When I was a third-year resident in ophthalmology, I accidentally ran over my foot with a stretcher. I didn’t think much of the minor discomfort on the side of my left foot until the day. When I got out of bed one morning, my first step was met with excruciating pain. My fifth metatarsal head was hot and significantly swollen, so I immediately reached out to a former rheumatology supervisor, who was kind enough to assess me that day.
When he first told me I had rheumatoid arthritis, I was in shock. I had no family history of the disease and was otherwise in perfect health. The erosions staring back at me on the X-rays were surreal. I couldn’t believe what I was seeing and hearing. I was immediately thrown into a state of uncertainty. What would this mean for the surgical career I had worked so hard to achieve?
From an intellectual perspective, my uncertainty around the illness was relatively low since I had studied the condition during my rheumatology rotation earlier in residency. From an emotional experience, however, I felt overwhelmed with memories of patients with severe and chronic pain, as well as deformities in their hands and feet that limited their mobility and activity. These memories heightened the unpredictability of what would follow for me.
Uncertainty–not knowing what to expect or what an outcome will be–is a constant condition humans grapple with and a significant source of stress. Yet, three key concepts help you manage your response to uncertainty more effectively: perceived control, locus of control, and outlook. Together, they will help you regain your firm footing and reduce your stress.
1. Perceived Control
Perceived control relates to how much control you believe you have over your circumstances. The emphasis is on belief, The more control you believe you have, the easier it is to manage the unknown.
The very nature of uncertainty is the perceived lack of control, and the unpredictability associated with it. When you apply to a competitive program, for a new job or that highly sought-after promotion, there are a host of uncertainties ahead of you: Will you be selected for the position of your choice? Where will you live? How will you transition? Will you make the right decisions along the way?
In many circumstances, you truly do not have control over the situation. Yet, there are things that you can do to increase your perceived control. Rather than focusing on the aspects of a situation, you don’t know, focus on the actions you already know you can take.
I couldn’t determine how my condition would impact me ten years later, but I could control how I responded to it daily. I consulted with my physician, focused on available treatments, and I accepted emotional support from my family, and my mentor who worked with me to ensure that my residency training would be optimized as I learned to manage my condition.
2. Locus of Control
Locus of control centers on whether you tend to believe things happen to you or because of you.
For individuals with an external locus of control, there is a sense that things happen to them due to chance or luck, with the belief that they have little control over the outcome. They tend to avoid the subject of uncertainty altogether. This has the short-term advantage of not confronting the uncomfortable intellectual and emotional experiences that accompany the unknown.
As time goes on, however, the disadvantages of this avoidance become more obvious. Situations continue to evolve while the issue continues to be avoided, with levels of complexity often increasing as time goes on. When people with this viewpoint emerge from their avoidance to finally deal with the situation, they often face even more unknowns: more unpredictability, more uncertainty, more increased risk, and even more stress.
In contrast, for people with an internal locus of control, there is a sense that success or resolution happens because of them, through their own efforts and abilities, and with the belief that they have significant control over the outcome. They actively confront circumstances around them and tend to view uncertainty as an opportunity to investigate, adapt, learn, and grow.
If you find yourself defaulting to an external locus of control, try imagining the situation another way. Try to focus on what role your actions play–how they may be contributing to the uncertainty, and how they may help you resolve it.
Finally, consider your outlook. Do you approach things from a positive perspective, or is it your tendency to focus on the negative?
Everyone’s response to uncertainty is different. Some people have a negative response and shut down. Others actively fight and try to lessen their uncertainty. From an intellectual standpoint, as an example, you can study an issue and lessen the uncertainty by assessing probabilities, based on what you have learned.
From an emotional standpoint, however, it can be extremely difficult to manage the unknown. Most people appreciate their routines and have their own habits and plans based on their expectations. Disruption and redirection to an unknown path can be uncomfortable and unwelcome, particularly if you feel like you have little control.
If you find yourself struggling with negative emotions in response to uncertainty, shift your outlook by reframing the situation as a set of new opportunities. The possibilities and lessons to be learned are endless, and as new circumstances present themselves, you can choose the options that best align with your goals.
Life may not look the way you thought it would, but when you look at each moment as an opportunity to grow, learn, and discover, uncertainty becomes less stressful.
As a high achiever or planner by nature, you typically have a clear sense of where you want to go and how you want to get there. Accepting the need to waiver from your path can be immensely challenging and stressful. I experienced this firsthand when diagnosed with rheumatoid arthritis early in my career.
Uncertainty challenges your ability to be open and flexible to constantly change circumstances in unpredictable ways. However, with an optimistic outlook and a reasonable degree of flexibility in your perceived control and locus of control, the stress associated with uncertainty can be transformed into a valued resource. It can offer a source of motivation for learning and exploring potential for new opportunities.
Copyright Nina Ahuja, MD