Mindful Journaling for Re-Thinking Your Career in Medicine: Staying, Leaving, or Practicing Differently

There comes a time for many physicians when troublesome questions begins to surface:

• Can I continue practicing in this way?

• What needs to change to make my practice sustainable?

• Is it time to move on?

• Are there other ways to use my skills, knowledge, and gifts that I haven’t yet imagined?

These questions, which may arise at any phase of your professional life, don’t always yield easily to analysis. In fact, thinking harder, what we might call ruminating, often makes problems feel less resolvable. Instead of finding clarity, you may begin to feel more uneasy, more torn, caught in a whirlwind of what-ifs and afraid of making the wrong choice.

This is a good time to tap into your inner wisdom, and this is where journaling can help.

In my work with physician clients facing difficult questions, I often encourage journaling as a reflective practice. It’s a simple, analog way to get in touch with your own inner life. In many ways, it’s a form of mindfulness. Writing by hand often works best, as this tends to create a strengthen the mind-body connection and deepen awareness. But choose what feels most comfortable and accessible for you.

The journaling reflection that follows is not meant to force a decision. Instead, it is an invitation to listen differently, to slow down and give your mind the space it needs to breathe.

To begin, set aside anywhere from 10 to 30 minutes. Choose a time when you can take a quiet and uninterrupted pause, maybe at the beginning or end of the day. Let your intention be to meet your own presence rather than productivity.

Step 1: Name the Question (Without Answering It)

Write the question that keeps returning for you. Perhaps that’s:

• Is it time for me to change the way that I am working?

• Is there a way to practice that feels more sustainable?

• Who am I if I am not in my current practice?

• What would it mean to me to leave medicine altogether?

Your question could be something else entirely. Perhaps it’s very personal, or maybe it’s connected to your family. No matter what question you choose to sit with, choose something that matters to you.

Once you’ve acknowledged your question in this simple way, write:

Right now, I don’t need to answer this question. I am simply acknowledging that it is here.

Pause, breathing in and breathing out, before moving on.

Step 2: Notice How the Question Lives in the Body

Without analyzing, reflect on:

• Where do I feel this question in my body?

• What does it feel like? Is it tight, pressing, restless, dull, vibrating, sharp, or charged? Maybe it is simply a weight, or something else.

• What happens if I stop trying to solve it, even briefly? How does the sensation change?

Write what you notice. If an answer feels clear, sit with it for a while. If it doesn’t, give it time. Resist the urge to fix.

Step 3: Release the Urgency to Decide

Complete one or more of the following phrases:

• When I try to force an answer, I notice that I feel…

• What I am most afraid would happen if I don’t decide soon is…

• If I trusted that clarity will come in its own time, what would soften right now?

Allow your writing to be honest and unedited.

Step 4: Remember How Insight Has Emerged in the Past

Think of a time, whether personal or professional, when an important decision became clear without effort.

• What was happening around that time?

• What was my state of mind or body?

• How did that sensation of knowing feel when it arrived?

Write without trying to draw conclusions.

Step 5: Give the Answer Time to Grow

On a new page, write:

I am allowing this question to rest.

Then ask yourself:

• What helps me stay grounded while this question matures?

• What kind of space, support, or pacing allows clarity to emerge naturally?

• What would it mean to trust my capacity to find my way?

• Who or what might support me in staying present with this question, rather than rushing toward an answer?

A Closing Reflection

Before you stop writing, choose one sentence you can return to when stress or anxiety rises. For instance:

• I don’t need to have all the answers right now.

• I can rest here in this moment, and it’s ok.

• I trust myself and my inner wisdom.

Life is not a board exam. Some decisions are not meant to be rushed. They are meant to be lived with until, in their own time, they resolve themselves into something that feels steady, clear, and right. This is not the same as avoidance.

Keep this in mind:

• You are not behind.

• You are not failing.

• You may simply be in a necessary period of transition.

Allowing uncertainty to remain present is not procrastination or a dismissal of its importance. It is a necessary first step. Action taken without intention can easily lead you off course.

Return to your journal daily if possible; even a weekly practice can be transformative. With time and mental space, the next step often becomes clear. If the weight of the process feels heavy or unwieldy, a physician coach can serve as a trusted thought partner, helping you to reflect, stay grounded, and find your own way forward.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Managing Uncertainty as a Physician

An earlier version of this article appeared on this website in July, 2022

Uncertainty is woven into the life of every physician. Patients don’t always get better, there is not always one best choice or right answer, and sometimes your decisions are affected by factors that are completely out of your control.

For most physicians, managing uncertainty doesn’t come naturally. Perfectionism may be an ever-present companion. In many ways it can be a strength. The drive to excel benefits your patients and fuels your professional growth. But when you set unrealistic standards, perfectionism can shift from being an asset to becoming a barrier, undermining both patient care and your own well-being.

Layered on top of that is the responsibility you carry. Every decision can directly affect another person’s health, and that weight can make uncertainty feel almost unbearable.

And then there’s medical culture, which often rewards confidence and conviction, even when doubt is inevitable.

Add the natural physician desire for control—to fix problems, to restore order—and it’s no surprise that “not knowing” can feel like failure. Together, these forces make it difficult for physicians to acknowledge, much less embrace, uncertainty.

The Cost of Intolerance for Uncertainty

A recent study of over 2,000 faculty physicians found that intolerance of uncertainty was associated with a three-fold higher risk of burnout. Physicians who struggled with uncertainty were also less likely to feel satisfied in their careers and more likely to be disengaged at work.

As you might expect, those who struggled with uncertainty were much less likely to be satisfied with their career, and tended to be less engaged at work. Factors that correlated with a greater intolerance of uncertainty were

• Female gender

• Primary care

• Earlier stage of practice

• Lack of a trusted advisor.

Yet intolerance of uncertainty was not limited to these groups. The study found that many male physicians, specialists, and senior clinicians also struggle with its impact.

Burnout and physician unhappiness are crucial pain points in our current healthcare environment. Not surprisingly, stress from uncertainty correlates with depression and low levels of resilience. Intolerance of uncertainty has been linked to poorer outcomes and even to increased healthcare costs. And burned out physicians are more likely to leave the practice of medicine.

Naming the Challenge

Medicine rewards precision and stoicism. From training onward, physicians are expected to project confidence—even when the answers aren’t clear.

That’s why it’s especially powerful when senior colleagues and mentors acknowledge that uncertainty is part of the work. Simply hearing “I don’t always know either” can normalize the experience and help younger physicians feel less isolated.

Building Skills to Navigate the Unknown

Although becoming comfortable with uncertainty may always be a challenge, managing your response to uncertainty can open up opportunities to react to life’s curve balls in ways that are both positive and beneficial to all involved.

In their thorough analysis of the issue, Samuel Reis-Dennis and colleagues describe “three corrective virtues” that might help physicians navigate the challenges that uncertainty creates. These include:

• Courage: avoiding the tendency to run away from threats by developing strategies to cope with new challenges

• Diligence: seeking guidance from trusted colleagues and staying current on the medical literature

• Curiosity: addressing uncertainty by viewing it as an opportunity to learn and grow

These virtues remind us that uncertainty isn’t a personal failing but a natural element of the constantly shifting world of medical practice.

Finding Support

Recognizing the impact of uncertainty is one thing—navigating it is another. Medical schools are beginning to teach these skills, but once in practice, many physicians find they still need additional support.

Working with a coach or trusted advisor can provide space to process uncertainty, identify strengths, and discover practical strategies tailored to your unique needs. Building these skills doesn’t just benefit you—it also enhances your care for patients, strengthens your resilience, and can help to restore meaning in your professional life.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

References

Allison, J. J., Kiefe, C. I., Cook, E. F., Gerrity, M. S., Orav, E. J., & Centor, R. (1998). The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO. Medical decision making : an international journal of the Society for Medical Decision Making

Begin, A. S., Hidrue, M., Lehrhoff, S., Del Carmen, M. G., Armstrong, K., & Wasfy, J. H. (2022). Factors associated with physician tolerance of uncertainty: an observational study. Journal of general internal medicine

Berg, S. (2020). Feeling burned out? Try picking up the phone to call your coach. American Medical Association

Cook, J. (2022). Forget resilience, improve your uncertainty tolerance. Forbes

Iannello, P., Mottini, A., Tirelli, S., Riva, S., & Antonietti, A. (2017). Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. Medical education online

Reis-Dennis, S., Gerrity, M. S., & Geller, G. (2021). Tolerance for uncertainty and professional development: a normative analysis. Journal of general internal medicine

Simpkin, A. L., Khan, A., West, D. C., Garcia, B. M., Sectish, T. C., Spector, N. D., & Landrigan, C. P. (2018). Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study. Academic pediatrics

Sinsky, C. A., Brown, R.L., Stillman, M. J., & Linzer, M. (2021) COVID-related stress and work intentions is a sample of US health care workers. Mayo Clinic proceedings