Scene 1: I’m working on a lecture presentation and reviewing responses from a survey that was taken at one of our conferences where I asked participants to rate their level of work-related stress.

Scene 2: I take a break from my lecture writing and review recent emails I’ve received. I come upon one from a reader who says, “Jack, thanks for offering this free suicide management course. I’m always impressed by how you make things happen… It seems like you just go and do the things you want to do.”

The juxtaposition of these two scenes, occurring minutes apart, struck me. I’m certainly glad to know that someone I know thinks well of me. It’s certainly better to be thought well of rather than poorly.

But I wouldn’t be writing about this if there wasn’t more to it than that. What struck me was this reader who sent me the email was impressed with my “doing what I want” and this contrasted to the large proportion of stressed clinicians, so many of whom feel beset by uncertainty and function at work with a sense of lack of control. In the survey results regarding job stress, one in five admitted being so stressed that they’re ready to quit their job as physicians, with 84% of respondents experiencing at least moderate work-related stress.

So, I thought, perhaps if I share my belief system or mindset, I can help at least a few of clinicians who feel very stressed – and stuck – into beginning to undertake positive changes in their lives. Here are some of my thoughts.

Change Is a Habit … And a Skill

A person need not be born a risk-taking, thrill-seeking daredevil to become comfortable with and good at making life changes. I believe that the more you engage in change the easier it becomes. It’s like working a muscle – your change muscle. Here are some ways this occurs:

  • As you make changes, you begin to experience the benefits of change and thereby increase your willingness to engage in more change.
  • You proceed through the change process and realize you survived it; nothing horrible occurred as a result and, often, some benefit accrued. You become comfortable taking on bigger changes.
  • As you initiate and implement changes in your life you develop skills. Quite simply, you get better at it. You begin to notice the pitfalls – that you avoid in the future – and the effective interventions – that you further refine and make greater use of.

You might notice that becoming more comfortable with, and successful at, making changes is based on well-established cognitive-behavioral techniques. The three bullets above correspond to 1) behavioral activation that leads to reinforcing (rewarding) outcomes, 2) exposure that leads to desensitization to the discomfort that change can provoke, and 3) skill acquisition.

I was quite change-averse for most of my life. For example, when at age 40 I started my company’s first review course, I lost 15 lbs. in the two and a half months preceding it because I was so anxious, I couldn’t eat. I would wake up every morning as dawn was breaking with a distinct thought in my head, “Who the hell do you think you are holding this course?!” I was particularly agitated by the thought that the physicians who signed up had to actually get on airplanes to come to the course. That I had my fellow clinicians take such a big and definitive step to attend a course I was holding felt like the height of hubris. The only reason I went ahead with that first course is because I thought it would be more damaging to the chances of those first 12 participants to pass their board exam if I canceled than if I proceeded.

After that first course, I went on to hold more many live courses from 2002 until now. With each course I have become slightly less anxious but by no means NOT anxious. Many times the evening before a course, I have to go jogging – and I don’t like jogging at all – to help dissipate my anxiety.

And so it goes.

Start Small

Many entrepreneurs, such as myself, are actually risk-averse. We don’t bet the store on some new product or service. Rather we start out small, taking a series of incremental steps. If our product-in-development doesn’t take off, we have time to adjust it or kill it, and move on to another initiative.

I advise the same when making personal changes. I don’t recommend, for example, telling the boss to shove it, selling your house, and moving to Madagascar.

For most people, making a small meaningful change is best. Try it, learn from it, take a deep breath, and take the next small step.

I had a great little book I bought many years ago called Change Your Questions, Change Your Life. The author Marilee Adams writes that change often triggers anxiety; it awakens your ever-vigilant amygdala. She recommends making changes so small they get in under the amygdala’s “radar.” In one example the author gives, a woman who suffers from obesity and several medical consequences, reports that her doctor nagged her to change her diet and to exercise. She didn’t do any of it although she agreed with her doctor it was the right thing to do. She finally got some traction when the doctor told her to tear up her health club membership and just stand up and walk in place during commercial breaks as she watched TV. That was her first successful step in a series of steps that led to her eventual loss of weight and improved health. That first change was so small, it didn’t trigger her anxiety of failure, which she had already experienced a lifetime’s worth.

Meaningful Change

If you’re embarking on a process of change, it helps if you know what it is you want. This sounds obvious, but most people, including our patients and us too, often may not be fully clear what it is we are striving for.

I’m partial to the “5 Why?” approach. If you start with the desire to “not work so hard,” for example, ask yourself “Why? Why do I want to not work so hard?” After each response, ask yourself “Why?” four more times. Only then might you come upon your very specific motivation to change (your source of pain) and your real desired outcome. Try it. It may blow your mind!

I’ll stop here. Please share with me your struggles with change, failures and successes both. I’d love to share your thoughts with the other clinicians who regularly read these articles. I am happy to give you your byline or keep it anonymous. Your call.

Until next time,

Dr. Jack

Language Brief

“You will never ‘find’ time for anything. If you want time, you must make it.” – Charles Buxton

“Begin doing what you want to do now. We are not living in eternity. We have only this moment, sparkling like a star in our hand – and melting like a snowflake.” – Francis Bacon

“I held a moment in my hand, brilliant as a star, fragile as a flower, a tiny sliver of one hour. I dripped it carelessly, Ah! I didn’t know, I held opportunity.” – Hazel Ying Lee

“In the end, it is important to remember that we cannot become what we need to be by remaining what we are.” – Max De Pree