An Internal Standard


Do you need an audience? Is perfection, is excellence the goal because your best is the only thing that will satisfy you or is excellence relative to those around you.

The people we consider great have very little in common with one another. The one thing that all of them have is an internal compass, a north star within themselves to find their way despite the fickle nature of the opinions of the mob around them. Both the cheers and heckles are equally untrustworthy.

As yourself if you require the cheers of the crowd or whether you privately revel in knowing your best was all you had. I have mentioned this previously, but it is worth repeating. The phrase “just do your best” has been hijacked and distorted. It has become an excuse for not winning, for taking some of the pressure off of meeting a more objective goal such as a place in a race or a score on the test. “Just do your best.” There should be, there can be, no higher bar than that. What this phrase says is that you leave it ALL on the floor. That at some point you fail, not because the effort was absent but because the personal limit of possible and impossible had been reached. “Just do your best.” That is call to be exhausted at the end of the day. That is the desire to keep going even when there is no one else above you to beat you and no contest to measure your worth. “Just do your best.” That is the internal compass that only you can read, meaning that you and you alone are the only one who will ever know if you are truly at your best. Your mediocrity may look like another’s excellence. Or your excellence may look like some else’s mediocrity. “Just do your best.” This says that it does not matter if your best is below average or so far above the best that no one else could hope to beat you. You are the goal. You are the measure. And only you will know when that goal has been reached. Your internal compass is all the audience you require. The cacophony of any audience is then, superfluous.

There is a quote that roughly goes “the heroes of today can only be revealed tomorrow.” Playing for the favor of the mob is not the way to find truth, happiness, or fame. Rather it is a sure way to lose yourself amidst the contradictory and competing advice.

What else would I be doing?


What else are we to do?

Regardless of what I am doing, I find it helpful to ask, “what else would I be doing if I were not doing ___________.” There is a big lag between the big picture questions that we ask and the day to day activities which occupy the vast majority of our time. Reconciling higher ideals and ambitions to low order processes is often more difficult to do consistently than establishing a higher ideal in the first place. A common example of this goes:

Q: What is my higher goal or ambition?
A: I want to love people?

Q: How do I do that?
A: By being nice or kind to people (Whoever said that nice/kind=love should reevaluate)

Q: How am I doing that?
A: By doing the same things I would always do but with a smile and maybe a nice compliment to people.

Or some variation of this. We can agree that this is certainly not bad, however it results in steps that are not really concrete or actionable. When I am considering whether or not my day to day work is aligning with overall goals, it is easier for me to ask, “what else would I be spending my time on?” Often I work until reasonably late at night. In some cases this can be a negative, in others a positive. When I am considering whether it is a negative or a positive I use that question. If the answer is that I would be investing in relationships by having a drink with or helping a friend the extra work is called being a workaholic and is a negative. However if the answer is that time would be spent watching Netflix or staring at my navel (just to make sure its still there-fun fact, sometimes you can see it bounce with the pulse from your abdominal aorta), then the extra work is called ambition and is a positive. By asking a more simple, yet direct question, I am better able to evaluate my use of time, and thus also my priorities. If you ask this question and find a better use for your time, transition to that new task or activity. If you ask this question and find the answer is less worthy of your time, continue in your task knowing you are operating at your optimal already. 

A Dynamic Character

2011-08-16 14.11.46

The most compelling thing about most stories, whether that be movies, TV series, books, even video games or comics, is that there is a gradual progression that happens within the main character. Stories of fiction and nonfiction both compel us with this transformation.  Throughout the Harry Potter series by JK Rowling we see Harry begin as a relatively whiny young boy and become a young man willing to sacrifice himself for his friends. In Lord of the Rings we see a hobbit step out of the comfort of his small village to take a stand against an evil much larger than himself. In Schinder’s List we see Oskar begin as a rather hedonistic businessman to a man who sacrificed his business and his personal wealth to protect his workers. In A Tale of Two Cities we see Sydney give his life for another ending with the famous quote “It is a far, far better thing that I do, than I have ever done; it is a far, far better rest I go to than I have ever known.”

While the adventure and drama within a story are certainly exciting, it is the transformation and growth that compels us to keep coming back to the story. Consider it. Our favorite stories are not the most action packed or even the most well written. They are the ones in which we identify with a character and watch them develop through the pressures and hardships of the story.

The challenge then for us is to grow, to progress through the adventures and the difficulties we face. The greatest failure of any story is to arrive at the end, through all the turmoil and all the strife, and be the same person as the one who began the journey. As dynamic characters in individual stories the adventure is not set, the characters have yet to be filled in. Pick the adventures, roll with the punches, find sojourners to travel with, and let the experiences change you.

Hard for the sake of being hard


Life is hard. Sometimes we make it harder than it needs to be. Actually, often we make it harder than it needs to be. In daily life this can be for a handful of reasons including:

  • The sense of the importance of each tasks becomes inflated. Simple tasks like picking up groceries can become stressful if it feels like the success of the days rests on every task. In some sense when the completing the list becomes the ultimate goal completing list can its own stressful task.  
  • The importance of our role in the task becomes inflated. I always find it funny when I get sick and the world keeps moving just fine. Progress is still make, nothing falls apart, and sometimes, people barely notice I’m not there. Humbling and relieving at the same time.
  • The amount that we can affect the outcome becomes inflated. Sometimes watching stats in real time, whether that be a sports game, election results, or stock prices, it seems like I can push result one way or another by elevating my blood pressure. That is, that the more I stress about an outcome the more likely it is to come out in my favor. In reality many of these things are unalterable by my actions. Understanding how much influence we have on the outcome is key to how much pressure we feel.

The point is that many things in life ARE difficult. So let’s save the heavy lifting for those instances and do our best to enjoy the other adventures that come our way.

Pursuing happiness

Marx is often quoted as saying “Religion is the opiate of the masses.”

More accurately and articulately he said:

Religion is the sigh of the oppressed creature, the heart of a heartless world, the soul of soulless conditions. It is the opium of the people. The abolition of religion as the illusory happiness of people is the demand for their real happiness.”

Regardless of your thoughts on religion, whether organized or not, hopefully a common goal is the abolition of illusory happiness and the demand for real happiness. Most will agree that opium is not a problem when it is used appropriately for acute relief of pain in a self-limiting environment. However it becomes a great evil when it is used for escape and becomes an addiction. Unfortunately even amid the recent scourge of the opioid epidemic in America there is an easier, often encouraged form of illusory happiness and escape from reality. Media, whether that be TV shows, social media, creative forums, news outlets, games, or movies, provides an escape. Who hasn’t started watching TV or scrolling through facebook and realized several hours had passed in short order. While this is absolutely better than shooting up with heroine from a shared needle, the desire to escape reality through artificial happiness through digital media can be just as easy. Considerations of our place in this world, our goals for our lives, and the plight of those around us are easily drowned out by the noise of media. (As I am writing this I am surrounded by three screens with news and medical queries demanding to be read, so this is as much a reminder to me as to anyone else).

Especially during busy weeks I have tried to begin to consider the why behind my use of media. Why am I pulling out my phone? Am I expecting an email or phone call? Why am I watching this show? Is it because I enjoy the story or because I don’t want to think about more serious things in the time before bed. Why am I scrolling through social media? Is it to connect with and encourage others or is it to try to see where my life ranks in relation to theirs? Why am I looking through ads online? Is it because I actually need something or is it in the hopes that a creative advertiser will convince me a new product was the element my life was lacking?


To the end of the abolition of illusory happiness and the demand for real happiness, let us be mindful of what we invest our time and our talents in before they become an addiction we cannot overcome.


Make your own compass, find your own north star.


Make your own compass, find your own north star.

Two books, read in combination, make this poignant point. In Arrowsmith by Sinclair Lewis, Martin Arrowsmith, a medical student who becomes a physician and a scientist struggles between the pursuit of scientific rigor, treatment of suffering patients, and the expectations of society around him. In Atlas Shrugged by Ayn Rand, Dagny Taggert rejects artificial notions of altruism to pursue what she loves for her own enjoyment. Warren Buffet refers to this compass as an internal scorecard (see The Snowball by Alice Schroeder). The internal compass is not a fixed or unalterable construct; rather the internal compass provides direction when the easiest course of action is to follow the applause of the mob.  Like a dog chasing its tail or a compass in an MRI machine, with the ever changing preferences of the audience no progress can be made. In any direction one will find a plethora of critics and yes men, supporters and detractors, comrades and enemies. The internal compass is not a rejection of absolute truth but a rejection of the noise as a way to find that truth. In life the compass is adjusted by new events, new experiences, and new knowledge, but never by the roar of the crowd. Having an internal compass means that the applause of others does not signal the finish line and that the jeers of the mob do not mean that one is going in the wrong direction. Develop this compass, adjust it as you discover more, trust its direction, and follow it home.


Movement is only progress if it is towards the goal.


Make your own compass, find your own north star.

For the patient


One problem confronting the American healthcare system today is the projected shortage of physicians. Depending on the study, within the next several decades we will be short tens of thousands of physicians (61,000-95,000 by 2016 numbers released by the AAMC). At the same time many physicians are reporting dissatisfaction with their occupation and high rates of burnout with many physicians stepping away from seeing patients to retire, find another occupation, or employ their expertise in a non-patient setting. Therefore one way to alleviate the shortage of physicians is to keep more physicians in practice for longer.

People go into medicine for many reasons. Many good, some not. Whether said or unsaid, many go into medicine because of the challenge, because they find the human body interesting, and because they enjoy solving problems. And medicine certainly provides a venue for solving challenging problems associated with the human body. Howeveras important if not more important than raw intellectual power is the need to be able to relate well with others even when going through difficult circumstances.

If I were to make a prediction, it would be that those medical students and young physicians who first and foremost were interested in the patient and secondarily were interested in the disease process were the ones who went on to have successful and happy practices. With the push for humanism in medicine, perhaps we will see this trend alleviatethe projected physician shortage and help to make healthier physicians and patients.



In marketing and advertising, one of the key, eye catching words is NEW. Everyone likes new things. When was the last time you saw something advertised as “old”? If something old is being advertised it usually gets labelled as “retro” or “throwback”. As a culture we are obsessed with new. Which is great. Forward progress requires some aspect of new but every new thing is not progress. New companies, new churches, new books, new technology, new currency, and new entertainment have been used to create progress. But in markets saturated with new things, often refining and perfecting the existing can be the way forward. Running through the city within the span of several miles tens of churches, mostly empty on Sunday litter every block. On the same run the same is true of businesses and homes. Very often new churches are started, everyday new businesses are created, and continually new houses are being built. Often these become consumables, hot for a moment, stagnant for a year, and liquidated soon after. Are new things actually better? In some cases yes, but often no. Take books for example. While new books can be excellent, how many guaranteed excellent books have you and I not read? Have we exhausted the classics and other books which have stood the test of time? (I would list excellent old books and authors but surely would offend someone by including or not including a specific book or author). Instead of being taken in by the word NEW we should find how that new or old object will fit into our larger goals. If we understood everything about the “new” object, perhaps we would go back for something old we “knew” more about.

With Great Joy


In the locker room during one of the NBA Finals games, Golden State Warriors coach Steve Kerr, encouraged his player to play with “great joy” because they were enjoying an opportunity that very few people in the world would be able to enjoy- playing for an NBA championship. Although you and I will almost certainly not play for an NBA championship or become a sports star, there are many things in life that we must rediscover with “great joy”. We are all creatures of routine, and with that comes the danger that we will become desensitized to the privilege which we have. Each season the NBA players play 82 games, with additional pre-season games, summer games, and then, for the good teams, playoff games. This can amount to 100 or more games a year. Despite this repetition, the challenge to the Warriors team was to recognize their privilege and enjoy the opportunity.

Often rewording our occupation or our educational responsibilities helps put this privilege into perspective. During undergraduate studies, almost daily I would think of college as an extended summer camp- meals were provided or easily accessible, my friends were housed nearby, and I spent the day exploring interesting things. This emphasized the privilege of attending college. Conversely I could have spent each day thinking about how mundane the classwork was, how rainy the city could be, and how uninspiring some of my fellow classmates could be. Simply reframing my daily routine could turn it from a privilege to a chore.

Now that I am working on medical and graduate studies I have the opportunity to rethink or reframe my routine again. On the one hand I can spend the day considering how inefficient some aspects of the system are, how unclear some of the requirements are, and how long some experiments can take. This can make even the shortest program feel like a lifetime (and certainly doesn’t endear one to peers and colleagues). On the other hand, I can spend the day realizing that this is a new form of summer camp where I can pursue questions that interest me while learning new techniques, and interacting with many people that inspire me. The switch from the routine as a chore to a privilege, while a small mindgame, must be done intentionally and consistently. Just like the Warriors, you and I all have the opportunity to do things that are a privilege, that other people dream of doing. Focus on those and do these things with great joy.

A Founding Father and the Fourth


Ron Chernow’s book Washington: A Life chronicles the life of George Washington from his childhood years through 8+ years of leading the Continental Army to the postwar years and his presidency. As many have noted, perhaps the greatest thing that George Washington did for the nation, something that few other great men in history have done and which enabled the establishment of the United States, was that he repeatedly stepped aside from positions of power and returned the power to the people. This was evident both when he was the General of the Continental Army and became even more apparent when he stepped aside from additional terms of being President of the United States. What Washington, and many of the founding fathers at that time, understood so well is something which we have lost sight of- democracy is neither permanent nor guaranteed.

Timothy Snyder, Yale professor and author, rightly notes that there are a not insignificant number of democracies which have transitioned from democracies to totalitarian states. These changes, typically begin and are completed within 1-3 years and without the full recognition of the masses until the transition has actually taken place. Remember, even now, that there have been, and always will be, minority groups looking to exploit world events to gain and hold power. Democracy must be something that is guarded, protected, and sacrificed for, because even greater sacrifices will be required if it is ever lost. One of the final points Snyder makes is that if “if none of us is prepared to die for freedom, then all of us will die in unfreedom.”

Happy belated Fourth of July