A few years ago, my wife and I planned an entire summer down to the week. School let out in mid-June, back in session mid-August, and we didn't want to waste a single day of it. There was a trip to see family, we were gonna go to the beach, there was swimming, four weeks of day camp for the kids, and then at the very end, the grand finale, Legoland and Disneyland.

Now, we decided not to tell the kids. We wanted them to enjoy the entire summer without counting down to the last week. Every piece of it got planned, coordinated, scheduled, and then, like it always does, the summer had other plans. One kid got sick, then the other. There was a GI bug, then walking pneumonia, antibiotics, inhalers, missed weeks of camp.

By the final week, we thought we'd finally made it through. We told the kids Thursday night, and they were out of their minds. They were so excited. And then on Saturday, the night before we flew out, my son started shivering. We took his temperature, 102. All of that planning and none of it mattered.

Well, hey everyone, and welcome back to the Better Physician Life podcast. Thank you so much for being here. Now, that fever story isn't really about parenting, by the way. It's the same thing that happens to us every day at work, and most of us have never actually looked at it closely.

Today, I want to talk about control. Not the 30,000-foot, the healthcare system controls everything version, but the actual daily version, what you can control and what you can't. And I think most of us get this wrong in two totally opposite directions at the same time. Stick with me, I'll show you what I mean.

So there's a pattern I see constantly, both in myself and in the physicians I coach. We treat control like a light switch. It's either on, or it's off. Either I'm fully in charge of what happens, or I have no say in anything at all. There's no dimmer. There's no in between. And because there is no in between, the moment something proves we're not fully in charge - you know, like a fever the night before a trip, or a complication that has nothing to do with our skills, or a schedule that blows up no matter how carefully we built it - we don't decide that particular thing wasn't mine to control.

We conclude something way bigger. "I have no control. Not here, not anywhere." That leap is the whole problem, and it cuts two ways. The first way is the one we talk about more. We try to control stuff that was never controllable in the first place. Think about how much of your day goes into trying to guarantee an outcome that was never yours to guarantee.

You run the differential, you order the test, you double-check the plan one more time, not because it necessarily changes anything clinically, but because some part of you is still trying to outplan that summer fever. And honestly, of course you do. 

Our whole training rewards that type of process. More vigilance, more thoroughness, more checking, and the outcome usually does improve. So somewhere along the way, we build this equation and never look at it again. More effort in, better outcome out. And for a long time, that equation holds. You work harder, you get better at your job, and the results follow closely enough that that illusion never gets tested.

Until it does. A patient does everything you ask, and the numbers still don't improve. A procedure goes exactly the way it's supposed to, but you don't get the result you had hoped for. A colleague does the same workup and initiates the same plan, but the patients have very different outcomes, and you can't find the reason because there isn't one to find.

In those moments, the equation breaks, and most of us don't update that equation. We update our opinion of ourselves instead. You know the feeling. Everything by the book, nothing out of place, and some part of you is still braced, expecting that something is bound to go wrong anyway. And that bracing is important.

It's worth noticing. Because somewhere along the way, you learned, "If I'm careful enough, nothing bad happens," and that's just not true. It never was. One physician I coach put it better than I ever could. You spend your whole career controlling everything you can control inside an environment that was never fully controllable to begin with.

That's not a weakness, that's the job. But it's also a trap. You get so good at controlling the sliver you actually can that it starts to feel like you can control all of it. Now, in the last episode, I talked about what happens when a complication turns into a verdict. Something goes wrong that was never fully within your control, and instead of understanding that for what it was, you tell yourself something else entirely: "I failed."

This is that same thing, just with a bit of a sharper edge. During our training, we learned, “Do it right, and you get the right result.” So when we don't get the result we wanted, the conclusion isn't, "That wasn't mine to control," it's, "I'm not good enough." One bad outcome, and suddenly it's not about the outcome anymore. It's about you. Sound familiar? 

Now, this is only the first half of that duality, holding too tightly to the things we never fully control. 

But there's another piece here, and it's not something we talk about a lot, and it might just be the one that costs us more. Like, a lot more. At the exact same time we're white-knuckling outcomes we can't control, we are handing over enormous amounts of control that actually is ours, and we're doing it while telling ourselves we have no say in the matter. 

Have you ever heard another physician say something like, "I have no control at my job," or, "The administration runs everything," or, "I just show up and do what I'm told"? Yeah, me too. And there's some real truth in that. The administration controls plenty: your templates, your staffing, your RVU targets, how patient messages manage to find you after hours.

That's not imagined. That's our reality. But at some point, a lot of us just stop looking for places we still have a say. You're not a passenger in that system. You're one of the main reasons it runs at all. But honestly, I don't think that's even the piece that matters most. The bigger cost isn't happening at the hospital.

It's happening at your own kitchen table. You finish your last patient of the day. You tell yourself you're just gonna knock out three inbox messages before you go, and then 40 minutes disappear. Nobody made you stay. Nobody stood in the doorway and stopped you from leaving. But that habit stopped feeling like a choice a long time ago.

What time do you actually leave? Not what time you're actually done, but what time do you actually walk out the door? Is the drive home actually a chance to decompress, or do you spend the entire time replaying the most frustrating parts of your day? When the school play starts at 6:00, do you go, or do you tell yourself that you couldn't, that work was too busy, that it wasn't up to you?

You open Epic one more time after dinner just to check tomorrow's schedule. You're replaying a complication in your head while your kid is telling you about their day, nodding along without hearing all the giggles and without feeling all the snuggles. You answer one quick patient message at 9:30 PM, and the 15 minutes you told yourself it would take turns into another 40.

None of that is required. It just stopped feeling like a decision. You gave your attention to the schedule, the complication, the message. Your family got what was left over. That's the real price of deciding you have no control, not a broken healthcare system. It's that we spend all day fighting for outcomes we were never guaranteed, then hand over the evening without a fight.

A missed dinner, a missed play, being physically present at the table and mentally still finishing your charts. Some of that really is out of our hands. Mandatory call, an employment contract, a household running on one income. I'm not gonna sit here and pretend those constraints aren't real. But more often than we'd like to admit, we stop looking for the choices that are still there long before we've actually run out of options.

So here's the thing: control isn't one dial. You are not either fully in charge or fully powerless. You're usually both in the same five minutes about different things. Maybe you can't control your son's temperature the night before a trip you've been planning for months. But you very likely can control what time you walk in the door tonight, or at least most nights. 

Those are two different categories, and treating them like the same thing is where all of this goes wrong. We're trained to be precise. That's the job. Nobody wants a physician who's kind of sure. We run the workup until we know.

We rule things in, we rule things out. We don't chart, probably fine. Bring that same level of precision here. Don't let this one stay vague. It's not, do I have control or don't I? Take it item by item, line by line. This piece, no. That piece, yes. 

Whether the test comes back abnormal, no. How you deliver the news, yes. How many patients are on tomorrow's schedule? No. Whether you check your phone at the dinner table? Yes. 

It sounds almost too simple when you say it out loud. Sometimes that's a sign it's been obvious all along. Most of us aren't short on insight here. We're short on the habit of actually sorting through it.

Instead of defaulting to whichever belief is easier in the moment - either I'm responsible for all of it, or none of it is up to me - because neither of those is ever 100% true. Most days are a mix. Some things are yours to control, and some things aren't. It's not about making that distinction a single time.

It's getting a little better at making it every day. Because tomorrow, you'll have another schedule you didn't design, another inbox, another patient who doesn't follow the plan, another result you wish had been different. None of that is changing, but somewhere in that same day, there will probably be three or four decisions that are still completely yours to make.

What time you walk out the door, whether you open Epic again after dinner, whether you spend the drive home replaying clinic or actually leave it behind before you pull in the driveway, whether your attention stays with your family once you're finally sitting at the table. That might just be enough.

Maybe not enough to control your entire life, but enough to stop handing over the parts of your day that were never anyone's to take. If you're trying to get better at that, actually recognizing what's yours instead of managing what never was, that's exactly the kind of work I do with physicians every day.

You don't need to blow up your career or overhaul your life. Sometimes you just need another physician to help you sort through what's actually yours to control and what never was. And if you are interested in having that conversation, you can learn more at betterphysicianlife.com, and I'll link it in the show notes.

Because you can't change the 102-degree fever, and you can't get that vacation back. But every day, you'll have another chance to decide, Epic or not, phone down or not, present or not. The only question is whether you will. 

Thank you so much for listening, and I'll see you next time on the Better Physician Life podcast.