Tag Archives: growth mindset

The Expert and the Student

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What do you take for granted that you know and do?
How do your conversations with colleagues differ from those with ‘laypeople’?
How does your specific expertise emerge and manifest outside of its own domain?

Friend recently told me about the time his friend offered their Adderall (a stimulant used to treat attention deficit and hyperactivity disorder) for his full body, multi-system allergic reaction to food (which technically constitutes anaphylaxis and should be treated with epinephrine, or at least a strong antihistamine like cetirazine [Zyrtec] or diphenhydramine [Benadryl]). I had immediate, strong, and mixed feelings and thoughts: What? Oh, your friend was trying to be helpful.. and that is absolutely not the right thing.. and omg, what badness could have happened? ANTIHISTAMINES FOR ALLERGIES! And this is why everybody needs an accessible primary care doctor, FFS. Okay, okay, self-regulate. Friend has lived with his allergies for however long, he has apparently handled it fine thus far; this is not my business. Unsolicited medical advice is not often welcome, Chenger, so zip it! And GAAAAAAH, my dear friend, the next time you have an exposure, I pray please for you to have more knowledgeable folks around you! OH that self-restraint really challenges me sometimes.
I share this story as an example of how my doctor mind is always present, always assessing. I felt caring, protective, and concerned when Friend told me, and not at all dismissive or condescending, so I hope that is not how it comes across. All I want is for Friend to be well, to have all he needs for that, and to help if I can, within appropriate boundaries. I hope I respected his boundaries well that day, while still conveying how much I care.

Opioids, anti-inflammatories, corticosteroids, Tylenol–they all address pain, and by different mechanisms, with different side effects, and can be combined and not in certain ways–I know these things. Blood count, chemistries, lipid profiles, iron, B12, CRP, sed rate, TSH–I have ordered and interpreted these and other ‘routine’ blood tests for almost thirty years now. I see patterns for fluctuations, correlates to behaviors, and advise accordingly. Pain, headache, dizziness, nausea, rash, shortness of breath, diarrhea, and myriad other things–I know what’s common and how to treat. I know what to do when I don’t know what’s happening. I know who to call for help. I know how to sit with you, my patient, when things are uncertain and you feel acute distress. I know how to listen beyond the objective answers to my questions. I see you, or at least I do my best. And the longer we know each other, the better I know how to help you, no matter what’s going on. I am an expert at primary care internal medicine.

“Routine,” Orthopod said to me before my knee surgery. I imagine he saw me as a fellow physician and assumed I understood the technical aspects of procedure risk and outcome expectations–which I did. And I was the patient in that scenario, anxious despite my expert medical knowledge, and possibly in part due to it, because I also know how things can go unexpectedly sideways in any operating room. “Routine for you,” I replied. I trusted him, the surgical expert, with my knee and my health. No longer a medical student, and still a learner in a different role, I felt vulnerable and safe. I think we both had a little a-ha moment then.

“Jacob, watch, please? Where does the movement start, again? What is the difference doing it this way versus that way?” In the gym, I am absolutely still a student, though I have been an athlete since adolescence. I have passed the prerequisites of anatomy and physiology. I understand force, mass, and acceleration. And every session, there is still no shortage of new knowledge, experience, and practice to acquire. This is what brings me back so enthusiastically–the more I learn, the more confident I get, and the better I can perform. I make steady progress because my teachers are both knowledgeable and approachable, generous and creative with their instruction.
I wonder what/where/how I might be more willing to study if I had such teachers?
How lucky that throughout my life, I have benefited from so many amazing guides, mentors, and coaches.

In preparation for this post, I listed things at which I am expert, proficient, and novice. Obviously the novice list is longest–humbling and inviting! The proficiency list is gratifying, actually, as I can stand justifiably confident in a variety of diverse skill domains–yay! And when I’m honest, the expert list is remarkably short, which is as it should be.

So it makes me think: How wonderful to be a student of everything, including in my own areas of expertise! Medical knowledge has doubled at least twice since I started training 29 years ago, and that rate continues to accelerate. There is simply too much for any generalist to know, even though we still know a lot and continue to learn about everything. Every time I connect with a specialist colleague, I walk away or hang up smarter and a better doctor for my patients. Bless my colleagues, all!

When I describe my interest in leadership to people, I say that I ‘study’ it. To some, I may seem like an expert. And though I do consider myself advanced in my leadership education, I will always consider myself a student, because every leadership role is unique and fluid. I will never be in a position to not learn and improve. I value humility; when I see it in experts and leaders, I trust them more immediately and implicitly. That is the kind of leader I aspire to be. Learner-leaders cultivate other learner-leaders by example. What an excellent, virtuous cycle!

Student mindset is growth mindset, a beginner’s mind. Maintaining it helps me connect more easily with others with whom I may mutually teach and learn from in loving and organic, natural and synergistic reciprocity. It keeps me open and improves, hones my overlapping, intersecting skillsets. It deepens all of my life experiences, inviting contribution from anyone I meet, anything I do. Everything blooms in brighter, more vivid color and texture; every day holds infinite possibility!

I meet experts in multiple domains every day, and I wish I had time to pick all their brains. My morning pages and brain dumps help me process and integrate all of these encounters and more. So much to gain, so many people to meet and love, so much connection in the offing, oh my goodness, it’s just too good!

My wishes for you, dear readers:
May you meet experts who enrich your life by kindly sharing their wealth of knowledge.
May you stand ready to receive their offerings with openness and curiosity.
May you share your treasures of life experience with generosity and humility.
May all of these encounters nourish you, mind, soul, and being.
And may it all make us better for ourselves and one another.

Onward!

Cultural Perpetuity

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What kind culture do you wish to perpetuate?  What specific actions, policies, behaviors, and outcomes would it manifest?

I learned the term ‘cultural perpetuity’ this past week, from a thought-provoking article on how Maslow’s Hierarchy was influenced by and also misrepresented Blackfeet Nation teachings:

  1. Self-actualization. Where Maslow’s hierarchy ends with self-actualization, the Blackfoot model begins here. In their view, we are each born into the world as a spark of divinity, with a great purpose embedded in us. That means that we arrive on earth self-actualized.
  2. Belonging. After we’re born, imbued with a divine purpose, the tribe is there to love and care for us.
  3. Basic Needs & Safety. While in Maslow’s model, we find love and belonging only after attending to our basic needs and safety, the Blackfoot model describes that our tribe or community is the means through which we are fed, housed, clothed, and protected. The tribe knows how to survive on the land and uses that knowledge and skill to care for us.
  4. Community Actualization. In tending to our basic needs and safety, the tribe equips us to manifest our sacred purpose, designing a model of education that supports us in expressing our gifts. Community actualization describes the Blackfoot goal that each member of the tribe manifest their purpose and have their basic needs met.
  5. Cultural Perpetuity. Each member of the tribe will one day be gone. So passing on their knowledge of how to achieve community actualization and harmony with the land and other peoples gives rise to an endurance of the Blackfoot way of life, or cultural perpetuity.

I also listened this week to the Building an Anti-Racist Workplace episode of Adam Grant’s podcast WorkLife.  It’s an insightful, enlightening, and empowering interview with John Amaechi, whose work I will now explore further.  In their discussion on allyship, Amaechi points out that we upstand against racism and sexism not just to help our individual friends or coworkers, but because we uphold certain core values.  Thus, we speak and stand up to defend and disseminate a certain culture—to perpetuate it:

Adam Grant (21:43):
I wanna talk a little bit about sort of the- the ally perspective here. Just thinking about my own failures in anti-racism and other people who I know, recognize the problems and care about the problems, but haven’t done much about them, I keep coming back to this literature on psychological standing.That sense that, you know, it’s- it’s not my place, it’s not legitimate for me to speak up because I’m white. What are your thoughts on overcoming it and getting those people who are by-standing for those kinds of reasons on board?

John Amaechi (22:13):
There’s a couple of things that I’m trying to do. One of them is to stop the alignment of allyship with black people as individuals and start the alignment of allyship with their own principles or with their organization’s values. So racism is an incivility. Sexism is an incivility. I do not require sisters nor a mother, nor a wife to be against sexism and misogyny because it is an incivility. If I’d intervene on something that’s racist, it’s not on my behalf or another one of my black colleagues. It’s because it’s an incivility against the values that people say they share. Today it’s not about an individual. It’s about standing up for your values and understand that you don’t need to have a black person in your team for that to be important because the presence of a black person has never been required for racism to occur. The presence of a woman has never been required for sexism to occur. As men, we know that the absence of woman reveals sexism and misogyny.

What culture do you lead?

In my role as interim clinical director of a small practice, I see myself as a steward.  My best contribution to most places I inhabit is to highlight and foster relationship and connection.  At work, this manifests as effective teamwork, high engagement, and positive morale.  Last year as we recruited for a new medical assistant (MA), I got to listen on the phone as our current MAs interviewed a candidate.  Through my own questioning, the candidate’s responses were short and sedate.  Then each MA on the team met with her, describing with energy and conviction how they live out our core values of collaboration and accountability, as well as our mission of providing compassionate, holistic patient care.  With each encounter, I heard the candidate’s responses lengthen and deepen.  I heard her own energy and engagement rise to match that of the team.  It was one of my proudest moments as director—I could see (hear) and feel how far our culture of connection has come, and how it could persist after I pass the baton to the next director.

What is the dominant (perpetual) culture in America?

Do not underestimate the complexity of this question, and its profound implications.  The first answer is, of course, it depends whom you ask.

For far too many, the dominant American culture is white male supremacy.  For the past year, I myself find it inescapable.  Increasingly, every time I consider what to post to this blog, or jeez, every day and in almost every domain, the primacy of white men pervades my consciousness like smog on a hot, humid day.  Let me be clear:  White men are not each and all bad; I do not assume every one is a racist sexist, even the actual assholes.  But whenever American systems are examined, we find that they are primarily designed, favored, empowered, and perpetuated by and for white males—it’s baked into our societal structures, hence the terms ‘systemic’ and ‘structural’ racism and sexism.  If you are a white male, it may be hard for you to see the barriers that have not impeded your life journey (Amaechi discusses this in the podcast as well).  You may have answered that dominant American culture is one of success with hard work, of equal opportunity, and of individual freedom.  Of course that is a culture we’d all love to perpetuate.  How could we achieve it for everybody?

What culture do you work to perpetuate?

I think it’s about the values and commitments we hold highest and manifest most in our daily activities.  What do our daily encounters say about our priorities?  What do we want more of, and thus work for every day, for ourselves, our friends, our colleagues, patients, parents, and children?  I want mutual respect and unqualified acceptance.  I want sincere valuation of diversity and real, wholehearted inclusion and integration of that diversity—of thought, experience, wisdom, and perspective—into a coherent, synergistic mosaic of strengths, engaged in service of elevating every individual to their highest potential.  I want to perpetuate a learning culture, one that operates with a growth mindset, founded on kindness, generosity, humility, curiosity, and resilience. 

None of this happens automatically; even well-established gardens of inclusive culture require regular tending.  I have to renew my commitment every day, in every encounter.  I fall down regularly.  And I give thanks every day for loving companions who help me up.  I try also to appreciate the challengers, to see them as allies rather than enemies or hindrances.  That is walking my talk, no?  To value those whose goals and values don’t align with my own, to find a place for them—for everybody—in my world?  I’m strengthening my practice of self-assessment.  How did I walk the talk today?  How can I do even better tomorrow?  The more concrete and specific, the better—words, actions, and attitudes.  It’s my own version of “trudging the road of happy destiny.”

On that note, I leave you with two more resources that hold me up this weekend:

First, Hank Azaria’s conversation with Dax Shepard and Monica Padman on the Armchair Expert podcast.  They discuss addiction, privilege, and racism, among other things.  What an inspiring example of vulnerability, courage, humility, connection, and lifelong learning and growth.

Second, a Forbes profile of Sharon Salzberg, 4 Ways Loving Kindness and Mindfulness Can Change Your Life.  You may read them and think, “Duh, I know that.”  But ask yourself, how does your knowing translate to doing? 

We have our whole lives to practice.  As Simon Sinek says, the goal is not to be perfect by the end; it is to be better today.