The how-to of change

Dr. Ainsley McCaskill used to have trouble fitting in the hour-long bike rides she did for exercise. That meant she hardly ever exercised. To improve consistency, Dr. McCaskill thought about the smallest thing she could do regularly. “I decided to exercise for 10 minutes a day. Anything 10 minutes or longer counted,” she said. “I exercised every day for six months. I had not done that since I was a child. “It’s about setting yourself up for success and being clear about what success means right now. I used to think exercise had to be 45 minutes or more, which, as a professional adult, isn’t always realistic.” These are the types of tips Dr. McCaskill teaches clients. A family doctor and hospitalist in B.C., she is also a certified coach working with physicians and other professionals. The Medical Post asked three experts, including Dr. McCaskill, for their tips for physicians who want to make a change—personally or professionally. All three experts echoed this recommendation to take the smallest step and it is the basis for many books on how to improve your life, including the popular Atomic Habits by James Clear, which is based on the premise that small habits over time compound into major results. Take small steps Dr. Michael Vallis (PhD) is a registered health psychologist in Halifax and a health behaviour change consultant and associate professor in family medicine at Dalhousie University. He says the idea of setting small goals can be difficult for physicians. “Most of us, especially ambitious people like doctors, tend to think if you’re going to do something, you have to go big. But the evidence supports the opposite. It says the smaller goals are ones you can actually achieve and that even minimal effort has positive effects,” Dr. Vallis said. “So rather than deciding you need to run a marathon, which is a goal few people could sustain, micro goals like taking a 10-minute walk after lunch are really motivating for people.” But how do you even figure out what changes to make? Dr. Vallis says that people often choose changes based on knowledge—we all know getting more physical activity is good for you. But he encourages people to make changes based on their values. Those are the ones more likely to stick. “The things that drive human behaviour tend to be our families, our relationships and our work,” Vallis said. “Try to identify, ‘If I do this behaviour, how would it bring me closer to the person I want to be?’ Change is hard. We find that when people align their goals with their values, they can overcome the barriers to change.” Choose your own happiness Even then, making a commitment to yourself can be a challenge, said Dr. Murray Erlich, a retired Toronto psychiatrist who is now a certified life coach working with doctors. “Medical school attracts people who are achievement oriented and medical training helps people learn to focus less and less on their own well-being,” he said. “So, doctors don’t do much about their own happiness. They may believe they don’t have the right to make themselves happy if it’s going to create a negative change.” For example, a doctor might want to limit the number of patients they see in a day because they’re burned out but not make that change because they are afraid of not meeting their patients’ needs. “So, they must learn how important it is to take care of themselves. For their own sake, but also because if you are feeling better, you are giving from a place of abundance, rather than from a place of deficit.” To make this easier, Dr. Erlich suggests focusing on the benefits and how this change would serve you and your patients. Think of future you Another helpful mindset trick is to look beyond the moment. “In the moment we focus on what we feel like doing right now,” Dr. Erlich said. “In the moment, it’s a lot nicer to sit on the couch and watch TV and have a snack and not go to the gym. So, it’s important to focus on the bigger picture goals. If you want to get your blood pressure down, focus on that when you’re deciding in the moment rather than what’s my superficial momentary desire.” Set yourself up for success Dr. Erlich also suggests making your goals as easy as possible, for example, getting your workout clothes ready the night before your morning gym visit. He also recommends thinking of someone you admire and recognizing what habits they maintain to help you move in that direction. “Instead of comparing yourself and being self-critical, use them as a role model and visualize how you can adapt their habits to your life.” He also suggests asking for help to make reaching your goals easier, whether that is from a professional life coach, a friend or your spouse. All three experts also recognize that many changes physicians would like to see are beyond their control and would require healthcare system-wide transformation. “I think it can be helpful to recognize it is not always your responsibility to be juggling all these balls,” Dr. Vallis said. “There is a lot of stress on physicians, and I think it can help to set boundaries and . . . to defend those boundaries.” Dr. Erlich says it is OK to be less rigid about certain work responsibilities. He uses the example of becoming less perfectionistic about reports and consultation letters. “That can be scary, so it is important to tolerate the anxiety that comes with making that change,” he said. “I don’t mean cutting corners, but sometimes people are overly thorough because they’re perfectionistic or frightened of making an oversight. So matching what you do with what is required can help ease things in your practice.” The system can be “incredibly frustrating,” Dr. McCaskill acknowledged. “Burnout is a system issue. It is a problem exacerbated by systems that are inefficient.” “The classic physician experience is to feel like you’re working in a broken system and there is nothing you can do. Some people turn toward leadership roles to try and change the system. But that means taking on more projects. So, a lot of people stay frustrated. I think we lose interest in trying to make changes when we have limited success.” Dr. McCaskill also wants physicians to know that providing gold standard care does not mean we all have to run our practices the same way. “We expect that what works for everyone else should also work for us,” she said. “We conform in how we practise ... in the business model and the hours we keep. And I think that’s unrealistic. It totally disregards that people have different strengths, different life situations and different interests.” This means paying attention to what feels easy in your day and what is weighing you down, Dr. McCaskill said. “Take some time to consider what within your control would make tomorrow better. That’s super important because the system’s not going to be different when you get to work tomorrow.” A good first step is those small, sustainable changes, Dr. McCaskill said. “Being able to prove to yourself that you can make a sustainable change is so empowering. Especially when your daily experience is that you want things to change in the system and they never do. That makes it difficult for us to see all of the opportunities we have each day to make the changes that we want and to have the life that we want.”

The how-to of change

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