The Problem With Other People: How Unspoken Expectations Keep Physicians Stuck  | Ep14

Michael Hersh, MD

[00:00:00]  I've spent more time than I care to admit, stuck in traffic on my way to and home from work. Hands clenched on the steering wheel, jaw tight, just waiting for the guy in the left lane to move over already. It's so easy to believe that my frustration is about the traffic. Or the other driver or my city.

But the truth is, most days the real traffic jam is happening in my own mind because just like on the road in medicine, there are all of these rules, both spoken and unspoken about how people should act, how I should act, what getting ahead is supposed to look like, and what I started to notice, whether I'm in the car.

At the hospital, or even just at home, was that I wasn't just reacting to what other people were doing. I was reacting to how things weren't going the way I thought they should. Ready to learn more? Stick around.

 Well, hey everyone and welcome back to Better Physician Life, how to get unstuck in your medical career. I'm Dr. Michael Hersh. Thank you so much for being here today. If you are a physician who's ever felt a little off course, like maybe your career looks good on paper, but inside something isn't quite lining up anymore, maybe you're overwhelmed, disconnected, or just wondering, is this really it?

This podcast is for you. Now, as I work with physicians, it's amazing how often we end up talking about expectations and how they sneak into our lives and quietly, or sometimes not so quietly pull us away from the connections we really want. I didn't even realize I had a rule book at first, but I did. It turns out I always have.

It was just kind of this invisible script that was always running in the background. One I never consciously wrote, but that I was definitely living by. Every time I got annoyed when someone showed up late or frustrated when a colleague missed something I thought was obvious, I was flipping through that rule book.

Brooke Castillo calls this the manual, and yes, as in the owner's manual, and once I learned that term, I just couldn't unsee it. So just like an owner's manual, it's made up of all the expectations we have for how other people should behave so that we can feel okay. And most of the time we haven't actually shared any of it.

We just assume they should know, and when they don't, we feel let down or frustrated, or angry or betrayed, even when their actions were totally neutral. It's the everyday stuff. Hoping your spouse does something special for your birthday. Expecting a colleague to take initiative. Wishing a patient would follow through on the medical advice, you know, would help them.

It's not that any of these things are bad to want, but when we never say them out loud and then base our peace of mind and happiness on whether or not they happen, that's when resentment starts to creep in. So I frequently try to remind myself of the quote. Expectations are premeditated resentments.

Yeah, I know that one. Stings expectations are premeditated resentments because what I [00:04:00] started to see was that I wasn't just frustrated with people. I was waiting for them to make me feel better. If they would just do what they're supposed to do, I could finally relax. If my team was more efficient, I could get out of work earlier.

If my wife took out the garbage, I could go to sleep earlier. If the administration would just stop accepting every single Epic upgrade that comes their way, my day would be so much better. Stop moving those buttons a quarter of an inch. That's when I learned about emotional childhood and emotional adulthood, and it shifted something in me.

So what are those terms? Emotional childhood is when we hand over control of our feelings to someone else, our mood, our stress, our peace, all completely dependent on how other people behave. [00:05:00] And it's subtle. It doesn't always feel like blame, but it is. If you would change, I could feel better. Sound familiar, especially in medicine, where so much of our day feels shaped by other people, patients, administrators, colleagues.

It's so easy to fall into that mindset. But emotional adulthood is about taking responsibility back gently. Honestly, it's saying I get to decide how I feel. I can set boundaries, I can communicate what I need. I can notice what I'm making someone else responsible for my peace, and I can shift that. Now it's not easy and I definitely don't always get it right, but the more I practice, the more I realize [00:06:00] I don't have to wait for the world to behave before I can feel.

Okay. Letting go of the manual is where that piece starts, and as I started to do that, something unexpected happened. I began to notice how tightly I was holding onto my own identity. There's this quote from Game of Thrones, Tyrion. Lannister says, never forget what you are. The rest of the world will not wear it like armor, and it can never be used to hurt you.

That one stuck with me. Because for so much of my career I was careful, careful not to seem uncertain, careful not to mess up careful about how others saw me, my skills, my decisions, even just my personality. And it's not that I stopped caring what people [00:07:00] think, but what shifted is I started caring more about what I think.

When I began to own my story, my quirks, my strengths, my mess, it took some of the sting out of the criticism wasn't hiding anymore, and with that came a kind of freedom. But I also saw just how much I'd been trying to subtly control the world around me dropping hints. Over explaining, getting quietly resentful when people didn't pick up on what I needed, even though I hadn't told them.

And the more I tried to manage everything, the more disconnected I felt. I was exhausted. Not because people were doing things to me, but because I was quietly carrying it all. The truth is I wasn't just writing manuals for other people. [00:08:00] I have one for myself too, and it's not small. For those of you who remember sifting through encyclopedias, that's what my manual looks like for me.

Volumes and volumes of how I thought I needed to show up and be so that I could be happy and man, I was failing my own test every single day. No matter how much I achieved or how hard I pushed, it was never quite enough because the manual I had written for myself didn't have an end point. It didn't have grace, and it was built on things like perfectionism and people pleasing, and the fear that if I slowed down, everything might fall apart.

And the hardest part. I didn't even realize how loud that internal script had become until I started to question who I was without it. [00:09:00] And honestly, that question brought up a lot of fear because in medicine we don't just carry expectations, we multiply them. We inherit a culture where the rules aren't just suggested.

They're baked into our training. Always say yes, never show weakness. Don't complain. Avoid mistakes at all costs. These weren't just professional standards. They became personal truths. So even when everything looked fine on the outside, I felt depleted and exhausted because the expectations I had for myself weren't just high.

They were impossible. But as I began to question that internal script and let go of the idea that I had to constantly prove, perform, or anticipate everything, I [00:10:00] started to feel a little more human, a little more grounded. I gave myself permission to rest, to step back when I needed to. To not be on all the time.

And the more space I created for myself, the more room I had to offer grace to others, when I stopped demanding perfection from myself, I didn't need the world to be perfect either. Letting go of the manual isn't about lowering standards. It's about loosening the grip and making room for something a lot more human. I've seen how unspoken expectations quietly erode connections in my life.

This was a lesson I learned the hard way with my college roommates. In marriage, friendships, and work teams, we wait for people to just know, we hope they'll meet the standard [00:11:00] without being told what it is. And then we get hurt or disappointed or resentful. I've done it too, waiting for people to meet needs they didn't even know existed.

That's why now I try to pause and ask myself, why am I feeling let down? Did I actually say what I needed? What story am I telling myself about why they're not doing what I want them to do? Because the truth is wanting things from people isn't wrong, but how we hold those things does matter. That's the difference between a manual and a boundary.

A manual says, you need to act this way so I can feel, okay. A boundary on the other hand says. Here's what I need and here's how I'm going to take care of myself. It sounds like I need some quiet time [00:12:00] After work to reset. I'll be in my office for an hour, or if I'm picking up an extra clinic or doing extra cases at the end of the day, I'll need some extra time off to balance it.

Boundaries aren't about controlling other people. They're about owning our own needs and being willing to say them out loud. And once I started doing that, I noticed another shift. I began to rethink all the ways I was saying yes. Look, as a Gen X doc, I was taught to grab every opportunity. More patients.

Sure. Join another committee. Absolutely. Leadership role. Let's go. That hustle, it helped me grow fast, but it also left me exhausted. And then I came across Dr. Jimmy Turner's Hell yes policy. If it's not a hell [00:13:00] yes, then it's a hell no. And at first that felt very risky. Saying no was not how I was trained.

It wasn't how I got to this point in my life. It felt like letting people down. It felt like letting myself down because I couldn't rise to the occasion or because I was missing out on opportunities. But when I started saying no to things I didn't actually want to be doing, I created space for what actually mattered.

Life shifted from frantic to focused, from obligation to intention. Now still Cutting back didn't automatically bring clarity into my life. That came when I started saying yes to things that truly aligned with what I wanted my life to look like. In 2020, I stumbled into physician coaching. I didn't sign up because I thought it was a fix for everything that was going wrong in my life.

I wasn't looking for a [00:14:00] miracle. I signed up because I couldn't keep going the way I was. I was tired and stuck and unsure of how to make anything better, but I knew something had to change and that one seemingly small investment shifted everything. I became genuinely curious, maybe even a little obsessed with how coaching worked.

I wanted to understand the tools, the process, the why behind the relief. I was starting to feel. So I signed up for a coach certification program. Then I launched a business and I started writing and started speaking and started this podcast. And each time I said yes to something that moved me forward.

Even just a little, I noticed my life getting better and I wanted more of that each, yes, pulled me closer to the life I actually wanted to be living. The early yeses built my [00:15:00] career, and I could not be more grateful for that. But my mid-career nos have given me peace. They've given me breathing room and career longevity, and the ability to stop fantasizing about walking away from medicine altogether.

Now I look for the yeses that energize me rather than exhaust me. The ones that feel like me. But here's the thing, we're not just writing manuals for other people. We're also living inside the ones they've written for us. Patients expect instant replies. Administrators expect quiet compliance and the culture around us.

It says A good doctor is always available, always composed, and always in control, and that weight is pretty heavy. [00:16:00] So when I started letting go of those expectations, when I stopped chasing gold stars and approval, it felt like losing part of my identity. It was vulnerable. Maybe even a little scary, but that's where the real growth happened.

Owning my values, making peace with imperfection, letting people down sometimes and surviving it. These are the hard-won lessons. These are the lessons earned. These days when I catch myself slipping back into old habits, trying to control, getting quietly resentful, hoping people are just going to get it, I try to pause and I ask myself, am I expecting someone to follow rules they don't know exist?

What do I actually need right now and how can I meet that need myself? [00:17:00] And. Is there a kinder, more compassionate way to interpret what's happening? That one is super helpful and has gotten me out of some very tricky situations because this work, it's not about perfection, it's about awareness and choice.

When I feel off track and need something to ground me, there are a few things I try to come back to first, just noticing what's happening. Awareness. If I feel irritated or resentful, I try to pause and ask, what just happened? What got triggered? Is there a silent expectation here? I'm not recognizing, is there a rule I'm holding onto that no one else even knows about?

Maybe not even me. Then I try to take ownership. Not they made me mad, but I'm feeling frustrated. That tiny shift, it really matters. It reminds me that I am in charge of [00:18:00] my own emotional life, not someone else. And if it feels safe and right, I try to communicate, actually say what I need out loud. It's something I've learned to practice because remember, clarity really is kindness for me and for the people around me, and when I'm feeling stuck.

I try to lean into curiosity. Could there be another story here? Maybe their behavior wasn't about me at all. Maybe they're overwhelmed or distracted, or just human and finally, self-compassion because I still mess up. I still get it wrong. I still fall into my old patterns, but I'm learning to meet those moments with grace.

To treat myself like someone I care about, a friend, my wife, one of my children, [00:19:00] because if I can hold myself with compassion, I'm much more likely to show up that way for others too. And there's one phrase I return to again and again, respond to the content, not the tone.

Whether it's my daughter, a colleague, or a patient, if someone's short or snappy, I try to hear what they're really saying. Underneath it all, it's not always easy, but it keeps me from escalating. It keeps me connected to who I want to be in that moment. Growth is messy. It's non-linear. A yes from last year might need to become a no Now.

An old ambition might not fit anymore, and that is totally okay. We get to choose again every day. So as you think about your own life, here's a few things to think about. What expectations either spoken or unspoken [00:20:00] are shaping your relationships right now? Are there places where your manual might be creating distance or disappointment?

Are there needs you've been hoping others will just know, instead of saying them out loud, where might you be ready to step a little more fully into emotional adulthood and what boundaries might be asking for your attention? What would a true hell yes look like in this season of your life and maybe more importantly.

What might happen if you set the manual down altogether? What might open up for you in your schedule, your relationships, your sense of wellbeing, because every choice we make, it's a quiet vote for the kind of life we want. So what are you voting for? What are you saying yes to? And what are you finally ready to let [00:21:00] go of?

Because the traffic, it's still gonna be there. The detours are still gonna come, but the path, that part can be yours in your voice, at your pace, in your own lane. Thank you so much for being here with me today, and I will see you next time on Better Physician Life. Take care.