When Things Fall Apart, Do THIS Instead

A practical framework for navigating medical crises without losing yourself

Dr. Sarah sat in her car after being escorted out of the hospital, termination letter crumpled in her lap. For the first hour, she'd spiraled through every interaction from the past year, searching for what she'd done wrong.

Then she remembered the framework we'd worked on in coaching.

Instead of continuing the self-blame tornado, she took a different approach. And it changed everything.

The Problem with Our Default Response

Last week, we explored the toxic assumptions that make everything worse when crisis hits in medicine. The automatic "What did I do wrong?" response. The belief that we should be able to prevent all negative outcomes. The assumption that authority figures are always rational and right.

These thought patterns don't just make you feel terrible; they keep you stuck in emotional chaos and prevent you from actually learning or moving forward effectively.

Today, we're diving into what to do instead.

The 4-Step Framework That Actually Works

When something goes catastrophically wrong; termination, disciplinary action, devastating patient outcome, you need a systematic approach that honors your humanity while helping you navigate the crisis effectively.

Step 1: Allow the Emotions (Yes, Really)

Before you do anything else, you need to let yourself be human. What are you actually feeling?

• Angry that you weren't given any warning?
• Devastated that your patient died despite your best efforts?
• Scared about what this means for your career?
• Guilty about the outcome, even if you did everything right?

Can you name the specific emotion? Can you feel where it sits in your body?

We're so afraid of the discomfort of emotions that we immediately try to push them away, judge ourselves for having them, or pretend they don't exist. But emotions are information. They're also inevitable when you're human working in high-stakes situations.

Get an emotions wheel if you need to. There are dozens of feeling words beyond "fine" and "stressed." Research shows that when you can specifically name and label emotions (called affect labeling), it actually helps you move through them instead of getting stuck.

Important caveat: If there's something urgent requiring immediate attention, handle that first. But most situations give you space to process emotions before jumping into action.

Step 2: Explore What's Here to Learn (Without Self-Hatred)

There might be something for you to learn from what happened. The key words are "might" and "without self-hatred."

Sometimes the lesson is clinical:

• "I should have asked different questions"
• "Next time I'll involve a specialist sooner"
• "I need to be more assertive about my clinical concerns"

But sometimes the lesson is about systems and human nature:

• "People make irrational decisions"
• "Logic doesn't always apply in administrative settings"
• "Sometimes there's no good explanation for why things happen"
• "Fair treatment isn't guaranteed, even when you do everything right"

If you've been terminated without cause and genuinely can't identify anything you did wrong - no bad outcomes, no complaints, no feedback suggesting problems, then maybe what you're learning is that medicine operates in ways that aren't always fair or logical.

That sucks. It's devastating. But it's also reality.

Take only one or two passes through this reflection. Don't sit and microanalyze every interaction from the past six months. That way lies madness and keeps you stuck in rumination instead of moving forward.

Step 3: Choose to Have Your Own Back (Even If You Made a Mistake)

This is the step that changes everything.

You need to decide that you're going to support yourself through this crisis, even if you made an error in judgment.

Here's what I need you to understand: You are not perfect. You are not infallible. You will make mistakes because you're human.

Sometimes those mistakes have bigger consequences than others. But if you're going to throw yourself under the bus every time something goes wrong, where will your mental health be? How sustainable is that approach over a 30-year career?

Think about how you'd respond to a close friend going through the same situation. Even if they made a mistake, would you tell them they're a terrible person who should never practice medicine again? Probably not.

You'd likely acknowledge that they're human, they tried their best with the information they had, and they can learn and grow from this experience.

You can take responsibility for your reasonable part of what happened AND still have your own back. These aren't mutually exclusive.

Replace that harsh internal voice (the one that sounds suspiciously like your meanest medical school instructor) with one that's firm but kind. One that can acknowledge mistakes without character assassination. One that can take responsibility without drowning in shame.

Step 4: If There's a Repair to Make, Make It

If you made a mistake that hurt someone - a patient, a colleague, someone at home - and there's a way to repair it, do it. Don't delay. Don't put it off indefinitely.

This might look like:

• A genuine apology that acknowledges impact without making excuses
• Changed behavior moving forward
• Additional training or education if relevant
• Systemic changes to prevent similar issues

But here's the crucial part: you need to go through the other steps first. You need to process your emotions and choose to support yourself before you can make a genuine repair.

When you try to apologize from a place of emotional chaos and self-hatred, it often comes across as either defensive or self-flagellating - neither of which is helpful.

If you can't actually make the repair (maybe the person won't talk to you, they've died, or you've been fired and have no access), find another way to bring closure. Write a letter and burn it. Do a loving-kindness meditation. Have a conversation with a therapist or trusted friend. Find some way to process and release what you're carrying.

Why This Sequence Matters

You might need to adjust the order depending on your specific situation, but these steps themselves are crucial.

Most of us have been trained to skip straight to self-blame and then try to fix everything immediately. That approach keeps you stuck in emotional chaos and actually makes it harder to learn effectively or repair relationships authentically.

When There's No Logical Explanation

Sometimes you'll go through this entire process and realize there really isn't a rational explanation for what happened. People made bad decisions. Systems failed in inexplicable ways. You got caught in the gears of broken machinery.

In those cases, the lesson might be: "Sometimes things just don't work out and I won't always know why."

That's a devastating life lesson, but one most of us need to learn in some form. Medicine teaches us to believe that everything has a logical explanation and that good outcomes follow from good decisions. But real life is messier than that.

The Long Game

This framework isn't just about surviving individual crises. It's about building sustainable ways of existing in medicine without sacrificing your mental health on the altar of impossible expectations.

Bad things will continue to happen:

• Patients will have poor outcomes despite excellent care
• Systems will make decisions that don't make sense
• People will behave irrationally
• You will occasionally make mistakes

But you don't have to let these inevitable challenges destroy you. You can learn to move through them with your humanity and sense of self intact.

What Changes When You Do This

When Dr. Sarah used this framework instead of her usual self-blame spiral, something shifted. She still felt devastated about losing her job. She still worried about her future. But she didn't spend weeks torturing herself trying to figure out what she'd done wrong when there might not have been a good answer.

She was able to process the genuine grief of the situation, learn what there was to learn (in her case, that employment protections for physicians are often inadequate), and move forward with her job search from a place of confidence rather than shame.

The women physicians I work with who use this approach don't become immune to professional challenges. But they stop letting those challenges destroy their sense of self-worth and their love for medicine.

Your Turn

The next time something goes wrong in your medical career (and it will), try this framework instead of the automatic self-blame spiral.

Allow your emotions. Learn what there is to learn without self-hatred. Choose to have your own back. Make repairs where possible.

You deserve to have a sustainable career without sacrificing your humanity in the process. And medicine needs physicians who can navigate challenges with resilience and self-compassion.

The alternative - the constant self-blame and responsibility for things outside your control - isn't serving you, your patients, or the profession.

It's time to try something different.

Ready to learn how to navigate medicine's challenges without losing yourself? Listen to the full episode where we dive deeper into each step of this framework.

Want weekly doses of reality and hope for your medical career? Join our community of women physicians who are choosing to thrive instead of just survive.

Feeling ready to break free from toxic responsibility patterns? Schedule a discovery call to explore how coaching can help you build sustainable ways of practicing medicine.

You have more power than you realize - not the power to control everything, but the power to choose how you respond when things inevitably go wrong. And that makes all the difference.