The Passive Victim Trap Facing Too Many Doctors
There’s no denying that it is supremely tough out there but the terms seem rather fatalistic. Or do they? Let me ask how you currently feel? That’s not a definitive way of approaching the question because how we each feel is likey to be different from one another, with a range sufficiently diverse that it challenges meaningful conclusion. However, let me qualify, then, with pre-qualification question. Do you ever experience a sense of dread, deep concern or hopelessness about your work circumstances, what’s happening around you and indeed what might be happening to you? If you don’t, then let me save you some time – you don’t need to read further. However, if you are still here, we are going to explore some uncomfortable realities in the interests of… well, your health and wellbeing, to put it frankly. I can’t promise to be gentle but I can assure you I’ll be supportive and useful. Shall we get started?
Falsely Fatalistic or Realistically Defined?
Let’s start with a couple of definitions and see if the shoe fits.
Armegeddon is defined as a dramatic and catastrophic conflict, especially one seen as likely to destroy the world or the human race. Is there a dramatic and potentially catastrophic conflict within healthcare? We would have to conclude that there is, possibly more than one. We are undoubtedly facing an unprecedented battle for sustainability in the face of overwhelming growth in demand, driven by population, ageing and evolving medical complexity. But can it destroy populations? What’s happening to the population of junior doctors? Or nurses? Or emergency care professionals? Or GPs? Or senior managers? So I hope we don’t have to debate that one further.
Meeting your Waterloo is described as to be defeated by someone who is too strong for you or by a problem that is too difficult for you and I am guessing that if this wasn’t the case, you probably wouldn’t even still be reading because you’d have your answers or know what to do. Of course, in this case, it could be both someone and a problem, the combination making the conundrum all the more wicked.
In reality, I don’t think you have to look too far afield to reaslise that you are surrounded by increasingly stressed individuals in increasingly overwhelming circumstances and it is affecting some of them in an increasingly adverse manner, from physical manifestations to deep psychological distress, marital discourse and mounting workplace-based problems. As that stress gets worse, so too does the melting pot of complex behavioural dynamics, reducing the likelihood of a good outcome for anybody and, more frighteningly, creating the perfect conditions for large scale system collapse. However, in this article, we are not so much concerned with them (except our basic human concern for their welfare), as you. How are you doing?
Examining Your Present & Emerging State
I’d like to examine this from two perspectives – where you are and where you are going. In time honoured tradition, we’ll address the last first, as it will put the first in context when we get to it. Let me start by asking you some questions, one of which is a very, very difficult one to answer. Not because you don’t necessarily know the answer but because of what the answer might mean. Here goes:
- Is there more work this year than last year?
- Is your service under more strain this year than last year?
- Is there a greater potential for quality and safety concerns this year from last year?
- Do you believe that the coming year is going to continue these trends?
- Do you find yourself more irritable, tired or fed up than last year?
- Do you question where it might end up more frequently this year than last year?
Did you have a fair degree of ‘yes’ answers in that? I am guessing so and that’s probably distressing enough but I have held back the really tough question. Are you ready? Sitting down, perhaps? OK, I can’t put it gently and so I am just going to come out with it:
- If you asked yourself these questions each year (and subconsciously you may well have been doing this in recent years already) for the next 5 years and each year you got a straight ‘yes’ vote across the batch, what would your life be like and what would the consequences of that exponentially increased level of pressure and overwhelming be, on you, personally?
If you were observing a colleague going through what you are describing, watching their energy decline, their physical health complaints increase and their overall passion for life and medicine abate, what would you advise them to do? An easier question to ask would be whether you would advise them to just keep going and see what happens over the next 5 years? I am certain the answer would be ‘no’ but this is where it gets tricky. You’d almost certainly advise them to address the problem, make changes or protect themself before the situation became personally unrecoverable without severe loss. The trickiest bit is that you can see that when your are the advisor but you don’t do that when it’s yourself in the hot seat. Understanding why that happens is crucial to you avoiding what we describe as the Passive Victim Trap. I suspect that if you are still reading at this point, you are probably concerned that this is a trap you have firmly fallen into already.
What you can probably see by now is that the first perspective – where you are – is rendered somewhat redundant by the second perspective. If where you are is fine, then you aren’t reading this article. I got rid of you in paragraph one, remember. If you are this far though, this first perspective spans a range from just about holding on, at the benign end (I know, it doesn’t sound that benign), to a deep sense of hopelessness towards the much more malignant end. The disturbing point I am trying to get across is that if your answers to the 6 direction questions were yes, then your answer to the 7th question has to be a dark destination for you personally and one that you are uncomfortably, if not openly, admitting you are stumbling towards. Enough of the toughness though, as I promised to be supportive. We have to understand why, given that EVERY person reading this is a highly intellectual, scientifically-orientated individual who has achieved amazing things with their life. In many respects, it doesn’t make sense. Except that it does, it’s just not sensible, and that’s different.
Explaining the Passive Victim Trap
To understand this more, we have to take a quick trip back into history. When I say ‘quick’, I don’t mean ‘recent’ as the genesis in this problem is evolutionary and concerns your lizard brain. It’s concerned with survival. It’s very simplistic. It’s designed to produce primarily one of only two responses – flight or flight – and it evolved at a time when the question to be answered was equally binary. This threat is either going to ‘eat me’ or ‘be eaten by me’ and that’s as complex as it got. Only occasionally did it have to face a more complex, truly comparative dilemma and none of those came even close to the nature of complexity we face today. It’s trying to face that complexity in circumstances using the simplicity of the lizard brain that will be your downfall – more accurately, your fall down, into the Passive Victim Trap.
The trap occurs because you enjoy a challenging job, with decent social circumstances, sufficient financial resources and plenty of intellectual stimulation. You also know it’s probably yours as long as you want it. But the enjoyment and indeed the physical and mental sustainability are eroding, year on year, as you know, or you wouldn’t be reading this far. So, the lizard brain picks up the threat, easily… and it just has to decide ‘fight or flight’ to save you. BANG! There’s the problem… it IS a survival question (we established that with the 7th question above) but it isn’t very binary and either response seems inadequate to the circumstances. What’s more, both responses appear risky when you consider what you already have. So you freeze, again and again, even if you know and acknowledge that continuing to do so is at odds with survival. Would you like to know when that changes?
There will come a point in time where the consequences of not addressing your circumstances are so acutely felt or imminent that the lizard brain now does indeed have a more binary question – address it or suffer true, unequivocal loss. At this point, you will be resigned to act decisively. The problem is though that at this point, you are also faced with a new set of terrible realisations:
- Some level of destruction may already be irreversible
- You’ll need to act immediately, increasing the risk of a secondary mistake
- You will find yourself without sufficient palatable options (forcing you to take what’s going)
- The destruction around you will be in full force, making calm, considered, rational action all the more difficult (or at least undermined by others in the middle of the melee)
I might hazard a guess that at this point you are not entirely sure whether you should have read this far? After all, although you weren’t at all personally safer before I shoved this into full view, you were probably a lot less stressed about it and that had its advantages. Fellow Ostriches would be proud though and I think you now know that. I think we need to switch to what to do about it.
The Solution to the Solution
I cannot tell you what you should do. I do not know you or your circumstances. However, if you are still reading at this deeply uncomfortable point, I can confidently tell you what you shouldn’t do. You shouldn’t do NOTHING. No, that’s not poor English. The meaning is clear – inaction is the wrong course of action and you need to see it as an active choice (the choice to DO nothing) in absolutely the same manner as any choice to do SOMETHING. Consequently, you can start to evaluate whether actively doing nothing is more or less risky than actively do option A or B.
What we need to do is concern ourselves primarily with the confidence to act and how you might choose what that course of action may be, not ‘whether’ to act, which I think you have already answered. We are dealing with ‘WILL’ you act, not ‘WHETHER’ you should. Key to this is acting from a position of rational evaluation, based on a distinct plan and with various contingencies and provisos built in. That ‘plan’ would also include the timing of any moves, considered just as carefully as the choice of moves themselves. A really good plan may well still have ‘whether’ to act built into it. However, it will most likely have distinct milestones or triggers that ‘trigger’ (spooky) action, so that once these criteria are fulfilled, you are perfectly happy to act and fully confident about the steps you are going to take.
I would advocate two early actions that are rarely wasted and, regardless of your current state, make all downstream actions and choices much easier to make, not to mention, improving life along the way. They are:
- Stabilise the present
- Evaluate the true extent of the Armegeddon around you
The first piece of advice involves carefully considering what you are currently doing and whether it is already unsustainable or sufficiently unpalatable as to justify some action. The actions start with implementing some protective boundaries, which can come in your time management practices and some distinct rules around the work-life boundaries specifically. Am I suggesting ‘working to rule’? Possibly, although that is simply an extreme version of boundary setting based on your terms & conditions. If already that lizard brain is starting to say “ohhh, I don’t know…” then just ask yourself this – which is more painful, some difficult conversations and the odd uncomfortable perception, or risking your health, marriage and happiness?
The second recommendation will reinforce the first but the first gives you the time and headspace to put the second into action. Whereas you can commence the first tomorrow, you have some homework and some detective work to do in the second. However, it’s vital to address the lizard brain requirement for one course of action that is clearly superior to another in terms of risk. Put starkly, if you are going to ‘leap’ you have to have the full knowledge and reassurance that ‘not leaping’ is riskier. We have to turn that basis from someone else’s opinion (remember, it’s easy for them because they are not doing the leaping) to your fully researched, considered evaluation. It will probably never be perfect but all the time it is unsubstantiated, it isn’t good enough to overcome the freeze. You have probably heard the phrase or question “what would you do if you knew you couldn’t fail?” I am asking “what would you do if you knew you were going to fail if you did nothing?” Right – something! Leap!
I am not going to pretend that any of these issues are easy. Right now, you’ll see people acting when they shouldn’t, not acting when they should and acting, without you having any clue as to whether they are supremely informed or naively misguided. Don’t be afraid to ask for help but be careful who you ask for help from – they may be just as driven by their lizard brain, which could be convincing them that the best way to feel secure is to convince everybody else that you are all secure. I am not saying you are not. I am not saying you are. I am saying there’s a great deal at stake and consequently you owe it to yourself to find out, more for sure than now.
If it’s any help at all, you might want to consider one last reflection. If ‘some’ action wasn’t at least probably necessary, just how and why did you get through such a painful article to this very question?
Some Potential Options
The goal of the article is to provide you with useful guidance as comprehensively as possible. However, we also get asked whether we can help. We can to an extent, and here are a few options.
Boundaries & Control
We have three basic options:
- Time Management & Personal Effectiveness Open Course
- Stress Management & Resilience Open Course
- Achieve Digital Learning Package (has a super-comprehensive time management programme within it)
Understanding More Deeply
If you wish to get started on determining just how much trouble we are in, we also have three options:
- Insights – Understanding the Evolving Healthcare Landscape Open Programme
- Insights Subscription (a digital learning package with an update service)
- Our NHS is CRASHING (the paperback)
- Our NHS is CRASHING (tablet & Kindle version)
Decision-making, Choices & Your Head!
We have a special half-day programme that is designed to address the very issues that this article highlights. It’s information, it’s therapy, it’s coaching, it’s supportive, it’s confidential and it’s very, very honest. It’s also booking quite fast because numbers are limited and the first one turned out to be a revelation to some of those attending, who have become our passionate advocates for the second one. Have a look. Not for everyone. But for some people, it’s life-changing (or rescuing).