How to ask for what you want

Women are less likely to ask for what they want in negotiations. 

As a group, we don’t advocate for ourselves as strongly as males due to the way we are socialized and our culture.

 Typically we are more concerned about what others think of us (although we have no actual control of what others think of us).

It’s not that women are poor negotiators.  In fact, we are outstanding negotiators in the right circumstances.   We negotiate very well when we are negotiating on behalf of others.

This is called, “The mama bear effect.”

No joke, this is a real thing.  It plays into our societal norms.  Negotiation researchers have discovered that women will indeed advocate as strongly as men and achieve the same outcomes as men when they are fighting for others.  We find our voice, our passion, our strength. 

This is such a useful illustration of how we are conditioned to care for others more than we care for ourselves. 

Other tips for negotiating for others women have used is asking others for advice.  You can use the tools say of mentioning to a superior at work, “I am interested in advocating for women physicians.  What would be your advice?”  People will search their own brains to come up with knowledge that may be helpful, they may think of assets, resources, allies, methods, that you would not have thought of, but perhaps equally as important is they begin to see themselves as your ally.  They can become more invested in your cause.  Women also are often typically strong in building relationships. 

Know when to be a humble advice seeker and a passionate mama bear, have evidence, build human connection and community.  Persistence.  Clarity.

When you argue with reality you lose 100% of the time.

-paraphrasing of a quote by Byron Katie

Some say all stress = resisting / not accepting what is.  Wishing it was different. In our minds.

What has happened has happened.

There is no changing what happened.

There is only changing how we perceive what has happened.

We can change the narrative.

We can change the story we choose to tell ourselves about the same circumstance.

Perhaps a slightly more useful story.

And that story, that can make all the difference.

We’re not in Kansas anymore

The Norman Rockwell era is over

The iconic photos of the old white male physician caring for patients in their homes or in the office no longer represent modern day medical practice.

These days we spend more time facing our computers than facing our patients.

How has it come to this?

By accident.

It wasn’t purposeful that society decided to take the noble profession of healing and turn physicians into the world’s most expensive, overburdened, and overworked data entry clerk..

The United States health care system was never purposefully planned to be the way it is (whether you are referring to the complexity of the current health insurance landscape or the impact of the Electronic Health Record on doctor-patient interactions).   Our current reality is just a result of previous decisions that hadn’t fully considered the long term impact. 

Now that we know the impact of the current health care system on physicians, one thing is certain, this is unsustainable.

Things have to change.

We have to say goodbye to the old romanticized Norman Rockwell image, but we also have to say goodbye to the doctor facing the computer screen more than they face the patient.  This is the end of an era. 

The sooner we realize that they way it is now was never planned, it was never intentional.  People didn’t realize the consequences of their actions as we implemented Electronic Health Records.

We didn’t realize that children all across the country would start pretending they are doctors by sitting behind laptops in their homes in their beds and on their sofas typing saying they are “charting”.  This is not what we want our children to think being a physician is.  This is not what we will allow medicine to become.  The care of the patient is not in the care of the computer.  The care of the patient is in caring for the patient.  Presence.  Listening.  Caring.  Examining.  Not charting.  No my precious little ones, charting from home is not what being a doctor was meant to be.

Rather than allowing the future of medicine to further develop randomly, we must purposefully lead with humanism, compassion, caring, healing, and include the health and well-being of those of us who will live much of our adult lives in the health care system. 

Done is better than perfect

I’ve heard this a million times.

Perfection is the enemy of good enough. 

Embrace mediocrity.

But we are doctors.  We spend our entire lives striving to be the best.

That is how you get to be a doctor. Your whole life, you are at or near the top of your class, achieving, receiving external rewards, striving for perfection.  At each step we are rewarded for this behavior.  Gold stars, awards, admissions, scholarships.  My medical school has a 2% admissions rate.  That means 98% of the well intentioned 10,000 students who believed they had a chance to get in will be rejected.

You can imagine the culture and mindset this has created for those of us in medicine.

We are immersed in a culture of perfection and self-sacrifice.

We have to pay close attention, we can’t miss anything, lives are at stake.

Yet, this perfection, is at what costs?

When is done better than perfect?

My coach talks a lot about B minus work.  Many doctors just can’t even fathom B minus work.  We are not B minus people.  We are A or A+.  Well, if B minus is just too far to go, how about A minus or B plus. 

You know, we have found an interesting thing in medical school.  Changing preclinical years from a traditional A, B, C graded system or a Honors, Near Honors, High Pass, Pass graded system to a Pass / Fail system actually decreases distress.

It’s true, when you stop grading students, even perfectionistic medical students, their well being improves.

What are the lessons from this for us that are further along in life?

How about we learn we have finally reached the pass / fail portion of our lives?  We can start to embrace the pass / fail mentality.  We don’t need to get honors anymore.  We don’t need the gold stars.  It is proven and well documented in academic medicine literature that changing to the mental construct of pass / fail improves well being. 

The test scores didn’t change, the pass cut off didn’t change, USMLE Step 1  didn’t go away.  Just the perception of the pressure to be perfect or that they were always being ranked or that they had to constantly strive for Honors went away.

Try and think outside the box a little for yourself.  Where are you striving for Honors?

Is it your notes? Do they have to be perfect?  I’m sure you have a good reason they have to be perfect.  Maybe you are the consultant and you want to send a thorough assessment and plan to the primary physician.  Maybe your patients are very sick.  Maybe you can’t stand those other physicians notes that are terrible. 

When my students are in distress, I always tell them P = MD.

You’ve likely heard the old joke asking what do they call the person ranked last in their medical school class?  Doctor.

Now, I don’t want you to be a bad doctor.  But I know you are not.  You are reading this blog. That means you care.  That means you are engaged.  That means you are curious.  Chances are your notes are pretty great.  Perhaps you could cut them down just a little bit?  Outline format for part of it?  Only you know yourself and where you have room to grow or room to cut back.

Where else are you criticizing yourself for not being perfect? Perhaps in your parenting?  What if however you are showing up as a mom is totally okay?  What if you don’t have to be the perfect Pinetrest mom?  I know I’m not.  I don’t even pretend to be. 

For me, it’s mostly in my work life where I obsess.  Long emails, long letters of recommendation, “perfecting” my papers before submitting.  The notes sitting way too long in my inbox.  But I am learning, growing, practicing, and seeing so much more every single day that “Done is better than perfect.”  I swear I need this as a tattoo.  A constant reminder. 

Because in life, there is no more Honors, Near Honors, High Pass, Pass.  That phase of life is so far behind us (thank goodness).  P = MD.  And uh, our passing or “good enough” is most way more than B minus work for most people.  It’s just our personality, we are over-achieving perfectionists, it’s in our nature.  We have been selected and rewarded for it our whole lives.  So now that you have arrived, as a full-fledged attending, after years and years of sacrificing yourself for others and 80 hour work weeks while others were on vacations, getting married, and having babies, I encourage you to continually remind yourself over and over and over, “Done is better than perfect.”   Then find a way to go enjoy this life you worked so hard to create.

What if?

You know how your brain is always coming up with disastrous stories?

If someone is late or missing? It often isn’t long before our brain starts having to create some explanation for things it doesn’t understand.  The lack of knowledge creates a burning desire to create a story to make sense of the world. 

You brain starts to come up with, “What if….”

If someone is late unexpectedly, your brain may offer up something like,

“What if they are no showing me on purpose?”

“What if they forgot about me?”

“What if they don’t like me?”

“What if this is never going to work out?”

 “What if they were in a car accident?”

“What if they died?”

Yeah, within a few minutes we might go from just a little bit of curiosity to worry to they are likely dead.

What if is usually followed by something our brain is offering up that is a worry or concern.

But what if…. we could use this framework and redirect it toward possibilities that were exciting or inspirational?

What if….

This is the moment it all starts to change?

This is the time things will finally start to get better?

I could find a way to create a life I love?

This is all here to teach me something?

I have way more choice in my life than I ever saw or realized?

I chose to live as if my life is short, because it is?

I could actually design my life on purpose rather than live by default?

I were responsible for my life? What would I create? What would I allow?

We could bring some joy back into medicine?

I didn’t have to spend nights and weekends on the computer?

I could focus on my patients and on healing rather than administrative tasks?

I could find a babysitter?

I could get a massage this weekend?

Every day is a step closer to living the life of my dreams?

I am the one who can change all this and all I have to do is decide it is going to change and then it will?

Ask yourself some “what if” questions.

See what your brain starts to come up with.  It’s so fun.

Asking better questions / the Socratic method

Questions open a pathway in your brain.  When you are asked a question, your brain seeks to answer it.  It’s like an itch that needs to be scratched.  When something is left undone, your brain wants to close the loop.

Personal development guru Tony Robbins has a saying that the quality of your life is determined by the quality of your questions.

However, asking better questions is certainly not a new concept.

In the 1700s Voltaire said, “Judge a man by his questions, rather than by his answers.”  (Well change that to gender neutral and say judge a person by his questions…”

In fact, over 2000 years ago, Socrates laid the foundation for western systems of logic and philosophy with the Socratic method of questioning.  

Socrates said ultimate wisdom comes from knowing oneself.

He then says the more a person knows, the greater his or her ability to reason and make choices that will bring true happiness.

I love that.  It focuses on choices.  It emphasizes that the person themselves has the knowledge and the power to make their own choices to bring happiness.  So many of us believe that the circumstances of our life (how many patients are on our schedules, where we work, what our spouses say, etc) determine our happiness.  Yet, that gives the locus of control and power to someone else.  Happiness is an inside job.  Per Socrates the more we know ourselves, the more we can make choices that will bring happiness.  

However, what is so interesting is that Socrates didn’t lecture about what he knew.  In fact, he claimed to be ignorant.  He simply asked questions. 

He asked questions that led his students to think for themselves, he led them to come to their own logical conclusions.

His questions were designed to enlighten.   These kinds of questions can stimulate critical thinking, curiosity, discovery, learning, and even challenge your own beliefs. 

Purposeful questions in the Socratic method can serve as a logical step-wise guide to help students come to their own insights.  The Socratic Inquisitor models joy in the quest for knowledge.  He or She is curious, seeks self-improvement, and realizes that we never stop learning from one another.

When done well this can allow people to a journey of discovery. 

When done poorly, the person can feel humiliated.  I’m guessing that having been in the culture of medicine, you likely have seen this done poorly.  This is what we refer to as “pimping”.  This is asking a question for the intent of humiliating the learner

Most of us in medicine are familiar with the Socratic method, whether we realize it or not.  Some of us are more familiar with how it evolved and was warped into “pimping,” which has evolved to maintain the hierarchy and cultivate humility.

For you, we’d like to focus on you formulating questions for yourself in the true Socratic method to stimulate learning. 

Yet often the questions we ask ourselves are more like pimping.  We ask ourselves things like,

“Why can’t I ever get my charts done?”

“Why am I always behind?”

“Why can’t I ever change?”

“Why can’t I ever lose weight?”

“Why is my partner such a pain?”

Our brains are designed to then answer these questions.  The disempowering questions and resulting answers are more along the lines of pimping.  Not helpful.  Designed to humiliate.

Think of what kind of questions you could repeatedly ask yourself that might be more helpful.  That Socrates might ask you (or us) if he were alive today and trying to create insights and learning through supporting someone on their journey of growth.

Perhaps things like

“What do I want to do more of?”

“What can I delegate today?”

“What can I say no to?”

“What can I control in this situation?”

“How can I make this a little better?”

“Are there any easy wins here?”

“How can I enjoy this process?”

“What is good about this moment?”

“What do I love about myself?”

“What are my strengths?”

“How can I make my life a little more fun?”

 “What am I excited about?”

“What can I learn from this?”

“What did I learn today?”

“Who have I helped today?”

“What is a possible solution to this problem?”

“What else could this mean?”

“How could I take better care of myself?”

“How could I choose to show myself some kindness in this situation?”

“Why has everything about my journey prepared me perfectly for this moment so that now I can take the next steps I want to take in my life?”

Practice asking yourself some useful questions.

That brain you have is pretty powerful and designed to answer questions.  You may just be surprised what great answers you start to discover.

What do you believe?

What do you believe?

Why do you believe that?

One of my favorite definitions of beliefs is just a thought that you have thought so many times you think it is true. 

Many beliefs we have serve us.

We believed we could become doctors.

We believed we could help people.

Some of our beliefs are really holding us back, and we call those limiting beliefs.  We can address those specifically in a later blog.  For now, we are just trying to raise your awareness that much of what you believe to be true, is just the way that you see or interpret things.

It’s so funny that once you learn to start separating the subjective experience of the world from the objective facts, you may begin to really see that much of how you see the world is “just a thought” or that your thought is a “belief” about the world. 

What is interesting is that we have the power to see these thoughts as beliefs, not necessarily the only way to see the world.  There may be other people who see this same thing differently.  You may even see this same thing differently on one day versus another depending on your mood, if you are tired, overwhelmed, behind, versus if you just had a great day.

That’s so much of what we do in coaching is I ask you what is going on in your life.  You tell me all about it.  I listen.   Then we take a step back together and separate out the facts versus the thoughts.  We look at what you think and what you believe.  We ask if those thoughts are serving you.  If so, you keep them.  If not, we help you look at another way to see it, a way that might be less painful or even more helpful.

Even just distancing yourself from the thought and see the thought as separate from you and that one day it might be optional, or you could replace that thought with some other way of looking at the world can be freeing.

Remember that your thoughts are a reflection of biology, they come from your brain.  Your brain is designed to be incredibly efficient.  Therefore, once you think a thought enough times, it becomes a default pathway, like a superhighway in your brain.  You don’t have to concentrate to think it.  The new beliefs, those they are more like bumpy dirt roads.  It’s not fast or easy or quick to get down the new road or to repeatedly connect new neural pathways.  But it’s so worth it. 

Beliefs are some of my favorite things.  They give me hope.  I believe that medicine doesn’t have to be the way it is now.  I believe that doctors are people too and deserve to be treated with compassion. 

I believe we are not cogs in a wheel or revenue generating machines.  I believe we are healers.  I believe healing is about connection.  I believe the care of the patient is in caring for the patient. 

I believe we were not trained to save lives so that we could spend most of our time staring at computer screens typing in clinic, in hospitals, and at home on nights and weekends. 

I believe somethings got to give.  I believe change is a foot. 

I believe we are uniquely positioned to demand change and create change.  I believe now is the time.  I believe I am part of the solution, that all of us are part of the solution. 

I believe we will leave medicine better than we found it.  I believe this is all just a phase. 

Just as people wore neon in the 1980s and hair bands were all the rage in the 1990s, this is just a phase that one day people will say, remember back in 2010 to 2020 when doctors sat and faced computer screens all day every day and got terribly burned out until things finally had to change? 

I think nearly everyone agrees.  All the major medical associations and all the lead medical journals are paying increasing attention to physician distress in the current health care system.  I don’t know what the answer will be, I don’t think anyone does.

It doesn’t matter exactly how it will happen, because we have to be committed to the result no matter what. 

Everything is just an experiment to find out the best way to make it happen. 

I believe this with all my heart.  I believe.  What do you believe?

Are you a problem solver?

You may be familiar with Carol Dweck and her book on Growth Mindset.

It is really helpful for parenting and even for us as adults.  Rather than thinking that we have a fixed mindset or fixed capacity to excel in certain areas, it focuses us to put our attention on when we can and are growing. 

Instead of telling my 6 year old that he is “a good reader”, I am telling him, “I love to see you trying so hard and sounding out such big words.”

I tell him all the time that I love to see that he is “solving problems”.

I do then actually say that we are problem solvers in this family.  As I don’t mind if his mindset is fixed on us all being problem solvers. 

I do this for myself most often when I feel overwhelmed.  I remind myself, I am learning to be a problem solver.  If I am a problem solver what would I do? How would a problem solver handle this?  What do I need to solve this problem?   Focusing on solutions. 

(I’m not gonna lie, very often the thought that occurs to me is that a babysitter is the solution).

You can do nearly anything you set your mind to, so try and think next time you are stuck about how you could be a problem solver and what possible solutions are available to you.

Because remember, we are here to teach you how to find solutions for yourself.  You can do this.  You can do hard things.

Subjective versus objective

There is a reason that medical notes start with a subjective section about what the patient says in their own words.  Then we purposefully separate out that story from what we label as objective facts. 

The objective facts are usually pretty standard.


General appearance

Head and neck





Sometimes additional exams if you are gyn or neuro.

Then labs.

Then special studies.

It’s all very objective.  Numbers.  Things we can measure.

If we repeat the measurement there may be slight variation, but for the most part these things are relatively objective, repeatable, and everyone agrees on them.

We can separate this out from the story that someone is telling about the facts, which we call the subjective part of the medical note.

This could include whatever the patient states, whether we have any way of knowing if it is indeed true or not true.

We can use this skill in our own lives.

Let’s say for instance a patient had a fasting glucose of 200.

Now, if this was my fasting glucose, I’d be pretty unhappy.  I’m guessing if it was your fasting glucose, you too would be pretty unhappy. 

However, there are many patients who would be either completely indifferent or actually thrilled that their fasting glucose was “only” 200.  I have many patients who would be happy with this number. 

So the objective data is what everyone can agree on.

If everyone in the whole world agrees on it, that’s a fact.

If not, then it likely has some subjective component to it and it’s just a thought, a narrative, a belief.

When  you can start to see SO much of the world around you as just a narrative, just a story someone is telling themselves, it really starts to shift the way you see things.  It’s like having magical secret X ray classes. 

I want you to take a look at your own life and write down all of your thoughts.  Just do a thought download, or journaling, about everything you can think of that is bothering you right now.

Then go through with a pen and circle the things that are indisuputable facts.  There are typically very few things.   Then only the circled items go in the objective section of the note.  Everything else is a story we are telling ourselves over and over again. 

Let’s look at your story.

Our enemies are our biggest teachers

The Art of Happiness by the Dali Lama is one of my favorite books. There is so much wisdom in there and it is easy to read for a non-Buddhist. One of the concepts I appreciated was that our enemies are our biggest teachers. We enjoy spending time with people we get along with easily, who we find fun, entertaining, and who bring us spontaneous joy. However, we don’t learn as much by spending time with people who agree with us and are easy to get along with. We don’t grow as much. It is those who we find challenge us, those we challenge us to dig deep to find compassion, patience, or tolerance help us to become better people. Think about your child throwing a tantrum, a “difficult” patient, a demanding boss, an MA who isn’t doing what you think she should, or even an inefficient Electronic Health Record. These situations challenge us, yet they challenge us to grown.So the next time you feel irritated, annoyed, frustrated, you can just tell yourself that there is a lot of learning and growing happening.Every time I am at work and I start to feel really annoyed, I just try to ask myself, “What is this here to teach me?” or “What can I learn from this?”. Even if the answer is just I can learn that I don’t like working in a hectic environment or I don’t like being in a situation where I am interrupted often, I find I learn more about myself, who I am right now, and what I want to create more or less of in my life every time I am irritated. See if you can find what you can learn from the situation or person next time you are irritated.