DTD 181
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This is the Drive Time Debrief, episode 181.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we are gonna talk about a concept called the flea effect, which essentially is just a metaphor for learned helplessness. In the middle of last century, Maxwell Maltz popularized the [00:01:00] flea in a jar anecdote in his motivational talks as a vivid illustration of self-imposed ceilings.
The story goes that after being put in a jar with a lid, fleas jump, but repeatedly hit their head on the lid. Eventually, they learn the limit and stop ever jumping higher, even after the lid is removed. We internalize limits based on past conditioning. I feel like this was very much happening to me when I was at the peak of my burnout. I feel like I had tried several things. I had learned that what I did didn't matter, and maybe it truly didn't at that time.
And so then I kind of stopped trying. After a while, I stopped being on committees because I was like, what is the point of this? This is a waste of my time. It's 6:00 AM after I've been on night call. Everybody else is a surgeon in here. You know what I mean? And like starting their day and I'm exhausted at the end.
So, this can be an example at system levels where maybe trainees stay [00:02:00] silent after seeing what happened to somebody else that spoke up and it was particularly malignant. I remember talking in my own place to a vice president or something, and he is telling me the story of like the ER, like I just don't even get it.
They had been using a really old ultrasound and why didn't they just ask for one? And I remember thinking at that time, of course, I didn't say anything, so look what I was perpetuating. But I was like, they stopped asking because it didn't matter if they asked before. And he was new and he got them a new ultrasound like the next week, you know?
But I'm like, what you're witnessing is learned helplessness, like they've asked for help 850,000 times and it just fell on deaf ears. So they stopped asking. So I'm glad that you helped them get an ultrasound, but this is a symptom of a much bigger problem. This is not just people refusing to ask for help.
This is a sign of people that have asked for help multiple times and it didn't matter at all. And so they stopped asking. I feel like we see this with chronic [00:03:00] overload where it just becomes accepted to be not fully staffed, or it just becomes accepted to have to pick up more than full-time.
I don't know. I just feel like we see examples of this all over. I wanna point out that when we stop asking and stop trying to hold a boundary on what is actually sustainable, the system gets really comfortable with it. They are so comfortable with our discomfort. You know, this is a generalization.
Not every system is this way, but these ones that are under functioning are perfectly content to let us over function and continue to do so until, you know, we burn ourselves out and they're just like, ah, we'll just hire somebody else and they'll do the same thing. Because all you doctors are overfunctioners and we know how it's gonna go, so, yeah, who can really blame them?
Makes life easier for them. Right. To not have to worry [00:04:00] about staffing or worry about attending to these concerns that people have. 'Cause they give up asking, what if we just didn't give up asking? What if we held some boundaries and said, yeah, no, I'm not gonna work 80 hour weeks anymore. No, this isn't safe.
Like I get it though. This is a phenomenon. It happens to dogs, it happens to fleas, it happens to humans too.
And it takes effort to keep ramming your head against the wall. And I think that's why we stop. And I also now, I don't know, but I like to think that our systems aren't trying to maliciously—it's a business for them. But if people stop raising the issue, then all of a sudden problem solved, you know?
Right. Yeah. So, yeah. Or they create layers between—Yeah, yeah. The person on the front lines in the bunkers and the one that actually can put the kibosh on it, because I know that's even—mm-hmm. Yeah. Even going back into the dumpster fire after my sabbatical, you want to put it nicely—it [00:05:00] was that. It was motivating to bring, you know, things forward.
And then I noticed that, oh, okay, we have a few more layers. When you feel just like the effort—beating your head against the wall, the effort to go through all the layers.
And knowing that you could have five meetings and nothing gets accomplished. 'Cause really, decisions aren't made in meetings. They're made among the layers. And if you can hang in there and get to that layer, that matters, that actually makes the decision. But that takes effort and energy. And I get it.
Like you don't wanna do that with every single tiny issue. If you feel like you're the only one sticking your neck out too, that doesn't feel safe. Yeah, I mean, specifically before you left Kendra, one of the medical directors that we had that ended up leaving said exactly that.
Like, it turns out I'm middle management. I don't have authority to do any of the things that I thought that I was gonna be able to change, and I can't do it anymore. I'm supposed to sell these things that I don't agree with in the first place. Mm-hmm. And like, I'm done. And he left. So, yeah.
We're gonna do [00:06:00] some podcast episodes coming up on polyvagal theory, which is so interesting to me learning about that. 'Cause it's not just a behavioral thing that we learn. There's a neurologic basis for us just giving up apparently. So, stay tuned.
That will kind of help explain some of why it's easy to give up. Yeah, so more examples, clinical scenarios. Maybe you stop reporting safety issues because whatever happens to those things. At one time I really didn't—I threatened to fill out a MERS report every single day because there were too many people in the waiting room.
And then I ended up not doing it. 'Cause I was like, what would happen? But I should have, I really, I kind of wish I would've, first of all, just because I like being unmanageable. So, but anyway, it was unsafe, so why didn't I report it? I don't know, whatever. And then, so funny, something like today, Amanda, now everybody, even patients get to fill out safety reports.
Nice. There you go. Yeah. Now I work in a lovely place where Kendra's my boss and [00:07:00] she does a fantastic job and I feel like I work in some sort of unicorn situation, but I know the stuff that you bump your head against Kendra and I'm glad that I don't have to do that.
But I appreciate all that you have done for where we do work. 'Cause it is an amazing, it's an amazing unicorn. That's all I can say. So. And some of you do work in unicorn places, most of you don't, but there you go. Providers might stop suggesting workless—oh my gosh, Kendra, I'm thinking of you. When you had solutions for us during the early COVID things and then it would get smashed by somebody elsewhere.
You might stop suggesting workflow improvements when effort number 85 also gets ignored. In your personal life, maybe you abandon exercise routines because you're not seeing results fast enough and you believe that you can't make it stick or that it's not possible for you. There might be boundary myths, like, I must always be available to be the best doctor.
God, I feel like a lot of us got this message somewhere and [00:08:00] it's so intrusive to your life. So just think about—are there any limits that it might be worthwhile to push once more just to see if it truly is a real limit or if it's just been internalized, you just assume you're gonna hit your head on the top of the jar.
Yeah, just being aware, we always talk about that—awareness being look at the dynamics and see if it feels good, and if it feels like everyone is operating with integrity and transparency and if not, do something, speak up, create a boundary. So some ways that we can address this flea in the jar effect.
Firstly being aware, identifying any problems. If you're one to journal, I find it can be really helpful to get thoughts outta my head and really look at them objectively. There's different parts of my brain that will actually try to squash the thoughts of rebellion or of change [00:09:00] in the interest of safety before they can even completely form. So writing them down really helps get some clarity about, oh yeah, this really actually isn't okay. What's happening? So maybe list what's going on in your mind about a particular topic, list beliefs that you might be having that may be holding you back and maybe try to answer the question, what's stopping me?
We can also talk to our peers about it. Ask a colleague, what rule do you follow that isn't serving you? What rule, external or internal have you identified that it's something you do because it's expected? Maybe that actually is harming you? And the truth is, when these things are harming us, they're harming the whole system.
It's not sustainable to allow a system to carry on with overfunctioners 'cause it rots itself from the inside out. I had this in my burnout where [00:10:00] I was like, well, I went to med school and I did this particular residency and I can't do anything else. I really believed that. And now, I mean, it took a weekend of plagues to change my mind about that, but as soon as I was like, Nope, I have to try something else, then all of a sudden it was like, oh, well I guess I could do this or I could do this, like.
And for me, I did the fellowship. Now all three of us are doing real estate ventures. We have a side business. Laura created a school on the side. I mean, why couldn't we? But like at that stage of my life, I truly believed there was nothing else possible for me. And that makes me sad for that version of me.
Because what in the world? What in the world? Yeah. But I believed it with all my heart and soul. Yeah. It's heartbreaking. And so many doctors get stuck in that, that that's their identity. That's all they can do. You guys, well, hopefully, if you've been listening to this podcast long enough, you've heard multiple different variations of [00:11:00] other things that you could be doing, and if it's just money, hey, like you can learn stock trading.
I've learned stock trading. I currently make more stock trading than I do at work, which is so sad. What? Like, it's not hard. There's so many things that you are smart enough to do and money does not need to be a limitation for you. So yeah, think about what it is that you're thinking that really is holding you back.
Do some micro experiments. If you're one who's nervous about, you know, about being a little bit rebellious or defiant, try speaking up once in a meeting. Try if you're one of us ER doctors, try actually setting aside 15 minutes to feed yourself at work without having to answer questions or attend to, you know, all the minutia that we get bombarded with, maybe take a couple of minutes to do some mindfulness.
You're absolutely entitled to do that while you're trying to navigate this [00:12:00] crazy job that we have. You could use the nonviolent communication format to say something. I feel like that's such a nice, like, here's what you start with—when this happens, I feel this right? Because I have human needs and this is what I need, or this is what might make it better.
Like that is such a benign way. We're not saying you have to be like riotous whenever you speak up. If you haven't never spoken up, absolutely try it. Yeah. And Chat GPT can help you come up with great ways to communicate and increase your opportunity for influence on entities that might not listen to you.
Sometimes it's easier to speak up—certainly for me, it has been easier to speak up when I see injustice being done to other people. I had to speak up in a meeting a few years ago because our nurses weren't getting paid enough. And I don't know this situation now, but the ER [00:13:00] nurses and the PICU nurses were getting paid the same as like the well baby nurses and there's just no comparison. The skill level required and the stress and the PTSD that you accumulate in our job. So it was pretty easy for me to speak up about that. It's not like, it's just not okay that they aren't being compensated better for this incredibly difficult job you are doing—we always say that discomfort, moving into discomfort in the direction you need to go, going through some discomfort is what is gonna change your brain. So it is important to pay attention when you are able to do that. When you're able to do a little micro defiance or—I mean, I wouldn't even call it a defiance, because it's good for the organization when we speak up.
It's good when we speak truth to what we're seeing. So every time we're able to do that, celebrate it because that provides evidence to our [00:14:00] brains that we're able to do it. Like maybe a limit that you believe you have is you can't run more than five minutes. Maybe that's a belief you have.
Well try it. Try running five minutes and 10 seconds. I promise you that you can run as much as you want if you lean into that discomfort and keep going. So remember, like make a little note to yourself every time that you are able to overcome a limit you previously thought was insurmountable.
Then the third thing we can do to combat this flea jar effect are CBT or cognitive behavioral therapy techniques. These are some of the things we work on with our clients—looking at the thoughts that we're having, like I can't [00:15:00] do that, or I just can't make myself do this. I invite you to look at that and see, is that absolutely true?
Like I can't run more than five minutes. Well, have you ever, have you tried? You're 100% sure you can't. Well, then you can look and see if there's evidence. Well, I did succeed once or I can't do it yet. Changing that into a little bridge thought or even sometimes we have to say, I'm working towards believing that I can set appropriate boundaries with my work.
I'm working towards believing that I can be a runner. I am developing the identity of being a runner. Just shifting the thought. I don't know the details of the neurochemistry of it. It will be interesting 'cause I feel like we're gonna learn that in coming decades. But you can tell immediately when you change a thought from a negative, like I can't to, I believe that I can.
Taking in that growth mindset, I'm working towards believing that I can, it's a different energy you feel. You just feel better, you feel more motivated. So when we notice those limiting beliefs, replacing them with empowering [00:16:00] alternatives is gonna change our life.
The fourth thing is building supportive habits. Having a buddy, you know, whoever that person is, you are complaining at work to right now. That could be your buddy, your boundary partner, where you hold each other accountable for like one thing. For instance, my buddies are some of the APPs I work with, we're holding each other accountable for getting charts done and leaving on time.
More—it's me. Can you keep them accountable now? 'Cause it drives me nuts to see that like, you know, when you're staying late and doing unpaid work, you're lowering your hourly rate and they already are underpaid. So they need to get out on time. So have a buddy, do some boundary audits with each other and make sure that you're operating from a place of—really it's integrity when we're trying to over-function. It's not a place of integrity. It's a place of trying to earn our worth and we don't need to be doing that.
Professional help [00:17:00]—consider coaching. This is a huge part of what we do in our practice, is helping people identify where they're over-functioning, identify false limits, false beliefs, challenging them, and creating strategies for new ways of thinking, new ways of doing things. It is absolutely transformational.
A therapist can help with this too, especially if you have a deep seated schema or—you know, a schema is like a set of beliefs that may not be serving us. Like a lot of doctors have this false schema of, if I'm not a doctor, then I have no worth, or if I mess up, I have no worth.
These are deep seated things that definitely serve us to work on and root them out. Organizational advocacy, you know, there's little things that can be done, little small policy changes that can shift the rudder substantially and point things in a better direction. Like having [00:18:00] some protected wellness time.
For instance, having a monthly wellness talk or getting together as a group for a social event or for your specialty group. There's sabbaticals available. Yeah, there's some places that schedule a sabbatical for you. Like, I cannot wait. What? Where's that? Whoa. I think it was Michigan. But it's like every 17th month you have a sabbatical. I was like, what? Wow. That's brilliant. Anybody listening to—if you wanted to have a wellness talk for your group, we do those regularly and we'd love to help if you'd like. So just hit us up. We do that in the goodness of our hearts right now. We just love being able to share that wellness information with all the doctors and APPs we can. And then the fifth thing is to celebrate and reinforce ourselves. Any kind of habit change, behavioral change, any kind of neuroplasticity [00:19:00] is made more solid, made more permanent by celebrating it. So if you notice that you got your charts done and left work.
That needs to be celebrated. That's not just like, oh, I finally did what I was supposed to be doing all along. No, most doctors are not doing that right now. When you are able to do that, celebrate it. And it doesn't have to mean you go and drink a bottle of wine, you are giving yourself a pat on the back and saying, yes, I have imaginary, like little fireworks go off in my head when I do something.
That was hard. That I was able to overcome my natural tendency to just conserve energy and avoid pain. And if I'm able to do that, then I have those little fireworks go off. I'm like, yay, go me. Or I do a little dance. Or, there's all sorts of little ways that you can celebrate. And if it's like a policy change, celebrate that publicly.
If your [00:20:00] place of work has made a policy change that is in favor of wellness. Like really make that a big deal. Shout it from the rooftops and say, Hey, look what they're doing. Often, they will respond to positive reinforcement and feedback just like the rest of us will.
And email us. We'd love to hear those stories, your personal stories or stories of your healthcare organization, changes that have been made that are in the right direction. Email us at [email protected] and we'd love to hear about it. Yeah, thanks for joining us today guys. We hope that this has given just a little bit of anecdotal reference to that idea of learned helplessness and inspired and encouraged you to either speak up for the first time or keep speaking up.
You know, your work. It does not go unseen and that consistency with which you are motivated to keep showing up, especially advocating for the way you know that it should be, or that you feel there's an [00:21:00] injustice that needs to be righted. We will be there cheering you on and we are excited to see what the direction of medicine—it is changing, like the small rudder on a ship, it is changing and so we are seeing evidence for that.
So we'd love to tell you that we are back to host an amazing event at ACEP Scientific Assembly 2025. If you're gonna be there, we want you to join us. This is our third year to host this amazing event—this year. It's called The Happier Hour. Happier Hour, right? So stay tuned for details. We'll have a link in the show notes where you can go to the page and find out all the details.
This is gonna be an amazing opportunity for physicians to meet up and create community and connection. So until next time, you are whole. You are a gift to medicine and the work you do matters.
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