Whether we realize it or not, rules influence every aspect of our lives. Especially those unwritten rules that everyone seems to know and abide by anyway. But what exactly am I talking about when I say rules? It’s not things like obeying speed limits or following proper procedures. I’m talking about those rules that affect how we think, what we believe, and ultimately, how we act. Those unwritten rules that keep us stuck.

In this episode, I dig into this concept of rules and how they dictate our lives, particularly as physicians. I explain what I mean by rules and give multiple examples. I also touch on a concept by Vishen Lakhiani called BRULES. I think you’ll relate to many of the unwritten rules I bring up and I hope it causes you to question and rewrite some of your own.

“So often in coaching, clients will just tell me the rules, like they’re true. And I know I did the same thing, and I still do in some areas. We all have these blind spots.” – Dr. Sara Dill

What You’ll Learn

• The BRULES concept (credit to Vishen Lakhiani)
• Common unwritten rules
• Questioning your rules
• Rewriting your rules

Contact Info and Recommended Resources

Book:

The Code of the Extraordinary Mind by Vishen Lakhiani

Podcast Episodes:

• How to Beat Burnout
• How to Drop Your Manual
• Thought Work: The Most Important Work You Can Ever Do
• Believing New Things

Connect with Sara Dill, MD, The Doctor’s Coach

• Website: saradill.com
• Work with me: saradill.com/coaching
• It’s not too late to join my Physicians Only Small Coaching Group! If you want to get in, sign up at saradill.com/coaching.
• I read all my own email and I’d love to hear from you! Please write to me at sara@saradill.com. 
• Get a FREE consultation with Sara! Sign up here: saradill.com/schedule
• Get Dr. Dill’s book The Doctor Dilemma: How to Quit Being Miserable Without Quitting Medicine
• Facebook
• Instagram

I’m Dr. Sara Dill, and this is the Stress-Less Physician podcast, Episode Number 27. Welcome to the Stress-Less Physician podcast. I’m your host, Dr. Sara Dill, MD. Using my unique combination of coaching and mindfulness tools, I will teach you practical ways to reduce your stress level, feel happier at work, and create a better balance between your medical career and personal life. If you are a busy practicing physician who wants to design a life and medical career that feels good to you, you are in the right place.

Hey, everyone! Welcome back to the podcast. So happy to be here. And today, I have an episode that I’ve actually had fun writing. And it’s about the rules that we believe that we don’t even know that we believe are rules; we just think that’s how life is, or that’s just how things are, especially when it comes to being a physician.

And I think a lot of us have rules. And I know I’ve discovered them both through my own coaching and then coaching clients, that we believe a lot of crazy things that other people don’t necessarily believe. And the reason I thought about doing this episode today is that this weekend, I was hanging out with some friends. And I was getting gently teased because I have a lot of rules for myself. So yes, I am doing a podcast on, “Choosing New Rules for Yourself to Live By.” And I would also say I do have a lot of rules.

But I was thinking about some of the rules I have, and they were silly. We were talking about rules in the kitchen, like I have a little zone in my kitchen where I don’t like dirty dishes to go. It’s where I put the clean dishes and everything. And then I have a separate little dish towel that I just used to dry glassware and dishes off. So, it’s a dish towel that—the rule is you aren’t supposed to wipe your hands or your face on it. So, I realized that sort of silly, but it works for me. And that’s sort of an example of a rule that I’m okay keeping. But I do try not to enforce it too much with other people because I realized other people don’t know what that special little dish towel is. Anna, my sister, if she’s listening, she will know. I think it’s maybe a family thing or something. Who knows?

Anyway, the rules I’m talking about today could be something like that, right? Especially if they’re causing friction in a relationship. A lot of us have rules for how you load the dishwasher or rules on other things, which generally are just preferences. But the rules I wanted to talk to you about today are rules that you believe that might be causing you to feel stuck or feel like you don’t have a lot of options in life. So typically, if you are a physician, and you are unhappy or you feel stuck, or you feel like you don’t have a lot of choices or options, it’s probably because you’re believing some outdated and just unhelpful rules. So, I just want to start by asking, what rules do you believe? Do you even know what they are? Do you know that a lot of what you think is true is just not true. Or at least it’s optional?

I learned a phrase called brules, that’s B-R-U-L-E-S—it stands for Bullshit Rules, so it’s brules—from a book called The Code of The Extraordinary Mind by someone named Vishen Lakhiani—I might be messing up his name, sorry. I love this term, though. And I have adopted it for myself. So, I like to think about these outdated crappy rules that a lot of us have, that we don’t even know we believe in as these bullshit rules or brules. So, I just wanted to give credit to him for introducing that term to me.

So often, in coaching, clients will just tell me the rules like they’re true. And I know I did the same thing. And I still do in some areas. We all have these blind spots, and it’s why I have a coach who gently helps me see what brules I still believe and question whether I want to keep believing them. You can see the results and believing them and then decide is this something I want to keep believing on purpose? Do I want to keep living my life by this rule that perhaps comes from culture, other people, maybe the culture of medicine, maybe my family? Or do I want to let it go? Do I want to come up with a new rule for myself?

So today, I wanted to just list some of the most common rules I hear with my coaching clients that I think often are bullshit rules or brules. And notice, if you believe any of these, what would change if you no longer believed them? Do you know people who don’t believe these rules, what’s different for them? And maybe there are some rules here that you believe in, you want to keep believing, that’s totally fine. And maybe there’s some rules here that you don’t believe. That’s good to know, too, right? Because we all have sort of our different patterns of beliefs and assumptions.

And again, typically, if you are feeling stuck, or like you don’t have a lot of options, it is often because you’re believing some rules about life, or about life as a physician, in particular. So let’s go! These are in no particular order; they were just ones that I hear a lot of. So, I talked to a lot of clients about whether to leave a job, whether to leave a job in particular, or leave medicine, even more specifically. And some of the rules I hear about that, sound like this, “You can’t quit a job before two years, or it’s going to look bad.” And the assumption there that it will negatively impact your career, and it might be harder to find a job.

Another rule that I hear a lot is: “you can’t quit too many jobs.” Either again, it’s going to look bad, and you won’t be able to find a new job as a physician. I will just say I don’t believe either one of these because I’ve left multiple jobs, some of which I left in under a year or at a year, and it’s fine. I believe you can always find a new job. Another bullshit rule would be: “You can’t just quit your job as a physician.” I would say maybe you actually can. You need a good reason to leave a job, especially a job as a physician, right? You need a good reason to leave your career.

I hear this one a lot: “It’s hard to find a new job as a…” and then just insert whatever specialty you are. I hear it in all different areas. A lot of people believe that they’re easily replaceable as a physician, and thus, they really shouldn’t risk getting fired or let go. They need to sort of say yes to whatever is asked of them. A lot of people tell me that you can’t take however many years off as a doctor and practice again, right? Again, people have different ideas; you can’t take one year off, you can’t take five years off, you can’t take multiple years off as a doctor, and then practice again or easily practice again.

Again, I took, I think, five or six years off and went back to practice, so I don’t really believe that role anymore. I think a lot of us, as residents heard the advice and the rule that once you leave academics, you can’t go back, or it’s really hard to go back again. Thus, the idea was that you should stay in academics from the get go, because otherwise, you can never go back. Again, I would question that.

Another rule a lot of us believe is that: “as a doctor, you owe a debt to society and thus, you shouldn’t just leave medicine.” This actually I heard a lot more of during COVID. It was really interesting to me. And this wasn’t one that I had really ever come across before. And I certainly didn’t believe. But I’ve certainly seen that actually in print as well, this idea that since taxpayers helped fund a lot of medical school education, somehow that we are obligated as physicians to continue to practice, even if we don’t want to, or even if we’re burned out, or even in a job or position. That is not where we want to be.

I hear this idea that: “you have to take call if you’re a physician all the time.” And again, you can just insert your specialty. It definitely is a belief that some physicians have more than others, but I would question it. What if you had a medical condition that precluded you from taking call or precluded you from doing a lot of things that you think are an absolute obligation in your field. Start to wiggle that loose a little bit. Just notice if you believe that.

“Being a doctor means you’re always going to be working long hours.” That’s maybe another rule that a lot of us believe. Burnout is inevitable as a physician. I talked about that in the podcast last week. A lot of us just think burnout is sort of a badge of honor even, but definitely inevitable in our role as a physician. What about this one? Do you believe that you need to be realistic in your goals for your career? Or maybe you need to be realistic in just setting goals in your life? You have to be realistic. That’s a belief that a lot of people don’t share, right? That’s sort of a rule that sometimes we have. “You can’t just stop being a doctor,” I hear that one, too.

“Being a physician should be a vocation, not just a job.” And this sounds nice, I think. But sometimes that belief that rule can be very painful when your job might just be a job that you’re going to, because you need to earn a living, and it might not be your vocation. Or you might be going through a phase where you aren’t really enjoying your work as a physician. Is it okay to care about money? Is it okay to see patients largely for the paycheck and not have it be a passion or your vocation all of the time?

“Caring about money is unethical as a physician.” I think a lot of us physicians have interesting and sometimes unhelpful beliefs about money. I know I certainly did when I was in medical school, and even as a younger junior attending, too. So, looking at your money beliefs, and especially money and medicine and earning a living as a physician. Do you believe that it’s not okay to just see patients for a paycheck? Like I mentioned before. Do you believe that being successful requires a lot of hard work? Do you believe that working hard makes you a better person? And can you see that that belief might cause you to constantly choose to work harder than perhaps you otherwise would? Is it possible that working hard and being a good person are not related?

Do you have the rule that being lazy is bad? What about the rule that taking the easy way, or doing something easy is somehow less valuable than the hard way? I think this is a very common sort of belief in medicine, that somehow the hard way is inherently better or more valuable than doing something, not unethical, but just in an easier way. Do you believe that as doctors, we don’t have a lot of usable skills outside of medicine, and that physicians don’t have other career options?

Those two beliefs will often lead you to feel very stuck and constrained in your career. And again, I’m not suggesting that you need to leave medicine. But if you believe that you don’t have a lot of other options, often, you’ll feel much more trapped. And often, that makes your experience of practicing medicine, much less enjoyable. Knowing that you have lots of options, often won’t lead you to leave medicine, it just makes you enjoy it more. Do you believe once a physician, always a physician. I will say I actually do like this belief, I believe it. But it feels like freedom to me, it means that even when I’m not seeing patients, I’m still a physician, I still carry those skills with me. But if it feels heavy to you, if it feels confining to think “once a physician, always a physician,” then I would question it.

What about this rule? Do you believe that you can’t just do what you want to in life? Do you believe you can’t just change your mind? What if you can do what you want to in life? What if you can change your mind? What if changing your mind is always an option? Do you believe that success requires hard work? Does working hard mean you’re successful? Is that a rule that you believe? Do you believe that your career should always look like other people’s, right/ That especially as a physician, there’s sort of an accepted path and you just need to follow it? Do you believe that you can’t just take a sabbatical or time off as a doctor? What if you didn’t believe that? What if it is possible?

I hear this a lot. “Don’t ever let your medical license go, or don’t let your medical license expire?” Maybe, why not? You can probably get it again. You may not want to. But is that just a hard and fast rule, and is it causing you some stress? What about the idea or the rule that you need to be really serious as a physician? Practicing medicine isn’t fun and games, it’s serious. Now, I will say that medicine can be serious. But can it also be fun? Are you allowed to have fun? Are you allowed to maybe be somewhat playful, if that’s your personality, right? Just notice, what are your rules about practicing medicine, how it has to be?

“Being a doctor isn’t just a nine to five job.” What if it can be? Do you want it to be a nine to five job? Or do you not? Again, that could be a belief that someone feels a lot of pride about, and someone else could have a lot of stress about. So again, these are all just to notice, do you believe these things, and is it serving you?

What about the belief, “You can’t just take a lunch break as a physician?” We all know you’re too busy. But what if you can? That’s what I mean, look at your beliefs big and small and notice how they’re shaping the role and the way you show up in your life, both as a physician, and more broadly. What would be different if you knew that you could always find another job? What if you knew that you are always allowed to change your mind? What if you knew you didn’t have to follow anyone else’s rules or live up to other people’s expectations? What if being unrealistic is how you set goals? What if your dreams and your goals are supposed to be wildly unrealistic? What if you just get to believe your own rules?

And I will say that, yes, there are consequences to choices, right? The decision, say, to take a sabbatical or to want to take a sabbatical or time off, means you might need to look at your savings, right? Or how much income you need to have coming in. I’m not just saying that there’s no consequences to choices. But what if you really do have a lot more degrees of freedom over the choices you have. I am also not suggesting that you make up your own medical beliefs, either, right? I am a big fan of science and research. But I’m also a student of history. My undergraduate degree was in the history of science.

And so I do also believe that much of what we think to be true in medicine is probably not completely true or possibly very wrong, right, or partially wrong. I think we continue to learn more and get better and better. But what would it look like to relax your grip on being right and knowing the rules and playing by the rules, and ask what rules you might be wrong about? Maybe I’m wrong about having that special little towel reserved for dishes. I don’t know, I guess I could question all of those silly things.

Again, some rules are fine. Some rules help us not have to reconsider everything in our life. But I just would love this episode and some of these rules that I encounter in my clients and in myself, to maybe just cause you to wonder, what would your life look like if you knew that following the rules was really optional in so many areas? What do you want your life to look more like?

If you have any questions, or if you just want to share with me some other bullshit rules that you may be used to believe and no longer believe, I would love to hear from you. Again, you can always send me an email, sara@saradill.com. I read every email. And it’s still not too late to join my small group coaching program. Our next meeting is in two weeks on Monday, the 22nd of August. So if you’re listening to this before then and you still want to get in on it, if I still have room then, I would love to have you join us. All right, I will talk to you next week. Have a wonderful week, everyone. Bye!

If you are a busy practicing physician ready to start feeling less stressed, enjoy work more, and learn how to create a more balanced and sustainable medical practice and life, sign up for a consult call with me at www.saradill.com. That’s S-A-R-A-D-I-L-L.com. It would be my privilege and pleasure to work with you.