Facing Our Absolute Fears

Absolute fears are fears that every person has. It’s at the core of being human. Facing our fundamental fears doesn’t mean they need to be solved. Awareness of them, respecting them, acknowledging them matters far more. What absolutely fears do we face as physicians?

Our absolute fears are the ones we are less likely to acknowledge and most likely to hold us back from making necessary changes to our lives.

Facing Absolute Fears

From my experience, it’s not necessary to develop solutions for our absolute fears. It’s more important to recognize them and think them through. Awareness.

At least give them some attention. Journaling about them, talking about them, or just being aware of them will help you gain power over your fears.

Absolute fears rarely have solutions. Your predictions about how you’ll respond to those undesired events will likely never be accurate. But our worst fears probably will never be as bad as we expect them to be.

Most of us will lead very dull lives. All the fears we have will only exist in our minds.

1. Malpractice

Imagine you miss sepsis on a patient. An otherwise healthy 40-year-old comes in with a cough and signs of dehydration. They look great on discharge, but somehow a temperature is never documented. They go home and code that night and die in the hospital the next day due to sepsis.

You’ll get dragged through the court system. You’ll dread every time you go to check your mailbox. Eventually, you’ll stand trial, and your management habits and education history will all be questioned.

You’ll lose, and your insurance company will pay. You’ll be devastated for months, maybe years. You’ll fear switching jobs because you’ll know that you’ll have to disclose this on the following application.

• How can we ever feel confident again in the exam room?
• Would we lose our jobs because of this?
• What if we get sued for far more than our coverage?
• Can we even continue practicing medicine?
• What will this do to our mental state?

2. Cancer

Your biggest fear may not be work or income-related. You’re afraid you’re going to get breast cancer or colon cancer. Going to the doctor and not knowing whether the doctor is giving you honest health advice or just trying to recommend a treatment to pad their pockets.

The information on cancer cures is as reliable as stock market news. Not knowing whom to trust and not knowing how you’ll react is a big unknown.

The fear of our lives getting cut short when we aren’t ready to die yet.

• Chemo, radiation, surgery, IVs, hospital stays, medications… and then what?
• Are we ready to die?
• How do you say goodbye to all the things you haven’t even had a chance to do?
• What’s it like living with cancer?
• How will our loved ones handle it?
• What comes the afterlife on this earth?

3. Divorce

Some of us aren’t in the most stable of marriages. We’ve tried everything to make it work but sticking it out further seems like a losing battle.

If it wasn’t for the kids, it might be a much simpler decision, but there are the in-laws, the school, the house, the money, the insecurity, and the stigma.

It’s not the divorce that’s the biggest problem; it’s what will come after it.

• Will single life be better?
• Will the kids resent us for breaking up the family?
• Will we lose all of our married friends?
• How will we support the household financially?
• Are others going to judge us?
• Can we get back into dating?
• What’s the newest dating app?

4. Quitting Medicine

Many of us are burnt out to a crisp, and medicine seems like the biggest curse in our lives. We can’t stand seeing another patient. The commute to work is horrendous. We fall asleep the night before our shift, dreading going to work.

Even though medicine has taken everything out of us, quitting is a terrifying thought. Waiting a little longer seems like the right thing to do – hoping that we’ll change or something else around us will change.

• What would life be like if we weren’t doctors?
• Are we just going to be equally miserable in other professions?
• What if medicine is the only reason we have any self-worth?
• What would we do without the income from medicine?
• How much of our identity is tied up in our profession?
• What if we regret the decision to quit?
• What if we end up broke?
• What if we can’t get back into medicine?
• How will others judge us?

5. Moving

Imagine leaving the beautiful beach city you’re currently living in and ending up in a shitty town with fucked up neighbors. You did it to save money, control your overhead, and live a less chaotic lifestyle.

You’re working a ton, and most of your money is towards the mortgage, rent, or commuting expenses.

That beautiful beach is less than a mile away from you; you only get to party there once a month. The idea of going there and finding parking alone is a turn-off.

• How much will you hate yourself for giving up something familiar and stable?
• Will you feel like a failure because you were downgraded?
• Can you make new friends in the new city?
• Is moving for the sake of saving money a valid reason?
• How will your family handle it?
• What about the school system?
• What if you hate the new job in the new city?
• Will your partner resent you? Your kids?

6. Selling the House

Your house is comfortable and beautiful, and it’s in a great part of town. But so much of your time and money goes towards this house. The idea of selling it and renting a small home for $2,500/month makes you drool.

Having a $1M mortgage didn’t seem like a bad idea when you started your career. But now, you are tired of all the bills and would love to make a dent in your debt.

You tried taking more vacations, having more kids, remodeling the home, and buying new cars. But nothing is distracting from this heavy debt.

• Will you recover the money you sunk into the house?
• Should you sell even though you would take a loss?
• Should you just rent your next house or buy a cheaper one?
• What if the new landlord makes you move after 1 year?
• What if you’ll regret the decision later?
• Didn’t renting suck as a medical student?
• Is your partner just going along with the decision, or will they resent you?
• Will your current house even sell?

7. Going Broke

Even if you’re a diligent saver and invest your money wisely, there is always a chance that your wealth will get wiped out.

There is the 401k, the IRA, the inheritance, the house, and the emergency fund. Those times when the market dives makes you relive that fear of going broke.

You know your net worth, and the absolute fear of going broke creeps up when you see the net worth number drop. You start to check your net worth even more regularly when the market isn’t doing well.

• What would you do if you had to start saving from scratch?
• Could you go back to the grind of saving every last dollar?
• Could you go back to working overtime?
• What if your investment strategy is total bullshit?
• What if you lose it all in the next market crash?
• What if you panic and sell your investments?
• Will you let your family down and ruin their futures?

8. Never Retiring

It’s not good to work hard purely for the sake of retiring. Even though you hope that retiring will mean that you can escape the grind, you aren’t sure that retirement is feasible with this wildly fluctuating economy.

Congress could pass laws to tax the net worth you’ve already accumulated. They can keep pushing off the retirement age. Your income might get taxed at even higher rates in the future.

There might be deflation or hyperinflation. There might be a significant stock market crash which will keep your net worth down to half its value for over a decade.

• Could you keep working until age 80?
• What if you had to do the same bullshit with the same nurses and patients for another 40 years?
• When will you get a break from the grind?
• What if you end up not saving enough?
• What if a significant medical expense or a significant life event eats into your investments?
• What about the sequence of return risks?

9. Loneliness

For the single doctors out there, it is alone that sucks. Having great friends helps, but it’s not the same as being in a healthy relationship with a significant other.

Some of us have been through some shitty relationships, and getting into another one is disgusting. But being alone at age 60, 70, or 80 is an absolute fear of ours.

• What if this is as good as it gets?
• What if the feeling of loneliness never disappears?
• What if you never meet an ideal significant other?
• What if you can’t make new friends?
• What if you lose the friends and family you already have?
• What if you become decrepit and need someone to take care of you?

10. Boredom

Imagine that you are bored with your job, bored with your partner, bored with your house, and bored with your lifestyle. Nothing about what you’re doing and how you live excites you.

You are plenty busy with responsibilities, but you’re starting to feel dead on the inside, and you are mostly going through the motion to fit in.

You know it’s not depression. You are just bored. It’s not what you wanted out of life. You never stopped to ask yourself if this is what you wanted – you just did as you thought you should do.

• What if life is never going to get better than this?
• What if your commute to work is as exciting as life will get?
• What if you’ll never shake this boredom?
• What if you can never find something that captures your interest?
• What if you make a drastic change and end up just as bored as you are now?
• What if you’re just depressed and not bored?
• What if you’re being ungrateful?

11. Quitting Job

Working for the same medical group can get boring, but sometimes it’s much worse than that. The workplace can get toxic, you might be feeling burnt out, or you might not be getting the compensation you deserve.

Medical professionals have plenty of job opportunities but leaving a job also means giving up tenure, employment benefits, and your network of colleagues.

• What if the next job is much worse than this?
• Should you bother staying longer to vest?
• Would working per diem for a couple of years make sense?
• What if there are no other jobs?
• What if you regret it and can’t come back to this job?
• What if you have to work much harder at the next job?