Imaging is the great equalizer

Imaging is the great equalizer. When we look deep into ourselves from the vantage of this fundamental level, with exterior barriers and labels removed, we just might just see ourselves, other people, and our lives in a whole new light.

From Dr. Cullen Ruff’s Looking Within: Understanding Ourselves through Human Imaging, currently an Amazon Black Friday deal for a whopping $0.99 on Kindle.

When I see patients these days, it’s usually because I’m about to put a needle somewhere, but Ruff is old enough that he has decades of stories from an era where radiologists got (relatively speaking) a lot more patient facetime.

And yet, what a strange job we have, bypassing everything externally visible to study people’s insides.

To be home is to be known

If anyone was looking for a summary of a core problem in American society, from former Surgeon General Dr. Vivek H. Murthy’s lovely book, Together: The Healing Power of Human Connection in a Sometimes Lonely World:

While loneliness engenders despair and ever more isolation, togetherness raises optimism and creativity. When people feel they belong to one another, their lives are stronger, richer, and more joyful.

And yet, the values that dominate modern culture instead elevate the narrative of the rugged individualist and the pursuit of self-determination.

To be at home is to be known. It is to be loved for who you are. It is to share a sense of common ground, common interests, pursuits, and values with others who truly care about you.

In community after community, I met lonely people who felt homeless even though they had a roof over their heads.

And, when people are desperate for community, the ones most emotionally convenient or accepting may not be ones that provide meaningful uplift.

Communities that focus on us vs. them distinctions, scapegoating, and villainization aren’t about bringing people together. They’re about frustration and fear.

Tomorrow is a new day

Finish every day and be done with it. You have done what you could; some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day; you shall begin it well and serenely, and with too high a spirit to be cumbered with your old nonsense.

—Ralph Waldo Emerson, in an 1854 letter to his daughter.

It’s my birthday today, and this is something I think about when considering my relentlessly increasing age.

The best day for a new positive change is always today. But we’re very fallible human beings and I’ve been stress eating for about six months, so barring that, let’s not discount tomorrow either.

Bigger isn’t always better

From Company of One: Why Staying Small Is the Next Big Thing for Business by Paul Jarvis:

I like reading things that are not about medicine and seeing what lessons cross domains and apply. The premise of Jarvis’ book is that growth for growth’s sake is a terrible business model for many businesses and especially the many people that run them. It’s okay to be big, but any decision to grow the enterprise should be an active choice considering all factors and not just the default MO taken from the recent start-up culture of silicon valley.

My wife left her employed university position last year to start a solo private practice, and it’s been wonderful. It’s not hard to see how there are so many downsides to being part of large company or expanding your own business too much. On the former, no control. On the latter, so much time managing the machine that it’s easy to completely lose track of why you started the practice and what you liked about it.

But here are four passages that also resonated with me as a physician and educator:

Miles Kington, a British journalist, reportedly said that “knowledge is knowing that a tomato is a fruit. Wisdom is not putting it in a fruit salad.” We should never assume that having an abundance of knowledge is the same as having an abundance of wisdom.

This is the problem with equating performance on a knowledge assessment like a high-stakes multiple-choice examination with real-life competence. Knowledge is important, but it doesn’t mean you can perform in your field.

More isn’t better—better is better. There are advantages to putting in the time and effort to master a skill, but there’s also a great need for balance.

“More isn’t better” is a real truism for so many things in our world. We should question whenever something or someone simply wants more of us: more hours, more years of training, more free labor, more notches on the CV belt. It’s not necessarily that the “more” is inherently bad–it almost never is–but that doesn’t mean it’s worth it.

Sukhvinder Obhi, a neuroscientist at McMaster University, coined the term “power paradox” to describe what happens when we gain power through leadership: we subsequently lose some of the capabilities we needed to gain it in the first place—such as empathy, self-awareness, transparency, and gratitude.

The power paradox explains much of the bullying we see within strict hierarchies: how excrement rolls downhill from the top of a poorly-run organization all the way to the youngest least experienced students who are just doing their impressionable best to insulate themselves from the worst of indoctrination as they grow.

[Cal Newport, author of So Good They Can’t Ignore You] believes that we need to be craftspeople, focused on getting better and better at how we use our skills, in order to be valuable to our company and its customers. The craftsperson mind-set keeps you focused on what you can offer the world; the passion mind-set focuses instead on what the world can offer you.

There are some people who in life (or medical school), are confident they know exactly what they want. They are passionate about dermatology and orthopedic surgery. That’s great.

But I don’t think there’s anything wrong with the rest of the world, those who simply don’t know or seem to be missing that “passion.” I agree with Newport that passion is something you can grow through competence and the craftsmen mentality. There are no perfect jobs or fields. There are good and bad aspects to everything, and suggesting otherwise drives so much anxiety in the specialty and residency-selection process.

Success has more to do with you, your goals, and your perspective than it does with exactly what box you place yourself in.