Where You Get Your Dopamine Matters

In Medicine, when we talk about dopamine, we are often talking about patients and issues relating to addiction and lifestyle habits. We are often talking about dopamine in a negative context thinking about how it drives addiction behaviors or how it contributes to poor lifestyle choices. And while these things are important, we are often not talking about how to use dopamine and reward in a helpful way.

We are especially not talking about the role of dopamine in helping Physician wellbeing.

Dopamine is a key neurotransmitter, and it plays an important role in reinforcing behaviors that keep us fed, keep the species reproducing and have us seeking comfort and rest. It is normal for the human brain, including the brain of Physicians, to seek dopamine. But when humans are trained to ignore their bodily instincts including for sleep, food, rest, and emotional connection to other humans, as sometimes happens during medical training, our dopamine-seeking behaviors will sometimes come to rely on people pleasing, perfectionism, overworking, overeating, over drinking, and “overing” any number of other things, including social media, gambling, etc. 

Physicians are at high risk for addiction to these things. But oh, they also can be more likely to stay stuck in situations where they receive dopamine from people-pleasing and perfectionism because their training has taught them to rely on these things as their source of dopamine. 

Which makes it especially difficult when Physicians are trying to work on setting boundaries, and saying no. Not only have these things seemed off-limits to us during our training,  but also they are commonly the source of our most concentrated dopamine. If we are not receiving dopamine from the chocolate hidden in our desks and coffee chugged down, we may be receiving dopamine from being the person who all of the nurses turn to with your questions, from being the team player, from being the “nice one.”

So instead of white knuckling our way through habit-changes in a way that deprives you of your usual source of dopamine, we often need to start rewarding ourselves in other ways on purpose before making changes. 

How do we do this?  One place that is highly effective to begin is to start celebrating your wins. This is often done with a coach or a supportive colleague or a group, but can also be done on your own. Start writing down or saying out loud what you did that day that was good, helpful, and/or a step forward. This is different from a gratitude journal in that you are actively noticing and calling out something that YOU did, no matter how small. You took a walk for 5 minutes during your lunch break. You asked the right question. You finished your clinic day with half of your notes done. No win is too small for you to notice here, so long as it gets written down or shared with someone who will celebrate with you. This practice builds a habit of dopamine hits that reinforce goodness, rather than regrets.

And once you start getting used to receiving your dopamine in this way, from celebrating your awesome moves, it’s easier for other sources to fall away. You won’t need that midday hit of candy or Facebook. It becomes more logical to make changes in your day that improve your effectiveness and boundary-setting because of what you now notice that you GAIN, instead of feeling what you lose.

Where you get your dopamine from matters. It matters for your habits, it matters for your evolution, it matters for your life.