Managing internal, external expectations key for ophthalmologists
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For many ophthalmologists, managing the weight of expectations is half the battle.
In fact, the internal expectations that surgeons place upon themselves can be just as stress inducing as those that come from their peers, employers and patients.
Source: Stephen D. Klyce, PhD, FARVO
In a recent episode of Healio’s Mend the Gap podcast, Healio | OSN Board Members Cathleen M. McCabe, MD, Marguerite B. McDonald, MD, FACS, and Laura M. Periman, MD, spoke about the difficulty of managing these expectations, as well as useful techniques for processing failure, overcoming imposter syndrome and knowing your worth.
Cathleen M. McCabe, MD: What we wanted to talk about is the setting of expectations. What do you do when you feel like you’re not meeting either your own expectations or external expectations, when things really aren’t going the way that you planned? I know you’ve had many experiences of successes, but I’m sure somewhere, hiding behind the curtain, there were some struggles that you had as well, and that’s what we want to talk about. Where do you find that you have the most stress internally? Is it meeting your own internal expectations, or is it trying to conform to somebody else’s external expectations? Or a combination of those?
Marguerite B. McDonald, MD, FACS: I have the most stress meeting my own internal expectations and standards. So, if there are external expectations, I’m dimly aware of them. Most of the pressure comes from inside of me.
McCabe: I think part of it is in our profession. It’s so detail oriented, it tends to attract very detailed, precise, maybe even perfectionist personalities. But I think what that ends up doing is, we have these ideas in our head of where we should be, what we should be doing or even the whole idea of pleasing everybody, and it can sometimes get out of hand. So, is there something that you do internally to calm down that part of you that says, “Do it all, be perfect at everything” and those high expectations that you set for yourself? How do you try to make yourself more realistic?
Laura M. Periman, MD: I think you are spot-on that there is a high achiever perfectionistic initial drive that got us through medical school. It got us into a very difficult to match into specialty. It makes us leaders in our field. The good news is that as I get older and more mature, I’m better able to compartmentalize that. And it’s something I always knew I needed to do, but I don’t think I could until I got further along in my career.
I still stress out terribly over unclear expectations. I can deliver on whatever it is, but when I don’t know what the expectations are or they are unclear, that is very triggering for me. So, I try to separate out and really get granular on what the expectations are. I have found that that helps me manage and mitigate and separate some of those stressors around performance and expectations.
The value of saying “no”
McCabe: When you are talking about the parts [of your practice] that are not so clearly laid out, how do you prioritize those for yourself internally? Do you think about that and go, “In 2 years, 6 months, 5 years, these are the things I think are most important. I want to publish and move the field forward in this area of cornea,” or “I want to do a lot of mentoring and education of young ophthalmologists?” Do you prioritize that in your mind so that you’re saying “yes” to the things that move you forward best? And is it very intentional that way?
McDonald: It’s very intentional, and I’ve learned that in order to meet your goals that you have prioritized, you have to say “no” a lot. That’s very hard. And girls are raised to say “yes” and be pleasant and to please everyone. So, it’s hard to just say “no,” but you have to do it, or you’ll drown. You’ll drown in misery.
Periman: I agree with you. It is so hard to make that transition between learning how to say “no” because at the end of the day, you’re staying authentic to yourself. If you have this intentionality to your goals and your priorities in saying “no,” it’s actually a gift to you and the other person asking you because not only would that not meet your goals and expectations but possibly not theirs because your heart is not in it. Saying “no” creates room for “yes.”
McCabe: Yes, I think you could think about it internally as, “I’m not saying no to this. I’m saying my time is, yes, going to be spent on this other priority that I have already decided outranks this thing that’s being asked of me.”
Processing and learning from failure
McCabe: When you don’t meet your own expectations or somebody else’s expectations, how do you get back on the horse and say, “OK, I’m going to be kind to myself but wrap my head around it and move on?”
McDonald: You give yourself a pep talk. Suppose you are learning something new, say, a new technique in the operating room or a new skill, you say to yourself, “OK, that wasn’t my greatest performance. What are the learnings? What can I take away from this? And do I really think that anybody else is learning faster than this?” Probably not. Everybody, and surgeons in particular, has to remind themselves that you can’t go your entire professional career without complications or making a judgment error.
McCabe: That’s why it’s called the practice of medicine.
McDonald: The people who have great judgment in the OR had bad judgment at one point, and that’s how they learned. So, you just have to reassure yourself that you have feet of clay, you’re a normal human, and next time you’ll be better. The time after that, you’ll be better yet. Sometimes it’s hard to be that super positive. My husband is really good in moments like this, too.
McCabe: I was going to ask you that. It could be your husband, it could be your spouse, your partner, an adult child, your parents, a colleague or a dear friend who you’ve helped through struggles and is there for you to pick you up when you’re not feeling so good about something. But I think it is important to have your person, whoever it is, that is there to say, “Look, you’re spectacular.” It’s so important. It seems silly, but it’s amazing what that does to your day and what that does to your ability to go back into the next door where maybe somebody is upset that they waited or are not seeing the way they wanted to at that moment or whatever it is. But just that tiny little affirmation, even from somebody else, is so important and so helpful.
Periman: I think we are good at giving that kind of grace and space to other people, and that should be your litmus test for how to talk to yourself. So, in other words, if somebody on my team is learning how to do something, when there’s a mistake that’s made and they feel really bad, I say, “Listen, did you do it on purpose? No, but you’ll learn from it. And it’s fixable.” And then all of a sudden, that burden and that shame is just lifted off, and they’re able to lean into that growth mindset. I think as women, it’s really important to make sure that we’re nurturing and affirming that it’s OK to make those mistakes and continue to grow for ourselves, as well as for everyone around us.
McCabe: It’s so easy to criticize yourself and be hard on yourself and not let yourself move on. But if you just say, “If this entire identical situation happened to my colleague, my friend or somebody that I was counseling for the same thing, what would I say to them?” We’re so much kinder and more forgiving and understanding of somebody else’s normal human mistakes than we can be of our own. That’s a great way to frame it.
Silencing the imposter
McDonald: I do think men are able to get back on the horse faster than we can after a mistake. A man will say, “Wow, today was not a good day in the OR.” But they don’t go home and lay in a pool of perspiration all night long and cry. They’re like, “This wasn’t a good day.” But they don’t take it as a reason to quit ophthalmology or stop operating. Women take all this way more to heart and start to ask questions. “Why am I here? Why am I a doctor? Why am I on planet Earth?”
McCabe: I think it’s that imposter syndrome, right? It’s always lurking somewhere, even when you feel comfortable with what you’re doing. You feel like you have your lane, and you’re really doing fine in it. Maybe people ask you questions about it, and you feel like you’re somewhat authoritative. It’s two inches behind you, ready to tap you on the shoulder and say, “Just remember, maybe you’re an impostor in this role and you don’t deserve to be there.”
Periman: I think it’s a call to us as senior ophthalmologists to pass that grace along to the next generation. I want every generation to be more confident and more secure that you deserve to be here. You are needed here, wanted here and very much a part of moving the entire field forward.
McCabe: And that your perspective matters. That’s the message I usually try to convey. You have a unique perspective that nobody else has, and that gives it value just inherently. Nobody else can see the situation from your point of view. Therefore, you should speak up and share it because nobody else can.
Periman: Maybe that’s the antidote to the imposter.
McCabe: You’re not an imposter of yourself.
Periman: No. Nobody can be you but you.
McCabe: We all have that imposter syndrome or feeling that we failed something or whatever it is. What would you tell yourself if you could go back to all the times you, as Dr. McDonald said, “lay in a puddle of sweat, crying through the night” over something that happened? What would you do or how would you say that to yourself to prevent you from getting to that point where you are having a meltdown?
McDonald: Certainly, positive reinforcement from your nearest and dearest really helps. But try to take the 10,000-foot view of yourself. This is a tiny pebble on the road to success. You’re on the road to success, and you’re making tremendous strides. This is a little tiny bump in the road. Look at all you’ve done. Look at all you’ve accomplished in your life so far. This too shall pass. You will master the situation. You can talk to yourself, and it really helps to have friends who say the same thing to you.
McCabe: I don’t think I ever finish a day where what I said were my goals in the beginning of the day actually happened. I just set the goals and get to the end of the day. I failed a bunch of them but had some successes, hopefully, too. I just start over the next day. Just give yourself the grace to start it again the next day. A new day, a new set of goals.
Periman: I love that approach. Sometimes I feel you have a laundry list of things to accomplish, and you might get through a fraction of them and mess up some of them even. The concept that you can look back over your shoulder at just how far you’ve come, realizing that some days might feel unproductive, but really, they aren’t. You got through another day. You were here in the world, you contributed, and tomorrow’s a fresh start. Tomorrow is a new day.
McDonald: As a friend of mine says, another day on this side of the grass is a good day. That’s the 20,000-foot view.
Editor’s note: This excerpt has been edited for clarity.
- For more information:
- Cathleen M. McCabe, MD, of The Eye Associates in Sarasota, Florida, can be reached at cmccabe13@hotmail.com.
- Marguerite B. McDonald, MD, FACS, of OCLI Vision on Long Island, New York, can be reached at margueritemcdmd@aol.com.
- Laura M. Periman, MD, of Periman Eye Institute in Seattle, can be reached at dryeyemaster@gmail.com.
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