Welcome to the Deep Dive, where we unpack complex
ideas and explore insights that might just change
the way you approach your professional and personal
life. Today, we're embarking on a, well, a deeply
insightful journey, I think, into the very nature
of happiness, success, and crucially, how we
grapple with the inevitable challenges that come
with demanding careers. For many of us, especially
those of you navigating high stakes environments
like medicine, the pressures to achieve, to be
perfect, to constantly innovate, and, you know,
to always stay positive, well, they can feel
immense. But what if those very pursuits, those
relentless efforts to always feel good or be
seen as flawless, are actually holding us back?
We're going to challenge some deeply ingrained
beliefs about what it truly means to thrive.
We'll be looking at why our attempts to always
feel good might paradoxically be making us feel
worse, and how, counterintuitively, embracing
discomfort and imperfection can lead to profound
personal and professional growth. We're incredibly
fortunate to be joined today by the insightful
Professor Moimam, who will help us navigate these
often uncomfortable yet ultimately perhaps liberating
ideas. It's a genuine pleasure to be here. This
exploration into human values and our intrinsic
relationship with suffering, it's not merely
an academic exercise, I believe. It's particularly
relevant, as you say, in high -stakes professional
environments, where the pursuit of an idealized
version of perfection can often lead to burnout,
disillusionment, and a profound sense of disconnection
from one's true purpose. Understanding these
dynamics is, I think, crucial for sustainable
well -being. That's a powerful starting point.
So let's begin to unpack this. We are constantly
relentlessly bombarded with messages telling
us to be happier, healthier, and better than
everyone else. Just open any social media feed,
and you're met with a curated highlight reel
of successes, perfectly managed careers, seemingly
flawless lives. It's quite something. It can
feel like we need to give a damn about absolutely
everything all the time, every patient outcome,
every administrative task, every new research
paper, every potential career advancement. In
the relentless pursuit of what we perceive as
positive, this constant striving for an ideal
state can actually be profoundly detrimental
to our mental well -being, particularly for medical
professionals who are already under immense systemic
and internal pressure to perform flawlessly,
to never make a mistake, and to always present
an image of unwavering competence. Indeed. What
you're describing perfectly illustrates a curious
phenomenon, often termed the backwards law. It
suggests that the more desperately you pursue
a positive experience, be it happiness, wealth,
or even external validation like professional
recognition or attractiveness, the less satisfied
you ultimately become. The paradox lies in this.
The very act of intensely pursuing something
reinforces an underlying feeling of lacking it
in the first place. Oh, right. Think about it.
If you're constantly trying to be happy, it implies
you're not, doesn't it? And that very pursuit
creates a kind of void. For medical professionals,
this can manifest as an endless chase for the
perfect diagnosis, the ideal outcome for every
single patient, or the unblemished career path
free from any perceived failures or setbacks.
This relentless pursuit, ironically, can lead
to significant internal distress, a sense of
chronic inadequacy, and ultimately burnout because
the goal posts are always shifting. Like a treadmill
you can't get off. Exactly. It's like being on
a hedonic treadmill, where no matter how fast
you run, you never quite get anywhere new. Your
brain adapts to new levels of pleasure or achievement
very quickly, you see, prompting you to seek
the next high. This leads to a perpetual state
of desire rather than contentment. That's truly
fascinating, and it challenges so much of what
we're taught, doesn't it, about striving for
goals. So the desire for more positive experiences
is itself, in a way, a negative one. It's a bit
of a mind bender, isn't it? Could you elaborate
on this concept because it really does go against
a lot of conventional wisdom, especially in fields
where achievement is so highly valued? Certainly.
Consider the profound observation by the philosopher
Alan Watts who said something like, You will
never be happy if you continue to search for
what happiness consists of. You will never live
if you are looking for the meaning of life. This
suggests that constantly striving for an external
definition of happiness or success Well, it keeps
us from truly experiencing what's present. When
you're perpetually looking for happiness to arrive
from an external source, a promotion, a successful
procedure, a new car, you're by definition not
experiencing it now. You're just always waiting
for it. Exactly. It implies that a certain comfort
with what is, even when it's challenging or uncomfortable,
is actually a more direct route to genuine satisfaction
and a sense of well -being. It's about being
present with reality, with the struggles and
the triumphs, rather than always chasing an idealized
future state that remains perpetually out of
reach. For a clinician, this might mean finding
fulfillment in the nuanced, often imperfect reality
of patient care, rather than only in the miracle
cases or the textbook outcomes. And where does
this overwhelming societal pressure to be amazing,
to constantly perform at an exceptional level,
come from? Particularly for professionals who
often have exceptionally high standards for themselves,
like doctors who often feel they must embody
an almost superhuman level of competence and
composure, especially when life and death are
on the line. Well, our contemporary consumer
culture and the pervasive nature of social media
play a profoundly significant role. They really
do. They fostered what has been termed a feedback
loop from hell. We're constantly inundated with
images and narratives of others appearing to
live extraordinary lives, the perfect patient
interaction, the breakthrough research, the seamless
surgical procedure, the perpetually calm and
compassionate bedside manner. You know, the sort
of thing. Yes, those curated highlights. Precisely.
And this creates a deeply problematic and insidious
assumption that negative experiences like anxiety,
fear, guilt, or even simple frustration are somehow
not OK, or that they indicate a personal failing.
We start to feel bad for feeling bad. which is
an incredibly self -defeating and exhausting
cycle. This internal conflict, particularly for
those in roles demanding constant composure,
rapid decision -making, and profound resilience,
can lead to chronic stress, deep -seated anxiety,
and an almost existential unease. It's no coincidence,
I think, that stress -related health issues,
anxiety, disorders, and depression have seen
a significant rise, despite widespread material
comfort and unprecedented technological advancement.
The crisis, for many, becomes less about material
lack and more about a spiritual void, a profound
sense of not knowing what truly matters, when
everything appears available. When every possible
achievement seems within reach, yet none truly
satisfies or brings lasting contentment. It creates
a vacuum of meaning. It's almost like we've become
victims of our own success, in a way, with so
many opportunities and so much information that
we don't know what to truly invest our energy
in, leading to a kind of internal paralysis or
even a sense of being perpetually overwhelmed.
This is precisely where accepting the negative,
acknowledging that these feelings are normal,
becomes so crucial, isn't it? It means moving
beyond that destructive internal conflict you
described. Precisely. The acceptance of one's
negative experience is paradoxically a profoundly
positive experience when you're able to not give
a damn. about the inevitable pain and struggle
inherent in life, when you stop resisting it,
you become remarkably resilient. Now this isn't
about apathy or indifference. It's about strategically
choosing what truly matters to you and acknowledging
that nearly all worthwhile achievements, all
significant growth, and all genuine satisfaction
emerge from confronting and surmounting discomfort.
So leaning into the difficulty. In a way, yes.
Take the American poet and novelist Charles Pukowsky.
His epitaph simply read, don't try. This wasn't
an invitation to laziness, obviously, but a powerful
philosophical statement suggesting that his success
came not from striving to be a winner or conforming
to expectations, but from an unflinching honesty
about his own failures and limitations, simply
allowing himself to be who he was and write about
it. Interesting take. For medical professionals,
this could mean moving beyond the idealized self
-image of the infallible healer and embracing
the complexities and emotional toll of their
demanding work, the difficult conversations,
the ethical dilemmas, the inevitable human errors,
the profound losses. Recognizing that these very
challenges and difficult moments are an intrinsic
part of the growth process, not deviations from
it, is key. It's about finding strength in acknowledging
vulnerability, not hiding from it. So if trying
to avoid pain only causes more suffering, and
if we're to lean into discomfort, how do we actually
learn to embrace it? Especially when dealing
with the intense psychological and emotional
toll that professions like medicine can take.
We're often taught, aren't we, to compartmentalize
or suppress these feelings, to maintain a professional
facade, to appear strong for our patients and
colleagues. Well, pain, whether physical or psychological,
is fundamentally a crucial feedback mechanism.
It's a biological alarm system, really. It teaches
us what to pay attention to, what our limitations
are, and how to avoid making the same mistakes.
Neuroscience research has consistently shown
that our brains register little difference between
physical and psychological pain. Neuroimaging
studies, using fMRI, for example, demonstrate
activation in similar brain regions. The insula,
the anterior cingulate cortex for both physical
injury and deeply failed social exclusion or
emotional disguise. So it feels the same biologically?
Very similar pathways, yes. Just as the stub
toe teaches you to be more careful, the emotional
pain of a difficult outcome, a misdiagnosis,
or a personal failure in your practice can teach
invaluable lessons in resilience, adaptation,
and, frankly, humility. The real danger lies
in a society that increasingly coddles itself
from these inevitable discomforts, leading to
a profound disconnection from reality. When we
attempt to shield ourselves from all forms of
pain, we lose vital learning opportunities and
become rather fragile. And it's not just about
avoiding pain, is it? It's also about acknowledging
that problems are a constant and inherent part
of life woven into the fabric of our existence.
Even for highly successful individuals like leading
surgeons or pioneering researchers, it's not
about eliminating problems, but maybe changing
the kind of problems you have. Absolutely. Life
is an endless series of problems. The solution
to one merely creates the next. Now, this isn't
pessimism. It's a deeply rooted realism, I think.
Warren Buffett, for instance, he has money problems,
but there are arguably better ones, issues of
investment diversification or philanthropic strategy
perhaps, than say the survival challenges faced
by a homeless person. Different scale of problems.
Precisely. And this is a critical insight. Don't
hope for a life without problems, because such
a life is a fantasy, a delusion. Instead, hope
for a life full of good problems, those that
challenge you, force you to grow and align with
your chosen values. Denying problems, or worse,
adopting a victim mentality, only provides a
temporary high through delusion or blame leading
to long -term insecurity and emotional repression.
This is particularly salient in high pressure
fields like medicine where admitting to struggle,
acknowledging a systemic issue, or even a personal
mistake might be perceived as weakness. Which
can be incredibly damaging. It can. This can
lead professionals to deny or externalize issues
rather than confront them head -on, perpetuating
the very problems they seek to avoid, and eroding
trust within teams and with patients. This raises
an important question, then. If emotions are
simply signals, as you've described, providing
us with feedback, how do we prevent them from
dictating our actions? Especially the powerful
negative ones, which can be so overwhelming and
demand immediate reaction in a clinical setting.
That's a crucial point. Emotions evolved for
one specific purpose, to help us live and reproduce
better. Fundamentally, they are biological signals
nudging us towards beneficial change. Negative
emotions, for instance, are call to action if
you feel crappy. Whether it's frustration with
a colleague or anxiety about a procedure, it's
often because an issue is unaddressed or unresolved.
It's your internal system saying, pay attention.
A warning light. Exactly. Positive emotions,
on the other hand, are rewards for appropriate
action, reinforcing behaviors that serve us.
The critical point is to recognize that just
because something feels good doesn't necessarily
mean is good for you in the long run, and vice
versa. A difficult conversation might feel bad
but be incredibly necessary. We could question
our emotions rather than blindly trusting them,
especially in professional contexts where a detached
analysis, ethical considerations, and rational
decision -making are sometimes paramount. However,
it's equally important not to fall into the trap
of repressing negative emotions entirely, as
that denies us vital feedback needed for problem
solving and personal growth. Finding a balance.
It's about discerning the message. Understanding
the why behind the feeling, not silencing the
messenger. So it's not about being emotionless
or cultivating a stoic detachment in all situations,
but rather about understanding their purpose,
interpreting their signals, and then aligning
them with our deeper values, making them work
for us rather than against us. Precisely. It's
profoundly about choosing your struggle. Everyone
naturally desires happiness and an easy life,
free from friction. But real, lasting fulfillment,
profound meaning, and genuine growth don't come
from avoiding pain. They come from accepting
and actively engaging with negative experiences.
For example, aspiring to an amazing physique
isn't about enjoying every single minute in the
gym. In fact, much of it involves discomfort,
doesn't it? It's about appreciating the pain
and physical stress of the process. The burning
muscles, the sweat, the exhaustion, the discipline.
That's where the satisfaction lies. Similarly,
a successful medical career isn't just about
the rewarding cases, the successful surgeries,
or the accolades. It's also profoundly about
embracing the long, often unpredictable hours,
the complex ethical decisions that keep you awake
at night. Difficult conversations. Absolutely.
The emotional toll of those conversations, the
grief of losing a patient, and the inevitable
setbacks and human errors that occur. Who you
truly are, your character, your resilience, is
forged and defined by what you are willing to
struggle for. It's in those moments of pushing
through discomfort that true character is revealed
and built. And this leads us to the idea that
we're perhaps not as special as society often
tells us we are, which can be a particularly
tough pill to swallow in high -achieving fields
where exceptionalism is almost an assumed trait.
It's as if simply being good isn't good enough
anymore. The You Are Not Special notion. It is
a powerful, almost confrontational counterpoint
to a culture increasingly obsessed with exceptionalism.
The self -esteem movement, which gained traction
back in the 1970s, focused heavily on feeling
good about oneself regardless of actual achievement,
leading to practices like great inflation and
participation awards. Decades of data suggest
that merely feeling good about yourself without
a valid reason, without earned competence, fosters
a population full of what has been referred to
as Jimmy's. Individuals with delusional self
-confidence often all talk and no action, who
may live off the efforts of others or fail to
adapt to real -world challenges. Imagine a Jimmy.
in a hospital setting. Perhaps a resident who
constantly overstates their capabilities, avoids
difficult learning opportunities, or blames nurses
or other team members when things go wrong, rather
than taking ownership of their own areas for
growth. That sounds dangerous. It hinders genuine
progress, absolutely. True self -worth, in contrast,
isn't about how you feel about your positive
experiences. It's about how you feel about your
negative ones and your willingness to address
them honestly, to accept your flaws and work
on them. Entitlement, whether manifested as superiority
or victimization, is a destructive high that
prevents genuine improvement because it blinds
individuals to their actual problems and their
own capacity for change. This tyranny of exceptionalism
feels particularly acute in high -achieving professions
like medicine, where average is often synonymous
with failure, and there's immense pressure to
always be at the forefront, discovering the next
big thing, publishing groundbreaking research,
or performing the most complex procedures. Correct.
The constant flood of extraordinary information
via mass media, academic journals, professional
networks, it conditions us to believe that exceptionalism
is the norm. We see the groundbreaking research,
the heroic interventions, the perfect academic
records, the doctors who cure seemingly impossible
diseases. However, since most of life is, in
fact, an extraordinary and quite average, much
of clinical practice involves routine cases,
careful documentation and incremental progress.
This relentless exposure to exceptionalism leads
to widespread insecurity and a pervasive feeling
of not good enough. I can see that. This drives
people to compensate through various coping mechanisms,
often unhealthy ones, such as workaholism, obsessive
pursuit of status, or an inability to delegate.
For medical professionals, it can lead to a feeling
that unless they are at the absolute pinnacle
of their field, constantly innovating or achieving
breakthrough successes, they are somehow failures.
But true greatness, as the discussion suggests,
often comes from an obsession with improvement.
Stemming from an honest belief that one is not
already great, but could always be much better.
A growth mindset, essentially. Precisely. This
means accepting the bland and mundane truths
of life. That most of it will be boring, routine,
and not nit -worthy in a headline -grabbing way.
And that's perfectly fine. Actually, it's normal.
This acceptance lifts that immense self -imposed
pressure and paradoxically frees you to pursue
what truly matters, focusing on consistent incremental
progress rather than a mythical, unattainable
peak of perfection. It's a compelling argument
against the relentless pursuit of external validation,
isn't it? It suggests that the real, transformative
work happens internally, shifting our focus from
outer accolades to inner integrity. So if accepting
imperfection and embracing struggle are key to
a more fulfilling professional and personal life,
how do our values play into this? And how do
we even begin to identify what truly matters
to us, especially when we're so conditioned by
external measures of success and prestige? Ah
yes, values. This is where the concept of the
self -awareness onion comes into play. It's quite
a useful framework for introspection, I find.
It has multiple increasingly challenging layers.
The first layer is a basic understanding of our
emotions. Being able to identify what makes us
happy, sad, angry, anxious or hopeful. Just knowing
what you feel. Exactly. But even that isn't always
straightforward. We all have emotional blind
spots, often related to emotions we were taught
were inappropriate or undesirable during our
upbringing. For example, some might have been
told that doctors don't cry or you must always
be strong. It takes years of conscious practice
and effort to identify these suppressed emotions
and learn to express them appropriately. But
it's hugely important for psychological health.
OK, so that's layer one. What's next? The second,
deeper layer, involves asking why we feel these
emotions connecting them to our underlying understanding
of success or failure. Why do you feel that intense
frustration when a patient doesn't follow your
advice? Is it because you genuinely care for
their well -being? Or perhaps because you perceive
it as a failure of your own authority or skill?
Digging deeper into the why. Precisely. Why do
you feel lethargic and uninspired after a successful
procedure? Is it because you've become disconnected
from your initial purpose? This layer helps us
understand the root cause of our overwhelming
emotions, moving beyond surface level reactions.
But the crucial and often most uncomfortable
layer is the third, our personal values. A core
of the onion. Exactly. This involves asking,
why do I consider something a success or a failure
in the first place? By what standards do I measure
myself, my career, my relationships? Our values
fundamentally determine the nature of our problems
and thereby the quality of our lives. If your
value is external validation, your problems will
revolve around seeking approval. If it's compassion,
your problems will involve navigating suffering.
Many people avoid this deep self -questioning,
often blaming external factors for their dissatisfaction.
It's the hospital system, it's difficult patients,
it's the long hours. which prevents them from
addressing the true root causes of their issues,
which often lie in misaligned values. It's about
questioning the very metrics we use to measure
ourselves, then, rather than just the goals themselves.
That can be a radical shift in perspective for
professionals accustomed to clear, often externally
defined, objectives like passing exams, achieving
board certification, or securing grants. Precisely.
We see this contrast vividly in what's been termed
rock star problems. Take Dave Mustaine of Megadeth,
for instance. Despite immense success selling
millions of albums, touring globally, he reportedly
still considered himself a failure for decades.
Decades. But why? They were huge. Because his
metric was being more successful and popular
than Metallica, the band he was famously kicked
out of early on. His value was based entirely
on external comparison, leading to decades of
internal torture and resentment, despite his
considerable achievements. Wow. In stark contrast,
Pete Best, the original Beatles drummer, who
missed out on, well, arguably the biggest global
superstardom imaginable. He reportedly found
deep happiness by reprioritizing his values,
moving away from fame and glory towards a loving
family and a simple life, working for the civil
service. His internal metric of success, based
on what truly mattered to him, connection and
stability, allowed him to find fulfillment. Despite
missing out on the Beatles? Quite. This highlights
that some values, frankly, are more conducive
to healthy problems and a fulfilling life than
others. Some values just lead to more suffering.
That distinction is incredibly clear. And you
mentioned values that lead to poor problems.
Could you expand on what constitutes these values
that tend to generate unfulfilling, often unsolvable
problems? Certainly. Common values that can lead
to poor problems include prioritizing pleasure
above all else, seeking constant highs. Also,
chasing material success or status is the primary
goal. Always needing to be right is another big
one, and maintaining a facade of constant positivity
or superiority. Why are those so problematic?
Because these values create problems that are
often unsolvable and leave us feeling empty.
They're either externally dependent, relying
on others' opinions, or fleeting circumstances
impossible to achieve perfectly, or they require
us to deny reality. For example, if your self
-worth is based on always being right, you'll
struggle immensely to learn from mistakes, accept
feedback, or be open to new perspectives. That's
highly detrimental in any evolving field like
medicine, where new research constantly challenges
old assumptions and continuous learning is absolutely
paramount. You have to be willing to be wrong
sometimes. Absolutely. Similarly, denying negative
emotions by forcing positivity is a form of avoidance.
It prevents you from addressing underlying issues
that genuinely require your attention. Healthy
emotional expression, even of anger or frustration,
is crucial for problem -solving and psychological
well -being, as long as it aligns with broader
values like respect and nonviolence. It's about
expressing the emotion appropriately, not suppressing
it entirely until it manifests in unhealthy ways.
What, then, are healthier values that can lead
to more meaningful problems and genuine fulfillment?
What should we strive to cultivate? Healthy values
are typically achieved internally. They are immediate
controllable, and engage you directly with the
world as it is, rather than how you wish it were.
You don't need external circumstances to align
perfectly to enact them. Examples include things
like creativity, honesty, humility, curiosity,
perseverance, or compassion. Things you can practice
moment to moment. Exactly. These are values you
can embody and enact regardless of external circumstances,
day in and day out. When you choose better values,
you allocate your energy to things that genuinely
improve your well -being and generate happiness
as a side effect, not the primary pursuit. You're
not chasing happiness. You're living in a way
that produces it. This is the essence of self
-improvement, choosing better things to give
a damn about, leading to better, more solvable,
and ultimately more fulfilling problems, and
thereby a richer life. And this choice itself
is incredibly powerful, isn't it? It suggests
that even in seemingly dire, uncontrollable circumstances,
we retain a profound sense of agency over our
own experience. It is profoundly so, because
you are always choosing whether you realize it
or not. The distinction between a problem being
merely painful or genuinely powerful often lies
in whether we feel we chose it and are responsible
for our response to it. Consider William James,
often called the father of American psychology.
Despite a life plagued by severe health issues,
intense depression, and repeated professional
failures, he transformed his life. He did this
by dedicating one year to the radical experiment
of believing he was 100 % responsible for everything
that occurred to him, regardless of fault. Everything.
Even things outside his control. Yes. This radical
acceptance of responsibility, even for things
not objectively his fault, empowered him to change
his circumstances and ultimately shaped his profound
legacy. He found that by taking responsibility,
he gained power over his own life and choices
rather than remaining a passive victim of circumstances.
So it's not about fault, but about responsibility.
That's a crucial distinction, especially for
professionals who might carry immense burdens
of responsibility for patient outcomes, for team
dynamics, even when factors are beyond their
direct control. You might not be at fault for
a global pandemic, for example, but you are responsible
for your actions within it. Exactly. Fault is
past tense. It's about what happened. Responsibility
is present tense. It's about how you choose to
respond now. You might not be at fault for a
difficult situation like a complex medical case
with an unexpected turn or a patient's non -compliance
leading to a poor outcome, but you are always
responsible for how you choose to react to it,
how you see it, and what values you apply to
that moment. For example, in a challenging surgical
case, if an unexpected complication arises, you
might not be at fault for its occurrence, but
you are absolutely responsible for your immediate
response, your critical thinking, your communication
with the team, and your subsequent learning from
the experience. Owning your response. Yes. Malala
Yousafzai, shot by the Taliban for advocating
for education, exemplifies this on a grand scale.
She didn't choose the attack, obviously, but
she chose how to respond, ultimately turning
profound pain into a platform for global change.
Blaming others while a common human response
only perpetuates one's own misery and effectively
disempowers you. It's about taking ownership
of your emotional landscape and deciding on better
values to move forward, even when the circumstances
are not of your making. It's the profound recognition
that while we can't always choose what happens
to us, we always choose how we respond, and that
choice defines our agency and our character.
This leads beautifully to the idea of embracing
uncertainty, which can feel deeply counterintuitive,
almost professionally irresponsible perhaps,
especially in professions where precision, evidence
-based practice, and certainty are often prized
above all else, and where mistakes can have profoundly
significant, even life or death, consequences.
Indeed, certainty is often the enemy of growth.
It sounds paradoxical, but it often is. We are,
in essence, always wrong, just progressively
less wrong, as we learn and grow. Our understanding
evolves. Our brains are fundamentally meaning
machines, constantly trying to make sense of
experiences to form coherent narratives. In doing
so, we often unconsciously fabricate connections
or memories to maintain existing beliefs and
preserve a sense of certainty, even when that
certainty is, frankly, an illusion. Our brains
trick us. To some extent, yes. The phenomenon
of false memory syndrome, for instance, has powerfully
demonstrated how susceptible our beliefs and
memories are to our current values, desires,
and even suggestions from others. Therefore,
continuous self -scepticism and rigorous challenging
of our own beliefs and assumptions, even deeply
held clinical ones, is not merely beneficial.
It is the only logical path to true progress
and intellectual development. Clinging to the
illusion of certainty ultimately limits our capacity
to learn, to adapt to new evidence, and to innovate.
For a medical professional, this might mean accepting
the inherent uncertainty in a complex differential
diagnosis or being open to a new, perhaps less
conventional treatment pathway when standard
approaches fail, rather than clinging stubbornly
to familiar but ineffective methods. It's about
being open to being wrong, then, rather than
clinging to what we think we know, which, as
you say, can be a particularly challenging mindset
shift for medical professionals who are extensively
trained to diagnose with confidence and act decisively.
Precisely. The more you embrace being uncertain
and not knowing all the answers, the more comfortable
you paradoxically become with the inherent complexities
of your field and of life itself. Uncertainty
removes judgment of others and, crucially, of
ourselves. It fosters openness to new experiences
and continuous learning. It also directly confronts
what has been called Manson's Law of Avoidance,
which states that the more something threatens
your identity, the more you will avoid it. Interesting.
How does that work? Well, this is why people
can be afraid of success just as much as failure
both challenge who they believe themselves to
be. If your identity is the expert who never
makes a mistake, admitting an error or facing
a truly novel uncertain case can be terrifying.
it threatens that core identity. So you avoid
situations where you might fail or even succeed
in a way that changes you. Exactly. Letting go
of rigid self -definitions such as I'm not good
at patient communication or I'm not cut out for
the specialty or I'm not an academic is incredibly
liberating and allows for real growth. The idea
is to metaphorically kill yourself psychologically
to let go of arbitrary self -constructions that
trap you in fixed roles and limit your potential.
True self -knowledge in this sense isn't a fixed
destination, but a continuous journey of discovery,
an acceptance that you never truly know yourself
completely, and that's a profound and good thing
as it encourages continuous striving and evolution.
So if we're always choosing and we need to embrace
uncertainty and the possibility of being wrong,
how do we translate that into tangible action
when we feel stuck? overwhelmed, or perhaps when
facing a daunting new medical procedure, a complex
research project, or an ethical dilemma with
no clear answer. Ah, well that's where the do
-something principle comes in. It's a powerful
antidote to analysis paralysis, I find. We often
operate under the assumption that motivation
will precede action. We think we need to feel
inspired, then we become motivated, and then
we act. Right, I need to feel inspired, then
I'll act. That's the usual model. It is, but
the loop actually works powerfully in reverse
as well. Action leads to inspiration, which fuels
motivation and so on in an endless positive feedback
loop. If you lack the motivation for a significant
change, perhaps starting a new research project
that feels too big, tackling a complex clinical
challenge you've been putting off, or even just
writing a difficult referral for a patient, simply
start with the small, menial task related to
it. Don't wait for the lightning bolt of inspiration.
Exactly, don't wait. The act of doing something,
even imperfectly, even if it feels trivial, generates
momentum, creates small wins, and sparks insights
that you couldn't have achieved through mere
contemplation or worry. This approach makes potential
failure feel less significant because any action,
regardless of its immediate outcome, is considered
progress, a step forward in the process. So it's
about breaking the paralysis and just beginning,
even if you feel completely clueless or worried
about getting it wrong or unsure of the final
destination. It's about iterative progress, a
bit like a doctor doing daily rounds even on
difficult cases just keep moving forward. Exactly.
As the famous saying goes, do or do not, there
is no how without the doing. You figure out the
how by doing. You might feel that changing your
values and the things you truly care about will
feel disorienting, even like a failure, and it
may lead to friction or rejections from others
whose relationships were built on your old values.
That can happen. But these discomforts are inevitable,
a necessary side effect of genuine growth. As
part of the process, it's about recognizing that
not knowing what you're doing is entirely normal.
even when you're accomplished and highly experienced.
Life is about navigating uncertainty and acting
anyway. The fear of not knowing or of making
mistakes can be crippling. But the only way through
it is to take that first step. Even if it's a
crappy first step, like the novelist who committed
to writing 200 crappy words a day and ended up
writing 70 novels, the action itself sparks the
inspiration and motivation to continue. It's
the consistent, imperfect action that truly transforms
us. Shifting gears slightly, let's talk about
relationships. You've suggested that true freedom
and meaning actually come through commitment,
and that this requires the often difficult ability
to say no. How does this apply to our personal
and professional interactions, especially in
complex, team -based medical environments where
collaboration is vital, but so is protecting
your own well -being? Well, absolute freedom
by itself is often meaningless. If you have infinite
choices, none truly hold significance, do they?
True meaning and importance in life come through
the rejection of alternatives, a narrowing of
freedom, and a deep commitment to one path, one
belief, or one person. This might seem counterintuitive
in a culture that champions endless options and
constant flexibility. Keep your options open
is the mantra. Right, don't tie yourself down.
Exactly. But depth of experience, achievable
only through sustained commitment and focused
effort, yields profound rewards that breath alone
cannot. Consider the author's personal anecdote
of five years of extensive global travel. While
exhilarating, he noted many experiences ultimately
lacked lasting significance because they weren't
deeply invested in, just skimming the surface.
This applies directly to professional specialization,
to building long -term patient relationships
based on trust, or even to conducting consistent,
focused research over many years. The willingness
to say no to countless other attractive opportunities
to dedicate your finite time and energy is what
gives weight and meaning to the yes you give
to a chosen few. It allows you to achieve true
mastery and impact. And this idea of saying no
and setting clear boundaries is central to healthy
relationships, isn't it? Whether with colleagues,
patients, or even family, it's not just about
protecting your own time, but about fostering
genuine connection. Crucially so. Unhealthy relationships
are often built on two people trying to escape
their own problems by using each other, rather
than acknowledging and addressing their individual
issues with mutual support. The key difference
lies in clear, respectful boundaries and the
willingness to both reject requests when necessary
and to be rejected without resentment. That's
important too. Being okay with someone else saying
no to you? Yes. This means taking responsibility
for your own values and problems rather than
constantly molding your behavior to accommodate
others or taking on their issues as your own.
For medical professionals, this could mean setting
limits on work hours to prevent burnout, a very
real issue. or clearly communicating realistic
expectations to patients about treatment outcomes
or your availability, even if it might lead to
initial discomfort or perceived disappointment.
It's about fostering respect and self -reliance
in others, rather than creating co -dependency
or accumulating resentment through over -giving.
So a saver mentality, where you constantly try
to fix others' problems, whether they're patients,
colleagues, or even family members, isn't actually
helpful in the long run. It sounds like it can
actually be quite detrimental. No, it often creates
codependency and can ultimately disempower the
other person. Genuine love, support, and professional
collaboration involve helping someone solve their
own problems, equipping them, supporting them,
but not solving the problems for them. True growth
comes from wrestling with one's own challenges.
Right. A sacrifice is only truly valid if it's
voluntary and given without expectation of return,
not born of obligation, guilt, or manipulation.
Conflict, though uncomfortable and often avoided,
is not only normal but absolutely necessary for
building genuine trust and maintaining healthy
relationships. Conflict is necessary. That sounds
challenging. It is. But without open disagreement,
without the ability to frankly say no or express
a differing opinion respectfully, relationships
are built on manipulation, resentment, and misrepresentation.
They become superficial. Trust, the most vital
ingredient in any relationship, whether a patient
-doctor bond or within a multidisciplinary team,
is earned through honesty and a consistent track
record of aligning values with actions, especially
after a breach of trust has occurred. If someone's
highest priority is always to feel good or to
make others feel good without facing underlying
truths or difficult conversations, the relationship
ultimately suffers and lacks depth. Finally,
let's confront perhaps the most profound idea
we'll discuss today. the inevitability of death.
For those in medicine who confront life and death
daily, often holding it in their hands, how does
contemplating our own mortality shape our values
and purpose? It must be a uniquely intense experience
for medical professionals. It is intense, yes.
Humans uniquely conceptualize their own death,
unlike any other creature we know of, and this
leads to a deep pervasive death terror and existential
anxiety. This subtly or sometimes overtly, underlies
much of what we do and how we live. To compensate
for this terror, we construct immortality projects,
grand narratives about our lives, building legacies,
achieving greatness, contributing to something
larger than ourselves that will outlast us. In
a sense, yes. Our values are, in essence, these
immortality projects. They are the things we
choose to believe are more important than our
own fleeting existence. When these values fail,
or when we lose sight of them, death terror can
creep back to the forefront of our consciousness.
Ernest Becker, who wrote his seminal work, The
Denial of Death, literally on his deathbed, argued
that embracing the impermanence of existence
is the bitter antidote to our frivolous ambitions,
our sense of entitlement, and our endless distractions.
It forces us to confront what truly matters beyond
our fleeting individual existence. That's a powerful
perspective. And as someone who has deeply felt
the sting of loss, I can certainly attest to
how it fundamentally shifts your outlook. The
death of my friend Josh some years ago was profoundly
painful. Yet paradoxically, it cracked open my
world in a way nothing else had. It gave me permission
in a strange way to truly live, inspiring a deep
sense of responsibility, insatiable curiosity,
and a drive to work hard at what genuinely matters.
All subsequent struggles, even significant ones,
have felt lighter because they are measured against
that ultimate truth. So how does facing mortality
directly, for all of us, help us live better
and make more meaningful choices in our professional
and personal lives? Your experience resonates
deeply with a core message here. Confronting
death, truly peering into that darkness, forces
us to obliterate superficial values and ask the
truly important question, what are your legacy?
How will the world, or even just your small corner
of it, be different and better when you're gone?
What mark will you have made that transcends
your individual existence? Now, this isn't about
grand achievements for everyone, not about building
hospitals or discovering new cures for every
single person. That's not realistic or necessary.
It's more personal. Yes. It's about choosing
values that stretch beyond serving merely yourself.
Values that are simple, immediate, controllable,
and tolerant of the world's inherent chaos and
uncertainty. This is the root of true happiness.
A fleeting yet profound sense of being part of
something greater and more unknowable. The more
we peer into the darkness of our own mortality,
the brighter and clearer life's true priorities
become. Stripping away the trivial and focusing
our precious energy on what genuinely contributes
to our lives and the lives of others. And accepting
suffering as an inevitable, even valuable part
of the human experience. We've covered a remarkable
amount of ground today, haven't we? challenging
the very foundations of how we define success
and happiness, and offering a compelling new
lens through which to cope with the inevitable
struggles and imperfections of life. The core
idea, it seems, is that choosing what to give
a damn about, choosing your struggles wisely,
and accepting the discomfort that comes with
growth. Well, that's perhaps the most worthy
struggle of all. I think so. For those of you
navigating demanding professional landscapes,
particularly in medicine, the insights we've
discussed offer a powerful and practical framework.
A framework for cultivating genuine resilience,
building true self -worth that isn't dependent
on external validation, and finding a deeper
sense of purpose beyond conventional metrics.
It's about embracing imperfection, choosing your
battles wisely, and aligning your actions with
values that truly resonate with your deeper purpose,
leading to a more meaningful and impactful career
in life. It certainly gives you something profound
to think about, doesn't it? Remember, you are
already great. Not because of external achievements
or because you've avoided all struggle, but because
you continue to choose what to care about in
the face of endless confusion and inevitable
death. And that, in itself, is a beautiful and
courageous thing. If you've found value in today's
Deep Dive, please do consider rating and sharing
this with a colleague or friend who might benefit
from this conversation. Until next time, keep
digging deeper.