12:running your own race, with Emily Rose, MD   

Working with the myth of perfection, learning to run your own race, and finding joy as you keep tuning your instrument, with Emily Rose, MD  

Many non-crucial details of emergency medical cases, like when a case happened or the age or gender of the patient, have been changed randomly to preserve patient confidentiality. As always with the Emergency Mind Podcast, the goal is not to provide medical advice or commentary on medical care, but to explore best practices and ways that we can all improve how we think during an emergency and apply knowledge under pressure. Additionally, the views expressed on the podcast are personal views and do not represent the views of the employers or organizations at which we work.

Introduction and Early Training


05:00—I really like Emily’s discussion about being cool under pressure here because it elegantly dissects out some of the different parts that together make up sangfroid. Not panicking is different than successfully taking calm action – both are needed but they are actually separate skills.  


08:50—We talk a bit about this in Episode 04 (Sangfroid) but it’s worth repeating here: performance under pressure is a skill that you choose to train, not something that you’re either born with or not. Stories like Emily’s here are really important because they show the variety of different paths that people can take when it comes to becoming a student of thinking under pressure. No one says you have to be perfect in the beginning.


11:00—The book Emily references here is The Happiness Advantage: How a Positive Brain Fuels Success in Work and Life, by Shawn Achor. I haven’t read it, but from what Emily describes, it sounds excellent and strongly related to the Stoic concept of acting where we have control.


Neuroplasticity, Growth, and The Myth of Perfection


12:00—”The concept of neuroplasticity – I’m not one set of gifts or abilities, but I can really grow in any area, should I just commit the time and energy to.” Absolutely love this idea Emily digs into. All of us can get better at these skills, but it starts with a commitment to do so.


12:50—What Emily talks about here, changing the relationship with what it means to struggle, is deeply important. We will return to it later in the episode a few times as we discuss the myth of perfection and the importance of concentrating your energy where you are.


13:20—Emily’s structure here of “we fall short of our ideal self everyday,” is certainly one way to look at it, but I prefer the Japanese concept of “Wabi Sabi,” which describes the idea that nothing is perfect, nothing is permanent, nothing is complete. Instead of focusing on where we fall short, this focuses on being fully where we are today and allows for continued growth and change outside the idea of an “ideal” self. For more on wabi sabi, I’d recommend this book, Wabi-Sabi for Artists, Designers, Poets & Philosophers, by Leonard Koren.


Running your own race

15:45—There’s a tension here between comparison being the “thief of joy” and the desire to consistently improve yourself and your art. Comparison is useful when we’re working openly on ourselves and our skills – getting into the “ugly zone” as Dave Alred describes it in The Pressure Principle—it is less useful when we use it to beat ourselves up for not being the same as someone else. Part of the answer I think is something we get into with Dan McCollum in Episode 13 about developing a culture of continuing improvement were we focus on making more explicit that all of us are constantly working on ourselves.


17:20—I love the idea of the use of repeatedly revisiting our goals to guide our growth in the way that Emily describes here. Even though we are all running our own race, there’s so much utility in working with others to help us run better and faster and make sure we stay running in the right direction.


21:18—This part, starting with “my training has been a series of awakenings…” is just excellent. This is part of what training should be – whether in emergency medicine or anything else-- not just a growth of skills but also a deeper dive into a stronger and more expansive version of yourself.


25:09—The exploration here of the difference between algorithmic and more “intuitive” or “explorative” thinking is a continuing theme of experimentation at The Emergency Mind. See for example, Episode 03 talking about individual skill training then flexible thinking, Episode 07 talking about improvisation in jazz, and Episode 14 talking about algorithms when facing an explosive.


26:25—I do not recommend doing this. In fact, please don’t do this.


Refining your Trajectory


29:45—None of us are ever finished products. Emily’s discussion about having the humility to continue to ask and explore when we don’t totally know something here is excellent.


31:10—In her excellent book The Upside of Stress, Kelly McGonical talks about a similar idea when she describes what a “mindset” is – to her, a mindset is a new belief about an idea that enables us to take a series of small actions which, combined over time, add up to a massively different result. It might look like the result comes directly from the new belief, but really it’s a combination of multiple small actions we can take once we believe something different. As Emily puts it – it is the daily habits and choices that change us and make us who we are. Aristotle (probably) said it this way: “excellence is not an act but a habit.”


33:18—My karate teacher growing up, Master Steve Selby, said it this way: “Practice does not make perfect. Perfect practice makes perfect.” If we are pointed in a suboptimal direction, we’re unlikely to succeed regardless of the effort we put in. The excellent book Peak, by Anders Ericsson, talks a lot about this.


34:30—Thinking in Bets, by poker champion Anne Duke, is an excellent exploration of decision making under uncertainty.


37:41—We’re not trying to find a solution to who we are and what we do, since a solution implies an end product that is finished and no longer growing. Instead, we’re consistently working on ourselves and refining our trajectory.