This is the Drive Time Debrief, episode 209.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we are continuing our series on emotional intelligence, which is something I learned absolutely zero about in medical school, but it is the secret sauce to success in life, having a high EQ as opposed to IQ. So today we're gonna talk about motivation, which honestly, all of us got through med school.
So at baseline it's not a problem. However, when we get stressed, this may become an issue, and we're gonna talk about why high achievers sometimes still feel stuck, empty or disconnected. So if you've ever looked at your life and thought, I should be more motivated than this, first of all, note the should.
Which is just being Judgey McJudgers about yourself. Or if you've ever said, why does this feel so hard when I've worked so hard to get here? Then this episode is gonna explain a lot. In episode one, just as a recap, we talked about self-awareness, which is noticing what's happening internally.
Within yourself. In episode two, we talked about self-regulation, which is how to recover or downshift. Once you notice, once you actually check in with your body and realize that you are activated, what to do about it. And then today we're gonna talk about motivation, which we are not glamorizing hustle culture.
We are not suggesting that you need more discipline. This is not an episode about productivity tips. Some shallow hack or anything. We're talking about why so many high achieving physicians feel stuck, depleted, or disconnected even when things look good on paper. And I think we've all had, all three of us have had a variation of this experience.
Like this is all that there is. Or like, this is the life I worked so hard for, and why does it feel so, ugh. You know, so I wanna offer a quick caveat before we dive in, because this matters. If you're under extreme stress, burnout, chronic overwhelm, or shut down, we talked about being in your dorsal vagal era.
I can't even make myself do self care sort of place. You may look and feel less emotionally intelligent in that moment, but it's not because you've lost your character. You're not secretly lazy. It's because your nervous system is prioritizing your survival over any other nuance, and it makes sense.
Like step one is compassion for why you are where you are. Always it makes sense if you look at it. Emotional intelligence skills like reflection, empathy, flexibility, even motivation are state dependent. So if part of this episode lands like, I get it, but that ain't happening, that may not be a personal failure.
That may be your current physiology, and we're gonna talk about motivation more as a skill. And also that when you're in that survival state, your nervous system can block access to that. Yeah. So let's start by clearing up a misconception. Motivation. What we're talking about today is not willpower, it's not discipline, and it's not work ethic.
Okay? Because we check all those boxes, we have those plentiful. That's how we made it this far. And if motivation was just about discipline, doctors wouldn't burn out. And we would be fine, right? If it's about willpower, work ethic, I mean they'd be off the charts for us. We have those down. Sure. Motivation is actually about energy.
More specifically, what gives you energy, and on the flip side, what drains it. You can be incredibly disciplined and completely depleted, and let me say that again because I think you need to hear that again. You can be incredibly disciplined and completely depleted. Okay. Medicine trains and rewards
external motivation almost exclusively. So things like, you know, get the good grades or do well in college to get into a good med school. Do well in med school so you can compete for the residencies. Compete in residency because you wanna land a good job. It's always about metrics, grades, productivity, praise, titles, all the things, right?
And so external motivators, they just don't work. They're not gonna work for the long haul. They can't take us the distance. They stop generating energy and they start requiring it and sucking it from our ever loving souls. And that's when it not so quietly starts to erode. Welcome to the podcast. This is the Physician Motivation Trap.
This is the trap many of us fall into as physicians. You learn early that pushing harder gets results. Of course it does. The more effort and production, the more results. Practicing medicine is very outcome based. It's very results based. And when your motivation dips, we don't speak too kindly.
We just push harder. We just keep going, right? Push through this. What do we hear a lot? Like, just keep going, right? Mm-hmm. And that is not really the motivation we're talking about. It does not respond to pressure the way performance does. Suck it up buttercup. Yeah. None of the Suck it up buttercup.
Yeah. And yeah, we always say, we'll just push through, right? Anybody say that? I say that. Let me just push through this shift. Let me just push through this series of shifts. Right. I just gotta work the next three days. Well, pressure produces output and meaning produces energy. But when, like Amanda said, when we start using should, I should be able to push through this, I should be able to bounce back after three nights and be ready to go for an 8:00 AM shift less than 24 hours earlier.
Right? Anyone? So when we say should, we're heaping up a whole bunch of shame. It is not compassion and we say things like, I should be able to do this. I should be more motivated. I should want this more. I should be more happy. I am in this job, career, whatever you thought that this was gonna look like.
I should be more grateful for this. Right? Well, this should is often a sign that external motivation is doing all the work and it's exhausting. So sometimes should, just noticing when you say should is also that physiologic warning sign. So if we can give you any red flag today, anything to pay attention to.
Notice when you're saying should, it's what we say when we're trying to override depletion with moral pressure, asking a tired nervous system to perform. Most likely it's on fumes. And I think what is eye-opening is shifting that should to could, and realizing that we're the choosers. We are the choosers of our lives.
We don't have to do what other people say we have to do, like we felt like we did as kids. And I think this is one of the tasks of really fully growing into a mature adult, is learning to find our internal motivation rather than responding or reacting to external motivation. And I mean, I am currently in the process of this and it's exciting, those moments when I notice when I am doing things because I feel energetically drawn to doing them rather than feeling like I am trying to please somebody else through my efforts.
It's really exciting. It's exciting but it's a journey. Because this stuff is hard wired into us folks. We definitely have been wired to respond to the shoulds. So we're gonna talk a little bit about how motivation breaks down, especially in doctors, and that motivation, that loss is rarely like sudden or dramatic.
It typically comes on gradually, many times over the course of years. Although we've had some, even med students approach us with like symptoms of burnout already just in med school or recent grads. So it is happening earlier in some of us. So I'm gonna just share a little case here and we can reflect on it.
This is the successful physician who feels flat. So Dr. E is respected, competent. Financially stable, no obvious crisis, no clear dissatisfaction. Just this quiet sense of emptiness or like, is this all there is? Work starts to feel heavy. Joy feels muted, if felt at all. And when Dr. E has some opportunity for rest,
there is no sense of restoration or energy returning. Is Dr. E suddenly lazy? No. No. Is Dr. E failing in his or her job? No. Dr. E is experiencing a motivation depletion. And what happens here is when you have achievement without nourishment and you spend years running on this fear of failure or fear of disappointing others, or fear of falling behind, or maybe you're struggling with imposter syndrome, you're afraid of being found out, like those are powerful motivators, but they are not nourishing motivators.
In fact, they will suck the life out of us and eventually our nervous systems are just like, I'm not doing this anymore. Like I don't want to and I can't do it. So even if cognitively we're still on board and we're still like trying to do all this stuff, our bodies will stop us. So often
a physician may have some symptoms of like, I'm more tired than normal, or I just need a vacation. Or, you know, something's just not quite right. And then they hit a burnout wall. Doctors typically don't pay attention to the warning signs coming up for that, so just be aware, like our bodies will shut the whole thing down if they don't like the way it's going.
And a lot of times we have this identity based motivation. I'm a doctor, you know, I'm the responsible one. I'm the capable one. I'm the one who keeps it all together, or I'm the one who helps everyone else keep it together. And then there's no room for like, what do I really want?
What are my desires for my life? What is actually gonna feel good to me and help me feel fulfilled and in touch with myself and with the people around me. I might be seeing other people as objects to manage, and we would never think in our mind, oh, this child is a thing, or my spouse is a thing.
But oftentimes we are treating them that way and that does not lead us to feel connected. We have a feeling of obligation and over time that's going to make our motivation wither and we will feel trapped. We'll feel like we have less choice, which is just gonna drive a loss of motivation even more.
Burnout versus demoralization. This piece matters. Not all loss of motivation is actually burnout. Sometimes it's just we're demoralized, like we're having this sense that our effort is no longer aligning with what actually matters to us. This isn't, we're weak, or this isn't that we actually weren't cut out for medicine after all. Suddenly we've had a change of mind. No, this is just information. It may be us growing more into who we actually are instead of an automaton who's just trying to please other people or just trying to achieve to prove our worth. This is where it's helpful to just be clear.
Motivation, especially when we're talking about doctors who have self-motivated enough to get outstanding grades, show up for exams, show up for graduating college, and making it into medical school, and showing up for clerkships and proving ourselves competent in a million different ways.
This is not a mindset issue. It's oftentimes just an access issue of who are you? Who are you doing all this stuff for, and where is your energy? Are you feeling trapped? Are you feeling a loss of choice? And that is gonna manifest itself in your body, saying, dude, we've had enough of this. I don't wanna do this anymore.
I think that's a good point to say that burnout, like a lot of what I'm hearing in some of our clients is they're like, am I burned out or I'm just sick of this? Like, yeah, like hearing what patients are coming in saying, and then mm-hmm. Just the amount of, I mean, I know going through med school, like, I mean, we've been in this for a while, so there wasn't really social media and so you were just fighting, maybe just a misunderstanding, but your word was still the information piece that most of these patients were getting, and now there's information overload, and so you're spending your energy
undoing this information. And that client's like, is this really burnout? Or I'm just so frustrated with not having the ability to choose. So not only are the visits getting shorter, but they're not even able to choose how the visit goes because the patient comes in and they just start like, I saw on TikTok or social media, like whatever.
And so, and that loss of just even like fighting the shorter timeframes. Fighting the misinformation, fighting instead of educating the patient. They're really just undoing a lot of misinformation or information that doesn't even pertain to them at all. And so I wonder too, not only do you feel dysregulated in your nervous system, because that's frustrating day in and day out.
Mm-hmm. But then you're not even able to choose how that visit's gonna go, how your day's gonna go. Even if you see what's on the schedule and you had some impact on how your schedule went. It's the type of visits, even like, that's another level.
Yeah. Yeah. This is such a timely thing because same thing, like clients this week have been like, do you ever just think that this is all just a performance? And this is somebody who's getting another certification and another certification and she's like, did I ever wanna do any of this? Oh, wow.
That is such a good question. Wow. Wow. Get in touch with yourself and if you're listening and that is you, I just wanna offer you hope. That you have the whole rest of your life, we can help you decide if this is something that you want to continue to do. If this is something that you don't wanna continue to do, nobody is saying you have to be locked in.
That is what kept me shackled for a long time. Thinking that like, well, I'm stuck. What am I gonna do? I don't know anything else. Mm-hmm. Really? Yeah. Yeah. Right. We have the skillset, we're hard workers, all of that sort of stuff. Yeah. We have all of that, and a lot of people's qualifications come to them through their culture too.
Like there is an expectation from parents or culture or whatever that this is one of the only acceptable jobs. And then to sit there and reflect, like, I don't know that I even like this. You can go anywhere from there.
I want to give you hope that that's not a scary thing. That is being honest with yourself for the first time. And can you imagine even asking yourself that question and you're wondering why your motivation is waning? Like even stop to think and ask yourself, is this really even what I wanted to do?
And say, you did ask that, for all of you out there that are like maybe even giving yourself permission to ask that question for once in your life and then you're like. Oh, who am I doing this for? And then you're wondering why your motivation is waning. I think it's helpful to just take a minute and look at what brought you to medicine to begin with. Who suggested it to you, or why was it that you decided to come down this path and are those reasons still valid? Do you find this work energizing?
Do you find it fulfilling and invigorating? And we would argue that if not, that doesn't necessarily mean that you're not supposed to be in your job. I'd say probably most of us go through a period where we feel like that. There are adjustments that we can make to our workflow, our boundaries, our thought processes that can make it feel better.
And sometimes it was what we were supposed to do for a season and it's time to move on. So all of that is valid. It's helpful to get in touch with our nervous system and really know what is going on. Because what you're describing with these patients who are coming in and are sometimes arguing with doctors, it's this sense of mutual invalidation where the patient doesn't feel validated by the doctor.
Because the doctor's not saying, oh yeah, what you saw on TikTok was right. And the patient is not validating the doctor. So both people feel terrible. We can learn to navigate those interactions in a way that we can still feel good and a patient might still feel heard and validated, and it's hard to do when we're already really kind of in the depths.
And so let's talk about the nervous system lens a little bit in particular as it relates to motivation. We've done a couple of podcasts on polyvagal theory. This just as a refresher, this was originally described by psychologist Stephen Porges, and the takeaway of that is how this theory helps explain how autonomic nervous system states shape our energy, our engagement and motivation, and in simplified terms when our bodies or nervous systems feel safe and resourced and like we have what we need, which does include
some level of validation. Then we have access to curiosity and creativity. We're able to connect with others more readily and we can feel motivated. But when our systems, our brains, our bodies feel pressured or threatened, then we don't have access to those things. We go into fight or flight, and that is where that urgency comes, or maybe we go into fawn or freeze.
That's where that shutdown, that dorsal vagal shutdown shows up. We're a fawn or a freezer. So when the system feels pressured we'll go to one of these places. And when that pressure becomes chronic, especially in situations where we feel controlled, trapped, like our voice doesn't matter. And I would argue sometimes in these patient interactions, we might feel trapped because we might feel like there's nothing that we can say, that our voice doesn't seem to matter, even though
we're being approached as an expert in this situation, or we might feel like we can't say no, and sometimes this looks like I can't leave my patient's room until I've made them happy with me, which could take a long time. And I'm gonna offer that that's not gonna provide more energy for you.
So when we're in these states of feeling trapped or unable to say no, our systems often will shift into this conservation mode or like lie down and die mode is what it may be. So in that state, like our motivation isn't disappearing because we're lazy. It's disappearing because our body's like, this is enough.
We have got to conserve energy, or I'm gonna try to make this as painless as possible. Just go to sleep in a bush somewhere. That's what we're talking about. So from this polyvagal perspective, this is the dorsal vagal shutdown mode that we're talking about, which happens after a period of chronic stress where we've been in fight or flight for so long that our body's just like, I'm not gonna get out of this.
So this is reflecting a shift towards conservation. Not even necessarily collapse, although it can go to that in extreme cases, but it's like a protective place. I don't wanna feel pain anymore. I'm so frustrated. I'm just so tired. And here's that bridge to the emotional intelligence piece that we've been talking about, is that when we are under threat and we are in that threat physiology, we just don't have the same access to reflection or curiosity or empathy or flexible problem solving that we otherwise would, because
those would more typically come when we're in that ventral vagal state, place of connection, where we're more in our higher order brain, our more human brain, the prefrontal cortex, not in a stress response situation. Because reflection, curiosity, empathy, flexible problem solving, those are all regulated state skills.
We have to be calm, we have to feel safe for us to be able to access those. So we don't wanna shame ourselves for not being able to be empathetic when we've had a hard day, like that is normal. The first step really is to notice the state that we're in, and that requires us to actually get more in touch with our body.
Are we feeling tight in the chest? Do we feel sick to our stomach? What is happening and are we in fight or flight, freeze, or fawn? And get ourselves back into that regulated state so that we can use the skills that we have. Because we all have these, we have these skills. We would not be where we are if we didn't already have these skills.
So this is especially relevant for us as doctors because when we feel micromanaged, we feel like metrics matter more than our medical skills and our ability to heal, our ability to connect, but we feel driven by productivity or criticism from outside places. We don't feel able to say no, whether that be to people above us in the hierarchy or to our patients who say, oh, I just have one more question, doctor, and you already should have been out of that room five minutes ago.
If we feel trapped by obligation, our nervous system is going to feel trapped. Our nervous system is going to register this as an inescapable situation, and it's not going to like it. Inescapability is one of the fastest ways to shut down motivation. So if you've ever thought, I don't care anymore, I just can't make myself try, like that is normal. It's normal, and we just need to have compassion and be curious about it. Why? I've done so much. I've achieved so much in my life. Why is it now that I have no motivation to do this thing? It's a sign that your nervous system is no longer experiencing agency or freedom of choice, and our nervous systems like choice.
We've talked about psychological reactance before. None of us want to be told what to do. And if we feel like we're being told what to do in a way that is infringing upon our agency, our nervous systems are going to rebel. They're going to argue back and make it harder for us to motivate to do that thing.
So if you find yourself in this dorsal vagal conservation or shutdown state where you just come home from work and you can't even make yourself get on the couch, you just sit on the floor or lie on the floor and stare at the ceiling or sit in your car and you can't get out, the solution is not to pressure ourselves.
I need to go do that house project, or I need to go cook dinner or I need to do this. That pressure is going to feel like even less choice to your nervous system. The first move is to recognize where you do have agency and restore it in tiny ways. One boundary, one choice, one no. So notice when you say yes, and you really mean no.
One protected value. So your nervous system starts believing again that your efforts are going to lead somewhere. And sometimes I honestly think it is our autonomic nervous system trying to decide if it can trust us. If it can trust us not to self-betray and keep saying yes when it's like, hey, no, no.
We don't have the bandwidth for that, and then we're up here being like, sure, I can do that. No. Our nervous systems need to learn how they can trust us to keep the whole of the organism safe, the whole of the organism thriving, recognize our capacity and not try to override it time and time again, just in the name of pleasing other people.
That's so good. So if you're listening, you may know that our pet peeve of all time is when there's an article about doctor burnout or like things are hopeless and then it's like the end,
move on to the next horrifying article or whatever. So we always like to leave you with some hope, like something that you can actually do about this. Like why talk about it if there's nothing that you can do about it. So here's the good news. Your motivation, your sense of agency, all of that can be rebuilt even without changing jobs.
Without getting a one-way ticket on a train to nowhere and never coming back, without getting a new identity from the government and like going into a witness protection program. Tempting. It does sound amazing. I'm just saying, doesn't it? Right now, I'm not sure I would be sad. Yeah. Or like completely upending your life.
Okay. Because you may not have the energy to do that yet. Maybe that's step two. But let's talk about what to do right now when you're in that state. So step one, we're gonna shift from pressure to permission. Sustainable motivation starts with permission. And what am I talking about?
That means permission to ask, what matters to me now, what actually gives me energy? What am I doing out of obligation alone? And a classic, Kendra shared before when she first started coaching, they were like, what makes you happy? And she's like, I don't know, what do you mean? These questions aren't dangerous.
Avoiding them is, like there's no question why you're feeling meh or demotivated or whatever. We're not infusing any light in your life. Okay. So then step two, we move on to values-based motivation. That feels totally different. It sounds like this is what actually matters to me. Metrics be danged.
You know what? Yeah. This aligns with who I wanna be. This actually is worth my energy. I'm telling you. It is such a different place. It doesn't feel like work. When you are in that state, it doesn't feel like effort. It feels satisfying. You sleep well at night when you're doing the things that align with you.
Values don't require pressure. It's more of a pull situation. Totally, totally different. So let's talk about another case scenario. So same job, different energy. So Doctor F, she doesn't change roles. She changes alignment. She stops saying yes automatically. She protects one meaningful activity, maybe a week, maybe a month.
I mean, whatever is possible, she reduces one draining obligation. I'm telling you like time management is not so much about super scheduling. Step one is getting rid of all the crud that you don't believe in. It's just an obligation. It's just energy draining. Get that off the list. So her workload looks extremely similar, but her energy suddenly starts to shift.
It starts to feel completely different. That's motivation. It's not from a pushing, you should situation, but from an alignment, a pulling, I want to situation. So step three. Energy is the new metric. Instead of asking, am I doing enough, start asking yourself what gives me energy and do more of that. What drains my energy?
Do less of that. Motivation follows energy, not the other way around. You're not supposed to be living your life exactly how somebody else is. Stop comparing yourself. You're on your own journey. Start getting in alignment with yourself. So a simple motivation reset question could be, if I weren't trying to prove anything, what would I choose here?
This is a fascinating question of like, if the apocalypse happened and it was only me and like five other people in the world, or even just me in the world, would I be doing any of this? You know, would I care, would I care about this whatsoever? So that question of if I weren't trying to prove anything,
what would I choose here, that reveals where motivation has gone quiet, not necessarily completely gone away.
And if your motivation feels off, it doesn't mean you're ungrateful or lazy or broken. Like we said at the beginning of the show, it usually means you've been running on fumes for a very long time. And so we've given you some practical suggestions of how to get in a better state instead of being in survival state where it's just chronic threat, chronic overdrive.
Let's throttle down. Both emotional intelligence and motivation are state dependent, and sometimes you don't need another strategy. You need your nervous system back online. So like I said, just throttle down, figure it out. Ask yourself these questions. Motivation isn't something you force.
It's something that you actually listen to. And so we'll dive in in our next episode in this series, and we'll talk about empathy and why physicians feel so much, they get depleted so easily and how to care deeply and for the duration without burning out. So until next week, try this. What actually gives me energy and what is quietly draining it?
If you have to sit down with paper, you know, I know some people go ick at journaling because they're like, roll their eyes, whatever. Okay, don't journal. Just get a pen and piece of paper and put energy and sucking or something and just write everything that gives you energy and everything that's
sucking it out of you, right? And get clear so you can see it on the page. And that brings your prefrontal cortex online and it allows you to get clarity. We're giving you permission. That's your homework. And that question is where the motivation actually begins again. So thank you for joining us today.
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