by Jeffrey Cohn | Feb 22, 2023 | Uncategorized
Many people are challenged by feeling a sense of having lost control of their lives. In an effort to regain a sense of being in control we may act in ways that make us feel like we’re taking charge. In fact, what may be happening is mostly taking place in our brains. The circumstances that led us to feel like we had no control are still there. Our now believing we had regained some sort of control is really a myth. And the impact of the actions we’ve just taken may have far-reaching, long-lasting effects. In this third installment about our Saboteurs, from the framework created by Shirzad Chamine and Positive Intelligence I’m focusing on the Controller, one of my lead Saboteurs.
Like with all Saboteurs, our Controller overuses and abuses actual strengths we have. Physicians are likely to have many of these strengths, as well as to manifest the Controller Saboteur. Let’s explore what these strengths are and how they bring benefits into our lives and those with whom we interact. These include:
- Confident, action-oriented, decisive persistence
- The ability to challenge oneself as well as others
- An ability to do the right thing, even if it’s unpopular
- Seeing possibilities and having the ability to activate ourselves and others towards those outcomes
I like the imagery of a huddle, where someone is taking charge, setting up a strategy, helping everyone feel engaged in pursuit of a common goal. When I’m in this position of taking charge like this, I feel like I’m shifting into another gear. I can recall a night on-call receiving a stat consult on a young woman in a coma with almost no platelets (the blood cells involved in clotting). When I got to the hospital, I immediately went to the hematology lab to look at her blood smear. It was clear from what I saw under the microscope that she likely had a condition called thrombotic thrombocytopenic purpura (TTP). This was one of the diagnoses that, when I learned about it in med school, I remember thinking, “Man, I don’t want to get this.” At that time the mortality was > 90%. However, at the time of this story significant advances had been made such that, with ideal management, cure rates were very high. However, treatment needed to be initiated rapidly.
Shifting into high gear, I saw the patient (who was in the ICU), called the docs and nurses involved in her care together, than mapped out our “game plan.” We all had to play our parts. I contacted the Red Cross who were going to bring in equipment that could help filter out the harmful proteins leading to this condition while infusing healthy ones back into the patient. The residents got a surgeon to insert the special kind of IV line needed for this infusion, and talked them through their concerns about doing this procedure in someone with so few platelets. The nurses provided fabulous care and kept the family up to date about what was happening. Within an hour the Red Cross was in the room and their procedure was underway. By the following morning the patient was awake and speaking, her platelet count was on the rise, and she was headed towards the outcome we all hoped for: a complete cure.
There are way too many times when physicians turn into Controlling authoritarians. While sometimes this may result in short-term outcomes that make it look like this is a good strategy, there are long-term consequences- and sometimes catastrophic results. When a person’s Controller takes over they feel the need to be in charge, no matter who knows best. They will push people well beyond their comfort zone, avoiding any danger signs. They actually get energized when others push back, and then they’re surprised when others feel disrespected or hurt.
When I was a med student a patient came onto our service one night who was having a serious gastrointestinal hemorrhage. She was quite elderly and not a candidate for any surgical procedure. The standard medical treatment at that time was a medicine called Pitressin. Our team contacted the patient’s physician to ask for his management plan and he told us to start her on the medication Pitocin. We told him we thought he meant Pitressin but he persisted in insisting that she receive this incorrect medication, eventually yelling at us, “I’m her physician, you need to do what I’m telling you to do!” The following morning, when he reviewed the chart and her orders (what he had demanded we do), he yelled at us that we never should have ordered Pitocin- that we clearly knew he had made an error and we should have overridden him. All of us who cared for that patient that evening were scarred for quite a while- and the patient received awful care. These are the kinds of results that a Controller run amuck produces.
If you feel you often have your Controller showing up, there are ways to intercept it and make different, better decisions through mental fitness. The sense of not being “in control” can become an opportunity to explore. There are so many things to discover and learn when you are in uncertain situations. Since so much in our lives is uncertain, that means you can grow in many dimensions as you respond to whatever comes your way. Mental fitness uses the imagery of sailing, saying, “While I may not be able to control the wind and the waves, I can still be an amazing sailor!”
Interested in learning more about Positive Intelligence/becoming more mentally fit? Visit my website at https://caretochangecoaching.com or contact me at https://calendly.com/cohnjb827/discovery-session-?month=2023-01 for a conversation.
by Jeffrey Cohn | Feb 4, 2023 | Uncategorized
Who really likes conflict? Isn’t avoiding conflict whenever possible an honorable goal? Except what happens when there really are conflicting perspectives- how does resolution happen? If you choose to avoid conflict rather than advocate for your point of view, or at least make sure it’s heard, what happens then? Probably your perspective may not get considered, and, when decisions are made favoring another viewpoint, you may feel disappointed, even resentful. Consider all the energy and time wasted by avoiding some conversation about this conflict…
This is the domain of the Avoider, one of the Saboteurs I often see showing up in me. In Part One of this series I described the Positive Intelligence© framework. As with all Saboteurs, the Avoider overuses and abuses actual strengths that, when used appropriately, make the person the beautiful being they are. Strengths of people with the Avoider include seeking peace and harmony, both internally and with others. These people can go with the flow, feeling calm in stressful situations in ways that make others feel better. They typically are optimistic, expecting that something good is likely to happen in whatever situation they find themselves in. And they avoid judging others, choosing instead to find some positive attribute in almost everyone.
I can recall experiencing this kind of calm leadership when I was still a med student. Our team was re-rounding at the end of our day on a patient who was dying of throat cancer. Earlier in the day, when he was coughing up some blood, the ENT docs following him told us that his tumor was sitting on his carotid artery and there was no treatment available. As our resident led us into the room the patient sat up in bed, opened his mouth, and blood began to pour out. I began to run around like a chicken without a head, asking if I should call the blood bank or anything else.
My resident said to me and the team, “Calm down,” and to the nurse said, “Please give me 3 vials of morphine.” He injected one vial after another while the patient, who had been awake while he was bleeding to death, gradually closed his eyes and died. I’m not sure I ever witnessed a better example of being able to be calm in a crisis and act in the best interest of a patient.
A situation that frustrates many clinicians caring for patients in Intensive Care Units that involves the Avoider is the patient who is at the end of their life as a result of a progressive, fatal illness who is on life support AND has never been engaged in conversation about what care they wanted when their illness got to this point. People who have the Avoider are conflict averse to an extreme, using procrastination to Avoid dealing with challenging, potentially unpleasant tasks. This kind of conversation is not easy or quick, and many physicians choose to Avoid it, saying things to themselves like, “They’re not ready for this yet- I don’t want to take away their hope. There’s more that we can do.” So, what happens? The conversation never takes place, decisions get made that are more comfortable and easier (like “do everything”). Meanwhile patients and families suffer, clinicians experience moral distress, and the physician with the Avoider, somewhere deep inside himself, may be beating himself up, saying “You SHOULD have talked to her about this!” Nobody benefits, everyone is harmed with this kind of Avoidance.
If you feel you often have your Avoider showing up, there are ways to intercept it and make different, better decisions through mental fitness. Tasks and conversations that are being avoided don’t need to feel “hard.” They can actually be viewed as opportunities and gifts- as ways to learn and grow, to become stronger in some way. The “mental muscles” that one uses and strengthens by tackling and completing a challenge that your Avoider would have wanted you to Avoid makes you equipped for even more difficult challenges in the future.
by Jeffrey Cohn | Jan 22, 2023 | Uncategorized
I took care of cancer patients for the first 20 years of my career. Much of the time I recall being a kind, thoughtful physician who strove to provide excellent care. Occasionally, however, I was a very different person: almost unfeeling, blunt, and rigid in my certainty that I knew what was best for my patients. The story of Dr. Jekyll and Mr. Hyde comes to mind. How could this be?
2022 was a year of discovery for me. As I immersed myself in the world of mental fitness coaching through POSITIVE INTELLIGENCE®, I was able to see myself differently, appreciating my best qualities as well as the ways I have self-sabotaged through the years, often harming myself and others. I learned that purposeful practice focused on strengthening three “mental muscles” enabled me to command my brain so that I could spend more time focusing on possibilities and positivity and less on “what’s bad” and negativity.
The POSITIVE INTELLIGENCE® operating system focuses on using our body’s ability to rewire our brains through neuroplasticity so that we have greater access to our “Sage” brain, regions that connect us to sources of wisdom and well being. This rewiring also lessens the power that our survival brain has over us. Our inner “Saboteurs” reside in these survival regions and create/amplify much of the pain and suffering we experience in daily life. There are 10 Saboteurs; the “lead” one is our Judge, the voice that criticizes ourselves, others, and various situations/circumstances. That Judge is surrounded by 9 “accomplices,” each with their own attributes.
All Saboteurs take innate strengths we have and overuse and abuse them, creating outcomes that are totally opposite of what we’re hoping for. We all have some of each of these Saboteurs within us. This is the first of a series of pieces I’m writing about this group of accomplices. I’ll be sharing what I’ve discovered about myself through the lens of these Saboteurs and how that applies to being an excellent physician/physician-leader.
My dominant accomplice Saboteur is called the Hyper-Rational (H-R). The strengths that people who have the H-R often display include being able to analyze situations and gain deep insight; great powers of perception and observation; a striving to be expert in certain areas of knowledge; and an innovative/inventive streak.
When I think back over my career, first as a practicing physician, then as a physician-leader, I see these strengths being linked to doing my job at the peak of my abilities. When I walked into an exam room and saw my patient was clearly sick with something that hadn’t yet been figured out, my ability to use rational thinking powers kicked in and helped make a diagnosis and initiate an appropriate therapeutic response. In addition, as I was using this “superpower,” I was exuding an aura of calm confidence that we would get to the bottom of what’s going on and that my patient would be feeling better soon. Patients and families found this to be very reassuring.
Once I moved into my leadership role, when I was at my best, I continued to use my rational thinking strengths to benefit my team, my organization, and the communities we served. My deep desire to continuously learn and grow brought us to the cutting edge sometimes, and we received recognition for impressive outcomes using novel approaches to quality improvement. As we, as an organization, tackled complex challenges, I was sometimes able to perceive things differently than my peers, asking questions that others weren’t asking, and discovering issues and solutions that were “hiding in plain sight.” And when the model for change we were using required me to use expertise to facilitate well, allowing others to discover solutions themselves (rather than me provide any answers), I was able to take off my expert’s hat and trust that the people I with whom I was working were going to be the source of the pathway forward. People were drawn to work with us, and many used their time working with my team as springboards into future even more successful careers.
Sadly, I recognize I don’t always use rational thinking in ways that lead to good outcomes for me and those around us. When these talents get in the hands of my H-R, they get overused and abused, and the outcomes this generates are diametrically opposed to what I’m hoping for. People who have the H-R often appear intellectually arrogant, making others feel less smart, even inferior in some way. They frequently think their thoughts in private and express their ideas in ways that seem to “come from left field,” leaving others out of any thinking and feeling that went into the process. Speaking of feelings, they often try to push aside feelings altogether, since they are “distractions” from the rational thinking process, the only thing that matters. People with the H-R Saboteur often choose not to roll up their sleeves and get involved in the sometimes messy work of figuring things out, preferring to observe the “craziness” from a distance.
I can recall a woman in her 40’s that I was treating for multiple myeloma, back in the days where our treatment options were much more limited than they are now. I felt like the wisest approach to give her the best chance of the longest survival possible included a stem-cell transplant, a fairly risky and toxic treatment that required a several week hospitalization. She lived in poverty and used drugs, particularly cocaine occasionally. While she was quite willing to receive any “standard” treatment for her disease, she had no interest in the aggressive approach I recommended, despite my strong, “rational” urgings. At this point I recall becoming “hijacked” by my H-R Saboteur who was saying things to me like, “What’s wrong with her? This makes no sense! She doesn’t even know what’s best for her! Doesn’t she realize I know what’s best for her?” The result of this hijacking was I felt anger and disappointment towards her. This definitely impacted our relationship- I felt myself unwilling to give her the caring, the empathy that I typically gave to my patients (maybe particularly the patients who chose to follow my recommendations?).
I brought my H-R Saboteur into my leadership role sometimes too, occasionally with potentially catastrophic results. I can recall this happening when I made a presentation at a Board meeting. I reported outcomes from an initiative that my institute had participated in. The outcomes had been published in a paper written by the investigators (not me) and the conclusions of the authors were troubling. They had identified a number of serious care issues that were present across the participating institutions. I rationally described the findings and asked the group present, that included the CEO, Board members, and clinical leaders, how they felt these outcomes related to care at our institution. Later that day I was called into the CEO’s office. He was angry, to say the least. He felt he and others present had been “blindsided” and that I had “thrown down the gauntlet.” He felt certain that the clinical leaders present felt that I was shining an unfavorable spotlight on them and their physicians and that I had lost trust with them. In my H-R thinking, I felt “all that I was doing” was presenting data- how could people take offense with that? At no point had I even considered anyone’s feelings, let alone thought about sharing this with my “colleagues” in advance. I created serious distance between myself and my peers that day, something it took a long time to recover from.
Thankfully, the lessons I’m learning as I become more mentally fit are weakening my H-R Saboteur. It’s always there but I can intercept it and hand off the trigger for its reaction to my Sage brain. Appreciating that my rational brain is a useful tool and not the answer for every challenge has been liberating. Using parts of my brain that I’ve underutilized in the past through the rewiring my stronger “mental muscles” are triggering is bringing me more joy and a greater sense of wellbeing. I’m already a better version of myself, I’m a still a work in progress, and I’m enjoying the process immensely.
