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Join Miguel Villagra, a hospitalist, as we explore how our thoughts shape emotions, dissecting cognitive distortions like all-or-nothing thinking, overgeneralization, and more. Discover strategies to break free from negative loops, challenge assumptions, and cultivate a balanced perspective. Learn how awareness of our thoughts can lead to enhanced emotional well-being.

Miguel Villagra is a hospitalist.

He discusses the KevinMD article, “The link between thoughts and emotions: How to change your feelings by changing your thinking.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Miguel Villagra. He’s a hospitalist. His KevinMD article is titled “The link between thoughts and emotions: how to change your feelings by changing your thinking.” Miguel, welcome back to the show.

Miguel Villagra: Thank you for having me, Kevin.

Kevin Pho: So you’ve been on the show before. Go to KevinMD.com/podcast, click on the search icon in the upper right-hand corner and search for Miguel’s last episode, where he shares his story. But today I want to go straight into your KevinMD article. It’s titled “The link between thoughts and emotions: how to change your feelings by changing your thinking.” How did this article come together?

Miguel Villagra: It came together through my own personal experience. I remember myself as a hospitalist and a medical director in the past, and I can tell you, Kevin, that learning how my thought processing works has been mind-blowing for me, not only in my professional life but even in my personal life. That’s what led me to write the article and share it with some of the physicians who might be getting to know these issues. Knowing how the mind works might be helpful for them too.

Kevin Pho: All right, so tell us more about that. Tell us about your thought process.

Miguel Villagra: Absolutely. So the first concept, and to be honest, this is nothing new, this is as old as humanity, is the idea of reality: How we perceive reality and our circumstances will definitely be defined by how your mind processes that information. Therefore, our thoughts will determine the emotions we might develop, depending on the circumstance we’re dealing with, and eventually that will determine the actions we pursue and the outcomes we will have in our lives and also in our profession. That’s why it’s important to be aware of what I describe, or what I call, cognitive distortions, which are pathological thought processing that might lead you to get in trouble in your life and your profession too.

Kevin Pho: So when you were a hospitalist and you were feeling these emotions of burnout, what kind of thoughts were you having that potentially led to that?

Miguel Villagra: One of the themes, and I’m going to name just a few of them that I have seen a lot, not only personally but as a medical director with some of the peers who were under my leadership, is what they call all-or-nothing thinking, where everything looks black or white, right? So I’m going to tell you personally. I recently had an experience with a patient where the patient outcome was not that good. We deal with that, because we’re taking care of sick patients, but the idea in my mind that I was able to catch immediately was, “I feel like a total failure.” That was my thought process.

To be honest with you, when it happens once, that’s expected and normal. But when you’re doing it repeatedly, and you’re telling yourself that, with your voice telling you you’re a total failure, you will definitely get to be a total failure in your life and profession, because you keep telling yourself the same thing. So I’m going to be honest: The first thing is just to be aware of what you’re thinking. Just that level of awareness can be empowering. But ultimately, what you most definitely want to do is try to replace your thoughts with something that is more empowering and positive, instead of the negative that you’re bringing into your life.

Kevin Pho: So let’s apply that technique to the example that you just mentioned. You said some of your colleagues or trainees have succumbed to that all-or-nothing thinking. What would you do to help approach that?

Miguel Villagra: Absolutely. So the first thing I recommend, and it has been added into my life, is I do what is called a thought download. At the end of the day, I spend around three to five minutes writing down all my thinking about everything that I experienced through the day. It’s not something that will be that time-consuming, again, three to five minutes that you spend, and you start seeing what your mind was thinking throughout the day. As I just told you earlier, just building that level of awareness can definitely be empowering, but ultimately, what you will do is write down that thinking, and sometimes seeing the nonsense of this thinking will definitely help you, or lead you, to replace it with some other ideas.

Going back to the failure, that particular patient outcome that we were dealing with that didn’t go well gave me that thinking of “I’m a failure.” Well, guess what? I had a lot of compliments from patients the same day, but I was just ignoring that because I was just focused on the negativity of that poor complication. So when I wrote down my thinking, I saw that the balance for the day was even more positive than negative. That sometimes doesn’t happen, right? Sometimes you might just have a completely negative day. But for that particular experience, I was able to definitely drive my thinking from the negativity to a more positive one.

Kevin Pho: One of the other things that you mentioned in your article was the concept of overgeneralization and how that can trap you into anticipating negative outcomes. So talk more about that.

Miguel Villagra: That’s definitely tagging onto the prior one. It’s similar, but I call it more like the bad-luck event. You’re attaching a poor event, or a negative event, to something that will happen over and over again. I’m going to give you an example. I recently had a friend who was investing in a new venture startup, and the investment went poorly. It didn’t have the results he was expecting. This person is a very smart, savvy investor, doing really well in real estate and some other areas, but this particular investment didn’t go well.

We know that with venture capital and new startups, out of 10, seven or eight of them don’t do well. Maybe a couple of them will give you a decent investment return, and maybe one will give you a great return. He knew that, but what he was thinking was that because this event happened, he just had this bad luck, and this was going to happen over and over again. In this very savvy investor, it was leading to inaction. He was not even following his amazing investment plan, just because he was caught up on this particular event and focused on it. He was thinking that things were going to happen over and over again, and he was bringing this bad-luck effect into his own personal and investing life. So that’s the best example I can give you of it. And again, understanding how well he was doing in so many of the other investments he was making actually led this particular person to start going back on track with his investment plan.

Kevin Pho: So just as a segue from that, a lot of times people focus on a negative and they don’t embrace the positive, right? Sometimes you call it disqualifying the positive. So talk more about how some of us in medicine just don’t focus on what’s positive in our lives.

Miguel Villagra: Absolutely. So disqualifying the positive is something I see a lot, and we take for granted what we’re doing: We’re saving lives every day, and sometimes we get compliments from patients. Even though, as you know, the health care system is leading patients to be more angry and frustrated, and sometimes they pick on us, and it’s very challenging to practice medicine nowadays, sometimes we ignore even the minimal compliments that we have. I remember when I was a medical director, we had this accomplishment table where we were putting even a minimal positive outcome, or even a minimal compliment we were getting from patients, because sometimes we just ignore that.

I can give you an example. I recently had a patient whose leg we saved. He was having an acute embolism of one of his major arteries, so I was with this vascular surgeon, and we were rounding together. This particular patient was very rude with the staff and everything, but he was very complimentary of the surgery saving his life. I remember when we walked out of the room, this particular surgeon, who is amazing, told me, “This is nothing for me. Why? I mean, this is what I do.” And I was like, “Well, you are undermining this compliment from this patient. You just saved his leg.”

So sometimes you get into this idea and you take for granted what you’re doing, and what you’re doing is fulfilling your career. You got into medicine to save lives, and sometimes we do save lives and do an amazing job, and we just ignore that.

Kevin Pho: So we’ve talked about a few areas of the thought process that can lead to negative emotions. Now, in order to change some of those thought processes, where do you recommend that we start? There are so many things that we could potentially influence. Where do we start?

Miguel Villagra: Right. So again, I would say the first is to be aware that this exists. The second thing is to be aware of something called the comprehension trap. Just being aware of something doesn’t mean that it will drive a change in your behavior. So it’s about being aware of it and implementing some changes in your life and your routines. To give you the first example, doing a mini thought download and some journaling could be extremely useful for most, and meditation helps for some, because you can see those thoughts floating around.

But you need to understand that going from point A to point B is a whole process. You don’t expect someone to go from “I’m a total failure” to “I’m a total winner,” right? This process definitely takes time, and that’s why you need to be consistent in building new habits to make you aware of your thought processing. You will be seeing that minimal changes will have a compounding effect, and that truly had a compounding effect on my personal and professional life. But change takes time, so don’t get discouraged by not seeing immediate change.

Kevin Pho: So in your case, how much time did it take in order to make an impact that moved the needle?

Miguel Villagra: Well, I’m going to say, practically speaking, with the idea of the journal, in order to be truly consistent with it, you need to do it at least for a few weeks, three to four weeks minimum, and then you will say, “Yes, this is a routine.” But for doing this and making these changes, sometimes it takes a few months, to be honest. That’s something that everyone needs to be aware of, because sometimes people get discouraged because they did it just once and they expect everything to change, and it doesn’t work that way.

Kevin Pho: So tell us a success story from one of your coaching sessions where you implemented some of these strategies to help change the thought process of one of your clients and really move the needle for them. You don’t have to go into a lot of detail, but just give us a before-and-after picture.

Miguel Villagra: I recently had this amazing hospitalist physician, a female in her late 40s. She takes a lot of time with patients, and she is very knowledgeable, but she was very frustrated with the job. She was actually planning on quitting her job. So I had a coaching session with her, and we were going over her thought processing, and her main issue was that she was leaving work later than everybody else. Now, this particular physician has a very supportive husband, and her two kids were taken care of. She really didn’t have an issue specifically with the fact of leaving late, but it was her thinking, because in her mind, she was thinking that she was not like everybody else. She thought that she was not as good and efficient a physician as everybody else, because they were leaving earlier than her, even though she didn’t have a problem with that.

So I was trying to point out to her: What is the standard for rounding, right? Is it 20 minutes, 40 minutes? There’s no such thing, right? She was an amazing physician, getting a lot of compliments from patients, and she was not having a problem with leaving a little bit later. I just emphasized the fact that she was spending the time that she felt she needed to spend with her patients, to go deep into their charts and so on and so forth. So this particular physician didn’t need to leave her job. She just needed a little bit of coaching to understand her thought processing.

I remember the first time she used the words “I should be leaving earlier,” and I kind of challenged her: “Why should you leave earlier if you’re just spending enough time to take care of your patients? Leave when you are done.” And she was feeling really, really good after understanding that there was nothing wrong with that. Because when you use the words “I should,” you’re using a little bit of shame and thinking behind it, right? You feel there’s something wrong with you. I encouraged her to understand that there are physicians who leave later. In my career, I have seen physicians leave a little later too, and some of them have issues with that, but this particular one did not have any issues. She ended up staying in her job, and she felt very good about that, because there was nothing wrong with her. It was just her thinking telling her there was something wrong with her for just leaving later.

Kevin Pho: We’re talking to Miguel Villagra. He is a hospitalist. His KevinMD article is titled “The link between thoughts and emotions: how to change your feelings by changing your thinking.” Miguel, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Miguel Villagra: Absolutely. I will say that understanding your thought processing and your thought patterns can be very empowering and eye-opening for a lot of people. I will also say, as a take-home message, if you feel you’re struggling, try to seek help, because sometimes just a minimal twist in your thought processing can be mind-blowing and life-changing for a lot of physicians. And embrace minimal wins in your practice. Don’t ignore those; celebrate them, and spend some time to reflect on what’s going on with your life. Those would be my takeaway points.

Kevin Pho: Miguel, thank you so much again for sharing your time and insight, and thanks again for coming on the show.

Miguel Villagra: Thank you for having me.