Operate with Zen

6. Discussion: Integrated Habits with Dr. Angela Smith

July 01, 2021 Phil Pierorazio Season 1 Episode 5
Operate with Zen
6. Discussion: Integrated Habits with Dr. Angela Smith
Show Notes Transcript

Angela Smith, MD is an Associate Professor of Urology, Vice Chair of Academic Affairs and Director of Urologic Oncology at the University of North Carolina at Chapel Hill.  In addition to being an extremely successful academic urologist, she is a mom and staunch advocate for faculty development and well-being.  In this podcast, we discuss good and bad habits and how to integrate them into a surgical life.

Phillip Pierorazio:

Welcome to operate with Zen. I am joined today with Dr. Angela Smith, my good friend and colleague.

Angela Smith, MD:

Hey, Phil, how are you doing? Thanks for inviting me today.

Phillip Pierorazio:

I am doing great. It's wonderful to have you. Yeah, it's great to be here. So obviously, I know you very well, but give the audience a brief introduction.

Angela Smith, MD:

My name is Angie Smith, and I am a urologic oncologist here at University of North Carolina. Um, you know, I do about 50%, research, 50% clinical, and outside of Urology, I'm also a wife, a mom, of two little girls, five and seven years old. So, you know, I would say I have a full life a lot of fun. I really enjoy everything I'm doing right now. And, yeah, it's really good to be here to talk a little bit about habits.

Phillip Pierorazio:

Awesome. Well, really excited to have you here and kind of launch into some of the interview and discussion part of this. So I want to start, I'll ask you a couple questions, then feel free to fire back at me. But tell me about some of your either good or bad habits that don't have to do with meds?

Angela Smith, MD:

Sure, yeah. I've thought a lot about these habits during the pandemic, because you know, we're all at home, I think there's been a lot of time for reflection that I didn't have before then, or at least life was happening so fast it was hadn't paused to really consider it. In terms of outside medicine, I would say some of my good habits that I've developed over time, revolved around exercise. You know, I never saw myself as a person who enjoyed exercise to be quite honest, I was the person who said, I actually don't like it, I just do it because I have to. And more recently, I've developed good habits where I really enjoy it. In fact, when not when it's missing, I really, I feel like I might my life suffers in many ways, but it's been my relief. So I would say that that's one of my good habits. Some of the bad habits I have right now that you know, I always have, like one habit I'm focusing on so right now, as an example, my bad habit is revolves around social media. You know, I, many of you who listen, you know, Phil, I know you're on Twitter, I'm on Twitter. I'm not on Facebook anymore. And so that was one way I can sort of decrease the amount of social media, but Twitter itself, you know, it takes time. And I think it's addictive, you know, to be on social media. So I'm working on that a number of different ways. I'm happy to talk a little bit about that. But I would say those are my, my probably my number one good habit. And my number one bad habit that I'm working on.

Phillip Pierorazio:

Yeah, those are great, let's, let's work on some of the affirming the good habits. And we can both get into our bad habits a little bit in a second, I'll give you kind of my personal good habit, I would say is very similar. It's definitely exercise related. And I would say, my morning routine. So the way my morning starts off now is I wake up, the first thing I do is I go to our little workout space. And I'm typically doing yoga can be anywhere from 10 minutes to 30 minutes. And it's just a way to kind of wake up body and mind. Typically, I'll fold in five minutes of mindfulness after that. And then I've kind of learned to build in other habits. So I go directly from there, I go upstairs, I've gotten into fresh juice, both my wife and I. So I make juice, I have vitamins, I sit there, and I clean up everything. And then I kind of go get dressed and get my day started. So it's a really nice morning routine, I think a really healthy way to start. And notice I didn't say I don't pick up my phone. I'm not looking at the TV, my mind is fresh. And I find it a really nice way to wake up body and mind.

Angela Smith, MD:

I love I love that because you know if I do reflect on my exercise routine, it's similar in the sense that I built it over time. You know, I didn't just all of a sudden one day say I'm going to exercise every day for an hour. And that's just going to be what it is. I mean that there's no way I think I could have built it. With that in mind. I sort of started small Honestly, I just said you know what, five minutes, you just got to do five minutes. And if you want to do more great, but you don't have to and I think that helped my mind. wrap itself around this new concept that I'm going to be exercising regularly. And from there I actually built over time and I built like things around it. I'll give you an example. I don't like drinking water. I'm a urologist that doesn't like drinking water. But I what had happened is I realized I got dehydrated during the day and I thought well what's the habit? I could create where I could start myself off with success. And so I thought about what I could do. And there's a lot of, we can go into this a little bit later, but how you create the habit, but I decided to drink a glass of water every day. So basically, before I go to bed, I pour a big glass of water. And I put it into my my, my nightstand and so when I wake up, the very first thing I do, is I drink that entire glass of water. It's a big glass. It gets me hydrated. So that's my first start. And then I go and get dressed for exercise. You know, I do I use peloton because it's easy, and it's in my house, I go upstairs, and I created a room, that's just for me, you know, it's no, no kids are allowed in this room, my room, and it's our guest room, but no one really, you know, comes over of course anymore with a pandemic, though it's really just my room. And it's very peaceful. And I really love the way that it feels when I go. So I, I just look forward to going there. Then I do whatever exercise routine I like, sometimes I do yoga, but sometimes I do really hard workouts, just depends. And then after what I look forward to and sort of like what you said, Phil with your juice juice, I love a nice cup of coffee. And so I know that when I'm done, I'm going to get a really nice cup of hot coffee with a little I use heavy whipping cream, because that just helps me stay safely satiated until lunch because I do a little bit of intermittent fasting. And that wrapped around together feels like it almost feels comforting is probably the best word because I'm so accustomed to it. I look forward to it every day.

Phillip Pierorazio:

Yeah, that's great. I have to tell you enjoy. It's always funny. For those of you who don't know, US engine, I have been friends for 15 years now. And we basically interviewed for residencies together and ended up in different parts of the country, I have the exact same water habit. I terribly hydrated during the day. So at night, big glass of water, first thing I do is I drink that that water. And actually I probably say that's what starts my starts my habits, right, as we kind of do things together. And I think the other nice thing that you've touched on is, you know, you start your day with an intention, you're starting your day with an intention for wellness, for putting yourself in the right space, both physically and mentally. And I think that that carries through to say good habits throughout the rest of the day.

Angela Smith, MD:

It does, I think you're right. And, you know, I sort of stopped with my cup of coffee. But if I really reflect on the true habit of what I do, in fact, today, it's exactly what I did I drink, I woke up, I drink my cup of water, extra size had my coffee, but then I always take a shower. And when I take my shower, I actually tell myself three things because I take a quick shower, it's five minutes. But in that five minutes when I'm shampooing my hair, I say three things. Today I'm going to focus on X. Today, I'm going to let go of y and three, I'm grateful for, you know, the so I like that because it sets an intention for that day and it changes from day to day. If it's Wednesday, I call them wild Wednesday, I have a lot of patients. That day I do surgery than I have clinic and I do procedures and I do a lot of teaching. It's just it's jam packed. Sometimes my intention is you know, I let go of perfection. Sometimes that's what I say on Wednesdays, it's not gonna be perfect. But today I'm going to focus on getting my notes done by four, I'm just going to everything I'm going to do is about getting my notes done by force, I can go home, and it's so effective. It's amazing how just a thought just a small feat of a thought can actually, you know, translate into practice like actual success of that the you know, what seems like a crazy goal and crazy intention really, really can be effective. You start your day with that mindset. I don't know if you have any similar mantra, I know you're interested in somewhat in mindfulness. But do you have anything similar to that?

Phillip Pierorazio:

Yeah, I've got a couple of and the one I'll share right now is I've actually now started in my in every the first operation of the day in the O R. When we do our timeout, we set an intention for the day. And I typically ask the trainees, whether it's the resident or the fellows, or sometimes it even works into the nurses or the or the text or the anesthesiologist in the room. What's our intention for the day. And sometimes for a junior trainee, it can be something very tangible, like I want to work on retroperitoneal anatomy today, or I want to learn how to throw this suture better. And sometimes it's more of a mindful approach. I want to work on being more efficient today or being more kind today to other people in the operating room. Whatever it is, we set an intention for Dane just like you said, you build that that brain science in and there is actually really good science that you're basically creating. Those neural connections. So whether it's for kindness or efficiency or anatomy, just by thinking about them before you're doing that you're helping train that brain circuitry so that when you actually do it, it becomes easier. So really phenomenal stuff you're bringing up?

Angela Smith, MD:

Yeah, I agree. And I hadn't thought about it in the or because I don't I don't bring in my team. But it's a great idea. because like you said, you know, in the O R is a team mentality. If everyone has that same intention, it can really manifest into a really great day. And I, I think sometimes we do that, unofficially, you know, you come in in a great mood. And I've seen that actually, before, you know, you come in in a great mood, and everyone becomes, you know, it's infectious. Everyone's in a great mood. And even if things don't go the way you intend that that mood transfer transcends those challenges. But he come in in a bad mood, it sets the intention. But having that actually verbally stated out loud, it's a good idea. I'm going to I'm going to try that you always have good ideas, Phil,

Phillip Pierorazio:

likewise, I'm learning from you too, as always, yes, we talked about some good things and good habits. I like your bad habit, social media is a big one, I definitely have worked on limiting my time and try to really partition that out. My bad habit is that I'll own up to this is after dinner, I have to have something sweet. And that's another habit I have. That's bad. I try and relate. I try and say that maybe this is a good habit because I limit myself typically to one or two cookies. But that's certainly a bad habit. And it's linked to dinner, and I can't get away from it. I dinner need something sweet. And then the meal is kind of done for

Angela Smith, MD:

what are you trying to do to change it? I mean, I think that's the interesting part of habits. It's actually the, you know, you and I both do peloton and I've heard coaches say, you know, enjoyed, enjoy the process, rather than the outcome. And I'm trying to embrace that a lot with habits because it's almost like a challenge. And you know, a lot of surgeons who are listening, we're all type A many of us, many of us are type A, let's just say, and we enjoy a good challenge. I try to, to frame it in that way, like, I'm gonna, I'm gonna overcome this, and I'm going to figure it out. It's a puzzle, but I'm going to figure it out. The What are you doing to try to, to curb that bad habit? Because I'm going to learn from you. And maybe I'll try that too.

Phillip Pierorazio:

Yet, to be honest with you, I'm not sure I'm ready to tackle this one. But what is the first step, when you want to change it? Exactly. And what I have done and to kind of use that coaching mentality where I've kind of flipped This is later in the night, I don't have any other sweets, snacks. And what I say is, when I get that craving, when I want something else, I'll go for a piece of fruit or go for something healthy for me and ends up being grapes, for whatever reason, they tend to be sweet and fill me up. So that ends up being my new key. So when I get the craving later, I've only I've limited myself to the one or two cookies after dinner, and I'm not going for you know, the second or third helping of dessert. So that's kind of where I am with it. I eventually want to work to not needing it at all. But it's it's tricky.

Angela Smith, MD:

Well, I think what you bring up is it's a good point, which is that I think all habit, habits need to be changed incrementally, it's really hard to change something that is so deeply ingrained in what we are accustomed to doing on a daily basis all at once. And you know, that goes back to my exercise routine. I was doing it wrong in the sense that, you know, it's the first of the year I was the very typical person who would, you know, get a gym membership and just like go all out no for a few weeks and just lose steam completely. And because I I think part of it, and reflecting on myself is I'm a perfectionist. And once I missed a day or two, I just kind of gave up, I'm like, I can't do this. Whereas when I made the the challenge or the habit, something really small, so small, that I was like, you know, I can do this. And even if I miss a day, I get right back on, that made all the difference. And so, you know, for me, the bad habit I was talking about with social media, and I should say it's really my smartphone. So I shouldn't blame social media. It's not just that it's my smartphone, I have, you know, email on it. And, and I have, you know, all of this. I, I, I would say that, you know, what i what i what has helped me tremendously is incremental changes. So my first is I put a screen time passcode like a child. I don't trust myself and so my husband holds the key to my screen time. So I'm only allowed a certain amount of Twitter a day in Keeps me honest. And if I want more, I actually have to go to him to enter that screentime pass code. And I'm too proud to do that. So I actually that helped quite a bit. But you know, I found workarounds, like I can go to the Internet, and that's harder to create a screentime password code around. So I'm still, I'm still working on this bad habit, but I know it's there. And I know I can conquer it, it's just gonna be really small things until I get there.

Phillip Pierorazio:

That's great NGO, you know, you bring up kind of a concept there of either nudges, or you know, limits and actually limiting your behaviors. And there's lots of apps or behaviors that you can do to kind of help with that. And that brings us a little bit to kind of theory of habit formation. Thank you turned me on to atomic habits and some of the books in this realm. So you know, I think one of the most powerful messages from that book is, it's, it's about owning the identity, right? So I guess I'll use the analogy, right? If I want to get rid of the sweets, then I have to, instead of trying to say, all right, I need to cut out sweets after dinner, it's what would a healthy person who doesn't eat sweets do? Well, they wouldn't need to cookies after dinner, right? And so it's kind of changing the mindset to an identity instead of a behavior. What other pearls do you have for kind of habit theory? Or how do you, you know, prescribe to changing your habits?

Angela Smith, MD:

Yeah, I think the first thing I do is try to think about the goal. Like I want to get out of the habit. So maybe I have a bad habit, why is it bad? And what do ideally, what who do I want to be instead of that person, so, you know, the simple example was the hydration, right? I'm a dehydrated person who doesn't drink enough water. So I wanted to figure out an easy way to to change that. And I, so then you start thinking that, you know, there's Four Laws of behavior change, you know, I love atomic habits. And I wouldn't say I'm an expert in habit changing, I just really enjoyed that book. And it was very operational for me. But the Four Laws of that change, and I know you know them, but the first is you got to be, you got to make it obvious, you know, something that's going to be right in your face. And so for me, I knew the night before. If I put that water next to my nightstand, when I wake up, it's the first thing I see, like, literally the first thing I see. And so that was my obvious, you know, requirement and then you want to make it attractive. So, because I get up, I don't have to get out of bed yet. So it's easy for me to just down that water, make it easy, it's already there. That's the third law of behavior change, and then make it satisfying, it does feel good to start your day with water. You know, it does feel sort of energizing, it kind of gets you going, you know, to exercise. I can I apply that pretty much to every habit I have. So my coffee after after exercise. That's like my satisfying habit. You know, I enjoy. I mean, exercise itself. It's hard, and I do hard workouts. So does it feel good when I'm doing them? I'm not at that point. To be honest, I'm not gonna say I'm not gonna lie and say that I love every minute of exercise. I don't. But it's satisfying, because I know I'm going to get a nice hot cup of coffee and then later I will feel really good. So I think that that for me is the, the satisfying aspect and, and then to bring it back to my bad habit, which is social media and really frittering away my time at night. That's really where my problem is, I, I kind of get on my phone, and I just before I know it, as hours passed, and I need to go to bed. Whereas I really want to be a reader, you were saying, you know, change your identity. I don't want to be a person on their smartphone. Okay, so I tell myself now, I am a reader. And every night I read, so rather than say what I don't do, I try to I denta phi with who I want to be. So as a reader, I don't use my smartphone, I picked up a book, and I make it satisfying always get a hot tea now at night, and I drink hot tea while I read a book. And so I'm trying to sort of incorporate all these things like they get attractive, make it easy, make it satisfying. I know like having that hot tea, sitting in this like really comfy chair, in my bedroom, kind of gets me ready to sleep. It also is really, I feel really good after I do it. It's just a matter of doing it often enough that all of those good feelings become a new pattern, you know, a new pattern for you and a new identity.

Phillip Pierorazio:

I think that's great, Angie, you know, you bring up two important, I guess we'll call them you know, habitual theory kind of concepts there too. And the first is linking your habits, right, one of the easiest ways to build a new habit is to tie it into another good one. So if you've just listed four habits you put in a row, that help you get to a really good outcome and a really good space at night, that help you get away from social media. And the other concept is the carrot and the stick phenomenon, right, you're giving yourself a big carrot at the end of your workout with coffee. I was talking with one of our chief residents the other day, who was preparing for boards, and is having a really hard time studying. And when they when they get out of work. They want to go home, do their exercise, and then study and I say, all right, well, you love your exercise, why don't we try flipping it the other way, go home, do your studying. And your carrot is when you're done with your hour, hour and a half of studying, then you get to do the exercise you've been looking forward to all day. And so I'll report back on you and see if that's work. But it's a you know, it's it's another way to kind of think about this concept.

Angela Smith, MD:

Yeah, I agree. And that, you know, there, you know, we this, this talk isn't or, you know, our podcast today isn't about productivity. But it certainly, you know, integrates into the topic of habits. And I know that Eat That Frog. Many folks have heard of that book. But I and I love it because it actually integrates many, many different things into a very short book, which is great, because, you know, it doesn't take very much time to read it and it but it one of its one of its central tenants is in really the the reason for the title of the book is that, you know, doing some hard things first. And then some of the easier, more enjoyable things later, can be incredibly impactful in terms of productivity. And that I would say is one of the greatest has had the greatest impact on my own productivity over the last several years. I can honestly say now, I'd never say I could have ever done getting gotten to this point. But I'm actually caught up. I'm not behind in anything. I am very, I'm I'm very careful to always do the hardest thing first. And I and I'll tell you, it took me years to cultivate that habit. It is a habit. But once you do it, again, you have that good feeling afterward. And that becomes addictive. And so I I found I found that to be very powerful for me and I I tried to, you know, just nudge my mentees in that direction. Because I do think it has to be a personal decision, you have to want to do it. It's sort of like what you said you weren't ready, you're not ready yet to change your habit of eating sweets after dinner. And that's okay, actually, that's, I think, incredible to know that you're not ready. Because it's only when you're ready that that you're going to be effective. And at some point you will be and at that point, you start thinking of creative solutions. And that's I think that's the fun part of habit change is to think about creative ways to change your identity. And isn't that cool that we all get to do that at any point, we can change who we are, and it's just up to us. We just make a decision.

Phillip Pierorazio:

So awesome. You know, we've kind of both said throughout this we are both peloton people. And I think there's some really unique things that peloton does that helps you build good habits. And I would leave some of that to the success of the company. But obviously there's other successful exercise companies and apps out there. But I think, you know, kind of tell you my theory on this, you tell me if you agree with us or not. But I think the first one that a lot of the instructors say is showing up is really the decisive moment, congratulations, you signed up, you clicked you clicked on you put your shoes on, and you clicked into this class. That's the hardest part once you're there becomes relatively easy. And I think that's one of the first steps to building a good habit of just showing up.

Angela Smith, MD:

Absolutely, I couldn't agree more, I think that is it. And an even if it's five minutes, and that's really goes back to these just tiny little, you know, atomic habits, like the book, you know, the title of the book states, it's, it's these are micro habits, you know, it doesn't have to be big, life changing. You know, decisions, it's just saying, hey, five minutes a day, I'm going to show up, and tends to be that when you show up, you're like, well, I'm here already, I'll go ahead and do a little bit more. And that's how a habit builds over time. You know, you might start with five minutes. And then you say, well, you can keep going for a little bit. I'll do 10 minutes and then you know now it's 15 now, you know and eventually you get to an hour or whatever, you know, whatever you end up feeling is right for you. But I I think you're right, you know, that's that's one one aspect and I think the other is breaking is not breaking the chain. You know, I don't know if you feel the same way Phil but you know, I've heard and I'm sure others have Seinfeld. He says like his he attributes his success to never breaking the chain. He always writes a joke a day no matter what. He never breaks that chain. I think about that. A lot. I think I cannot break the chain. So if you look at my peloton, you know, history. It's not that I always work out every day or you know, for an hour, but you will see I do not break that chain. Even if it's mindfulness on peloton for five minutes or walking for five minutes doesn't matter, I have to do five minutes. And there's no excuse. I don't allow myself any excuse because we all have five minutes. So I don't know what you think about that. But I think peloton does a good job of of maintaining, you know, in celebrating streaks, you know, you'll see, there's, you know, high fiving people who have done it 10 days in a row, or whether it's 10 days or you know, 10 months there, there are streaks to be celebrated. What do you think about that?

Phillip Pierorazio:

Yeah, I think that's one of the things they do really well. And we know that habit tracking, whether it's through peloton, or making checkboxes, you know, on your your legal pad for the day or index cards, whatever you have, creating that visual cue has tremendous impact on motivation. And there's actually a lot of science and behavioral science behind that. The visual cue is inherently motivating, it creates a huge feeling of satisfaction. Forget the class in the satisfaction you get from working out or doing whatever the habit may be, when you get a huge satisfaction just from checking the box. I know we all do that with our with our to do list. And it also like you said it gives you motivation. It keeps you honest, I do the same thing. My my peloton tracker is blue every day. Most days, it's not an intense workout. But I'm doing something. And I think one of the I forget where this piece of advice came from. But you know, the best workout you do is the one that's absolutely miserable that you didn't want to do. Yeah, right. It's, that's true. Yeah, there's kind of this sense of kind of compounded interest, right. And if you work out every day, even if it's just a little bit, you're building on that interest. But the minute you take the step backwards, you don't do something or you don't do that habit, you've now not only have you not gone forward, but you've taken a step backwards. So it's the habits that you don't want to do on a daily basis, the ones that I really struggle with can have the most impact. So yeah, great, great points.

Angela Smith, MD:

Yeah, and I think I'll also add that, you know, one of the issues I had, again, recognizing the perfectionism that I have in myself, is that, you know, it doesn't always have to be perfect. So while I say you know, don't break the chain, occasionally, it's going to happen. I mean, I do have a chain going, I don't know how long it's been now, maybe six months, since I've had a single day I've missed, but I know it's probably going to happen, I'm maybe something happens, I don't do it. And I forget right before bed, when I was going to do it, I go to bed. And sure enough, I break the chain. That doesn't mean you give up. You know, and I think that that I had been a lesson I've had to learn, you know, just because it's not perfect doesn't mean that that it's all over, you start again, it's okay to miss a day, but don't let it be more than a day, you know, the next day you double down, get right back on the horse and keep going. One of there's a coach out there who I love her mantra because you know, just from, again, an individual who wants to get straight A's, you know, in school, etc. Even when I'm doing my my clinic notes, it's like, how do I get done? You know, before five o'clock? Well, I had trouble with trying to be too perfect with them, you know, trying to get the wording right and sentences structure like does it really have to be full sentences? No, it doesn't, you just want to make sure it's clear, concise, and you're getting the information across. And so I To this day, still use her mantra, which is b minus work, b minus work, work. And I'm typing out my notes trying to get home. I just say that in my head to myself. And in realize that perfectionism isn't necessary in our lives, it really isn't in many ways that can harm us. And when you're trying to create these habits, trying to throw that a little out the window. I mean, you know, even these small habits, you know, you know, it might not not be as perfect as you'd like them to be. But as long as you remain consistent. That's that's the most important aspect of a habit, I think.

Phillip Pierorazio:

Yeah, that's a great analogy. And I've heard it given different ways, you know, for instance, with public speaking or when you're giving your talks, right? Do you get invited to give the podium at the AU way, you're going to give your A plus talk, right, you're going to be prepared, you're going to know it back and forth. And no offense to any of our residents or trainees but when you're giving the the resident conference, we'll call it B plus, we won't say too much. But you know, it doesn't have to be the A plus talk. And actually, they may benefit more from the informality of that, right. It doesn't need to be the crisp, most best talk you've ever again. And I love your analogy with the clinic notes too. I think it's really important. Get the important information forward and move on. Yeah, absolutely. As you say the The last thing I was gonna bring up about peloton which I think is a really good habit building kind of technique is the tribe, right? I mean, that's what peloton means that's where that comes from. But humans are tribal. And by surrounding ourselves with like minded people, whether that's through workouts or work, or surgically or academically, we help move in the right direction. So, you know, I tell people, or I'd like to think of myself as put yourself in the right circles, right circles for success. And if you're not feeling supported, or you're not feeling that you're in the right situation, then then maybe it's time for a change, because it is one of our strongest supporters of good habits.

Angela Smith, MD:

Yeah, absolutely. I agree. I mean, I, I think the people around you, it, you know, it brings joy to our work or co workers that, you know, whether it be on peloton, and people cheering you on, and you're cheering other people on, feeling a sense of community where you are, can be, you know, could have tremendous amount of power in what you do every day. Why I worked at UNC, I love my partners, it's, it's honestly, the number one reason I'm here. Because I find joy in sharing what I do every day with my friends. It's really as simple as that. And I love the patients I see too, for that same reason. Just it's, I think having that sense of community brings more of a purpose to what we do every day. And that that translates to habits as well, when you have that sense of purpose that's beyond just getting up and, you know, exercising for exercise sake, so to speak.

Phillip Pierorazio:

That's great. So in the last little bit here, you know, the podcasts called operate with Zen. So I want to focus a little bit on surgery and how we make these habits specifically to our surgical career. So can you tell us a little bit about habits you have whether it's Oh, our academics clinic? I mean, we mentioned some of them throughout, but I'd love to hear anything else you want to share about your surgical habits?

Angela Smith, MD:

Yeah, absolutely. You know, I think there are small things. So nothing really big. I think the first thing I've said some of these in different ways throughout this podcast, but I'll kind of summarize them here as I believe them to relate to surgery. So I said that I have a mantra when I take my showers in the morning, which is I have one thing I'm going to focus on one thing I'm going to let go and then one thing I'm grateful for, and I'm on my days and the or they usually revolve around around the case. You know, sometimes we have cases that are going to be challenging. So I set my intention in that way. And I think that's really very helpful in calming me in getting my head in the right place. And having a plan for surgeries. I you know, I have a trainee, I usually ask my trainee, what they want to get out of the case. So very similar what you said, Phil, about intentions, I don't do it. You know, I don't say what is your intention, so to speak. But I do ask, you know, what is the thing you you feel? Well, actually, here's the exact question I asked, What are you feel most uncomfortable about? Because that gets to the heart of what they need to learn, because we're tend to be most uncomfortable about the things we don't know enough of. So that is an easy question that I always ask because then I know, this is what we're going to focus on today and the or exactly what you're uncomfortable with. Because if we focus on that, over time, that thing you were uncomfortable with? Well, you'll be start, you know, you'll start eventually becoming, you'll have more comfort around it, because you know what you're doing, you're just focusing on it. So that's another aspect of the in the O R. But of course, we're not just surgeons, we're in the clinic for the clinic. One habit I always have is I always preach art. I didn't believe in that before. But I you know, experiment. And I always encourage folks, you know, when you're thinking about habits is what I do. I always experiment. I never take for you know, you know, great for granted that I know for sure this is the best way, I always assume there's a better way. And until I experiment, I'm a scientist at heart. I'm going to experiment with a different way. And so I always had always believed erroneously that pre charting was a waste. It's not for me, I can tell you I tried both ways. I save a lot of time with retargeting, save a lot of anxiety, I teach better. And so I always preach art, at least the day before. If not, it's usually the clinical day proceeding sometimes that's a couple days before and I just have all my notes ready to go. And then you know, I spoke about the clinic I spoke about the O r. o and I will say in the clinic I always finish my notes. I always close my notes before I leave always. I mean there's really no exception to that and I don't allow myself any any wiggle room. I just I do it. It's one of those things, you know, I I just I don't myself make excuses in my head. And it's possible I do it. And then the last is, is academics, you know, because we have, we have multiple, we all have multiple roles. And for academics, very similarly to precharging. I, in some ways pre chart my schedule the day before. So I have on my schedule today, this our discussion today, Phil, and then I have that marked down for this hour, I have what I'm gonna do the next hour. And right before I leave, I always basically plan my next day, I know exactly what I'm going to do in the morning, it's going to be my hardest task, I already mentioned that, and I write down as long as you know how long I think it's going to take, and I blocked it off my calendar, you know, so tomorrow's reach or research day for me. So I know that I'm going to be working on an oral one. And I have to work on my specific games. And that's hard. That's a lot of deep work as they say. So that's my first my first task. And I'm going to spend an hour and a half on that. And I know that's a lot of time, but it needs a lot of time. And he's a lot of thoughts. So I would say that's probably my biggest habit for the academic, you know, research side. So I have many more, but I would say those are the, you know, fundamental habits that I've built into each aspect of my professional life.

Phillip Pierorazio:

Thanks, Angie, thanks for for sharing those, I just want to highlight, you know, throughout the podcast, you've brought up limiting your time in several different ways. You talked about it with social media, now you're talking about in your academic day structure, talked about it in your clinic time, and limiting your time forces you to be efficient, and it's great habit building, right? You know, if you've got an hour and a half, you can't mess around for the first half an hour of your arwen time, you've got to get it done in an hour and a half, because you're moving on to the next task after that. And that's great habit building.

Angela Smith, MD:

Yeah, it's true. I mean, I, I read some somewhere, and I don't know even how to describe this, you know, quote, or this concept to you. But, you know, life is about where we choose to focus our time and attention. And we are the ones who make those choices. So when you you know, you have to self reflect and know where you're, you're spending your time where you're placing your energy. And when it doesn't serve you well, it's up to you to change it, and to recognize that and change it and put that time and energy somewhere else where it best serve you. And so that's what I tried to do. And it's it's always a continuous iterative process.

Phillip Pierorazio:

That's a great, great, great message for anybody out there, and everybody out there listening. That way. I'm gonna leave with with one habit, learn from from Dr. Walsh, and I had a really good fortune of training with Dr. Walsh and doing a couple 100 prostatectomies with him. And anybody whether you do cancer or benign surgery, being in the operating room, we know we're procedural. And he obviously broke the surgery down into steps that were easily adjustable. But I think more importantly, set the operation up the exact same way every single time, from the drapes, to the instruments to the steps of the procedure. So not only when something wasn't right, not only did it put you out of procedure, but it created kind of this visceral response where your habit was off, something was different, something changed. And I try to instill that in the trainees and obviously, I don't do open prostates. And I don't do as many prostates as some other people. But if you do this, if you follow similar principles, and similar steps in your habit formation, you kind of get a feeling when things aren't right. And that can alert you to something else going on that you may need to address in the operating room.

Angela Smith, MD:

That's such a great example of habit and action. And the Oh, I love I love it. I completely agree. I mean, habits make us comfortable. And I think as a mother, you know, I think about how when my my children were very young, I would read books about what you're supposed to do and how kids crave consistency and routines. And the older I get, I realized we do too, we really do too. And that's what a habit comes down to is providing consistency and routine to give ourselves comfort, whether it's in the car, or in the clinic, in our personal lives, wherever we are. And, and that's why I spend so much time on my habits because I feel like that has brought me the most joy in all aspects of my life.

Phillip Pierorazio:

And I can't thank you enough for sharing your thoughts. And speaking with me today. It's always fun. It's always a pleasure speaking with you, I've learned more things than I can jot down on a piece of paper here. I went to a couple sheets of paper. But thank you,

Angela Smith, MD:

Phil. I love talking to you. It's always a pleasure. And in Likewise I always joke we have so much in common. And it's fun to talk about these things with others. I think that's why This podcast that you're doing is is really, it's so it's so important and it's something unique that we don't always hear as surgeons. And so I appreciate you bringing me on and, and talking about this and allowing me to speak a little bit about my own experiences. Well thank you and I look forward to talking to you again. Thank you.