One of the smartest decisions that I made in medical school to do it “with” a buddy. To understand the significance of this, you need to understand that a big part of the application process for medical school includes the idea that we know stuff. It isn’t natural to admit that we don’t. I can still remember when I worked up the nerve to be vulnerable and ask my friend, Lynn, if we could make an agreement that if we didn’t understand something, we could be honest ask each other for help.

The great thing about getting older is finding the wisdom to reexamine my perspective. Fred Kofman, in his book Conscious Businesssays that we all think that our perception of reality is absolute truth. Our perception is actually a combination of facts + interpretation. The problem is that we assume that it is all fact. For years, I delegated mindfulness meditation to the “woo-woo” category of New Age mysticism.

I can still see with tremendous clarity, my family gathered around our black and white television as Neil Armstrong took mankind’s first step onto the moon. It was July 20, 1969 and I was only 12 years old. How do memories stick for 50 years? I think a more interesting question is how did we get there in the first place? I still remember that as well.

For years, I’ve heard people talk about “unconditional love” and it sounded so right. I’ve been rethinking the idea lately. Unconditional love seems so passive. Here’s how it works: You do something that offends me or hurts me. I sit and wait for you to come and ask for forgiveness. When you finally come to me, as the gracious king on the throne I grant you forgiveness. If I’m in an especially good mood, I won’t make you kiss the ring. It’s love unconditional, but it seems strangely centered on me.

As a physician, I have a unique perspective on the world because I spend time with people backstage. Not the fancy, polished versions that the rest of you see. I get to see people when their masks are off and they are feeling vulnerable.

Sometimes life can feel overwhelming because our world is changing at an ever increasing pace. Sometimes I get stuck. To make great choices, we need great options but sometimes our brain blinds us and we experience tunnel vision under pressure. When you understand how your brain works, there are some practical strategies you can use to break through barriers.

I thought diversity was all about making up for past oppression. I thought it was about giving underprivileged people a break so they could catch up. I thought it was about leveling the playing field. While that may be part of it, I now see diversity in a new light that has changed my life… for the better. This is huge.

When I’m delivering keynote presentations, it’s fun to watch the faces of the doubters. I’ll say something about their “inner voice” and they shrug their shoulders. Then I say, "For those of you who are shrugging your shoulders and saying 'I don’t have an internal voice', that is the voice I’m talking about." It’s always there. It is always talking. It is a commentary that’s always running. In fact, there are several voices. If you still don’t believe, think about this morning when your alarm went off. One voice said, “It’s time to get up, we’ve got a lot to do today!”

As a kid, I grew up in Tacoma. It was a cross between “The Sandlot” and “Our Gang”. Mike Armstrong’s Dad, named us “The Lenore Street Packrats” and it stuck. We were intense about football. In fact, we were so intense that we had The Front Yard Football League (FYFL). We typed up the rules (with a typewriter), laminated them (with Saran Wrap), and posted them on the telephone poles (that carried the wires for the telephones that hung on the wall).

Disengagement is breaking the bank. Studies show we are losing up to $605 billion... every year! That's a lot of money. But working with organizations around the country, I’ve found that this is not what’s keeping leaders up at night. Muhammad Ali was right. It’s not the mountains, it’s the pebble in your shoe

Leadership under pressure can be draining. If you’re feeling tired and burned out, it’s not all “in your head.” You can't fix it by just making the decision that you’re going to have a better attitude (although that's an important part of it). You have to take care of your body as well. I have to admit, I haven’t always done a great job at that, and lately, I’ve discovered what I’ve been missing.

Unfortunately, over the course of my career I have seen way too many of my colleagues sacrifice themselves on the alter of “the patient must come first.” If we want patients to receive the very best care, they can’t come first. It is time for us to rethink this and I believe that there are some principles from the international disaster response world that you will find helpful.

Even though I learned years ago about the benefits of exercise, throughout my life I’ve been inconsistent at best. In fact, my all time “days-in-a-row” record was five days — when I was a gymnast in high school. Bam! Today, at 60 years old, I obliterated that record when I hit 365 days in a row. This post today is not about the benefits of exercise (although there are many); it’s about how to develop habits, so you can change your life.

For the past several months I've been involved in a project with three of the top thought leaders in the area of burnout, engagement, and transformation in the healthcare environment. While we all have quite different approaches to the topic, we all agree on one core fact: this work, if it is to have a lasting and meaningful impact, has to start deep within the individual. The process happens from the inside-out: the individual transforms the team and teams transform the organization. Policies and programs alone will never fix burnout.

Back in the day, Rome had four different schools for gladiators. They had the best medical care, the best training, and they even ate fortified barley. It was expensive to have a gladiator so it made sense to train them to be tougher so they would last longer. The problem is, their burnout rate was about the same as ours: 50% because they fought to the death. Healthcare professionals (like docs, nurses, administrators, physical therapists, and pharmacists) can only become so “resilient”. We cannot “resilience” our way out of healthcare burnout. There aren’t enough gladiators.

It’s next to impossible to implement lasting, positive change in an organization if the culture doesn’t provide fertile ground for growth. So how do you go about building a healthy culture? Captain Bligh of the stricken HMS Bounty, tried a top down strategy when he declared: "The beatings will continue until morale improves." While leaders can point the ship in the right direction, they can’t change the culture by themselves. It takes powerful teams to make a positive culture.

Think back to when you were a kid and an adult asked you what you wanted to do when you grew up. Once you figured out the answer, do you remember how you felt when you stood tall and said, "When I grow up, I want to be a paleontologist (or whatever)!" I suspect that even now you can recall that sense of passion in the center of your chest. You wanted to make a difference with your life.

My third grade teacher, Miss Henderson, was wrong about failure. Most of us go to great lengths to avoid failure…at all costs. It’s no wonder. They drill it into us that failure is bad. But, if we dig a bit deeper, we may discover our fear of failure tangled with our fear of being rejected. We make it about us and not about the people that we are trying to serve. I’ve written before about the power of Target Fixation (you go where you look). Once we take our eyes off of the people we serve and put them on ourselves, we can become more concerned about risk than we are about results.

Surveys from a variety of the organizations I’ve worked with confirm that our mindset is in a constant state of flux. Mindset is not a one-and-done sort of a decision. The decision to be a powerful-giver has to be made over and over again throughout the day. If all is well, it is easier to feel empowered and choose to give. When your boss is a knucklehead or you have to pick up the slack for a slacking co-worker, the choice can be quite different.

Healthcare burnout is threatening the foundation of medicine. There is a lot of talk about the outward symptoms of burnout: emotional exhaustion, feeling detached, and feeling ineffective. However, if we hope to make a significant impact, we are going to have to look deeper... several layers deeper. Of course, there are obnoxious workplace stressors that contribute to the risk of burnout. These include the electronic medical record, regulatory requirements, and insurance mandates