When Everything Falls Apart: Why Your Default Thinking Might Be Making It Worse

⚠️ TRIGGER WARNING: This episode discusses challenging topics including job loss, disciplinary actions, and references to physician suicide. While this episode is not about physician suicide specifically, these topics are mentioned in the context of understanding how certain thought patterns can contribute to physician mental health struggles. Please prioritize your wellbeing - if this feels too heavy today, consider skipping to next week's episode which focuses on solutions and moving forward.

When Everything Falls Apart: Why Your Default Thinking Might Be Making It Worse

We need to talk about what happens when things go wrong in medicine. Really wrong. Like getting terminated without cause, facing disciplinary action, or dealing with a bad outcome that leaves you questioning everything.

If you're like most physicians, your first instinct is probably to ask: "What did I do wrong?" And that question? It might be the very thing keeping you stuck in a cycle of self-blame that's slowly destroying your mental health.


The Responsibility Trap We All Fall Into
You were trained to be hyper-responsible. Before medical school, you were the reliable one, the one who turned things in on time, the one people trusted. Then medicine amplified this tenfold. Morbidity and mortality rounds, medical-legal responsibility, the weight of life-and-death decisions - all of it reinforced one core message: You are responsible for everything.

This serves us well in many ways. Patients need physicians they can trust. But it becomes toxic when we start believing we're responsible for everything - other people's emotions, their satisfaction, outcomes beyond our control, and yes, even the broken systems we work within.


The 5 Deadly Assumptions That Keep You Spinning

When something goes wrong, we default to these thought patterns that feel logical but are actually destroying us:

1. Logic Always Applies
You assume there's a clear reason for everything. But here's the brutal truth: many physician contracts now allow "no cause" terminations. They literally don't have to give you a reason. They can just say you're done. No explanation, no opportunity to learn or improve. The logic you're searching for might simply not exist.

2. Everything Is Preventable
Medicine teaches us that preparation and knowledge prevent harm. Hand hygiene prevents infections. Sterile technique saves lives. But we take this too far, believing we should have been able to prevent whatever bad thing happened. Bodies didn't read the textbook. Cancer advances despite perfect care. Deaths happen even when we do everything right.

3. Everyone Else Has It Together
You assume other adults - especially those in authority - are logical, rational beings who have their emotional lives sorted out. Meanwhile, you feel like a hot mess. Plot twist: they're human too. They make decisions based on emotions, incomplete information, and sometimes pure irrationality. You just don't get to see their internal chaos.

4. You're Responsible for Bad Outcomes (But Never Good Ones)
When something goes wrong, it's your fault. When something goes right, you got lucky. This thinking pattern is so ingrained that you probably didn't even notice it until I pointed it out. You carry the weight of every negative outcome while dismissing your role in positive ones.

5. Authority Figures Are Always Right
The hierarchy in medicine teaches us to trust that whoever is most senior, most published, or in charge knows best. But many decisions affecting your career aren't medical decisions - they're business decisions, profit margins, optics management. There isn't always a "right" answer, despite what your training taught you.


The Real Cost of These Assumptions
These thought patterns don't just make you feel bad - they're literally dangerous. When you assume you're always wrong, always responsible, always the problem, you create a mental environment where taking your own life can seem like the logical solution to an impossible situation.
I'm not being dramatic here. We lose too many physicians to suicide, and these toxic thought patterns are often part of the path that leads there. You hide your struggles because you assume everyone else has it figured out. You blame yourself for systemic problems. You carry responsibility that was never yours to bear.