How to Develop a Thicker Skin in Your Medical Practice

Do you have an employee who frequently has his or her feelings hurt, who seems to take everything personally, or who is prone to tears? Do you replay scenes from work in your head at night, beating yourself up for not handling or anticipating things better, or for making an honest mistake? Or do you or your employees find yourselves feeling hurt, embarrassed, or betrayed by a careless remark, a funny look, or the least bit of criticism? If so, you would all benefit greatly from having a thicker skin.

Making everything about ourselves can give us a skewed view of our world and make us overly sensitive and self-absorbed.

Of course, developing a thicker skin may be easier said than done. It may be human nature to make everything about us and to take things personally. However, as Ma(1) succinctly puts it, “You are not the center of the universe.” Making everything about ourselves can give us a skewed view of our world and make us overly sensitive and self-absorbed. It also can encourage us to invent stories and imagine things that aren’t there. For example, Ma says, we may encounter a person who is not paying enough attention to us. We may brood and ask ourselves, “‘Is she mad at me?’ ‘Did I say something wrong?’” Our gloomy thoughts can intensify, Ma says, leaving us emotionally crippled and thinking that we have ruined everything. Yet, there may be a good reason for the inattention that has nothing to do with us. The person may not have noticed us or be distracted. But even if he or she is intentionally ignoring us, Ma asks, “Why are you fussing about it?”

Coworkers may feel they need to tiptoe around or avoid a thin-skinned colleague or manager.

Of course, no one enjoys being ignored, facing criticism, or dealing with social rejection. However, it may be impossible to interact with people day in and day out without an occasional brush with these challenges. This is especially true in a busy medical practice, where emotions and stakes can run very high, and where there is going to be a fair amount of pressure put upon us. However, being thin-skinned will help no one. Coworkers may feel they need to tiptoe around or avoid a thin-skinned colleague or manager. And the thin-skinned person is going to feel a great deal of pain, which is unpleasant and unproductive, of course, but which will also deplete energy and focus and diminish performance.

Fortunately, the medical practice manager is in an excellent position to develop a thicker skin and to teach his or her employees to do the same. As Licht(2) suggests, “Learning how to be emotionless in the office is a gift and one that you have to give yourself. The thicker your skin, the less stress you will have.” Of course, it can be challenging to take yourself completely out of the equation, remove your ego, and remain objective. Striving to be emotionless, as Licht suggests, may not be the best goal for a medical practice employee. No one advocates that medical practice personnel become so tough that they become rigid, unfeeling, and incapable of compassion. The good news is that going to that extreme is not necessary. In the following sections we explore skin-thickening strategies that you and your employees can use to reduce or eliminate stress in your medical practice, without closing your hearts to others.

External Versus Internal Expectations

Medical practice employees have many expectations placed upon them. Some of these expectations will come from a supervisor, HR, an employee handbook, a governing body, or a professional association. Some will come from a patient, a physician, or a coworker. And some will come from within. One way that you can begin to develop a thicker skin is to differentiate between external and internal expectations and to assign each its proper weight. As Hughes(3) suggests, internal expectations “should always take precedence” as we try to develop a thicker skin.

Often, we are harder on ourselves than we would be on anyone else.

Of course, you will need to fulfill the expectations of your job, and no one is suggesting otherwise. But often, we are harder on ourselves than we would be on anyone else. Unfortunately, when we place unrealistic expectations on ourselves, our skin gets thinner and thinner. For example, if we expect to be perfect, we may beat ourselves up when we goof or when someone criticizes us. If we expect that everyone is going to like us all of the time, we may become upset and worried when someone doesn’t. And if we expect to be appreciated and applauded, we may feel hurt and unappreciated when no one seems to take notice. As Hughes suggests, “When you prioritize the internal expectations you hold for yourself, you naturally develop the thick skin required to put yourself out there.”

Begin the process of thickening your skin by examining your internal expectations. Are you being fair with yourself? Are you being reasonable? If not, write and recite affirmations that help you to develop more reasonable and healthier self-expectations. For instance:

• I listen to criticism with an open mind because it can help me to improve.

• I do my best because that matters to me, even when no one is watching.

• I make mistakes and I learn from them.

• I like myself.

• I am worthy of respect.

Although you may not be able to change the expectations others place on you, you can weight them differently, and you can change those you place on yourself. In time, reading or reciting your affirmations can help you to shift your self-expectations so you no longer feel crushed by external ones. As Hughes suggests, “Turn your attention back to what’s within your control.”

Fifteen Strategies for Developing a Thicker Skin

Most of us admire people who can take criticism or abrasive comments without being wounded. If you believe that you or one of your employees is too thin-skinned, here are 15 strategies that can help:

1. Try your best. We succumb more easily to guilt and shame when we know that we have not done things to the best of our ability. When we try our best, we can take comfort in knowing that we gave it our all, even if we fail or if others don’t like the outcome. As Weingarten(4) suggests, “If you try your best to do something right and you fail, at least you tried, and that is better than not trying.”

2. Reframe. If someone says something unkind to you, Ma suggests that you reframe the comment to take the sting out of it. For instance, if a patient says that you don’t care about him or her, possible reframes may include:

   • The patient may benefit from more of my undivided attention, more eye contact, or more TLC.

   • The patient may need my reassurance that she’s going to be OK.

   • The patient may be upset, hurt, or angry at someone and is taking it out on me.

   • The patient may feel lonely.

   • The patient does not know me or know that I care.

3. Dig for the softer emotion beneath the anger. Angry criticism almost always means the critic feels hurt in some way. As Hendrickson(5) explains, “Anger is a secondary emotion. It’s a reaction to a softer primary emotion underneath like hurt, shame, guilt, or humiliation.” People get hurt first, Hendrickson says, and then they get angry. But when you listen beneath the anger for the softer emotion, it’s much easier to feel sympathetic toward the critic. What then? Hendrickson suggests you try to find out what button you may have inadvertently pushed. Then, “kill them with kindness,” she says.

4. Don’t retaliate. If someone says something to you that hurts you, you may be tempted to respond in kind. However, getting along with people and being kind to them is better than saying something mean because you feel hurt. As Weingarten suggests, “In life, we experience highs and lows, but the lows make us stronger and more compassionate.”

5. Stop the self-talk. Counter self-defeating self-talk with what Ma calls “truth talk.” As Ma explains, “You can be your own worst enemy, so give yourself a break.”

6. Remind yourself to stay strong. If you find yourself giving in to feeling hurt, Licht suggests practicing a mental chant. For example, Licht suggests: “I am valuable, and I will not let this break me.”

7. Remember that everyone gets rejected sometimes. As Ma suggests, “Pick yourself up, dust yourself off and move on. Don’t be discouraged if it takes a few times to get it right.” Successful people are rejected over and over, but never stop trying, Ma says.

8. Encourage more rejection. The more we put ourselves out there, the more often we will deal with rejection. According to Weingarten, that is a good thing. With more rejections, we can learn to treasure criticism that can help us improve, Weingarten says. As well, we become better at separating useful criticism from nasty, destructive comments that serve no purpose other than to hurt us.

9. Remain cool and collected. Licht suggests that you validate the concerns others have and that you use language that makes others feel heard. Keep your voice even and calm. However, she also suggests that you explore other avenues. For instance, Licht suggests, you might say, “I hear what you are saying, but it would be really helpful if you could show me an example of what you are looking for.” Or, “I might have misunderstood your directions. Let me take another stab at this.”

10. Focus on your goals and the steps you need to take to get there. As Ma suggests, “Don’t be self-focused. If you do focus on yourself, you’ll likely dwell on your shortcomings.”

11. Agree when you can. If you’re getting panned for something beyond your control, Hendrickson suggest that you agree with the critic. For instance, if test results are late getting back from the lab, agree that the delay is disappointing. As Hendrickson suggests, “Redirect the anger away from you and toward the situation.”

12. Don’t become defensive. As Hendrickson warns, defensive arguments don’t come across as logical or reasonable, but rather “tiresome and difficult.” Even worse: blaming. Hendrickson strongly suggests not throwing someone under the bus. “It just looks pathetic,” she says.

13. Realize that you can reject criticism. It is possible that the critic is wrong. As Hendrickson suggests, “When it’s your turn to hear criticism, remember: Just because someone says it doesn’t mean it’s true.” You don’t have to heed or accept every piece of advice or criticism you receive. Rejecting useless criticism can be empowering, Hendrickson says. (For more information, see the sidebar 10 Ways to Thicken Your Skin against Criticism that accompanies this article.)

14. Find thick-skinned role models. The next time someone lobs a bomb your way, think about people you admire who kept forging ahead, despite their obstacles and critics. As Dinwiddie(6) suggests, “You might even want to post their picture, or quotes by them, by your workspace to inspire you to keep going.” Dinwiddie’s examples of famous people who overcame rejection include Dr. Seuss, Madonna, Lady Gaga, Hillary Clinton, and Gloria Steinem. Additionally, Bill Gates, Jim Carrey, Albert Einstein, Stephen King, Benjamin Franklin, Richard Branson, and Oprah Winfrey all overcame tremendous obstacles and criticism. Search for and learn about more examples of accomplished thick-skinned people to identify those who inspire you the most.

15. Reject insults. A catty, entitled, selfish, or demeaning remark reveals more about the person who says it than it does about you. As Hendrickson suggests, “The only person those remarks degrade is the critic.”

What to Do When You Feel Your Skin Thinning

Despite your best intentions to use the skin-thickening strategies listed, it is the rare person who never succumbs to having a bad day because he or she has been hurt by others. In fact, being hurt is part of the human experience. And, keep in mind that you will be more likely to be hurt when you are worn out and vulnerable, when someone has found and exploited your Achilles heel, and when you are plagued with self-doubt.

You don’t have to allow occasional bouts of thin skin to destroy you. On the contrary, you can look at them as opportunities to grow stronger. As Young(7) suggests, “The only way to develop thicker skin emotionally is to have some scar tissue.” Look to the human body for inspiration. Our bodies have an amazing healing mechanism, Young explains. For example, when we break a bone, the refusing of bone tissue makes the point of breakage stronger than it had been before. It can be that way with your emotions, too. Young suggests that the best way to absorb and handle pain is to use it to make yourself stronger against similar attacks in the future. Think of your pain as an emotional wound that will heal and scar over. However, as you build your emotional scars throughout your life, be mindful not to overdo it. Don’t scar so extensively that you close your heart completely. Remember that each scar is relatively small, just as each refused bone from a former break is in just one bone, not the entire skeletal system.

Stay True to Your Vision

Developing emotional scar tissue goes hand in hand with developing and staying true to your vision. As Young says, “It’s important to focus on your goals constantly and your vision of how you want your life to be. If you can make the picture of what you want perfectly clear and desirable, then you can take a lot more abuse before you get there.” Criticism has the potential to derail you, Young warns, to make you focus on pleasing everyone instead of staying committed to your vision. His advice: “Whenever I face a lot of criticism, I go back to my goals and what I want.” If you don’t have goals that are clear and real in your mind, Young warns, “they will be outspoken by the next jerk who doesn’t like your ideas.” Know what you want, Young says, and keep that first and foremost as you move forward.

But what if you don’t know what you want? Young suggests that you start there. Otherwise, it’s going to be very easy for people to “seduce and threaten you off track,” Young says. In the end, Young suggests, having a thick skin means that you’ll be more independent. “When you don’t rely on the constant approval of other people, you’re free to pursue what you really want,” Young says. Being able to thicken your skin is therefore not only liberating, Young adds. It will also enable you to take more risks, accomplish great things, and inspire others.

References

1. Ma L. The thick skinned: it’s not all about you, so stop picking on yourself. Psychology Today. June 9, 2016. www.psychologytoday.com/us/articles/200409/the-thick-skinned . Accessed July 22, 2019.

2. Licht A. Seven ways to develop a thick skin in the office. Forbes. May 4, 2017. https://www.forbes.com/sites/alizalicht/2017/05/04/7-ways-to-develop-a-thick-skin-in-the-office/?sh=1bd446cf26ee . Accessed July 22, 2019.

3. Hughes AJ. The secret to developing thicker skin. M: Mission Originals. July 25, 2018. https://medium.com/the-mission/the-secret-to-developing-thick-skin-a6151c33ceb1 . Accessed July 23, 2019.

4. Weingarten R. How to develop a thicker skin at work without being obnoxious. Ladders. January 1, 2019. www.theladders.com/career-advice/how-to-develop-a-thicker-skin-at-work-without-being-obnoxious . Accessed July 26, 2019.

5. Hendrickson E. How to grow a thick skin and handle criticism. Quick and Dirty Tips. January 21, 2016. www.quickanddirtytips.com/health-fitness/mental-health/how-to-grow-a-thick-skin-and-handle-criticism . Accessed July 26, 2019.

6. Dinwiddie M. Dealing with criticism: 5 tools to develop thick skin. Tiny Buddha. https://tinybuddha.com/blog/dealing-criticism-5-tools-develop-thick-skin/ . Accessed July 29, 2019.

7. Young SH. How to develop a thicker skin. Scott H. Young. October 2008. www.scotthyoung.com/blog/2008/10/20/how-to-develop-a-thicker-skin/ . Accessed July 29, 2019.

Ten Ways to Thicken Your Skin against Criticism

Criticism is the fodder for a thin-skinned person’s anxiety mill. If you or an employee crumbles at the first sign of criticism, Awosika(1) suggests that you:

1. Understand the limited mindset of others. People who are afraid to move outside of their comfort zone will try to project their limitations onto you, Awosika says. Unfortunately, many of us have been raised to view life with a limited mindset. Understand how your critics see the world and you won’t take offense at their comments, Awosika suggests.

2. Understand who you seek approval from. Why do you want others’ approval? How important is it that they approve? What is the worst-case scenario if they don’t?

3. Understand that haters come with the territory. As Awosika suggests, “It’s impossible to be well known or recognized without having critics.” Ask: Is this person giving me thoughtful feedback? Or is he or she just trying to get under my skin and/or one-up me?

4. Recognize that being upset is a choice. You may not be able to control what another person says or does. But you can choose how to react to it.

5. Don’t tie your well-being and self-worth to the opinion of others. Find your happiness and meaning in the effort you put forth and in what you produce, Awosika says, not on what others think of you.

6. Don’t respond to people who are trying to tear you down. Don’t feel the need to defend yourself when you’re being attacked. It’s a waste of your time and energy, and it probably won’t do any good, Awosika says. Put that energy toward continuing to create something positive through your work.

7. Google negative comments about Mother Theresa. You will find about a half-million or more results of people bashing Mother Theresa. As Awosika suggests, “Even the most pious individuals aren’t immune to criticism.” Understand this fact and embrace it.

8. Value work over criticism. As Awosika suggests, “No one ever built a statue of a critic.” A critic takes a small amount of time to judge work you may have spent several hours, days, months, or even years to create. “It’s much easier to critique other people’s work than to do work of your own,” Awosika says. Pay the closest attention to the people who walk the walk, not just talk the talk.

9. Appreciate the people who look up to you. There are going to be people who respect you for putting yourself out there. And there will be those who will appreciate your hard work. As Awosika suggests, “Keep in mind that you’re touching other people’s lives with the work you do.” It would be selfish to hide your gifts from a world that needs them because you are afraid of criticism, he says.

10. Do great work. When you take the time to do great work, you can thwart potential criticism. You can also feel positive about the work you do even when it’s criticized, Awosika says.

Reference

1. Awosika A. How to develop obnoxiously thick skin: 10 tips for facing your fear of criticism and social rejection. Be Yourself. January 12, 2016. https://byrslf.co/how-to-develop-obnoxiously-thick-skin-10-tips-for-facing-your-fear-of-criticism-and-social-dabe32a23163. Accessed July 25, 2019.

Taking Things Personally? Here’s Why, and What to Do about It

Most people who take things personally learned to do that in childhood. As Brenner(1) suggests, “When we are young, events happen that bring about emotional reactions in us. If you didn’t have the means to experience the feelings and let them go, they leave an impression in your body and mind, creating a sensitivity to reacting the same way again and again.” Decades later, Brenner explains, we experience rejection and disappointment as we did in childhood and revert to the childhood tactic of taking things personally. Then, Brenner warns, the “spinoff stories start.” For example, we tell ourselves, “I’m not deserving,” or “I’m inadequate.” These experiences congeal into an identity in which our adult selves take everything personally. That keeps us frozen and limited, Brenner says.

Unfortunately, an identity in which we take most things personally can be very real to us. It can become who we are. We then go through life thin-skinned and easily hurt. However, Brenner says, when we step back and examine things more objectively, we can begin to see that we are creating stories. When that happens, Brenner says, “you realize that you don’t have to make big deal over something that isn’t real anyway.” Brenner’s advice: Be like the sky. Let dark clouds and difficult thoughts and feelings move through you. Think of them as “nothing more than insubstantial wisps of energy that appear and disappear,” Brenner says.

It takes time and effort to erode lifelong habits that feel so real, Brenner says. Her advice: Be very kind to yourself. Brenner suggests, “When you notice that you are taking something personally, step off the habit wheel. Pause and take a breath.” Consider that your thoughts and feelings don’t accurately match up with reality, and that they don’t define you. When you discover that everything in the world is not personal, Brenner says, you will find “the deepest peace beyond imagination.”

Reference

1. Brenner G. It’s not personal. Dr. Gail Brenner. September 10, 2013. https://gailbrenner.com/2013/09/its-not-personal/ . Accessed July 26, 2019.