Stop Physician Burnout with the Reverse Differential Diagnosis
Doctors are trained to be diagnosis machines. You plop us down in front of a complete stranger for 10 - 15 minutes and we will diagnose the problem - and be in action to treat it - in somewhere between 5 seconds and 15 minutes. It's what we do dozens of times a day and thousands of times a year in our practice.
We originally learned how to do this in the familiar exercise of Differential Diagnosis
In this post, let me show you how this basic function of a good doctor invisibly robs us of the ability to be happy, content, grateful and relaxed. You will also learn how to turn the process around and perform a Reverse Differential Diagnosis any time you wish -- to find blessings showering you like a thunderstorm any time you step out of your physician programming.
Differential Diagnosis and your Sh*t Glasses
You remember the exercise of differential diagnosis. Give us a single symptom, skin lesion, odor on the breath, appearance of the tongue, laboratory abnormality -- the barest hint of pathology -- and we will make an exhaustive list of all the diseases this one clue could represent. Often, many of the options on the differential list are potentially fatal.
Differential diagnosis is an extremely important skill for your patients and the success of your practice. It is meant to only be used at work, in your professional capacity as a physician. In a different setting it could also be seen as an exercise in abject paranoia!
If you don't have an "OFF SWITCH" on this skill -- and it can bleed out into your private life and really mess up a doctor's ability to be happy.
The automatic process of differential diagnosis hums along at an unconscious level - feeding worry, dissatisfaction, an inability to completely relax and be grateful. It can block your ability to simply relax and feel a sense that everything is actually OK.
- It is one thing to possess a finely tuned ability to ferret out the problem/disease/pathology in our work with patients.
- It is another thing when all you can see is problems, danger and what is not working ... everywhere in your life and all the time.
Remember X Ray Spectacles? When you put them on, you could see through things to find the bad guy. As doctors, the medical student training exercise of the Differential Diagnosis installs a set of glasses on us as well. They aren't X Ray specs though ...
For doctors, it is as if we are wearing "Sh*t Glasses"
Here is a story that illustrates this point
Imagine you and I are leaning on the railing of the balcony at Grand Central Station in New York City. Down below, we can see several hundred of people in the central lobby scurrying from train to train. Got it?
It would only take about 10 seconds for both of us to spot the one person in the crowd who is LIMPING. We would point at them simultaneously -- and then get into a heated discussion of whether it is their hip, ankle or knee.
I want you to know one thing for sure.
ONLY DOCTORS DO STUFF LIKE THAT !!
- Normal People might see the man on his knee proposing to his fiance.
- Or the florist bending down and giving a child a single rose.
- Or the little Corgy puppy with one floppy ear
All of these are in this same scene. Our doctor programming renders them invisible most of the time as our unconscious conditioning runs the differential diagnosis loop constantly.
We tend to see sh*t/pathology/danger everywhere and all the time. We see suspicious moles at the grocery store, Von Reklinghausen's disease in every lump and bump at the PTA meeting.
It is as if our whole life becomes a differential diagnosis exercise. You have a single loose stool at breakfast and by lunch you are convinced it is either Crohn's Disease or salmonella.
Let's turn this on its head!
You can put the Differential Diagnosis in reverse as well. It can be a powerful force for good in your life when you turn it 180 degrees and start over.
Try this Simple, one minute exercise:
For the next 30 seconds name every disease you can think of that you are NOT SUFFERING FROM AT THIS TIME.
Don't just read that sentence and smile.
Give me a 15 second dump of all the things that are NOT HAPPENING to you right now.
I will get you started (and I sincerely hope you are not suffering from any of these ...)
- Beri Beri
- Diphyllobothrium latum
- Sclerosing cholangitis
Notice none of those are happening to you right now ... and smile.
No matter what you think has caused this good fortune -- the grace of God, or Karma or luck -- none of this is happening to you right now. You are, in fact, one of the very most fortunate people to have ever walked the face of the earth.
You have complete justification to be as grateful as you wish.
Notice this too. You are an experienced pro. If you ran the Differential Diagnosis in reverse for just a very few minutes, the list of bad things you are NOT suffering from will be in the hundreds.
I hope you can see that you are literally being showered in blessings ALL THE TIME.
It is a different and equally valid perception of reality to the Sh*t Glasses view.
And we haven't even started counting the basic blessings of civilization that are unrelated to our ability to diagnose diseases.
My list always starts with the basics ...
- indoor plumbing
- hot water
- the flush toilet
- ice cubes
- those jars of already peeled and chopped garlic
- red wine
From now on ... Recognize the Sh*t Glasses when you have them on
- Notice when you are driven by your programming to see bad things all around
- Realize it is only a habit, born of the conditioning of your medical education and that you have the power to take a different viewpoint
- Take a deep breath, take the glasses off -- and throw your Differential Diagnosis skills into REVERSE
- If you still have troubles finding something right in this moment ... you could start with the fact that your teeth don't hurt and your underpants are dry.
PLEASE LEAVE A COMMENT
What is your favorite blessing to recall when you are over stressed or down in the dumps?