout can negatively impact the bottom line – reducing levels of patient satisfaction, safety, and quality of care.

How The Charter Commits to Physician Well-Being

The charter itself has three “key commitments” including “societal, organizational, and interpersonal and individual commitments” to improve the physician experience.  Additionally, it lays out four guiding principles for organizations to support physician well-being:

  • Patient care: Effective patient care promotes and requires physician well-being.

  • Well-being of all: Physician well-being is related with the well-being of all members of the health care team.

  • High-value care: Physician well-being is a quality marker.

  • Shared responsibility: Physician well-being requires collaboration between individual physicians and their organizations.

Has your organization signed the Charter? SurgeonMasters is committed to the Guiding Principles of the Charter, and we recommend your organization sign and commit to it too. 

Signing on to the Charter would be a great first step for any organization looking to reduce burnout among their physicians and staff.  

SurgeonMasters offers a vast array of resources and practice support for organizations and healthcare professionals navigating a life and career in medicine. The SurgeonMasters peer-support system provides a confidential, nonjudgmental, and enriching environment for self-development and team-building.

Reach out to to learn more.

Simple Reminders for Calming Physician Overwhelm

In our current healthcare system, feeling overwhelmed is common among physicians and a huge contributing factor to burnout. One of the main reasons physicians feel overwhelmed is that they have been trained to shoulder the majority of the responsibility, even in areas that are unrelated to patient care. During these times there are simple, positive ways to calm the overwhelm. In this article, we are going to offer up three helpful reminders all physicians can use when feeling overwhelmed.


Expect the Unexpected

Despite your best efforts, unexpected challenges are sure to crop up during the course of your day. Training yourself to expect the unexpected, and accept the unexpected, will help you better prepare for difficult situations when they arise.

Prioritize Your Time & Efforts

There is always more to be done! Our first one or two priorities usually get done but we cannot do it all! Keep doing a great job of managing the urgent and important tasks.  However, moving down the list, how do you address non-urgent tasks? These usually create the most angst when neglected for too long, because they are often on our mind but frequently incomplete. 

Which takes us to our third reminder.

Delegate & Rely on Staff

As physicians, many of us were taught to pick up the slack and do things ourselves. But this is a great way to welcome feelings of overwhelm, especially when we often don’t account for our lives outside of medicine. What tasks can YOU delegate and empower your staff with? That’s why they’re there, after all! 

Calming the feeling of overwhelm by having simple strategies to process important tasks are both helpful. 

What common circumstances are present when you start to feel overwhelmed? 

What strategies have you used to gain control of the situation?

SurgeonMasters provides a supportive, nonjudgmental, and enriching environment for self-development. Here, practicing surgeons can evaluate their current practices, create short- and long-term goals, refine their focus and self-inquiry, manage stress and frustration, and develop strong relationships with their peers. Check out our vast array of wellness and burnout prevention resources.

Reach out to to learn more.

Moving Away from Second Victim Syndrome

A recent article published on titled “Second victim syndrome: a doctor’s hidden struggle” outlined the concept of second victim syndrome and its impact on physicians experiencing burnout. In this article, I’d like to offer my perspective on this concept and how we can better approach it to prevent burnout and promote well-being.

2nd Victim Syndrome.jpg

What is “Second Victim Syndrome?”

Second victim syndrome is a term coined in 2000 by Dr. Andrew Wu that refers to the psychological trauma that a physician may experience in cases of medical error. In a case of medical error, the patient is the first victim and the physician or healthcare professional is the second victim.

Severe cases of harm can lead to severe feelings and thoughts. Mild and moderate cases of harm still stir these feelings and are generally under appreciated for long-term effects. In these cases, the hospital performs root cause analyses and tries to determine ways to prevent errors in the future, while the physician is left alone to deal with the psychological trauma.

These analyses are appropriate if there are lessons learned. Often the system wants or insists that a new lesson is learned. Most frequently the root cause is not new to the system, though it may be new to that physician. To many physicians, the root cause analysis prioritizes the process and even the analysis rather than the humans involved. When lessons are learned, this is a great thing. When NOT, they may not realize the additional harm that is caused to the humans in overanalyzing the medical error. Whether an error actually occurred is not as simple as you might think. Similarly, who made the error makes it even more confusing. Internally, human minds are processing this information very rapidly, while the system processes at a different pace. The humans are further isolated and the feelings are can be GREATLY exacerbated.

So what can we do to help physicians deal with second victim syndrome?

Changing the Language from “Second Victim Syndrome”

First, what if we change the language of "Second Victim Syndrome?"

Many physicians don't want to be considered a victim (nor should we be). Healing, recovery, and learning is strengthened by the concept of moving out of the victim mindset. What if we just call these “adverse outcomes?” What if we appreciated that all involved in the adverse outcome have needs to heal, recover, and learn?

Emotional First Aid & Employee Assistance

Second, the best programs are not in place for surgeons and physicians to leverage when they need assistance. We need to get past “solutions” that are essentially just lipstick on a pig, and invest in real education and resources. For instance, we don't teach healthy empathy and very little attention is placed on emotional intelligence or skills in our training.

Few physicians are even aware if an employee assistance program exists or they might not have access if they are not employed by a hospital or system. Even when available, surgeons are internally and culturally least likely to reach out for support or "feel" that the support "doesn’t get us." Physicians and surgeons are not trusting of confidentiality and safety, as often these have been violated by the system. Lastly, physicians might accept support, but only after repeated offers. We have much more training in giving versus receiving care and support.

We need to offer peer-support that is built around the individual. Each situation is unique, and right now our healthcare system isn’t offering the support physicians need. Too often the support is lacking adequate funding, scheduling conflicts with clinical or personal time, and clarity of physician purpose and goals. There are best practices for peer-support, and we all have to be willing to embrace them.

We all know there’s a long way to go in creating the change our system requires. When medical errors do happen, what if we started with a truly confidential physician-to-physician conversation with someone who understands what we are going through?

With a vast array of resources, including physician coaching, advocacy blogs and podcasts, health and exercise guidance, and resilience training, SurgeonMasters provides a supportive, nonjudgmental, and enriching environment for self-development. Coaching is one avenue that provides an environment for confidential peer-to-peer connections.

Reach out to to learn more.

Burnout vs. Moral Injury - And the Winner Is ...

Note: This is part one of an ongoing blog series on burnout vs. moral injury. This first installment dives into moral injury as a concept and how it differs from burnout. In part two, we will discuss managing improvement through the Quadruple Aim rather than focusing solely on patients and “the bottom line.”

A popular article published in STAT argued that physicians today are not suffering from burnout, but rather “moral injury.” From the article:

“Physicians on the front lines of healthcare today are sometimes described as going to battle. It’s an apt metaphor. Physicians, like combat soldiers, often face a profound and unrecognized threat to their well-being: moral injury. Moral injury is frequently mischaracterized. In combat veterans it is diagnosed as post-traumatic stress; among physicians it’s portrayed as burnout. But without understanding the critical difference between burnout and moral injury, the wounds will never heal and physicians and patients alike will continue to suffer the consequences.”

FIGHT night! (2) (2).jpg

The authors’ perspective on "moral injury" is valid. My added perspective is that physicians are very well trained in NEGATIVE resilience and poorly trained in POSITIVE resilience. There are so many viewpoints on this topic, and I believe the vast majority are truthful. Certainly, the article’s popularity confirms that the concept of burnout may not resonate with many physicians. There are so many health conditions that have been described with different names or terminology. As physicians, discussing mental and emotional issues with patients comes naturally to us. Turning the lens on ourselves and our colleagues is more difficult. Our lack of self-awareness, our competitive nature, and our negative perception of the word burnout could all explain the lack of resonance of “burnout” with physicians.

The Weigh-In - What the Literature Says

We certainly do not need to be stuck in the old literature, in which Maslach defined burnout as a series of symptoms including emotional exhaustion, depersonalization (or cynicism), and a decreased sense of personal accomplishment. Much has been learned about burnout over the last few decades. If you are interested in a deeper dive, feel free to check out the article Understanding the burnout experience: recent research and its implications for psychiatry by Christina Maslach and Michael Leiter. Burnout is not a failure of resourcefulness or resilience.

Moral injury in medicine is described as the failure to consistently meet patient’s needs or to provide high-quality care. It results from highly conflicted allegiances to patients, organizations, and self.

While I personally believe that you don’t have to measure everything in medicine in order to manage change, many of those involved in healthcare, including a lot of physicians, want to follow the science. For those, we need to be measuring something and tracking the effectiveness of our interventions. One can attempt to measure resilience, attitude, productivity, and much more. There are many available assessments that can help - such as the Maslach burnout inventory and the Physician Well-Being Index.

Moral injury in medicine is described as the failure to consistently meet patient’s needs or to provide high-quality care, and one that results from highly conflicted allegiances to patients, organizations, and self. In part two, we will discuss managing improvement through the Quadruple Aim rather than focusing solely on patients and “the bottom line.”

Scoring the Fight - Who Wins

All of these descriptions of “the problem” are valid. Currently, I am not aware of an assessment tool to measure moral injury, or the number of repetitive cuts that one can endure before healing begins or recovery is no longer possible. If we want to find solutions, what if we moved past which words are better? Resilience? Burnout? Well-being? Moral injury? I am passionate about working on them all, for “I do what I do to make a major positive impact on other people’s lives.” I am willing to measure subjectively, rather than just objectively. Many in our healthcare system want or demand an objective measure. Without an objective measure of moral injury, we may need to continue to measure burnout or well-being.

I commend the authors for a very well-written article. When the system is burning out or morally injuring surgeons, physicians, and many others in healthcare, who is the winner?

No one wins.

Let’s change the system in many ways and keep supporting each other as we do it together.

SurgeonMasters is building a community of surgeons and physicians focused on changing the practice of medicine. Email to contribute your voice to the conversation.

Source - Physicians aren’t ‘burning out.’ They’re suffering from moral injury, By SIMON G. TALBOT and WENDY DEAN, JULY 26, 2018.