I recently had a conversation with a physician friend of mine. He made the comment, "Matt, I am an 'A level' doctor." My initial reaction was a mental chuckle as I attributed the statement to an inflated sense of hubris that is not uncommon among certain physicians.
"Of course you would classify yourself as an A doc, wouldn't we all?" I thought. As we talked, he elaborated on the thought as he rattled off a few examples of physicians that would be considered B level. After my initial judgmental thoughts, I realized that he was on to something. There was something that resonated in this idea of striving to be an "A" level physician. What he was getting at and giving a letter grade is the concept of excellence, the idea that we have been talking about here. He was striving to be the most excellent physician that he could be. As we continued our conversation, my next thought was, "Which list am I on?"
Hugh Hewitt, a radio commentator that I regularly listen to, frequently quotes Apple co-founder Steve Jobs saying, "A's hire A's. B's hire C's." By this he means, those who are extremely talented, the best, surround themselves by other highly talented people. Those who are mediocre tend to not. Whether it be fear of being exposed, not having the insight necessary to recognize suboptimal performance, talented people fleeing mediocrity, or some other reason, people who are classified as B performers are not often surrounded by A+ people.
Another semi-cliched quote that I like to remember from time-to-time is that we are the average of the 5 people that we spend the most time around. The principle of "Reversion to the mean" is just as applicable in human interactions as in statistics and finance. Think about it, when you are around lazy and complaining people, what do you tend to do? Is this when you produce your most effective work in the most optimistic mood? No. On the other hand, when you are surrounded by talented, dedicated, hard-working people what happens?
So, what does it mean to be an "A" physician? In the context of this forum, what does it mean to be a physician that lives and works with excellence? Practically speaking, what does this look like?
Excellent Physicians act like Excellent Physicians
The first characteristic of being an excellent physician, is to act excellently. That may sound a bit cliched. Of course, it seems obvious to state that something that is a thing acts consistent with that thing. But if we step back and analyze the statement an important thing that we notice is the intentionality that is bound up at the heart of the statement.
To be an excellent physician requires a particular intentionality. It is not a status that is natural. It is not a default posture. It is not a state that we can achieve and then comfortably remain. Being an excellent physician is a constant, daily struggle to be just a little bit better today that you were yesterday. It is the habit of making 1% improvements each and every day. James Clear, in his book Atomic Habits discusses the power of these small and incremental changes. A 1% change compounded daily over 1 year yields a massive improvement.
Intentionality requires insight to see oneself accurately. When I was a boy, my mother had a prayer that she repeated often, "Lord, help us to see ourselves for who we truly are, not as we want to see ourselves." The first and most important step to any process of improvement is an honest assessment of the baseline situation. We are always prone to inherent bias toward viewing our own performance favorably and viewing any failures as the fault of some external phenomena. But if we want to be better, it is vital that we honestly reflect no not just our strengths but also our areas of weakness.
Intentionality also requires insight and understanding of what the ideal example of a thing ought to look like. For us as physicians, this means developing in our minds a portrait of an ideal physician. Fortunately, history is a generous tutor. Medicine is a rich and iconic profession full of magnanimous titans but also maleficent miscreants. As we run our race, we have a cloud of witnesses (both in and out of medicine) to look to for their example and support. They build for us a physician archetype to follow after. As I think about this archetype, a few characteristics come to mind. These characteristics are:
Recognition that I am not full knowing and there is much more to learn/know
Fostering a habit of being a life-long learner.
Constant habit of skills practice
Seeking to incorporate new and up-to-date information
Recognizing points of weakness and working to improve
Seeking quality
Being humble
My friend shared with me a quote attributed to Maya Angelou. She said, "Do the best you can until you know better. Then when you know better, do better." This quote conveys the idea that we don't know everything. But we should be constantly learning. And once we learn something, we are now accountable for what we learn. It is now up to us to decide whether we are going to live with a sense of mediocrity or use the new knowledge as an opportunity to improve.
Excellent Physicians associate with Excellent Physicians
Proverbs 27:17 says that "As iron sharpens iron, so one person sharpens another." The community you surround yourself with says much about who you are and who you want to be. As we mentioned earlier, those around you are either going to build you up or tear you down. It is a rare situation where you can be an immovable force facing a stiff headwind. Don't get me wrong, we always have the opportunity and even responsibility to try to be a positive example for others, to be the sharpening stone for others. But, just like wind and water over time have an eroding effect on stone, doing this day after day with no backup or support will eventually have more of a negative effect on you than a positive effect on those around you.
Complacency is the killer of excellence. Complacency is a comfort with the status quo and a capitulation to mediocrity. Why? Because it is easy. Complacency rests on the laurels of hard work that has already been done, not recognizing that excellence is the constant, continuous pursuit of being better. The US Navy SEALs have a phrase, "The only easy day was yesterday." This motto reflects the sentiment that excellence is not easy. Excellence is the recognition that better is hard work. But it is rewarding work. So if you want to be an excellent physician, look around at who you associate with? Are you spending your time interacting with people who are comfortable and complacent? Or, are you fostering a community of highly skilled and functional professionals to encourage and foster a sense of growth?
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