# DTD 205
This is the Drive Time Debrief, episode 205.
Hey guys, welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. Today we're gonna talk about regrets, which is something that physicians struggle with a lot we've noticed. Myself in particular, I am case number one. I'm very proficient at regrets and ruminating and replaying things over and over and over.
This can happen to physicians with patient outcomes or maybe you missed a diagnosis. It can also happen at home—how you disciplined your child. Maybe you lost it 'cause you were tired and exhausted. There's a lot of opportunities for humans in general, but especially physicians to experience regret.
So let's talk about it. Regret isn't the enemy. Rumination is—like not moving on from the regret. So there is a book called The Four Agreements, which brings this up and for whatever reason this kind of really made an impact on me. He asks, "How many times do we pay for one mistake?" The answer is thousands of times. We are the only species who remembers that one time in second grade when I said that stupid thing. We're the only species who will relive that moment over and over and over, and we can end up beating ourselves up over it. This episode is going to attempt to capture how regret can excessively punish us long after its usefulness is done. We wanna transform regret from a thorn in your side into a guidepost for growth.
Okay, so why does regret exist? Well regret, if we see it as feedback instead of punishment, it can kind of help maybe be the catalyst to moving on. So modern psychology sees regret as counterfactual thinking—our minds' attempt to simulate a better choice so we can learn from experience.
So let's compare useful versus harmful regret. Useful regret is honest reflection about what happened and why—this leads to learning and improvement. Harmful regret is the rumination part. This is looping the same scene with self-judgment and often self-criticism. Instead of true insight, this doesn't teach anything and just continues to add stress, and it continues that loop that never stops. The psychological cost of too much regret is increased stress, increased anxiety, increased burnout, and this is really big in medicine because even going to this shift or going to work the next day after maybe something occurred, just stepping into the hospital or stepping into your office or stepping into the OR after something occurred can really take you to level 10. It can just ignite that stress response outta nowhere. I mean, it really can blindside you, and especially if you're still caught in that trap or that loop of rumination.
So regret's job is really to point you toward growth, not rent space in your head indefinitely. Mm-hmm. Not to live rent free, that's for sure. Yeah. Especially because when we allow it to do that, it starts becoming tied to our identity and that's the space where it really becomes problematic when we start to identify as someone who has made this mistake and allow it to somehow affect our worth or our value as a clinician or as a human being.
And so it's really important to interrupt these rumination loops. So how do we know when regret has gone past its purpose? There's actually some signs we can watch for. If we are replaying the same moment repeatedly with no new insight—that honestly, I think that that can actually be a trauma response for some of us in some of these particularly bad situations that may have happened. And sometimes might be something to work with a therapist on and do some EMDR or some other kind of trauma therapy to get out of that loop because making an error does feel like an existential threat to a doctor. It feels like our careers, our lives, everything is on the line if we somehow make a mistake.
Next sign to watch for is if our thoughts shift from "what happened" to "I am bad" or "I'm a bad doctor." And that's what I was talking about there with it shifting into our identity. Every doctor makes mistakes. Not many of 'em talk about it. Every doctor makes mistakes. Every doctor is human. At this point, we may have robot doctors at some point, but right now we have human doctors and all humans make mistakes and it does not make us bad or good. Doesn't make us bad if we make mistakes or good if we don't. We're just human. And so allowing ourselves to think that our worth is somehow tied to our ability to avoid error is a fallacy.
Next sign to watch for is if our focus or our sleep or our ability to be present with our patients, with our friends, with the people we love—if those things have been eroded, there is a problem and regret has gone past its purpose. If you notice that you're avoiding conversations or colleagues or tasks or even, you know, I've had clients who knew they needed to make a job change, but because of situations like this, even in the remote past maybe in residency, they felt shamed by a situation. It keeps them stuck because of their fear of judgment of others and like, you're just gonna be stuck and live in that river of misery forever. So it's important to notice if we're avoiding things that we really need to be doing or people we need to be engaging with because we're afraid of being judged.
When regret becomes chronic, especially after an adverse patient outcome, it contributes to our distress and can actually make us less efficient, less good doctors. Ironically, when we're focused on ourselves being bad doctors, guess what? It's gonna make us more of a bad doctor. Sadly, there's that old saying, you know, "Where your focus goes, your energy flows," and if your focus is on how you failed at something, it's gonna create more failure for us.
So this physician distress in the face of having made a mistake can lead to increased defensive medicine practice, burnout if we don't address it appropriately. So the useful distinction between helpful regret and really unhelpful rumination over bad things that happened is that regret leads to reflection.
And I'll give you an example. When I was in residency, I had a patient come in. He had COPD, was actively smoking. And I remember saying to him as like the cocky young doctor that I was like, "You know why you're here? Why do you keep smoking?" And he said to me, "You cannot talk to me that way." And did I regret talking to him like that? Yes. And have I ever spoken to a patient like that again? I don't think I have.
If I were to keep replaying that in my mind, like "What a jerk I was, gosh," you know, it would've potentially created a lot of anxiety and other issues for me. Instead, I look at it and I say, "I do regret that." And, you know, obviously this is a lower stake situation. No harm was done. He wasn't gonna sue me over it. But I was able to look at it and say, "Yep, I should not have behaved like that, and I'm going to make a change from that point on." So I'll take the regret, I'll have some reflection and make a plan for something different. What the opposite of that is, is ruminating over it and replaying it, and then feeling stuck, kind of like we described earlier.
So we do have a tool to offer. And that is that we can have a regulated reflection window. For instance, give yourself like 10 minutes of focused reflection. Then consciously close the loop and move on to the next task in your day. This is backed by cognitive research that shows that reframing will help reduce rumination and support self-regulation. And note that we're not just shoving it out of our mind, we're giving it some space in a timed manner, closing that loop and then moving on. And hopefully by doing this, we can help keep our brains, you know, our brains are just ruminating on this, hoping to try to prevent it in the future. If we give it that specified amount of time to reflect on it and give it the attention it deserves, hopefully our brains can let go and let us move on with our days and with our life.
Okay, so if we're taking spinning out and ruminating off the table, then what should we do instead? So there's three Rs that we're gonna talk about: repair, release, and refocus. Three practical steps.
So number one, repair what you can. Here's the deal. You regret it because you would've liked to have done it a different way, or maybe you feel guilty because it's not in alignment with who you are. This happened to me when I was working nights and I'd be super cranky with my kids. I would have regret about that because that's not how I wanna be. It's not how I wanna show up. So then step one, take responsibility. Repair what you can. If you can apologize or you can correct something, do it with clarity and brevity. So something like, "I'm sorry for X, here's what I've done to already correct what I can and here's what I'm gonna do going forward."
This decreases guilt and restores agency. Our patients even like to hear this sort of thing. They're not always as judgmental of us as we are, but they do wanna know that what has happened to them will serve a purpose. That there's meaning that's gonna come from it. That there's an apology, that they are seen as a human being.
So take the regret, take the feelings of guilt or whatever it is, as a message that you aren't in alignment with you. Here's what ruminating about it does. It turns all the focus on you. You turn inward. You're just thinking about what a terrible human being you are. You're not fixing anything. Learning the lesson and doing a repair is so much more useful for everyone involved, including yourself. You move on. The only way you can help something is if you then turn the focus back outward. "All right, that happened. I don't like it, so what am I gonna do about it?"
Okay, so repair, that's step number one. Number two is release the judgment, but keep the lesson. Accept that your choices were made with the best information you had at the time. You can tell me why you did the thing you did. Maybe you were tired, maybe you just didn't know. Maybe the labs looked good. Maybe you know, you know why you made that decision at the time. You couldn't see into the future to see the result of that, or if you could see the future, but you were just too tired and you were working with the best that you had at that time, right? Release the judgment. It has happened. There's a good reason why that happened and you can keep the lesson and do something about it. So really shift from "I failed" into "I learned something" or "I'm horrible" into "I really would like to do this better next time."
This is a cornerstone of psychological resilience and reduces the self-punishment. A lot of our suffering is from ourselves. At least that is my experience. Like there is no one on this planet harder on me than me. Okay. Yeah.
I like how you said earlier about that there's a lot of guilt that comes with regret. And what's fascinating is we've talked about Brené Brown's Atlas of the Heart, like understanding our emotions and guilt is one of those nice ones that it's actually okay to feel because it says there's a behavior that is not in line with my values. And that's a real distinction to make. It's a behavior. You are not bad. You are not anxious. You do not have to accept a label. It's guilt. It was a behavior that happened or a decision that happened that wasn't aligned. And so you got that check. You got that feeling of like, "Oh man," and so what's so lovely about that is that's not who you are. So you don't have to identify with it. It just allows you to reflect and it actually is that gut check like, "Hmm, that doesn't feel good. That doesn't feel right. I'm not sure what it is in the moment, 'cause right now I made that decision, but maybe with that reflection time, I can understand where it came from," and that is so good because then that spurs a different decision later. You get another chance to make a different choice. And that's the beauty of guilt. It's not permanent, it's just that gut check. And if we can see it as less emotional or if we can get some distance there and just see it for what it is, man, that could be revolutionary actually.
Yeah. I'm so glad that you brought that up because I saw somewhere that's like only two people don't feel guilt: sociopaths and dead people, so yeah. The fact that you have some guilt means you're a human being and you're actually functioning correctly. Now let's repair. Mm-hmm. Yeah. Lucky for us, we have both in the ER. Good news. Yeah. Touché. Yeah.
So let's do something useful. Repair, release the judgment, and now let's refocus on what you can control. Spending a lot of time in "how you wish you would've done it differently" and "how you know you're this horrible human being because this happened," keeps you in the past. It is ruining your present moment, and it's also keeping you from doing anything in the future about it. Regret, you know, it lingers longest because your mind is filled with imagined better outcomes. That's what I would always do when there was a patient outcome that I didn't love or had missed something—my brain would offer up every time, "If you had only done this" and then it's this picture of rainbows and daisies. And you don't know that, you don't know that at all. There's a good chance if you would've brought 'em back from the light that the brain function might not have ever come back.
One of the saddest stories in the ER that I ever had was a mom whose child was in a car accident, and she told me because her child never did come back to his full functioning self. And she said, "I prayed, I prayed with all my might that night that he just lived. And I am here to tell you that's not what I should have been praying." Mm-hmm. Because the fallout from that, so like, with our OB clients a lot, you know, a delivery that goes badly is so hard and we don't know that it's not the best outcome that could have happened. You don't know that.
So anyway, I didn't mean to go way off in a sad tangent there. There's this movie, have you guys seen this movie About Time? It's a very interesting movie where in this family, the men can go back in time. They have this like special thing they do and they can go back in time and they can do things or say things a little differently. And it is interesting to watch what happened in the movie and how he tried to make changes and even when he made changes, the outcome often was still the same. Especially changes that weren't related to his own showing up. You know, we don't know. We don't know that if we had done that thing different, if anything would've been different. We just don't know. You don't at all. And just notice your brain offering that up, that everything would've been perfect, that like everyone would've been happy and skipping around and celebrating. You don't know that at all. That's just a very painful loop that your brain is offering up. Hmm.
Okay. So there's a tendency to imagine it would've been so much better had the thing not happened. Also, it's just a better use of your energy to take it from rehashing the past over and over and over. Here's the thing. It's over and done with. There's not a single thing you can do about it. Now what you could do is use that energy and turn it into some concrete action steps. Let those feedback loops guide future choices rather than past suffering. And that doesn't take very long. It doesn't take months of ruminating over it. It's just like, "Here's the lessons I've learned. Here's what I wanna do next time this situation presents itself." Okay? Done. Let's move on.
You already are a better doctor because of what it is that happened. You're already a better parent because you learned the lesson of whatever. You're already a better significant other, whatever it is. You've taken that because you've had regret 'cause you're not a psychopath or sociopath and there is guilt about it. That's what it's there for, is so that you learn the lesson, you move on, you don't do it again.
So bonus insight for clinicians would be that open communication with patients after poor outcomes when it's appropriate, not always appropriate, but it can preserve trust and reduce the emotional burden. Being transparent and empathetic is not weakness. It's restorative for everyone involved.
Yeah, that's a really great point to end on because I think that also shows the humanity part of us that we aren't robots, actually we are humans, we're people and we have feelings, and when something just really does not go right, the vulnerability of those emotions and just being able to appropriately display those. I think that is what that human connection, it also shows our humanity and I think it really does go a long way to helping, you know, the patient's family recover and restore what they feel like maybe they have lost or or just didn't expect.
So regret does have a job. Rumination doesn't. To recap and treat regret as a signal, remember that guilt that you feel is the emotion. It's a signal. It's just giving you a message. It's not a period, it's not the end of the sentence. It is a signal just to pay attention to, and once the lesson is learned, letting go isn't forgetting. It's choosing to invest your energy where it actually does good. And that's just to learn the lesson, to see what happened, take the information, and then you have another opportunity to make a different choice or a better informed choice. Or maybe you would do the same thing all over again. Who knows? But the good news is it's information and it doesn't create an identity for you. It doesn't create something that you can never recover from because that is just false. Those are lies and they're thoughts that need to be challenged.
So what we'll leave you with is what regret wants most isn't to hold you prisoner. It wants to move you forward.
So thanks for joining us today, y'all. We had a great conversation and if you have found it helpful, the best way to support us is to subscribe. So click that button now, rate us, leave a review. That helps other physicians find us and it moves us up on the list. And we'd love to hear from you. So if you had an experience with regret or something that came up while listening, go ahead, shoot us a quick email [email protected] and we'd love to hear from you. And don't forget to follow us on the socials. Find us @TheWholePhysician on Insta, Facebook, LinkedIn, and TikTok. And we love that you spent time with us today.
Until next time, you are whole. You are a gift to medicine and the work you do matters.
