In this second of three posts on people pleasing, I offer 12 signs that may mean you’re a people pleaser and how that negatively impacts how you show up in medicine.
To learn about where people pleasing comes from, then read last week’s post here.
This post will segue into the final post next week about how to control, constrain, and overcome people pleasing.
Side note: Having recently watched the Disney movie Encanto, I feel like I could write this entire post with examples from that movie. But, I’m not a recently-released-movie-spoiler kinda person so I won’t do that. I’ll probably save those for social media posts at some point!
People Pleasing in the Flesh
Last week I introduced people pleasing and how such tendencies arise. Today I take a deep dive into the manifestations of people pleasing, and specifically what that looks like within medicine.
Recall that people pleasers rely on others’ approval to feel better about themselves. They cannot generate such positive sentiment for themselves, instead relying on others to fill their cup, so to speak.
It’s sort of like needing a magic mirror on your wall to tell you daily that you’re awesome. Or in the case of the Evil Queen from Snow White, that she’s the “fairest” of them all. (I know the colorism is blatant; the story was published in 1812.)
Y’all, if your mirror is actually talking to you, then you might need to get out a little more…pandemic and all.
So here are 12 signs that you may be a people pleaser. These are by no means hard or fast rules, but instead are more akin to symptoms in medicine that may suggest a particular diagnosis.
1. You need external validation.
I know, I know: I sound like a broken record. Everyone likes praise and recognition for good work or kind deeds, but people pleasers depend on it. They cede their emotional wellbeing to the whims of others hoping they will shower them with compliments.
This is completely disempowering because you’re defining your worth based on how you’re perceived, not based on your intrinsic, unalienable self-worth. It’s a life operated out of fear of rejection and a lack of self-love.
I can’t help but chuckle—as I write this I’m staring at a recent gift from my brother with a “motivational compliment” that I’m definitely not using for external validation:
“Okayest” is still a superlative, right!? If so, I nailed it!
Some clinic docs add in patients because they feed off the positive feedback and thanks from the patients whom they work in no matter the impact on themselves, their other patients on their schedule, and/or their families. Often, it’s a net negative for many of these downstream impacted folks.
This can be challenging to tease out, but the point is that they’re doing this to fill their validation quota even if it benefits others without full consideration for downstream impacts.
2. You can’t say “no.”
If you’re always seeking external validation, you will do whatever it takes to secure it. That means saying “yes” to the requests of those around you so that you can feed the validation machine.
Everytime you say “yes” to something you’re saying “no” to something else, even if you don’t realize it at the time. You only have so much time and energy, and every request for some pulls you away usually from yourself and those you love (who deserve your time and energy).
I have an entire post on this that you should check out called Saying “Yes” to Less and “No” to Mo.
The same example above applies—physicians adding on every patient who requests to be seen. They cannot say “no.” And others will take advantage of this, not necessarily from a place of malintent.
You’ll find other examples of this everywhere in medicine.
Maybe it’s addressing all the “oh by the way” concerns as you’re ending a patient visit. Yep, that’s people pleasing.
Maybe it’s taking on every committee request and research project thrown your way despite having a full plate of commitments already.
I had one nephrology attending in residency who put literally everyone on dialysis even when not appropriate and his partners disagreed. He wasn’t trying to practice bad medicine—he just couldn’t say “no” to any patient.
He thought he was doing right by them, but I’m sure there were instances where he wasn’t. People pleasing can certainly impact our care.
Interestingly, this can also manifest as flakiness where you don’t show up or back out of commitments at the last minute because you realize you can’t or don’t want to do them. But when the request was made, you agreed wholeheartedly. Perhaps you even volunteered.
3. You over-apologize.
Apologies are a normal part of our interdependent human behavior. When a rule of social conduct is violated, an apology can serve several purposes: 1) acknowledge that wrong was done, 2) re-establish the rule in the relationship, 3) validate the person who was wronged, and 4) rebuild trust.
However, over-apologizing is problematic. It often stems from being too hard on or blaming yourself or worrying that others are blaming you.
No matter the underlying cause, apologizing when no wrong has occurred can make it appear as if you were wrong (even if you weren’t). Apologizing unnecessarily can also validate or give credence to others’ unreasonable requests of you or your time.
Avoidance of conflict is another reason you over-apologize, and that is addressed below in #9.
In medicine, this can take many forms but one that comes to mind is apologizing while asking for help with a task that that person is supposed to do. The apology positions you as the “bad person” and drives home any guilt you already have about appropriate delegation.
Don’t be sorry for being you. Don’t apologize for having needs.
4. You are overly sensitive to criticism.
No, I’m not! You take that back!
Wait, dammit!
People pleasers see criticism as personal attacks against them. After all, when your self-worth is tied to how others’ regard you, simple criticism about actions you’ve taken or your performance seem like direct assaults on your dopamine supply.
Gotta protect that dopamine supply.
Taking feedback on patient presentations in training can be extremely tough for people pleasing trainees. I’d say a lot of feedback is poorly delivered in medicine, including that intended to be constructive, in large part based on the “pimping” nature of our “Socratic” teaching methods (#notactuallysocratic). It’s hard to break free from the way it’s always been done.
5. You are overly agreeable.
Listening quietly to opinions with which you disagree is a good social skill—and one that’s severely lacking in this day and age.
However, pretending to agree to remain in others’ good graces is being dishonest with yourself. It compromises your self-integrity.
Medicine is very hierarchical and patriarchal, especially in training. Some of the hierarchy is justified in the name of learning and patient safety. But it also creates an environment where trainees feel compelled to agree with their teachers, even if they actually disagree.
For people pleasers, this phenomenon is only amplified when you add on top of the pressures of the hierarchy/patriarchy the craving for validation.
6. You are a “fixer,” and bear responsibility for others’ feelings.
You hate to see anyone struggling, hurting, or sad. And you think you have the power to fix that and make or keep them happy. The desired consequence of this is that those people in turn will like you.
It may come naturally to think this way because you’re putting your emotional wellbeing in the hands of others, so it innately makes sense that you can do the same for others (even if this is not an overt realization, it supports a congruent line of subconscious reasoning).
But everyone is responsible for their own feelings; their thoughts drive their feelings.
Even Meatloaf understood this. Except it turned out he meant he won’t get vaccinated against COVID. ☹️ RIP.
You can buffer endlessly helping “fix” everything for everyone.
Many physicians have a fixer mentality in medicine, not just the “bone broke, me fix” orthopods. Couple that with people pleasing and patient dissatisfaction for outcomes beyond your control and you can see how medicine can drive people pleasers to severe burnout.
7. Your to-do list is filled with others’ tasks.
People pleasers don’t feel like they’re in control of their time because so much of it is dedicated to activities that they think others want them to do. It’s hard to find time to do the things you need to do.
I see lots of physicians who struggle to delegate because they were taught the mantra, “If you want something done right, then do it yourself.” For people pleasers, this mantra is even more powerful because it gives them more reason to avoid conflict that may arise asking for help or delegating.
So that means physicians are making all the calls, printing and mailing all the letters, filling out all the forms, and handling all the faxes. And that’s not a great use of your time. Your time is best spent as a diagnostician and/or proceduralist.
8. You engage in self-destructive behavior to ensure others’ comfort.
This one is very interesting.
People pleasers actually end up mimicking and acting like the people around them. It engenders trust and positive feelings; it’s ingratiating.
This is especially true in social situations. You may actually eat more food when around others to make them happier even if you’re trying to diet!
I’m not saying this is a feeder-eater relationship. But sorta….
What this boils down to is thinking that your needs, opinions, ideas aren’t as important as those of others.
Unfortunately, this one is ingrained in one of the most pervasive narratives in medicine: the patient always comes first.
It’s a noble narrative and endeavor, but for the best patient care and outcomes, patients can’t always come first.
Physicians have to be able to care for themselves and their own to be able to be their best at doctoring. It also helps them stymy burnout and stay in medicine longer serving their patients.
An offshoot of this is indecision. You want to gather everyone’s input before making any kind of decision to make sure it’s aligned with their views and will keep you in their good graces.
9. You avoid conflict at all costs.
People are opinionated, imperfect beings, which means that tension and conflict are inevitable.
Conflict doesn’t mean irreconcilable differences—it could be anything big or small. But it’s hard to stand up for the things and people in which you believe if you won’t go to bat for them, because that often means navigating conflict.
And conflict is anathema to people pleasers. It’s like garlic to vampires or water to the Wicked Witch of the West.
See the delegating example given above in #7.
Furthermore, you feel guilty or mean when you set and/or enforce boundaries about who is responsible for and manages which tasks in clinic. This is why it all ends up back on your plate.
10. You never admit when you’re hurt.
Being honest with others requires you to be honest with yourself first. People pleasers bury their negative emotions because they may appear unattractive to those whose recognition they seek.
In doing so, you deny yourself the human emotional experience and true connection with others. After all, you can’t form authentic relationships with others when you’re preventing yourself from showing up fully, part of which is sharing your vulnerabilities and negative emotions and experiences.
You inadvertently keep the relationship in the superficial realm only.
Furthermore, at some point you resent being asked to do more and wish people would consider your feelings and needs.
I think this drives such a large part of the burnout that physicians experience—specifically the domains of emotional exhaustion and depersonalization.
11. You get resentful if the praise stops.
This is related to the last one.
People pleasers hold themselves to very high standards because it garners them the praise they seek. In fact, many of them display perfectionistic tendencies. You can read more about perfectionism here.
Again you like to be recognized for your achievement—here meaning helping others to your exacting standards. If the almost transactional praise is not offered in return, then you may start to resent those you volunteered to help in the first place.
The praise. Give it to me.
Similar to the last one, this ends up accelerating the two above-mentioned domains of burnout.
12. You think self-care is optional.
Finally, your drive to elevate others’ needs means you neglect your own.
Similar to #8 above, you don’t take care of yourself because you don’t have time to do that when your brain seeks the dopamine hits afforded by helping others.
Self-care is scary when you’ve avoided tuning in to what your body and mind needs for so long.
You rationalize to yourself that it’s more important and noble to take care of others than it is to take care of yourself.
This results in physicians being unhealthy, both physically and mentally, leaving medicine, or becoming a statistic—the 400+ that die by suicide every year.
Wrapping Up
People pleasing can seem like a benign trait, but it results from a thought distortion that can end up derailing your career or even destroying your life.
If you see yourself in several of these 12 signs I’ve outlined, then you likely are a people pleaser to some degree.
Next week’s post will examine how you can start to put the kibosh on people pleasing and learn to put yourself first.
Oh, I think you’re mistaken. It’s actually the opposite. We want to do all of those things. As well as spell “squash” correctly.
How many signs of people pleasing do you recognize in yourself? Let me know in the comments below.
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