Published in American Urological Association News - October 2018
Reprinted with permission from AUANews, volume 23, issue 10, 2018; © American Urological Association 2018.
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How to Use Your Vision
This statement can elicit all sorts of responses. The important thing is how you can use your vision to your advantage to create your best performance.
Visualization (Planning) and Vision (Aspirational Goals)
There is an important distinction between visualization and vision. Visualization is a version of planning, wherein you can walk through the steps of a skill, procedure or surgery to rehearse the sequence a few times before performing it live.
Vision, on the other hand, is more of an aspirational goal. Organizations often define their vision in a Vision Statement. Individuals can also have a vision for their future. This aspirational description of what one would like to achieve in the intermediate and long term serves as a guide to making choices in the short term which will serve that goal.
Vision: the Power of Seeing Where You are Going
In order to see, we must first look. When we are seeking improvement, whether in our surgical skills, our hobbies, our business or something else, we can look at what has previously worked to improve performance and put that on repeat. Or we can look to others to see what we can adopt. What works best depends greatly upon your vision.
Vision to Reach the Peak
I recently attended a conference in Colorado and brought along my 14-year-old son. One day, his vision included climbing to the top of a summit near our hotel. In order to reach the top, I needed to tap into the hiking skills I acquired as an Eagle Scout, as well as the breathing techniques I practice in yoga. While physically these skills would be helpful in succeeding the climb, it was the mental strength and perspective that I needed to visualize.
What do you have that can help you reach your summit or peak? What do you need to borrow or learn to help you get there?
Vision When Things Get Choppy
On this same trip my son also envisioned going white water rafting. I knew I could control the controllables and so I made sure we had proper safety equipment, understood the different rapids categories and paid attention to our guide. I knew I could not control the rapids, whether they would be powerful, powerless or somewhere in between.
Our journey started out choppy with class 3 and 4 rapids. In the middle of the excursion we floated smoothly but then returned to some rough waters. Rafting is like other life endeavors — it is unclear whether the waters will be calm or take an unexpected turn into choppy rapids. Prepare for the possibilities and then go with the flow.
What if your career were a rafting trip? Are you in a phase of rough waters or a calm float? When between rapids, are you looking around and taking in all of the beautiful sights?
Vision—Which Way Do I Look?
“Sometimes in order to keep moving forward, not only must you take one step at a time, but you must be willing to look back occasionally and evaluate your past, no matter how painful it is. Looking back lets you know whether or not you are headed in the right direction.” — G.K. Adams
How does it benefit you when you look back? How can your vision assist you in making your actions consistent with your intermediate and long-term goals? What is your vision?
Published in American Urological Association News - July 2018
Reprinted with permission from AUANews, volume 23, issue 7, 2018; © American Urological Association 2018.
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Questions vs Answers
From our first day of preschool to our last day of residency, our performance is largely determined by our capacity to deliver the right answer in the right moment. The better a surgeon’s ability to deliver the right answer, the better their ability to help patients and build a thriving practice... Or so the story goes.
Lately, I’ve been wondering if the medical community’s emphasis on having the “right answer” is the wrong approach to training the next generation of surgeons.
The Risk of Being Answer-Obsessed
When the objective is having the right answer, learning becomes an act of memorization as opposed to higher learning. When education becomes a glorified fact-checking process, thoughtful questions aren’t asked, new connections aren’t made and development occurs at a snail’s pace.
What if we shifted the emphasis away from having the answer? This isn’t to say that having the wrong answer to established medical knowledge or best practices would be acceptable, but what if we reinforced asking thoughtful questions as a valued part of the education process? You know, the kind of questions that
stimulate higher thought and deeper thinking
ultimately lead to medical breakthroughs and innovations
challenge dogma or even our answers
What if we taught medical and surgical students to make a strong habit of asking questions, the same way we encourage them to make a habit of having the right answers?
Questions for Established Surgeons
This applies not only to medical students and young surgeons, but to established surgeons as well. Established surgeons (including yours truly) can benefit mightily from asking more questions. Asking questions is how we learn to reengage with our professional passion.
When we ask ourselves “why did we get into this career in the first place?” we can reconnect with the reasons we started our adventure. Asking “what makes me happy?” and “for what am I grateful?” is how we create a better attitude for ourselves and deal with many of the unique frustrations of working in the surgical field.
Questions such as “what are other perspectives to look at this?“ and “how would it feel to be in their shoes?” are key to improving our capacity for communication and mutual understanding with our patients, with our families and with our colleagues. When we create time to reflect on a busy day at the practice and ask ourselves “what can I get better at?” and “what new things am I learning?,” we inspire and influence ourselves to truly improve.
If we want to build reciprocity in our roles and relationships, and if we want to ensure our lives are fueled by a cooperative exchange of give and take, we must engage with questions like “what is my give and my take in this role?” and “what is fair to everyone involved?”. However, most importantly, if our goal as surgeons and members of an essential health care field is to find simple solutions to complex problems, then we must be encouraged to ask questions.
Published in American Urological Association News - April 2018
Reprinted with permission from AUANews, volume 23, issue 4, 2018; © American Urological Association 2018.
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Diversity is an interesting term. We talk about it all the time in the media but rarely do we grasp the true meaning of the word.
Diversity isn’t the exclusive property of the progressively minded, nor is it something that can only be applied to matters of gender identity or racial makeup. Diversity is about more than that.
Diversity, to quote Malcolm Forbes, “is the art of thinking independently together.” I’m worried that far too few surgeons are approaching diversity in this manner.
My concern isn’t the lack of gender or racial diversity in America’s surgeons (those may be pertinent issues as well but that’s another conversation) but rather, the lack of diversity in what it takes to be a great surgeon.
I fear the surgical culture is too restrictive. It has been my experience that our culture stifles differences of opinion and shuts down thought patterns that deviate from the norm. I know a lot of surgeons who have had similar experiences throughout their time in practice. Just because we’re all surgeons doesn’t mean we have to think alike, talk alike or live alike.
Admittedly, we should all act on core principles, that is to say intelligently and professionally, in the operating room but outside of work, who cares? We don’t need to vote for the same political candidate. We don’t need to live in the same kind of neighborhood or drive the same kind of car. And we certainly don’t all need to like golf or tennis.
Surgeons are different, and those differences are OK! In fact, they’re more than OK. They’re wonderful, and they need to be embraced by the surgical community and its leaders.
When we embrace intellectual and philosophical diversity, we develop a better attitude towards our profession and our peers. Instead of getting frustrated by an opinion that is radically different from ours, we learn to appreciate that difference and approach it with a positive attitude. That improved attitude leads to improved communication in the workplace, which naturally leads to better complex problem solving, and healthier professional roles and relationships, all of which are empowered by a cooperative exchange of intellectual give and take.
As forward thinking surgeons, we need to ask ourselves how we can engage with our peers (and the opinions of our peers) without attacking. Everyone has a valid opinion and should be treated as such. How can we cultivate positive change without lambasting those who view the world, be it the surgical world or the world at large, through a different lens?
Of course, I don’t have the answers to these tough questions, at least not yet, but I’m willing to put in the hard work required to uncover them. And I hope to some degree I’ve inspired and influenced you to do the same.
Published in American Urological Association News - October 2017
Reprinted with permission from AUANews, volume 22, issue 10, 2017; © American Urological Association 2017.
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The Mental Strength of Surgeons
Surgeons are a lot like high performance athletes. Not in the physical sense (although there are certainly some very athletic surgeons out there!), but in the mental sense. Successful surgeons are mentally tough. They have hardiness and fortitude, and can push through life’s disruptions.
When faced with the everyday challenges of surgical life, elite surgeons go beyond the barriers of what’s comfortable using the same mental toughness the world’s most elite athletes tap into during training and competition. There is a resilience and willingness to go beyond the point of exhaustion to secure the “win.”
For surgeons who’ve been struggling or surgeons simply looking to stay at the top of their game, understanding what it takes to be mentally tough is critical. The best definition of mental toughness that I have found comes courtesy of authors Peter Clough and Doug Strycharczyk in their book, Developing Mental Toughness. 1 They define mental toughness as “The quality which determines in large part how people deal effectively with challenge, stressors, and pressure...irrespective of prevailing circumstances.”1
Strycharczyk and Clough continue their defi nition by breaking the broader concept of mental toughness into the 4 keys of 1) challenge—viewing challenges as opportunities rather than obstacles; 2) control—believing fully in the power of self-determination; 3) commitment—an unwavering ability to see assignments through to completion; and 4) confi dence—complete confidence of self and one’s ability to succeed.
Elite surgeons have each of these 4 keys. Applied outside the operating room, they maintain thriving careers. Applied to their personal life, they achieve lifestyle-friendly and sustainable careers.
Challenge. Mentally tough surgeons don’t think they can succeed inside and outside the operating room— they know they can. Their attitude is one of maximum positivity, built to withstand the gauntlet of surgical life.
Control. Elite surgeons believe fully in their ability to control their destiny. That belief cultivates an insatiable passion for performance improvement, which naturally leads to sustained professional success.
Commitment. The best surgeons are the most committed—those unwilling to retire from the day until the job is done. Through relentless practice, these surgeons become masters of complex problem solving and time management. They learn to reduce a problem to its simplest form before attempting to solve it, allowing them to get more done with less time and effort. This helps them be more committed.
Confidence. Mentally tough surgeons inspire and influence themselves using internal rather than external rewards. Because they have an internal well of 24/7 motivation, their confidence in themselves, their abilities and their mission can’t be shaken by setback.
Ultimately, the only thing that binds elite surgeons and elite athletes more than any other is an uncanny ability to find the positive in everything.
It is not that elite surgeons and athletes never have “down” moments, as they absolutely do. However, when those down moments occur, they are confined to just that moment. When the moment passes, elite surgeons know how to bounce back. They put a positive spin on things, find a silver lining to extract, and resume their quest for professional and personal excellence.
For those surgeons reading this article who think they lack one (or more) of the 4 keys to mental toughness, don’t worry, as they are skills that can be learned over time with an investment of time, energy and (of course) practice!
1. Clough P and Strycharczyk D: Developing Mental Toughness: Improving Performance, Wellbeing and Positive Behaviour in Others. London: Kogan Page Publishers, 2012.
Published in American Urological Association News - July 2017
Reprinted with permission from AUANews, volume 22, issue 7, 2017; © American Urological Association 2017.
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Why Surgeons should Build their Emotional IQ
Surgeons are smart. But what kind of “smart” are we? Too often, we focus on building academic intelligence. We zero-in on test-scores, professional distinctions, prestigious degrees, and, in the process, we forget about another kind of intelligence, "emotional intelligence," an intelligence that is critical to sustainable success. Don’t worry, this isn’t another feel-good, “get-in-touch-with-your-emotions” article. This is an article dedicated to the sharing of the real-life value of developed emotional intelligence.
Passion for Performance Improvement
Why did you become a surgeon? What was the emotion behind that decision? Your emotional motivation is the key to overcoming frustration, exhaustion, stress, or negative emotions that keep us from reaching the heights of our professional potential. Identifying and understanding that emotional motivation is leverage to perform and improve—and positive emotions are the key to sustainable growth.
Role and Relationships
Yes, you’re a surgeon, but are you a parent? Spouse? Friend? Teacher? The roles and relationships we have in our lives come with their own unique emotional costs and benefits—anxiety, stress, overwhelm, joy, excitement, etc.
Learning how to identify when the costs become too great is essential. Any role or relationship, left unchecked, can become a leach in your life, taking and taking until you’ve got nothing left to give, and your practice suffers.
Obviously, attitude is a byproduct of emotion. Attitude dictates our state-of-mind when we walk into (or out of) the operating room. Emotional intelligence allows surgeons to more easily shift from sadness and gravity to happiness and gratitude and helps us convey hope as well as a caring and confident attitude that resonates with patients.
Ever heard the saying, “it’s not what you say, it’s how you say it?” Tone, inflection, posture, eye-contact, and energy, are just a few of the many components that determine how effectively you communicate. And, like it or not, your emotional state weighs heavily on how you communicate. As a surgeon, having a high emotional IQ means you can recognize what you and others are feeling and keep emotions in-check, preventing them from contaminating your communication with peers, patients, family, and anyone else you encounter.
Emotional intelligence is time-sensitive, balancing the emotional needs of important relationships with your personal needs. You know those mornings where you can’t get going? Or those days when you look up from your desk only to realize it’s 8 pm and you haven’t eaten, exercised, or checked-in with spouse all day? Emotionally intelligent surgeons aim for focus and quality over quantity.
Inspire and Influence
So much of your success is tied to your ability to inspire and influence others. How can you inspire others if you are no longer inspired? How can you successfully influence if you can’t emotionally connect to the worries, fears, and emotional drivers of others?
Complex Problem Solving
Successful surgeons have trained to solve complex problems but that ability can be compromised by the taxing emotions that commonly accompany the problem-solving process. Emotions like frustration, anger, embarrassment, disappointment, self-doubt and hopelessness. Emotional intelligence comes from small successes and knowing that failure breeds resilience, determination and useful knowledge.
It’s hard to be a great surgeon, stay healthy and lead a sustainable career if you’re running low on energy. Nothing saps energy as quickly as negative emotions. Emotional recharge and recovery restores calm, hope, joy and confidence.
When positive emotions prevail in your life, growing and maintaining a successful surgical practice is much simpler.
Published in American Urological Association News - April 2017
Reprinted with permission from AUANews, volume 22, issue 4, 2017; © American Urological Association 2017.
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The longer you have been practicing, the harder it is to question your status quo.
It is hard to rock the boat. It is especially hard to rock your own boat.
You have invested so much time into being who you are...a surgeon and much more. You’ve spent time building up your conviction in what you do, how you do it, and, the more core issue, why you do it.
But we are able to stay more current and well when we are willing to question assumptions. When we think we have all of the answers we stop asking questions. Instead we say or think things like:
They will never agree to that.
I will be mocked if I suggest this.
That failed last time I tried.
These are assumptions - a belief that if something happened in the past, it will happen again. Assumptions are more likely to lead to failure. When you apply a different approach and create persistent action, you are more likely to succeed.
Take a look back into the past. Did your past successes mostly come from persistence and challenging assumptions? I’m betting they did. Ask yourself, “Just because it happened before, why does it have to happen again?”
Let’s make it even simpler.
I propose that we should be regularly asking ourselves three simple questions:
Why am I doing this?
What if I change how I do this?
What if I change what I do?
Please keep in mind that bringing up questions does rock the boat. I don’t love encouraging pain on others, so please be prepared to ask for help from others that care about you.
When in doubt, start challenging the assumptions on how you do things first. After you practice this a little more, you can start challenging what you do.
Lastly, cautiously challenge your why. From personal experience and with many hours of working with other surgeons, I’ve noticed that energy expended tends to be reversely proportional. That includes physical, mental and emotional energy. If you are not challenging your “core WHY” or your purpose, it is not as stressful.
This is not restricted to challenging your own assumptions. You can ask these same questions of others (your hospital administrator, your partners or colleagues etc.). When you do challenge others, try to be just as respectful. Why? What if? If it isn’t at their core, they will be more willing to explore challenging the assumption as well.
Published in American Urological Association News - January 2017
reprinted with permission in AAOS Now - January 2017
Reprinted with permission from AUANews, volume 22, issue 1, 2017; © American Urological Association 2017.
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Less Balance! More Focus!
The other day I was reminded of a very important idea while I was at my yoga class:
The value is in focus, not balance.
Much of what is required in yoga and a surgical career takes balance. And on many days, I find myself pushing for more and more of that balance. Sometimes I waiver, sometimes I fall, but I am always striving for that balance.
The benefits of balance are real, and I see them in so many ways which, is why I constantly strive for it, whether I’m at home, at the office, or in the yoga studio.
Unfortunately, any time I struggle with balance, my mind has a tendency to see that struggle as failure. When I am unable to hold a pose, or my career starts to take up too much of my time, I see that absence of balance as a personal shortcoming.
But that’s not how it should be because battles with balance are really opportunities for focus which leads to rhythm which leads to good things.
One of the key practices of highly successful surgeons is rhythm.
In my experience, getting into YOUR rhythm depends upon where you feel you’re functioning.
· Burned Out? – Learn to triage your time, especially time for yourself
· Surviving? – Learn to adjust your priorities consistent with your values
· Succeeding? – Learn to increase efficiency and return on investment
· Thriving? – Enjoy the journey!
When surgeons are in rhythm, they can go from one role to the next and one patient to the other, with the focus and mindfulness that leads to quality treatment and care.
And how do we define quality?
When our patients say we seem to “really care” or that we “listen well,” those moments are a reflection of quality derived from focus.
When our kids or spouse feels we are less distracted by work or enjoying our time with them, then we are injecting quality drawn directly from the purposeful focus of our attention into these relationships.
Are you battling for balance?
How can you use that battle as an opportunity to channel focus?
Remember--focus will bring you to rhythm, and rhythm will bring you to some fantastic spaces.
Published in American Urological Association News - October 2016
reprinted with permission in AAOS Now - September 2016
Reprinted with permission from AUANews, volume 21, issue 10, 2016; © American Urological Association 2016.
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The Need for Surgeons to Have Flexibility
As surgeons, we know the importance of precision.
We are exact.
We are meticulous.
And we are this way because a misstep could cause serious, irreversible injury.
But that obsessive compulsiveness does not need to permeate every aspect of our world.
By learning to master the art of mental and emotional flexibility, we can receive more happiness and joy from our normally rigid practices and lives.
The palm tree and the surgeon
I live in San Diego, your host city for the Annual Meeting AUA 2016, where the streets are littered with palm trees—a universal beacon of ocean-side tranquility. Most of the time, these trees stand firm and tall, unwilling to waiver to light breezes coming in off the Pacific.
However, when a storm hits, the palm tree ceases being rigid—it flexes in strong winds to avoid being uprooted or splintered. After the storm, the palm stands tall again.
Surgeons are rooted in rigid principles that allow them to stand tall in the operating room. But like the palm tree, we must learn to practice flexibility when the situation calls for it in order to avoid becoming uprooted or damaged.
Surgeons thrive in the routine, in the regimented.
But life is neither routine nor regimented, and when something challenges our routine, it’s easy for us to become angry or frustrated.
That’s what makes flexibility so important.
Flexibility is the mechanism that allows us to weather storms of the unexpected, whether they arise in the workplace or elsewhere. Flexibility lets us bend with the wind like a palm tree, instead of standing rigidly and dangerously in opposition to it.
To help you become more comfortable with mental and emotional flexibility, try practicing some of these strategies:
Stray from your daily routine on your downtime
If you always go to Starbucks on the way to the hospital, take yourself to a different java house. Always go to the gym on your way home? – skip the treadmill and go see a movie.
Is your workout routine perhaps boring? Change it up. Start intentionally injecting variety into your life and see how good it feels to stray from the norm.
Practice an open mind
Start being more aware of your thoughts and feelings. Avoid a rigid, one-sided thought process.
Embrace the random
When something unexpected emerges in your day, don’t stew over it. Embrace it as a unique opportunity.
Incorporate movement and exercise
Feeling stressed or worn out? – get out of the office and go for a brief walk. Doing so will help you cultivate clearer, more positive thought patterns.
Learn to embrace and practice flexibility. You’ll bend rather than break beneath the pressure that is a surgeon’s life.
 Bartels, L.: “10 Brain Tips to Teach and Learn.” SharpBrains. Web. Accessed 4 June 2016. Available at http://sharpbrains.com/blog/2010/12/08/10-brain-tips-to-teach-and-learn-ideas-for-new-year-resolutions/.