What we don’t know continues to hurt us

Dr. Joel C. Small discusses self-awareness and motivation to change

Extensive research into behavioral change has identified various stages that lead to purposeful and sustainable behavior modification. The transtheoretical model (Prochaska and Velicer, 1997) of behavioral change describes an initial stage of “precontemplation” in which people are unaware that a behavioral problem exists and, therefore, fail to recognize the consequences of their behavior.1 Such individuals show little interest in changing their behavior because they are simply clueless that their behavior is creating a problem. Abraham Maslow, a noted American psychologist, is attributed with another similar finding that deals with the development of competence. His four stages of competence describe an initial phase of “unconscious incompetence” in which the individual fails to recognize, or is unconscious of his/her own incompetence and, therefore, is unreceptive to learning a new and useful skill that will likely move him/her toward the competence that he/she so desperately needs.

What Maslow describes is, in my opinion, the leading cause of suffering, dissatisfaction, and burnout in the healthcare industry. As a healthcare coach, I spend much of my time helping clients come to the awareness that we are often our own worst enemies by failing to recognize our behaviors that create personal and professional barriers to our fulfillment. This significant blind spot leaves us in a state of limbo — chronically suffering the symptoms of a curable malady yet lacking the capability to acknowledge its existence.

Furthermore, our formal education, while teaching us to be masterful technicians, has failed us in the arena of entrepreneurship and leadership competence. Michael Gerber, in his bestselling book, The E Myth, describes a technician as someone who eventually suffers disillusionment with his/her chosen profession because he/she lacks awareness of the necessary entrepreneurial skills that are essential ingredients for long-term success and fulfillment.

I see this problem often in the healthcare industry because, as technicians, healthcare providers create systems to manage and use them as a substitute for entrepreneurism and leadership. Gerber uses the analogy of a juggler with too many balls in the air. Eventually, the juggler is overcome by the task, and the first ball falls, creating a domino effect as the remaining balls follow suit. This, in my opinion, is what happens when healthcare technicians adopt a systems management approach rather than an entrepreneurial and leadership philosophy. Systems management is burdensome and tedious, and unless properly delegated, it becomes overwhelming. No wonder we are prone to disillusionment and burnout. We adopt a systems philosophy that is incompatible with our desired success and fulfillment.

Quite simply, we are not suffering because we lack intelligence or even financial success; we are suffering because we lack self-awareness and the motivation to change. Because we suffer from unconscious incompetence, we fail to recognize the real cause of our suffering and tend to blame external forces for our disillusionment. We lack the awareness that we are the ultimate arbiter of our “emotional success.” Our suffering and frustration are both caused by and resolved by us. Once we come to this awareness, we can begin the process of turning frustration into fulfillment, finding passion, and creating energy where burnout once existed. By acknowledging that a problem exists and that we are the cause, we become motivated to acquire the knowledge and skill that will lead to sustainable behavioral change.

It goes without saying that we cannot solve a problem when we fail to acknowledge its existence. Some of us accept our suffering and dissatisfaction with our profession because we have come to believe that it is part and parcel of our job. We see no realistic resolution to our pain, and we begin to feel trapped and helpless. Metaphorically, we become captives in a cage with no bars.

The greatest and saddest irony of all is that our chosen profession is unique in that it offers us the greatest freedom to purposefully create our ideal environment. Many of us chose the healthcare profession for this very reason; we are our own boss. No one can fire us except our regulatory boards. We can work when we want, how we want, and for as long as we want. We can create a large mega practice or find our fulfillment in a small boutique clinical practice. The choice is and always has been ours.

Trust me when I say that many of those working in a corporate environment envy us for our degree of freedom and would gladly trade places. Currently, the level of disillusionment in corporate America is approaching epidemic levels2 as budget restraints require more work from fewer people, and corporate layoffs along with the need for retraining have left many loyal workers unemployed with no prospect of a bright future.

The good news is that we are not meant to suffer from disillusionment and burnout. With proper guidance and the implementation of some basic entrepreneurial skills, we can find sustainable joy, fulfillment, and financial reward in our clinical practices.

If you are currently experiencing frustration or burnout with your chosen profession, seek answers now. Acknowledge that a problem exists and that you likely are the cause of the problem. Also acknowledge that you hold the key to resolving the problem. Seek help, and never accept the false narrative that pain and suffering go with the territory. With the proper mindset and the motivation to change, a better future awaits you.

Joel C. Small, DDS, MBA, ACC, FICD, is a practicing endodontist and the author of Face to Face: A Leadership Guide for Healthcare Professionals and Entrepreneurs. He received his MBA, with an emphasis in healthcare management, from Texas Tech University. He is a graduate of the University of Texas at Dallas postgraduate program in executive coaching and limits his coaching practice to motivated healthcare professionals. He is a nationally recognized speaker on the subjects of leadership and professional development. Dr. Small is available for speaking engagements and for coaching healthcare professionals who wish to experience personal and professional growth while taking their practices to a higher level of productivity.


**To receive a free copy of my “Core Values Exercise,” please contact me at joel@joelsmall.com. I am also available for a complimentary coaching session to discuss your practice-related issues.

  1. Adams S. Most Americans Are Unhappy at Work. Forbes Online. June 20, 2014. https://www.forbes.com/sites/susanadams/2014/06/20/most-americans-are-unhappy-at-work/#5a6bff30341a. Accessed July 6, 2017.
  2. Prochaska JO, Velicer WF. The Transtheoretical Model of Health Behavior Change. American Journal of Health Promotion. 1997;12(1):38-48.

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