Secret Trauma Or “I don’t know why I have such big feelings about this” (Another Important Idea from Dr Becky)

Many of my physician clients share an odd history, which I haven’t talked about here, though I have definitely experienced it myself.

Trauma responses as they relate to people-pleasing, note completion or setting boundaries.

Now, once upon a time, we just had “fight or flight” recognized as sympathetic nervous system reactions to a stressor; these innate responses are triggered in response to threat so that we can literally survive encounters with big predator animals.

But we also now recognize “freeze” and “fawn.” Responses of either a deep numbness and (seeming) lack of response in the face of threat, or an immediate subservience that arises in the face of threat (think “If I can just appease them, then I will be ok”).

If you encountered the difficulties of medical school and residency and even early attending years with frequent “little t” experiences, there’s a pretty good chance that you have picked up “freeze” or “fawn” or both as responses to certain kinds of conflict you encounter in your day.

“I can’t keep the next patient waiting while I finish this note or they will be upset” (fawn)

“I can’t manage any more patients per day, but everyone else seems happy to double book so I don’t have a choice” (fawn)

“This patient yelled at me, I must have done something wrong” (fawn [misinterpreting someone else’s feelings as being “your fault”])

“I can’t even look at my inbox right now; I’ll be up all night with notes anyway so I’ll just do it then” (freeze)

These are common themes that pop up in my conversations with other physicians over and over again; often they have tried to work on note efficiency, attended “Epic classes” or bought a charting program, but it “doesn’t work.” The reason it doesn’t work is that there are often big feelings hiding underneath what we are labeling “inefficiency.” Feelings that we can’t upset/disappoint/inconvenience other people, despite having more work to do than is reasonable, diminishing access to help and resources, and having both a strong desire to help people and a strong work ethic. Total set-up, with a side of fawning.

This is why people-pleasing can sometimes run sooooo deep. It may be something that you picked up in early childhood, where your young brain learned that your survival depended on making others happy (whether it was true or not, that’s what your brain learned). It may have learned that more recently during training, where you had to be helpful, bright, accommodating, cheerful, a “real teamplayer,” or some other mix of adjectives that told you that you were safe, that you were going to “make it” through the challenge.

So the next time you find yourself judging yourself for not being able to “just get it together and get my notes done!” I want you to pause and check in. Is there a part of you that feels its unsafe to say no, keep others waiting, etc? If so, let’s talk. Click here and let’s set up an intro call to talk about what’s getting in your way, and make a plan to move forward.