I've gotten good at overriding them

It is 7:30 on a Tuesday morning. Someone at home sick, or a pipe burst, or the tire is flat. It doesn't much matter which one it is. Each is one of modern life's inconveniences that cannot be ignored, and they arrive at 7:02 in morning when you have a full clinic ahead of you.

You could cancel. You could ask for coverage. You already know there is no real backup system for that. Ignore the thing at home instead and there is no backup system there either. All options have quiet costs that will be pain later

Work usually wins. Everything mostly works out, and a little of the joy you used to feel when you got out of bed each morning it eroded. Nobody at home is completely happy and nobody at work is completely happy, and you finish the day stressed and a little bit grumpy.

Your body sends up a signal that this might not be a sustainable path, a signal you have received countless time, and override it again. Mind over matter. I am really good at quieting my internal alarms.

What arrives after that is sneaky. A little resentment. A change in your mood you notice but don't name out loud.  Sunday night dread.

My podcast guest last week got tired of the resentment and the dread and did the thing few of us do. She pivoted.

Dr. Bertina Hooks is a board-certified internist who hit burnout four or five years into her career as a hospitalist. Here is the part I want you to notice: she started moving before anything forced her to. Locums first, for the autonomy. Then her own practice, then a second location. Then the pandemic, and three years on the front lines of it.

Then, in 2022, a personal medical crisis forced another pivot.

She went back to clinical work by redefining how she practices. And out of that recovery came a question she says she had never actually sat with: who am I outside of medicine?

What I keep turning over is the distinction she draws between a reactive pivot and a strategic one. Reactive is emotional and fast and usually begins with quitting. Strategic takes intention, time, and patience — you get clear on what you value, build what she calls an ideal job profile, then go explore before you leap. Most physicians, she says, have no idea what the options even are. We finish training believing there is one door.

Two things she said have stayed with me all week. The first is that burnout does not go away with rest. Take the vacation; it is waiting for you when you get back. That one is worth sitting with if you have been telling yourself you just need a few days.

The second is the one I have been repeating to myself. Burnout is not a verdict on you. It is information.

That reframe is the whole episode, and it is why I wanted her on the show. The signal is not the enemy. It is the only part of this that is actually trying to help you.

Listen to this week's episode →

One thing to do with this today: name the smallest signal you overrode last month. Not the dramatic one. The small one you talked yourself out of on a Tuesday at 7:30.

Her memoir, From Fire to Freedom, comes out this Wednesday, and she also hosts the Mindful Practice Podcast if this conversation lands for you.

If you have named that signal and did not like what it said, that is a reasonable thing to talk to someone about.

I'm here if you need me.

— Ben