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.

Brainy Kid

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.

Smoking Man

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.

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.