This is the Drive Time Debrief, episode 224.
Hey, guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And we are continuing our series on cognitive dissonance and physician well-being. In episode one, we talked about the cognitive dissonance theory, the idea from psychologist Leon Festinger that humans experience psychological discomfort when beliefs, behaviors, identity, and/or values conflict with one another.
In that episode, we discussed how doctors often reduce that discomfort, not by changing their behavior, but by changing the story they tell themselves about the behavior. Turns out that's a lot easier for us than actually changing our behavior.
In episode two, we expanded into physician identity, how sometimes burnout becomes especially painful when medicine stops being just a job and it becomes who you are. And today, we're taking the next step. Why do the most intelligent, capable people, AKA physicians, sometimes stay trapped in situations that are clearly harming them?
Why do people continue overworking, over-giving, over-functioning, and self-sacrificing even when part of them knows that that is totally unsustainable? So we're gonna talk about effort justification, the sunk cost fallacy, martyrdom culture in medicine, and why suffering can become tied to identity and worth. Okay, so let's start with effort justification and why humans need their suffering to mean something.
And we talked about this like, someone's coming to rescue you, you know, the white horse that's not coming, right? We need it to mean something. So one branch of this cognitive dissonance research is called effort justification, and this idea is pretty simple. The harder we work for something or the more we suffer for it, the more psychologically motivated we become to believe it was all worth it.
Because if it wasn't worth it, then suffering feels meaningless, and then the brain is confused, and we hate confusion. This happens everywhere in human life. People tend to overvalue relationships they fought hard for, jobs they sacrifice enormously for, expensive purchases, difficult achievements, or organizations they devote years to.
Why? Because admitting that this may not have been worth what it cost me creates enormous psychological discomfort. So instead, humans often unconsciously increase the perceived value of the thing itself. So let's talk about a real-life example here.
Think about someone who waits in line for six hours for a concert ticket, and this may be my story, a product launch or a trendy restaurant. Okay, so we're waiting in line for six hours, and if the experience seems mediocre, they're still more likely to describe it positively because why?
I waited in line for six hours for this, right? Which creates pressure for the outcome to feel worthwhile. Otherwise, the suffering or the waiting in line feels irrational. Like, "Oh my gosh, I waited in line for this." The same thing happens in difficult relationships. Someone may stay in that toxic relationship for years, partly because I've already invested too much emotionally, too much time, too much money, whatever.
I've given up so much for this to not matter. So the investment itself changes the perception. And why does this hit us as physicians so hard? Well, medicine creates one of the largest psychological investments imaginable. Physicians sacrifice years of training, sleep, financial security, time with family, emotional energy, mental health, so much more, parts of our identity.
I mean, the list goes on and on. And on top of that, we delay getting married, finding a partner, having children, figuring out what our hobbies are, traveling somewhere fantastic, financial freedom, rest, health, like you name it. That list goes on and on and on, and this goes on for decades. And so when we think about that level of sacrifice, it creates an enormous internal pressure for medicine to feel worth it. So imagine a physician who says, "I spent my entire twenties and thirties building this career," and then that doctor starts realizing, "I'm dreading work.
I am totally disconnected from the neck down. I'm totally disconnected from my family." And a hard reality hits: "I'm not even sure I like my life anymore." That is terrifying, and it creates terrifying dissonance because now the brain must reconcile, "I sacrificed everything for this," with, "This is actually probably not making me happy."
We also hear, "This is not what I thought it was gonna be." And those were my words, like, "This is not what I imagined this would be," at the ripe old age of 40 or something like that. Like less than 10 years out of residency, I was like, "What is happening?" So this is very, very painful psychologically. So instead of examining this discomfort honestly, we'll double down.
We'll work harder because, like, at some point it's worth it, right? We will burn our candle at both ends. We'll sign up for more committees. We'll try to be some sort of admin. We'll try to achieve awards or levels of hierarchy of like leadership. We'll try to get more credentials, right? Oh, maybe if I'm fellowship trained, this certification, this, that, it's gonna be worth it. It's gonna be worth it. And not really because we want to, but because psychologically we need the suffering to make sense. And medicine subtly teaches one day this will all feel worth it, and sometimes it does. But the emotional wellbeing does not automatically appear at the end of the prolonged endurance.
We also look at that arrival fallacy, or like, one day I'll be happy, or once I'm an attending, I'll be happy. Or maybe once I get a house, I'll be happy. Or maybe once I get the job in the city that I wanna live in, I'll be happy, right? But then realizing that this can feel destabilizing for physicians who built their identity around this delayed gratification.
Yeah, I just think that somebody's feeling sucker punched right now. Yes. You know? This was definitely a punch. Let's just throw this in the garbage, but it explains a lot, and so that's why we're gonna talk about it because once you realize that this is a human tendency, then you can do something about it when you realize you're rationalizing, when you realize what you're doing.
And the only reason why I say that is because I lived this way for 15 years or more, I don't even know how long it was, until one day it was like, "Oh, wait, why couldn't I change things for myself?" But that came at the end of a series of terrible events, which I don't wish on anyone, so what we're doing is trying to help you all avoid an existential crisis.
Consider this your life buoy we're throwing out. Come on, just take it. Let us reel you in. Yeah. So now we're gonna talk about sunk cost fallacy and why it's so hard to walk away from these harmful situations. It's very closely related to effort justification, which we just talked about. But sunk cost fallacy is technically when you've already invested in something that cannot be recovered, time, money, energy, years, emotional investment.
And this fallacy happens when people continue investing more in something primarily because they've already invested heavily into it in the first place. So we're deluding ourselves that we should continue to invest more to make it mean something, even when that thing might be harming them.
So importantly, the decision is driven by the past investment, not whether the current path is healthy or sustainable. So a real-life example outside of medicine, we're talking about the expensive tickets, right? That you waited six hours for. The day comes. Now you're sick, you're exhausted, life events have happened, and it
really isn't ideal to attend the concert. But you think, "I've already spent the money." So you force yourself to attend and, shocker, you have a miserable time. The money's already gone either way, it turns out. But psychologically, humans struggle to waste their previous investment. So a bigger example is this one.
You might be deeply unhappy in your relationship, but we've already spent, you know, 10, 20 years together or whatever it is. That prior investment then becomes the reason to continue suffering. A physician example might be a toxic practice. So if you're working in a place that's chronically understaffed, with impossible metrics, constant moral injury, unsafe workloads, and increasing emotional exhaustion, part of you knows this environment is not good for me.
But another part says, "But I've worked too hard to leave. I've already invested so much time. Starting over would be irresponsible." There are some of us out there listening who are very duty-driven, and somewhere you've picked up this story of when I commit to something, I see it through to the end. Sometimes the best thing to do would be to walk away from this situation. But you have to know what's going on in your brain for you to even identify that that's what's keeping you stuck in this. Yeah, I will say, some people will think -- oh, yeah. Yeah. Hey, that's a good point. I'm thinking immediately of growing up in my family of origin, it was like, "Oh, no, once you commit, you see it through.
We are not quitters." You know? Mm-hmm. And that became like a family identity. While I can see where that would be like, okay, you know, you don't just wanna quit something like, "Oh, they hurt my feelings, I quit." I really think my parents were trying to instill a sense of pride in the team or whatever,
because both my brother and I were involved in sports. But then it's like, that was in me. Mm-hmm. I mean, so everything I did, that applied to everything: college, med school, residency, you know, all the things. Yes. Even when I was like, "I'm not sure. I have a brand-new baby, fourth year med school."
Like it was like, "I think I need to take some time off," but to me that sounded like quitting, and it was like, "Nope, I'm not a quitter." Yeah, so literally this week I had a client that was struggling with this, and what we had to look at was your commitment to this toxic job or your commitment to this position that is unpaid and is not in alignment with any of your values.
You also have to weigh that against the duty to yourself, the duty to your family who is getting the shell of a version of you. But your brain isn't even holding that in, like it's just looking at, "I committed to this one thing." Well, you're also committed to lots of other things, and you're not weighing the time commitment against those either.
So that was tremendously helpful for him. He's like, "Oh yeah, the duty to my family means a lot more to me than this completely ridiculous position that I'm holding just because I committed to it." And so then it enabled him to see clearly that this is not a commitment worth sacrificing himself and his family over.
Some people hold themselves back because what would other people think? Comparison is just the worst. Getting free from that is something that I think most of us struggle with, or the story that I should be able to handle this. So now you're trapped between the psychological reality and your identity investment.
So an important point is to mention that we're not saying that physicians should impulsively quit medicine. That's absolutely not the point. But the point is awareness, because many physicians don't even allow themselves to imagine alternatives.
If you're so deeply committed to, I said yes, and now I'm committed to this to the end, and something turns out to not be as advertised, to not be fulfilling whatsoever, you might not even be allowing yourself the objectivity that you need to change something. Alternatives do exist out there.
You might not be able to see them because the emotional weight of prior self-sacrifice feels overwhelming. So another example might be subspecialty training. So you might pursue a fellowship, leadership roles, academic promotions, additional certifications, not because you genuinely want them, but because stopping would psychologically feel like failure.
So the justification becomes, "I've already come this far." That might be sunk cost fallacy.
Wow, so many wake-up calls today. It's so rude. It's so rude. Yeah. So good. So good. Let's talk about martyrdom culture in medicine, and that's when our suffering becomes morally glorified, at least in our own minds. There are some really beautiful values that lead us to pursue medicine. Things like service, compassion, dedication, responsibility. Those are all great things, and the only problem is that sometimes those values can drift into a martyrdom culture, and that happens when suffering becomes morally glorified.
So examples, and I think we've all heard about some of these things. Bragging about never eating during shifts. Like, maybe not even bragging, but just it being a thing that people don't go eat food for 10 minutes during their eight, nine, 10, 12 hour shift or their workday. Talking about how little sleep we're functioning on.
That's not great. Not taking vacation. Hopefully nobody's doing that. You gotta take a vacation. Working while sick, and I think of these stories of people working with an IV pole. You know, like they're puking their guts out. They're about to pass out. They get a nurse to hook an IV up to them, and they're going around seeing patients still.
I used to brag about that. Like, "Oh, my colleague's so awesome. I'm so awesome..." Like, and then it took a book club with non-physicians in it to see the horrified look on people's faces to be like, "Wait a second." Mm-hmm. Last night I was at work and the OB floor is in the same hospital building as the pediatric ER, and the charge nurse called down, and we only see kids in the pediatric ER.
Charge nurse calls down, "Hey, we've got a nurse who's really sick with a UTI. Can she come down and you guys treat her and give her some fluids so she can keep working?" I was like, "No. Absolutely not. She needs to go home, or she needs to go get some adult care." Like, so much wrong with so many boundaries being crossed.
I mean, that's just crazy. People, when you're sick, you should not be at work. That's how normal people who do jobs operate. You just go home. Seeing exhaustion as evidence of commitment, nope. Nope. It's just evidence of our own inability to take care of ourselves. Believing boundaries equal selfishness, and I think it's interesting, these younger people coming up and generations following ours seem to have better boundaries, and it's interesting that sometimes those are cast as selfishness by people who grew up being completely self-sacrificing and proud martyrs.
I think it's interesting. It'll be interesting to see who has the better outcomes. And over time, many physicians start either consciously or unconsciously absorbing this message, "The more you suffer, the better doctor you are." That was certainly true for me in residency. I definitely -- it seemed like the people suffering the most were the best.
Looking at that, why is that psychologically dangerous? Because we have now tied our self-worth to depletion, to becoming smaller. This is like a complete no-win situation. So here's an example outside of medicine.
Parenting culture sometimes glorifies never resting, total self-sacrifice. Or workplace cultures where people might wear burnout like a badge of honor. Some of us confuse suffering with virtue, and there are definitely times where suffering can be a virtue if there's meaning behind it, if there is a real benefit, and if the suffering is not decades long and not resulting in you having an MI or an early death because you didn't get enough sleep or didn't take care of yourself. So I just think that's important to think about.
What is the purpose of the suffering? Is the suffering so that I can have great metrics for my hospital, and I can look good when they put those up on a PowerPoint for everyone to see? Is that what the suffering is for? I don't think that makes us virtuous. So here's an example for a doctor, the hero identity, where a physician either picks up extra shifts constantly, or extra committees, or extra tasks, and is answering all the messages in real time, never fully disconnects. I think this sometimes happens in leadership positions, especially like lower leadership medical director where just on call twenty-four seven, you take the text messages while you're on vacation.
That's just not sustainable. And maybe they even feel guilty resting and other people praise them, telling them they're so amazing, "You're such a team player, we can always count on you." From the outside, it looks admirable, but and I think about this with that IV doctor still at work, it's setting up a precedent.
It's setting an expectation that other people could be held to because you are doing it, but now the next person's gonna be expected to do it too. And inside, that person is likely feeling exhausted, probably resentful. They're probably not fully present emotionally at home, and they're probably burning out. And then slowing down may feel actually psychologically threatening.
I've seen this over and over with clients where slowing down feels unsafe to their nervous systems because that suffering has been so tied to their identity and just being busy and quote productive. And they wonder if they stop over-functioning, "Who am I even?" If I'm not this hero doctor who does everything.
So we just invite you to think. If you were to distinguish between meaningful sacrifice versus normalized self-abandonment, what would you say? Many of us struggle to make that distinction. There are definitely times where medicine requires sacrifice. If I'm about to walk out the door and two cardiac arrests are brought in at the same time, I'm going to stay.
That is a sacrifice I'm willing to make because I recognize that's just overwhelming for my partner. If, you know, 20 upper respiratory infections check in as I'm walking out, no, that's not the same thing. So it's good information to look at and decide for yourself what is meaningful sacrifice versus where am I normalizing self-abandonment?
And remember that chronic depletion is not proof of moral superiority. Making your care sustainable is not the same thing as endless self-erasure. In fact, it's the opposite. So a healthier reframe that we can use in our physician identity might sound like, "I can deeply care about patients without abandoning myself."
Yes, it is possible. Or rested physicians are not less compassionate physicians. Actually, guys, they are more compassionate. When our needs are met, we are more compassionate. We think more clearly. We're more organized. We're able to connect with people better. Or boundaries protect longevity, empathy, and presence.
Boundaries are not selfish, they are essential, and that's how we create sustainability. So when we think about meaning versus martyrdom, we're gonna do a little audit. Ask yourself, "What parts of medicine or my career genuinely feel meaningful to me?"
I would say it's probably not the charting, so make sure you're doing B-minus work on that. But the parts that are genuinely meaningful, that's where we can focus our energy and effort. What sacrifices actually align with my values? It's probably not taking on three extra committees. It's probably not staying late for those 20 upper respiratory infections that are not actual emergencies.
Which sacrifices have simply become normalized? And this is cultural. If we look at the way these systems are set up, our healthcare system is assuming that we are self-sacrificing, and this is true for doctors, nurses, anybody who is providing care. The assumption is that we are caring people and that we will make sacrifices that may sometimes harm ourselves.
So who's benefiting from that? Just good questions to ask. Do I associate exhaustion with worthiness? That may take a little digging under the surface, but it is down there. It's definitely some of the programming we were given in our training. And I'm just gonna offer that maybe it doesn't have to be that way. If I rested more, what uncomfortable thoughts or emotions might appear?
That one may be a little bit more advanced. Some of us use overwork, over-functioning, over-busyness as a way to buffer against feeling hard emotions. Uh-oh. That's okay. That's okay. It's only a problem if we don't look at it and allow negative outcomes to come from it. So just take a minute and ask yourself, "What are some uncomfortable thoughts or emotions that might be popping up if I'm actually allowing myself to rest? And can I accept those thoughts? Can I just allow them to come and not make it mean I have to do anything?" It doesn't mean I have to change careers. It doesn't mean I have to make any big changes.
But just allowing those thoughts and emotions can help us. As you are answering these questions, we invite you to answer not with judgment or being harsh on yourself or harsh on that little voice in your head. Just be curious. Like, what does all this mean? What do I really want? And is all this sacrifice I'm doing leading to that?
Is it leading to what I want? Or is it leading to me retiring and then dying young? How many of us have seen that happen with colleagues? Getting to retirement age and suddenly they get a big cancer diagnosis because they've been neglecting their health all these decades. Or you know, they're out a year and then just drop from an MI.
That's not what we want. At least that's not what I want. So let's just look, be curious, and figure out where these sacrifices are taking us.
Becoming aware can be what interrupts these automatic patterns, this automatic way of behaving. That's the first step, just noticing and being aware.
Yeah. I think many physicians stay trapped in these painful patterns, not because we're weak, but because human psychology makes it really difficult to question something we sacrificed so enormously to achieve. Effort justification, sunk cost thinking, martyrdom culture, all of these create powerful pressure to continue enduring.
Amanda tells her story all the time. It wasn't till physical, somatic symptoms and diagnoses that she was like, "Okay, hold up." Right? We allow a huge level of pain, and it's like a little bit of pain, medium pain, moderate pain, and then it has to reach a level that is just incredible, for most people who would sit around a book club and go, "Now you did what?"
But suffering and meaning are not the same thing, and sometimes the bravest thing a physician can do is stop automatically glorifying exhaustion long enough to ask, "Is the way I'm living actually sustainable?" And that, my friends, can be the question of the hour. So we invite you to think on these things just a little bit.
Ask yourself these questions with curiosity, not judgment, and really figure out at the core of what you're doing, is this sustainable? And that's it for today's episode, friends. If you found this conversation helpful, the best way to support us is to subscribe, so click that button now. Leave us a rating and review because it helps other physicians find our podcast and moves us up on the list.
And if you do leave a review, take a quick screenshot and email it to [email protected] and we will send you a free e-book on emotional regulation, which just happens to be one of our most requested and impactful topics. And don't forget to follow us on the socials @thewholephysician. We love connecting with you there. And before we go, we wanna tell you about our first exclusive physician-only wellness retreat. We're collaborating with MedTreks International, and we are inviting you to the lush, restorative Bodhi Tree Yoga Resort in Nosara, Costa Rica this November 2026. Join us for renewal, revitalization, connection, all while taking in the sounds of the jungle in a tropical paradise, spending your days with other physicians immersed in wellness activities brought to you by your fellow Whole Physician team.
And we know that there are so many unique challenges practicing today, so this is an opportunity to just leave equipped with actual meaningful wellness. We'll provide the link in the show notes, so just click on it, all the information is there. Thanks for spending time with us today. Until next time, you are whole, you are a gift to medicine, and the work you do matters.
