Welcome to the Drive Time Debrief with The Whole Physician, a podcast to burnout-proof your medical career with candor, humor, and encouragement. You spent tens of thousands of hours learning how to care for others, but now it's time to learn proven tools to care for yourself with the power of your mind. If you're tired of feeling stuck, disillusioned, and exhausted, you're in the right place.
Start your journey to bring back contentment and purpose. Now, here are your hosts, three board-certified emergency physicians: Doctors Morrison, Cazier, and Dinsmore.
Hey, guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kindra. Today we're going to talk about the hidden cost of triangulation.
Have you ever been frustrated with someone at work, walked into the doctors' lounge, found a friend or a favorite colleague, and said, "You're not going to believe what just happened," or, "You won't believe what this person just did"?
Or maybe you're upset with your spouse and you call your sister, or your teenager is driving you crazy and you complain about them to your other child. That one, please don't do that. It will get you in trouble. Or maybe your department chair is frustrating you, so you talk about them with everybody else in the department except directly to them.
"Can you believe what so-and-so is doing? Can you believe they did this?" And before you know it, you've somehow been drafted into a conflict you weren't even part of ten minutes ago. There's actually a name for this: triangulation. It is extremely common, and especially common in medicine, because it often feels very hard to address problems directly.
Triangulation happens when tension between two people gets managed by bringing in a third person. Person A has a problem with person B, but instead of the tension staying between A and B long enough for them to work through it, person A brings in person C. And here's the thing: it usually works, at least temporarily. It gives some relief.
Anxiety might go down. We feel more understood by person C. Someone is agreeing with us or validating us, telling us we're not crazy, and suddenly we feel a lot better. Except the original relationship hasn't gotten any better. Sometimes it's gotten worse. So today we want to talk about why human beings triangulate, why physicians may be particularly vulnerable to it, and how to recognize when a helpful conversation with another person has turned into something much less helpful.
The goal here is not to never talk to anyone about your problems. We need to talk to people. Most of us need therapy. We need coaching. We need to talk to our friends, seek consultation, and ask for help. Sometimes bringing in another person is exactly the right thing to do. The question is whether this third person is helping me deal more effectively with the person I'm having difficulty with.
Sometimes they are. The key is recognizing when they're not. Are they becoming a substitute for dealing with that person directly? That is the key question, and it's what we're going to talk about.
So let's talk about why we create these triangles. It usually isn't because someone woke up thinking, "Man, I'd really like to make this relationship as dysfunctional as possible today." Triangulation is usually an attempt to regulate your discomfort. Imagine two people with some tension between them. Something has happened, and one person feels criticized, rejected, disappointed, angry, or embarrassed. Maybe they don't know how to bring it up. In my family of origin, there was a whole lot of "let's pretend none of this happened and not deal with it directly."
Maybe an attempt at discussing the issue turned into an argument. Maybe you're terrified of conflict, or you have no idea how to hold conflict at all. Maybe the other person holds more power over you, or maybe you simply want someone to tell you, "Yes, you're right."
Like, "Am I the only one here? Did you hear that too?" That sort of thing, because it feels good to have somebody on your side. Direct tension is uncomfortable, so we discharge some of that tension somewhere else. We end up talking to another person, and our nervous system says, "Finally! Somebody gets it." This is one of the reasons triangulation can become so reinforcing. It works beautifully in the short term but often terribly in the long term. How many of our habits are like that? So many. My Real Housewives binge, for example, was really good in the short term, but when it was 4:00 AM and I had to get up for an early shift, it was not good.
So now we've taken a two-person problem and created a three-person emotional system around it. Sometimes that system becomes habitual or stable. A spouse complains repeatedly to a friend about the marriage. The friend becomes increasingly convinced that the spouse is married to a monster. They've only heard one side of the story, and the friend reinforces one interpretation of everything that happens. Now every new disagreement gets filtered through that new alliance.
Or imagine a medical department where one physician is frustrated with another. Instead of addressing that individual directly, they start talking to other people: "Hey, do you think something's up with so-and-so? What's their deal, anyway?" Soon an informal coalition starts. People are discussing the physician's personality and motivations. Are they even competent? What's going on with their marriage? Maybe it's their childhood attachment style. We get way into the weeds, discussing anything except actually addressing the behavior and having a conversation that could result in something beneficial.
Something interesting has now happened. The original disagreement may have been relatively small, but the emotional system around it has become its own entity. It has become huge. So triangulation isn't just a little harmless gossip, although gossip can absolutely be part of it. It's about managing relational tension through another relationship. It's the wubbie you go to instead of the person you need to be having the conversation with.
And listen, most of us do this sometimes. Physicians especially, because medicine creates unusually fertile ground for triangulation. We work in high-pressure environments. We're tired. We're snapping at people. There are steep hierarchies, and sometimes direct confrontation carries professional risk. And physicians often have remarkably little training in interpersonal conflict. It's not part of those ten thousand hours we spend in medical school and residency. We're just supposed to figure that part out on our own.
A lot of us also don't come from families where that was part of the discussion, and we've never seen healthy conflict. Many of us are completely unfamiliar with it. In our training we learn how to put in a central line or manage septic shock, but there wasn't a six-week rotation on how to address a colleague you're upset with without creating a departmental civil war. That would be a good rotation. A very useful one.
So guess what? We do what humans do. We find someone safer. We don't like feeling unsafe, so we create safety for ourselves. Maybe we talk to the charge nurse, our work spouse, or our favorite consultant, or maybe we put it in the group chat. Sometimes that's genuinely helpful, but sometimes it means that everyone knows there's a problem except the one person who needs to know about it, the one person who could actually do something to solve it.
That's the first thing we want you to notice. Where does your discomfort go when you're upset with somebody? Who hears about it first? And does that person move you toward the original relationship, or is it your wubbie, so that you can move away from it?
I want to highlight something you said there, just to make this real: sometimes direct confrontation does carry risk in medicine, and that's because it is an abusive system. In a healthy system, a healthy family, or a healthy work environment, we can give feedback without fearing retribution, and that's just not always the case. So I want to acknowledge that it's not always possible to bring our concerns directly to the people involved.
That's a good point, and it brings us to an important distinction: not every third person creates an unhealthy triangle. Third parties can be enormously helpful, such as a therapist, a mediator, a coach, a chief wellness officer, a mentor, or a friend. All different types of people can serve important functions. Sometimes, as Laura was alluding to, the direct conversation could be unsafe, or it might happen at a very inappropriate time or in an inappropriate manner. Sometimes there's a power differential, which can also be intimidating.
Then there's harassment, abuse, discrimination, impairment, and patient safety issues. You can imagine how quickly this can spiral. So we're not suggesting that every problem should be handled privately between two people. But the better question to ask at this point is: what role is that third person playing?
We like to think of this as the difference between a bridge and an alliance. A healthy third party tends to function as a bridge. They say validating things like, "Yeah, that sounds really painful. What do you think you need from her? What do you think you need in order to come to an agreement?" Or a close friend might call you out: "What part of this do you think you're contributing to?" Or they might simply ask, "Have you told them that? Have you had that discussion?" What would it look like to address this behavior by giving them the benefit of the doubt rather than assuming intention?
A third party, whether a therapist, friend, spouse, or anyone else, doesn't serve much purpose if they're just saying, "Yeah, you're right. That dude sucks," or "That dude's terrible," or "Everybody else at the hospital is the problem," or "Everybody else in that department is the problem." Someone who is looking at this objectively and loves you can say, "It makes sense that you're upset, and I'm wondering whether that interpretation is the only possible one." Or we sometimes ask, "What else is possible?" That's building a bridge. That's the third person helping you become more capable of returning to the relationship with clarity.
An alliance works differently. That conversation goes, "Exactly," or "They always do that," or "They never call back," or it involves name-calling: "Yeah, I can see that. They're a narcissist," or "I don't know how you tolerate that person," or "Yeah, everybody thinks they're impossible." That's coming alongside in a different way, one that doesn't really explore the problem. It's building a case, and building a case feels very different from trying to understand. Once the case against the other person is being built, you start to get into confirmation bias, and that becomes incredibly powerful.
Now everything they do from that point forward becomes evidence. If they're quiet, they're withholding or mad or upset. If they talk, they're defensive. If they apologize, they're manipulating. If they don't apologize, they don't care. There's a lot that can be left to interpretation, and there's no move left on the chessboard that can change your conclusion. You become stuck.
So here's a question we think is worth asking: After I talk to this person, am I more curious about the person I'm struggling with, or more certain that I already understand them? Does it make me more compassionate toward them, or does it swing me toward contempt? Does it help me prepare for the difficult conversation, or am I more convinced that having the conversation is pointless? Does it make me more interested in solving the problem, or just more interested in proving that the other person is one hundred percent responsible?
Because sometimes what we call processing is really rehearsing the prosecution, and that's a distinction worth making.
Physicians should recognize this, because we would never accept that standard of evidence clinically. Imagine deciding on a diagnosis and then interpreting every subsequent finding exclusively as proof that your diagnosis was correct. We would call that premature closure. But relationally, we do it all the time. We diagnose people. We call them selfish, lazy, narcissistic, toxic, controlling, or difficult, and then once we come to that conclusion, we gather evidence. Sometimes that label may point toward something real, but labels can also prevent us from seeing the person standing in front of us.
The healthier third party helps us hold on to complexity. Yes, the behavior may have been hurtful, and you may not completely understand why it happened, and yes, your feelings are real, but your interpretation is still interpretation. Both can be true.
Okay, so let's talk about how to step out of a triangle. First, we need to start noticing. Notice when you're being invited into a triangle. Say someone says, "Don't you think she's being unreasonable?" That is often an invitation. We don't have to reject the person or invalidate them. In fact, let's not invalidate them, but we also don't have to join a coalition against the other party. We can say, validatingly, "Yes, that sounds really frustrating. Have you talked with her about it? What has happened so far? What would you like to happen?" Or, "What do you think your next conversation with him needs to sound like?" When we make these moves, we're staying emotionally connected to the person, which is what we want. This person came to us for support, and we're not turning against the third person. This is a really powerful skill, and we just need to know that we can support somebody without agreeing with every interpretation they have. Support and agreement are not the same thing.
Second, if you're the one talking, ask yourself what you actually want from the conversation. Do I want perspective? Comfort? Advice? Validation? Help preparing for a conversation? I'm going to be honest: sometimes we need a reality check because circumstances are so confusing that we're not sure what's going on, and that's okay, too. Am I just looking for someone to tell me I'm right? That's where we can get into trouble, and it makes sense that we want that, because it feels good to be right. There's nothing shameful about that. But when we know what we're looking for, we have more choice as we proceed in that conversation. And do we actually want to be close to this third person? What are we hoping to achieve? That's just important to know.
Third, consider whether the person we're talking to is an appropriate person to involve. This is particularly important with mutual friends, or with anyone whose image of the person we're talking about will be affected by what we say. We want to be very, very careful. For instance, if you're angry with your spouse and you repeatedly describe your spouse's worst moments to mutual friends, those conversations don't disappear when the conflict is over. I would say this is especially true if you're describing your spouse's worst moments to your relatives, because they will remember that and hold it against your spouse even after the issue has passed. You can forgive your spouse, and your friend or relative might not.
The same thing can happen at work. You may resolve a conflict with a nurse or another doctor, but if you've talked about it with multiple other colleagues, now six other people have a version of that person in their heads that the person may never even know exists. I saw something like this happen at work recently with a nurse who quit. I really liked this nurse a lot, and it made me so sad to see these accounts of her being circulated when she wasn't even aware. She was already gone. So there's a relational cost to all of this, and that's just something to be aware of.
Finally, whenever it's possible and appropriate, let's move the information toward the place where it belongs. If you have a problem with me, eventually I need to become part of the conversation. Maybe after you've calmed down, which is usually a better place to start. Maybe after talking with someone trusted, maybe a therapist, sometimes even a mediator. Maybe in writing, or through an appropriate institutional process. But the goal is movement toward resolution rather than endless circulation of the grievance. We all know how it feels to hear the same stories again and again about somebody who's not doing what they're supposed to be doing. It just drains everyone.
Now, as with most things, there are exceptions. If the relationship is somehow unsafe, coercive, or abusive, or there's a major power imbalance, direct confrontation may not be appropriate. In those situations, getting support and outside intervention can be essential. But in ordinary relational conflict, triangles thrive when nobody takes the problem back to the relationship where it started.
There's one question we can use to help interrupt this whole pattern: Have I said this to the person I'm saying it about? Ouch. Yeah. We don't particularly enjoy that question either, and it's so normal, natural, and routine for us in medicine to talk about people rather than to them. But this question is a really good one, and it will help us stay out of triangles.
Triangulation is so common because it solves a very human problem. When you have relational tension, it hurts, and there's no better remedy than recruiting someone onto your bandwagon, because it makes you hurt a little less. But reducing anxiety and solving a problem are not the same thing, and sometimes the conversation we have about someone becomes a replacement for the conversation we need to have with them. Instead of having it about them, it might have a bigger payoff if we have it with them.
Sometimes you do need a third person, because that person may be wiser, or far enough removed from the situation to bring a calming presence or some clarity, and that's where a healthy support person really adds to the situation. But sometimes the third person becomes our ally against the other person, and that's when the triangle starts doing damage.
So just notice. Maybe you've already had this experience while listening, or maybe sometime this week, notice when this happens. Notice when the recruitment conversation starts, and notice where you go when you have relational tension that feels uncomfortable. You don't have to judge or condemn yourself. Just notice. When you get frustrated about a situation or a person, where do you go? Who do you tell? Who do you recruit, and who recruits you? And after those conversations, ask yourself, "Am I becoming more capable of dealing with the actual relationship, or less?" Because healthy support should eventually increase our capacity for relationship, not replace it.
Next time, we're going to take this one step further and talk about something almost all of us do: venting. Victorious venting, as I like to say. Venting can feel incredibly healthy, and sometimes it feels so good. But sometimes what we call venting is actually resentment rehearsal, coalition building, or gossip with excellent branding. I'm going to use that one next time: "I have some excellent branding on my gossip." Just kidding. We're going to talk about how to tell the difference, and we'll go deeper into when venting is healthy and when it's not.
That's it for today's episode, friends. If you found this conversation helpful, the best way to support us is to subscribe. Click the button now and leave us a rating and review. It helps other physicians find our podcast and moves us up the list. 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 is one of our most requested and impactful topics.
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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.
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