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[00:00:00] Hey, guys. Welcome back to the podcast. I'm Amanda.
I'm Laura. And I'm Kendra. And so I want you to imagine a physician who is sitting on a question they haven't answered yet, something like, " Do I stay in this job?
Do I stay in this town? Do I stay in this relationship? Or do I try to actually make this work?" It's a loaded question, and here's what we notice. A lot of people choose neither, not because they have thought about it and decided to either stay or go, but because choosing feels too hard, and the stakes feel too high, and the indecision has unwittingly become its own answer.
So here's the thing about that. Not choosing isn't neutral. When you're in limbo, half committed to staying and half fantasizing about leaving, neither version gets your full attention. You're not all in where you are, and you're not actually building towards your next step. You're just stuck, and stuck has a cost that compounds steadily week after week in ways that eventually show up in your work, your relationships, and your [00:01:00] health.
That stuck feeling is usually not strategic. In coaching, it's called an indulgent emotion. Today, we're talking about four very common indulgent emotions that physicians get caught in. That's worry, indecision, which also goes along with like confusion or overwhelm, but I'm just gonna call it indecision, self-pity, and doubt.
So we're gonna talk about what they are, what they're doing to you, and one concrete first step to take with each of those scenarios, something that you could decide to do before you even walk out of the car or wherever you're listening to this Okay, so definition time. What is an indulgent emotion?
Because the word indulgent might land a little weird for some of you, let's just start the way your third-grade teacher meant it. Here's the working definition: an indulgent emotion is one that is familiar enough to be comfortable, it doesn't require action, and it gives you [00:02:00] just enough of a payoff to keep you in it, even when it's not getting you anywhere.
Okay? So this is an emotion that is so familiar, you're comfortable feeling it, and you don't have to do anything about it, and it just gives you enough that you're like, "Oh yeah, I'm just gonna stay right here." So think about the last time you reached for something: a cookie, a scrolling on your phone, another cup of coffee.
Not really 'cause you needed it, but because you were avoiding something. It was there, it was familiar, and it gave you a moment of something before you went back to the thing you were putting off. That's kind of the same thing we're talking about here. An indulgent emotion isn't dramatic. It's not a full-on mentee bee.
It's more like a little buzz, right? And so here's what makes it tricky, though. These emotions feel productive. So, like, if you're worrying, you feel like, "Oh, I'm just prepping," right? "I'm preparing for worst-case scenario." [00:03:00] That seems productive. Or like, "Oh, I'll just sit here and think about not making a decision.
Okay. That feels productive, thinking about my thinking, but n- not unless you're doing a full-on metacog. But self-pity feels like honest assessment. Yikes. Doubt. Oh, it feels like you're doing your due diligent, right? You're not sure.
You have some doubts, so let me just research every single thing in PubMed on it, right? But you're not actually, like, pulling the trigger. So these feel like you're working on the problem, but you're not. You're actually just stalling. And the key distinction here is an indulgent emotion keeps you in motion without getting you anywhere.
Okay? Make sense? You're on the ride, and you feel like you're going forward and backward, but you're on the ride still. And you stayed in the same spot. It has a payoff, usually comfort, avoidance of risk, temporary relief of not having to decide, but there's no traction. You feel [00:04:00] like you're dealing with it, but two hours later, you're actually still in the same place.
And there's a useful frame from psychology here. Researchers who study rumination, which is that repetitive, passive focus on distress, consistently find that it doesn't lead to problem-solving. It just leads to more rumination, right? You're still on the same fast spinning ride, but now you might go backwards.
So we're not going forward anymore. We're going backwards, but we're still on the ride. We haven't gotten anywhere. Psychologist Susan Nolen Huxima? Who spent decades studying this found that people who ruminate report feeling like they're working on their problems, but the cognitive activity isn't generative.
It's circular. That's the clinical description of what an indulgent emotion does. So the indulgent emotion is often a stand-in for the thing you actually don't want to feel. Because underneath worry, usually there's some fear. Underneath indecision is a decision that you're just maybe not ready to [00:05:00] make, and underneath self-pity, well, that might be grief or anger, and that just may feel too big, or maybe you were even told or, or not even told, but maybe you growing up, you just felt like that grief or anger was just too big of an emotion, and so no one held space for it and, and no one could actually, like, take it, so it was just too big.
It was too big. And underneath doubt is often the terrifying possibility that you might actually be capable, and capable means responsible for actually what comes next Oof That's deep Okay. Right? So let's talk directly about each of these four um, indulgent emotions that we're covering today. So worry, running that what, what if loop instead of using that energy to solve the problem.
Here's what worry looks like in practice. So you discharge a patient this afternoon, the plan was solid, you reviewed it twice, but at 10:00 PM, what if I missed something? What if they come back? What if I made the wrong call? That's not clinical diligence. Clinical [00:06:00] diligence is what you did during the shift.
This is your brain deciding to start running a loop that feels thorough, but it will never move you anywhere. Like, you could marinate on that for the next two years and never know the answer. Or maybe you're lying awake thinking about whether or not to leave your practice. Well, but what if the next job is worse?
What if things get better here? What if I can't build a patient base again? What-- I might regret it. What if I stay and nothing changes, though? So you go through every possible outcome in both directions and, surprise, surprise, arrive again at no conclusion. Because worry was never designed to produce conclusions.
It was just designed to keep you vigilant. And research backs this up. Worry activates the brain's threat detection system, which is helpful when there actually is an imminent and actionable threat. But when human beings conjure up imaginary threats that are abstract or in the future, like career decisions or post-discharge [00:07:00] second guessing, that same system just keeps firing.
There's no end to it because there's no answer to these questions that you're asking yourself. So psychologist Thomas Borkovec, I've probably butchered that, he's worked extensively on worry, and he describes chronic worry as a cognitive avoidance strategy.
So what that means is that if your brain can convince you to stay mentally engaged with the feared outcome, then it prevents you from processing the underlying emotion or, God forbid, actually taking action. What that costs you, if you stay in worry, is that you're depleted before you even walk in the door at home.
You lie in the bed running loops instead of sleeping, and the clinical decision or the career question that you're worrying about, if you're stuck in limbo, one foot in, one foot out, then it's a choice for the, the status quo. You end up staying in whatever you're in So let's talk about confusion/overwhelm/indecision.
This is where you're using, "I don't even know where to [00:08:00] start," as a reason to not start. This one's sneaky because it feels humble. It feels like truth. It feels honest. So imagine our favorite hero physician saying, "I need to figure out whether to stay or go. I just don't know how. I don't even know where to begin.
I don't even really know what I want." Well, that's a heck of a lot of not knowing, especially for someone who in two seconds flat can pull up the latest recommendations for the treatment of s- some, you know, er- ehrlichiosis or something else that the average person has never heard of. So here's the irony.
Our doc knows quite a bit. She knows exactly what's draining her. She has a rough sense of the life that she imagined that she would be living and isn't. but sitting in confusion feels safer than committing to a direction that might not work out, and boy, do we not like falling on our faces. So sometimes we'll stay stuck in the thing that already isn't working.
" I just don't know" is not a neutral state. It is a choice to stay in a holding pattern. So [00:09:00] decision fatigue research, first described by psychologist Roy Baumeister, shows that the mental effort of holding open decisions, like choosing to, to put a pin in it and come back to it later, that depletes the same cognitive resources that you need for things like judgment and self-regulation.
So every unresolved question running in the background of your brain is an open tab, and the more open tabs you have, the less cognitive energy you have available for the thing that's directly in front of you. So when a physician says, "I'm overwhelmed" or "I can't decide," one of the real questions is, how many decisions are currently in a holding pattern?
Because that's an open tab in your brain. It costs the same mental energy as deciding, but you're not getting anything for it. You're not moving anywhere. You're just opening up another tab. So just notice the thing that feels like not knowing is usually not knowing. It's usually not deciding, and those things are different problems, and they have different solutions.
Okay? Now we're gonna move on to [00:10:00] self-pity, and I think self-pity, th- this is what they use in the, like, coaching and behavioral health world. I don't know that a lot of us identify as having self-pity, but just stick with me here. This is when we're lingering in that this is unfair. Boy, I don't identify as somebody that has self-pity, but boy, have I been the victim of the system a lot or...
You know? So, so clearly I do have this tab running. So lingering in the this, this is unfair instead of reclaiming your agency. So- Let me be clear, m-much of what physicians are living through is genuinely hard. The documentation burden, the administrative metrics, the expectations that have nothing to do with why you went to medical school in the first place, that's all very real.
n-not discounting that at all. But there is a version of sitting with that reality that becomes something else. It becomes the fixed position. Like, I don't have good boundaries because the culture doesn't allow that, or I can't take time off because nobody supports that here, or I can't make a [00:11:00] change because that's just not how medicine works.
Every story then ends in the same place. Every reframe gets met with another obstacle of why it won't work. That's not processing. That is establishing a residence in what you're currently in. So Marty Seligman's research on learned helplessness is useful here. This is the pattern where repeated exposure to difficult circumstances trains the brain to stop attempting escape, even When eventually escape becomes possible. What matters for our purposes is this: the brain learns helplessness the way that it learns anything else, with repetition.
So the more times you complete the loop of, " I've considered changing something, but it won't work, and so I stayed," the more automatic that loop becomes, and at some point it feels like a conclusion. It just feels like the truth. It feels like reality about your life. So self-pity has a payoff. The payoff is that it's easy.
There's no- absolutely nothing required of you. You are the victim [00:12:00] 100% of your circumstances. If the situation is the problem, then you're off the hook, and that feels comfortable in a very weird way, in the same way that a, like a numb foot is comfortable. Technically, it's not like sharp stabbing pain, but let's just acknowledge it's not okay.
It's, it's not where you wanna be. So what self-pity costs is the resentment compounds year after year. It starts showing up in your work, in how you talk to colleagues, in how present you are at home. And then let's round it out with doubt. This is questioning your competence to Hold yourself back so that you don't run the risk of failure.
So doubt is endemic in medicine, and it runs deep, and I'm sure some of our training and all the comparison that happens is not helpful with this. But the question of whether to stay in a toxic environment or leave often gets completely derailed by doubt. Am I reading the situation right? Maybe it's not really that bad.
Maybe I'm the problem. Maybe I don't have what it takes to do something different. The [00:13:00] doubt doesn't help you assess the situation more clearly, it just keeps you from acting on what you already deep in your gut know. like imagine a physician who spent three years not applying for a position that she clearly objectively was qualified for.
Her reason might be, "I'm not sure I'm ready." When you ask a person like that how many years it would take before she knew that she would be ready, there, there's never an answer. So the doubt wasn't based on her qualifications, it was a way of failing ahead of time so that you wouldn't have to risk failing in real time.
Here's what the research show. The imposter phenomenon, which was first described in 1978 by Clance and Imes, they were studying high-achieving women, And since discovering that in 1978, it's been documented extensively across professional groups, and obviously we know that it, it affects physicians.
So that means imposter phenomenon isn't correlated with actual incompetence. It's correlated with high achievement in high-stakes environments. Studies on physician burnout and career satisfaction [00:14:00] consistently find physicians who experience the most severe imposter phenomenon are among the most skilled clinicians.
Over and over it shows this. So the doubt is not diagnostic of your ability, it's diagnostic of the pressure that you're under. And here's the irony, is that doubt can't tell you your actual skill level. It can only tell you how afraid you are of being wrong. Those are two different data points. Yep, and that makes sense.
It makes sense to be afraid of being wrong. Yeah. Okay, so what do we do about all this? Here's some some first steps for each of these indulgent emotions. So for worry, schedule it, then stop it. The obstacle is that you've tried to stop worrying and it doesn't work because your brain interprets stop worrying as something else must be wrong if I'm not paying attention to this.
So the tool there is to give the worry a container. Schedule ten minutes, set a timer, or [00:15:00] maybe it's on your drive home. At the end of your workday, before you le-leave the building, maybe you schedule your worry even before you leave or schedule it before you get out of your house and come inside. Write it down.
You know, there's something about writing things down that helps your brain rest because it realizes you're not gonna forget it now. It's, it's out and it's on paper forever. You can burn it if you want, but it does help your brain get out of that thought loop 'cause a lot of times it's just trying to make sure you don't forget.
Don't forget. Don't forget. You might mess up. When you write it down and you give it the attention it's demanding, maybe for like ten minutes, then you close it outside that window. When that loop starts, you redirect. That's a worry. I have time for that Thursday at five, not now. And something about that allows that more immature part of your brain to rest, and it's gonna get addressed.
We have it on the schelu- schedule. It's on the calendar. [00:16:00] We don't have to do it right now. This works because it removes urgency. When your brain knows that there's this designated time for it, it doesn't have to keep this alarm running. this is not a new idea. It's something called stimulus control for worry, and it's a core component of cognitive behavioral therapy.
You know, they use it in their protocols for anxiety, and the mechanism is straightforward. You're-- basically, you're training the brain to associate a specific time and place with worry processing, and that helps reduce the intrusive, free-floating, nonstop, constant movie running in your head version. The first step is you can today name one worry that's been running in the background.
Write it down. Pick the next time you'll give it ten minutes. Schedule it. That's it, and you don't have to solve it today. Just give it a time so it knows it's gonna be heard. It's kind of like an annoying... I don't [00:17:00] wanna say anybody in your life is annoying, but maybe it's like an annoying acquaintance who wants to be your best friend and they keep, they keep calling you and texting you, and they're, they won't leave you alone.
You're like, "Okay, I'll meet up with you for ten minutes on Thursday." For overwhelm and confusion, we're going to reduce the question. What does that mean? Overwhelm really expands to fill the m- available mental space, and it feels so true. There's-- I don't think there's another emotion that feels so deeply convicted in reality for so many of us other than overwhelm.
"Well, I'm just overwhelmed. I can't do it. I am overwhelmed. I don't know where to start." And usually, what that means is I'm trying to solve everything at one time. So here's the tool, is to shrink the question until it's answerable. Not, not like, "Should I stay or leave medicine?" Or... But, "What's one [00:18:00] conversation I could have in the next two weeks?"
Maybe it's reaching out to a colleague at a different institution where you might be interested in taking a job. Maybe it's reaching out to a locums, you know, a locums company to see about maybe figuring out something where you could just scale back and make your own schedule. How about if you're in a giant chart hole?
It's not, "How do I get on top of all of this documentation?" Not, " I'm gonna, like, spend ten hours tomorrow doing it," but, "What is the one note that I'm most avoidant about?" Which is the note that's bothering you the most, and just go towards that. One thought that I like when I'm in overwhelm is this idea that I could do twice as much as what I'm currently doing.
Sometimes that's not completely believable, because I'm doing so much, but sometimes it is. Sometimes if I look at my actual time audit of what is going on, I'm like, "Okay, I could definitely squeeze more things in here so I don't [00:19:00] have to feel overwhelmed." It's not helping me get stuff done. Your brain isn't confused.
It gets overwhelmed by the size of these questions, the implications of the change, and if we just choose a smaller question, take a tiny bite... You know, what do they say about how do you eat an elephant? One bite at a time. That's what we're talking about here. So before you wor- walk into work, name the one thing, the one thing that if you moved on it today would make tomorrow feel lighter.
Not, not a whole list, not the whole decision, just one thing. That's your job, not the whole pile. Just one thing that would help move you forward. And as far as those chart holes, if you pay attention to how much time it actually takes you to do one note, it's surprisingly oftentimes short, especially if you're doing the recommended B-minus level charts.
You can get those done in three to five minutes, and it's amazing how good it feels just to start chipping away at them. Okay, for self-pity, we're gonna separate [00:20:00] the facts from the conclusion or the story that our brain tells us. The facts are really... They really are hard sometimes. It's hard to identify them.
It's... A lot of times, it's just a hard truth that we don't have any control over, and it feels important to acknowledge that, and it is. The problem is acknowledging it when it becomes a permanent stop instead of a waypoint. So, like, we feel stuck in what the actual facts are.
Here's a tool. Split the difference. We can sit in this thought, "This situation really is genuinely difficult," and acknowledge that. This is something we talk about with our clients a lot, is that, "You know what? We're not here to gaslight you and tell you that your job is anything other than freaking hard," 'cause it is.
This is, like, the hardest job I can think of. it's probably subjective, but I can get on board with it. Being it is a difficult situation, [00:21:00] and the idea that there is nothing I can do is a story about it. It's a conclusion that we make, and we can examine that. Try this. The situation is genuinely difficult, and what is the smallest thing that's actually within my control right now?
Is there something that I can do to better take care of myself or to make the situation better? There is research on agency or that feeling like you're in control of your life, and how important it is to our wellbeing, and it's consistent. Perceived control, even small amounts of it, is one of the strongest predictors of psychological resilience or of just, like, feeling better.
Once you recognize that you are a chooser, you get to choose. You, you don't have to go to work tomorrow. You don't. You want to because, I mean, most of us actually want to on some level because of the paycheck and the, [00:22:00] the interactions with most of our patients, and we want to keep working, but we don't have to.
And so being able to own that, that, "Oh, actually I'm choosing to go," man, it makes everything s- feel so much better. We don't have to fix this crazy broken system, and we're gonna point out this system has been broken pretty much the whole time, and so it's probably not getting fixed anytime soon. We need to just find one place where we're not completely without some agency or influence.
So here's a step. name one thing you've been telling yourself that you can't change. Then ask, "Is that really genuinely impossible? Is that thought one hundred percent true, or is it that the cost of changing feels too high right now?" And you're allowed to decide the cost is too high. You don't have to change anything.
Just be clear that it is a choice. It's not a wall. And this very basic example is you are choosing to go to work. Nobody's holding a gun to your [00:23:00] head to get in the car and, and push the button or turn the key. You are choosing to go. You don't have to go. And just owning that's gonna feel a lot better.
All right. For doubt, let's run the evidence, not just this crazy same thought loop that we're stuck in. Doubt really feels... It feels like rigor. It feels like I have high standards. It feels like I'm being so careful, and that's really hard to argue with because, you know, in medicine, we do actually need to have some really good, careful self-assessment.
However, constantly asking if we're good enough or if we belong is not making us better doctors. It's just not. It's making us more scared and anxious doctors, and we're not using the best parts of our brains. So let's stop asking, "Am I good enough?" And start asking, " What's the evidence? What does the record show?"
Look at what you've done. Look at all the hoops you have jumped through, all [00:24:00] the exams you have passed, all the patients you've seen and made better. Look at what you've done, not what you haven't. Don't look at what could go wrong. What is the factual record of your competence, the decisions you've made, your-- all the situations you've navigated, all the problems you've solved?
You, you wouldn't assess anyone else, you wouldn't assess a patient this way, your child, a friend. You would not assess anyone else by looping through their reel of bloopers for their lives and saying, "Oh, look what, like what a screw-up you are." No. That's not what we would do. So we don't need to be looking at our own worst case scenarios without looking at, man, all the good things that we have done Pick one area where doubt is currently running.
write down three pieces of concrete evidence that you are capable of handling it. I mean, feel free to write down three things that make this doubt feel real. I think when you get them on the [00:25:00] paper, paper, you'll look at them and you'll be like, "Oh gosh, that's stupid." Write down the evidence of, of the doctor that you are, of, of your competence and your goodness and your skill.
Things you've done, decisions you've made well, moments that you came through. That's the most important data. That's the data that's gonna help give you the confidence you need to help move forward Here's your one practice to carry out of this podcast. If you're in your car, take it, take it out of the car with you.
On your next commute or, you know, next time you have a few minutes of downtime that you're thinking, maybe tonight, tomorrow morning, pick one of the four emotions that we talked about today. Pick, you know, the one that felt the most familiar, the one where you thought, " Yeah, yeah, that's where I live right now," for a lot of us, it's all four.
Then ask yourself three questions: What is this emotion doing [00:26:00] for me? What is the payoff that keeps me coming back to it? Like what's it helping me avoid? What pain is it helping me postpone? Because it's not helping you avoid it, it's just postponing it. What is this costing me right now? Not like eventually, but right now, this week, what is this emotion costing me?
And what is the smallest possible move that is not sitting in this indulgent emotion, Whether it be confusion, overwhelm, indecision, self-pity, or doubt, what is the thing that we can do that helps us get past this? You don't have to solve anything today.
You just need to get honest about the pattern. And I'm gonna-- I'll be honest here with you, too, is when we're in these indulgent emotions, it's very, very hard to see them ourselves. This is where working with a coach is incredibly beneficial because a good coach will help you feel safe while they [00:27:00] point out what kinda baloney your brain is up to and let you decide.
Do you, do you really, do you wanna keep feeling self-pity? You can. It's totally an option, and there is a cost to it. When we get honest about what's going on and get that self-awareness, that's what makes moving past it and walking into something new, some new growth, something that feels much, much cleaner and better, that makes that possible
So here's what we want you to take from today. we covered, worry, confusion and indecision, self-pity, and doubt, they're not random. They all do the same thing. They keep you feeling like you're engaged with the hard thing without requiring you to actually move, and they're expensive.
I mean, worry takes your sleep. It takes you away from being present. Confusion keeps decisions in a holding pattern. It drains your cognitive resources. Self-pity keeps you from finding [00:28:00] one degree of movement that's actually available, and doubt keeps you from acting on what you already know. So you probably came into this episode thinking about that stay or leave question or something like it, and we're not here to tell you the answer, but we will tell you this.
Indecision that comes from one of these four emotions isn't actually a pause. It's actually a choice, And it's costing both options the best version of you. So name the emotion, see the pattern, then pick even a one-inch move. I just recently attended a celebration of life and it was interesting.
They brought up a quote that I found real interesting that one teacher had told this person that was like, "If you don't know what to do, just do something, and if you don't know where to start, just start somewhere." So that's that one i- inch move that hopefully we've inspired you today to do. So That's it for today's episode, friends. If you found this conversation [00:29:00] helpful, the best way to support us is to subscribe, so click that button now and leave us a five-star rating and a review. It helps other physicians find this podcast, and it moves us up on the list. And if you do leave us a review, we wanna see it, so take a quick screenshot and email it over to [email protected].
And just for doing that, we will send you our free little e-book on emotional regulation, which is actually one of our most requested and impactful topics. And before we go, we want to invite you to our first exclusive physician-only wellness retreat. We are collabing with MedTreks International to visit the lush restorative Bodhi Tree Yoga Resort in Nosara, Costa Rica.
And this is a true sanctuary built for renewal. We want all doctors who are ready to restore their vitality and reclaim their joy walk away with some practical, sustainable tools. And so we, your team here at The Whole Physician, are gonna [00:30:00] be managing the content, but we know that you will just walk away with new connections with other colleagues who are going through the exact same thing.
So we'll provide the link in the show notes to sign up, and it is this November 2026. We hope to see you 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.
