DTD 180
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This is the Drive Time debrief, episode 180.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. I'm Kendra. And it turns out that my TikTok feed is full of sociology and psychology and all sorts of other niche topics. And what's all over my for you page right now is different [00:01:00] explanations of psychological phenomena and I just loved the way that they explained it.
So today we're gonna talk about something called the empty boat effect. And so close your eyes if you want to, not if you're driving, but imagine that you are drifting peacefully down a glass smooth river. Things are so serene. Your oars are barely making ripples in the water. Your mind is calm, free of judgments.
Until wham, another boat smacks right into you, and all of a sudden you are on high alert. Your heart spikes, your muscles clench, and you are ready to fight. You fling your eyes open, ready to unleash your fury on the idiot that hit you. Only to realize that the other boat is empty. And so now that there's no one to direct your anger at it drains away, replaced more with astonishment than anything else.
So what is this parable trying to explain? It's intent versus perception. So we have talked before in some of our thought error [00:02:00] podcasts, which I think are numbers five through nine. There's something called personalization. A lot of times we take things personally when there is really nothing to take personally.
That empty boat had no ill intent. It just hit your boat 'cause it was not guided and it just, that's what happened. Habitually, we assume that events are targeted at us when in fact they're just random events. They're totally impersonal. They're neutral, and so it is a good thing to notice when we're creating these narratives for ourselves.
That like they meant to insult me or this is all happening because I did this. Or that's happening to them because of whatever reasons when really it's just neutral random events that happen. We turn neutral events sometimes into personal attacks, and the philosophical roots behind this empty boat effect idea is based in a Daoist tradition.
That encourages non-action rather than resisting the event. We've [00:03:00] talked about this equation before of pain times resistance equals suffering. It's this whole resisting that the thing happened, making it mean something that makes the entire situation worse than the actual original event. So the Daoist idea of non-action is the ability to respond with ease instead of resistance or force being able to flow like water rather than fighting what's happened.
And in coaching, this applies where when you're in a coaching session, we love for you to do, you know, to do a brain dump. Tell us all the things that are bothering you, and then we reframe it as, oh, okay, this person said words to you. That's neutral. It's the whole story about it that gets us all worked up.
So this podcast that we're talking about is to start to reframe things as, is it possible that this is just an empty boat event, where like, no one's targeting me. I'm not, you know, being punished for [00:04:00] anything. I just got hit by the boat because it was just floating down the river.
And that's what happened when we're able to start looking at the circumstances of our lives as more neutral it does reduce our distress quite a bit. Sometimes we start to realize that many, many things are truly not personal. It's the story that we make about it. And so when we can start objectively looking at the things that are happening to us, we can start to notice that there's sometimes not as many things to be angry about.
Yeah, that's a good illustration of just floating down the river. You just got in the way of the other boats, so when the arrows are flying, you may have just stepped in front of one that it wasn't targeted to you. It's funny that you mention arrows 'cause that's also another idea like Buddha's second arrow that the first one pierces you.
But then the whole story about it, whenever you make it mean something terrible and personalize it. That's the second arrow. That was totally [00:05:00] optional. Just stick with the first one and skip the second one. Avoid the resistance.
So how do we apply this? Let's talk about a few examples that we might see in medicine or taking care of patients every day. And then we will talk about how maybe we can gain insight from the reframe. So like when you're taking care of a patient and you know this patient's come in pretty grumpy and they already came in grumpy, like you just happened to step into that room or step into that room of Mr. And Mrs. Grumpy and like those were the cards, right? You didn't really intend to step into Grumpy's room, but that's what happened. And so they'll snap, they'll like blow you off. They'll minimize what you're saying. Or they'll say, you didn't listen to anything I said, you're not hearing me.
Or maybe you, you know, tell them what's gonna happen in the visit. And they're like, I want a CAT scan. You know, whatever. You know, they just have this expectation, but when they blame or you get hit by the boat, it stings. It hurts. [00:06:00] You're ready to like go full on.
But what happens is if we can take a step back and realize that their frustration is from whatever they've been experiencing prior to getting there. Lately people Google things, right? So they may have Googled their symptoms on the way to the ER, right?
So now it's created fear. And so this may be arising out of fear or maybe they tried to get into their PCP, they tried to get into this, and now the last resort is the ER at 2:00 AM, right? So frustration already came about before you even stepped into the room, right? So this is not a personal vendetta against you that just happened to step into the room.
Maybe you could pause, take a step back, get out of the boat, step on the shore, see the big picture. I don't know, but realize that maybe they just need to be validated. Like, Hey, I understand your frustration not being able to get into your primary care doctor. Let me clarify that in the ER, this is what we can do and what we can't do, blah, blah, [00:07:00] blah, anyways, but instead of reacting out of taking it personally, like, oh, this person came into room 14 where I was walking, and they are like, you know, throwing the arrows at me.
The idea is to look at the big picture or help to realize that like we said, the boat just smacked you, you just happened to get in front of it. It wasn't just because of you. Yeah. The next thing we can think about is like an inter-colleague conflict, which this happens.
So if you call a consultant and you feel like you teed this patient up or this consult up, whatever it was, and they either come down to the ER or maybe they just reprimand you over the phone, but it is like, why are you calling me? This is an inappropriate consult. Have you thought of this? Did you do this?
I mean, any number of questions that they fire back. You could easily get bristled by that. I remember getting very defensive, like thinking like, are you questioning the fact that I worked up this patient, blah, blah, blah. Well, it might not be [00:08:00] that at all. How many calls have they gotten in the last hour?
What are they working with in the OR? Maybe they've been understaffed in the OR so they turnover time, like say it's a surgical consult. Their turnover times have been slow today, so they're frustrated already because they haven't been able to turn their ORs. Maybe they're stressed out, stuff at home, stuff at work.
Maybe there was a miscommunication, maybe I've run into this several times where the consultant actually wasn't even on call. So the operator like got it wrong, but then they lash out at me 'cause they're like, why are you calling me? And I'm like, and so my next question is, are you on call? And they'll say no.
And I'm like, well, sorry to bother you. That was the operator. Let me go back, you know, and re-page or whatever. But it is really just being able to step back and to understand that there are a whole bunch of things that can play into this interaction that does cause some reactivity or could make you pretty defensive.
So even if you find out that consultant wasn't actually on call, okay, so we call the right consultant, or [00:09:00] even if they were on call then, you know, things like, okay, can we go over the details together? How would you feel supported in this? This is what, you know, I am considering that this is a vascular problem.
Is it not? Like something else that keeps the main thing the main thing, and that's good patient care. Another scenario may be the EMR. Oh yes, this is definitely a bristling topic. Computer, EMR, whatever you wanna say, but in a scenario where the chart, the electronic medical record locks up, you're right in the middle of doing your whole note, or maybe you put in a whole series of orders and all of a sudden it locks up and you know you are cussing at the computer screen at that point, right?
Mm-hmm. Well, okay, did the EMR say I'm going to make Dr. Morrison's day extra difficult? No, of course not. It just happened. Epic or whatever your EMR does not work perfectly all the time, and it isn't targeted. It's like whatever the system chooses to do at the [00:10:00] moment. So considering once again, you're going down and you're putting these orders in and all of a sudden it glitches, obviously it wasn't specifically glitching on my computer. Just for me, just to make my life hard, just to say, oh, there's Epic. There it goes again. Throwing a tantrum and then I usually shut it down. Go see a patient come back that really can diffuse in the moment, that could even change the trajectory of the way the rest of your workday or shift goes.
Yeah, at one time I worked all nights and guess what? The Epic upgrades always happen at night and I would just storm around like nobody cares about the ER and take it so personally. Well, what did I want them to do? Like do it on a Monday at 10:00 AM when legitimately every I mean, I don't even know what was I trying to accomplish with that story I was telling myself, because it only made me furious and probably made everybody else around me miserable 'cause I'm just storming around like, I don't know. I mean, it just is what it is. Like what did I want to [00:11:00] happen? But I am guilty of this kind of thinking all the time.
So how about another example, you know, missing a subtle lab abnormality or just, you know, reading down a whole bunch of labs that came back quickly and you call the consultant to get the patient admitted and they were like, what about this creatinine of 2.5? You're like, sugar, shoot, nuggets.
Like you missed something like that, patient's gonna be admitted anyways, probably didn't change the outcome, but instead, you're whispering under your breath or you get off the phone, I'm incompetent. I'm a bad doctor. How could I miss this? All of these things, you know, the voice inside your head that just can completely annihilate you. Well,
how about we take a step back, like, how about a nonjudgmental space for grace, where you say, oh, okay, I see. I was trying to get three patients admitted at once and I was going in order and I missed this, or something. Shifting it to say like, okay, what did this [00:12:00] situation teach me? I probably shouldn't try to admit three patients at once or whatever. But anyways, what can you learn from this situation for next time instead of calling yourself names that aren't helpful, and then also, once again, could change the trajectory of the rest of your day. You could feel pretty down about that when honestly, the patient's getting admitted anyways and it doesn't really change the big picture, but really saying those words to yourself or beating yourself up over something like that. Where are you really gonna be at the end of that? And that's, that's super helpful. Yeah. That's one of Byron Katie's like main premises. That meeting your thoughts with understanding, brains offer up all kinds of different thoughts and sometimes they are scathing criticisms, but you don't have to attach to that.
I loved the idea of your inner critic being its own empty boat. It doesn't have to mean anything. In the same way that your brain will sometimes get a song loop stuck in your head. You're not doing that on purpose. It doesn't mean anything. It's just [00:13:00] happening. Your brain will offer up some pretty horrendous critiques of yourself sometimes too. Just be aware that could just be an empty boat and let it go on. That's probably easier said than done since you're living inside your brain with your inner critic, but that is something that you can eventually accomplish. So much of the time that inner critic is really loud and it seems like everything it says must be true and it's just not.
And it's definitely worth trying to work with your higher parts of your brain, strengthen them so that they can learn to soothe that inner critic, so it's not such a dominating force in your life. And being aware that's actually the first step.
So yeah, awareness is key. Another scenario would be delayed imaging. How much of that do we have control over? But how many times do we say they're doing it just to me, it's just my CTs, right? When either the patient doesn't go for the CT forever or the [00:14:00] radiologist doesn't get back to you timely, what do we say?
Oh, they're just not taking my patients. Or that radiologist doesn't care that I get my reports before my shift is over, right? Why does this always happen at the end of my shift? You know, I'm waiting on two CTs or whatever. Well, workflow, backlogs. They're not indifferent. Everybody experiences those, they're ultra painful towards the end of your shift, I get it. But they cause delays. This happens and framing it more neutrally lets you call for status updates instead of stewing, which is what I have taught myself to do in that last hour like, okay, I need a status update.
And sometimes just calling for the status update, all of a sudden it appears, right? No, but instead of trying to internalize it or take it personally it does help to just keep it neutral. Like, Hmm, I wonder what's going on? Or how about critical feedback in rounds?
So there's an attending that tersely points out a documentation error in front of the round, you know when we used to do round rounds or round on patients and they point it out [00:15:00] in front of everyone, so you're definitely gonna walk away feeling a bit embarrassed, humiliated, whatever that feeling that comes up for you.
Is it about that brisk style with which they went about it? Or is it just pointing something out like, Hey, this documentation isn't efficient, or whatever. It could be just that person's type of teaching style and the point that they're trying to bring out in the moment is less about you and maybe more about like how the labs are reported or how Epic makes the chart, you know, who knows? But even if it was something about the fact that something was missed or not pointed out, I mean, it could be a question later in private, like, Hey, did that have anything to do with the way I presented that patient? Or is it more or less the way the EMR, you know, reports it out or whatever.
So clarification on the situation could go a long way. And then of course when family members, anyone, anyone know about these? When angry family members chime in? Well, [00:16:00] for example, a patient's spouse might unload frustration at the slow pace of how everything's going. Especially, we experience this a lot in the emergency department.
Some people, they think emergency department means express lane. I'm not sure that just sometimes is correlated, but you take it as I'm slow or you don't appreciate my care or they hate you. You know, or something about the care that you're giving, the distress over the loved one's health. It's probably what's projecting as anger on you. They're stressed out about not knowing what's going on with their loved one, especially if they don't go to the hospital all the time, or they don't have a loved one that's sick all the time. They're stressed out because they've had to bring their loved one to an emergency department because they think that they are ill, and that stress and that worry and that fear can project as anger or frustration or impatience with the whole process.
So acknowledging them or acknowledging that they may feel a little bit like [00:17:00] frustrated at the process really says, I'm seeing you. I am meeting you where you're at, but then let me tell you about how it goes in the ER. So you are meeting them right where they're at, but then you're explaining, I know you don't come to the emergency department all the time, but this is how we roll. This is how it goes here, or something to that effect. And that really allows you to also stay neutral, not take it all the way into your core, that the slow process of the ER and this patient's spouse's frustration has nothing to do with you. It's really just meeting them where they're at, acknowledging their fear, frustration, and anger, and then like offering a bit of clarification.
Okay. Let's talk about using this inside of the empty boat to create a better life, especially as we face these triggers at work, in relationships, we're constantly faced with things that could rile us up. And using this little parable can help us in those [00:18:00] moments if we choose to use it. So the first thing we can do is take a little micro pause and take a deep breath.
If you haven't listened to Jefferson Fisher's podcast, I love the Jefferson Fisher podcast. He is just awesome. He's a trial attorney in Texas, and he gives such great communication advice. One of his pieces of advice is let your breath be the first word. And so whenever you feel a little trigger, you feel a little riled up. If you carry a pager, maybe your pager goes off. I'm thinking of several little triggers I have. Oftentimes it's in like some of the shorthand that nurses use on our communication board. Family would like an update when I was just in there five minutes ago. Things like that.
An unvaxxed kid, I get triggered and so those are some of my little empty boats that I have, so I can take a deep [00:19:00] breath or two or three. Inhale for four, hold for four, and exhale for eight before responding. Really engage that diaphragm to activate the vagus nerve to help calm myself down, and then I can label and reframe it.
So I can label, mentally say, empty boat. Empty boat. This is not meant to irritate me. This is not suggesting that I haven't been attentive to the family. This is not suggesting anything about me personally and reframe it, that empty boat again, not about me, and then have some questions. Curiosity is always a good thing in my opinion, and so just ask myself. Is anyone actually targeting me? Is anyone actually trying to drive me nuts? And is it possible that neutral factors are at play? Usually when I see that little unvaxxed [00:20:00] comment, I've never even met this family. I have no idea what's going on.
It could be some medically legitimate reason that they have chosen to not vaccinate, or it could just be that they are living their own life and having their own choices, which is also completely legitimate. So my higher brain will tell me, so is it possible that it's just neutral? And most of the time it's just neutral.
So if there's something that is really riling us up and we're taking it home and we're ruminating about it, which we doctors love to do. That might be a time to, unless we wanna keep ruminating, which that's also an option, we could just take a minute to write it down, like get all those thoughts out of our brain.
Sometimes we call it a thought dump or a thought download. And look at the thoughts that we're actually having and notice what was the trigger. Notice that that bump probably had a [00:21:00] neutral cause. What was the neutral cause? What was the other side of the story? And then what reaction am I having to it and why? How could that empty boat analogy help shift the next time I'm in a situation like that? If I am able to look at it now at home where I'm calm and I'm definitely safe, am I able to imagine a different way of showing up in response to that trigger?
I had a client the other day who had called a consultant, and in my opinion it was totally legitimate and she did an excellent job. She called someone whose office had sent a patient to the ER and labs were not back yet, but it was the end of the day and she wanted to give the doctor the opportunity to come [00:22:00] check the post-op patient out before going home, and he gave her a really hard time for that. And she made it mean that she did something wrong. And I was like, well, wait a minute. No, you were trying to do him a favor and a way she could reframe that if she couldn't get to I didn't do anything wrong. She could also just get to, he said some words to me, or he said 10 words to me.
And the rest is a story that I made up about it. And when we can look at it like that, because it is always words and he might say the same words to somebody else and somebody else might not have that response. So just different ways to look at what happened and help neutralize the experience so that we're not taking things so personally.
And one last little thought strategy you could use is habit stacking for lasting change. So linking that empty boat idea if it's helpful to you to [00:23:00] opening a patient door or picking up a chart or washing your hands or clicking out of the note or whatever rituals you have at your shift, change something that you can regularly remind yourself of that empty boat and reminding ourselves that we're in charge of our responses and reactions. It doesn't always feel like that, but we definitely can train our brains to be more in control of how we show up, even in really triggering situations. And that is what real, personal, emotional power looks like, is things that used to drive us absolutely nuts. We can look at and not go into fight or flight over, we can be neutral about it and respond in a productive way that doesn't jack our sympathetic nervous system all up.
Yeah, because we say this, all that we can do [00:24:00] really is control us. We can't control anybody else. So hopefully that, the key takeaways here are that you realize that we are just trying to help you be able to keep your poop in a group during your workday and just not lose it over things that are most likely not targeted at you.
So a pause and breath shifts us from that fight or flight into a more calming, parasympathetic. It also helps us to be intentionally aware of the things that do trigger us and how we can react. And then labeling this personalization as quote, empty boat thinking and then reframing. It really embeds a higher level of resilience.
So we hope this has helped you. Obviously we love when you leave us five stars and a review 'cause it helps other doctors find us. Email us at [email protected]. And as always, we put so much goodness out there on the [00:25:00] socials. So follow us and we're excited to announce that we are back to host an amazing event at ASEP Scientific Assembly 2025 in Salt Lake City.
This is the third year we're a part of this electric event and we're calling it the Happier Hour. You right. Did there, happier hour. So stay tuned for details and we want you to be a part of this event where physicians get to meet up, create community, and connect. So until next time, you are whole. You are a gift to medicine and the work you do matters.
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