If you have ever lost it mid-shift, frozen when you should have acted, or spent the next two weeks asking yourself what’s wrong with me, you already know what character assassination feels like.
In this episode, we break down a simple and effective reframe that interrupts the self-flagellation shame spiral without making excuses or lowering standards. You will learn how to move from why did I to, of course, how to give yourself a legitimate and hard-earned break, and why self-compassion is not softness but one of the most underutilized performance tools in medicine. Topics include physician burnout, self-compassion, cognitive reappraisal, shame and self-criticism, communication under stress, and physician coaching.
Mentioned in this episode
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The Core Idea
Something hard happens at work. You freeze, snap, lose it, or fall apart. That is the first hit. First-order distress.
Then comes the second hit. You grind yourself down for having that response.
Why did I react that way. What is wrong with me. My partners never do this. I should be stronger than this.
That second hit is self-flagellation. Research on rumination and shame shows it usually causes more suffering than the original event. You are not processing the distress. You are extending it.
This tool interrupts the second hit. It is not about making excuses or lowering standards. It is about making your experience intelligible and moving from judgment to discernment.
The Reframe
Shift from why did I to given that, of course.
Not: what is wrong with me. But: what was I working with.
Your emotions, reactions, and struggles are not character flaws. They are outputs of a system responding to conditions. Assess the conditions.
When shame hits, there are two common failure modes. The first is suppression. Push it down. Get over it. Move on. But the body stays activated. The emotion is still running underneath. What we suppress we end up feeding.
The second is collapse. Going fully into the spiral. The why did I loop that runs on repeat and gains momentum. That is not processing. That is drowning.
Reappraisal is the third option. When you change the meaning of an experience rather than fighting it or collapsing into it, the nervous system gets an accurate read of the situation, and the emotional signal changes. Not because you talked yourself out of it. Because you stopped being at war with it.
The Four Steps
1. Notice the story The language of should and why did I is the tell. When you catch it, that noticing creates the pause. You cannot control your immediate reaction. But what happens in the seconds after it, that is where you have influence.
2. Name three conditions Facts only. No character judgments. Sleep status. Hours worked. Emotional load already being carried. What you had just been through. Three is enough. You are building context, not a legal brief.
3. Complete the sentence Given these conditions, of course I ________. Say it out loud if you can. The goal is to shift from what is wrong with me to what was I working with.
4. One small action What can you do in the next two minutes. Not the next month. Two minutes. Drink something. Step outside. Finish one small task. The purpose is to shift out of the rumination loop and into forward motion. Even a trivial concrete action does this. You will feel the shift, not just think it.
What This Is Not
Not lowering your standards. Not avoiding accountability. Not making excuses.
You can say of course I reacted that way given what I was carrying and still ask what do I want to do differently next time. Both are true. One without the other is incomplete.
Where to Start
Think of something recent you judged yourself for.
What are three conditions that were present at the time. Facts only.
Complete the sentence: Given these conditions, of course I ________.
Say it out loud. Notice what happens.
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