When we decide to focus on all that is good in our lives, happiness increases, blood pressure drops, and heart rate decreases [6, 7]. Unfortunately, in orthopaedic surgery, it can be challenging to stop and take note of all of the good stuff. There just are too many things on the to-do list. Not enough time in the day, it seems. Perhaps we need to do a better job of making the time. A predominant theme in our profession is the seemingly endless and unfulfilling cycle of striving for unrealistic and ego-centric goals—a cycle we can stifle by practicing gratitude.

Early in my career, I strove to become the best orthopaedic surgeon as a salve for feelings of inadequacy. I sought affirmation in the workplace that I lacked in my childhood. I sacrificed precious time at home for that one more patient, one more consult. Although I managed to hold onto a good family culture, I found myself, at times, in danger of drifting away from loved ones. How did I get there?

The Cycle: When Competition Among Colleagues Turns Toxic

As a former athlete, the lessons I learned on the football field, boxing ring, and wrestling mat forged discipline and team spirit. These virtues, when applied to a noble calling (patient care), can lead to fulfillment. Competition has its merits.

But when coming out on top becomes the purpose itself, misery is sure to ensue. Turf battles over patients with enticing insurance and surgical diagnoses move us farther from meaningful pursuits such as serving others. Competition for employment in desirable living locales can incite hostility, greed, and selfishness—dark emotions not associated with happiness.

There may be times in your personal life and in your career when resources dwindle [12]. A scarcity mentality manifests where practitioners hold that there are only so many shoulders out there to fix. Thus, if Practice A is seeing 30 shoulders a week, there are 30 less shoulders to go around for Practice B.

A quest for beating the other guy seems to permeate the psyche of many, and outperforming one’s peers often is encouraged in the workplace. Employers, practice plans, and hospitals incentivize healthcare providers by rewarding them for productivity. A surgeon who generated USD 1.2 million in billing may fixate on a colleague who mustered USD 1.4 million, rather than celebrating a truly productive year.

In such a tense and competitive arena, a natural focus arises on what others may have. Many feel that they are always falling short of unreasonable standards and their focus drifts to one trait or the competitive advantage a rival is perceived to have. Envy is indeed gratitude’s enemy.

The Cycle: Ego-centered Life

Working in a hypercompetitive field can lead to ego-centric thinking in which career goals trump all else. Perhaps initially, family and friends stick around. “It’s just a crazy few months,” we may tell them. But then the next promotion is within reach. And so we miss a dinner or holiday. Maybe an even better job opens up with more clout behind the title, but even more responsibility. We go for it, because (we say) this is best for the family. In reality, though, ego-centric thinking has taken over, and this way of thinking is destructive. We skip another of our son’s games. We miss another anniversary. Career goals are achieved, but at what cost?

In spiritual terms, the Ego is a pseudo-identity our minds create characterized by labels, masks, judgments, and an imagined self. It carries the false hope that these characteristics will bring us happiness. Though ego-based living promises gratification, it delivers misery [8]. The Ego is never fully satisfied and demands constant attention. It syphons our energy and only perceives events in the context of self. Ego-based living causes separation from others and from a higher purpose.

The need for approval and the need to control are prime functions of the Ego and do little to foster a general sense of gratitude. There is no allowance to reflect on blessings, as people places, and things are regarded in the context of “what’s in it for me?”

The Cycle: Losing the Support System

I became acquainted with a well-known surgeon who slowly forfeited his home life in order to “succeed” at work. A series of decisions, which subjugated the needs of his family to lofty career aspirations, created the end (an almost inevitable) result. He became a department chair and published extensively only to find himself divorced, estranged from his children, burnt out, and living in an apartment alone.

Contrast this plight to a surgeon who is close to his or her loved ones and arrives at work happy, balanced, and well-rested. This surgeon also does research and writes because it brings the satisfaction of effecting positive change and using one’s talents for a higher purpose.

Which surgeon will be more productive over the long-term?

Inner feelings of deep inadequacy may encourage a prepossession of all that is lacking in one’s life [4]. Wealth, great achievement, and positions of power will not satisfy a broken self-image. Possessions may only temporarily soothe a deeply held belief that “I am defective.” No temporal object, position, or achievement will bring lasting happiness—especially to one with a damaged regard for self.

When anxiety or depression descends upon one’s emotional life, gratitude will depart. A suffering soul simply has no inclination to celebrate any aspects of life since the focus is on all that we do not have [10].

Disturbances of mood indicate that distorted thinking is present. Cognitive behavioral therapy is predicated on the notion that mood disorders are the byproduct of cognitive distortions. That is, a misperception of reality may occur in our minds and lead to a diminished sense of peace and joy. Some common cognitive distortions include catastrophizing, whereupon one negative event is grossly magnified in terms of its consequences. Another distortion is “all-or-nothing thinking” in which people, things, and occurrences are seen as all bad. There is no allowance for mistakes or subpar performance. One errant move in the operating room or not getting that promotion you wanted translates to “I am a lousy surgeon.”

Breaking the Cycle

Practice Gratitude

Distorted negative thinking simply displaces any room for gratitude. After years of self-reflection, prayer, and therapy I now recognize that peace of mind is an inside job and that no job title or acclaim can match the peace of self-acceptance and connection to one’s higher power.

The brain is plastic and its inner circuitry can be changed [1]. Past history, genetics, traumatic experiences, and years of learned behaviors can be neutralized with a decision to practice gratitude. The brain can literally be rewired to more easily transmit circuits associated with generation of good feelings. A willful and deliberate focus on all that is good in one’s life will shift one’s baseline temperament and increase feelings of well-being. But it requires a decision, and it requires practice. Author Angeles Arrien [2] refers to this practice as “Grateful Seeing.” When we decide to focus on all that is working in our lives without denying current burdens, we cultivate more-positive thinking and thankfulness. This practice lowers the threshold for feeling-good circuits to discharge in our brain and raises our baseline happiness index [6].

A decision to direct our attention to positive and realistic thoughts, in addition to considering all we really do have in our lives, will increase awareness of how blessed we really are.

Heal the Brain and Quiet the Mind

I make the daily decision to reprogram my brain. Raised in a home where criticism and fault finding were the orders of the day, I purposefully extend compliments to staff, residents, friends and most importantly, my family. Compliments can best promote healing when they are true and precise. In other words, merely telling a resident “good work” will not be nearly as effective as, “You did a great exposure of the axillary nerve.”

In addition, I have dedicated my life to being a love finder rather than fault finder. There is good in every person and event. When we decide to look for good, it will manifest.

Yoga, meditation, and mindfulness practices slow brain activity and lessen the intrusion of negative thoughts [5]. Evidence is mounting that our natural, authentic state is one of peace and gratitude [11]. True and lasting happiness can only be attained when we can quiet out minds and the demons of dysfunctional thinking are tamed.

Gratitude Journal

Keeping a journal of all that is good in one’s life will boost your mood and increase productivity. Simply entering an entry a day of something or someone to be grateful for will help divert one’s mind from negativity [3]. The gratitude journal should delve into detail and should focus more on people than things. Each entry should be regarded as a true gift. The journal should be referred to often so that the subconscious mind has time to truly absorb and incorporate these positive messages.

Apparent misfortunes can be reconsidered in a different light. Difficulties and challenging times always hold a blessing and lesson—if we decide to look for it. A decision to restructure occurrences and transform them into blessings is possible in any event. The infection after that ACL procedure may carry the reminder to drape more carefully in the future. The nagging cough, which doesn’t seem to go away, may instruct one that rest or vacation is in order. Even a lawsuit may herald a reexamination and reaffirmation of basic core values and motivations for becoming a surgeon.

Einstein once stated that the most important question one could ask was, “Is the universe friendly?” [9]. That is, a belief that every event is rigged to ultimately serve some benefit.

In any event, ask “Where is the gift?”

Tomorrow, try this:

  • Spend 10 minutes a day engaging in a practice to quiet your mind, whether it be prayer, yoga, or deep breathing.

  • Keep a gratitude journal and make five entries every week about something or (even better) someone to be grateful for.

  • Begin the habit of thanking your OR team after every case, regardless of the outcome.

  • Thank your partner, friend, spouse, or significant other every day for his or her commitment to the relationship.