I lifted the boulder that was my head, looking once again at my clinic schedule.  Suddenly the day ahead loomed heavy, dark, oppressive.  No, not really, but I did feel abruptly bummed, when I had arrived that morning in a cheery mood.   My medical assistant noticed the change in my affect and inquired; I pointed to a name on my screen.  The same curtain of dread fell over her being.  “Oh no, I know him.  He’s a jerk!”  We had both made this diagnosis with conviction months before.

This day, I entered the exam room prepared to meet The Jerk.  I took a deep breath and noted my negativity.  I made myself ask extra questions to make sure I wouldn’t miss something, despite the urge to exit the room as soon as possible.  I reviewed medications, discussed his next colonoscopy, all in a perfectly professional manner.  The visit went without incident, nothing to write home about.  Was my care of him medically standard and objectively sound?  Absolutely.  Was I my best self?  Absolutely not.  The difference?  My best self is healing, and he got none of it.  I left Best Me at the door, along with my ability to connect to him as a person.  The other difference?  I suffered through that visit.  Physicians’ work fulfillment comes in large part through meaningful relationships with patients, and I got none of it—it was a lose-lose.

My son’s fourth grade teachers developed a resilience curriculum a few years ago.  The ABCs lesson resonated with me in particular.  (See the links below for more information on the concept.)

A stands for Adversity: The bad thing that happens to us.  In this case it was my patient’s previous behavior, which made my staff and me feel used and ignored.

B stands for Belief: The one(s) we make up based on adverse events.  For example, he is a jerk, a whole jerk, and nothing but a jerk.

C stands for Consequence.  Here’s the rub: The belief, not the adverse event, determines the consequence.  My diagnosis of Jerk hijacked my entire experience of him, precluding the human connection that could have benefited us both.

This story almost repeated itself months later, after a particularly contentious interaction with another patient.  I ranted colorfully to my colleague, who wisely reminded me that the patient might not be a jerk, that I could withhold that judgment yet.  When the patient came next, I took another deep breath.  Maybe she wasn’t a jerk, I repeated internally.  Prepared to meet her best self, I brought mine.  I could literally feel the difference—the tension in my neck loosened; my smile arose more naturally.  Our conversation hit some speed bumps, but we connected, somewhat—there was still something off about her behavior.  As I discussed her case with other specialists who met her, we all agreed that she probably lived somewhere on the autism spectrum.  Now in her late 50s, she had achieved remarkable success in her career, likely with little to no acknowledgement of, or accommodation for, her social challenges.  We genuinely admired her, when at the outset we could have dismissed her as just another Jerk.  In the end the whole team felt satisfied that we had brought our best to meet her needs, and we all learned along the way—a win-win.  By changing my beliefs after a typical adverse event, I steered the consequence of my own experience to a positive, productive place.

Life will never cease to hand us opportunities to practice our ABCs, and as with any skill, we will improve with each occasion.

Below are links to pages that describe the ABCs concept and it’s origins. I have no financial or other interests in these entities. 

http://www.dartmouth.edu/~eap/abcstress2.pdf

http://www.edutopia.org/blog/teaching-the-abcs-of-resilience-renee-jain