The Art of Overcoming Overthinking

The Art of Overcoming Overthinking

It was a Tuesday evening, and I was in the midst of a challenging High-Intensity Focused Ultrasound (HIFU) case. The patient, a young lady, had been enduring heavy menses and severe dysmenorrhea due to a sizable posterior adenomyosis in her uterus. While I had encountered numerous cases like this before, this one proved to be particularly difficult.

In certain instances during HIFU procedures, we inflate the bladder with saline to use it as a window for the treatment. This case was no exception. However, sometimes air can inadvertently enter the bladder, leading to the formation of bubbles. This is a precarious situation because these bubbles can harm the bladder’s mucosa. In such cases, the usual course of action is to remove the saline from the bladder and refill it, with the issue typically resolving itself.

However, in this patient’s case, even after multiple attempts, the bubbles persisted. I was at a loss for what to do next. I continued the treatment, but as I documented my notes, my nurse informed me that fresh blood had appeared in the catheter. Panic set in. I had encountered a similar incident before, but in that case, the bleeding resolved after a few days. This time, it looked different – the blood was fresh. Worries about potential mucosal injury plagued my thoughts. This anxiety was further compounded by the fact that I was scheduled to travel to Penang the following day for a workshop and attend the Annual Congress of the Malaysian Obstetrical and Gynaecological Society. Cancelling the trip wasn’t an option; I was the main surgeon for the upcoming workshop.

The haematuria persisted, and I had no choice but to inform the patient about the issue, reassuring her that it would likely resolve on its own within a few days. The next day, I left for Penang, leaving the patient in the care of my colleague. On the flight and upon reaching Penang, I couldn’t help but worry about her. What if she had sustained mucosal injury? Would it be permanent? Might she require bladder surgery? Could she sue me? These thoughts consumed me throughout the day.

That evening, while dining with a colleague who was a speaker at the congress, I shared my misadventure. He advised me not to fret, but my concerns persisted. I called the hospital and asked the nurses to send me photographs of the hematuria every six hours – I needed to know if it was improving. Sleep eluded me that night.

The following day, I continued with my worrying as I demonstrated two Vnotes hysterectomy cases, fortunately guided by my colleague from India. The surgeries went well, but my anxiety remained high. I continued to receive photographs of the hematuria from my hospital in Melaka every six hours. Thankfully, it was gradually becoming lighter – she would be okay. My preoccupation endured for the duration of the conference over the next two days, tarnishing what should have been enjoyable moments. Finally, on the third day, the urine cleared, and I breathed a sigh of relief. I vowed never to operate the day before traveling out of town.

This is what we call overthinking. It’s the tendency to ponder all possible outcomes when an event occurs. It’s something that happens to all of us, but learning to manage it is crucial, especially for doctors in private practice. I discussed this in detail in my previous blog post titled “How to Manage Your Emotions When Complications Arise During Surgery?”

Recently, I had the opportunity to read a book that sheds light on this very issue – “Soundtracks: The Surprising Solution to Overthinking” by Jon Acuff.

“Soundtracks” delves into the concept of overthinking and offers practical steps to conquer it. Acuff introduces the notion of “soundtracks” – those repetitive thought patterns or scripts that influence our actions and decisions. Overthinking isn’t a personality trait; it’s the sneakiest form of fear, robbing us of time, creativity, and goals. It’s an epidemic.

Here are the essential steps to overcoming overthinking, as outlined in the book:

Steps to Overcoming Overthinking:

1. Awareness of Soundtracks:

    • Recognize negative or unhelpful thought patterns that contribute to overthinking, understanding that these thought loops can be automatic and counterproductive.

2. Isolate Your Soundtracks:

    • Identify specific recurring soundtracks that hold you back or cause anxiety, jotting them down for clarity.

3. Reflect on the Origins:

    • Understand where these soundtracks come from, whether rooted in past experiences, criticism, or societal pressures. Recognizing their origins can help challenge their validity.

4. Label and Reframe Negative Soundtracks:

    • Give a name to your negative soundtracks, distancing yourself from them. Reframe these thoughts with more positive and constructive alternatives.

5. Replace with Positive Soundtracks:

    • Cultivate new, positive soundtracks aligned with your goals and values, countering the negative ones and guiding you toward productive thinking.

6. Practice and Consistency:

    • Changing thought patterns takes time and practice. Be consistent in challenging negative soundtracks and reinforcing positive ones.

7. Externalize Soundtracks:

    • Share your soundtracks and struggles with trusted friends or a therapist, gaining perspective and support.

8. Set Clear Goals:

    • Establish clear, actionable goals that provide direction for your thoughts and actions, with positive soundtracks aiding in their pursuit.

9. Take Small Steps:

    • Overcoming overthinking doesn’t require massive changes overnight. Start with small, manageable steps toward your goals to build confidence and momentum.

10. Celebrate Progress:

    • Recognize and celebrate your successes and progress, reinforcing positive soundtracks and motivating continued growth.

11. Develop Resilience:

    • Understand that setbacks and negative thoughts are part of life. Build resilience by learning from these experiences rather than succumbing to them.

12. Practice Mindfulness and Presence:

    • Cultivate mindfulness techniques to stay present in the moment, preventing overthinking about the past or future.

13. Maintain Self-Compassion:

    • Be kind and forgiving to yourself. Understand that everyone grapples with negative soundtracks, and it’s okay to have setbacks as long as you continue working on improvement.

So, what advice can I offer young doctors entering private practice?

  1. Overthinking is more common than you might think, especially when things go awry at work.
  2. Acknowledging overthinking and taking steps to reduce it will greatly benefit you. The earlier you address it in your career, the better.
  3. I still stand by the importance of maintaining a journal, documenting your daily activities and thoughts. It remains a valuable tool for overcoming overthinking.

In conclusion, the art of managing overthinking is crucial for surviving and thriving in private medical practice in Malaysia. Learning to control those ever-running soundtracks in our minds can make a significant difference in our personal and professional lives, allowing us to focus on our patients and our own well-being.

Thank you for listening to this podcast. Please subscribe to this podcast to learn more about surviving private practice in Malaysia. Bye


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Dr. Selva

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

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