The good and the bad


We have a wealth (also known as a glut) of information around us and in the news. There will always be something terrible happening that we can read about. Horrible people do horrible things. Nature does horrible things. Horrible things randomly happen. In generally things are improving despite what the news cycle tells us. People’s behavior is improving (see Angels of Our Better Nature by Steven Pinker) and fewer people are dying around the world from preventable or treatable diseases (see Bill Gates and the Gates Foundation). In general, things are improving yet we can still overwhelm ourselves with all the stories of evil.

Balance in this area seems to be difficult. One one hand we do not want to be in an isolationist bubble. We want to be aware of what is going on around us. However we also should keep ourselves focused on the good, those things that might not be news but are encouraging. As Philippians says “whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable, if anything is excellent or praiseworthy, think about such things.”

Any idiot can be a downcast “realist” by thinking about all the bad things that are going on and all the bad things that could happen to them. It takes far more work and discipline to engage in the important struggles of the day while maintaining an attitude of gratefulness and an optimistic outlook. In general, if it is something you can directly change, engage with it. Otherwise move on to the causes that you can directly change. The idea that feeling sad or indignant or angry or dwelling on bad things in the world is, by itself, a virtue is poorly formed. Dwelling on these things without action means nothing. Be intentional about being grateful for the good and actively work to improve the bad.

Towards being intentional

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Let’s talk for a moment about social media, in particular Twitter. Social media is not inherently bad, but it is probably not as innocuous as it appears on first pass. And, as we’ve seen in the past several years, a simple 140 characters is enough to end careers and uproot lives. The larger problem of social media witch hunts aside, the fact that a quick tweet can drastically change things, is an important consideration. One of the reasons that guns or cars can be so dangerous and must be handled carefully is for that exact reason. A small squeeze of the trigger can have irreparable consequences. Losing focus on the road can have dire consequences. In the same way, small tweets have been used to destroy careers, announce major policy decisions from the government, and spark debates that waste everyone’s time and energy. It would be nice if there was a safety on Twitter, something like grammerly but for insensitive and alienating comments. Not something that censors (We are big fans of the first amendment after all), but something that says “this is racist/sexist/mean, are you SURE you want to post this for everyone to see?”. Perhaps a voluntary breathalyzer or drug test before you could post would also be beneficial. The things that take years to build can often be destroyed in seconds.

The big push in using social media must be being intentional about it to relate to one another in positive ways. Thoughtless scrolling and mindless posting is dangerous, and the drastic downside far outweighs any potential upside. Live intentionally.


Jack of all trades, Master of none


It is surprising to me how often I hear this used as a compliment still. Although it is intended as a compliment, it is most assuredly a criticism not an aspiration. At most we should hone a handful of crafts, a handful of things, because the opportunity cost of trying to learn a little bit about everything is knowing everything (or at least, a lot) about a single thing. An inch deep and a mile wide.

Consider how we got to where we are today. Specialization plays a huge role in that. Look at the things around you. Few, if any of them could you have made by yourself without the help of many experts or professionals. Most of us could not build a computer from the ground up, and even if we could we certainly could not manufacture the necessary parts alone. Most of us could not build a car even if we had all the rights parts and a detailed instruction manual. Most of us are probably not doing ourselves (or our doctors) a favor by surfing Web MD or watching Dr. Oz to try to self diagnose what seems to be ailing us. Most of us cannot act well, sing well, or write well. Most people cannot grow enough food or gather enough provisions to keep themselves fed. If we each tried to make our own clothes the result would almost assuredly be extremely time consuming and uncomfortable.

I was listening to the Director of the National Center for Advancing Translational Sciences at the NIH. He commented on the fact that there are over 7,000 diseases. SEVEN THOUSAND, with more being discovered every year. As a medical student with books and books just summarizing the most common of these diseases this can be discouraging. The reason there are so many advocacy groups for less common diseases is that physicians cannot keep the signs and guidelines for every disease in their head all at once. The key is knowing when and who to ask for help.

The reason we have specialists is because they can have in depth knowledge about a specific area without concern for everything else. In the Emergency Department or with the primary care physician, the task is to know the most common diseases, recognize when someone is acutely ill, and then know who to call (or page) in each instance. A primary care physician memorizing large lists of genetic loci and rare neurologic conditions is not benefiting his or her patients through this impressive, but futile efforts. Stabilize, recognize, and treat or refer. The emergency physicians and primary care physicians are experts in that task! Even the more “general” medical disciplines are still specialists as it pertains to their job.

The physician however should NOT be working to be the best accountant, or computer programmer, or car mechanic. Physicians fixing their own cars could probably cause enough accidents to generate a whole new medical speciality.

Find what you want to be an expert in. Develop your craft. Hone your skills. And, be content with being ignorant in many areas of life. That is the cost of specialization and contributing to society as a whole. That is the cost of progress.

A student and a patient


Often when I was first talking to and working with patients I felt bad for them. As a student there is always someone there who could do a better job than you whether that be the resident, fellow, or attending, and instead the patient is stuck with you. Sometimes your stethoscope (or hand) is cold or your questions annoy them (how dare you, of course, they have never smoked, drank or done drugs). Naturally, most patients are sick, and many sick people want to be left alone. All of these made me feel slightly bad for the patients I saw.

Several things changed how I view my interactions with patients. First, they are not receiving lower quality care by any means. If anything, they have another set of eyes and someone who is attentive to their problems. The expertise of the attendings and the appropriate care will all be provided regardless of whether the student is present. The one thing that the patient is giving the student is time. In very few cases have patients ever seemed to mind that my questions and exam take longer than someone more experienced, or that I might have to pop back in at a later time to obtain a piece of information I missed initially. In fact many patients appreciate the extra time and the extra efforts you go to. Second, the thing that most sick patients want more than to be left alone is for someone to care. Listening to someone’s story, to how long the disease has caused them pain, or to how many doctors they have seen can be its own form of therapy. As the saying goes the job of a physician is to cure rarely, to treat often, and to comfort always. Students and patients often have time in the hospital during which they are not busy and listening to the story can be a key aspect of comforting. Third, you are doing this for the patients you will see in the future. When it takes a little longer to hear a murmur in a patient’s heart or the patient has to take a couple of extra deep breaths so you can hear the wheeze, it is for the patients who will be seen and treated by you in 10 years.

So instead of feeling bad for patients, I appreciate the extra time I have with them and the experience they provide me for treating patients in the future. And I am thankful for their patience with me and their gift to the patients I will treat in the future. 

External validators



The percentage of the population that will complete a marathon during their lifetime has dramatically increased. At the same time the average marathon time has also dramatically increased. On the one hand this is great. More people are getting out of the house and participating in a group activity to increase fitness. In a day and age when poor eating habits and a sedentary lifestyle are rampant, getting people involved in an activity to counteract that is often difficult. Physical exercise, is a critical component of both physical health as well as mental health. Marathons provide goals for people to strive towards and a sense of accomplishment once they reach them. In many ways the increased number of people finishing marathons, even at a slower rate, is fantastic.

On the other hand this is also troubling. One likely reason for the increase in average marathon times is that people are entering races with less preparation than in previous decades. This is unfortunate as there seems to be a move towards treating the marathon as a bucket list item rather than a culmination of adequate and meticulous training. I had a professor who used to call examinations “celebrations of learning”. In many ways I think that in school, in running, and in life, this is a much healthier attitude to have. Today, in schools as well as in marathons there are large numbers of people who desire the external validation of a diploma, an award, or medal, rather than the internal validation of knowing they learned something or became stronger through the process of diligent planning and execution. While the external validations can be helpful measures of our progress or how our efforts compare to those around us, the internal validation, the internal compass, is far more important to long term success and development as a human being. Any idiot can fill a shelf with awards, degrees, medals, and ribbons. However the real rewards are in watching all the hours in practice, all the hours of work, all the hours of study come together into a thing of excellence. Diligently pursuing meaningful skills day after day is the way to excellence. The external validators are merely artificial finish lines and illusory goal lines.  Do things that matter.

Finding your hill


Often lack of purpose and direction is mistaken for lack of will and drive.  The two of these could not be more different. Will and drive are the means to get to a prespecified end. It is the blood, sweat, and tears that it takes to achieve a goal. Purpose and direction, on the other hand, are what defines that end and marks the goal. It is the line marking the finish or the syllabus at the beginning of a term. To have purpose and direction does not mean that one will also have the will and drive to reach the end. And to have will and drive does not mean that progress in a productive direction is being made. One must have both in order to succeed. The ability to look ahead and set a course must also be coupled with an unyielding will and a ruthless grit. Without one, progress halts. Purpose without the drive presents itself as one listlessly bobbing in the current, looking at the nearby island and wishing they were already wading ashore. Drive without purpose results in a similar lack of progress but presents itself as a wild thrashing in the waves without a pause to chart the course to shore.  

I would guess that most people struggle, not with drive as some would suppose, but with finding a purpose. While older generations look at the younger generations and criticize their drive, I wonder if instead, the issue lies within finding a purpose. As humans, endless striving is in our nature. We are constantly pursuing more. We are constantly looking for the next thing. However, we are also constantly searching for purpose and a meaning to our existence. Anyone will work tirelessly when a great vision is cast, a compelling mission is presented, or a worthy opponent presents itself. The threat of fascism in World War II united nations and compelled individuals to work without selfishness for a greater purpose. The problem is never people are not willing to sacrifice, but that they need to see the greater vision they are working towards. Great leaders (NOT great humans), are able to cast this vision and provide a unifying purpose and direction. Hitler rose to power with such abilities. As did Mao. To counter these great leaders (and great human beings) united their people under an even more compelling purpose. Churchill lead his nation from the edge of destruction to the freedom of Europe. Roosevelt rallied the industrial and military might of the United States and used the fight in Europe to also fight the economic war at home.

They say the first thing you should do when you know you are lost is to stop walking. Stop. Think. Orient yourself and establish a course. The same is true in life. There are too many hills to take them all. Pick the strategic ones. The ones that will improve the world and improve yourself. Don’t run up every hill, don’t spread yourself too thin. Find your purpose, and the drive will find itself.

A focus on food


I am unclear why two things we love, eating and entertainment, have become so linked. Sit down to eat a snack or a meal by yourself and most people find themselves checking their phone, reading a newspaper, or watching TV. I am certainly no exception. But, as research and personal experience both demonstrate, our brains are wired so that actual multitasking, in this case, fully enjoying both food and the entertainment, is impossible. Yet we do this All. The. Time. It is easy for us to demolish large quantities of food without appreciating or even acknowledging it when we are focused on something else. We do this at the movie theatres where huge bins of popcorn and giant cups of soda are consumed on autopilot while we focus on the plot unfolding on the screen in front of us. We used to visit a man who hated to eat and listen to the radio at the same time because he found that he would get enraptured with the radio and the next thing he would know, the food would be gone without any enjoyment by him. Multitasking food and entertainment steals enjoyment both from our food and the entertainment and for no significant gain.

Try this sometime. Sit down in a quiet room and eat. Enjoy the meal. Consider how it tastes and how it takes away the feelings of hunger. Even in a quiet room focusing on the food and not on the to do list in your head is an issue. Don’t talk with other people or surf the internet. Don’t think about your favorite book, movie, or TV show. Don’t think about other people who would like the food. Don’t make plans for the rest of the day. Focus on the food and the act of eating. Then focus on the entertainment.

Your attention is one of the most valuable assets you have, spend it wisely.

When the best has come… and gone


The best is yet to come. A cheery proclamation about the future or a silent hope for things to come. Whether on greeting cards, in graduation caps, or lyrics in a song, the statement expresses the sentiment that warmer, sunnier things are on the horizon.

But what about when the best is behind us? When all we can see, to put it morbidly, is a slow slide into the abyss? For everything, there will be the day when we hit our peak, when we ran our fastest mile, wrote our best piece, or put together our most beautiful art. If striving is the base state of being a human, where does this leave us when the best has come… and gone? As cheerful as springtime with the promise of good weather and good times can make us, so the slow darkening of days, falling of leaves, and cold weather can also cast the dampening gloom. And this decline is not simply one for old age, but a continuing cycle of declines throughout life. The best gymnasts and football players often hit their primes in their teens or twenties. Triathletes or runners often in their thirties. Your best cholesterol levels and healthiest weights were probably as children. The most productive career years for many come early in their careers.

The response to this inevitable decline can be diverse. One option is, in the words of the poet, to rage against the dying of the light. We can become bitter, sad, and mournful. Slightly better, we can take the stoic option and endure. On the other hand, we can find new things to pursue that we can still improve at. We can contentedly reflect on the glory days. We can live vicariously through others. We can make the joy of the activity the object instead of the outcome. Even if it isn’t our fastest mile perhaps it can be the most fun. It becomes healthy for our goals and values to change. Status symbols, prizes, and awards give way to quality time, personal bests, and brand new pursuits. Like a good hike up a mountain, the path up is enjoyable for the challenge, the struggle to catch your breath, and the burning in your legs. The brief pause at the top is memorable and well worth the climb. On the way down you can breathe easily and talk while viewing your surroundings. The journey then is defined by transitions. From ascent to descent, and from trail to trail. Certain aspects of each portion of the journey are far better but there is a valuable and enjoyable component unique to each.

Be purposeful. Be flexible. Journey well.

On the wrong side of history


There have been several mentions in popular media and news outlets referring to the actions of several current people being on the wrong side of history. They might be right. They could also be wrong. It is important to remember that history will judge the actions of today based on the values of tomorrow. It is very easy to look down upon those who owned slaves in America or supported the Nazis in Germany. It is easy to say that we would have acted differently than the people of that era. It is easy to say that we would run into a burning building or give the last of our food to help someone else. It is an entirely different thing to actually act in such a manner. The generations to come are a fickle audience, with the benefit of hindsight and the presumption that they have learned from our mistakes. Those who have stood out as heroes in bygone eras have done so by acting practically in the present, with provisions for coming generations, and a keen internal compass allowing them to weather the barrage of the criticism and hardship in the present.

The opposite of the strong internal compass is the self-esteem crowdsourcing the current atmosphere of social media has created. This method exposes us to the buffets of the judgments of others and the swirling currents of popular opinion. Encouraging generations of exemplary human beings requires a resistance to popular opinion in deference to the internal compass. Crowdsourcing our self-esteem prevents the formation of this internal compass during the formative years and replaces it instead with a superficial morality and character that are based, not on hard-won beliefs and values, but on the positive and negative feedback of acquaintances who may or may not actually care. At the end of the day, at the end of your life, being on the right side of your social bubble, or even history, is far less important than being at peace that you are sailing in line with your compass.

Nuts on both sides


Polarization and extremism in the political spectrum. There seems to be the popular notion that the ‘other’ side of the aisle, the other side of the political spectrum is the problem, the most dangerous thing to progress and the current state of affairs. However this seems patently incorrect. Extremism, on either side of the spectrum, left or right seems to be the most dangerous thing. In a recent conversation with a well educated but misinformed scientist, he asserted that the worst thing that happens with left wing extremism is “a bunch of hippies getting high”. Within the last century the Soviet Union under Stalin and the People’s Republic of China under Mao are examples of far left political ideologies which rapidly generated a higher body count and levels of oppression than a big bag of weed. However, just because these far left governments were, to put it lightly, far from ideal, does not mean that a far right government is a good idea either. Germany under Hitler and Italy under Mussolini are two of the worst examples of behavior from the far right. This is the point of democracy. To prevent extremism by individuals in either direction. To use the numbers and the might of all the individuals in the population to counter bad behavior on both sides. Political wellbeing should not be thought of a game of tug a war but a seesaw. Instead of dragging others as far as we can to one side, our goal must be, as a large population, to congregate slightly to one side or another of center in order to balance out the nuts on the far edges. And there are certainly nuts on both sides.