Spaces like this group chat are vital in high-stakes careers. When things are hard, the best way to decompress is to laugh about it with someone who has experienced it with you.

This is a common theme in many walks of life: challenges forge stronger bonds. We all have to endure difficult seasons. Be it loss, disease, financial setbacks, or demanding situations in the workplace; hard times are inevitable.

The people who endure it with you understand it in a way no one else can.

They, too, were changed by the catalyst of your own inner journey. You may come away with your own insights and strengths, but the process that forged them was the same.

We need those people in our lives. I certainly did as a resident. Even now, I deeply value those friendships.

Subscribe now

Friendships Forged By Hard Times

In most residencies, you work side-by-side with your colleagues. They’re next to you in the call room to bounce ideas off of, or even to blow off steam. You might be the intern in the ICU overnight, but your senior resident isn’t far off.

It’s different in anesthesia. As residents, we saw each other for lectures. We worked in pairs during our first month. We did workshops and simulations as a team. But for the majority of our training, we spent our days in the OR solo.

The End of Block Parties

Our blocks, or clinical rotations, were a month long, and we marked each completion with a happy hour at a local bar or restaurant in Baltimore.

That month could subjectively expand or contract based on the rotation. Strange, how a month in the ICU taking 28-hour call every third day could feel like an eternity; while a rotation doing nerve blocks or labor epidurals could go by in the blink of an eye. Talk about relativity.

After a few drinks, shared stories, and laughter, it felt like the rotation had been boxed and sent down the river. It was another month down on the way to finishing residency. To leaving behind years of self-inflicted indentured servitude. Hallelujah.

It was also an important part of processing challenges. Ever notice how much better you feel when you get something off your chest?

Seeing the glimmer of understanding in someone else’s eyes validates what you’ve been through. It can help bring peace to a mind full of confusion or self-judgment.

COVID Took Away A Lot Of What Held Us Together

The end-of-block parties disappeared. Casual conversations faded. Shared spaces to decompress were reduced to Zoom calls.

We were scattered. Masked. Repurposed.

Over the course of a year, I forgot what my colleagues looked like without masks.

In a strange way, it clarified everything. It made it obvious who you could still reach, even when everything else felt distant.

When we finally returned to normal life, seeing my friends from work felt like a celebration. I had missed their presence in a way that felt like mourning.

What Hard Times Reveal

It doesn’t take a global catastrophe to need people in your corner.

Anyone can show up when life is going well. When the cases are smooth. When there’s something to celebrate.

But the people who sit with you in the uncertainty…
who answer your call after a brutal day…
who understand the weight of a decision you had to make without needing an explanation…

Those are your people.

Hard times don’t just change you.

They make it obvious who’s standing beside you.

Subscriptions are free, and come with weekly reflections from my side of the drapes. We’ll reflect on the various parts of the human experience that are brought to light by these intense, vulnerable, and life-changing moments. If you’ve experienced hardship or navigated the medical field, you’ll find something here that resonates.

Subscribe now

It will give you a sense of what drove my path toward achievement and installed an unconscious need for success into my identity.

A lot of people carry something similar. Different details, same weight. That weight shapes how they see the world, and how they show up in it.

It took me years to recognize it in myself.

The greatest turning point in my life came disguised as panic attacks. They started when I was 24. At the time, it felt like something was breaking.

Looking back, they were the beginning of something else. Let’s start about 10 years prior.

High School

The assistant principal pulled me out of Spanish class.

I thought I was in trouble. Mr W had called me out for wearing a sleeveless shirt.

“Look how tough I am.”

Out in the hallway, he lowered his voice.

“We approved you for reduced lunch, so now they’ll be forty cents.”

Relief wasn’t what I felt.

Yes, it helped my mom. But it also confirmed something I already knew—we were poor.

I walked the halls with my head down.

My dad had left that summer. We were close to losing the house. I was a socially awkward freshman trying to disappear in five-dollar jeans that felt like they had a spotlight on them.

Home was both comfort and stress. I loved my family. I hated our situation.

I’d finish my homework and leave as fast as I could, skateboarding until sundown.

Karate twice a week. Football after school.

At karate, every punch felt like survival.

At football, every hit reinforced a belief:

you’re less than.

The Inner World

I was always an overthinker.

The stress at home didn’t just sit in the background. It became the structure of my inner world.

Negative thoughts. Worry. Constant tension.

That was the baseline.

I didn’t talk much. When I did, it was quiet and measured. Filtered through the same internal scrutiny I assumed everyone else was using.

Over time, your thoughts stop feeling like thoughts.

They start feeling like reality.

They become the lens.

Everything passes through it.

A clear mind lets you see things as they are.

Stress, shame, and fear distort it.

Anger colors everything red.

Depression turns it grey.

When that’s all you’ve known, you don’t question the lens.

You assume the world actually looks that way.

The Pressure to Survive

Despite my circumstances, the most important thing I had was internal. It started as a survival mechanism, but slowly changed over time. I had the utmost faith that I could be anything I wanted to be. The belief that what’s inside me is greater than what’s around me.

I held onto that belief even when nothing in my environment supported it.

From watching my mom swipe a food stamps card at the grocery store… to building a life I once couldn’t even picture.

That pressure transformed my life.

The Pressure to Succeed

The environment improved. I was studying medicine and the future looked bright. My confidence grew and my sense of responsibility sharpened.

Something followed me from the past: the pressure that once helped me survive had found a new target.

Instead of worrying about survival, I worried about performance.

Instead of feeling “less than,” it became: am I good enough to be here?

In medicine, achievement is everything. You’re rewarded for it at every step.

The most impressive med students go to the highest-paid specialties. Forget the sacrifice, look how amazing you are. Make a name for yourself. Change the world.

At some point, it becomes easy to believe that your accomplishments are what make you who you are.

And if that’s true, then every mistake feels like a threat. Every setback feels personal. Every moment of uncertainty becomes something to escape.

From the outside, it looks like success.

From within, it feels like walking a tightrope. If you fall, your whole life falls with you.

That’s why the panic attacks started.

As a second-year med student, I rear-ended a truck while thinking about Step 1. The truck was fine, but my Kia Forte took quite a hit.

Something had to give.

Where’s the Freedom? Where’s the Peace?

How do you fail without feeling like you’re dying in the process?

How do you succeed without needing it to survive?

Freedom comes from releasing the need for success to define you.

When you do that, you can still pursue excellence without it feeling like life or death. You can handle setbacks without collapsing or taking it personally.

If you’re interested in the deeper side of this: how meaning, perception, and experience interact, I explore that more in The Unseen and The Meaningful

Why This Matters

A lot of high-achievers are still carrying the same weight. It just looks more polished now. We’ve normalized it in medicine, but it doesn’t necessarily mean that it’s healthy.

Stress from caring for patients, staying up all night, and making critical decisions is real and appropriate.

Stress from needing to prove yourself or from tying your worth to performance is much different.

Success changes your environment.

It doesn’t automatically change your mind.

I’ve been working people on changing their relationship with success, failure, and pressure—especially in medicine.

If that’s something you’re navigating, you can reach out here:

Reach out here

I just knew I didn’t want to miss this.

It was a Friday evening in the Trauma Resuscitation Unit at Shock Trauma in Baltimore: my first real exposure to medicine as a volunteer.

I was one of three pre-meds there to restock trauma bays, spike IV fluids, and see as much as possible. While we weren’t permitted to enter the operating room, it was amazing to see the fabled and world-famous Dr. Tom Scalea lead rounds and discuss the management of these patients.

A young man came in after a motor vehicle accident, badly concussed and with slowly mounting pressure in his cranial vault. A neurosurgery resident came to evaluate him, and I asked if I could listen in during his interview. By the end, he called his attending and said, “We’re gonna place a drain.” I had no idea what that meant, but I knew that I had to see it. This would be my first time witnessing a procedure.

A couple of medical students came to observe as the resident began setting up the trauma bay and his equipment. My heart was racing. I didn’t know what to do, and I wanted badly to be helpful in some way. One of the med students told me to get a mask and a hair cover while they finished prepping the patient. I darted around the unit, grabbing a mask and covering my hair.

Upon my return, the resident started to sterilize the patient’s lower back. The med student pointed to a spot behind the resident, “That’s probably a good place for you to stand.”

“Oh, and by the way, that’s a shoe cover on your head.”

I was wondering why it was so tight.

It was amazing to see the lumbar drain placement. I even got to hold a vial of lidocaine for the resident to draw up into his sterile syringe.

I hope this reaches someone who’s just getting started, or feeling afraid of showing up as less than a finished product. There’s never a perfect time. One day you’ll look back on your own humble beginnings with humor and gratitude. Keep going.

This photo is from my first year of medical school: back when I still had hair and thought I needed to have everything figured out.

And over time, you start watching yourself the same way.

Subscribe now

From the moment we enter medicine, we live under a microscope. We place ourselves beneath its lens as pre-medical students and remain there for years. If anything, the magnification increases over time.

Seven or more years of being evaluated, watched, and judged. There are real consequences for missteps.

Some people thrive under that kind of pressure.

Others don’t.

I recently met a third-year med student in the OR who was completely overwhelmed. He had 30 minutes to find his resident, log into the EMR, review his patient, and anticipate every question he might be asked about the surgery. He had never even scrubbed into a case before.

“I probably should have taken that beta blocker,” he said.

“I didn’t sleep at all last night.”

This is the microscope effect in real time.

At this stage of training, medical students are expected to have low skill and low familiarity. Both improve with time. What makes the experience uncomfortable isn’t lack of ability, it’s the internal pressure to be seen as something else.

Imposter Syndrome

Imposter syndrome tends to show up in high-performing people.

At its core is a split identity that creates constant internal tension:

• I’m not proficient, so I must be insufficient.

• I’m pretending to be good at something that still intimidates me.

• I feel uncomfortable in both identities.

That’s exhausting.

Striving to become something while feeling unsatisfied with what you currently are.

The most damaging part of imposter syndrome is the inner narrative that turns normal learning into a personal indictment.

There’s another option.

Be honest about where you are. Humble enough to name what you don’t yet know. If you’re asked a question and you don’t know the answer, “I don’t know” followed by a curious inquiry, is often the best response. You’re there to learn, not to perform.

If you’ve done a procedure zero times, say that. Let the discomfort rise and pass without turning it into a story of inadequacy. Everyone starts at zero.

Drop the resistance to being a work in progress.

Five Common Forms of Imposter Syndrome

• The perfectionist

• The superwoman/superman

• The natural genius

• The soloist

• The expert

Most of us experience at least one of these at some point in our careers. While imposter syndrome is common early on, it often resurfaces during transitions into new roles, new environments, and increased responsibility.

It Can Return at Any Level of Training

As a travel anesthesiologist, I’ve learned to expect uncertainty on the first day at a new job:

Meeting new people

Finding the ORs, pre-op, and PACU bays

Learning a new system and culture

Regardless of my experience, I’m humbled every time. My new coworkers don’t know my capabilities. Some may even carry baggage from prior negative experiences with other travelers.

It can feel like I’m under the microscope again, and to some extent, that’s true.

I’ve placed plenty of arterial lines at various institutions, yet I still feel nervous placing my first one at a new site.

Why?

Because I want it to go well. I want my colleagues to trust me. I want to be seen as competent and capable.

This, too, is imposter syndrome.

I’m walking the line between years of training and experience and the very real need for guidance as I find my bearings in a new hospital.

It’s far more comfortable a place than where I started as a first-year resident (low skill, low familiarity), but it’s still an opportunity to practice acceptance.

If my goal is to prove how much I know or avoid appearing unfamiliar, I miss opportunities for learning and connection.

By asking simple questions like, “What’s your policy on this?” or even asking for directions, I begin building trust.

Regardless of how far you are into your career, this mindset can persist.

It often becomes most apparent when you finally become the boss.

I’m supposed to be in charge, but sometimes I don’t know the best path forward. If I admit that, will people lose confidence in me?

In these moments, you have a choice. You can muscle through and act anyway, or you can name the uncertainty and invite input.

Counterintuitively, teams trust leaders more when they acknowledge limitations and make space for collective reasoning.

What if a learner asks me something I don’t know?

No one expects the attending to remember every word of the textbook.

Each question becomes an opportunity for shared learning. The words “I’m not sure” feel very different when spoken from curiosity rather than self-condemnation.

Confidence isn’t the absence of uncertainty.

It’s the ability to tolerate it without pretending.

New to Medical Mindsets? Start here:

In 1983, the death of Libby Zion, an 18-year-old college student, prompted investigation that revealed poor supervision, physician exhaustion, and impaired decision-making. The case ignited public outrage and forced medicine to confront a reality it had largely normalized.

In response, New York State imposed duty hour limits in 1989:

• An 80-hour workweek

• 10 hours of rest between shifts

• In-house call no more frequently than every third night

In 2003, these limits were adopted nationally after some modifications by the ACGME, becoming the standard structure of residency training in the United States.

An uncomfortable question lingers:

Why these limits?

What data were they based on?

They were not designed to optimize human performance, cognition, or decision making.

They were created in reaction to a patient’s death.

We’ve fooled ourselves into thinking that protecting resident well-being is at odds with patient safety.

The Heuristic Behind the 80-Hour Week

By many accounts, the 80-hour cap was not the product of physiological modeling or sleep science.

It appears to have merged from a heuristic compromise:

• A presumed 10-hour workday, 5 days a week (50 hours)

• Plus working every fourth night (~30 additional hours)

Total 80 hours per week

Later, Paul Friedman, co-chair of an ACGME duty hours working group, acknowledged that 80 hours was “a number with some general acceptance, without much scientific underpinning.”

In other words, the limits were not evidence-based.

They were politically survivable.

A Clarification

I want to be explicit:

I am not arguing that medicine is “too hard,” nor do I advocate for “softer” residents or disengagement.

I am questioning why endurance itself became the virtue, rather than a tool. A tool that can be:

• trained,

• used intentionally,

• time-limited,

• and protected by deliberate safeguards for both physician wellbeing and patient safety.

Why does residency training appear intent on pushing young physicians to the edge of imposed limits?

The answers are familiar:

• Dogma

• Bravado

• “I did it, so you should too”

• And, most honestly: staffing constraints

There are simply not enough residents to design better systems.

Other High-Stakes Professions Made Different Choices

Military: Intensity Is Time-Limited

Even in professions explicitly designed around danger and sacrifice, exposure to such conditions is finite.

During the war in Iraq and Afghanistan, average deployment lengths were around 7.7 months. Based on role and mission type, these could be extended to 9-15 months.

The DOD calls for at least a 1:3 deployment-to-dwell ratio (one year deployed followed by ~three years at home)

Even elite units rotate people out.

The assumption is not that humans adapt endlessly, but that cumulative strain eventually matters.

Aviation: Fatigue Is a Safety Threat

Commercial aviation takes an even firmer stance.

A few of the regulations enforced by the Federal Aviation Administration:

• Maximum 100 flight hours per month

• Maximum 1,000 flight hours per year

• Minimum 10 hours off before duty

• Required opportunity for 8 hours of uninterrupted sleep

• If these rules are violated, backup pilots are called or flights are cancelled.

Fatigue is treated as a systems failure, not a character flaw.

Aviation assumes what medicine resists:

Human have finite cognitive bandwidth, and fatigue cannot be trained away.

Medicine: Endurance as Identity

Medicine chose a different path, which stands in sharp contrast to other high-stakes professions.

The implicit assumptions persist:

• Fatigue is a rite of passage

• Endurance signals commitment

• Competence increases with exposure alone

• Opting out implies weakness or disengagement

There is value in acclimating young physicians to long hours and night shifts. Making tough decisions under strain is part of the job.

A Profession of Constant Demand

Medicine may not carry the immediate personal danger of combat or aviation, but it places a relentless demand on the nervous system:

• Continuous decision-making

• Sustained vigilance

• Responsibility for others’ outcomes

• Missed meals

• Long days stretching into nights

• Weekends and call

For many physicians, this structure persists for 15-20 years, often longer.

Some carry this cognitive load into their 70s, after paring back nights and call.

A sad state of affairs for physicians, by physicians.

Is it wrong to want better?

In a culture that celebrates achievement, self-sacrifice, and quiet endurance, that line is rarely discussed, and even more rarely respected.

There’s a delicate balance here, and it’s worth examining.

On one hand, many of us chose this profession knowing it would demand sacrifice. Not everyone can tolerate the hours, the uncertainty, and the regular exposure to suffering. This was never meant to be easy.

This is the challenge we signed up for.

On the other hand, we’re now facing a national burden of burnout, depression, and early exits from the profession. Something clearly isn’t working, and it’s happening at a scale that’s hard to ignore.

This tension isn’t unique to healthcare, nor is it new. Across history, individuals and societies have wrestled with the same question.

How much suffering is meaningful, and when does it become unnecessary?

I felt this question come into focus for me after a busy night shift on labor and delivery.

Nothing catastrophic happened. There was a steady pace of twelve epidurals and a few emergency C-sections. The patients did well.

But I remember standing there the following morning, feeling that familiar mix of fatigue and alertness that comes after years of training. Capable, competent, and quietly depleted. I wasn’t in crisis. I wasn’t overwhelmed. I was just tired in a way that felt cumulative.

I caught myself thinking, This is just what the job requires.

Not Can I handle this?

But Should this level of endurance be the default?

That question lingered for quite a long time.

We see this tension play out between opposing poles.

Between sacrifice and boundary-setting.

Between growth through endurance and agency through refusal.

Between rising to meet a challenge and recognizing when the cost becomes too high.

The Pursuit of Happiness

In recent years, one end of the spectrum has emphasized happiness, comfort, and optimization. Courses like Yale’s The Science of Well-Being highlight something important: fulfillment isn’t one-size-fits-all. What energizes one person may exhaust another.

Still, this line of thinking can drift toward a kind of utilitarian minimalism, reducing life to the pursuit of comfort and pleasure.

The fantasy looks something like this: maximum freedom, minimal obligation. The four-hour workweek. Twelve weeks of vacation. Doing only what you want, when you want, all day long.

For some, that vision feels liberating. For others, it feels hollow.

The Pursuit of Honor and Glory

At the opposite extreme lies a different ideal: endurance as a virtue.

Think of military heroes who rise to the call. Think of David Goggins. Think of the physician who spends twelve years in postgraduate training, barely home, relentlessly productive, leaving a mark on the world.

This path is fueled by honor, legacy, and self-transcendence.

It works for some people. It even creates conditions for clarity, purpose, and pride.

But taken too far, it leaves little room for rest, reflection, or choice. Suffering becomes proof of worth rather than a means to something more meaningful.

Life After COVID

COVID didn’t create these tensions, but it did expose them.

We’ve seen permanent shifts in how healthcare systems function and how clinicians think about their work. Remote options expanded. Specialty preferences changed. Emergency medicine residencies went unfilled, while the need for highly committed surgical specialties continued to grow. Conversations about mental health in healthcare workers moved into the open.

Burnout rates climbed. So did skepticism about endless sacrifice.

Whether this shift ultimately leads to healthier systems or simply different forms of disengagement remains to be seen. But one thing is clear: many of us are no longer willing to suffer automatically, without understanding why.

And maybe that’s not a failure of character.

Maybe it’s an invitation to ask a better question. Not How much can I endure? but What am I enduring this for?

Invitation

This essay continues a series on finding meaning and discernment, exploring the difference between automatic suffering and chosen endurance.

If you’re interested in cultivating more presence in your work and life, you’re welcome to subscribe.

Subscribe now

The Camel

The Lion

And the Child

These transformations fit very nicely into the medical profession.

The Camel

The camel bears weight. It carries burden without complaint.

College? Med school?

Other people’s expectations? Career advice? Debt?

Load it on.

The camel lowers its head and moves forward.

As a premed, I couldn’t imagine spending my twenties doing anything but becoming a physician. I saw it as an honorable sacrifice. When people said, “That’s a long road,” or “Doctors are married to their jobs,” I heard it as validation.

Six figures of debt?

That was future Joe’s problem.

The only thing that mattered was getting through each day and learning as much as I could. I was optimistic, maybe blindly so, but deeply committed.

That’s camel energy: endurance fueled by meaning that hasn’t yet been questioned.

The First Transformation

Medical school doesn’t immediately break the camel. It rewards it, in fact.

We recite the Hippocratic oath, put our heads down, study relentlessly, and accept the hierarchy. Morning rounds. Afternoon rounds. The occasional public humiliation. Still moving forward.

“Hey how’s it going?” becomes “How’s studying?”

“Any fun plans this weekend?” becomes “Are you on call?”

Friends got married, bought homes, and went on vacations.

I rode my bike to the hospital for another 28-hour shift.

Somewhere here, endurance stops fmeeling noble and starts feeling heavy.

The Lion

The lion says no.

I like to think of residency as rebellion in slow motion. You still follow the rules, but internally you begin noticing what doesn’t align with your values. You form opinions about how medicine should be practiced. You develop your own style, boundaries, and values.

The lion continues to suffer for a noble cause, but one of his own choosing.

In other words, the lion rejects meaningless suffering.

This phase is uncomfortable, but necessary. Many residents describe it as burnout, but more accurately, it’s identity formation under pressure.

The Child

The final transformation moves far beyond resignation and escape.

No longer bearing the weight with complete abandonment of the self.

No longer rebelling from a place of frustrated self-defense.

This transformation requires the bold act of creation.

The child says yes from authenticity.

Think late residency and early attending years. After years of sacrifice and resistance, something new becomes possible: responsibility without self-erasure.

Not every physician reaches this stage. Many stay camels forever. Some get stuck as angry, oppositional, and exhausted lions.

The child is rare because it requires integration.

This is the beginning of a series exploring the tension many of us feel, but might hesitate to name, especially in the workplace.

Rising to meet the challenge

versus

Putting ourselves first

Medicine demands endurance, no doubt about it.
But as we transform into more authentic versions of ourselves, we also require a more sophisticated form of discernment.

Invitation

If you’re interested in cultivating more presence in your work and life, you’re welcome to subscribe.

Subscribe now

If I can frame my interactions with patients as a skill rather than a component of who I am, then I can accept feedback without it feeling personal. Skills can be practiced, refined, and improved.

This is the freedom in separating identity from behavior.

The thing about feedback, however, is that in public, 95% of what we receive is praise. My assertion is that the constructive comments that we actually need are often left unsaid.

Criticism makes people feel uncomfortable. It risks awkwardness. But when it’s framed appropriately, both parties benefit.

The teacher walks away knowing they’ve nudged the learner in the right direction. The learner is reminded that their skills are a work in progress, and that growth requires knowing what you don’t yet know.

Knowing as a Barrier to Learning

Frank Herbert captured this idea beautifully in God Emperor of Dune:

“Duncan, have I not told you that when you think you know something, that is a most perfect barrier against learning?”

This is what makes bravado so dangerous.

Believing that you are already good at something makes you resistant to learning anything new. Confidence eventually hardens into certainty, and curiosity shuts down.

This is the essence of the Dunning-Kruger effect: a cognitive bias in which individuals with limited ability overestimate their competence, while those with greater expertise tend to underestimate theirs.

Early confidence feels reassuring, but if left unchecked, it can create a ceiling on growth.

There is also the impulse to show that you already know what the other is talking about. It bubbles up quickly. Rather than risking the appearance of not knowing, we interject “I know.”

Why is this necessary? What image are we trying to protect?

Creating Safe Conditions for Feedback

You’ve probably heard a variation of the phrase: praise in public, redirect in private.

No one enjoys being called out in front of their peers. Here are a few principles that make feedback more effective and safe.

First, check in. How are you feeling? Are you still frustrated from a stressful case? Are emotions from a poor outcome still present? If they are, it’s better to decompress before offering feedback.

Next, create privacy. Set aside time at the end of the day to sit down, one-on-one.

During training, most criticism is (appropriately) funneled into private conversations with preceptors or written evaluations read from the comfort of home. Public berating has thankfully become far less acceptable.

But What Happens Later?

What happens when we finish training?

Where do attendings receive constructive criticism?

Medicine prides itself on lifelong learning. We apply this easily to academics and technical skills. But what about the hundreds of interpersonal interactions that we have every day?

When was the last time someone commented on how you explain risks and benefits? First year of residency?

When was the last time your active listening or empathy was evaluated? Probably in medical school.

These interactions shape most of our workday. If we don’t deliberately improve them, a subtle disconnect can begin to grow. We practice our technical skills and clinical judgment, but we slowly lose connection with patients, colleagues, and ourselves.

The Silence That Follows Training

There’s something unsettling about the idea that we can go decades in this profession without meaningful feedback.

Once training ends, the evaluations stop. The checklists disappear. No one sits us down to talk about how we speak to patients, how we carry stress, or how we show up for the people around us.

These things still matter. But giving feedback across hierarchy feels dangerous.

The Feedback That Never Left

I don’t pretend to have the authority to recommend systemic changes or sweeping solutions. That isn’t the point of this Substack.

Even in the absence of external feedback, something remains.

The inner judge you used during training. The one that helped you decide which qualities to adopt from certain teachers and which you wanted to avoid at all costs. That inner judge is still there.

It notices when an interaction felt rushed. When we spoke instead of listened. When we could have said something differently.

Most of us know, almost immediately, when we’ve missed the mark.

The problem isn’t that feedback disappears as we move through our careers. It’s that we stop listening to the internal signals that once guided us. We learn to override discomfort. We rationalize.

Bedside manner isn’t fixed. It’s a practice. It can be refined as long as we remain willing to notice ourselves.

Perhaps the most reliable feedback arrives at the end of the day, when we replay an interaction and ask ourselves whether we would do it the same way again.

Please, go home.

A final and fun reminder: never ask a trainee whether they would like to go home.

You’ve felt the awkward tension that follows this question. It feels like a trap, and it’s uncomfortable for both parties.

When you ask it, you’ve cornered them into choosing between appearing eager or appearing disengaged. We know that’s not the intent, but the fear is still there.

This is a public service announcement: please stop doing this.

If you’ve decided that they’ve had enough learning for one day, just dismiss them.

“Thanks for your help. You should get out of here. Go enjoy the rest of your evening.”

They’ll leave happily, you’ll avoid the awkwardness, everyone wins.

Invitation

If you’re interested in cultivating more presence in your work and life, you’re welcome to subscribe.

Subscribe now