Abstract
Emergency physicians routinely absorb stress that extends far beyond their actual scope of control, ruminating on consultant behavior, patient outcomes, and systemic failures that no individual clinician can resolve. This article introduces a practical mindset framework drawn from Byron Katie's three domains of "business" and Stephen Covey's Circles of Control, Influence, and Concern, reframed for the realities of emergency medicine. By learning to clearly distinguish what is and isn't within their domain, physicians can reclaim emotional bandwidth, reduce moral distress, and practice with greater clarity and presence. The authors offer a concrete clinical scenario and actionable questions to apply this framework in real time, on shift and off.
Key Findings:
- â—Ź Mental energy spent in "someone else's business", ruminating on a consultant's rudeness, a patient's poor choices, or a colleague's behavior, directly erodes the emotional bandwidth needed for effective clinical care.
- â—Ź Byron Katie's three domains framework (your business, someone else's business, God's business) offers emergency physicians a rapid mental triage tool for redirecting attention to what is actually within their control.
- â—Ź Covey's Circles of Control, Influence, and Concern map directly onto emergency medicine practice: focusing energy on the innermost circle (your own behavior and decisions) preserves agency and reduces burnout risk.
- â—Ź Western physicians tend to overestimate their circles of control and influence, an internal control fallacy (Nisbett, 2003), which increases frustration when outcomes don't match expectations.
- â—Ź Expanding the Circle of Influence over time, through mentorship, culture-building, and team communication, creates systemic change without requiring physicians to carry concerns beyond their reach.
The three circles applied to emergency medicine
Circle of Control
Your behavior, decisions, tone, and reactions
How you show up, conduct your exam, communicate with patients, and manage your own responses. This is where your energy belongs.
Circle of Influence
Team communication, mentorship, departmental culture
Indirect but real impact, speaking up about workflow gaps, mentoring colleagues, advocating to management. Worth investing in, steadily.
Circle of Concern
Other people's actions, patient outcomes, the system
Things you care about but cannot control. Spending energy here breeds frustration and disempowerment. Recognize it, then redirect.
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"You care. Of course you do. But caring doesn't mean that you have to carry it all. In fact, knowing what's not yours to carry may be the most compassionate thing you can do, for yourself and your patients."
Publication details:
JOURNAL
Common Sense (AAEM)
VOLUME / ISSUE
Vol. 32, No. 4, pp. 8–9
PUBLISHED
July/August 2025
AUTHORS
Amanda Dinsmore, MD; Kendra Morrison, DO; Laura Cazier, MD
SERIES
The Whole Physician
PUBLISHER
American Academy of Emergency Medicine (AAEM)
