The hidden way we sabotage clinical growth

I’m embarrassed to share this story. 

It was a long time ago and I chalk it up to an underdeveloped mind. 😂

I was 7 or 8 years old and was convinced that a “couple” could mean two or three. 

Even when I had older siblings correct me, I would become adamant that I was correct. I’m sure they just rolled their eyes at me.

I wasn't open to any discussion of the matter. In my mind, it was settled. 

Thankfully, I moved past this thinking with a little more growing up. 

I was thinking about this story when I thought about how often I can be blind to learning something new because of my need to protect my sense of self. 

It wasn't until I was exposed to a concept called the psychological immune system that I began to understand why I avoided uncomfortable learning experiences. 

The psychological immune system (PIS) was first introduced by psychologists Wilson and Gilbert in their research on decision-making. They shared from this article how this immune system is not unlike our physiological immune system: 

Here's a simple visual to help explain it 👇

But here's the rub...

Learning and growth can often be challenging, uncomfortable, and even threatening. 

When our psychological defence system maintains our sense of emotional equilibrium, it can actually work against our learning and growth when it stalls our learning through threatening experiences and information (Chapter 6, Handbook of Self-Enhancement and Self-Protection).

Since being introduced to this concept, I finally had language and a framework to understand how I've protected my ego at the expense of my growth. 

When our ego feels threatened, we can easily deceive ourselves, misplace blame, and trivialize new information. But in our efforts to defend our ego and ‘protect’ ourselves, we miss opportunities for learning and growing as clinicians. 

Before I dive into how I've stopped sabotaging my growth, I want to highlight some key defence mechanisms that can stymie our clinical progress.

The 4 Traps of the Ego That Sabotage Our Growth

There are so many ways - both conscious and subconscious - that aim to protect our ego and maintain our internal equilibrium. Here are the four that I have found the most common in my own experience: 

Trap #1: Isolate myself from outside help 

I've found my ego defences are active when I consider asking for help. When we were students, there was an expectation that we would ask for help. And there was psychological safety in our role as students asking questions. But the longer I’ve been out of practice, the harder it becomes to maintain a beginner’s mind. That place where we are humble and accepting of not knowing, coupled with having the courage and openness to ask for help from others.

Trap #2: Avoiding learning because of the challenge to my sense of self  

Have you noticed how it’s easy it is to have the intention to look something up, but not follow through? We chalk it up to being busy and not having enough time. But from my experience, I’ve noticed that the barrier isn’t always about time, but about my ego.

In some cases, looking something up will require me to confront my lack of knowledge about a topic. As Wilson & Gilbert highlight, our psychological defences are largely unconscious and we can remain largely unaware of their operation.

One example from my clinical practice was a clinical situation where a patient was complaining of persistent shin pain.  Because of my focus on other body areas, I put off placing attention on this area of complaint. This meant that I held off referring her for further work-up and imaging. I was disappointed with myself for not being more prompt in my referral. I felt my anxiety increase and my sense of competence threatened. 

I knew I needed to do a thorough case review to avoid future issues, but I avoided going deeper with this topic for some time as it forced me to confront this ego-threatening experience. 

Trap #3: Avoid Acknowledging Our Limitations

Another strategy I’ve noticed in myself is a tendency to avoid referring to another provider because of the impact on my ego. Sometimes it’s hard to acknowledge and accept that I may not be the best person to solve the patient’s issues and that they need another treatment. Confronting that reality can be an affront to the ego and threatens the psychological immune system. Knowing when to refer to another provider can be a challenging decision, but understanding the reason for avoiding referral is an important step to growth and quality patient care.

Trap #4: Distract Ourselves with Shiny Objects

Another strategy I've realized is distracting myself with new information or experiences - falling prey to a variation of the shiny object syndrome. We learn new information or take a course on a new topic because it doesn’t threaten our sense of self. While learning new information can be good, it’s not growth-producing if it’s an avoidance response to placate our ego.

It’s much more exciting and dopamine-producing when we are exposed to new ideas and information. Working through a past patient case where we missed a diagnosis may be a much more growth-giving activity.

I spent a number of years practicing piano and I often was working on classical piano pieces for months on end. Often I got tired of working through a section of music and wanted something new and exciting to work on. But it was in that repeated work that I grew as a pianist.

Another shiny object distraction is consuming social media content. We constantly get small dopamine hits that keep us feeling good and distract us momentarily from feeling threatened. (see my blog post here).

Here is a brief summary of the 4 Traps of the Ego:

If left untamed, these 4 Traps of the Ego can leave us stunted and stagnant in our professional growth. 

But the question is, how can we navigate the often delicate, temperamental nature of our egos and ensure it doesn’t get in the way of us growing and improving?

Given the length of this newsletter 🤪, I'm going to wait until tomorrow to share the 5 ways I've found that have helped me to avoid sabotaging my own growth. Stay tuned! 

To better flow, 

Andrew