Daily Affirmations and Physician Coaching
What a 1990s SNL character got right about coaching, and what he got right about getting it wrong.
During the early 90s, Stuart Smalley would sit in front of a mirror in a pastel cardigan and repeat his catchphrase. “I’m good enough. I’m smart enough. And doggone it, people like me.” The SNL character, created by Al Franken in 1991, was popular enough to carry his own movie. He was equal parts sincere, ridiculous, and awkward, in the way that exaggerated but honest comedy tends to be. Funny enough to earn the laugh. True enough to stick with you and leave you a little uncomfortable.
I think about that sketch, and others from that era of Saturday Night Live, from time to time. That speaks to the truth underneath the jokes, my own twisted sense of humor, and perhaps my own need for affirmations to get through the day.
There is a version of Stuart’s affirmation that plays out in hospital parking ramps every morning. You sit in the car a little longer than you need to. You say your own version of it. I’m good enough. I’m smart enough. And doggone it, I chose this. Then you trudge toward the staff entrance with your badge already in your hand.
The affirmation is enough to get you to the door. It takes considerably more to get you through the day. Clinic is overbooked. Your OR slot was bumped for a trauma. Your medical assistant was floated to another pod. And do not forget the mandatory staff meeting at noon to talk about the budget.
Good enough. Smart enough. Doggone it.
Why the joke lands so hard in medicine
Physician coaching can feel a lot like Stuart’s affirmations. I say that as someone who coaches physicians, which means I am on the hook for the criticism as much as anyone.
The skepticism is earned, because no affirmation will fix a fractured healthcare system or erase the difficulty of practice. Saying you are smart enough will not increase your productivity, make dinner when you get home, or manifest your notes at the end of the day. Most physicians are now employees, which means whatever semblance of control existed a generation ago is gone. Your clinic template was built by people who work in another zip code. They leave at five, and they do not have ninety minutes of charting waiting after the last family goes home. Staffing decisions arrive as poorly worded emails and are based on budget rather than need. You often have no say in who joins your team, how they are trained, or what support they get once they are there.
Tell any physician that they have more control than they realize and they are right to squint at you. Simon Talbot and Wendy Dean made this argument better than anyone in their 2018 STAT piece on moral injury. The language of burnout implies a failure of personal resilience. Physicians have resilience in abundance. What they lack is a system that lets them practice the way they were trained to.
So an affirmation shouted into that machinery is about as useful as a cardigan in July.
Where the character came from
The story behind Stuart is the piece most people do not know, and it is where the value of the character sits. Franken did not build him out of the self-help mantras of the time. He has said the character grew out of Al-Anon meetings he attended in support of his wife during her struggle with alcoholism. Stuart was modeled on a man he met there. Franken has described first finding the man faintly absurd, and then hearing him say something weeks later that landed with enough weight to change how Franken saw himself. Beneath the seemingly meaningless self-affirmations sat a truth that was hard to miss.
That is a parody built with affection. The comedy works because the thing underneath it worked.
The absurdity is not a reason to skip the affirmation. It is a reason to say it out loud, hear how it sounds, laugh at the silliness, and keep the part that rings true.
What physician coaching gets right anyway
Unclaimed time does not stay empty
You may not have built your clinic template, but you do control how you spend the gaps in it. Do you talk at the nurses’ station or work on notes? Do you eat at your desk or step away for ten minutes?Or do you scroll your phone or clear your in basket? None of those choices is wrong, and all of them are yours. So is the committee assignment you decline, the fellow you choose to invest in, the meeting you move because Thursday afternoons matter for a reason you can name. None of that fixes the system. All of it is yours.
The catch is that you have to notice the time you are already controlling without thinking about it. If you do not, someone else fills it. A committee, an add-on, a meeting that could have been an email. Most of us have never decided what that half hour is for, so it goes to whoever asks first. I once took a role I had reservations about. I said yes because it was the obvious next step. Only later did I understand that the reservation was information. The job was a good job. It asked me to spend my time on things I did not value. I had never put those values into words, so I had nothing to check the offer against.
That is the least glamorous part of this work and the part that pays. Not a mirror. A list. The way I approach development with physicians starts there for exactly this reason.
Nobody taught you the other half of the job
We are trained to be exceptional communicators with patients. Sit down. Ask open-ended questions. Listen first, speak second. Watch for the nonverbal cues. Deliver hard news in plain language and then stop talking.
Then we take that register into a budget meeting and wonder why it does not travel. The clinic manager does not need the news broken gently. The CFO is not looking for empathy, she is looking for the number and the ask. The medical assistant who has been floated three times this month does not need a differential, she needs to know whether you noticed. Same physician, three rooms, three different skills, and exactly one of them was on the boards.
That gap is not a character flaw. It is a curriculum gap, and curriculum gaps are fillable. Physicians who learn to read the room they are standing in get further with the same amount of leverage.
Numbness is a skill, and it has a bill
Medicine teaches us to get through a hard day by setting the feeling down and finishing the work. That skill is not optional. You cannot process a bad outcome in the middle of a code, and the family in the next room deserves your attention rather than your grief.
The trouble is that we set the feeling down and never go back for it. Twenty years of that is not resilience. It is a backlog. A physician who cannot name what he is feeling cannot tell a hard week from a wrong job. That gap shows up later as the flat, cynical exhaustion we file under burnout. Emotional awareness is not the soft part of this work. It is the diagnostic part.
Five minutes, one page
Draw three columns. Label them mine, shared, and theirs. Put every recurring frustration from the last month into one of them. Most physicians expect column three to swallow the page. It usually does not. The interesting column is the middle one, where you have partial leverage and have never used it because you never sorted it out of the pile.
The part Stuart got right by getting it wrong
Here is what I like most about the character. He never has it together, is anxious on his own show, and gets rattled by his guests. He also compares himself to people doing better than he is. Finally, he is a self-help guru with a running disclaimer that he is not a licensed therapist.
He keeps going anyway. That is the whole character.
Physicians are terrible at this. We are selected, trained, and promoted for getting it right the first time, and then we apply that standard to a domain where nobody gets it right the first time. You will set a boundary badly. You will name a value and then violate it the next Tuesday when the schedule gets ugly. The goal is not a clean performance. The goal is to try, notice, and try again in a slightly better direction. Marginal gains, in a career that will outlast the current org chart.
Back to the car
So the minute in the parking ramp stays. The mirror is optional and the cardigan is a hard no. What changes is the line.
Not I am good enough, which the template will disprove by 10 a.m. Something smaller and more defensible. Some of today is mine. Most of it is not. I am going to work the part that is mine, probably badly, and when the rest of it gets absurd I am going to notice that it is absurd and laugh instead of absorbing it.
It will not fit on a mirror. It is sincere and slightly ridiculous at the same time, which puts it in good company.
And a mirror was always the wrong prop. That is the one thing the sketch had backwards, and Franken knew it, because his own story does not have a mirror in it anywhere. He did not change by talking to himself. He changed because a man he had quietly written off said something true out loud, and it caught up with him weeks later.
That is the part worth keeping, and it is the part coaching is made of. Not the affirmation. The other person in the room, asking the question you have been steering around, and the several weeks it takes to land. You cannot get that from a mirror, because a mirror only ever gives you back what you walked in with.
So say the ridiculous line in the car if it helps. Then find someone who knows what your Tuesday looks like and say the true one out loud. And doggone it, the template still needs work.
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