The sense of self is one of the most powerful sources of human strength and angst. This episode provides a framework for cultivating one's sense of self and purpose. Concepts of dharma, as well as psychological and scientific constructs of self are discussed. References: Think Like A Monk, Altered Traits, Navigating Organized Urology, Peak Performance, Man's Search for Meaning.
Welcome back to operate. In prior episodes, we've discussed our dimensions we've gone over time, space routine, and the physical self. And in the episode today we're going to focus on the mental and emotional self. We're going to start addressing the question Who am I? And as we progress through other episodes, we're going to talk about a lot more specific topics like meditation or mindfulness, we're going to talk about burnout. We're going to talk about mentoring friendships, and how to deal with challenging people. But this will be the last foundational talk, the last foundational topic that we're going to discuss. So who am i is the eternal human question, existentialism, religion, mindfulness, monk practices, all seek to answer Who am I. And so Ramana Maharshi, who was a Indian Hindu, sage, said the thought Who am I will destroy all other thoughts and like the stick used for stirring in the burning pyre, it will itself in the end get destroyed, then there will arise Self Realization. And so the point of a lot of meditation and mindful practice is to get to Who am I that's the reason monks meditate. And as we work through this, we're going to come to the realization that a lot of physicians in today's day and age struggle with Who am I What is my identity, and there's tremendous strength in knowing that identity and working towards who, who you are and defining who you are. And there can be tremendous dissonance when we don't know who we are, and when we can't rectify our own identity, with our work and our work life. And so, if you look at the words health, healing, and Holi, they all derived from the root hold, there's a sense of being there. Another one of my favorite words, or concepts is that of integrity. And we often erroneously associate integrity with morality. But the real definition of integrity is that a is a sense of being whole of being undivided, or one like an integer in math, and when more and the reason it's erroneously associated with morality is that when moral challenges, or when we experience moral challenges, we often question our own integrity or wholeness. It really splits us up, we're not sure who we are, we become divided when pulled in multiple moral directions. And in mindfulness traditions, the mantra Om Namah shivay, is used to describe a love for your own innate strength, wisdom and fortitude. And there's a really interesting derivation here. shivah is a Hindu God, but it is really a concept of that which is innocent, benevolent, beautiful, transcendental or absolute. Ohm is the quote unquote sound of the universe, signifying often peace and love. And if you break down Nama Shivaya, the five syllables also indicate the five elements in Sanskrit of earth, water, fire, air, and the ether worthy in between. And so when you chant this mantra in these traditions, it helps harmonize the elements within bring to bring joy to oneself through your own innate fortitude, by defining who you are. And so there's lots of concepts, lots of foundations that talk about the importance of defining who you are, who the self is. And the Dalai Lama says the ultimate source of peace is in the mind, which far more than our circumstances determines our happiness. So how do we use our mind to determine ourself? Well, I'm going to give you the answer. Actually, you could go to Las Vegas and find the answer on any number of casinos, where you're gonna find signs that say, you must be present to win. The answer is in presence being available being in the moment. Much easier said than done, and we're going to talk about it. But Father, Richard Rohr, who is a Franciscan friar and spiritual writer says that all spiritual teaching, and this is not an oversimplification is about how to be present in the moment. And it doesn't matter that tradition whether it's Catholicism, Judaism, Buddhism, whether it's atheist, all of these traditions focus on how to be present. And being present is both the challenge and the reward of answering that question, Who am I? And as we try and figure out out how to be present. One of the other really good concepts and I'm walking you through a whole bunch of traditions here and hopefully one of them resonates with you. You can go only back to the Greeks. And the Greeks actually had two senses of time. Kronos, which most of us are aware of this is quantitative or chronological time, right. That's where Kronos word chronologic comes from, from the the the sequential time. But there's also Kairos k i, s, which is really in between time which is a qualitative experience, which is expressed as being fully in the moment, as opposed to existing within sequential time. And I think one of the best examples of being truly fully present, I think one of the most truly fully present beings in the world is a dog. And as if 2020 wasn't hard enough, I lost my dog. right before Christmas time. She was a 10 year old golden retriever retriever. She was a beautiful dog in many senses of that. But she was a truly present being right. And those of you who have dogs and a variety of other pets help you experience this right? When you come home, they are fully present in greeting you. When she was at the beach with a tennis ball, she was fully present in that tennis ball. And in that beach, taking in that experience, there was nothing else going on in her universe. When it was time to go to sleep or lay down, fully present and immersed in sleep. You could say the same for food, you could say the same for going for a walk chasing animals. They're fully present in their experience. And therefore I say dogs are a great example of a truly present being and something and behaviors of which we can all aspire to. Now Michele oka Doner is an internal, internationally renowned American artist and author using a different nature metaphor said a bird gets up every morning and sings that song. It does not wait to hear what other birds are singing, nor does it look to see if another bird is getting more notice. It knows its song innately and it sings. This is nature knowing your song. And this is the challenge for many of us who we don't know our song, it is not innate in us. And so our challenge really becomes working towards identifying who we are what is important now. And how does that define our being? This is the beauty and the challenge of medicine is that we have a lot of freedom in defining who we are. Some of us may choose to define ourselves as physicians, others surgeons, perhaps you consider yourself a scientist first and foremost, you could be a caretaker, a protector, there are a variety of definitions that we fall under all of watch, all of which define who we are and how we fit into our careers in our lives. And throughout the remainder of this podcast, we're going to talk about frameworks of how we develop that sense of self, how we develop who we are. And being honest upfront, I'm not going to give you specific examples because who you are is really unique and up to you. But we're gonna try and talk through different frameworks to help you achieve that self recognizing that it's going to change over time. In the discussion of physical health and physical well being we talked about Larry galax, he was the high school rugby coach with the incredible winning record, who really focused on teaching his team how to wi n when focusing on what's important now remember, was an acronym. And what he was really teaching his team and his players was to be present to focus on what's in the moment. And in doing so define their purpose as a team and as a player within that team. And one of the concepts we're going to put forth is that you can develop your presence or your or being present through identifying your purpose by identifying goals, values, your mission or whatever cliche you want to use. You can cultivate your sense of purpose, which will help identify your sense of self. So as we move through the next part of this podcast, we're going to focus on framework and how we define ourselves, giving you a bunch of different examples of how you can do it and how you can work towards your purpose. In the book altered traits Daniel Goleman, and Richard Davidson talk about different pathways one can follow to achieve or understand a life mission. You can work through an ethical stance or follow morals are a moral guideline, you can use altruistic intention. A life mission can be grounded in faith, whether that's religious faith or in just the belief of a you know The particular mission has value. Mission can be achieved through coaching and feedback, or what's termed personalized guidance. By appreciating people and principles, you can focus on devotion as to create a sense of life mission. And then certainly supportive communities or supportive cultures can help one develop a life mission. And a life mission does not need to follow just one of these particular paths. And none of these are mutually exclusive. You can kind of combine the ethical and the devoted and the community. And when we think about medicine and our path or our mission in medicine, we certainly farm follow moral guidelines. There's altruistic intention, we have a faith or belief in medicine or science. We are certainly involved in devotion to people. There is a sense of community and culture, and personalized guidance where that coaching and feedback that particularly exists, not just in academic medicine, but in Community Medicine, as well, where we're teaching and working with our partners and the people were around. And what's fascinating about the altered traits book is that Goleman and Davidson talk about ways to change your mind, brain and body, through mindfulness, through being present. You can create a behavior and a sense of who you are, neurologically, psychologically and physically, to not only identify but to cultivate your mission and basically, through an intentional approach you can define and achieve your mission in life. So the big question then becomes, how do we get ourselves in the state of mind to be present and to explore our purpose? So there's this concept of monkey mind versus monk mind, that's put forth in a lot of mindful practices, but the think like a monk book by Jay Shetty, really, I think summarizes it nicely. But just to kind of bring it forth. The monkey mind is overwhelmed by multiple branches and multiple thoughts and a person who's in a state of monkey mind can coast in the passenger seat and is often focused on multitasking where a monk mind is focused on the root cause of an issue. They live intentionally and consciously and are really focused on single tasking things we've talked about in prior podcasts. The monkey mind complains, compares and criticizes it often overthinks and procrastinates and work in exhibit demanding or entitled behaviors, where the monkey mind is compassionate, caring and collaborative. It analyzes and articulate thoughts clearly, and demonstrates an enthusiastic determined yet patient thought process. The monkey mind can amplify negatives and fears. While being self centered and obsessed. The monk mind will break down negatives and break down fears. While being more focused on self care and service. The monkey mind can be controlled by anger, worry or fear, often distracted by small things and focused on short term gratifications with with a mindset that changes on a whim. The monk mind controls and engages energy wisely. It demonstrates discipline while being focused on long term gain. And being committed to a mission, vision or goal. The monkey mind does whatever feels good, is constantly looking for pleasure in temporary fixes. With a monk mind is looking more for self control and mastery, looking for meaning in life and looking for genuine solutions. Admittedly, we all have times when we can be more monkey or more monk like. And we really need to be intentional and focus on how we can be more monk like, we see this in our day to days in medicine, whether it's actual patient care, whether it's our administrative responsibilities, or whether it's dealing with colleagues. You know, for instance, today had a stressful beginning to the morning, because patient care was delayed in a pre op. In a pre op setting something was totally foreseeable something that was totally preventable. And then the day where you're trying to do a larger volume of cases or you have a stressful day that can really start the day off on the wrong foot. But instead of giving into our angers, worries and fears, instead of being focused on the short term gratification of that first case, start, it's an opportunity to step back look at the long term gain or goals of the day. It's patient care, doing cases safely, taking care of our patients well. And what came out of that is looking for a genuine solution with the preoperative staff and administration. Rather than just blowing up and creating enemies in a hostile environment. We're able to An opportunity to improve patient care and the long term mission of our practice. And one of the concepts from mindfulness or a monk like approach is the concept of dharma. Dharma is the intersection of passion, expertise, usefulness, and compassion, which is exactly what it means to be a good doctor and a good surgeon, in my opinion, right. So once again, passion, expertise or skill, usefulness, and compassion. And people in medicine, people in surgery are drawn to Dharma, right? This is exactly who we are. And but cultivating and growing that Dharma from from an interest to a lifetime, is what's the challenge. And one of the really, I think, good, one of the flip sides of Dharma is that compassion is mixed in. So think about our old school surgeons think about some of our colleagues who can be jerks. But the concept of Dharma says that you can't be a jerk just because you're a skilled surgeon are good at what you do. And if you really want to embrace Dharma and who you are, you have to involve compassion, and caring. Now, many people are familiar with the Eisenhower decision matrix, which basically in a two byte toolbox looks at the important versus the non important, and the urgent versus the non urgent, where important and urgent tasks you want to do and do right now, non important non urgent tasks gets deleted. Not important but urgent tasks, you want to delegate to somebody who can do, right and the important but not urgent, you schedule a time to do a similar two by two box can be made for understanding Dharma and how you can bring out your own dharma. But instead, instead of importance and urgency, you can break this down by skills, and passion. So where you have skill, and passion, this is where you want to work the hardest. This is where you can really achieve depth, meaning and satisfaction. And for a lot of us surgery is where we achieve skill and passion. And this is where we should be carving out time to practice to coach to improve not only ourselves, but others. And by improving others, we can improve ourselves. On the flip side, where we have no skills and no passion. This is where we want to outsource. And as we work in departments, or groups or with other surgeons and other doctors, we can find other people to do the things that you don't love to do. And very importantly in this, we need to honor those people. So for instance, you may be very interested in Resident training, but have no interest in doing the tasks of the residency program director. Don't be a little that person because they do those tasks, we should honor them for doing the work that you don't want to do. And for loving something that we don't love. Every field in every specialty has the diagnoses that are less desirable and less fulfilling for some people. So for instance, for many urologic oncologist, pelvic pain, or chronic or caljan is a major turnoff from a clinical care standpoint. And we should honor our colleagues who are interested in intrigued by these disease states. And by these patients. Instead of belittling them or, or putting down their interests, we should embrace them because they're bringing energy and love to something that we don't have energy and love for. And together, we build a better patient practice and patient experience. There's a lot to be gained by by promoting others and, and really enjoying their successes, especially when it's something that we don't enjoy doing. Now, the interesting ones are where we have mixes of skill and passion. So where you have skill, but no passion. This is where you can try and add passion to that right? Something you may be good average or not particularly interested in spending time and devoting some of your energy or working with others in that area may help you develop some passion. On the flip side, where you have no skills but complete passion. These are your hobbies. I love basketball, not getting in the NBA anytime soon. I wasn't getting in the NBA 20 years ago, but I love to play basketball. I love to play with my friends and I love the game. So that's where you really want to identify your hobbies. Now Aristotle identified three kinds of work and here's another framework for you. And once again, we're trying, not everyone's going to identify with every framework. So we're going to try multiple frameworks. And hopefully one of them gives you a little bit of foundation to work on your purpose and your self identity. So, Aristotle, as I said, identified three kinds of work what he called theoretical work, where the end goal is truth, practical work, where the end goal is action, and poetical work which was bringing forth, which really refers to any human activity that achieves an outcome beyond oneself. And so we all have these frameworks, right, we have our theoretical work, which is our knowledge based work or medical work, we have practical work where our end goal is action, specifically in surgery and our surgical life. But we also have poetical work where we're trying to achieve beyond ourselves, and bring out the better whether it's in our patients, or our colleagues or our loved ones. And Steven akata, whom many of us know in urology, in his book, navigating organized, urology laid forth a strategy for career success. And in similar to Aristotle, in the beginning, you want to focus on your performance, your skills. And as you develop those skills and get better and develop expertise, you're going to transition to purpose, what is my purpose, whether it's in a community practice, whether it's in an academic setting, whether it's in a large hospital, or small Apple hospital? What is my purpose? Where do I fit in. And then lastly, you want to develop that purpose, in a direction that is most aligned with your passions. And I think that's a great formula for developing your career and being, quote unquote, successful. Now, we all have different definitions of success, but I think this definition will bring you the most happiness. So how do you find that passion? How do you find your dharma. So the first and easiest way to do this is to identify your values, write, write them down on paper, what's important to you, and one of the tasks we talked about before, is kind of aligning your values with what you're doing on a daily basis. So we can write down our values, right? Is it honesty? Is it camaraderie? Is it love? Is it trustworthiness? Whatever your values are, you need to put them down and understand them. And one of the ways I like to think about this is how do you want to be remembered? And I'm not going to get into a religious conversation here. But you can ask yourself the question, is there is there an afterlife, and no matter what your beliefs are, whether it's religious or not, I think it's pretty safe to say that one can definitively live on through the works you've done. And through the personal interactions you've created, right? memories will live on in other people. So how do you want to be remembered? How do you want others to remember you? Do you want to be remembered as the thoughtful, kind, skilled surgeon? Or do you want to be remembered as the person who threw instruments across the room when they weren't working to her to your liking? And you want to place those values, once you've identified identified them in the context of your life? What are your work values? What are your family values in whether it's research or business or your hobbies? How do you place those values in each context of your life. And lastly, identify your priority, right? I said before, you can only have one priority. That's the definition of the word. You can prioritize things underneath that. But you can only have one priority. And you can write that priority down, you can put it on your mirror, when you wake up in the morning, you can put it in your car, you can put it in your wallet or your purse, somewhere you can see it you can store it in your memory and keep it just as something to think about and talk about. But the last part of that is that your priority, and everything you've prioritized beneath that can and should be evolving. You are not the same today that you were 10 years ago, and you're not going to be the same 10 years from now. And you are today. And another really interesting framework for this comes from the psychology literature. And it's Maslow's hierarchy of needs. And this is basically a pyramid which starts from physiologic needs and ends at the top with self actualization. And basically the basic concepts our needs in the lower hierarchy must be satisfied before you can attend to higher needs, right so at the bottom of the pyramid, physiologic needs food, water, warmth, rests shelter, safety needs, security, safety, belongingness and loving which has to do with relationships and friends. esteem needs, which are feelings of accomplishment are all necessary to be, quote unquote satisfied before you can get to self actualization or achieving one's full potential, including creative activities. But what's important is that satisfaction is not all or none, right? You don't need to be 100% safe or have a 100% sense of belongingness or self esteem before you can move on, but you need to address them to certain degree. And the order of those needs certainly can be flexible. It can be influenced by external circumstances, different individuals may put belongingness and love head of esteem or accomplishment. But certainly things progress in a hierarchy before you can get to self actualization, or really determining your self, who you are, how you achieve your potential or what your Dharma is. And, you know, just kind of my brief observations on this is that you certainly can get stuck at a need. Right, and this is, this is a poor example. But I think it just serves the the analogy here, you can make the argument that obesity is a failure to progress from the physiologic needs of food. Now, that's an oversimplification. And there are lots of reasons where somebody could be obese or not obese, but you can understand kind of the framework. And you can act like a self actual or someone who gets to the top. And you can intentionally move yourself up the pyramid by being thoughtful as you address your needs. So recognizing whether it's on a large scale level, a weekly or daily basis, if you are not meeting your physiologic or safety needs, how are you going to safely be able to address your needs for relationships, self esteem, or self actualization, which is achieving your potential. Now the muscles model has been modified a little bit, we're basically the growth needs which are the ones that help you achieve self actualization have been broken down into cognitive needs, and aesthetic needs and self actualization leading to transcendence. But transcendence doesn't necessarily mean a monk like existence. But it refers to the fact that you can be motivated by values beyond your personal self. And once again, in medicine, this is what we're all striving to do. So as we think of our medical careers and our surgical careers. And as we think of our hierarchy of needs, right? We obviously have physiologic needs, and safety needs, we need to have safe and secure, secure careers. But we also need to work on our relationships, and our feelings of accomplishment work, whether that's in academic medicine, or in private practices, or in small groups, how we take care of our communities and our patients. That's what's gonna allow us to take the next step, to work towards our self fulfillment, towards transcendence, or working on needs beyond ourselves. And in the concept of self actualization. You can think of this similarly to enlightenment, but it really is more defined as achieving one's potential, and once again, highly individualized based on your individual values and goals, and can be structured based on context. So you may have a different goal of self actualization at home than you do at work. But often these things should be tied together. Really important, according to Maslow's, according to Maslow's construct less than 2% of the population actually self actualizes. And he came up from this came up with this model by studying Abraham Lincoln and Albert Einstein and Thomas Jefferson, Beethoven, Eleanor Roosevelt and Mother Teresa. And interestingly, as an aside, his work is criticized for being short on analyses of women and non white successful experiences. But he did say that self actualization or enlightenment could be realized to peak experiences. And these are the experiences that make us incredibly happy euphoria, joy, wonder, and that this is a process and it's continually moving, that a person is always becoming a never is a static person. George Sand the famous novelist, wrote one changes from day to day, and every few years one becomes a new being. And I think it's a great summation of how we need to think about our process of self and who we are. We're not going to get to an answer that static and figure that out, but it's going to be evolving and it's that process as we move throughout our life of being present, thinking in the moment trying to actualize who we are and reach our potential, yet striving For a moving target is what will actually give us joy, and happiness. And I'm going to read to you the 15 characteristics that Maslow listed of self actualized years. And while I read these to you think of the concept of the monk mind that we talked about before. So number one, self actualizes perceive reality efficiently and can tolerate uncertainty to they accept themselves and others for what they are. Three, they're spontaneous in thought and action, for their problem centered and not self centered. Five, they can have an unusual sense of humor. Six, they look at life objectively. Seven, they are highly creative. Eight, they are resistant to inculturation, but not purposely unconventional. Nine they are concerned for the welfare of humanity. 10 they are capable of deep appreciation, appreciation of basic life experiences. 11 they establish deep satisfying interpersonal relationships with a few people 12 they enjoy peak experiences those high joys 13 they have a need for privacy and working on their own occasionally, 14 they have democratic attitudes, that does not mean democratic politics. And lastly, they have strong moral and ethical standards. And so you can also think of how you can move yourself or check off those boxes, and you don't have to have all of them. But are you spontaneous and thought, but tend to be a little bit self centered? Well, you can work on that. Are you highly creative, but you have a hard time thinking about or spending time in privacy and cultivating those creative needs alone. So these are things you can do or things you can try and work on to identify your yourself in your dharma. And so what are some of the other behaviors leading to self actualization or enlightenment or achieving our Dharma or identifying who we are? Well, we want to experience life like a child, we want to be fully absorbed, and constant, and concentrated on what's going on. And when we get into some of the lectures on MIT, or some of the talks on meditation later, we're gonna talk about the beginner's mind, but you really want to be, have a beginner's mind. Be open to new experiences, you want to try new things. Instead of sticking to safe paths, listen to your own feelings, evaluate experiences, instead of tradition, authority, or the majority. Don't play games. Be honest, avoid pretences, and be prepared to be unpopular. If your views don't coincide with the group's of the don't coincide with the thoughts of the majority. But if they meet your values, and define who you are, take responsibility and work hard. And be insightful. Think about your own defenses. Think about when you are wrong, admit when you are wrong, and have the courage to give up the things that are holding you back. One of the great examples of this actually comes from Steven Carter's book again, he talks about Tiger Woods in the 2000 Tiger slam, which is where Tiger won four consecutive major Golf Championships in one year, leading into 2000. Tiger was self admittedly a mediocre sand player, but was great off the tee was doing really well on the greens. So he had two options, he could focus on improving his sand game, which was improving his weakness, or what he decided to do instead was focus on avoiding sand traps, avoiding the situations that were not to his strengths, focusing on what he was good at. And guess what he won by a healthy margin, particularly at teenagers. So it's a good analogy, that instead of focusing on our weaknesses, focus in focus on your strengths, focus on your Dharma, the things you do well, and they can really help you be successful. But I would say working on your Dharma is really hard work. You have to personally seek out and defend your Dharma know that no one else is going to tell you what your priorities and your values are or who you are or where you belong. And part of that is building both competence and character. And competence are the things we're good at right in the operating room, the surgeries you're really good at. The things we enjoy doing in medicine. character is the polite way of saying all of the stuff that we doing electronic medical records, dictating notes, filling out prescriptions, peer to peers, right. These are all the things that are character building, and you can't really have competence without character. So competence without character is narcissistic, you're totally focused on yourself, and you don't care what's helping to others. Character without competence means you're really not contributing with a purpose. You're just doing work to do work. And so as you think about who you are, develop both competence and character, enjoy those daily chores or the things that are less fulfilling for you as part of life as part of what you do, embrace them. Use them for what they are, if you're doing mindless work, use it as time to let your mind wander, to free up some of the to free up some of the subconscious strings of your mind that we talked about in earlier podcasts. Use the time for those unchallenging tasks to free spaces for reflection, and introspection. Why do you do what you do? And lastly, not a believer in Dharma, think this is Voodoo. I'm okay with that. We're all different. And we all interpret things differently. This works for me, doesn't mean it'll work for you. But there is there are a number of scientific studies that actually explain the rationale for hard work and how that helps us achieve purpose. And there's definitely some psychological constructs that we talked about before, like Maslow's hierarchy. But here's a couple other examples. There's something called the growth mindset put forth by Dweck from Yale in the 60s. And this is the belief that ability can be improved with practice. And there's a number of studies that show that hard work, healthy risk taking and productive failures can actually lead to progress and success. The challenge response was put forth by McGonigal, who's a health psychologist at Stanford. And one of the objective data that have come from from that body of work is that there's a 40% lower chance of premature death in Americans who view Stress Stress, as facilitative rather than stress as detracting from their experiences, and interesting that you could, you could delve into that study and say, Oh, well, there's the reason that there's a lower chance of premature death is because they have less stressful events, or fewer stressful events. And actually, if you look at the studies, there were similar numbers of stressful events in the group that viewed stress as facilitated versus those who viewed it as attractive. But, but the death rates were much lower in those who viewed stress as facilitative is to making them better, as opposed to those who held them back. And last is the opportunity mindset versus the threat mindset, where stress or hard work can induce an excitement, response, we can use that uncertainty that anxiety to be positive, rather than apprehensive or scared. And Viktor Frankl in Man's Search for Meaning if you have not read this book, you need to read this book, two part book in the first half, Viktor Frankl chronicles his experience in a holocaust camp of World War Two, and it is profoundly moving. And in the second half of the book, he puts forward his his, his psychological framework of suffering. And it's an evolution of Freud, where Freud believed a lot of our mental issues could be attributed to sexual frustrations. Frankl believed that a lot of our anguish as humans came from a sense of not knowing who we are, who we were, and really searching for meaning. And it is a beautifully written book. And I think one of the most powerful pieces of literature I've ever read. But some of the real take home from Frankl are that suffering is not always pathological. But it's a human achievement, especially when it results from existential frustration and distress. And by no means am I comparing our experience in medicine to what he went through in the Holocaust. But we all have frustrating and challenging experiences. And how we interpret those experiences and how we move on through those struggles are really what defines how we move forward, and potentially who we are. Now, Frankel also said hopelessness of a struggle does not take away from its meaning, and sacrifice can be meaningful. And lastly, our freedom and our personal struggles are related to a search for meaning search for who we are and how we fit in. So how do we use this purpose, to achieve performance? And another way to think of purpose is intention, right? We want to focus on something beyond ourselves, reflect on our core values. We can therefore improve our performance. We know that purpose can foster motivation. Motivation allows us to endure greater perceptions of effort. And inter greater perceptions of effort often allow us to achieve better performance. So in peak performance, which is a book I've referenced a bunch before, they use the example of the 2014, Boston Marathon, and Meb Keflezighi, who was the American runner, who is largely unsuccessful, and marathons as a winner prior to that, won the Boston Marathon the year after the bombings. And he said at the end, toward the end, I was remembering the victims who passed away and they helped me carry, they helped carry me through. So now we've learned that we can use our values to create a mission, we can build that mission upon foundations of stability, in personal growth. Lastly, we can use personal sacrifice and growth, to help us achieve our ultimate mission, our ultimate goals and help define who we are. So similar to how we identified our values, we can identify our purpose by thinking of those values, and ranking them identifying our priority, and then creating an intentional approach to how we achieve our Dharma or sense of being. I encourage all of my mentees to write a mission statement. Who are you? What do you want to be? What is your purpose, right, and this mission statement can change it can be different next week, it can be different a month from now, it could be different two years from now, probably shouldn't change dramatically, but it can change a little bit. And then what I call purpose, your purpose, right, so be intentional. And how you think about these things, you can create visual cues, whether that's something that inspires motivation or strengthen you in your office, whether it's putting a list of your priorities in your car, or in your medicine cabinet, or in your closet where you get dressed every day, I have a rock I put on my desk, and they gave this out as gifts a few years ago that says care for people. And when I'm having a tough day, and really struggling at my desk, or with why I'm doing what I'm doing, because all I doing is on the phone, handling issues or peer to peer or whatever it may be. I sit there and I look at the rock and I focus on caring for people. That's why we do what we do. And you can. And you can use self talk, whether it's a formal mantra or an affirmation of what you do. You can take those cues from meditation or mindfulness practices and put them in everyday practice. And every day, whether it's part of a nightly routine, or a morning wake up, you should reflect on your purpose and your intentions and your Dharma and how you're getting there. So remember that. So remember, as you work towards your goals and values, think about where do you want to be confident, set short term, and long term goals? Break it down, often into small wins. So you should be thinking, what do I want to achieve this year? What do I want to achieve five years from now? What do I want to achieve 10 years from now. And in academic medicine, this may have to do with specific projects, or grants, or career trajectories, and community practices. This may involve how you want to evolve your practice or your patient care, or your contributions to larger organizations or charity work. But we really want to think down short and long term goals. And just by writing them down and processing them, you're going to be working towards them. As you're looking at those bigger long term goals, it's really hard to imagine how you're going to achieve them. So don't try to achieve them all in one fell swoop, small wins small steps to get yourself closer and closer to those goals and to defining who you are. So how do we summarize today? So who am i is an incredibly powerful question that can lead to great happiness or personal struggle. And being present is both the key and the reward for determining who you are. And we want to think about the concept of Dharma right? passion, expertise, usefulness and compassion, can unite to form your purpose and help you define who you are. And if you don't buy Dharma if you don't buy by those concepts, think about the scientific data. Think about the psychological constructs that I presented to you. Work on cultivating your Dharma or your purpose. Recognize that you need both competence and character building. To get there and work towards your passions, you're not going to get there overnight. But by slowly achieving taking an intentional step intentional practice toward those goals, you will identify who you are, and how you fit in, and you can achieve great satisfaction once you've gotten. Thanks for listening. In the next episode, we're going to talk about personality and personal energy. We're going to talk about the good and we're going to talk about the bad and how you can harness your personality and your energy to work towards defining yourself.