Managing Uncertainty as a Physician

Uncertainty is a fact of life if you are a physician. Patients don’t always get better, there is not always one best choice or right answer, and sometimes our decisions are affected by factors that are completely out of our control.

Managing uncertainty is a skill set that doesn’t come easy for many of us. Perfectionism is likely a way of life, and to be truthful, that’s not always a bad thing. We want to do the best for our patients, we want excellent outcomes, and we want to be acknowledged for the care we provide. But when we set unrealistic standards, it can actually be a barrier to optimal care and to our own well-being.

A recent study examined the connection between tolerance for uncertainty and burnout in 2000 faculty physicians. Not surprisingly, intolerance for uncertainty was associated with a three-fold increased likelihood of burnout.

As you might expect, those who struggled with uncertainty were much less likely to be satisfied with their career, and tended to be less engaged at work. Factors that correlated with a greater intolerance of uncertainty were

• Female gender

• Primary care

• Earlier stage of practice

• Lack of a trusted advisor.

Although these were important risk factors, many men, specialists, and later stage physicians were also burdened by intolerance of uncertainty.

Burnout and physician unhappiness are crucial pain points in our current healthcare environment. Not surprisingly, stress from uncertainty correlates with depression and low levels of resilience. Intolerance of uncertainty has been linked to poorer outcomes and even to increased healthcare costs. And burned out physicians are more likely to leave the practice of medicine.

Our innate perfectionism combined with the prevailing medical culture of stoicism means that physicians may be reluctant to admit that they are dealing with uncertainty. This makes it all the more important for more senior colleagues and mentors to acknowledge that despite all we know and no matter how hard we try, uncertainty will always be a part of the life of a physician. Simply sharing that insight can make it a little easier to come to terms with the fact that we cannot control everything.

Although becoming comfortable with uncertainty may always be a challenge, managing your response to uncertainty can open up opportunities to react to life’s curve balls in ways that are both positive and beneficial to all involved.

In their thorough analysis of the issue, Samuel Reis-Dennis and colleagues describe “three corrective virtues” that might help physicians navigate the challenges that uncertainty creates. These include:

• Courage: avoiding the tendency to run away from threats by developing strategies to cope with new challenges

• Diligence: seeking guidance from trusted colleagues and staying current on the medical literature

• Curiosity: addressing uncertainty by viewing it as an opportunity to learn and grow

It’s not an easy task to recognize the factors that may be holding you back. And it’s even more difficult to be objective and to find your own way while living the unpredictable and demanding life of a physician. Medical schools are increasingly understanding the importance of teaching these skills, but it’s not always enough once you hit the real world. Working with a coach or trusted advisor may help to get you on track, discovering the solutions and opportunities that best fit your needs.

An earlier version of this article originally appeared on this site in July 2022.

---

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

References

Allison, J. J., Kiefe, C. I., Cook, E. F., Gerrity, M. S., Orav, E. J., & Centor, R. (1998). The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO. Medical decision making : an international journal of the Society for Medical Decision Making

Begin, A. S., Hidrue, M., Lehrhoff, S., Del Carmen, M. G., Armstrong, K., & Wasfy, J. H. (2022). Factors associated with physician tolerance of uncertainty: an observational study. Journal of general internal medicine

Berg, S. (2020). Feeling burned out? Try picking up the phone to call your coach. American Medical Association

Cook, J. (2022). Forget resilience, improve your uncertainty tolerance. Forbes

Iannello, P., Mottini, A., Tirelli, S., Riva, S., & Antonietti, A. (2017). Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. Medical education online

Reis-Dennis, S., Gerrity, M. S., & Geller, G. (2021). Tolerance for uncertainty and professional development: a normative analysis. Journal of general internal medicine

Simpkin, A. L., Khan, A., West, D. C., Garcia, B. M., Sectish, T. C., Spector, N. D., & Landrigan, C. P. (2018). Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study. Academic pediatrics

Sinsky, C. A., Brown, R.L., Stillman, M. J., & Linzer, M. (2021) COVID-related stress and work intentions is a sample of US health care workers. Mayo Clinic proceedings

HALT: A Self-Coaching Stress Management Tool for Physicians

As a physician coach specializing in burnout and professional transitions, I've seen firsthand how the current state of healthcare can push even the most resilient doctors to their limits. Unchecked anger, frustration, and passive aggressive behavior can often be symptoms of the times.

By now you probably know that burnout is not your fault. Nor is it a mental health issue. Instead, it’s the consequence of a broken system.

At the moment, this is the system we are living in. While some headway is being made, the forces that are driving the burnout epidemic are not likely to improve overnight. And while it can be tempting to lash out when you’re stressed, it’s likely to make the situation worse, straining your relationships with colleagues, staff, and patients.

Beyond burning your bridges, the effect that an emotional outburst can have on your own well-being is profound. What’s more, healthcare systems are cracking down on behavior that’s deemed inappropriate or unprofessional.  

Although you didn’t cause the problem, it’s important that you remain mindful of the far-reaching implications of your communications and actions, regardless of the high quality of care that you provide.

To get you back on track, the simple acronym "HALT" – Hungry, Angry, Lonely, Tired – can be an important tool for self-awareness and self-care.

HALT was originally developed by David Streem, MD, a psychiatrist and addiction specialist, as a reminder to stop and identify the triggers that might lead to a relapse.  But for physicians, the acronym is also an intuitive tool that can remind you to mindfully take a pause and check in with how you’re feeling, and why, when something or someone triggers a reaction.

By using HALT, you can slow your roll before impulsively acting in ways that might harm your personal and professional relationships.

Here's how HALT works:

Hungry

When you're hungry, or “hangry”, even small problems can feel overwhelming. Hunger can make your patience wear thin and your trash your tolerance for stress and difficult interactions.

If you’re like many physicians, being hungry may be your default mode. Although it shouldn’t be the norm, it’s painfully common for physicians to skip meals or eat irregularly due to hectic and overbooked schedules.

Junk food from the snack machine or physician’s lounge might fill you up, but it can make you feel even worse. One straightforward strategy that can help is to pack simple but healthy food for the next day each evening.

But hunger isn't just about food. It's often about other unmet needs, whether emotional, physical, or intellectual.

Take action on hunger by getting in a 10–15-minute break to reset your mind and body once or twice daily whenever possible.  You’ll probably find that when you fill up the tank, even out your blood sugar and slow down your sympathetic nervous system, you’re able to maintain a more balanced mood and energy level.

In the long run, the few minutes you set aside to care for yourself will pay off in more respectful relationships, improved productivity, and better health.

Angry

Anger is a natural emotion, but how you handle it in the workplace is crucial. Unchecked anger can lead to conflicts with colleagues and unpleasant meetings with administrators. When it carries over to the bedside or operating room, it may impact the doctor-patient relationship, undermine teamwork, and even affect patient care.

Become aware of this emotion, and how it feels in your body. When you find yourself getting angry, take a moment to pause and step back. Give yourself time to process, reflect, and move on.

Deep breathing, a short walk, or even bluntly but respectfully discussing your feelings with a trusted colleague can open up a fresh perspective and prevent words and actions that you’ll regret later.

Lonely

If you’re feeling lonely, you may react harshly to stress out of a sense of isolation. Although you’re likely surrounded by people all day, medicine, our profession, ironically, can be a lonely one.

The burdens of responsibility, the fear of making mistakes, the ever-present perception of competition, and the need for confidentiality can all leave physicians feeling isolated.

Acknowledging loneliness is the first step towards seeking connection.  Regular interaction with friends, family, and community, even if brief, can hold back isolation and create a sense of belonging. Finding a hobby that gets you out of the doctor mindset or working out with a group of like-minded people can help as well.

Tired

When you’re tired, everything just feels harder. It’s no surprise that fatigue is a common issue among physicians. Long hours, high stress, and fractured sleep while on call mean that more than 40 percent of doctors surveyed report that their work schedule simply doesn’t allow for adequate sleep.

Chronic tiredness can impair your judgment and your empathy. Although it can be hard to feel compassion for your staff and others though the fog of fatigue, noticing what’s driving your irritation can soften your reaction to stress.

How to Use HALT in Your Daily Practice

• Check In: Before reacting, run through your HALT checklist. This simple pause can reset your frame of reference.

• Be Proactive: Make time for healthy meals, use brief but meaningful stress-relief techniques like mindfulness, get regular exercise, cultivate a life outside of work, and do your best to get restful sleep.

• Seek Support: Don't hesitate to seek professional help if you're struggling with anger, loneliness, or fatigue. Therapy, coaching, and peer support groups can all be helpful, depending on your circumstances.

• Communicate with Colleagues: Foster an environment where it's safe to respectfully express what you’re feeling. This openness can build stronger, more supportive team dynamics.

When you’re feeling reactive, upset, or tempted to lash out, use HALT to take a pause. Are you Hungry, Angry, Lonely, or Tired?

Simply becoming aware of your inner state can help you to defuse a situation and craft a different response. It’s also a great reminder that caring for yourself is neither selfish nor optional if you want to work at your optimum.  

When you take care of your own needs, you’ll find that you will be better equipped to care for those whose lives and well-being depend on you.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.