Hey everybody. This is Dr. Incorporated.
I want to welcome you again to this week’s episode of the truth about employed physicians. We are picking up the conversation I’ve been having with my son, John, about various elements of the young doctor’s life. It’s been very interesting and I’ve really enjoyed these conversations as we kick-off 2021.
Thank you to all you physicians for the way you are continuing to really stand shoulder to shoulder to take care of patients who are dying of COVID, as these people are really sick. People are continuing to struggle with this, even though the vaccines have rolled out. It’s been still pretty challenging on many levels.
I know I’m thankful that I got the vaccine. But I’ve also had a dear aunt that died this year from COVID and it’s tough losing someone close to you. I think most of you probably know somebody in your circle that has died or passed away as a result of COVID 19. Again thank you to all you that stand in the gap to protect and treat others with this virus.
the Examined Life
Dr. Inc: The examined life was something, John, you saw and experienced in our home. We were pretty transparent in our home and did a lot of things together. You observed the importance of other men providing accountability to me and allowing others to speak into my life. Those trusted voices were an important part of my personal growth and kept me from making bad decisions in life.
Those friends provided insights into my life and really helped guide me along the journey of life. They operated as a friend, companion, sometimes as an advisor or a counselor, sometimes just somebody whom I locked arms with as a life companion.
So, John, as we start out, tell me a little about the people that you’ve had in your life that you would consider close enough to examine you. As you reflect on this, give us some examples of what this meant to you?
John: I feel like there’s a few people that come to mind. Initially one would be my wrestling coaches in high school. During those days, they knew me pretty well. I was more open to them than most people in my life as helped shape my inner and outer man. Another one that comes to mind immediately is my wife. I feel like she’s a very good accountability partner and knows me better than anyone else. Then there would be my friend, Ian, from med school as we got pretty close and kept each other accountable for a lot of different things. This close friendship has been really helpful for both of us in a lot of ways.
Dr. Inc: Why do you think it’s helpful to have somebody in your life that is shedding light on areas that you don’t see very well?
Trust Others to expose Blind Spots
John: They have shown me blind spots that are hard to see on my own. As trusted relationships, they can be more honest and open with me about the things that are flaws in my life. When I make mistakes they can be more straightforward and transparent with me about my imperfect decisions. Doctors as a whole tend to be perfectionistic and think they are right most of the time, so having someone empowered to expose my weak spots is incredibly humbling but also powerful.
The trust between the two of us allows me to take that criticism or advice, and take it well because it is for my benefit. I think that’s really important and is a big advantage over just trying to just do it all on my own. It’s very easy to miss things in my life while I am trying to focus on the primary process of becoming a doctor. It requires a sacrifice of everything else, so it’s easier to make mistakes when I don’t have an extra set of eyes to cover my back.
Dr. Inc: Yes, I was always grateful going through my medical education experience, residency, and then even into practice to always have a man or two in medicine that were close friends. People that I could spend time with regularly, and, feel like I could be authentic and honest with them about my life struggles and the hardships. Their support was critical as they spoke into my life. Sometimes they were people in medicine, sometimes that was people outside of medicine. I think both are equally important probably in terms of the examined life. But I think it’s always helpful to have somebody outside of medicine as well. They help keep me grounded in the non-medical world which has great value for a number of reasons. My faith community was always a wonderful repository for this.
John: Yes, I think that’s very valuable to have non-medical influencers in my life. But as I look at my peers and look around at other doctors, I don’t think they know how to express their need for others in their life.
Dr. Inc: Doctors, like most people, don’t like accountability for the most part, especially when they feel it’s micro-management. I think the personality of a lot of doctors is such that they are independent and prefer to do things on their own. Doctors are used to being at the top of the chain as decision-makers and prefer to not have people question them, or feel like they have to defend their actions.
John: It’s not necessarily as a doctor’s favorite thing to have their flaws or mistakes pointed out. They are trained in a model that has expectations of perfection and getting it right the first time. This conditions physicians to be over-confidence and perfectionistic. In turn, these behaviors make it difficult for us to admit errors, mistakes, bad decisions, or even uncertainty about decisions to ourselves. Then it’s even a more difficult step to be vulnerable enough to let others into your life about those things.
Marriage and Home Life
Dr. Inc: There’s no doubt about those tendencies. Those same conditioned behaviors can also impair our social skills and family life. I know my wife has been such an important person in my life to be able to speak truth to those blind spots in my world, a world that includes both work and home. One thing for sure is that I might get things right 99% of the time at work, but at home, that percentage is much lower. Raising children and being married can be complicated and unpredictable. Due to the complexity of the personalities involved, it’s just messier than my work life. At home is where the rubber meets the road and nobody’s perfect, including myself. So having a trusted and beloved mate through marriage is a great asset for living the examined life. My mate knows me better than anyone and has the power to lovingly speak the truth into my life and help me.
John: Yes, I have seen this play out in our home growing up as a doctor’s kid. You do tend to be a perfectionist and mom played a very important role in helping you to be a better father because she covered up a bunch of your blind spots. Not only did she cover them up, but she also made you look better in the process. That’s a real win. But for that to work out well, you had to be willing to let her into your life, into your world, and examine it.
Dr. Inc: I’m glad your wife plays that role for you too, John. Even though you are early in your marriage, you are both learning the power of the examined life within the framework of learning to become a doctor. As you go through this process now, you are establishing channels of intimate communication that will mutually help one another in the future. In essence, you are creating patterns that will be powerful well-springs for your future well-being.
Many physicians are unaware of the benefits of the examined life both within marriage and outside of it. And at the end of the day, the examined life almost always outperforms the unexamined life. With the way doctors value performance, this idea should speak deeply to their need for others in their life.
In other words, we all benefit from having a small group of people in our lives that help us to overcome our blind spots and helping us to grow and develop as a person. Doctors tend to have fewer people in this network, but really need it to broaden their own sense of humanity and identity. The self-sufficient, over-confident life will cause you to have blinders on, and you will miss out on the benefits of the perspective of others.
Role Models
John: As I have encountered perfectionistic and over-confident doctors in my training, I am not attracted to them. They don’t value input from me and others as they ignore the need for the examined life. They tend to repel others and create a barrier to social interaction. You don’t want to say much to them. Those are the people you don’t want to talk to, be around, or associate with. You learn to not ask questions and do your work for them. But the sad truth is that although they may be a great doctor, they are a horrible role model for a balanced and healthy doctor.
Dr. Inc: Yes, especially in training centers, there are always going to be those doctors who over-confidently isolate themselves from others speaking into them. They tend to be your classic know it all doctor, who critically analyzes other’s work and usually can identify some nuance of your clinical care that isn’t quite right. They feel like it’s their job to make you guess what they are thinking, because they believe their way of thinking is always right. What they rarely reveal to those training under them is a mutual sense of discovery, co-learning, and humble acceptance of input that values the thoughts of others. In some regards, they are conditioning their protegees to live unexamined lives.
John: This is a real tension for doctors. They are perfectionistic, high-performers, and are conditioned to be lone rangers who always know the right answer. Thus there is little need for inviting others into their life.
Professional and business-Financial World
Dr. Inc: In my medical world, I have always valued periodically meeting with a peer or colleague to simply discuss our well-being and management of our doctor’s life. Another doctor can speak contextually about the tensions we both live under at both home and work, and these can often be difficult for the nonmedical person to understand. The non-medical person simply sees the glamors of the “Doctor’s Life” and fails to understand our blind spots and unique vocational pressures. This used to happen easily and naturally in the doctor’s lounge of the hospital, but now doctors are so hurried that they rarely have a spare minute to relax during the day. So be intentional about finding a trusted peer to meet with periodically, even if it’s virtual. I really like Peerrxmed.com‘s program for doing this via s simple weekly blogpost.
I’ve, also found having a team of people around me is important. In my clinical office, it includes my office manager, my TeamCare nursing staff, my front office staff, my nurse practitioners, my clinical pharmacist, and my case manager. They all surround me and assist me with optimally taking great care of my patient panel. And I need them in the context of working as a team in primary care. There is just too much administrative and clinical work today for me to deliver primary care as a lone ranger. When doctors attempt to do everything on their own, because of their conditioning, they are eventually pushed towards burnout. EHR’s and 3rd parties in medicine suck the life out of us in medicine today.
Then there is my world outside of the clinical setting. In my home, I need my spouse-mate-companion to provide the needed insights in our home. In my case, my wife speaks life to me and provides me with the needed collaboration for optimally raising our children. She often reminds me, our home is not like the clinic, where I autocratically bark out decisions and orders have the team execute them. No, the paradigm at home is one filled with equality, mutual respect, and shared decision-making about life.
Then there is my financial-business world that requires attention and coordination of input from others who know our family, our goals, our mission, and our values. They work to help us reach those goals by providing professional input. In the past, I had several accountants, bankers, financial planners, and lawyers who I met within silos and my job was to pull together all their input and unify it. But then I discovered a better model through SimpliMD where my lawyer, accountant, tax-planner, business advisor, and investor all sat at the same table with me and together we met quarterly to discuss present and future planning. They worked together, synergistically to help my wife and me reach our goals. It was a game-changer, and I highly recommend this team model to all doctors. It’s kind of like the Mayo Clinic collaborative medical model but for the financial-business interest of doctors.
John: I feel like things are a lot less complex when you’re 24, 25 years old. So I don’t necessarily need as many of those people right now. But I guess you could say that we have our advisors in medical school and we have or financial aid gurus. We could do our own taxes I guess, but we pay someone to do them even though my wife is an accountant. We like the idea of somebody else looking things over to provide input on new tax codes/regulations/etc. In regards to investments, we like to do that ourselves. We used to have someone who helped us with that, but we felt like at our current stage in life we are better off doing it ourselves because it’s not that complex. I really enjoy personal finance although I know a lot of people find that stressful and would rather pass it off to someone else. But for me, I’d rather do it myself because that’s my fun thing to do in my free time. Because my wife does it all day long, she would prefer not to do it in our home. When I ask her to look at our personal finance Excel spreadsheet, she says “John, I looked at Excel spreadsheets the entire day, so I don’t want to look at an Excel spreadsheet after dinner tonight.” So I gotta find her at the right moment. It’s all about the timing! But that’s fair enough because if someone wanted me to do you more patient reviews after dinner or after I was done with work, I’d be like, I don’t really want to do since I just did that all day.
Dr. Inc: Just out of curiosity, do the two of you have your have a personal budget?
John: Yes, we have a budget. We keep up with it every month and year over year, just to see how we’re doing towards meeting our goals. There are some real details that go into it for us. Our first year of being married it was very detailed and probably over-detailed. There were multiple subcategories for each line item, kind of like what you’d expect an accountant’s budget to look like. Then this past year we toned it down a bit, but we still like to track what we are spending on things. You definitely don’t want to have to spend too much time on it, but you should also have some unified approach in marriage as to what you are spending your money on, and how much you are saving, etc….
Dr. Inc: I believe a budget is very important and we find it valuable to use it to help us reach our personal and professional goals. Your mom and I get away every fall to make an annual budget that incorporates our dreams and goals for the year(s).
John: Oh yes, I have seen you do that every year and I think that is great. But frankly, most medical students aren’t married and don’t have someone earning income in their home yet. They learn to subsist on loans, and meager living during med school. In that context, there is not much of a budget to manage. A lot of students have to take out loans for living expenses. It’s mostly for tuition because they don’t have a nice job to cover their living expenses and tuition. Loans for medical students are very accessible, so it’s pretty easy to get money. In fact, it’s so easy that you have to be careful not to take out more than you need simply because you can. The money flows freely in medical school as they are happy to give it to you and begin collecting interests on your future income. Medical students are a safe bet for good returns for most lenders.
Dr. Inc: For that same reason, lenders and financial professionals will continue to target you after medical school. They all know about your low risk and high income, and all want a piece of it ranging from disability insurance to life insurance to car salesman to realtors to bankers to investors. It just goes on and on for you as you grow into your physician world, a lot of people generally make a lot of money off of you.
That’s where I think having a team of people around you whom you can trust to know you, that know your goals, that know your interests, that can protect you is critical. And the more integrated that team is, the more individualized and successful will be your outcome. We meet with our SimpliMD team quarterly. This isn’t just to see how our investments are doing, but we gather their advice as we talk about various goals and issues in our life. We discuss the tax and business architecture questions that surround our personal and professional lives. They provide counsel and support that help us reach our goals. It’s the beauty of having other professionals in your life that can speak to you and actually keep you from making mistakes, and keep you from doing things that are not the right way to go. Assembling people like that in your life makes a lot of sense. Because we all have blind spots and this is especially true for doctors when it comes to business and finances.
the Learning Lab at Home
Beyond business and finance, I think it is even more important in the doctor’s home to create an environment that allows for imperfection, mutual support, team work, and embracing the holistic process of well-being. This includes both self care and family care.
For example, the simple and humbling process of learning to apologize. John, in our home, as you grew up with your other 4 siblings, you recall multiple times that I had to humble myself and come apologize to you, a sibling, or your mom for something I mishandled. Saying “sorry” and making restitution were something that we valued and learned in our home. That was part of the family learning experience that you observed relationally. And it was all part of living the examined life in medicine. I had to acknowledge that I was not perfect, and then model for you what to do when I made a mistake. Mistakes and errors will happen. What do when it happens, is more a learned trait.
John: It’s it’s humbling to do that, but yet it’s powerful. I always appreciated your efforts to demonstrate your humble humanity to our family. It’s one of the things that I admire about you. We saw you as superhero, but one that was very human and approachable to us.
Dr. Inc: I happen to think one of the great life skills for all people, but especially doctors, is learning to apologize. Saying those words, “I am sorry, will you forgive me?” or “I made a mistake, can we talk about how I can do things better next time?”. These are powerful words both at work and at home. In fact, the literature says that’s one of the greatest deterrence to a malpractice case is deploying a skillful apology.
I think the examined life is a very important part of our doctor’s life and it’s ultimately going to make us better physicians in the long run if we are able to embrace it.
Listeners and viewers of this social media station, I invite your feedback when it comes to your thoughts and experiences with the examined life.
Tell us a little bit about your own experience. Maybe the people that you’ve assembled in your life that have made a difference, whether it be personally and professionally.
I do invite you to have trusted friends in your life, because, at the end of the day, it’ll make you a better doctor and allow you to enjoy practicing medicine so much more.
