Below are the episode show notes and transcript. Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. Enjoy!

Show Notes

Giving thanks, thanksgiving, gratitude…

It’s not just a day of the year…

But an attitude, taking the time to reflect on what is important…

Listen to episode 18 to hear how to have gratitude for hard or unexpected situations because of the lessons learned

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Giving thanks, thanksgiving, gratitude, important things, but hard to implement. Sometimes life gets busy, hard things happen, and it’s tempting to complain. Stick around to hear how you can show gratitude for surprising things and take lessons from them into the rest of your life.

Gratitude for different things

I’m really thankful for my family, for my wife and my daughter, all my colleagues, friends of mine. These are really meaningful and impactful relationships and people in my life. But I wanted to take a moment today to explore five of the areas, five experiences I’ve had that, in the moment, I wasn’t very thankful for, but looking back, I can learn lessons that allow me to say, yes, I can actually be thankful for that and show gratitude.

Sometimes gratitude is difficult

This is kind of a natural time of the year coming up on the holidays when you think about, “How am I thankful for things that happened, people that are in my life?” And yet, this may be a time of mixed emotions. It’s a time when some of these things are hard to be able to say, “I’m thankful in some of these situations,” whether it’s a loved one you’re missing, or an experience that you didn’t get to have, or just something that maybe you regret. These are real things. And I don’t want to discount those, but I also want to take a look at some of the ways in which really there are some lessons from these situations for which we can be thankful.

So I’m going to dive into five areas, experiences in my life that initially I wasn’t grateful for, but I want to share how I’ve learned from those and ways in which my life has been richer as a result.

From scheduling conflict to choir

So first I’m going to start with back in high school for me when I didn’t end up being the valedictorian. It wasn’t my goal per se, but I had done well in my classes and was on track. I took a bunch of accelerated and advanced placement courses. Those were whatever were available at my high school, and some of them had a lower GPA than others courses that everyone was required to take public speaking, consumer economics.

You could actually pass out of consumer economics in order to boost your GPA by not having that count as a lower score. Looking back that wasn’t helpful for my financial education, and I honestly wish I had actually taken that at them at the time.

So I tested out of the consumer economics, great. That meant that more accelerated and advanced placement courses would lead to a higher grade point average due to being involved in a number of advanced classes. Then, I was in the band in high school, and with my Spanish class, I would have taken the same class junior year and senior year. It didn’t really make a whole lot of sense for me to do the same class over again. And so someone encouraged me to try choir. I was musical, played piano and saxophone, and I decided to go for it. And I am so glad that I did.

I ended up taking one less accelerated course than someone who beat me out or the top honors. And I didn’t get to give a speech at my high school graduation. Looking back, I wasn’t into speaking at that point, but it would have been an honor. And yet being in choir then gave me the confidence. When someone asked me my freshman year on orientation at college, “Hey, why don’t you audition for the men’s choir?” And I said, “Sure!” It ended up being such a rewarding experience.

I was in the all four years of college and made a lot of good friends there and opportunities to travel to Europe and around the US and was even involved in an opera music theater production, but it was a memorable experience. Yes, Ryan in makeup, and a red coat as a, as a soldier in “Patience”. So it was a great experience and all the result of me having this disappointing experience, but in the end, my life was richer for it.

Failure refines study process

So the second experience was in medical school. I was in my second year and amongst other classes, I was in histology in undergrad. I was a physics major with a pre-med emphasis. And I took the usual prerequisites, which included biology for two semesters. I didn’t take histology or cell biology. And so at the beginning of my second year of med school, I was reading the textbook, going to lecture, and doing the best I could to study. And yet I just barely failed my first exam.

It was really humbling from nearly being valedictorian in high school, graduating with honors in college and failing my histology exam. This was hard. So I ended up getting some feedback from the professor and it gave me a little bit of extra focus. I changed some of my studying habits and ultimately I was able to pass my class. It was hard, but I learned a lot from that situation.

I adapted my learning style. I was already figuring out that at least for me, going to all the lectures and reading all the textbook and the notes didn’t work for me, I ended up with kind of a hybrid approach where I would go to a few lectures for some classes. And I had to make my own notes and study guide in a different way that really pushed me. So it was a challenge. I got feedback and I made adjustments again, important skills that I needed, but it was hard.

Not a chief but leading in other ways

So from high school through med school, then in residency, I went to a big peds residency with multiple combined pediatrics programs. There were three categorical pediatrics chief residents each year. It was the type of thing that you would apply for during your second year. So a year and a half left in residency. And it was an extra year where you would have opportunities for leadership and teaching. I thought I have a lot of administrative skills during my time in the college choir. I was the assistant business manager and then business manager in successive years. And I was a physics major. So I thought I would be a great fit for this.

I was hopeful. And yet I wasn’t selected for any of the three spots, thought, all those scheduling spreadsheets, all those things. I enjoy teaching others. And yet, why was I not chosen? My colleagues thought I should have been. And yet later on, I saw that leadership involved getting others to follow you leading by example. And it gave me the opportunity to be done with residency after only three years where I could start honing my clinical skills as an attending. AND… I’ve had opportunities for leadership. I’ve had opportunities to influence staff, colleagues, I electronic medical record efficiency committee. These are all things that came out of me being disappointed by not being selected.

Growing where I am

Number four, I didn’t get any of the three inpatient jobs that I thought I wanted coming out of residency at the end of my second year and beginning of my third year of residency, I was looking, looking for a job.

So I was preparing to get married and helping with wedding preparations and started looking at opportunities, putting out applications. I had a couple of interviews. I thought inpatient medicine in pediatrics might help keep my skills more up to date, broader. It was just what I knew my pediatrics residency was great, but it was primarily an inpatient experience. I only ended up with two offers, one in my preferred location, and they were both outpatient.

I didn’t know the ambulatory skills that I lacked. And I found looking back now, these, the time of this recording five and a half years, that I’m in a great fit for me, got a diverse population, great colleagues, leadership opportunities. And I have grown a lot by ending up where I did. Did I think this is where I’d be? No, but I’m so thankful that I’ve been here.

Thankful for burnout?

Finally, I am thankful for my experience with burnout coming right out of residency into that outpatient job. I started out a full 1.0 FTE. That was about nine sessions a week as many new attendings do. I was relatively inefficient. And in the first few months, our electronic medical record changed. I was bringing notes home often. I prided myself as I had all the way through my schooling and training on being a hard worker and an achiever.

And yet, eight months out, when I picked up a week of newborn coverage, I found myself working 12 days straight. I had done this type of thing in residency, but this was different. It was being directly responsible, bringing notes home. On top of all the stresses of being a new attending. I was exhausted. This was the time when my wife and I sat on the couch and we had that conversation where she said “something has to change.”

I knew she was right. I cut initially to 0.8 and then eventually 0.7 FTE clinically, and ended up with some electronic medical record optimization time. It’s been a great fit for me. I still struggle with some of these burnout wellness. How much do I bring home? That’s why I was, like I said, in the intro, working on some of these clinical skills and efficiency tips. So again, my download free maximize your clinical efficiency, these things going room to room, using the EMR tools, maximizing my communication. These are big things and things that I consistently have to keep working on. I don’t like being told you have to do it this way. And yet some of these things are really helpful. And so it ultimately is a tool that I’m able to use to get to my goal of being able to spend time with my family, be able to leave work at work.

And overall this experience has helped me learn more of my limits. When does my stress increase? The importance of self-care. How to say no more often to be intentional with what I say YES to. I’m thinking about what I want with regards to my work and my life. It’s also helped that my learning some of these financial things through the White Coat Investor and others, that I’ve had the financial margin to be able to then create that professional and personal margin.

So what? What lessons have you learned?

So those are my five things that looking back on that, I’d be a little bit surprised that I’d be thankful for them. Take a moment and reflect what in your life could you look back on what your life could you look back on and say, actually, I could be thankful for that because of the lessons that I’ve learned, that if I didn’t take the time to say this is actually what I learned, I wouldn’t be thankful for those.

  • How could these lessons impact how you live today?
  • How you practice medicine and are any of these lessons, things that you can pass along to others?
  • Imagine what it would look like, where you could say, if things are good or in many cases, if things are hard, I can still grow.
  • Where would you be in six months, a year, five years, you took all of these lessons and applied them and shared them with others so you could pay it forward?