Welcome to The Deep Dive, the show where we cut
through the noise and get straight to the insights
that truly matter. Today, we're tackling a challenge
that I know resonates deeply with many of you,
especially those navigating the, well, the demanding
landscape of mid -senior roles in the medical
field. It's that pervasive feeling, isn't it?
Being constantly under pressure, striving for
clinical excellence, perhaps achieving it outwardly,
you know. complex procedures, groundbreaking
research, but secretly feeling, well, overwhelmed.
You might be delivering exceptional patient care,
hitting every professional metric, but then you
look around and wonder, what's happened to my
personal life? Am I truly connecting with my
team or am I just sort of managing tasks? It's
a familiar cycle, isn't it? You might try a new
stress reduction technique full of enthusiasm,
only for it to fizzle out after a few weeks,
or you attend a leadership workshop, but the
promised improvements and team dynamics never
quite stick. It can be incredibly frustrating
to feel like you're working harder, but not necessarily
smarter, or certainly not with sustained well
-being. That's why today's deep dive is so crucial.
We're not looking for quick fixes or superficial
tips to cope with burnout. This is a profound
exploration into what truly drives sustained
personal and professional effectiveness, particularly
within the healthcare context. It's a journey
to understand the foundational principles that
shape our impact, our relationships with patients
and colleagues, and, well, our overall well -being.
And to guide us through this intricate terrain,
we have the immense privilege of welcoming Professor
Mo Imam. He possesses a remarkable ability to
synthesize diverse insights, connecting them
directly to the broader implications of professional
and personal life, especially in high -stakes
environments like medicine. Thank you for joining
us. It's a real pleasure to be here. This area
of human effectiveness is one I find endlessly
fascinating, precisely because the challenges
you've just described are so, well, so universal.
Many medical professionals in particular face
quite unique pressures, yet the solutions often
feel elusive when we look in the wrong places,
perhaps focusing only on the external. Absolutely,
and that's a perfect place to begin, isn't it?
Many professionals express these very frustrations,
achieving career goals but at significant personal
cost, struggling to maintain commitments, or
facing a lack of genuine loyalty from their teams
despite trying seemingly good management practices.
Why do these outward approaches often fall short,
leaving people in this cycle of disappointment?
Well, it's a fundamental misdirection, really.
We often try to address symptoms with techniques
rather than dealing with the underlying condition
you see. Consider the example of some parents
trying to help their son with baseball. He was
struggling, getting quite upset, and they tried
everything. Encouragement, positive reinforcement,
telling others to leave him alone. But nothing
truly helped. And they could see his self -esteem
eroding. They were essentially trying to change
his performance, his outward behavior, without
really understanding the deeper dynamic. They
were, in a sense, getting social mileage out
of his good behavior. And when he didn't measure
up, it reflected on them. Ah, right. So it wasn't
just about his batting average. It was about
their perception of him and perhaps their own
roles as parents. Precisely. They eventually
realized that their efforts were rooted in a
subconscious desire for their son to be, well,
socially impressive to others, rather than a
pure concern for his own well -being. And this
brings us to a really critical distinction, the
character ethic versus the personality ethic.
Much of what we see today in self -help, and
even some professional development literature,
particularly the sort of quick fix advice, falls
squarely into what we might call the personality
ethic. Could you elaborate on that a bit? What
defines the personality ethic, maybe looking
at it through a medical lens? Certainly. The
personality ethic focuses on, well, superficial
traits. Think about things like a polished bedside
manner, but without genuine empathy underneath.
Or perhaps adopting a power look in the operating
theater simply to assert dominance. Or maybe
feigning interest in a patient's life story just
to gain compliance. While these techniques might
seem beneficial in the short term, they can actually
be quite manipulative, even deceptive at times.
They're designed to influence quickly, but they
lack genuine internal change. the facade rather
than the substance, like perhaps faking interest
in a colleague's weekend just to get them onside
for a project, or that quick smile for a patient
when your mind is actually completely elsewhere.
Exactly, that's spot on. The problem is that
while these secondary traits might work in brief,
sort of one -off interactions maybe in a quick
consult or during a rushed ward round, they hold
no permanent value in long -term relationships.
In patient -doctor relationships that span years,
or with colleagues in a tight -knit medical team,
true motives eventually surface, don't they?
If there isn't deep integrity and fundamental
character strength, the challenges of medical
practice, the difficult diagnoses, the long shifts,
the inevitable administrative burdens will expose
the true self. Short -term efficiency gives way
to a breakdown in trust and relationship failure.
Many people with what you might call secondary
greatness, social recognition for their talents,
or perhaps a brilliant surgeon known for their
technical skills seem to lack this primary greatness
of character. Sooner or later, this becomes evident
in every long -term relationship they have, be
it with patients, junior staff, or peers. That
makes perfect sense. I think we've all encountered
professionals who are incredibly charming initially,
but over time you start to feel something isn't
quite right somehow. So if that's the personality
ethic, what then is the character ethic? How
does that differ? The character ethic is, well,
it's foundational. It centers on profound integrity
and fundamental character strength. It's about
what you are, fundamentally, not just what you
do or say. There's a powerful observation that
really encapsulates this. What you are shouts
so loudly in my ears, I cannot hear what you
say. It means your character communicates most
eloquently, influencing people silently and unconsciously
simply by its constant radiation. It's not about
pretending to be something you're not. It's about
what you really are, perhaps a physician whose
compassion is palpable or a leader whose integrity
is simply unquestioned. That's a profound statement.
What you are shouts so loudly. It implies that
true influence isn't really about technique,
but about who you authentically are, especially
in a field like medicine where trust is absolutely
paramount. Precisely. While personality growth
and communication skills are certainly beneficial,
even essential in some medical contexts, they
are secondary. They have to be built upon a foundation.
Over generations, we've inadvertently become
so focused on building the visible parts, the
techniques and strategies that we've perhaps
forgotten the fundamental foundation that supports
it all. Trying to change outward attitudes and
behaviors will do very little good in the long
run if the underlying paradigms remain unexamined.
And what exactly do you mean by paradigms? How
do they connect to this fundamental shift you're
describing? Paradigms are essentially our fundamental
maps, the lens through which we see the world.
Think of them as the basic assumptions, the internal
frames of reference, that shape how we interpret
everything around us. Many years ago at Harvard
Business School, I saw a really powerful demonstration
of this. An instructor showed a picture, and
half the class saw a beautiful young woman, while
the other half saw an old, sad woman. Really?
Both from the same picture? Yes. And both groups
were sincere, clear -headed people, yet they
saw something completely different. That's incredible!
How is that actually possible? Well, the instructor
had preconditioned them for just 10 seconds by
showing them a slightly different image first.
If 10 seconds can have such a profound impact
on perception, imagine the conditioning of a
lifetime. Our families, schools, workplaces,
friends, and even prevailing social paradigms,
like the personality ethic we just discussed,
all subtly shape our maps, our paradigms. They
make us see the world not as it is, but as we
are. or perhaps as we have been conditioned to
see it. Right. So when we disagree with someone,
maybe a colleague on a specific treatment plan
or a patient about their health choices, we often
instinctively think there's something wrong with
them when actually we might just be looking through
completely different lenses. It's exactly right.
It shows how profoundly our paradigms affect
our interactions. When we open our mouths to
describe what we see, we are in effect describing
ourselves, our perceptions, our own maps. The
demonstration also highlighted that even when
people knew another viewpoint existed, they initially
struggled to see it. It took calm, respectful,
specific communication for each person to eventually
see both images. This reveals the deep -seated
nature of our conditioning. And until we change
our basic paradigms, until we see things differently,
until we change our being, we cannot create true
sort of quantum change in ourselves or in the
situation. And that's where paradigm shifts come
in, which you mentioned create powerful change.
Could you give us an example of perhaps an instant
paradigm shift? Certainly. I recall being on
a subway once in New York, and a man got on with
his children. They were running absolutely wild,
very loud, incredibly disruptive. Everyone around,
myself included, felt immense irritation. I couldn't
quite believe his insensitivity. So I finally
turned to him, with what I thought was unusual
patience and quietness, and suggested he might
want to control his children a bit more. He just
lifted his gaze, as if becoming aware for the
first time, and said softly, Oh, you're right.
I guess I should. We just came from the hospital
where their mother died about an hour ago. I
don't know what to think, and I guess they don't
know how to handle it either. Oh, wow. That would
be an instant shift. Your whole perception of
the situation would just flip completely. My
irritation vanished. Instantly. my paradigm shifted.
Suddenly I saw things entirely differently because
I saw differently, I thought differently, felt
differently, behaved differently, compassion
flowed freely, everything changed in an instant.
This illustrates how a paradigm shift can be
instantaneous and profoundly alter our entire
response. Of course, not all shifts are instant
like that. The change my wife Sandra and I experienced
with our son regarding his baseball was a slow,
deliberate process, an outgrowth of years of
conditioning. But both illustrate that until
we change our basic paradigms until we see things
differently, we cannot create true quantum change
in ourselves or in a situation. So if paradigms
are our subjective maps, our personal understanding,
what then are principles and how do they fit
into this whole framework? Ah, principles are
entirely different. They're like natural laws,
immutable and external. Think of gravity. You
can't break the law of gravity. You can only
break yourself against it. As Cecil B. DeMille
once observed about the principles in the Ten
Commandments, it is impossible for us to break
the law. We can only break ourselves against
the law. Principles are self -evident, universal,
and they apply regardless of our awareness, acceptance,
or belief in them. They aren't esoteric or mysterious.
They're part of the human condition embedded
in almost every major enduring religion and social
philosophy. Okay, so principles are the objective
reality, the territory, whereas paradigms are
our maps of that territory. Is that a fair way
to put it? Precisely. That's a very good way
to put it. Examples include fairness, which forms
the basis of justice, say, in a hospital complaint
system, integrity and honesty, which are absolutely
the foundation of trust with patients, human
dignity, service, quality, excellence, potential,
and growth. Growth, for instance, inherently
requires patience and nurturance, something often
seen in long -term patient rehabilitation or
mentoring junior doctors. These principles govern
the consequences of our behavior, regardless
of our internal values or beliefs. Humility means
submitting to these principles, recognizing we
are not ultimately in control of the consequences.
Pride, conversely, is the belief that we are
in control, that we can somehow defy these laws,
which invariably leads to negative consequences.
So, our values might guide our behavior, but
it's the principles that determine the outcome.
For a medical professional, this might mean that
while you value efficiency in clinic, perhaps,
it's the principle of patient safety that ultimately
dictates the consequences of cutting corners.
Absolutely. The personality ethic, with its focus
on quick fixes and superficial techniques, is
like trying to navigate a complex surgical procedure
with an outdated or incorrect anatomical map.
It's illusory and deceptive because it's based
on an incorrect understanding of how human relationships
and effectiveness truly operate. Adhering to
principles provides that correct map, making
our decisions meaningful and genuinely effective.
As Eric Fromm noted, the individual behaving
like an automaton, knowing only who they are
supposed to be rather than who they genuinely
are, is a sad consequence of living by a synthetic
external script. That really clarifies the foundation
beautifully. Now, moving from these foundational
concepts, let's delve into what you call private
victory, the mastery of self. This begins with
the concept of habits. How do you define a habit
in this specific context? Well, for our purposes
here, a habit is really the intersection of three
components. Knowledge, skill, and desire. Knowledge
is the what to do and the why to do it. The theoretical
paradigm, if you like. Skill is the how to do
it. And desire is the motivation, the want to
do it. For something to truly become a habit,
all three must be present and integrated. For
example, a clinician might know they need to
listen better to patients to interact effectively,
but they might lack the actual skill of deep
empathic listening or perhaps the genuine desire
to do it consistently amidst time pressures.
If anyone is missing, the behavior isn't truly
a habit yet. And these habits are part of a progression,
you say, from dependence to independence. How
does that typically unfold in something like
a medical career? We all begin life independence.
Think of being a medical student, a junior doctor,
where the paradigm is, you take care of me. As
we mature and gain experience, we ideally move
towards independence. I can do it myself, making
autonomous clinical decisions, for instance.
This is a significant achievement, freeing us
from being controlled by circumstances or others'
directives. However, true independence isn't
the ultimate goal in effective living, interdependence
is. But interdependence, the ability to share
deeply and meaningfully with others and access
their vast resources absolutely crucial for multidisciplinary
healthcare teams, is a choice only independent
people can truly make. Dependent people lack
the character, the self -mastery, to choose interdependence
effectively. This is why habits 1, 2, and 3 are
so critical. They are the private victories,
the essence of character growth and self -mastery,
and they absolutely must precede any public victories.
You simply cannot harvest a crop before you plant
the seed. It's an inside -out process, a natural
sequence of growth that cannot be shortcut. That's
a crucial point, the inside -out nature of it
all. Let's explore Habit 1, then. Be proactive.
What's the core principle here, especially for
a medical professional dealing with often uncontrollable
factors like patient load or system constraints?
Well, the core principle of proactivity comes
quite powerfully from Viktor Frankl, the psychiatrist
who survived the Nazi concentration camps. In
the midst of unimaginable degradation, he discovered
what he termed the last of the human freedoms,
the freedom to choose your response. Even when
everything else was taken from him, his family,
his profession, his dignity, his captors could
not control his inner world, his attitude, his
decision on how all of it was going to affect
him. Between stimulus and response, he realized,
lies humanity's greatest power, the freedom to
choose. That's incredibly powerful, especially
coming from such extreme circumstances. What
are the unique human endowments that actually
enable this freedom to choose? We possess four
unique human endowments that set us apart. Beyond
self -awareness, which is our ability to think
about our very thought process, we have imagination
the capacity to create beyond our present reality,
perhaps visualizing a better patient outcome
or different way to structure a service. We have
conscience, a deep inner awareness of right and
wrong, guiding us towards principles, especially
vital in complex ethical dilemmas common in medicine.
And we have independent will, the ability to
act based on our self -awareness, free of other
influences. Animals, by contrast, are largely
programmed by instinct. They can be trained,
certainly, but they cannot take responsibility
for that training or fundamentally change their
programming. We, as humans, can write new programs
for ourselves, totally apart from our instincts
and training. So proactivity is much more than
just taking initiative, then. It's about being
fundamentally responsible for our own lives,
not blaming external circumstances like, say,
overwhelming administrative tasks or difficult
patients. Exactly. Proactivity means our behavior
is a function of our decisions, not our conditions.
We subordinate our feelings to our values. The
word responsibility itself, if you analyze it,
means responsibility, the ability to choose your
response. If our lives feel controlled by conditioning
or circumstances, it's because we've consciously
or perhaps by default chosen to empower those
external factors. It's often hard to accept emotionally,
especially if we've spent years explaining our
misery by blaming others or circumstances. But
until we can say deeply and honestly, I am what
I am today because of the choices I made yesterday,
we cannot truly say I choose otherwise. That's
quite a shift in perspective, isn't it? Can you
give us some example of how this might play out
in a medical setting, perhaps? Certainly. I recall
a nurse who worked with a profoundly difficult
and, frankly, ungrateful patient. She described
her life as miserable, constantly taking her
frustrations out on her family when she got home
at night. Then she heard about this idea of choosing
her response. In that moment, she felt a profound
sense of liberation. She realized she wasn't
actually controlled by the patient's behavior.
She had the freedom to choose her own response,
choosing patients, professionalism, compassion.
This insight apparently transformed her life
and her relationships. It's a powerful testament
that is not what happens to us but our response
to what happens that truly impacts us. Our most
difficult experiences such as challenging patient
cases or stressful periods in a hospital can
actually become the crucibles that forge our
character. And this ties into the concept you
introduce of the circle of concern versus the
circle of influence. What's the distinction there
for a busy healthcare professional grappling
with so much? We all have a vast range of concerns,
don't we? Our health, our children's problems,
NHS waiting lists, global pandemics, systemic
bureaucracy in our trusts. These form our circle
of concern. Within that, there's a smaller circle
of influence, encompassing the things we can
actually do something about. Proactive people
focus their time and energy squarely on their
circle of influence. Their energy is positive,
enlarging, and causes their circle of influence
to expand over time. Reactive people, conversely,
tend to focus on their circle of concern, blaming
others, complaining about circumstances they
can't control. This leads to feelings of victimization
and, ironically, causes their circle of influence
to actually shrink. So, by working on ourselves,
within our circle of influence, say, improving
our own communication skills or managing our
own stress levels better, we can actually impact
the external circumstances that initially seemed
outside our control, like team dynamics or even
patient satisfaction scores. Precisely. My own
experience with our son and his baseball difficulties
illustrates this perfectly. For a long time,
my wife Sandra and I focused on his weaknesses
and how others treated him. All of that was within
our circle of concern. Nothing changed, except
our own feelings of inadequacy grew. It was only
when we shifted our focus to our own paradigms,
our own reactions, things within our circle of
influence, that we created positive energy that
influenced both ourselves and eventually our
son. Another powerful example comes from a group
of hospital executives I worked with during a
severe budget recession. Initially, they were
completely demoralized, focusing on what's happening
to us and the bleak future. On the third day,
we deliberately shifted to the proactive question.
What is our response? What are we going to do?
How can we exercise initiative within these constraints?
They brainstorm practical steps to manage costs,
improve efficiency, and increase patient engagement.
This shift from reactive concern to proactive
response, generated a completely new spirit of
excitement, hope, and proactive awareness. That's
a powerful transformation indeed. And finally,
on proactivity, you mentioned something intriguing.
Love as a verb. What does that mean in this context,
perhaps for patient care or team leadership?
Reactive people often equate love with a feeling.
They wait to feel love or connection to act lovingly,
driven by modern scripts that suggest we're simply
products of our feelings. But proactive people
understand that love is a verb. Love, the feeling,
is actually a fruit of love, the verb. It's something
you do. The sacrifices you make for a patient's
well -being. The giving of self in mentoring
a junior colleague. The acts of service, empathy,
appreciation, even when you don't feel like it.
If our feelings control our actions, it's because
we've abdicated responsibility. Proactive people
choose to subordinate their feelings to their
values and by acting lovingly the feeling of
love can also be rekindled or deepened even in
demanding medical situations or strained team
relationships. That's a challenging but ultimately
liberating thought. Now let's move to habit two.
Begin with the end in mind which you call personal
leadership. What's the core principle behind
this habit especially for shaping a medical career?
It's based on the fundamental principle that
all things are created twice. There's always
a mental or first creation and then a physical
or second creation. Think about building a house
or even planning a complex surgery. Before a
surgeon makes the first incision, they design
the entire procedure, planning it in meticulous
detail, visualizing every step, anticipating
potential issues. This mental creation absolutely
precedes the physical execution. In our personal
lives, and indeed in our professional medical
lives, if we don't take charge of our first creation
through conscious design, we allow external circumstances
and other people's agendas, be it administrative
pressures, funding cuts, or peer expectations
to shape our lives by default. We end up reactively
living scripts handed to us, rather than intentionally
creating our own. So it's about defining our
own blueprint for life, our own vision, before
we start building it day by day. And to help
us connect with that blueprint, you suggest a
rather powerful visualization exercise. Indeed.
It's quite profound. I invite people to imagine
attending their own funeral, perhaps three years
from today. Visualize yourself there, looking
into the casket and seeing yourself. Then listen
intently to what four speakers, one from your
family, one from your friends, one from your
work or profession, and one from your community
or other involvements would say about you and
your life. What kind of person, spouse, parent,
friend, or colleague would you want them to remember?
what contributions, what achievements would truly
matter. This exercise helps you connect with
your deepest, most fundamental values and establishes
an inner guidance system for your life and your
medical practice. That's a truly profound exercise.
It really forces you to confront what truly matters
in the grand scheme of things rather than getting
caught in what you call the activity trap, something
I suspect many doctors can relate to, just being
incredibly busy. Exactly. It's incredibly easy
to get caught up in the sheer busyness of a medical
career, working harder and harder at climbing
the ladder of success, only to discover, perhaps
much later in life, that the ladder was leaning
against the wrong wall all along. People often
achieve victories that feel hollow, successes
that come at the expense of things they suddenly
realize were far more valuable. Perhaps relationships,
health, personal well -being, even their initial
passion for medicine. By beginning with the end,
clearly in mind, you ensure that every daily
action, every long shift, every challenging patient
interaction contributes meaningfully to the vision
you have for your life as a whole. This sounds
like a clear distinction between efficiency and
effectiveness, doesn't it? It is. Very much so.
This brings us to the critical difference between
leadership and management. Management is fundamentally
a bottom line focus. How can I best accomplish
certain things? It's about doing things right?
Perhaps sharpening the surgical tools more effectively?
or streamlining patient intake processes more
efficiently. Leadership, on the other hand, is
a top -line focus. What are the things I want
to accomplish? It's about doing the right things,
about determining whether we're even in the right
jungle to begin with. Think of a group of medical
producers cutting their way through a jungle
with machetes. They're busy, efficient. The managers
are behind them, ensuring the scalpels are sharp,
protocols are followed, schedules are set. But
the leader is the one who climbs the tallest
tree, surveys the entire situation, and yells,
wrong jungle. And the busy producers down below
often respond, shut up, we're making progress.
Precisely. That's often the case. In our fast
-changing world, especially in healthcare with
its constant evolution, effective leadership
is more critical than ever. No amount of management
success, no matter how many patients you see
or procedures you perform efficiently, can compensate
for a failure in leadership in setting the right
direction. If we're busy doing the wrong things,
even very efficiently, we're still fundamentally
going in the wrong direction. So how do we actually
begin to write our own script, especially if
we feel we've been living with scripts handed
to us by our conditioning, our upbringing, or
perhaps the demanding culture of medicine itself?
Well, that's the process of re -scripting, or
paradigm shifting, and it's enabled by our unique
human down -ends, self -awareness, imagination,
and conscience. Through imagination, we can visualize
the uncreated worlds of potential that lie within
us. Perhaps a new approach to patient care, a
different research direction, or even a shift
in our work -life balance. Through conscience,
we connect with universal principles and identify
our unique contributions and values. Combined
with self -awareness, these empower us to consciously
write our own script, changing the ineffective
or incongruent paradigms we may have inherited.
A powerful example outside of medicine, but illustrating
the principle, is Anwar Sadat, the former president
of Egypt. He was deeply scripted from his background
with a hatred for Israel, publicly declaring
he would never shake the hand of an Israeli.
deeply rooted in his own inner conviction developed
during years in prison, he initiated one of the
most significant peace movements in modern history.
That's a remarkable transformation impacting
millions of lives. So this rescripting process
ideally leads to creating a personal mission
statement. Yes, exactly. A personal mission statement
defines your unique meaning and mission in life.
It acts as a personal constitution. based on
correct principles against which every decision
about your time, your talents, and your energies
can be measured. It becomes the unwavering anchor
in a rapidly changing world, providing purpose
and meaning. As Viktor Frankl discovered, even
in the death camps, having a sense of meaning,
a why, eliminates the underlying emptiness that
can often plague professionals experiencing burnout
or disillusionment. And you say this personal
mission statement provides four critical life
support factors. Can you outline those? Yes.
These factors are security, guidance, wisdom,
and power. Security is your fundamental sense
of worth, your identity, your emotional anchorage,
knowing you're grounded in your principles, not
just fleeting professional achievements or failures.
Guidance is your source of direction, an internal
frame of reference for making complex clinical
decisions or navigating ethical challenges. Wisdom
is your perspective, your balance, your understanding
of how principles apply and relate, for instance,
knowing when to push for an aggressive intervention
versus when to prioritize comfort and palliation.
And power is your capacity to act, to accomplish
something meaningful, and, importantly, to overcome
deeply embedded habits like procrastination,
perfectionism, or perhaps chronic overwork. These
four factors are interdependent and flow directly
from whatever is at the center of your life,
significantly impacting its overall effectiveness.
You also talk quite extensively about alternative
centers that people often build their lives around
and why they ultimately fall short. I imagine
this is very common in demanding professions
like medicine. Indeed, it's extremely common.
Many people center their lives on their spouse,
their family, money, possessions, pleasure, friends,
sometimes even enemies. or very commonly, their
career or work. While these can be important
aspects of life, when they become the absolute
center, they introduce significant vulnerability.
For example, if your emotional worth comes primarily
from your medical career, your status, your patient
outcomes, you become dependent and vulnerable
to the inevitable ups and downs, the politics
of your department, funding changes, or even
just the mood of a difficult colleague or patient.
This often leads to deep insecurity as these
external factors are constantly changing. Similarly,
if your life is solely family -centered, your
need to be popular with your children might override
their long -term growth and development, leading
to conditional love and emotional dependency
rather than fostering true independence. And
money or possessions as a center. I imagine that's
a common one in professional life, perhaps less
explicitly stated. Very much so. While economic
security is clearly important, if your fundamental
sense of worth is derived solely from your income
or net worth, you can become anxious, defensive,
and highly vulnerable to economic forces beyond
your control. Money itself provides no wisdom
or guidance and only limited power or security
in the deepest sense. Similarly, if pleasure
is your center, you'll constantly crave more
and more excitement or stimulation, often leading
to boredom and a wasting of potential. A pleasure
-centered life tends to leave capacities dormant,
talents undeveloped, and the heart ultimately
unfulfilled. Each of these alternative centers,
by their very nature, is subject to constant
change and external influence, thus fundamentally
limiting your security, guidance, wisdom, and
power. Even being church -centered, you suggest,
can be problematic. Yes, because simply attending
church or being active in a religious organization
is not synonymous with personal spirituality,
or living by core principles. One can be very
active in a church, but quite inactive in its
underlying gospel or teachings. If church -centeredness
becomes primarily about image or appearance,
maintaining a certain social standing, it can
lead to hypocrisy, undermining intrinsic worth
and security. A church, as a formal organization,
cannot provide deep permanent security. Only
living the principles it teaches can do that.
So a principle -centered life, then, provides
the stable, unchanging foundation. Absolutely.
By centering our lives on correct principles,
timeless universal principles like integrity,
service, fairness, human dignity, we create a
solid, unchanging foundation for our lives. Principles
don't react to being slighted. They don't get
angry. They don't have bad days. They don't die
or divorce you. They are fundamental truths that
govern consequences, regardless of circumstances
or how we feel about them. This brings profound
security, consistent guidance derived from a
correct map of reality, true wisdom that embraces
discernment and balance, and the personal power
to act effectively, unconstrained by the moods
or behaviors of others or external influences.
This is a crucial distinction we keep coming
back to. Principles are external natural laws
that govern consequences, while values are internal
and subjective beliefs. We need to value principles
to get the results we want effectively and sustainably.
And how do we tap into our capacity for this
first creation, this mental blueprinting, this
mission statement development, using our whole
brain, as you put it? Well, our ability to examine
our own thoughts, our self -awareness is absolutely
key here. The unique endowments of imagination
and conscience are primarily functions of the
right side of the brain. Research on brain dominance
consistently shows the left hemisphere is typically
logical, verbal, focused on parts and analysis,
while the right is more intuitive. creative,
dealing with pictures, holes, and synthesis.
To fully engage in first creation, especially
when grappling with complex medical scenarios
or planning our careers, we really need to tap
into that creative right brain to visualize,
to synthesize, to project a holistic picture
of what we want to be and do beyond just the
linear logical steps. So how do we actively tap
into this right brain capacity? Perhaps for a
medical professional looking to clarify their
path or find more meaning. There are two main
ways I suggest. First, you can consciously create
perspective -expanding experiences. We don't
have to wait for a crisis like a difficult diagnosis
hitting close to home or a personal illness to
force us to ask, what's really important here?
We can proactively choose to do exercises like
the funeral visualization we discussed earlier,
or perhaps vividly imagine our 25th or 50th wedding
anniversaries or our retirement party. Visualize
it in rich detail involving all senses and strong
emotions. I've done this in university classes
asking students to imagine they only had one
semester left to live. Suddenly their deepest
values surface and their actions become governed
by much deeper priorities like love, connection,
and reconciliation rather than just grades. And
the second way to tap the right brain you mentioned
is through focused visualization and affirmation.
This is about creating what I call a personal
positive present tense visual and emotional affirmation.
For instance, a physician who knows they tend
to overreact to administrative pressures or unexpected
delays might write an affirmation like, it is
deeply satisfying emotional that I personally
respond present tense with wisdom, calm and self
control. positive when new demands or interruptions
arise. Then they would visualize the scenario
playing out daily, seeing themselves handle it
perfectly, feeling the calm competence. So you're
essentially programming yourself for a desired
response. This could be incredibly powerful for
managing stress in high pressure medical environments,
couldn't it? Yes. In essence, you're consciously
writing a new script, one that's in harmony with
your deepest values and desired outcomes. My
son, Sean, used this technique extensively throughout
his American football career. We'd help him relax
deeply, then vividly visualize himself in the
toughest game situations, executing plays perfectly,
even visualizing feeling relaxed and confident
amidst intense pressure. Dr. Charles Garfield's
research on peak performers, from astronauts
to world -class athletes, consistently shows
they are powerful visualizers. They see it, they
feel it, they experience it mentally before they
do it physically, creating an internal comfort
zone. This is truly beginning with the end in
mind applied daily across all areas of life,
including preparing for complex surgical procedures,
challenging patient conversations, or even difficult
team meetings. That brings us beautifully to
Habit 3. Put first things first, which is all
about personal management. How does this habit
tie into the previous two we've discussed? Well,
if Habit 1 says you're the programmer and Habit
2 says write the program, then Habit 3 essentially
says run the program. It's the practical fulfillment,
the day -to -day, moment -to -moment living out
of your vision and values. It requires independent
will, self -discipline, integrity, and commitment
not just to short -term goals and packed schedules
or to the impulse of the moment, but to the correct
principles and your own deepest values which
give meaning and context to our goals, our schedules,
and indeed, our lives. This means having a clear
burning yes, burning inside that makes it possible
to say no to other, less important things. This
sounds like a much more profound approach to
time management, which is, let's face it, a perpetual
challenge for almost all medical professionals.
Indeed, it builds on previous generations of
time management theory, which evolved from simple
notes and checklists, to calendars and appointment
books, and then to prioritization based on values
clarification. But the most advanced, principle
-centered approach is what we call the fourth
generation, which focuses intently on quadrant
two activities. Quadrant two activities. Can
you explain what those are and why they are so
crucial for avoiding burnout and maintaining
effectiveness in a demanding field like medicine?
Certainly. Activities can generally be categorized
based on two factors, urgent and important. Quadrant
one is urgent and important crises, pressing
problems, deadline driven projects like an emergency
surgery or an urgent patient call. Quadrant three
is urgent but not important. Important interruptions,
some calls, some emails, some meetings, things
that press on us but aren't actually that important.
Quadrant three is not urgent and not important
trivia, time wasters, some phone calls, excessive
scrolling. Quadrant two is the crucial one, important
but not urgent. These are the PC activities,
things like prevention, exercise, healthy eating,
preventative care for ourselves. building relationships,
long -term planning, ongoing professional development
that's not tied to an immediate deadline, mentoring
junior staff, strategic thinking, and, crucially,
self -renewal. The key insight here is that the
enemy of the best is often the good, or even
the urgent. We often get caught up firefighting
in quadrant three, or reacting to the urgency
of quadrant three, which keeps us from the truly
important high -leverage work in quadrant two.
Saying no to urgent but ultimately unimportant
activities requires a clear sense of your mission
and values, that inner yes. burning so strongly
that you can decline genuinely, pleasantly, and
non -apologetically. So it's fundamentally about
scheduling your priorities rather than just prioritizing
what happens to be on your schedule or what shouts
loudest. Precisely. That's the essence of it.
The focus shifts from daily planning to weekly
organizing. As studies of effective people have
shown, most tend to think in terms of weeks,
providing a more balanced context. You identify
your various roles perhaps as an individual,
a clinician, a researcher, a team leader, a spouse,
a parent, a community member, and then you set
one or two important goals for each role for
the upcoming week. Critically, at least some
of these should be quadrant two activities. This
ensures balance, recognizing that neglecting
one vital role for too long will negatively impact
others. Your planning tool, whatever it is, needs
to reflect this. And crucially, it needs to incorporate
a people dimension. A people dimension. How does
that differ from traditional time management,
which often seems very task -focused? Traditional
time management often focuses on efficiency with
things, with tasks. But a principle -centered
person thinks primarily in terms of effectiveness
with people. There will inevitably be times when
quadrant two living requires subordinating your
carefully planned schedule to people. For example,
If a patient needs a deeper, more empathetic
conversation than scheduled, or a junior colleague
is genuinely struggling and needs real mentoring,
trying to be efficient with 10 minutes of prescribed
quality time will likely just create new problems
or further damage the relationship. You simply
cannot think efficiency with people. You must
think effectiveness. Your planning system needs
to reflect this value, allowing flexibility for
spontaneous human interaction without creating
guilt when you invest time in building relationships,
which is a vital quadrant two activity itself.
That's a profound shift in mindset, moving from
task efficiency to relationship effectiveness.
And this leads naturally to what you call stewardship
delegation. How does that work in practice, perhaps
in a busy clinical environment or research team?
Well, there are essentially two types of delegation.
Go for delegation and stewardship delegation.
Go for delegation is very method focused. Go
for this, do that, tell me when it's done. It's
essentially supervising methods. It severely
limits what one person can accomplish because
you have to be involved in almost every detail.
Stewardship delegation, conversely, is entirely
results focused. It gives people a choice of
method and makes them responsible for the results.
It definitely takes more time upfront in explanation,
training, and building understanding, but it
yields far greater leverage and builds much deeper
trust in the long run. It acknowledges and respects
the self -awareness, imagination, conscience,
and free will of the other person. So it's really
about empowering others to achieve agreed -upon
results rather than just dictating precisely
how they should do it. What are the key elements
needed for effective stewardship delegation?
There are five crucial elements that need clear
mutual understanding and commitment between both
parties. First, desired results. A crystal clear
mutual understanding of what needs to be accomplished,
focusing on outcomes, not methods. For example,
a consultant delegating patient follow -up calls
to a specialist nurse, agreeing on the specific
health outcomes or information needed, not dictating
the exact script. Second, guidelines, identifying
the parameters or boundaries within which the
individual can operate. Keep these as few as
possible to avoid slipping back into gopher delegation
or micromanagement. Include any critical failure
paths to avoid. Third, resources. Identifying
the human, financial, technical, or organizational
support available to help them achieve the results.
Fourth, accountability. Establishing the standards
of performance and the specific times and methods
for reporting back. And fifth, consequences.
Clarifying what happens, both positive recognition,
development opportunities, financial rewards,
and negative, perhaps retraining, adjusting responsibilities,
as a result of achieving or not achieving the
desired outcomes. Could you give us a tangible
example of this, perhaps outside a direct medical
context, to illustrate the principle clearly?
I often use the green and clean yard example
with my seven -year -old son. I wanted him to
take genuine responsibility for maintaining our
garden. Instead of just telling him to mow the
lawn or pull weeds, go for delegation, I took
him to our neighbor's impeccably manicured yard
and said, look son, that's what we're aiming
for, green and clean. That defined the desired
result. Then I told him he was completely free
to do it any way he wanted, except painted green.
Those were the guidelines. I offered myself as
a resource. I'll help you if you need me when
I have time. We established accountability by
agreeing to walk around the yard together twice
a week for him to show me how it was going, with
green and clean as the clear standard. And the
consequences were tied directly to his weekly
pocket money. The first day he did absolutely
nothing, which was initially quite frustrating
for me, I admit, but I remembered the core principle.
Self -management is hard, especially initially.
So instead of criticizing, I approached him with,
how's it going? Is there anything I can do to
help? He accepted my help. It required an investment
in my time up front in training and development,
showing him how to use the tool safely, how to
identify weeds. But in the long run, it built
his sense of responsibility immensely and saved
me countless hours. This is the core idea. Trust
is the highest form of human motivation. It brings
out the very best in people, but it requires
that initial investment in training and development
so their competency can rise to the level of
that trust. A medical team or a research group
or indeed any organization that effectively delegates
this way can achieve far, far more with much
less daily supervision and firefighting. That's
a fantastic illustration of the power of private
victory and how it sets the stage for effective
interaction. Once we've achieved a degree of
self -mastery, how does that translate to effective
interaction with others, which you call public
victory, something so critical in the complex
web of healthcare relationships? Public victory,
the success we achieve in working effectively
with others, is built directly and irrevocably
on the foundation of private victory habits one,
two, and three. Interdependence, as we discussed,
is a choice that only truly independent people
can make. If we lack self -mastery, if we haven't
paid the price of character development, our
attempts at human relations skills will inevitably
be superficial, manipulative even, like putting
a bandaid on a deep, chronic wound. This brings
us squarely to the concept of the emotional bank
account, which is absolutely central to all interdependent
relationships. An emotional bank account? That
sounds intriguing. Tell us more about that analogy.
It's a really powerful metaphor for the amount
of trust that's been built up in a relationship.
Every interaction is like making a deposit or
withdrawal. You make deposits through acts of
courtesy, kindness, honesty, keeping commitments,
and truly deeply understanding another person's
perspective. These build up a reserve of trust.
When the trust account is high, perhaps with
a long -term patient, a trusted colleague, or
a supportive department, communication becomes
easy. instant, and effective. You can even make
mistakes sometimes, and the high trust level
of positive balance will compensate for it. My
communication might not be perfectly clear, perhaps,
but you'll get my meaning because you trust my
intent. But if you habitually show discourtesy,
disrespect, inconsistency, or betray trust, you
make withdrawals. Eventually, the account becomes
overdrawn and trust diminishes, sometimes evaporating
completely. What are the consequences of a low
or overdrawn emotional bank account, maybe between
a doctor and patient or within a struggling medical
team? When the account is overdrawn, all flexibility
vanishes. Communication becomes tense, guarded,
often deteriorating into politicking, defensiveness,
or classic fight or flight responses. In intimate
relationships like marriage, it can lead to constant
tension or outright hostility. Think of a patient
who feels consistently rushed, interrupted, or
unheard by their doctor during consultations.
Over time, the withdrawals far exceed any deposits.
When that patient faces important or frightening
treatment decisions, even if the doctor has the
best clinical advice, the trust level is so low
that the patient simply won't be open to their
counsel. They might make decisions based on fear,
short -range emotional perspectives, or even
seek care elsewhere, feeling misunderstood or
uncared for. Building and repairing these accounts
is a long -term investment, not a quick fix.
And it's important to realize there are sometimes
automatic, unseen withdrawals happening in our
daily interactions, like a subtly dismissive
tone, a failure to follow through, or appearing
preoccupied. So what are the most important deposits
we can make, specifically thinking about professional
relationships in a healthcare setting? Well,
I suggest six major types of deposits. First,
and arguably the most important because it informs
all others, is understanding the individual.
You simply don't know what constitutes a deposit
for another person until you truly understand
them from their frame of reference. What might
be a deposit for you say? Providing a very detailed
technical medical explanation could actually
be a withdrawal for a patient if it doesn't align
with their deep -seated fears, their values,
or their level of health literacy. It requires
genuine effort to see the world from their viewpoint.
I had a friend who actively disliked baseball,
but spent six weeks traveling around taking his
young son to see every major league team play.
When I asked him about it, he said, I don't like
baseball that much, but I like my son that much.
That was a massive deposit because it was genuinely
about understanding and valuing his son's interest,
not his own. That's a beautiful example of valuing
someone else's perspective and making a tailored
deposit. What about the other five? Second, attending
to the little things. Small acts of courtesy,
kindness, and respect are vital. A simple, genuine
thank you to a nurse who's gone the extra mile,
remembering a patient's personal detail they
shared previously, offering a cup of tea to a
stressed colleague. These small things add up
significantly. Third, keeping commitments. This
is absolutely fundamental for building trust.
Broken promises shatter trust. Kept promises
build what I call bridges of trust. This is crucial
for things like following up on referrals as
promised, keeping appointment times reasonably
well, or delivering on commitments made to team
members. Fourth, clarifying expectations. The
root of almost all relationship difficulties
lies in conflicting or ambiguous expectations
about roles, goals, or responsibilities. Many
of these expectations are implicit and unstated.
Explicitly discussing roles and goals, whether
with patients about prognosis and treatment plans
or with team members about their specific responsibilities
on a project, prevents a huge amount of misunderstanding
and conflict later on. Fifth, showing personal
integrity. This means treating everyone by the
same set of principles consistently. Crucially,
it includes how you speak about people when they're
not present. Duplicity, like bad -mouthing colleagues
in the staff room or criticizing management behind
their backs, makes huge withdrawals because it
communicates your own lack of integrity. As I
often say, it's better to be trusted than to
be liked. Trust is built on character, not just
superficial pleasantries or trying to please
everyone. And finally, the sixth one, which I
imagine can be difficult but vital, making sincere
apologies when we inevitably mess up. Yes. Apologizing
sincerely when you make a withdrawal. It requires
immense character strength and personal security
to genuinely say, I was wrong, or that was unkind
of me, or I showed you no respect and I am deeply
sorry. This is particularly difficult but absolutely
vital in medicine when errors occur, whether
clinical or interpersonal. However, repeated
insincere apologies just saying sorry without
changing behavior actually become withdrawals
themselves. People tend to forgive mistakes of
the mind, errors in judgment, unintentional slip
-ups. But they do not easily forgive mistakes
of the heart -perceived ill intentions, bad motives,
or prideful cover -ups in defensiveness. A father
I knew once overreacted badly to his son, then
apologized shortly after. But the son refused
to forgive, saying bluntly, because you did the
same thing last week, Dad. The emotional bank
account was clearly overdrawn. His apology lacked
the weight of consistent positive deposits and
behavioral change. This concept of deposits and
withdrawals also touches on the laws of love
in life, doesn't it? Particularly regarding unconditional
positive regard. It does, very much so. When
we make consistent deposits of unconditional
love, which is not permissive or soft love, but
rather genuine acceptance and affirmation of
another's intrinsic worth, separate from their
behavior, we create a safe space that encourages
them to live by the laws of life. Cooperation,
self -discipline, integrity. Rebellion, whether
from a teenager or perhaps even a disillusioned
colleague, is often fundamentally a nod of the
heart, born of unmet needs for understanding
and validation, not just a disagreement of the
mind. Unconditional love provides the security
necessary for natural growth and positive change.
For example, a university dean I knew had meticulously
planned for his son to attend his prestigious
alma mater. When his son chose a different path,
the dean, after much soul -searching, consciously
sacrificed his own desire and resolved to love
and support his son unconditionally, regardless
of his choice. That unconditional love, though
incredibly difficult for him, ultimately empowered
his son and preserved their precious relationship.
And this relates to viewing problems as opportunities
even within the pressures of health care. Yes,
absolutely. In interdependent situations, which
covers almost all of health care, every P problem,
every production problem, every conflict, maybe
a patient complaint, a team disagreement, a system
failure, is fundamentally a PC opportunity. It's
a chance to build a relationship, to make deposits
into the emotional bank accounts that significantly
affect interdependent production and cooperation.
When medical professionals learn to see patient
concerns, team conflicts, or system glitches
not just as negative burdensome irritations,
but as golden opportunities to strengthen bonds,
clarify expectations, and build trust, interactions
shift from being merely transactional to being
truly transformational. This creates deep bonds
of trust and collaboration that are far more
resilient and effective. That leads perfectly
into habit four, think win -win, which you describe
intriguingly as seeking the third alternative.
What exactly is win -win in a complex medical
context where resources can be tight and pressures
high? Win -win is fundamentally a frame of mind
and heart that constantly seeks mutual benefit
in all human interactions. It means that agreements
or solutions are mutually beneficial and mutually
satisfying, where all parties feel good about
the decision and are genuinely committed to the
resulting action plan. It sees life, including
professional life, as primarily a cooperative
arena, not a competitive one. The core belief
underpinning win -win is the possibility of a
third alternative. It's not simply your way or
my way, it's a better way, a higher way that
we can potentially discover together, one that
satisfies the underlying needs of both parties
more effectively than either original position
could. This is absolutely crucial for things
like shared decision making with patients about
their care or for achieving effective interdepartmental
collaboration within a hospital. And you contrast
this win -win approach with several other common
paradigms we often fall into. Yes, understanding
the alternatives highlights why win -win is so
important. There's win -lose, which is the authoritarian
approach. If I win, you lose. This is often rooted
in personal insecurities and heavily scripted
from things like conditional love and families,
intensely competitive academic or athletic systems,
and even our often litigious society. In medicine,
it might manifest as a senior doctor dictating
treatment without genuine patient input, or perhaps
one department hoarding resources at the expense
of another. It might yield short -term compliance,
but creates weak adversarial relationships long
-term. Then there's loose win, which is the opposite
permissive, weak, often chaotic. It's essentially
being a doormat you give in, allowing others
to win at your expense, often to keep the peace
or gain acceptance. Also rooted in insecurity,
perhaps seen in a junior doctor constantly deferring
to seniors even if they have a valid clinical
concern. Loose -loose is the paradigm of conflict
and adversity, often driven by revenge or ego,
where people become so obsessed with making the
other person lose that they don't care if they
lose themselves. Think of a bitter departmental
feud or intractable industrial action. Obviously
not viable long term. And simply, WIN focuses
only on getting one's own way, securing one's
own gain, with no real consideration for the
needs or perspectives of others. While perhaps
seeming strong initially, it's just not productive
in the long run in interdependent relationships
where cooperation is needed. So why is WIN -WIN
really the only truly viable long -term alternative
in interdependent realities like a modern hospital
system or research collaboration? Well, think
about it. In an interdependent context, if one
party consistently loses, or feels they are losing,
the relationship itself, the goose that produces
the golden eggs of cooperation, innovation, and
effective results, will inevitably suffer. Trust
erodes, communication breaks down, motivation
wanes, and eventually the relationship ceases
to be productive. In the long run, If it isn't
a win for both of us, we both ultimately lose.
That's why win -win, or at least striving for
it, is the only real sustainable alternative
in situations where ongoing collaboration is
necessary. This is also why a crucial fallback
option is win -win or no deal. If, after sincere
effort, a truly mutually beneficial solution
cannot be found, you agree to disagree agreeably,
preserving the relationship for future possibilities.
It's far better to realize this upfront and walk
away with respect. Like a family singing group
I knew where the mother established win -win
or no deal to honor her children's creative input,
but to push through a poor compromise that creates
resentment and damages trust down the line. This
might mean, for a medical team, agreeing not
to proceed with a non -critical initiative if
consensus can't be reached, rather than forcing
a solution that alienates half the team. That
certainly takes a lot of maturity and security
to implement, especially the no -deal part. You
also highlight five essential dimensions required
to make win -win work consistently. Indeed. Achieving
consistent win -win outcomes isn't just about
attitude. It requires development across five
interdependent dimensions. First, character.
This involves integrity. alignment with your
values and principles, maturity, the balance
between courage to express your needs and consideration
for others' needs, and what I call the abundance
mentality. Second, strong relationships. You
need a high positive balance in the relevant
emotional bank accounts, built on trust. Third,
clear agreements. These need to flow from the
relationship and define the win -win terms, often
called performance agreements or partnership
agreements. Fourth, Supportive systems. The organizational
structures and processes, especially reward systems,
must be aligned with and support win -win goals,
not undermine them. And fifth, a clear process
for negotiation, which typically involves four
steps. First, seeing the problem from the other's
point of view. Second, identifying the key issues
and concerns involved. Third, determining what
results would constitute a fully acceptable solution
for all parties. And fourth, identifying new
possible options or alternatives to achieve those
results. The abundance mentality you mentioned
sounds particularly important for fostering collaboration
rather than competition, which can sometimes
pervade medical practice or academia. It is absolutely
fundamental to win -win. The abundance mentality
flows from a deep inner sense of personal worth
and security. It's the paradigm that there is
plenty out there for everybody, enough success,
enough recognition, enough resources. It results
in sharing of prestige, of recognition, of profits,
of decision making. It opens up possibilities,
options, alternatives, and creativity. In stark
contrast, the scarcity mentality is the zero
-sum paradigm. The idea that if someone else
wins, you must lose. It sees life as a fixed
pie. People with a scarcity mentality have difficulty
sharing recognition or credit, power, or profit.
They struggle with celebrating other successes
and often see differences as signs of disloyalty
or threats. This often leads to hoarding information
or resources and fostering unhealthy competition,
perhaps in terms of patient referrals, research
funding, or academic advancement. When you possess
an abundance mentality and are genuinely committed
to finding win -win solutions, your influence
becomes truly transformative, capable of changing
not only the relationship dynamics, but also
the individuals involved for the better. And
this abundance mentality and win -win approach
translates directly into creating win -win performance
agreements. How do these differ from traditional
management approaches? Yes. These agreements
fundamentally shift the paradigm from vertical,
top -down, hovering supervision to a horizontal,
self -supervising partnership. They move from
dictating methods to agreeing on outcomes and
empowering individuals. The five elements of
stewardship delegation we discussed earlier are
crucial here. specifying desired results, the
what, not the how, clear guidelines, available
resources, defined accountability standards and
timelines, and agreed upon consequences, both
positive and developmental. For example, imagine
a department head setting up a win -win agreement
with a new consultant regarding their research
focus. The desired results might be specific
outputs like publications in certain journals
within a time frame. The guidelines would cover
ethical conduct and resource constraints. Resources
might include lab access, statistical support,
and protected time. Accountability could involve
regular progress meetings against agreed milestones,
and consequences might be tied to career progression,
further funding, or recognition. This structure
empowers the consultant to take ownership and
manage themselves to achieve the agreed goals
because their own integrity and conscience become
the driving force, which is infinitely more powerful
and effective than constant external supervision
ever could be. The key insight is that people
tend to evaluate themselves much more rigorously,
using criteria they themselves helped to create.
And crucially, the reward systems must genuinely
align with and support these mutually agreed
goals. That's fascinating how empowering people
through clear agreements and trust leads to such
potentially dramatic shifts in effectiveness
and motivation. Now, moving on to Habit 5. Seek
first to understand, then... to be understood.
You use a very memorable analogy to introduce
this one. I do. Imagine going to an optometrist
because you're having serious trouble with your
vision and without listening to your problem,
without diagnosing, the optometrist takes off
his own glasses and hands them to you saying,
here, wear these. They've worked brilliantly
for me for 10 years. I'm sure they'll sort you
out. Hmm. It sounds utterly absurd, doesn't it?
Yet we do this exact thing constantly in our
human interactions, especially perhaps in health
care communication. We prescribe before we diagnose.
Most people simply don't listen with the genuine
intent to understand. They listen with the intent
to reply. They filter everything they hear through
their own paradigms, their own experiences, projecting
their own autobiography onto the other person.
Oh, I know exactly how you feel. Let me tell
you about the time I had something similar. I
have definitely been guilty of that myself. So
what exactly is empathic listening and why is
it so uniquely powerful, especially for a medical
professional trying to connect with patients
or colleagues? Empathic listening is fundamentally
about listening with the intent to understand.
It's about getting inside another person's frame
of reference, trying to see the world the way
they see it, to understand their paradigm, to
understand how they feel. It's focused entirely
on receiving deep communication rather than constantly
preparing your response or rebuttal. It's incredibly
powerful because it gives you accurate data.
Without it, you're working blind. And remember
the emotional bank account nothing you do counts
as a deposit unless the other person perceives
it as such a doctor can work tirelessly Applying
all their clinical skill to help a patient But
if they don't truly understand what genuinely
matters to that individual their underlying fears
their lifestyle priorities their values regarding
their health and quality of life All those well
-intentioned efforts can easily be perceived
as manipulative, uncaring, or condescending,
making significant withdrawals instead of deposits.
What does empathic listening actually look like
in practice, particularly maybe in a challenging
patient consultation or a difficult team discussion?
Well, it's a skill that can be developed, typically
progressing through four levels. First, there's
merely mimicking content, just repeating back
what was said. Second is rephrasing the content,
which engages the logical left brain. So if I'm
understanding correctly, you're saying the pain
is generally worse at night. Third is reflecting
the feeling, which taps into the intuitive right
brain. Sounds like you're feeling really frustrated
and perhaps a bit scared by this persistent pain.
And the highest level, the fourth, is skillfully
combining both, rephrasing the content and reflecting
the underlying feeling. So you're feeling really
frustrated and worried about this persistent
pain, especially because it seems to be worse
at night and is significantly disrupting your
sleep. This whole brain approach acknowledges
both the logical facts and the emotional reality.
For instance, in a typical parent -child conversation
about school problems, common parental responses
like advising you should just, probing, why didn't
you, or evaluating, that was very smart, often
shut down communication completely. But when
the father, in one example, simply reflected
the content and feeling, you sound like you've
really had it. You think school is for the birds.
You're feeling really fed up and frustrated about
school. It opened up layers of deeper understanding,
allowing the real issues to surface. This approach
turns potentially transactional or confrontational
opportunities into truly transformational ones.
This applies directly and powerfully to patient
communication and team dynamics. So by truly
seeking to understand first, you create the essential
psychological air, the safe atmosphere for them
to open up and trust you more deeply. Precisely.
It creates that safe atmosphere where vulnerability
feels possible. People open up remarkably quickly
and deeply when they feel genuinely understood
and accepted unconditionally. Now, it is risky
because it requires you to be vulnerable yourselves
to be genuinely open to being influenced by their
perspective, which brings us to the paradox that
you must be influenced yourself to genuinely
influence others effectively. But once you have
truly deeply understood their perspective, their
needs, their concerns, then you're in a much
stronger position to effectively seek to be understood
yourself. The ancient Greeks had a magnificent
philosophy of persuasion embodied in three sequential
words, ethos, pathos, and logos. Ethos is your
personal credibility, your character, the trust
people have in your integrity and competence
as a physician, for example. Pathos is the empathic
side, your ability to connect with the emotional
reality of the other person. And Logos is the
logic, the reasoning, the evidence behind your
diagnosis or proposed treatment plan. When you
seek to be understood, especially in interdependent
situations like patient care or team decisions,
starting with demonstrating empathy, pathos,
and building on your established character ethos
gives tremendous weight and credibility to your
logical arguments. Logos. That sequence makes
perfect sense. And that leads us naturally to
Habit 6, Synergize, which you define quite simply
as creative cooperation. What does synergy truly
mean in practice, perhaps within a multidisciplinary
medical environment where different perspectives
often collide? Synergy simply means that the
whole is greater than the sum of its parts. It
means that 1 plus 1 equals 3, or 10, or 100,
or more. The essence of synergy is actually valuing
differences respecting them. building on diverse
strengths and compensating for individual weaknesses.
You see synergy everywhere in nature. Two plants
growing close together can often improve the
soil and yield more than if planted separately.
Two pieces of wood bonded together can hold far
more weight combined than they could individually.
It's the very essence of creation. Think of the
ultimate synergy of a man and the woman creating
a child. In human interactions, especially when
tackling complex healthcare challenges or designing
new services, synergy happens when a group collectively
agrees to subordinate old scripts, old ways of
thinking, and write a new, better one together,
transcending individual limitations and biases.
This might happen during a complex Grand Rounds
discussion, where specialists from different
fields combine their unique knowledge to find
an innovative solution that none could have reached
alone. That sounds like it requires immense personal
security and openness, I imagine, especially
for highly trained medical experts who might
be used to leading or having the right answer.
It absolutely does. Many creative endeavors,
by their nature, are unpredictable, ambiguous,
even a bit messy at times. You need a high tolerance
for ambiguity and a sense of security that comes
from your internal principles and integrity,
not from rigid structures or always being right.
In the university class I was teaching once,
a student's authentic, vulnerable sharing prompted
others to open up in unexpected ways. Rather
than rigidly sticking to my prepared lecture
material, we allowed the energy of the group
to guide us. They spontaneously built on each
other's insights, creating a wholly new, far
more meaningful direction for the course than
I could have planned. Similarly, in my medical
consulting work, the real highlights, the breakthrough
moments, are almost always synergistic. They
typically require courage for the participants
to confront uncomfortable truths, to listen deeply
to differing views, which then leads to creative
insights and plans that no single individual
had initially anticipated, especially when designing
entirely new care pathways or tackling systemic
issues. So it's really about going beyond mere
compromise, where everyone gives something up,
towards discovering a genuinely third alternative
that's better for everyone. Yes, exactly. Think
back to the husband and wife vacation dilemma
we touched on earlier, where one wants a fishing
trip and the other feels compelled to visit an
ailing mother. Instead of settling for a grudging
compromise, maybe a shorter trip for both, or
a win -lose outcome, they leverage their high
emotional bank account their commitment to a
win -win outcome, and their skills in empathic
listening, habit five, to truly understand each
other's deep underlying needs and desires. They
then pool those desires, effectively getting
on the same side of the table to work together
on the problem, looking for a third alternative.
They might invent a creative solution that satisfies
both deeply, perhaps finding a lovely lakeside
cabin near the mother's location, allowing for
both fishing and visiting. or maybe arranging
excellent care for the mother so they can take
the fishing trip together without guilt, planning
a longer visit later. This creative solution,
born of genuinely valuing and integrating their
differences, not only solves the immediate problem
but also significantly strengthens their relationship.
And this principle of synergy, valuing differences,
also applies powerfully to organizational settings
like hospitals or research institutes. Undoubtedly.
True synergy thrives when differences in perspective,
experience, expertise, temperament are genuinely
valued, not just tolerated. Saneness is not oneness.
Uniformity is not unity. The real strength of
a team, or indeed any relationship, lies in its
complementariness, in leveraging those differences
effectively. Combining intuitive, creative right
-brain thinking with analytical, logical left
-brain thinking within a team creates kind of
psychic synergy, perfectly suited for dealing
with a complex mix of logical and emotional realities
inherent in life, and especially in healthcare.
For instance, I once observed a married couple
struggling terribly to communicate about finances.
It turned out the husband was strongly left -brain
dominant. demanding specific figures and logical
plans, while his wife was strongly right -brained,
communicating primarily through feelings, intuition,
and a general sense of security or insecurity.
When they finally understood this fundamental
difference in their processing styles, it opened
up completely new avenues for effective communication
and synergistic problem solving. Moreover, synergy
works powerfully by directly addressing the restraining
forces that often hold back positive change in
an organization or an individual. By creating
a safe, high -trust atmosphere where different
viewpoints can be openly discussed without fear,
you can often transform these resistances, which
are often rooted in valid concerns or perspectives,
into driving forces for growth and improvement.
This is absolutely vital for successfully implementing
new healthcare policies, technologies, or team
structures. So synergy really is the culmination
of all the previous habits, bringing them together
in a dynamic way for creative cooperation. And
that leads us, finally, to the seventh habit.
which is all about sustaining all of this progress.
Sharpen the saw. Yes. Habit seven is about balanced
self -renewal. It's encapsulated in the classic
story of the man in the woods sawing away feverishly
at a tree, looking exhausted. When someone asks
why he doesn't stop for a few minutes to sharpen
his saw, he replies impatiently, I don't have
time to sharpen the saw. I'm too busy sawing.
Sharvening the saw is the quintessential quadrant
two activity critically important, but rarely
feeling urgent that most people, especially busy
professionals, tend to neglect. But it is arguably
the single most powerful investment we can make
in ourselves because we are the instrument we
have to deal with life and make our contribution.
It must be proactively chosen because no one
else can do it for us. It won't happen automatically.
And you stress that this renewal needs to happen
consistently across four key dimensions for a
well -rounded, resilient medical professional.
Can you outline those? Yes. For true sustainable
effectiveness, renewal must be balanced across
four interconnected dimensions of our nature.
One, the physical dimension. This involves caring
effectively for our physical body, eating well,
getting sufficient rest and relaxation, and engaging
in regular exercise that builds endurance, flexibility,
and strength. Most people say they don't have
time for exercise, but my response is, you don't
have time not to. We're generally talking about
a minimum of three to six hours a week, perhaps
30 minutes a day, maybe every other day. This
proactive investment in our physical well -being
prevents many quadrant health crises down the
line. It's also about pushing ourselves appropriately,
just as building muscular strength requires stressing
the muscle fibers slightly, allowing nature to
overcompensate and rebuild them stronger. This
principle applies equally to building our emotional
muscles like patience, empathy, or resilience,
which are vital in high stress medical environments.
Two, the spiritual dimension. This is about connecting
with the center of our lives, our value system.
It involves clarifying our deepest values, renewing
our commitment to our principles, perhaps through
practices like prayer, meditation, spending time
in nature, or immersing ourselves in great literature
or inspiring music. It's about connecting to
our moral core. finding purpose and meaning in
our work and life, particularly in a vocation
like medicine, which can be both incredibly rewarding
and deeply challenging. I recall a story about
a man named Gordon, prescribed by his doctor,
interestingly, to spend a full day at the beach
with four simple prescriptions written on slips
of paper to be opened at intervals. Listen carefully,
try reaching back, examine your motives, and
finally, write your worries on the sand. Through
this process of quiet reflection, he had a profound
realization. If one's motives are wrong, nothing
can be right. Spiritual renewal provides that
deep sense of purpose and aligns us with correct
principles, our true north. And the mental dimension.
How do we keep that sharp amidst information
overload? Three, the mental dimension. This means
continually honing and expanding our minds. It
involves ongoing education. formal or informal,
serious reading, moving beyond just professional
journals to include great literature, biographies,
essays that broaden perspective, perhaps aiming
for a book a month, then maybe a week engaging
in analytical thinking, problem -solving, and
importantly, writing. Writing, perhaps through
journaling or even thoughtful letters, is a powerful
way to clarify thinking, process experiences,
and gain self -awareness. Many minds tend to
atrophy after formal education ceases, often
due to excessive passive consumption, particularly
things like too much television or aimless internet
browsing. I often recommend limiting TV to perhaps
seven hours a week, consciously choosing quality
over quantity, and dedicating regular time to
reading material that stretches the mind. This
expands our paradigms, sharpens the mental saw,
and trains the mind to examine its own programming.
It's about feeding your mind with substance,
not just noise, which is absolutely critical
for staying sharp and adaptable in a field like
medicine that constantly evolves. And finally,
the fourth dimension, the social and emotional
one. Four, the social -emotional dimension. This
dimension focuses primarily on habits four, five,
and six, developing skills and interpersonal
leadership. Win -win, empathic communication,
seek first to understand, and creative cooperation,
synergize. Unlike the other dimensions, this
one doesn't necessarily require dedicated time
blocks, rather it's renewed and exercised through
our everyday interactions with others. However,
it does require conscious effort and practice.
We have to push ourselves beyond our comfort
zones, especially if we haven't yet fully developed
the private victory foundations or the public
victory skills. A powerful concept relevant here
is the Dulcinea effect, drawing from the story
of Don Quixote, or the broader idea of the self
-fulfilling prophecy. Just as Don Quixote's unwavering
belief in the peasant girl Aldanza's potential,
whom he saw as the noble Lady Dulcinea, arguably
helped elicit her better nature, our genuine,
unconditional belief in the potential of others,
our patients, our junior colleagues, our children,
coupled with unconditional love and high expectations,
can literally help create that potential. This
is applicable to mentoring junior staff effectively,
empowering patients in their recovery journey
by believing in their capacity to heal or cope,
or fostering a more positive and supportive team
culture. There was a fascinating albeit accidental
experiment in England where a computer programming
error wrongly labeled a group of bright primary
school kids as less able and vice versa on reports
sent to their new teachers. By the end of the
year, the IQ scores of the children initially
labeled less able, but whom teachers treated
as bright had actually gone up significantly,
while the scores of those labeled bright, whom
teachers presumably gave less attention, had
relatively declined. It powerfully illustrates
how our expectations and treatment of others
can profoundly shape their reality and performance.
That's a truly powerful reminder of the impact
we can have, both positive and negative. Does
this principle of balance renewal also apply
to health care organizations or teams as a whole?
Yes, absolutely. Organizations like individuals
also have these four dimensions. You can think
of the economic or financial aspect as the physical
dimension. Developing talent, adaptability, and
innovation relates to the mental -psychological
dimension. How people are treated, the culture
of collaboration and respect, represents the
social -emotional dimension. And the organization's
sense of purpose, its contribution, its integrity,
reflects the spiritual dimension, its meaning.
Neglecting any one of these dimensions inevitably
impacts the others and leads to negative synergy,
where creative energies are often channeled into
fighting against the organization, becoming restraining
forces like internal rivalries, politicking,
or widespread burnout. A hospital focused solely
on economic gain or efficiency metrics, for instance,
often suffers from poor morale, high staff turnover,
and ultimately compromised patient care. While
financial viability, profit in a business context,
budget management, and public service is necessary
for survival, it is not by itself the sole purpose
or reason for existence for a healthcare institution
or any organization aiming for long -term effectiveness
and contribution. Balance renewal across all
four dimensions is absolutely crucial for sustained
organizational health, growth, and ensuring patient
care remains truly central. So it becomes clear
that all these habits are deeply interconnected,
creating a powerful synergy when practiced together.
Absolutely. They are sequential, but they are
also deeply integrated. Improvement in any one
habit synergistically boosts your ability to
live all the others more effectively. The more
proactive you become, habit one. The more effectively
you can exercise personal leadership, habit two,
and management, habit three. The more effectively
you manage your life according to your priorities,
habit three. The more time and energy you'll
find for essential quadrant two renewing activities,
habit seven. The more you seek first to understand
others, habit five, the more effectively you
can discover truly synergetic win -win solutions,
habits four and six. And renewal, habit seven,
is the very process of renewing and strengthening
all the other habits. The concept of the daily
private victory, consciously committing at least
one hour each day to your bounce renewal across
the physical, spiritual, and mental dimensions,
is perhaps the single most powerful key to developing
all seven habits consistently. It's entirely
within your circle of influence and builds the
essential intrinsic security necessary for achieving
sustainable public victories in your relationships
and work. And just to revisit that crucial distinction
one last time, principles versus values. How
do they tie into this final habit of renewal
and the overall framework? It's vital to keep
reinforcing this distinction, as it's so fundamental.
Principles, remember, are external, objective,
natural laws like gravity that govern the consequences
of our actions, regardless of our awareness or
beliefs. Values, on the other hand, are internal
and subjective. They represent what we feel is
important, and they guide our behavior. We achieve
effectiveness when our values become aligned
with correct principles. We should strive to
value principles like integrity, fairness, service,
growth, because adhering to them allows us to
achieve our desired results effectively and sustainably.
Humility in this context is fundamentally about
submitting ourselves willingly to these correct
principles, acknowledging that we are not ultimately
in control of the consequences of violating them.
Pride, conversely, is essentially the belief
that we are in control, that we can somehow live
life our way without regard to these principles,
which almost invariably leads to negative long
-term outcomes. Integrity, then, emerges as a
higher form of loyalty. It means being centered
on and loyal to principles rather than being
loyal merely to people, organizations, moods,
or impulses. It leads back to the idea that it's
truly better to be trusted than simply to be
liked, because over time, genuine integrity inherently
produces loyalty, respect, and deep trust qualities
that are absolutely crucial in the medical profession,
and indeed in all meaningful human endeavors.
Professor, this has been an incredibly insightful
and, dare I say, profound deep dive. It truly
highlights that genuine effectiveness isn't about
quick fixes or superficial techniques, but about
deep often challenging inner work and consistent
balanced renewal. It's been my pleasure entirely.
The underlying message, I suppose, is to strive
to live a life in crescendo, always learning,
growing, contributing, always seeking something
higher and better. Regardless of what you've
accomplished or experienced in the past, you
always have important contributions yet to make.
Avoid the common temptation to constantly look
in the rear -view mirror, dwelling on past mistakes
or even past glories. Instead, look ahead with
optimism and commitment. You have vital relationships
to build and nurture, a community to serve, perhaps
a family to strengthen, complex problems to solve,
new knowledge to gain, and perhaps great works
yet to create, all within your vital role in
healthcare and beyond. A life in crescendo that's
a beautiful and inspiring way to think about
it. Thank you. And for you, our listener, perhaps
consider this as you reflect on our conversation.
Which dimension of your own saw may be your physical
stamina for those demanding shifts, your mental
clarity for complex diagnoses and decisions,
your spiritual resilience when facing difficult
prognoses or ethical dilemmas, or perhaps the
quality of the social and emotional bonds with
your team, your patients, and your family? Which
one feels the dullest right now? What one small,
proactive, quadrant two step might you commit
to taking this week to begin sharpening that
particular edge, paving the way for a more effective,
sustainable, and ultimately a more fulfilling
career in medicine, and indeed a more fulfilling
life overall? And if you found this deep dive
valuable today, please do consider taking a moment
to rate the show or share it with a colleague
or friend who you think might also benefit from
exploring these powerful insights. Thank you
so much, Professor Mohi Mom, for this invaluable
discussion. Thank you very much for having me.
It's been a truly rich and enjoyable conversation.
And thank you, as always, for joining us on the
Beep Dive. We look forward to our next exploration
together.