The title is an incredibly inspiring and challenging quote from Adam Grant’s recent book Hidden Potential.

Like a lot of great advice, it’s easier said than done. I’ve been thinking lately about how unforgiving our world seems because it both never forgets, and it cancels easily. It can feel terrifying.

But this quote is both encouraging and forgiving - enough to move my intentions to write back into action. So for you and me both - let’s write and share bravely. If you make mistakes, learn. If you read and get value, share. I’ll try to do the same.

This will help each of us unlock more of our hidden potential and move together toward a culture of acceptance, consequences and growth.

Thank you Adam Grant for the deep dive into such interesting questions.

And thank you Seth Godin for the inspiration to do very short blog posts.

In the bustling world of startups and high-paced careers, the mantra often echoed is ‘work harder, work longer.’ However, is this narrative serving us, or is there a deeper, more sustainable approach to achieving our goals? In this Medium article, inspired by conversations with physician executive coach Dr. Michael Brown and lessons from Clayton Christensen, I make my case for the strong application of ‘creative constraints’ and how setting boundaries on our work hours, akin to Cal Newport’s advice, is more likely to lead to high performance, and “most likely to succeed” work, not just for startups, but in college, providing legal services, caring for patients, winning at sales, and providing wonderful world class technical support.

I’m still amazed at how necessary it is for most of us (myself included) to do the work again and again to shift our perspective from success being about hours worked to the more likely to succeed approach that prioritizes quality, adaptability, and sustainable high performance. Hopefully this “think with me” article helps save you some serious time (from overwork) and makes you and your team much more likely to succeed!

Most would say it is priceless, and yet how do we act? Instead of guarding this, we give it away to things that matter far less to us, but that seem more urgent in the moment. Especially work. Why do we do this?

I explore this in some detail in this new article in which I:

• do a thought experiment thinking about how we think about the value of an hour with our loved ones, and then think about the value of an hour of work
• take a look at some simple math of what working additional hours really means (TLDR; if you earn a salary and don’t earn overtime pay this often means that you are taking a 34-66% pay cut, which results in some ridiculous potential statements in getting home like “Hi Honey, I just worked 4 extra hours, missed our family time, and seeing the kids, and did it for a 34% hourly pay cut!”)
• see what assuming just basic equality between and hour of work and hour of time with your family means (what is $10,000 of extra family time?)
• look at end of life surveys to see what people really regret at the end of their lives (hint: it is not working more)

And then we explore 5 steps that can change this and some of the neuroscience and organizational psychology data that supports these steps. In short, these are:

1. Set clear time limits for yourself at work
2. Set priorities and time estimates for every task you do
3. Plan and replan your days, and work in focused, prioritized time blocks
4. Use the urgency of the shorter hours to drive yourself into more efficient work practices
5. Learn how to say no well to lower value work and tasks (especially now that you know how valuable your family and personal time is)

If you want to know the details, feel free to read the full article.

I care a lot about the projects that I am working on. I think you probably do as well. Why is it so hard to finish these projects, and why despite our best efforts are we so busy during our supposed down time. I’ve been thinking a lot more about this, and doing some “bad drawings” to help clarify why it keeps happening (I love and learned a lot from Math with Bad Drawings, and have found a much better question and 4 steps that I am using to help myself “finish better”.

The question I am using is “How can I get better at finishing well?”

The 4 key steps I am using are:

1. Taking the time to define ‘done’ for the project
2. Understanding that ‘done’ is most often a multi-step process.
3. Use the necessary slack time for the final steps as a “project learning dividend”.
4. Control the final number of iterations.

You can read more about it (and see the “bad drawings”) here.

There’s a great song by VNV Nation that I’ve been listening to each morning in the last few weeks — Gratitude.

It helps me start my day well, expressing for me not just the will to move forward with courage but what I find most powerful: an attitude of gratitude rather than regret for the hardships (and the challenges to come).

Here’s why I think this is so powerful.

The shift in attitude is instantly empowering.

As you move through your days, trying to navigate the chaos of the future, filled with doubts and questioning (especially if we are tackling something that truly will make a difference), using this power of gratitude to consciously shift from frustration or fear to gratitude can be instantly empowering.

Questioning is part of making us better.

What does this feel like as a doctor who wants to help provide the best care possible for all? The doubt is real. How will you know that this is the best care? Can you know? But the questioning matters. And if the questions helps uncover what we might be missing and improves the care we can provide, that helps us move us closer to the goal (often closer than we thought was possible).

It helps you to center and ground yourself in where you are (not where you wish you were).

What does this feel like as someone who cares about others flourishing and helping them live the best life possible? There are so many challenges, so many things that stop us from living our ideal life. But the questioning matters — it helps by grounding us where we are now. From here, what would the best life possible look like? This re-grounded view is something that we see people with a new terminal diagnosis access, the parents of children with tremendous complexity access: The power to live not in an imagined world, but to live in the best possible way in their actual world.

There is another line in the song that also matters:

“Inspired in me, an impetus to fight”

Ground your acceptance of difficulty in the understanding that you are worthy — and capable of fighting for change.

We know that one of the potential harms of positive psychology is that the unquestioning embracing of suffering (“making the best of what is”) can lead to an acceptance of the status quo. This can lead people to stay in bad situations with abusive personal or professional relationships. Ground your acceptance of difficulty in the understanding that you are worthy, and use that to fight for something better — for yourself, for those around you and for those who will come after you.

For all you do, and will do for others, I write this with gratitude.

There are a lot of great podcasts and videos out there, but the tools we have to find out about and manage them default us into the hyperactive hive mind approach and soon the signal is lost in the noise. This happened to me with podcasts. Inspired by Cal Newport’s Digital Minimalism, but extending it into my own Digital Essentialism, I use this simple 4 step technique to maximize the value and minimize the harms of the podcast ecosystem on my ability to make my time flow.

1. Differentiate between discovery mode and clarity mode
2. Set a strict show budget in clarity mode i.e. max 3 podcasts
3. Set a time-value budget for yourself and review the value you get (your time always has value, don’t give it away to low value activities).
4. Turn off auto-play and auto-recommendations - use your own lists, and search, which lets you be more intentional with your time.

You can read more about this in the longer article here.

The lens of caring so deeply for our children sometimes helps us see how our best self might guide us too. We had a recent important milestone birthday in our family. Like most people, I’ve always cared how people felt on their birthday, and have been sensitive to that balance of the joy of anticipation and that of preparing not to be disappointed. As a parent, this can become an intense pressure (not to disappoint), and something that can become more difficult during the teen years.

On this birthday, as I watched this being whom I love so much, I was anxious that she would be disappointed. Instead, the gift I received was seeing her behave with such grace throughout the day, receiving and reacting with delight to all her presents and cards (big and small), and the kind words and wishes from family, near and far.

It became very clear to me that while I had thought that she might always be wanting more, instead she very clearly knew when she had enough. I realized that this was a lesson for me, an important part of living a good life, and a sustainable one.

Yes, while I can strive to do more, to learn more, to contribute more, to earn more; I should always be clear about what is enough. If we could do that, I think we would all have a lot more grace, and joy in our lives. And even as we dream big, we’ll be much better able to plan and prioritize what will create real value for ourselves, and the communities and the earth that we care for.

If you know me or work with me, you know I’ve been focused on how I spend my time, and how I model that for my kids, for my patients, for my students, for my colleagues and for my fellow global citizens.

One thing I haven’t done – yet – is spend any real time on social media. I’m wary of the potential harms that social media may bring to me, my loved ones and society at large. But I have seen that others find benefits from using social media, including togetherness and an expanded sense of community.

I’m curious about how I might gain those benefits while avoiding the pitfalls. Ideally, I’d be able to use these social media tools in a way that’s productive and fulfilling both for me and the community, without getting sucked into spending lots of time constructing virtual performances for others, or losing my sense of reality in a misinformation miasma.

I want to invite you to think with me, to come along as I think aloud – well, on the screen – about many aspects of social media and answer some questions that arise. And of course, in the spirit of welcoming peer review, I’d also encourage you to share your own thoughts, ideas, strategies and crazy experiments we might consider!

You can read the full essay here.

We all have tasks on our list that for some reason we never get to, sometimes because we find them unpleasant, or not important, or they might have some emotional risk for us.

Often they are not immediately important, and so we put off seeing the doctor, or the dentist, or doing that chore. As a primary care doctor, I see this all the time.

Slowly these tasks move from “not urgent” to “urgent” and then suddenly we have to do them now and under stress!

Some writers have suggested that you should tackle the hard stuff first thing in your day, something that is referred to as “eating the frog”.

This seems to be attributed to a quote from Mark Twain who has been quoted as saying “If it’s your job to eat a frog, it’s best to do it first thing in the morning. And if it’s your job to eat two frogs, it’s best to eat the biggest one first.”

Luckily for most of our, our jobs rarely require us to eat a frog every day :-)

Instead of contemplating “eating the frog”, I use a little re-framing to help me tackle these unpleasant but important tasks. I spend just a little more time focusing on what is important about it rather than just what is unpleasant.

Most of the time these tasks help me build a strong foundation in some area - health, work, or home.

After re-framing the task as something that will help me strengthen my foundation, I either:

1. Break off a small chunk and just do it.
   • This was why I have a ‘chore’ timer in my flow timer. I can do almost anything for 10 minutes, and once I’ve started I often get into it and wan’t to get it done.
2. Or I do it in my “work on my foundation morning” which I schedule for a whole morning once a month (yes during the work week).
   • I do this first thing when my will-power is strongest. I also find that I have to use my chore timers during this time (otherwise it is very easy to get distracted with any other “easier” task).

I hope this helps you to have success in building your foundation in the coming month.

I’ve not written for a few weeks because my daughter and I just went on her 12-year-old adventure. I’ll write more about this later, but it was an amazing experience. Based on the hero’s journey, these adventures recognize the growth and development that happens every 3 years starting at 9 years old. This time my daughter guided us across Catalina Island on the Trans-Catalina trail, up and down mountains, around herds of bison. And while these are their adventures, I learned so much about my daughter and how she tackles the world, and about myself. Most of all, I learned how tough she is, and that many days in, even after six solid hours of hiking, she will decide on her own to pick up her pack and with silent strength lead on.

Sometimes it takes an adventure for us to see the powers that lie within our children and ourselves.

Adventure is out there. Make it happen!

You are smart.
You are hard working.
You are constantly striving.
You are optimistic in your planning and your schedules.

So how could you ever finish a week feeling like you “won”?

The default behaviours in general won’t do it for you - they will actually make you feel worse! And the pressure to work on the weekend to “just catch up” will be intense!

“If only you had planned better” - your productivity coach says.
“If only you had blocked off more time” - your deep work book says.
“If only you had been more intentional” - your intentional timer says.

Arg! Not helpful right now.

So what can you do?

I struggled with this a lot myself this week. I thought I had a project ready to push to completion, only to find a major error in it. But I had so much else planned, and the pressure I put on myself (and on those around me) was intense and mis-directed. I haven’t found it very useful to spend a lot of energy in stress and worry. And sadly both stress and worry seem to be contagious!

In my coaching this comes up a lot as well - especially on Thursdays and Fridays! This week it started on Wednesday for me.

I explore techniques I used to end the week well in this MakeTimeFlow article but the key point is to:

• Help yourself with your two inner advisors (I know this could sound hokey - but it seems to be able to engage more of your thinking brain when you are stressed out - give it a try)
  • what would your “ideal loving parent” say to you?
  • what would your “ideal boss” say to you?

I found the exercise helpful, and calming, and I could think straight again, and actually ended up feeling good about all that was done, and all that I learned this week. I’m even a little excited about next week (but I’d like the weekend first please!).

I’m not working on the weekend.

And next week I’m going to be clearly differentiating between “solid” goals and “stretch” goals, giving myself enough time to do a good job on the solid goals, and not feeling bad about not hitting every stretch goal.

Finally I wanted to share with you this wonderful quote from Marcus Aurelius which really spoke to me, especially this week:

“When obstacles get in your way, the obstacles become the way.” ~ Marcus Aurelius

Wow, so much has happened in this last year!

I really enjoyed the irony of my last post which was about kickstarting a new writing process - that quickly fell by the wayside and resulted in a whopping 0 posts for the rest of the year. Yeah - that worked!

So in terms of writing I’m starting chastened but still (perhaps ever) hopeful.

What has or is changed?

• New inspiration - seeing something done well makes it easier. I’ve been really inspired by Seth Godin’s writing and talks and his blog which seems very elegant in it’s readability, simplicity and focus on the audience so I’ve modelled my blog layout on his (thank you Seth).
• A new simpler design - more focused on reading and connecting (through the email newsletter) - and the delightful satisfaction of code and design as craft. In a fit of curiosity/interest/control-freakishness I decided to rebuild the template for this site by hand. This helped me to learn a lot more about how the static site generator (Jekyll) works and so made it much easier to customize. In the past I would have used Bootstrap to help kick-start any project that would involve CSS but I’d been hearing more and more about TailwindCSS and I really like their approach of reducing unnecessary abstraction.
• And a large dose of self compassion, so when one of my posts has fallen flat, I can help myself up, dust off and try again to be brave enough to write and to share.

So thanks for reading, and thanks for joining me on this journey, and let me know about your blog and newsletter :-)

For a long time, writing has sat languishing as wishful thinking amidst the cornucopia of good ideas. There are many, many reasons why it has been languishing here, including what I suspect are the usual suspects for many people. Here are some ways/motivations/tools that I am using to help me overcome this.

Make it a habit.

Write for 30 minutes in the morning. You can almost always afford this time. I do it after getting some tea, having some reflection time (where I just flow my thoughts from the previous day which helps me to clear my head), and read a little (which opens my mind more). On my really good days, I will also have meditated, and if I am really really good - have practiced some loving kindness too.

Make it easy.

Find a way to write and share it easily. For me this has meant:

• when blogging: use Vim + Goyo mode + Jekyll + Netlify to be able to write and quickly deploy
• when writing with others: use FreePlane or Vim for quick thoughts -> Google Docs/Word for sharing/reviewing, then translate it for deployment (Pandoc is helpful here too).

When you get stuck, break it down, make it real.

I often find that by being curious about small things, larger issues can be revealed. This means that your writing can balloon into bigger pieces. These are important for me, and I love diving into them, since they can really help to deepen my thinking. But it can also become a real blocker. In this case, I keep the larger beautiful mess to myself, and extract smaller, easily explainable pieces to share with others.

By making it real, I mean that you should start a new document that you plan to share with others on the extracted topic. This can create just enough momentum to get you over the activation energy needed to help you start and complete the smaller piece, and it gives you an easy way to share it and get feedback!

I want to share what I consider a treasured reminder of the humanity within the sometimes gruelling practice of medicine.

A few years ago, I was part of a team in Africa that developed an open-source system that notifies doctors of critical lab results within their hospitals. We developed this system to support bi-directional group based and closed loop communication. This work leapfrogs the system that we had been using in one of the best hospitals in the US. When I returned, I wondered why we still used the system we had. With some wonderful mentors, we studied this in our article - “Why do we still page each other?”.

In doing this work, I also ended up doing a word frequency analysis of the messages from all of the pages that had taken place in my hospital over a month, and was very surprised and touched when it showed this.

As one of the clinicians on the receiving end of these pages, I would never have guessed this. It showed me how human the communication was even when its main purpose is supposed to be critical results and action. It moved me so much that I have it printed on a canvas on my wall and inspired me to write the poem below. During this dark time of COVID, while society is suffering and healthcare workers are continually called on during crisis, this image and the resulting poem help to ground me in the deep humanity of what we do. I hope they are of some comfort to you too.

Continue …

This is a longer format article (there is lots to worry about after all - and lots to do!). To give you a quick sense of what is covered (and where in the article) this is a quick overview and table of contents. In this article major areas I cover are:

• Concerns and questions during the different phases of the pandemic:
  • During the Initial Phase
  • During the First Surge
  • After the First Surge
  • Ongoing Swells and Surges
• What can we do about it?
  • Understanding Disease Pathophysiology, Diagnosis and Treatment
  • Clinical Practice and Capacity
  • Improving Communication and Collaboration
  • Improving Education and Training
  • Reducing Inefficiency
  • Addressing the Disproportionate Impact on Certain Communities
  • Addressing Violence & Structural Racism
• Thinking about the Future
  • How can we think about being safe balancing social distancing vs relaxing and reopening?
  • Is there a large clinical backlog developing and how will we be able to catch up?
• Emerging concerns
  • When vaccines become available

Continue…

COVID-19 has resulted in a surge of patient cases, and also of information. Some of this information has been helpful, some harmful. The amount of information itself, and the feeling of urgency that accompanied it, has been felt by everyone, especially by physicians who are asked by almost all their patients to help interpret this for them. The speed with which we read has not changed, and the time available for reading has often decreased, filled with clinical surges or family responsibilities.

The large increase in information has itself become a possible problem in accessing good information. When there is an explosion of information without an effective way to select higher quality information, that increase in volume decreases the useful information for almost everyone: the noise (low quality information) overwhelms the signal (high quality information).

I’m certainly experiencing this. As a primary care doctor at a large academic medical center (and one that is conducting many therapeutic trials for COVID-19), I have both the opportunity and obligation to be as informed as possible. However, it has quickly become clear that I could spend all day reading news, journal articles, pre-print articles, and attending conferences and still not cover all the material.

COVID is a stress test not only for our public health infrastructure, but also for our organizational and personal learning systems.

Continue …

Sometimes the most amazing lessons happen at the most unexpected times.

Yesterday I did a ‘wellbeing hackathon’ with my daughter. Since she’s twelve, I thought I’d be teaching her a lot of what I knew about innovation and well-being. Instead, I did a lot of learning myself.

She and I have been building an internet-of-things connected device, thanks to an innovation award from the Brigham Health Physicians Organization. Our device was designed to be as simple as possible, measuring one thing: “are you happy or stressed?”. It is an early detection system for the epidemic of physician burnout - a ‘happy button’ to measure stress among healthcare workers.

And then the pandemic began in earnest…

Continue …