As part of the Mindful Decision Making series, Dr. Granville Lloyd and I review 7 Ways to Think Differently by Looby McNamara. This book is based on principles of permaculture where the creation of resilient, healthy, productive systems shape decision making. The parallels to medicine and surgery are clear and we hope you enjoy. (Music Credit: Sunshine, Simon Jomphe Lepine.)
As part of the Mindful Decision Making series, Dr. Granville Lloyd and I review 7 Ways to Think Differently by Looby McNamara. This book is based on principles of permaculture where the creation of resilient, healthy, productive systems shape decision making. The parallels to medicine and surgery are clear and we hope you enjoy. (Music Credit: Sunshine, Simon Jomphe Lepine.)
My name is Phil Pierorazio and I'm a urologic oncologist, a surgeon. Like many of you, I absolutely love what I do, and I would not choose another profession. But I've struggled professional identity practice efficiency and wellness over the years. operate with Zen is a podcast designed to explore a mindful approach to surgery and to being a surgeon. By discussing these struggles and mindful solutions, I hope together we can create a community of strong and healthy surgeons enjoy. And welcome back to Season Two of operate with Zen. We're gonna try something a little new. This time, we're gonna do something we're gonna call a book report. And I'm sure you'll give us feedback if you like this or you don't like it. But I brought on a guest back from season one. I'm sitting here with Dr. Granville Lloyd, from the University of Colorado. Granville, you want to say hi, introduce yourself again.
Granville Lloyd, MD:Hello, everybody. My name is Granville Lloyd. I'm a urologist at the University of Colorado. My clinical practice is at the VA. And it's an incredible pleasure to be back with Dr. Pierorazio.
Phillip Pierorazio:Yeah, great to be here with you Granville. So we this season, we're kind of talking a lot about decision making and effective decision making. And so in this perhaps short podcast today, we're going to talk about a book that you actually introduced me to and this was through your chapter in Stephen Taqaddas book on navigating organized urology, and this was a chapter on kind of work life balance and well being. And it's a book called seven ways to think differently by Looby MacNamara, and I'm going to introduce it with a quote that's not in the book for Marion Woodman and Marion Woodman, if you're not familiar with her was a Canadian, author and poet, thought of as a mythopoetic, writer, and a big figure in the analytical, Cyclops psychologist movement, as well as the women's movement. And she spoke and wrote extensively about the dream theories of Carl Jung. And this quote, and I'll read it to you and then we can reflect on a little bit says that the feminine and when she's talking about the feminine this quote, she's, she's referring to the yogic feminine, the Shakti, which is kind of the, the balance comes to us in nature. Go outside, look at the amazing waves of green, of lilacs of Blue Mountains, we are in the presence of the manifestation right here, and she's reaching out for you. And I interpret this, that we can learn a lot from nature. And that nature gives us a lot that we can learn not only from ourselves, but by what we see around us. And I thought it's just a great way to introduce this book.
Granville Lloyd, MD:I think that's wonderful. It's so much of this book, I think is very interesting, in ways to help people cast their frame and recognize that it is and we are all part of nature. I do want to take a second to give real thanks to my brilliant co author on the chapter induction acod, his book seroma Khakhra. And who introduced me to this book, because it is a wonderful book that talks a lot about sort of just those topics. I mean, how do you recognize your place? globally? How do you recognize your place in a larger frame that which you may be existing in? So it's fine. I'm excited to talk about this.
Phillip Pierorazio:Yeah. So just to give a brief background on the book, and then we're actually just going to talk through the seven ways to actually think differently is that this is a book based on principles of permaculture. And if you're not familiar with permaculture, it's basically the study of ecosystems and creating kind of productive ecosystems that thrive. And the goal of permaculture is to develop a resilient, healthy and productive ecosystem. And if you flip that analogy into medicine, I think what we're trying to develop in medicine are resilient, healthy, productive healthcare systems. And whether that's on the micro level of ourselves in our practice or our patients, or in our hospital or more global systems, we want resilience, we want health and we want things to be productive or efficient.
Granville Lloyd, MD:Absolutely. And and, you know, thinking that, you know, you and I both have the luxury and pleasure of participating in resident in student education and training to help those people especially enter through Enter into their training and careers with the the understanding of you know where they are within these these sort of bigger systems, I think it's just such an important thing to understand that as terrible as the day the week, the weekend the call the operations, the you know the number of console pages they got may have been did they can, there are things that they should still feel gratitude about. And that if if one can expand the frame of what they're looking at a little bit and say, Hey, this is part of it. From a nature standpoint, to say this is part of being an organism under stress. This is, you know, the old phrase, there is no pain, no growth without pain. And I think so much of it really does come down to just that expanding one's one's reference points in sort of stepping back, and rethinking certain facets of work in existence.
Phillip Pierorazio:That's great. So we'll get right into it. So there are seven ways to think differently, according to this book. And the first one is abundance, thinking and in abundance, thinking, this is a philosophy that there's plenty. So because there's plenty there's no need to hoard or to be greedy, or to be fearful of sharing. And there's some social science behind this. Another permaculturist, named Ethan Rowland, kind of put down eight forms of capital, which can be financial material, social, experiential, intellectual, spiritual culture, and health or well being. And I think some of the notable ones in medicine, I love your input to hear Grandfather, I mean, obviously, there are, there are financial forms of capital, right, and whether that's what we think about what we bring in as physicians, we all have RVU targets or things we need to to kind of gain for our department and our institutional well being. But on the flip side, our patients and payers are sharing in, in kind of that financial capital. There's also kind of experiential capital as we build a practice, or as we share cases with our colleagues, right, these are all things that can be shared, we could also hoard cases or hoard parts of our practice, which we have all experienced or maybe guilty of, I know I was for, at some points in my career. And then especially in academics, but I would say this is not exclusive to academics, there's intellectual capital, right, where we carve out our intellectual space or intellectual property, and we can be very protective of that. And I've learned over the years, that you're often more productive when you encourage others to work in your space. Right. And I used to be, as you may know, it, you know, I read a lot on small real masters, and I used to be very protective of that space. But now I love and I wish I learned this years ago, I I love when anybody writes on active surveillance for small renal masses, that means the message is getting out. And we're thinking about this, even when they challenge what you write or challenge what you think it's people thinking and working in an area. So it's just kind of the way some of the ways I've internalized this, this kind of theory,
Granville Lloyd, MD:it's such an interesting thing. You know, I think that humans are wired for survival based competition, I think that we come into things like, you know, our certain intellectual space, let's just take that, for example. And we say, Gosh, I need to protect this because there is only so much I think that's a reflexive starting point that everybody has, and it's, you can almost transition that over to Maslow's hierarchy of needs, and say, Oh, my God, I just got to eat, I got to eat, I got to eat. And then you get past that point, you published your first couple papers on small renal masses, or one way or another, you expand your thought a little bit beyond that you you ascend to a different level of the hierarchy. And and you recognize, hey, actually, I really am better served by making this a collaborative project by making this a collaborative concept by allowing people into the room. So I think it's very normal. And I think it's one of those things that is hard, but important to try to recognize that when you're faced with that feeling, that that's okay, that that's what happens, you know, and we have all I strongly suspect that 100% of us have had those feelings about whatever, I want all the views, I want all the stones to come to the ER, I want to do all the Terps I want to do all the routes, I want to take out all the you know, you name it, and and then after some period of time, you sort of climb out of that to a different level of thought, or just a different level of understanding and realize that there really isn't enough and I think we're uniquely luxurious in urology, because there really is a lot of disease out there and a small number of us, but, but I think it's so true and I think it's a normal phase to go through though I don't think anybody walks into it, you know, their first day of practicing. Oh, this is great. Let me just invite some of my partners to come do some of these prostatitis cases that came to me. But it's such an interesting concept.
Phillip Pierorazio:Yeah, no, that's great. And I think you bring up a great point that it is a transition. Right? And, and we learn to recognize that there is abundance, that we don't need to do everything, and that we can share. And by sharing, we all grow better together.
Granville Lloyd, MD:Absolutely. So in at the same time, I think, to not beat ourselves up too much for having a competitive nature. I mean, there is no way that you got into any form of medicine that you got into, you know, college, in the first place medical school in the second place, surgical training in the third place, probably fellowship, and the lofty position that whoever it may be holds now, without being competitive. And that's, that's why there's 7 billion people on Earth, I mean, we are as a species, to go back to the nature thing like that's kind of baked into us. And to some extent, at least recognize and validate that don't have to like it, and you don't have to accept it. And you don't have to let it do bad things. But it is kind of part of us.
Phillip Pierorazio:So we'll move on to the the next thinking. But I want to finish with a another quote here that I absolutely love. And this is from Satish Kumar was an Indian British activist and speaker, he was actually a monk, he was a nuclear disarmament advocate and a pacifist, and he said, have less food, but delicious, high quality food, and you will feel more satisfied, and you will be healthier, have fewer clothes, but beautifully made clothes and you will be more comfortable, have a smaller house, but let it be well crafted and personalized. And you will feel more at home. And I think that's something I've tried to incorporate it into my life. I've scaled down my closet, my wife and I are scaling down our spaces, and trying to be more thoughtful and really into what we have rather than having more. And I think that speaks to that abundance thinking process.
Granville Lloyd, MD:I couldn't agree more. I mean, there's good social science, supporting the idea that experiences end up being valued much more by people then do things. I mean stuff is just stuff. And they've done some studies where they asked people to predict how much they will value a thing into the future versus experiences. And everybody repetitively overvalues how much they will value the thing, and undervalues how much they will value the experience. But if you come back to him later and say, hey, you know, how great do you feel about that? Whatever it is giant new TV or something versus that trip with your family to you know, to the islands? The retrospective answer is universally the experience. I think that's beautiful quote.
Phillip Pierorazio:Yeah, like. So the select the second model is solutions thinking. And this one really says that you have to have a belief that there isn't an answer. And if you don't believe that there's a solution to your problems, you're going to be blind and deaf to them. And it really speaks to building resilience. It speaks to the kinds of solutions that exist. And as you think about solutions to your problems in life, there are technological solutions. We encounter this in medicine all the time, all the time, especially in urology, we have lots of new technologies to treat issues. There are different ways we can move or move either physically or more abstractly through our life. And I think one of the really nice concepts about solutions thinking is reframing or thinking outside of the box. And Einstein said, you cannot solve a problem at the same level of consciousness that created it. And so often getting outside of our natural confines or asking other people to help us get out of those confines, we can get to solutions that we may have been limited by so I'd love to hear your thoughts on this one, grandpa?
Granville Lloyd, MD:Well, I mean, again, it's it's it's such a great thought. I love the Einstein quote. And again, I think it's just one of those sort of framing challenges. I think that we all can run up against walls, in because walls exists everywhere, and you will hit those and it's only by stepping back and realizing that the maze is crafted of one foot high barriers, and you just need to step over them instead of trying to find a way through it. There's some other perspective that allows you to recognize a completely different solution. I mean, I've always thought of it like if you're just looking through a tiny little window, you just need to back the window up or think about the question differently and really reassess. I mean, I really think that's what what Looby MacNamara is trying to get at with the book with all these different ways to sort of help people reframe the question help people to accept the challenge. differently, perhaps use different metaphors to frame the question. And then to back up more from it and say, Okay, the question of how are we going to do more of this in our practice? should better be framed as how can we allow our practice to thrive in the current environment in this city and in this location? Or maybe the answer is not continuing to fight with the one hospital down the street. I've seen hospitals just dry themselves into the ground is systems, fighting battles, they just can't walk away from when opportunities existed in every other direction. And it's just it's it, I couldn't say it better than than you did, really that, to reframe the question. And to just think of it like, hey, there is an answer, it just might be totally different, is that it's such a brilliant way to think
Phillip Pierorazio:Yeah, and I think this is a great time to plug diversity, equity inclusion, right? You, you learn so much more. And it expands your thinking, by working with people from different backgrounds, and different experiences and different thought processes. And our good friend, Scott Agner says it all the time, you know, when we, when we have some of our deeper conversations is, you know, you learn very little by talking to people who think exactly like you do.
Granville Lloyd, MD:And yet we reflexively love it. Like, we can't stop, you know, we have our first day of interviews tomorrow, day after tomorrow. And and every time somebody that does the stuff I do, and I will end up on some conversational chain, it will be like, it's such a nice talk with that woman, because she's, uh, you know, she's a mountain biker. And we had this shared thing, and you end up missing all the interesting things, it could come from somebody of a incredibly different background.
Phillip Pierorazio:Yeah, that's a great point and a great, a great thing, we see a great metaphor for what we see in medicine. So the third way to think differently is to system systems thinking, basically, recognizing everything is related. And because things are related, there are two important concepts that we see in medicine all the time. The first is synergy, right? One plus one doesn't always equal two, sometimes one plus one can equal three, you can get more out of two things, and you can individually. And the second is the concept of emergence, which is robust in the permaculture literature, but also in science. And that something completely different can arise from two different things. Classic example, they given the book, hydrogen and oxygen are two very different gases, you put them together, and you get water, which is something very different. And I think we, you know, we can see this all the time in our collaborative work and the way we interact with colleagues in and out of medicine. I think,
Granville Lloyd, MD:you know, it supports the idea of process as one of the most important things over goals in a way. Because if you're looking at the system, and trying to support the system, and trying to perfect the process, and trying to improve the way you do the things that you do not as much bigger outcomes. In terms of, you know, gosh, we want to do more of this or that, or we have this goal to make a million dollars or whatever. But we just want to do a better job in our process, we want to improve our system that just results in better things happening in every kind of way. And as you said, with synergy, like you just don't know where the next sprout is going to pop up. But if you're working hard to support your system, and how it functions. And if you're working hard to improve your process of how individually you go about your day, as a group, you go about the care of the people that you care for, you know, the luxury that we have in medicine, that good things will come one way or another. There's such good data. This is a little bit of a sidebar, I have such a peeve that ever grows about how everybody discusses every job there is in terms of how much money they make. And the social science is black and white, that that's absolutely the wrong metric. And in fact, it's it's counterproductive. In this way, if you focus on the system that you work with, if you focus on the process that you go through, if you focus on your enjoyment in the job, then the income follows that and there's actually real data that choosing higher satisfaction positions, and this is not limited to medicine. This is globally in the universe, I'll say results in more income, whereas trying to choose more income does just the opposite, because it's just not that much fun. I mean, there's lots of jobs out there that pay very well. But that may be miserable to do and to conflate those two, but I think that that is a certain expression of systems. Thank you I think that is a certain expression of failing to recognize that those choices have synergy. synergistic, or disintermediate consequences.
Phillip Pierorazio:Yeah, that's right. I mean, you're right. If you're chasing the carrot, you're always chasing the carrot, right. But if you recognize the kind of the relationships you build, or where you receive joy in your life, then that becomes a natural consequence of doing the things you're really good at, and you enjoy doing.
Granville Lloyd, MD:So true.
Phillip Pierorazio:So, system number seven, the fourth way to think differently is to think like nature. And one of the things naturally, as humans, we think our experience is every everybody else's experience, and every other beings experience. And, you know, we're all aware of our our natural senses, right, sight, smell, taste, touch, that hearing. But there's, there's theories out there of up to 50, or 60 senses that we may have, which can include our sense of radiation from the sun, or temperature sense, and it and it's basically making these other senses more specific. And I think what's just important to recognize is that dogs hear differently than us. Right? They're animals that see at night, and we cannot. And nature interacts with itself in very different ways. And once again, we're constrained by the ways we think we interact with nature or life.
Granville Lloyd, MD:It, I mean, I don't even need to go as far as dogs to just be shocked. diversity of viewpoints. And it's one of those real challenges about how the world exists, because we all really do see it differently. And the good news is, you really do get to pick your own reality. And the good or bad news is the fellow in the office next year, the woman in the office down the hall gets to pick his or her own reality, and it may be extremely different. Although I would say that most many people don't start with the choosing their nature, their environment, their reality, I think they kind of come with certain baked in emotional, cultural, you know, ways to look at things and there's some really interesting thought of bumped into on those topics, but but to the point of nature, per se, you know, the the Japanese have the phrase of forest bathing is this important thing to just get outside, take a walk, and there's data that walking is better for your thought process than sitting around and going outside and walking is even more better. It I think it's because I mean, I don't know why it is, I think it's just the way our biology works, but, but just remembering that there's so much more out there. It's not just only the things that are happening in your little office and the things that are happening and whatever. It's an important perspective.
Phillip Pierorazio:And one of the other great concepts I love from this chapter specifically, is the concept of energy cycling. And in permaculture, if you add energy into a system, it creates waste. And by using existing resources, you minimize waste. And the easiest analogy for this is if you put fertilizer into a kind of farming system, you're going to generate wastes that need to be cleared. Otherwise, you're going to end up destroying your, your agricultural process. And I think we can see this throughout our lives too. When we add in waste when we add in the or I'm sorry, when we add in additional energy that doesn't need to be there. We create waste in our lives and in our systems. So love to hear.
Granville Lloyd, MD:Jeez, I mean, I, you know, I just I couldn't agree more. Number one, I think humanity broadly. And I hate to get overly metaphysical, but I think humanity broadly is in a process of understanding itself as a global organism. There's impressively and happily good data that life on Earth is much better for humans than it has been we are actually doing a better job with health than we ever have before. We are actually doing a much better job with food and nutrition and disease and longevity and happiness than we ever have before amazingly hard to believe. But on average, still true and utterly different from the fact that there's so far to go and so much room for improvement. But the the average life expectancy on the planet is up the average number of people involved in violent conflict is way down, which is great. But as an organism as a 7 billion member organism that has blanketed this globe, we Got hear through all the somewhat ugly, competitive, hunger based motivators. And we are still willing to band up into groups of people and fight each other and do all these things. And we're not quite to the point. You know, where I think it's too many people reflexively think of these kinds of topics. It's hard to walk away from more, it's hard for people to walk away from taking that fertilizer and saying, let's just fertilize and if two inches helps, then let's put four down and to recognize that there is such a thing as too much.
Phillip Pierorazio:Now, I love you being metaphysical. And, and you can bring it into it, yes, on a global scale. But we also see this in our everyday lives, we see this in our medical practices, right? How much waste is there? Because when you spend energy uselessly, right, we end up you know, and in some ways, we can see this as some of our sources of burnout, right, we spin our wheels with electronic medical records with calling for pre approvals for this and that, and in some sense, that is wasted energy, it is additional energy put into the system for no good purpose, and it generates a lot of waste.
Granville Lloyd, MD:Unbelievable waste, I think Jayco is here to help with the waste topic for sure, certainly in our hospital system. And insurers, their job is not to make our lives easy. Their job is to make our lives hard to redistribute the cash that they've collected from insurance but yeah, it's it's it's tough, it's it's systems are naturally extremely inefficient. And it's hard to recognize sometimes that less can be more
Phillip Pierorazio:so on to the next one, which is cooperative thinking, which is very similar to systems thinking but a little bit different. And this is once again gets to concepts of synergy, where putting things together, you know, the sum sometimes can be greater than just the parts. And the great analogy from the book or the South American crops known as the three sisters, this is squash beans, and sweet corns, which respectively, our ground cover a nitrogen fixer, and then support for the other climbing bean plants. And if you grow all three, together, you get much more robust crops than if you just grew each one individually. And once again, just kind of speaks to working together, recognizing diversity and how someone's strengths, maybe another person's weaknesses, and putting those people together may help us achieve common goals.
Granville Lloyd, MD:Yeah, I mean, I think those of us that have not made it to this point that understanding some of those merits have just missed the boat. I mean, it's just urology and medical practice, surgical practice are just not individual sports, we'd all like think of them as being individual sports, but we were doing an X GP kidney on the robot not too long ago, and and I wandered a little distal and got into a segmental, posterior segmental artery and started squirting blood everywhere and had my bedside not been so good. She knew to Kate Hill, thank you, Kate, to pull back and squirt the blood off the scopes, I could see, you know, we might have had a real problem. But you know, point being, it is always a team effort. If you don't have people in the operating room that feel good saying, Hey, where's the needle? Cuz our counts are off? And didn't you take three and instead of two, you know, you've just missed the boat at this point. I love the nitrogen fixing analogy. I mean, that's just such a great forest ecosystem sort of thing. And that really is what I love about this book. I mean, it really does help us see what we do as an ecosystem that needs to be nourished. And all these different levels, we need to think about how we are collaborating, and how can we better empower others to work with us and to help us because if they're not helping you, if you're showing up to the operating room or show up to the clinic, and you know, pardon my French being an asshole to everybody, they're not going to help you. And and that's not going to go very well. And if you step back and say what's the best for the health of this ecosystem, it's to find ways to make the whole ecosystem be better.
Phillip Pierorazio:Right? And it's, and I think one of the important things you bring about is not only working with people who do different skills, well, but honoring them, right. We also have this tendency to say, oh, man, I hate doing that. I can't believe that person likes to do that. That we should. This is a hard one to learn, but you say I love them for doing the stuff that I don't want to do and they do it really well. Right? That prevents me from having to do that. And we're all better because you know, so and so is really good at clerical work or someone is really good organizer where I'm a big picture person. Someone's really good at That's and I'm really good at writing. I mean, there's lots of these kind of collaborative relationships that we see in medicine. And we need to honor those people, which is sometimes where we do fall short.
Granville Lloyd, MD:Absolutely, absolutely.
Phillip Pierorazio:So two more ways to think differently before we wrap up here. The second to last one is thinking for the future. And the only thing that is constant is change. Right? And,
Granville Lloyd, MD:and, well, I think the pandemic has given us a really unique opportunity to live and appreciate that. It's hard to do like for whatever set of reasons we as humans, and beat our lifespan via whatever, like, we're just not wired to think differently into the future, there's the old Native American phrase, everything you do should be predicated towards what seven generations from now are going to do, which is an insanely long amount of time. In today's cycle, it's it really just seems to have devolved to what's the next political cycle that we need to focus on. And that's about two years, maybe four, depending on how you look at it. And very few people are actually making choices based on even the next generation. I think he gets talked about a lot, but I don't think anybody really chooses things. And it's hard to do, it's hard to say, is, you know, this, in terms of my practice going to be best for the people that are training right now. And they're going to be joining the practice, you know, in five years. I think that the a lot of the selfish thought that goes on a lot of the changes in the way practices are structured, a lot of the way that medicine is done from a business side really has been walking by the point of where does the future go for Urology. I like to think, in the topic of burnout, and the topic, especially of the really unnatural stresses that we as physicians and surgeons face from the electronic health record from administration from ever increasing regulatory requirements, the pendulum is starting to swing back a little bit. And to recognize that that is driving people out of medicine, that that's impairing our ability to happily be in medicine. And I think we're starting to view the future a little bit more through that I have, you know, this is a metric, we could say, Let's limit the number of clicks required on a federal level, let's try to, you know, track and minimize the amount of EHR time spent. In terms of where the future of especially urology medicine, and the practices that we're all in are going. But it's it's it's hard for us, you know, it's it's, it seems to be tough to find the right levers to pull to try to enact those changes in to try to get the future to be better. But it's such an important way for us to think.
Phillip Pierorazio:Yeah, and, you know, there's another permaculture quote that says the best time to plant a tree was 20 years ago, or right now, right. And I think, where I've taken that to heart is as we make decisions, and as we see challenges in our clinical practices, or academic practices, whatever it may be, you want to make the decision that supports the now. But you also want to make the decision that supports the future. And there are different balances, some decisions need a very now heavy focus, and some need a very future heavy focus. But it's important to think about both of them. And it's okay to say, well, you know, we don't need to think about the future on this decision. This is a now decision, but at least have that thought, you know, that that there's more than just the moment and it's, how are we going to make things sustainable.
Granville Lloyd, MD:So many of us, I think, have the thought process that, you know, when we were joining our practices we were starting out early on, and whatever kind of way, you know, back in the day, the old guys didn't take call, they reaped all the rewards, they own the practice, they collected the ancillaries that we didn't mean you name it. And then they just kind of wrote off into the wind and dammit, that's what I'm gonna do to as a chief resident, I'm going to let all the junior residents do the work and I'm just gonna, you know, not show up on Mondays, you name it. And I think that moving forward from that into more of a, you know, recognizing that where the future generation is going to be do I really want these juniors to be behaving like that later? Do I really want my future partners to have understood that the lesson is, take everything when you're an old guy and walk away and screw everybody. It's a hard lesson but an important one.
Phillip Pierorazio:Yeah. And I tell you, the University of Pennsylvania I met I was opening a brand new hospital this week, actually. So people will be able to figure out when we recorded this podcast by If I that statement, but I don't think this is the first hospital of its kind, but it's the first to my knowledge that is built as a modular hospital. And I thought it was a really fascinating concept. And the idea here is, you know, it's a massive hospital, however many 1000 patients, but it can be converted, recognizing our needs in medicine from 50 years ago, were very different 10 years ago, different five years from now, they're going to be even more different. And this building is supposed to last 50 to 100 years. And so, if there's another pandemic, and we need more ICUs rooms can shift their focus, right, that mo ours can grow or be shrunk based on movable modular walls. So that technology is built into the building to evolve as medical practice evolves. And I think it's a truly fascinating concept. And I'm, I'm sure other health systems will start thinking of it, and I'm sure they already are, but I thought was a really interesting concept that was really came to light and, and, you know, kind of my recent training and some of the emails that came across my desk today.
Granville Lloyd, MD:It's amazing, that's amazing that you all have done that.
Phillip Pierorazio:Anything I'm
Granville Lloyd, MD:congratulations to the hospital system. I mean, you know, I say this sitting as I am in the literally 27th Most Expensive building on the planet, that being the Rocky Mountain Regional VA in Denver, which was one or smaller than the previous one, and may or may not have reflected a failure to think about the future. So clearly, I that that thought is not everywhere, yet.
Phillip Pierorazio:Yeah, so I will, I'll leave this section with just one other stat from the book that says over seven years, every single cell in our body is reformed. So we are constantly changing, we are constantly evolving. And so we should be thinking about our individual futures in ourselves as well. And then the last way to think differently, according to Looby MacNamara is from thinking to doing and recognizing that action is cyclical. There's a design phase of doing phase reflect, think research and come back to designing, doing reflecting and moving forward. And I think this is something that's widely applicable to medicine, the way we interact with patients, the way we interact with our, our kind of our systems in a larger sense, and that there's lots of ways to work through processes. So
Granville Lloyd, MD:it's, it's the ultimate solution to so many things is just just do something, you know, in the domain of research that I think has been really interesting on this is the learned helplessness domain, because learned helplessness, the principle that if you take, I think the original examples were done with mice, and they take a certain group of mice and they zap them a bunch of times, just arbitrarily, they just give them some uncomfortable electric shock. And they take a different group and zap them when they step on, you know, plate a but not on plate B and they quickly learn. The mice that just get zapped all the time, are taught the lesson that they can't do anything about it, and they become physiologically very damaged by this. And it's a very real human phenomenon also, and I spent a fair bit of time reading about this working on that chapter just ended up finding it extremely interesting. The ultimate take home from learn helplessness and its interface with you know, be it depression, be it what we're calling burnout these days, be it any facet of unhappiness, is that the the default reaction to something that is perceived as helplessness or a situation that one can't change is passivity, it's to stop, it's to not do anything, and often devolves into I'm just gonna sit here and just get zapped. That's it, and there's no end game. And the solution to that, such as it can be as to just do something you know, and we hear those phrases in so many different ways from you know, there's the military phrase of a bad decision today is better than a good decision tomorrow. As a as a mid grade men's league hockey player, the way that we kind of think about is when the puck comes to you like the first thing you should do, pretty much always unless you already have a plan in mind. The first thing you should do is take three steps. I mean, just take receive the puck and get moving and do something and I think that that's the sauce of so many things like you can understand everything on how to think differently numbers one through Doing something is the hardest part and can be really the crucial step.
Phillip Pierorazio:I think those are all great points and great analogies. And, you know, the Learn helplessness I think is really important, right? We're all taught when, when a threat comes, it's typically your fight or flight response. But the Learn helplessness is the step beyond that you've exhausted your fight or flight, there's nothing you do. And you can either be helpless, and sit there and do nothing, or you can find a way to react. And I love one of the analogies, once again from the book is that water can overcome obstacles in a variety of ways. You can wait for more water to come and you can, by volume burst over your obstacle, you can crash right through it, if you have enough, water has enough force, you can learn how to flow around it or under it, or the most patient way you can dissolve your obstruction over time, if your water. And so you know, once again, a great analogy from from nature to think about how we can overcome our obstacles. And even though dissolving something over the time is pretty passive, you're still doing something something is being done.
Granville Lloyd, MD:I think the key of the analogies of the metaphor is just as you said, it's just so important. I think if you say to yourself, This is what I'm doing, even if it's the the relatively long timeline of I'm gonna, you know, slowly sit here and win through attrition. Then you've embraced and active solution. That's beautiful analogy.
Phillip Pierorazio:Yeah. And I know you, you occasionally indulge in the peloton and how many of the peloton instructors say to you, alright, you've done the hardest part of the workout you showed up? Right? You're here. You made that decision to be there. And the next whether 20 minutes, 30 minutes an hour, whatever deranged thing you're going to do your body over the next few minutes. You've shown up and that that truly is the hardest part because once you've committed to it, you're actually doing
Granville Lloyd, MD:Yeah, couldn't agree more?
Phillip Pierorazio:Well, that brings us to the end of the book, and this was really fun kind of talking through this with you Grandville. I don't know if you have any kind of closing thoughts or, or, you know, summation of the book that you want to share.
Granville Lloyd, MD:I think that this book, in really large ways, is just an imperative to all of us to step back and recognize the bigger frame of what we're in and not spend too much time staring at the ball right in front of your nose to expand the way that we look at things. And it provides some really neat mechanical ways to say, you know, how can I just consider this problem differently recognize that we probably do live in a very high degree of relative abundance, that we live in a system that we should work to make better. Thinking about things in terms of the future is important and easy to skip. It's a great book. And I think it really just provides a lot of good ways for us to re conceive our metaphors, I think in a lot of ways, maybe it's just the find a different metaphor. In the introduction of the book, they talk about moving, for example, from saying, Hey, I'm working so hard trying to keep these seven different balls in the air, which has the built in thought, oh my gosh, if I drop one, and we lose, and they're all gone, and it's over, and it's terrible, and it's scary, and I'm working so hard to say, I've just got a lot of pots on the stove, and I just need to pay attention to keeping all of them at a good temperature. The metaphors that we use for how we think about what we do are very important.
Phillip Pierorazio:Yeah, I couldn't have said it better myself. You know, there's lots of ways to get to a similar solution. And expanding your mind and being open to other possibilities is a great way to get there if you're struggling. So great talking with you, as always, Granville. I hope the audience enjoyed this. They will certainly give us feedback and let us know and hopefully we'll plan on doing some more of these in the near future. Thank you everybody for listening.
Granville Lloyd, MD:Thanks so much fell such a pleasure.