Sometimes you read a book and get a flash of insight – that “ah ha!” moment – about yourself and the ways you interact with others. That happened to me when reading “Range: Why Generalists Triumph in a Specialized World.” It helped me to understand and justify my interest in (this won’t surprise you) EVERYTHING related to geriatrics or palliative care. Also hat tip to Matthew Growdon for recommending the book.
Today we talk with Bob Arnold, who has a long list of recommendations for books that have the potential to generate an “ah ha!” moment. The podcast is ostensibly focused on becoming a better mentor, but as you’ll hear, we discuss techniques that can help you cope with anxiety, stress, your spouse…the list goes on. In reality, insights from these books can help you be a better teacher, a more curious person, as well as a better mentor or mentee.
Bob urges you to buy these books from your local bookstore. To that end, we’re not including links with the titles below. Please shop locally.
As a bonus, Lauren Hunt, frequent guest on GeriPal, heard we recorded this podcast and wanted to add a couple books to Bob’s list (she saw Bob give a talk about these books at the NPCRC Foley retreat). Her list will strongly resonate with women in academics. See below for Lauren’s two additions to Bob’s list, with her personal commentary.
- Lori Gottlieb, Maybe You Should Talk to Somebody: A Therapist, Her Therapist, and Our Lives Revealed
- Ethan Kross, Chatter: The Voice Inside Our Head, Why It Matters, and How to Harness It
- Eric Barker, Plays Well With Others: The Surprising Science Behind Why Everything You Know About Relationships Is (Mostly) Wrong
- Stephanie Foo, What My Bones Know: A Memoir of Healing From Complex Trauma
- Jennifer L. Eberhardt, Biased: Uncovering the Hidden Prejudice That Shapes What We See, Think, and Do
- Claude M. Steele, Whistling Vivaldi: How Stereotypes Affect Us and What We Can Do
- Marcus Buckingham, Nine Lies About Work: A Freethinking Leader’s Guide to the Real World
- Marshall Goldsmith, What Got You Here Won’t Get You There
- Adam Grant, Give and Take: Why Helping Others Drives Our Success
- David Epstein, Range: How Generalists Triumph in a Specialized World
- Douglas Stone, Thanks for the Feedback: The Science and Art of Receiving Feedback Well
- Douglas Stone, Difficult Conversations: How to Discuss What Matters Most
- Kerry Patterson, Crucial Conversations: Tools for Talking When Stakes Are High
- Kerry Patterson, Crucial Accountability: Tools for Resolving Violated Expectations, Broken Commitments, and Bad Behavior
- Anne Lamott, Bird by Bird: Some Instructions on Writing and Life
- James Clear, Tiny Changes, Remarkable Results, Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones
- Michael Bungay Stanier, The Coaching Habit: Say Less, Ask More & Change the Way You Lead Forever
- Peter Bergman, You Can Change Other People: The Four Steps to Help Your Colleagues, Employees–Even Family–Up Their Game
- Doug Lemov, The Coach’s Guide to Teaching
- Doug Lemov, Teach Like a Champion 2.0: 62 Techniques That Put Students on the Path to College
- Doug Lemov, Practice Perfect: 42 Rules for Getting Better at Getting Better
The Secret Thoughts of Successful Women: Why Capable People Suffer from the Impostor Syndrome and How to Thrive in Spite of It by Valerie Young
I was inspired to read this book after reading a post on the 80,000 hours blog. I had heard of course heard of imposter syndrome in the past but I didn’t make the connection to myself until I read this article and saw my thoughts printed on the page. You would think that after several years of a number of career successes, the imposter syndrome would have abated for me, but rather I found it getting worse! I thought that I should know more of what I was doing by this point in my career, but instead I often felt like I had no idea what I was doing!
So I came across this book and found it very helpful. Young defines people who have imposter syndrome as those who have a “persistent belief in their lack of intelligence, skills, or competence. They are convinced that other people’s praise and recognition of their accomplishments is undeserved, chalking up their achievements to chance, charm, connections, and external factors. Unable to internalize or feel deserving of their success, they continually doubt their ability to repeat past successes.”
I certainly related to the point that instead of successes alleviating feelings of fraudulence, the opposite happens, because it increases pressures to uphold one’s reputation. The pressures can be intense, leaving one wondering if it’s all worth it, and prompting fantasies of leaving the charade behind.
One thing I really liked about this book is that it places the imposter syndrome into the context of a patriarchal, misogynistic, racist society and organizations that create cultures that cultivate self-doubt (ahem academia). Imposter syndrome is a rationale response to a crazy world. We exist in a society and culture that actually judges women to be less competent at work (the studies she details are SUPER disturbing). It is not surprising we would internalize these norms. Also that being underrepresented in a field creates pressures not only to represent just oneself, but an entire gender. She focuses on women, but these concepts obviously apply to people of color and other disadvantaged social groups. And of course men can have imposter syndrome too.
Another part I liked about the book is digging into the notion that one’s success is due to luck, or being in the right place at the right time. She dispels these notions by pointing out that, first of all, luck is always present, even for people who are enormously talented and second, being the right place at the right time, having the right connections, and having a winning personality can sometimes actually be the result of skills or abilities, often the result of hard-work, hustling, and efforts to develop one’s socioemotional capacity.
This is a self-help book, so throughout she offers some useful rules and self-talk for responding to imposter syndrome thoughts. She details different ways to respond to thoughts based on your competence type. For example, if you are a perfectionist, she recommends reframing to a “good enough” quality standard—a mantra I adopted from colleague during the pandemic and has been incredibly helpful for me over the past few years. For the rugged individualist who equate true competence equals solo, unaided achievement, the reframe is “competence means knowing how to identify the resources needed to get the job done.”
Another really important idea she raises is that women often have difficult choices to make about their career and its impact on other parts of their families and their other social networks that aren’t as pronounced for men in our society. Sometimes it is difficult to disentangle these questions from feelings of imposter syndrome. For example, is reluctance to take on more responsibility at work or relocate because you feel inadequate or is it because of genuine concern about the impact on your family? Moreover, women (generalizing here) tend to place lower value on traditional measures of work success (e.g. money, power, influence) and greater value on connection and meaning. It can require a lot of soul searching to figure out whether one is avoiding career “success” out of fear or that certain paths are just truly not aligned with our values.
Finally, towards the end of the book, she introduces the idea of “faking it till you make it” and having chutzpah—i.e going for it. Of course, she’s not advocating for a George Santos approach (no lying) but just having a little bit more of a mindset that you’ll figure it out once you’re on the job.
I’d definitely recommend this book if you’ve ever struggled with similar feelings or mentor people who might. She’s got a breezy and relatable writing style that’s easy to read, lots of great real-world stories, and piquant quotes.
The No Club: Putting a Stop to Women’s Dead-End Work by Linda Babcock, Brenda Peyser, Lise Vesterlund, and Laurie Weingart
Summary of the book’s premise:
- Work activities fall on a spectrum from promotable and non-promotable (NPT).
- Promotable activities are those that advance one’s career. They use the word “advance” quite broadly to encompass various outcomes, like earning a promotion, getting plum assignments, increasing compensation, and enhancing marketability for other jobs. Promotable tasks are visible to others and increase the organization’s currency. Some tasks may be indirectly promotable—they help you develop skills that have the potential to enhance your future success or access to future promotable work.
- NPT’s are important to your organization but will not help to advance your career. These tasks have low visibility (think committees and other service).
- Too many NPT’s can lead to work/work imbalance where promotable tasks get pushed to the side and advancement slows, or work-life imbalance, where advancement continues but at the expense of time in one’s personal life (or both).
- Although not exclusively a problem for women, women are more likely to take on NPT’s at work. This is because they are both asked more often and are more likely to say yes when asked.
- They propose both bottom-up (women saying no to more things) and top-down solutions (organizations making efforts to divide up NPT’s more fairly and ensuring everyone is pitching in).
Before I read this book, I didn’t fully grasp the idea that an activity would be helpful to the organization but not to my own career. Sometimes requests for participation in these activities come with a veneer or prestige and lots of feel-good gratitude. I personally feel a lot of guilt and worry about disappointing people when I say no to things. Even declining to review an article for a journal is accompanied by some stomach knots (it’s so hard to find reviewers!) I also place a lot of value in collaboration and working in teams, and the idea of working in a culture where everyone is only looking out for themselves is not appealing to me. But I’m also worried at the level of overwhelm I experience at times and perhaps some of you have experienced as well. How do we ensure that we are on sustainable path where we can stay in and build the world we want to live and work in?
The book also got me thinking about what is promotable or not in academia, i.e. what is the currency. I think we all know that grants and publications are promotable activities, but even within that there are hierarchies. Some of these hierarchies I think I understand: a data-based paper in a high-impact journal has higher promotability than an editorial in a lower-impact journal. Some of them I’m not sure about: is an NIH project grant more promotable than a foundation grant and if so why (bc higher indirects?) Also, things like mentorship seem gray to me: senior-authored articles are evidence of independence and potential track to mentoring awards, but people often seem to place mentorship in the NPT category. I think having more transparency and discussion about what is promotable or not would be very useful.
Highly recommend this book for women, men, people in leadership, and employees. It’s extremely well-written, nuanced, and eye-opening.
This episode of the GeriPal Podcast is sponsored by UCSF’s Division of Palliative Medicine, an amazing group doing world class palliative care. They are looking for physician faculty to join them in the inpatient and outpatient setting. To learn more about job opportunities, please click here: https://palliativemedicine.ucsf.edu/job-openings
Eric: Welcome to the GeriPal Podcast. This is Eric Widera.
Alex: This is Alex Smith.
Eric: And Alex, who do we have with us today?
Alex: Today we’re delighted to welcome back to the GeriPal Podcast, Bob Arnold, who is a palliative care doc at the University of Pittsburgh. Welcome back to GeriPal Bob.
Bob: Thank you so much. I got such angry email after the first one that I decided I should come back. [laughter]
Eric: So today we’re going to be talking about kind of mentoring and a growth mentoring philosophy. Really talking about, Bob did a talk that I was not present at what meeting Alex?
Alex: This was the National Palliative Care Research Center’s Annual Foley retreat for investigators, researchers. And it was a wonderful talk on mentoring. Bob delivered the plenary session and he was so good that we thought, “Oh, we should try and figure out a way to have this on GeriPal because everybody out there is probably a mentor-mentee to somebody.”
Eric: So we’re not a hundred percent sure how this is going to work as a podcast versus the talk, but again, I heard great feedback about that and I just wanted to hear it too. So we’re going to try to dive into that. But before we do, Bob, I think you have a song request for Alex.
Bob: I do. Jason Isbell’s If We Were Vampires.
Eric: Can I ask why?
Bob: Because I think it’s the most beautiful love song ever about death and dying and being a vampire.
Alex: That’s great. I enjoy learning this one. I’m going to skip right to the second verse because I think it’s more relevant. (singing)
Bob: That was great. The only thing that might have been better if Jason would’ve been here, and so anybody who has a chance to go listen to Jason Isbell or his wife Amanda Sheer should take the time and do it. He travels with his band throughout the country like 280 days a year so it’s easy to find them.
Eric: I also have to say Bob, for all of those watching YouTube, I love your background. You’d get a 10 out of 10 on Room Raiders. I see some beignet mix behind you, a boomerang, a coffee pot.
Bob: Yeah. And it really is my, it’s not a fake bookshelf. It’s like a real bookshelf.
Eric: It’s like one of those games where you… It’s like you have to find a certain item like the first generation, what are those? The Apple iPods?
Bob: Yeah, I have water pistols. They’re not there. I have flunkies.
Eric: Is that a nobel laureate metal behind you too?
Bob: Oh no, that was something I got. I have little finger puppets.
Eric: No room is good without a finger puppet.
Bob: Oh my God. Yes. And these are like philosopher figure puppets. This is Hagle. [laughter]
Eric: When you give ethics talks, do you have your little finger puppets?
Bob: No, I don’t.
My ethics talks would be way better, if not more accurate.
Alex: Should we just do the rest of this podcast with finger puppets?
Eric: Bob, let me ask you, why did you decide to do a talk at this retreat on mentoring?
Bob: Well, it was less about mentoring. I mean mentoring was the hook to be able to talk about books that I think have made me better. I think one of the things are supposed to figure it out on your own, right? Either mentoring or being a mentee or being a junior faculty person and getting better. And you’re supposed to read the medical literature and basically I have sort of found that the medical literature are not the books that have helped me get better or smarter. So it’s all about what are the books outside of medicine that really help you be better at your job? And so that was the hook because I spent a lot of time reading books.
Eric: I lost my mute. Can you still hear me?
Alex: We can hear you.
Eric: Good. Sorry about that, so maybe we could just dive into that then, because again, I think if we just talk about what you talked about during the conference. Again, I’d love to hear it. What was the first book that you talked about at the conference?
Bob: So the first two books I talked about were, because I think that probably the thing that I’ve learned the most is I get in my own way. And if I was more aware of myself and better at staying out of my own way, that I’d be a better doctor, I’d be a better person, I’d be a better mentor. And so the two books that I talked about were Lori Gottlieb’s book. Maybe you Should Talk to Someone, which is this amazing book about this you know. She’s a psychotherapist but most end the doctor but most doctor books are like, “I’m the smart one and here’s how everybody else screwed up. And if you were only more like me, you’d be smart.” But her book is really about, “My boyfriend broke up with me. I’m sort of losing it. So I’m going to go to a therapist.” And it’s about her relationship to her therapist at the same time, she’s also a therapist, so it’s about the people that she saw in therapy.
And so it’s a fabulous book because it sort of talks about what it’s like to be in therapy and what it’s like that you come and you think you have one problem, but it’s really another problem, which is she thought it was a problem with her boyfriend, it was real. Some issue she had. It’s a great book. It’s got this story she tells about a woman with breast cancer and how to help people cope when they’re having cancer. And so she talks about it. Short story she read and how you can sort of worry about the future. You can enjoy the time you have. It’s just this fabulous book about why everyone should basically be in therapy.
Eric: Did it change anything that you did?
Bob: Well, it changed how I helped talk to people who are seriously ill and it acknowledged some of the feelings that I have and helped me be more aware of those feelings when I’m taking care of patients.
Eric: Yeah. Can I ask, how did it change you, how you think about talking to folks with serious illness?
Bob: Well, I think the story she tells, and I mean I get it wrong. She talks about, and it’s a lot like acceptance commitment therapy. It’s about she tells this story about this woman who was supposed to go to Amsterdam and she landed in Paris. And the question is, do you want to be mad every day that you can’t get to Amsterdam and that you’re not going to be in Amsterdam as long as you want? Or do you just want to enjoy the time that you have in Paris? Do you want to spend time sitting at the airport every day screaming at the people who can’t get you to Amsterdam?
There’s a certain sense that I see a lot of patients who spend all their time worrying about what’s happening with the cancer and whether they’re going to get more time and they spend almost none of their time enjoying the time that they have. And so helping me focus on the time that they have is useful. I’ll often in fact even suggest they read the story.
Alex: Yeah. I understand that the second book, as I recall you and I have the slides thank you, that you mentioned is Chatter, which is about the voices we hear in our head. So my question to you Bob, is do you hear voices in your head and are those voices badmouthing advanced care planning?
Bob: So they largely badmouthing me. And so the question is how do the voices in your head influence you in what do you do when your emotions get out of control? He’s a social psychologist at the University of Michigan and he gave really helpful advice about what do you do when the voices in your head feel out of control? Like there’s data that if you talk to yourself in the third person, it helps you gain control out of some of your emotions. I mean it’s just things-
Alex: Third person. Wait, so what would an example of that be? This is Chatter by Ethan Kross.
Alex: Cross? Kross.
Bob: K-R-O-S-S. That you would say that you would talk to yourself as Bob, you would use your name, maybe that’s not third person, but you would use your name in talking to yourself. He’s got great references at the end. It sort of talks about, it talks about how you should talk a bit to yourself. It talks to you about things that are unhelpful. That is one of the things I think we’ve often found is clinicians, is that when people are emotional, just naming their emotions at a certain point gets unhelpful because it just gets them to wallow in their emotions as opposed to gain some control over their emotions. And he talks about why that’s the case and some experiments about other things that you can do.
Alex: We should move on, but I’m just thrown by the third. The third person reminds me of Bill Applegate, who people know may know from the geriatric side who is former editor-in-chief of Journal of the American Geriatric Society and would famously refer to himself as Applegate. I’m sure that he had would’ve no problem thinking… You know the voices in his head are always talking to him in the third person. So that’s great.
Eric: I think about the Seinfeld episode and I think that’s probably the danger of this book is it’s probably okay to talk to yourself in third person but not to talk to others saying, “Eric says.”
Bob: Yeah, that’s probably true.
Eric: So do you actually do that, Bob?
Bob: When I’m in control enough to remember to do it. I mean one of the problems about being anxious is that you get out of control and the stories you tell yourself are all anxious stories about how things won’t work.
Eric: And just for a tip for our audience, let’s say I do start getting anxious. What does that look like using third person? Do you remember any of the tips?
Bob: You would just say things like, “Bob, is this really going to be the issue?” You would give yourself some distance from your emotion.
Eric: I’m going to try that. I’m trying that right now as we do this podcast. Because I hear that voice in my head saying, “Eric, do you stick on this or do you go to the third book?”
Alex: That’s me and your headphones by the way.
Bob: So the next group of books, one of the things I just read over the holiday, I read What My Bones Know by Stephanie Foo, which is this really distressing book about chronic PTSD. It helped me realize that when you’re in a society that doesn’t respect you or I began to draw connections between how my patients, who it isn’t one thing that gives them PTSD, right? It’s not this sort of acute thing, but every time they go out into the world, the messages are traumatizing and treating them as less than other. How that will affect your ability to make friends and it’s right.
One of the problems is that we only see the world from our own view. One of the books I talk about at the end is David Foster Wallace’s book. It was a graduation speak, which is This Is Water. And he sort of points out that all of our experience is only our experience. No one has exactly the same experience I have because no one looks at the world out of my eyes. It was a fabulous book that made me realize that everyone’s experience and in fact if they come from a life that was harder, particularly when they were young, is very different. I can’t see it because you don’t see all the trauma, you don’t see the way the world treats them differently than me.
It just helped me I think be kinder. Both the people external in the world. We all have this experience or the three of us probably do as men particularly when you get to be a man of a certain age. When you walk into the room with a resident or a student, no one forking pretends they don’t know that I’m the attending, right? It’s always clear that I’m the attending. And so I get used to people sort of treating me a certain way because that’s my daily experience. And this book and Biased, which is another book about how people, particularly people of color are seen either by white people or black people, help me sort of realize that I need to be more aware of the way that I get viewed compared to how other people get viewed and be curious about those experiences.
So that’s what I found from those books. And then Whistling Vivaldi is a book that talks about, again the stories we tell ourselves. It’s about stereotype threat and the degree to which if you come from a place where you’ve always been expected to succeed, you’re likely to tell yourself one story as opposed to if you’re a first generation person who’s ever been in college and you come from a community where you’re not in college, or you’re a woman who’s been taught that science isn’t what you’re supposed to be really strong and that in fact you don’t have that story in your head. It’s sort of related to this view of how do you develop grit. And so those three books were all just books that helped me think about how I needed to mentor better people across differences because it’s easy to mentor people who are like you. You are going to succeed regardless, and it’s way harder to mentor people who aren’t like you and bring different chat to the experience.
Eric: And any practical advice for our listeners putting those three together like what you do differently as a mentor in that regard?
Bob: Well, I think the main thing I do different is I get more curious and I am way better at assuming that if they’re not succeeding, it’s not them, it’s me, and I need to figure out how I can be more respectful or helpful to them rather than they’re not going to succeed because of them.
Bob: I need to use what Doug Lemov, we’ll talk about as positive framing. One of the things I’m now involved in teaching medical students and the bottom line is that everybody who’s in medical school is smart enough to graduate medical school. They may not graduate because of the internal capacity issue. And I need to encourage them to think about that. They’re all smart enough and they need to hear that I think that they’re smart enough, and they need to hear that I trust that any of the feedback I give them is just to make them better. Not that I don’t think that they can succeed.
Alex: Yeah, I like that approach. I think I’ve tried to take that approach as well with mentees that all of my mentees can make it as researchers and that they need variable levels of support and the types of support that they need may differ, but that they can all, and their pathways may be very different. They may be longer, shorter or travel through different routes, different topics, different issues, but they all have that potential within them. Yeah, I wouldn’t say that I learned that from books as much as I learned that from, as you are saying, a sort of revised approach to medical students at UCSF. It sounds like Pittsburgh has the same approach. You’ve made it here, you can all make it. It’s our job to help you get through this journey.
Bob: Yeah. One of the books that I didn’t talk about, which is what Shamu the whale, I think it’s called What Shamu Taught Me About Marriage. It was the most popular New York Times, their style section on love article ever. It’s basically that you get the behaviors that you encourage and if you’re not getting the behavior, it doesn’t make any sense to blame the person you’re not getting the behavior from. You need to be different. I think we’re really good at that as palliative care doctors when we’re dealing with families. We’re way worse at doing it when we’re dealing with colleagues or learners. We’re way more willing to blame them as the problem.
Alex: Just to clarify, Shamu is the whale, is that the orca whale?
Bob: Yes. That’s basically, it’s a story about this woman who couldn’t get her husband to put his socks in the laundry bin. And so she went to I guess San Diego, whatever, wherever they trained, Shamu the whale. And she watched how they trained whales, which are just large animals and then went back and used the same techniques to train her husband.
Alex: This is fascinating.
Eric: He really liked cod. So he kept on getting fish. Every time I hear some fish-
Bob: It’s that she rewarded the behavior she wanted rather than the behaviors that annoyed her because attention is… You know this is all childcare, right?
Bob: Attention is reinforcing even if it’s negative attention.
Alex: Well there’s a dangerous code of this story. They stop training orca whales because orca whale bit the head off of one of the trainers. And so now you go to Sea World and you don’t get to see this so-
Bob: You have to cut that from this story. [laughter]
Alex: … there’s some sort of parallel here.
Bob: That’s got to be triggering for someone.
Alex: Not only training your husband to put the socks away only works so far.
Bob: Okay. I’m not going to go there. The next one, the book that I would read if I was a junior faculty person just starting to help, I read two books. One is What Got You Here Won’t Get You There, which is this fabulous book by a guy named Marshall Goldsmith who’s a business consultant. And you may look and you should just put the whole list up when you-
Eric: We’ll put it on. We’ll have all of the books on our show notes with links in Amazon, right?
Bob: No, people should buy them from a real bricks and mortar bookstore because I read this story that 90% of the books that are sold in this country are sold through Amazon, which is great for Amazon and Jeff Bezos but if you want bookstores to live in your community, order them from the bookstore in your community. Okay, that was the public service announcement.
So anyway, this book basically points out that what helped you get good at one level won’t help you get good at another level. And the story I tell about this is I was a great intern because my obsessive compulsive disorder meant that I checked everything like three times and I would be like obsessive. I was a pretty shitty resident at the beginning because what it takes to be a good intern makes a really shitty resident because if you’re checking everything three times and not letting your interns do their job, you are intolerable. What makes you a good resident may not make you a good faculty person. And so he talks about those habits and how to get feedback on the things that are holding you up at getting better at the next level and how to go to your team and ask your team to give you feedback and reward them when they tell you things that you can do better.
Eric: So this is going against the Peter principle. You get promoted to the level of incompetence and how do you address that. Sounds like this is what this book is trying to do.
Bob: Yeah. Well it helps you. He basically is talking about people who got promoted to senior management.
Bob: And how they sucked at senior management. The things that made them really good salespeople, made them really bad senior managers.
Eric: Yeah. Can I ask how do you find the time to read all these books?
Bob: Well, I have no personal life. [laughter]
Eric: There’s probably a book for that too.
Bob: Yeah. I don’t know. I’ve always read a lot of books. I mean there are a lot of places you can find these books.
Bob: Twitter for all his craziness. Adam Grants on Twitter and he talks about 13 books every year that he recommends. There’s a fabulous sort of business improvement book club called The Next Big Ideas. And they publish 60 books every year that you should read. And then the New York Times book review. One of the books I’ve sort of have, everything I’ve learned about teaching and mentoring people about teaching has come because I read this book that got reviewed in the New York Times book reviewed by a guy named Doug Lemov called Teach Like a Champion, which is this book that basically he spent years going around watching really good teachers. And so he wrote these 53 and I think it’s more than that principles of things you should do to be a really good teacher.
You read this book and it’s like, “Oh my God, no one taught me to do that as a teacher.” And so when I mentor junior faculty now who want to be teachers, I have them read the science of how people learn because those were all really big books that taught me how people learn. Which is as Alex would point out as good if you’re teaching investigators too because how people learn, whether it’s learning to teach or learning to do research, it’s all learning. And we have such a bad idea of how people learn.
Eric: Can I ask you of those 53 principles that he went over, are there one or two that kind of pop up into your head when you think about that book?
Bob: Yeah, the two that pop up. One is that right is right. If I want people to learn the right thing, I need to stop rounding up when they get close, I need to ask them to do it again and get it right. And the other is he talks about a thing called cold calling, which is, well, he talks about something called rigor, which is the goal of a teacher with a group should get everyone thinking at the highest level. And yet on rounds I would do stuff like I’d say Alex, in which case, and I’d ask Alex a question, in which case Eric would be doing his grocery list as opposed to asking the question and say, “Guys, write down your answer in 30 seconds we’re going to discuss it.” Which makes both Eric and Alex think about it.
And then I get to choose who I call on because one of the things is I was this medical student who was like a gunner. I would always volunteer. I’d be the fastest to say shit, but I didn’t have the smartest things to say. And if I called call on people and have voice equity, it means that the people who are quieter and shyer get to contribute and are involved in on rounds the same as the people who are always willing to talk.
Alex: I like that.
Eric: I can also imagine it potentially increases anxiety levels too, if you feel like you can get called at any point.
Bob: So you need a rollout speech, right. You need to say upfront on rounds, “I’m going to ask you guys questions. I’m often going to give you a chance to think about it before I call on people.
Bob: Because this isn’t how fast you get it. If you don’t know it, oh my God, it’s okay because our goal at the end of rounds is we’ve all learned one or two things. Not that you start off knowing them, but that you end knowing them. You may notice that I call on everybody because I want everybody to learn because I want you all to be the best possible doctors at the end of our rotation. And I’m convinced you can be.”
Alex: I love that. Bob, I want to go back to the what got you here won’t get you there. And I think in my own journey as a mentor, when I first started, I’ve primarily been a mentee and I was really good at revising drafts, revise, revise, red line, red line. So for my mentees, my early mentees, I would completely rewrite everything they wrote, right? Like 80%. What I’ve learned over time is that it’s better to give them higher level comments upfront and then nudge them in the right direction when a sentence might need to be changed. I also need to find a greater comfort level within myself of stylistic differences and letting people have some flexibility.
Bob: No, I think that’s absolutely true. Can I make one revision?
Bob: I would say you can take the first paragraph and you can do a 90% change and then say, “This is a model for you of what I’m looking for.” Because if you just give high level comments, they may not know how to go from your high level comments to specific comments. And so telling them the high level, which is think like Alex Smith, that the expert doesn’t let them know how to go from Alex Smith the expert to them the novice.
Alex: Yeah. I think over time I’ve started to do more of collaborative writing, if that’s the right word. Or collaborative revising where they’ll send me a draft and then I’ll read over it but then live will work through changes and have some back and forth rather than I may email, you email me, I email you. It’s more of a conversation.
Eric: I also love that because the other thing, the danger of just all comments is its kind of like, “Oh my God, what are you trying to… Just edit it the way you want it. It’s stuff back and forth.” The interesting thing about the live it gets through that you actually, you can talk about why are you making this change? Why is this important? And also, this is not just about the paper, but it’s about this mentoring process.
Bob: Well, it’s about helping you learn to write, right?
Bob: Again, you need a rollout speech. The best example of that I had is that I used to just edit them and then send them to a person people and say, “Look at my comments.” I did that to someone who remained nameless, but her name is Wendy Anderson and she was just destroyed because I rewrote the whole thing and she thought it was a shitty paper and in fact it was a really good first draft. And so now at least even if I’m going to read the whole thing, I now have a, “I really thought this was good. I did a lot of moving things around. We should talk it through to see what you think about it.”
Alex: Yeah, I’ll say I had the same experience as a mentee. First paper I wrote up, Holly Prigerson destroyed it. Somebody who will name nameless but whose name is Holly Prigerson absolutely red lined it everywhere. I was so depressed. I was like, “I’m not submitting this. This paper is dead.” Then she came back to me, she said, “What happened to that paper?” I said, “I thought you thought it was terrible. I gave up on it.” She said, “No, it’s great. You just need to revise it.” And so I give a same sort of speech up front now I say this is not like high school or college where you get a letter grade at the end of your paper and one or two lines of feedback. This is a completely different experience and you can expect that we will go through at least 10 drafts of this before we’re done.
Bob: You’re giving what Doug Lemov would call out a rollout speech. You’re preparing them for what the experience is going to be like so that they don’t have the internal voice. See how I’m tying things together. Your internal voice doesn’t say to you, “I’m never going to be that good. I obviously can’t write.”
Eric: Or, “Bob will never be that good. Bob will never write through things.”
Bob: Whatever. If you start saying, “Bob, it’s going to be scary.” The other book that junior people should read, it’s called Thanks for the Feedback, which is a fabulous book by a guy named Doug Stone who also wrote the book Difficult Conversation, which I think is a book that everybody in palliative care should read because it talks about the frame of what a difficult conversation is, but thanks for the feedback. If you were me as an early faculty person, I would get feedback on papers and I would either be so angry at the person who gave me the feedback because obviously they were stupid and they couldn’t see what I was doing because they were so stupid. Or I’d be distressed because I never am going to succeed. And he just gives a saner way to think about how to look at feedback as a gift to help you get better.
Eric: I adore that book. And really you have to think about what the type of feedback that the person that you’re talking to is wanting. Do they want formative feedback, coaching feedback, or do they just want some praise like, “Great job for doing this specific thing.” It talks about all of our reasons that we get stuck in feedback like switch tracking like somebody’s giving us feedback and we’re going to jump on them for something they did wrong like Going to Get You. I love that one.
Bob: Oh, it’s a great book.
Eric: Yeah. It’s kind of changed also the way I think about how I give feedback to folks. If I remember, I think that’s my challenge for any of these books. You kind of have to remember them if you read them five years ago or just get in a habit really early on of just doing it over and over and over again so it becomes your habit. Do you have any advice on that, Bob?
Bob: Well only try to work on one thing at a time, right?
Bob: Remember that behavior change is really hard and it’s normal to forget most of what you read. So think about how to make things stick so that you practice and take things away. I mean when I trained in medical school, I sort of underlined everything. There’s all this data that underlining is completely unhelpful. You should read a chapter, you should then take some notes on it.
Bob: So some of this is how do you think better? Which is why the Doug Lemov stuff Teach Like a Champion and Practice Perfect. And for those of who like soccer, The Coaches’ Guide to Teaching are such a wonderful group of books because he takes the cognitive science literature and makes it practical for people who are teachers or mentors or coaches.
The book, other two books that I would have mentors read, one is called The Advice Trap and one is called the Coaching Habit because I think that one of the things that happens as you get more senior people come and ask you for advice and you’re like what Tony Bach calls an ATM machine spitting out advice. And yet it often is off target or it’s answer the real question that they had. And more importantly, you’re doing all the work and sometimes they want your experience, but sometimes they just want to think it through. And so the question is, can you slow yourself down and get them to think it through with you and get them to come to decision about what’s most important to them. They’re both a really easy books.
Eric: How do you find that balance? How do you find the balance between just inquiry, talking to folks about how they’re thinking about it and then also as a mentor, adding kind of your own Bob’s Sage advice?
Bob: Well first of all, Bob Sage advice has largely been a lot of screw-ups and then figuring some of it out. I think the question is what are they coming to you about? Are they asking a factual question? Are they asking… What are they asking? What’s the real challenge for them? If they’re asking should they do something, then if you say yes to this, what do you say no to? They need to internalize their own answers to those questions. I can tell them yes or no, but why should I tell anyone yes or no? I haven’t done that in my own life. I just say yes to everything. Hence, doing podcasts, whatever. I mean, the point is they need to figure it out and I can give them advice. If you’re like me though, advice shouldn’t be your first reaction. It can be your second or third reaction.
Eric: Okay, we got about seven more minutes.
Bob: It’s a little bit like patient care, right? It’s like motivational interviewing.
Bob: Giving people advice doesn’t get them to do what you want them to do. So the book for those people who want to write, which is I think one of the best books about living is called Bird by Bird by Anne Lamott.
Alex: Can get one myself right here.
Bob: In fact, all of her non-fiction books are amazing. Her book on having a child called Operating Instruction is a book if I’m going to give people a book when they have a new baby, because you don’t hate your baby at least part of the time, you’re not being honest. She’s a brilliant writer. She’s funny, she’s smart. I’m not very religious, she’s extraordinarily spiritual. And she writes, If You Want to Learn to be a Writer. I’ve read a lot of books about writing. It’s a fabulous book about writing. What did you like about it, Alex?
Alex: Shitty first drafts. Shitty first drafts, right? Just get it out. Don’t let the mental obstacle hurdle of trying to get out something that’s close to perfection that will satisfy your mentor stand in the way. Put pen to paper, write it out, type it out. Send me your shitty first draft.
Bob: Or if you’re as neurotic as me, I can’t write shitty first drafts because I get so anxious seeing on the paper. So I walk around my house dictating first drafts because it’s the only way I can get first drafts out once I get a first draft on paper. I love second through 12th drafts. I hate the sort of fine, I hate the proofreading of 13 through 15th graphs, but oh my God, second through 12th graphs make, I can’t stop working on them once I get them.
Eric: My startup speech, usually when I do a paper with somebody who really hasn’t done journal submissions before is, “By the end of this process you may begin to hate this paper.” At least that’s how I usually feel as it comes to the 15th round of edits just, “Why did I even do this? Why did I agree?” But in the end, it makes for a better outcome. Okay, so Bird by Bird, it’s about how to write, I’ve never actually read this book.
Bob: It’s about how to write. It’s really about how to live but she says it’s about how to write.
Alex: Yeah. Anne Lamott, Local Marine Product. Yeah. Great. Yeah. Any other books on writing?
Bob: So I like Stephen, what’s his name? The Stephen King’s book called On Writing. They’re supposedly Yael Schenker loves this book that’s written by she took when she was doing her GGIM fellowship that you guys do that is used at UCSF, I forget what it’s called.
Alex: Maybe the grant writing manual
Bob: Yeah. About medical writing.
Alex: Yeah, I’ll put a link if I can find it in the show notes.
Bob: Right. Those are the books I like about writing.
Alex: Strunk & White?
Alex: No, not so much.
Bob: Not so much.
Alex: And any fiction books that you’d recommend?
Bob: Yeah, I’m really bad at fiction because for fiction I basically read mindless mysteries and so I don’t sort of find fiction as helpful because it’s sort of turning off my mind.
Alex: That’s generally why I read. I almost exclusively read science fiction and fantasy, although I’ll occasionally get sick of it and then read one of these sort of make you a better person or a better mentor type books and then go back to escapism.
Bob: The last thing that I would have people read, which is a 10-minute read is David Foster Wallace’s This is Water. If you don’t like to read, Google it and pull up his commencement speech. He really talks about how hard it is to be in the world and how important kindness is to everybody who’s struggling in the world and how easy it is not to see the things that are so common in your experience because they’re just the normal day-to-day things in your experience and the degree to which you can sort of pay attention to them and deal with them will make you a better person.
Eric: I got a question for you Bob. Do you have your fellows, your palliative care fellows read any of these books? Is this any part of the formal curriculum or is this just one-on-one mentoring with Bob when they meet with you?
Bob: So the fellows who are doing a master’s in medical education will read all the medical education book. Anybody who wants to be a sort of a right, I’ll make read Bird by Bird. We give all the fellows or we did, thanks for the feedback because palliative care is the only specialty in the world that you start off at the beginning thinking you’re really good at having called the care conversations. So it’s a little bit disorienting because that’s why you went into palliative care. You’re really good at it to be told not as much as you think.
Eric: Yeah, I do a didactic at the start of every year. Basically, thanks for the feedback. So we have an hour-long session on how to receive feedback, not how to give, how to receive and it’s basically a hundred percent based on that book.
Bob: Yeah, we did it because we had some problems with fellows who thought they were really good and so they found it quite disconcerting. Then in the first month or two we wouldn’t let them have conversations by themselves.
Bob: Because they did it as an internal medicine residents do it all the time. The sort of analogy we gave is you can think you’re really good at tennis and then you go to tennis school and they’re like, “Oh my God, never hit like that again.” And in fact you get worse before you get better.
Eric: I just took skiing lessons for the very first time in my life and I’m actually a fairly good skier, but man it was very humbling because you actually start off on the easiest slope, it just most of the time you’re not even skiing, you’re learning where to put weight on your foot. You’re learning how to pivot. And it just reminded me of this is that you also have to do the progression. You’re not going to just start off on the expert mogul slope. If you want to practice moguls, you’re going to start off on the easy slope just relearning how to make a turn.
Bob: Right. You’re going to learn habits. So one of the books that I had is a book by James Clear called The Atomic Habits. He talks about how to get really good means that you build habits every day that build on each other and are like compound interest. And some of it is it means that you have to start as a novice and build the habits one at a time. We as faculty need to understand that whenever you learn a new habit, you’re going to get less good at the old habit. The example I’ll give is that when you’re teaching palliative care fellows to attend to emotions, they’ll get really good at attending to emotions, but they’ll forget how to take a history. Well, but if you think about it, it’s completely normal. They’re focusing all their attention on one skill and so the other skills are harder. They now have to learn how to integrate and that’s a whole nother thing to do. They’re going to teach you one thing in skiing, you’ll forget the other things until you learn how to integrate.
Eric: Yeah, I fell many times on the moguls because I was so focused on one thing like my ankle movement. Well last question for you Bob, and then we should get back to the song. Self-help books are also a multi-billion dollar business and there’s a lot of bad self-help out there. How do you distinguish the good and the bad? And how do you even pick the good and the bad? You sound sounds like a little bit you use online like Twitter for that and just to get your thoughts.
Bob: Yeah, I think it’s true. You read book reviews, you sort of see what other people use. The other thing I would say is you take what helps and leave the rest. So I love Give and Take by Adam Grant as a way to think about how I’m going to be in the world. I think for many of my female colleagues, Give and Take isn’t as helpful because they’ve been socialized that they’re supposed to give too much. And so it sort of sets them in the wrong direction. I would say read the book. If it doesn’t resonate or doesn’t seem helpful for you, then there’s probably another book that will help.
Alex: That’s great. I’m somebody who’s gotten into audiobooks recently. Any thoughts on reading versus listening to books?
Bob: So the question is, are you really listening? Are you doing something else while the noise is playing? If you want to use the book, you need to really attend to the book and attend to the knowledge in the book because there’s a whole bunch of data that if you’re doing something else, you’re not really listening to the book. It’s the problem with Zoom conferences, we’re all doing something else. And so if a hundred thousand people are listening, but no one’s using it.
Eric: Yeah. Except for our podcast listeners who have paid attention for the last 50 minutes, given your full attention which reminds me, we should probably get to the song. Alex, you want to play a little bit more before we end?
Alex: All right, here we go. I’m going to go back to the first verse now. (singing)
Eric: Well. That was great Bob. Thank you very much for being in this podcast.
Bob: Thanks so much for inviting me. And again, independent bookstores.
Eric: So we will have a list of all the books we talked about on our website. Notably they will not have links to Amazon on it. So go to your local bookstore, Green Apple or whatever the ones that near us to you and get whichever book you feel like on the list and with that-
Bob: And send me an email if there was a book that I left off that you think I should have read because that will be really helpful. Your crowdsourcing will help me.
Eric: Yeah, and if you’re on Twitter, share that. We’ll start a thread to this blog post. And with that, thank you everybody for your support.