How to handle frustration with the "system"

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I'm your host Toyosi Onwuemene, and it is always a pleasure to talk with you. Thank you so much for tuning in. I am speaking because you are listening. Thank you so much. So Jay, I'm talking about how to handle frustration with the system. Plug in any system you want here.

1:21 I am definitely talking about health systems. I'm talking about academic medical centers, but it's whatever system you want to plug in because there's always the system, either the system of grant submissions, the system of research administration, the system of seeing patients in the clinic. There's always a system. So I'm going to give some thoughts about how to handle or some thoughts to consider about how to handle frustration with the system. So I think when I was a younger faculty member, when I was earlier in my career, I feel like that was not that long ago. I was so much the crusader, like, oh my gosh, this is wrong.

2:02 I can't believe how terrible this is. Somebody should fix it right now. And then I would go marching to my division chief and I would say, hey, this is a problem. And here's my one page proposal that I spent all night agonizing over about how best to fix it. And you know, kind person that he was, he did not laugh at me outright, at least not to my face, but clearly must have been thinking, okay, she just, just was born yesterday. What is she doing? But I was really serious about my crusades and I would get angry and I'm like, I can't believe, I can't believe you haven't done, oh my goodness, I was such a crusader. And you know, it's not a bad thing. I think, you know, I was young, I had a lot of energy.

2:43 I'm still young, actually, I will tell you. But just, I had a different perspective then than I do now and a different understanding of how much, how valuable my time was and how valuable my energy was. And a lot of my energy just went into all these crusades that sadly I've won none of those crusades. And maybe I'm a little bit wiser now, but actually it just, the memory was triggered for me by a recent person that I met and she's a little bit younger. She just started her faculty career, maybe about a year, two years ago. And we were having a conversation about how the clinic sucks and this person doesn't know how to do this and I can't believe this patient didn't get scheduled for an appointment with me on time.

3:25 And wow, there was a lot going on and she was so hot, she was so mad. And I remember, I remember that experience of being so angry all the time because people should know better, should do better and they're not. Anyway, so it was actually that conversation that sparked this podcast episode because I want to share with her and with actually me when I was there and with people who are in the same place of frustration, I want to just share with them thoughts about how to handle frustration with the system. So I'm going to share seven things. So the first thing is to recognize that you don't have the power to change anyone.

4:06 And that's just a fundamental thing to recognize. This is so important because you always want to know like what power do you have? Let's say you're a superhero. What is your superpower? Okay, your superpower is that you can breathe underwater like a fish. Really great. But your superpower is not flying. And it's really important because once you know your superpower, you know what your superpower is and you know what your superpower isn't, there's some things you just don't try to do. The superhero who can swim like a fish underwater but cannot fly should not be trying to fly because trying to fly may result in an early death. Okay, so coming back from the superhero talk for you, okay, maybe you're not a superhero, but you got to know what powers you have, right?

4:53 And I hope you have the power of influence because that's really good. That works. But the power to change someone else, the power to make them do what they don't want to do, the power to make them see things like you see it so that they can do it the way you want it done, you don't have that power. I'm just very sure you don't have that power. Now if you told me that you go around threatening people and they're afraid and you use fear to drive them, okay, that might work. There's a lot of fear tactic use in medicine. Okay, okay. There's a lot of strong arming and there's a lot of manipulating. Sure, you can do all that. It's a lot of work, but sure. But just recognize that until you have no power to change them, I mean, you can for as long as you're wielding fear as a strategy or you're wielding manipulation, it might work for a little bit.

5:44 If you're really good, maybe it'll work for a while. But ultimately, even if you win them over, you win them over grudgingly, not because it's something you want to do. And as soon as you stop wielding whatever stick that you have, it will go back to normal pretty quickly. So it's just important to understand your superpower so that you don't invest time pretending to have a superpower that you don't have. And I will guarantee you have no power to change others and you know that. You intuitively know that. And so I hear people say, oh, I told him exactly what to do. I told him exactly how to do it. And he still didn't do it. It's like, yep, yep, that's not your superpower.

6:25 All right, that's number one. Number two, I mean, I think this is really important to sit down and consider. Again, I always talk about Simone's maxims because somebody quoted it to me and I think it's still an important paper today. And this is this kind of comes, I mean, it's along that flavor. But it's just you need to recognize that systems are the way they are because they work. Yes, it may be completely dysfunctional. It may be totally crazy. And like you can't believe anyone lived like this. And everybody may be whining and complaining about it, but they don't get to become the way they are by accident. Your clinic and the way it runs inefficiently did not happen by accident.

7:07 Your academic system and the way tenure and promotions happen did not happen by accident. The challenges that people experience in being underrepresented in the academy, those are things that don't happen by accident. They happen because they serve a purpose. Systems are the way they are because they work for some people. And usually they work for people with enough influence that going against the grain is usually not safe for other people, right? Systems are the way they are because they work. They serve a purpose. Systems work. They may not work in a way that seems functional to you, but they are the way they are because they work.

7:48 And the reality is the moment they stop working for the majority, then they change. But you are frustrated about systems that have been in place sometimes for 70, 80, 90 years. Some of you have institutions that are older than old. They've been around for a few hundred years. Wow. That's a lot of tradition, a lot of bias, a lot of just whatever it is that skews the culture of an environment has been going on for so long. You have to recognize that they are there because they work. You may not feel like it works. You may not feel like it's functional for patients. You may not feel like it's functional for your career.

8:29 I'm not going to argue that, but they work. That's why they're still there. And the moment they stop working for the majority, they get overturned. And so I want to just emphasize that. So you recognize that even though you're super frustrated, even though you feel like something should change, there are people who would prefer that things remain completely unchanged because the way the system is suits them just fine. For example, I remember a time that I was trying to get a badge at the VA, at the VA hospital, the Veterans Administration Hospital, and I went to line up. I forget if this was fellowship. I think this was fellowship because I had a VA that I was connected with for clinic for my fellowship.

9:15 And I went to go get a badge because I think my badge was expiring. And so I get there. It's probably like, I mean, it's after clinic now and I make it. I'm just in time. It's like 10 minutes to 12. And there's nobody in line. Can I just tell you that there's nobody in line? OK. So I'm waiting because I'm next. And there's nobody in line. This person who's working keeps working until it's 12 o'clock, then gets up, puts a sign outside the door saying off to lunch. And that was it. The whole place is shut down. I got there 10 minutes earlier, 10 minutes before lunch hour. Still didn't matter. The whole place shuts down at noon and then it's over.

9:58 I say to myself, do I go back without this ID or do I wait for them to come back from lunch? And I decided to wait. I waited the whole hour sitting outside the window. I mean, sitting outside the office and finally got my ID. Eventually. It took a long time. But you know, if you've ever had experiences with VA hospitals, and again, that's been several years and at least a decade since I worked in a VA hospital. So clearly, I'm sure things have changed now. But I'm just saying that things work the way they work because they work. Because it's the culture, right? The culture of a place is just the collective experience that everybody is having. And different people experience a culture differently, but everybody comes together to create the culture.

10:43 And so the culture we have serves a purpose, even if it's a bad purpose. It serves a purpose and that's why it's persisted. That's why it hasn't gone anywhere. So you just got to understand that this problem is older than you. Whatever problem you're frustrated by is usually older than you. In fact, it may be older than several generations of your family members. You just got to recognize that because here you are coming trying to, in a sense, fight against a pillar of your institution, a pillar, like a structural cultural pillar. That's what you're trying to come against. So you just want to recognize the impossibility of that task. Okay, number three is that you want to decide what's most important to you. I mean, the issues that we're bothered by are big issues.

11:25 A patient wasn't seen, a patient wasn't treated appropriately, someone's treated disrespectfully. You heard about there's so many things and they are all important. They are. You have to decide what is most important to you. What are you here for? This is so important, especially for people who are underrepresented in the academy. Why are you here? It's so important to clarify. I mean, and sometimes we feel like, oh, we're here to build community. We're here to do this. And it's like, yeah, you could do all those things anywhere else. But why are you here specifically? Like, what did you come to get from here that matters to you? What is it? I mean, this is really important because you want to be very clear on why you're here, why you're in this place, why you're in the system. What did you come to get?

12:06 For example, sometimes, let's say, you know, one of my fellows will be like off on a crusade and it's like, wait a minute, wait a minute, why did you come again to fellowship? I came to be certified, to be board certified in this area. Okay. Does this help you get that certification? I mean, you just want to be clear. Like, does it help you get to your goal? You want to be clear. It's like, well, no, I want to make sure it doesn't happen like this for someone else. It's a problem that's older than you. And after you leave, this problem will still be here. But you, you may leave without the certification you came for if you're not able to finish the work that you're actually supposed to do. And so it's just really important to clarify your goals for any environment.

12:47 And we always have a goal. We always have a goal in our interaction in any environment. It's very rarely that we don't have a goal. And patient care, it's part of that experience, but it's not our primary. It's not our only goal, right? Or solving the problem of unhappiness in medicine is a great goal, but may not be your primary goal. It would be nice to do your work, get your outcome and make everybody happy. But if you have to choose, you want to know which takes precedence. And that's important. What is most important to you? Peace of mind, joy, harmony, all those things. You just got to recognize your values and nobody can tell you what those are.

13:28 You'll be happy to work with you and help you figure it out. But you want to know that you know what's most important to you so you can clarify how much energy and investment you really want to put into handling or changing your frustration with the system. Okay, you've decided what's important to you. You're like, yes, this is something I really want to intervene in. Physicians are no longer happy. I'm going to do this initiative that's going to make all physicians happy. So decide on your intervention. It's one thing, you know, everybody can complain. I mean, oh my goodness, who doesn't love a good complaint? You sit down, you gripe, you're all angry, you all get so mad and then you can miss a rate because you're all experiencing the same thing.

14:11 So everybody feels so good. Oh, yeah. I mean, so amazing. So awesome. So sweet. But you're in leave complaining and determine what intervention do you want to champion? What is the answer to the problem of not enough providers to see too many patients? What is your answer to that question? Great. How do you determine to solve it? Oh, you have a plan, an incentive plan for all physicians who see more patients than they're supposed to. Good for you. Figure out the intervention. It's so important because I think so many people get stuck in griping that they haven't determined what intervention they want to see or what intervention they want to champion.

14:51 And you can make change happen. Absolutely. If you're very clear about what that change brings you, what gift it gives to you and what the intervention is that you have to make a difference. Okay. So determine after you decide what's most important to you. You're very clear about your goals for your stay here. Determine the intervention. So it's measurable, right? I made this intervention and this is the outcome that I got, right? Now in going to implement your intervention, whether that is you're trying to influence somebody else who's a decision maker, or you're trying to make a proposal to get people to buy in, whatever it is, it is important for you to decide upfront what you can and cannot live with.

15:32 This is important. For example, one of my mentees had a situation where she really was frustrated by the way her clinical environment was. I mean, she was so frustrated. She was like, they don't do this, they don't do that. There's not enough support. It was a litany of complaints. And so at some point you have to decide, okay, wow, this, you know, I've been complaining since the day I got here. This is the way it seems to always be. What can I live with? What can I live without? What can I live with? Right. So you're making the decision that's too well, oh, okay.

16:13 I guess this is just the way they work here. Can I live with it or can I just not work like this? And it's so important because the moment you recognize that you cannot work in a clinic where MAs are not available to support you, it's good. You now know what you can and cannot live with. What if you're like, it doesn't matter that there are no MAs. I'll work with one of the nursing staff who's not an MA, right, or one of the nursing staff, right? MAs are not nursing staff, but they're sometimes on their way to becoming nursing staff. So you decide that, oh, okay, I can't do this. Or you decide, well, you know, that's not such a big deal. You're the only one to decide what you can and cannot live with because the reality is that it is more likely that this problem that preceded you is going to succeed you.

17:02 It's just more likely than not. I'm not trying to be pessimistic here, but you want to say to yourself, if change will never happen no matter what I do, to what extent am I prepared to live with things if this is the way they always will be? But you just want to make a decision. If your decision is no matter what they do, I'm going to stay, that's important. But if you're like, you know what, I cannot live like this. This is not the way I've envisioned my clinic experience. I don't want to do this. You want to make sure that you decide which pieces you can do, which pieces you would prefer not to have to do. Okay.

17:43 The next thing is to set a time with which to see the intervention through because the thing about interventions is that they can take a long time. They need an awful long time for you to see it through, but you've got to decide, okay, I have 12 months for this intervention or I have three weeks for this intervention or I have two weeks. Whatever your timeframe, set it, set it. This is how much it's kind of like when you think about making an investment in the stock market, actually, to be honest, this is more like gambling with slot machines because I told you you can't change anybody, but we're just going through emotions here. It's like a slot machine. You put in a lot of coins, eventually you're going to hit, eventually.

18:24 But you may lose a lot trying to hit this one round, right? So you just have to decide, it's like, I'm just going to do X number of dollars. In the moment you get to the X number of dollars, you're done. Even if it's like, I bet the next one's going to be it. Even if that's how you feel, you just say, oh, that's enough. It's the same thing. You're going to set the time with which to see your intervention through and you're going to say, no matter what, no matter how close I am, three months from now, seven months from now, two years from now, I'm going to be done. And you want to make sure to set the time so that you can really make the investment push as hard as you want. And then turn around and decide, you know what, the time I set for it, it didn't work. No thank you. And the final thing is be okay with quitting.

19:07 In medicine, we struggle to quit things. We just feel like, nope, we must see it all the way through. We don't want to not do our obligation. But you know what, when you get to a place where you're like, you know what, people are hard to change. And I've done all the best that I can. I've created an intervention. I've seen it through. And wow, nothing's changing. It's okay to quit the crusade. It is okay to quit. And you may not quit medicine. You may not say, I'll never practice again. Or you'll never say, you may not say, oh, I don't want to do this clinical research thing anymore. Whatever it is, you don't have to quit the whole thing. But be okay with saying to the crusade, I've served you enough.

19:48 It's time to move on. And it's important to do that because if you think about how much energy you expend trying to fight for what should already be yours, or trying to make people see reason, or trying to make them come around to your way of thinking, it's a lot of energy. And it's energy that you are not spending doing things that actually move you forward. You are stuck in, to some extent, the past of what could be you or how people might respond instead of really moving forward into your space of creativity, whatever that looks like. And so it's important to quit so that you're released. It takes too much energy trying to convince people to do things that they actually don't want to do.

20:30 So when you have seen your intervention all the way through, you set the right time, the time frame that feels authentic to you, and you don't, if you don't achieve it, then you've got to be okay with saying, you know what? Okay, I quit. You don't have to quit everything. Remember, you just have to quit the one thing, that one thing that's really frustrating, and you want it to champion. You have to be willing to say, okay, maybe not me, maybe not me. If you struggle, if you struggle, definitely reach out to me. Let's talk about which of our programs may be a fit for you, and definitely reach out and let me know how I can support you. Again, remember that we have a webinar coming up December 20th at 12 p.m.

21:12 When you have no research mentor, please sign up on our website, clinicianresearcherpodcast.com. You can also sign up on our coaching website, www.coedcoach.com. All right, to summarize how to handle frustration with the system, number one, recognize that you have no power to change others. Number two, remember, assistance are the way they are because they serve a purpose. They work, even though they may not work to your benefit. You want to decide what's most important to you, why you're really here, making sure you're not losing sight of what you really came to do in this environment. Determine the intervention. Don't just sit and complain, and decide what you can and cannot live with, set a time within which to see the intervention through, and finally be okay with quitting the crusade.

21:59 All right, somebody needs to hear this episode, please share it with one person today. Just one person. Let's transform the lives of clinicians, scientists everywhere, one clinician scientist at a time, or one aspiring clinician scientist at a time. All right, it's been a pleasure talking with you today. Thank you so much for listening. I look forward to talking with you again the next time. Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor.

22:41 If you found the information in this episode to be helpful, don't keep it all to yourself. Someone else needs to hear it. So take a minute right now and share it. As you share this episode, you become part of our mission to help launch a new generation of clinician researchers who make transformative discoveries that change the way we do healthcare.