Health Care Disparities

Staying Professionally Fulfilled: No One Can Stop You But Yourself

Dean Gianakos, MD

Gianakos D. Staying professionally fulfilled: no one can stop you but yourself. Consultant. 2018;58(5):e166.


I recently saw a greeting card that caught my attention. It said: “No one can stop you but yourself.” I paused and read the words again: No one can stop you but yourself. The card now rests on my desk at home, in plain view, for me to reflect on daily. I interpret those words to mean that I have the freedom to change my life if only I muster the courage to overcome the things that can stop me: my insecurities, anxiety, excuses, and fear. The wisdom of the card is not breaking news. And yet the words resonated with me in a novel and powerful way.

The belief that physicians have this freedom may not be so obvious to them as they grapple with government rules, insurance hassles, and electronic health record inefficiencies. These problems seem to be outside of their control. No doubt external factors are significantly impacting the health of physicians. However, unless physicians deeply understand that they have a choice in how they respond to the conditions of practice, they will have little chance to improve the quality of their professional lives.

This is not to say that health care organizations should not assume significant responsibility for improving the adverse conditions of medical practice—they absolutely should. However, there will always be bureaucratic hurdles to endure. I believe physicians who take more responsibility for directing their professional lives will experience greater professional fulfillment.

I am not referring to physicians who are presently burned out or depressed. These physicians likely need acute interventions to hasten their recovery. I am talking about engaged physicians who recognize the stresses of being a physician and who desire to proactively take steps to prevent burnout—actions that not only promote their own well-being, but also align with their values and strengths. Ronald Epstein, MD, puts it this way: “People shouldn’t wait until they are feeling burned out to reflect on what’s most nourishing about their work.”1

In the last chapter of The 7 Habits of Highly Effective People, Stephen R. Covey shares how one passage transformed his thinking about personal choice and freedom2(pp309-310):


[O]ne day as I was wandering between stacks of books in the back of the college library, I came across a book that drew my interest. As I opened it, my eyes fell upon a single paragraph that powerfully influenced the rest of my life.


I read the paragraph over and over again. It basically contained the simple idea that there is a gap or space between stimulus and response, and that the key to both our growth and happiness is how we use that space.

I can hardly describe the effect that idea had on my mind. Though I had been nurtured in the philosophy of self-determinism, the way the idea was phrased—“a gap between stimulus and response”—hit me with fresh, almost unbelievable force. It was almost like “knowing it for the first time,” like an inward revolution, “an idea whose time had come.”

I reflected on it again and again, and it began to have a powerful effect on my paradigm of life. … I reveled in the inward sense of freedom to choose my response.

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The paragraph that Covey read over and over was written by the psychiatrist Viktor Frankl, who came to the above idea while in a German concentration camp. He realized that no matter what horrendous and degrading things the Nazis inflicted on him, they could not take away his power to choose what to think about, believe, or imagine. He realized that his internal response to conditions mattered more than the conditions themselves. Covey elaborates, “It’s not what happens to us, but our response to what happens to us that hurts us. Of course, things can hurt us physically or economically and can cause sorrow. But our character, our basic identity, does not have to be hurt at all. In fact, our most difficult experiences become the crucibles that forge our character and develop the internal powers, the freedom to handle difficult circumstances in the future and to inspire others to do so as well.”2(p73)

I believe some physicians tell themselves 3 stories that prevent them from assuming responsibility for their professional lives.3 One is the helpless story: There’s nothing I can do about the brokenness of the health care system. The government, insurers, corporate executives, and pharmaceutical companies have all the power. I’m just one physician in a small practice trying to provide excellent care for my patients. What can I do? The second is the victim story: It’s not my fault that the government imposed electronic health record requirements, impossible quality metrics, and burdensome documentation rules. I only work here. And the third is the villain story: Insurers, Big Pharma, and corporate America, they are the real crooks. They don’t care about our patients, they only care about their bottom lines.

There may be some truth to these stories. However, believing them takes control away from physicians. As I recommended in a recent commentary, don’t believe everything you think.4 Thinking differently about how to respond to practice conditions may change the way you feel about them and, in turn, prompt a change in behavior.

I don’t mean to suggest that taking responsibility for one’s choices is easy. It can be arduous, painful, and frightening. It requires self-knowledge and a clear sense of one’s goals, values, and strengths. However, once physicians understand—really understand—believe, and embrace the idea that they have a choice in how they practice and live their lives, they can begin to ask themselves important questions: What do I really want? How can I make my professional life more satisfying? Physicians who spend 20% of their professional time doing work they find most meaningful are less likely to be burned out.1 That 20% could be time spent teaching medical students, working at a free clinic, developing leadership skills, advocating for political change, honing business skills, or doing research. Or doing something else! The point is, physicians have choices.

Of course, meaningful time will not magically appear on physicians’ schedules. Physicians need the emotional and social intelligence skills to hold crucial conversations with their medical directors or organizational leaders to get what they want for themselves and their organizations. And they must be willing to accept the potential consequences of their choices, such as less income, or a more austere lifestyle, or less direct patient contact. Maybe most importantly, they must summon the courage to make decisions in the presence of risk and uncertainty. This is not easy to do.

For those physicians who think they have little control over their professional lives, I urge you to think again. No one can stop you but yourself.

Dean Gianakos, MD, is the director of medical education at Centra Health in Lynchburg, Virginia.


  1. Epstein R. Attending: Medicine, Mindfulness, and Humanity. New York, NY: Scribner; 2017:171.
  2. Covey SR. The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change. New York, NY: Free Press; 1989:309-310.
  3. Patterson K, Grenny J, McMillan R, Switzler A. Crucial Conversations: Tools for Talking When Stakes Are High. 2nd ed. New York, NY: McGraw-Hill; 2012:116-119.
  4. Gianakos D. Rethinking burnout: 3 suggestions to reduce the stress of practicing medicine. Consultant. 2017;57(2):126-127.