Things you should never do

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I'm Toyosi Onwuemene, and it is such a pleasure to be talking with you today. Thank you so much for tuning in. Today I'm talking about seven things you should never do. Seven things you should never do. I will say that when I first started my faculty career, I assumed everything was fair game, right?

1:25 The end justifies the means. You work super hard, you push, push, push hard, and you make sure you do all these things so that you can get the prize at the end. And one of the things that's challenging is that when you try to define exactly what is the prize that you're gunning for, it is so much harder in your faculty role than it was really at any point during your career, right? And so when you think about your training, medical school, like getting into medical school was the goal. Very clear goal. You're gunning towards it. You get in, you know you win. And then graduating medical school, that's a goal. And getting into residency, that's another goal.

2:08 Getting into a fellowship program, that's another goal. Getting a faculty role, that's another goal. Well, you have to become a faculty member. The goal becomes less and less clear. Is it achieve promotion? I mean, it's usually not like a clear goal that everyone's gunning for. It could be one. When you look at it, there's so many things that you could accomplish as a faculty member that there are many goals you could set. You could set, you know, be the best master clinician, for example. Or you could decide that you're going to get, you know, the biggest research grants. And one of the challenges with that is that, you know, the goalpost keeps moving.

2:48 Congratulations, you got your K, what about your R? Oh, congratulations, you have your R. What about your next R? Oh, congratulations, you have only one R. What about, you know, three R's? Oh, congratulations, now you've got three R's, what about the U? So there's always the next thing and the next thing and the next thing such that there's not really one big goal that you're accomplishing where it feels like, okay, you're now done. Congratulations, you've accomplished Nirvana as a faculty member. And that's why the reason is that the journey is so much more important. Actually, the journey has always been important throughout your training. But even more so as a faculty member where there's not one big goal, the journey matters a lot.

3:29 And so the whole idea of the end justifying the means is a little bit false because it's like, so what end exactly are you gunning for? And it's important to recognize the journey. So in the spirit of that, there are some things that you don't do because you realize that you want to live a holistic life. When you live a holistic life, you want to have an experience that you can look back on and enjoy and appreciate and say, well, you know, this was a life well lived. I made good contributions and I, you know, was true to myself and true to my values in the process.

4:09 And that's why I think there are some things that we should never do. I'm going to talk about seven of them. Okay. So number one is never, never, never, never worry about the future. Okay. Now, this is one of those where it's like, what do you mean? We're always worrying about the future. And I agree, it's a cultural thing. If you're an academician, you're always worrying about the future. When am I going to get this grant funded? When is the money going to come through? When are they going to review it? Am I ever going to get funded? What's going to happen if things don't work out? What's going to happen if I can't fund my research? How am I going to move forward? There's so many things that we could worry about.

4:52 And at the end of the day, we have no control over the future. What we do have control over is the way we show up in the present. But here's a challenge about worrying about the future is that we go into the future to worry and then we become absent from the present in which we can actually make a difference. So while I have no control over whether they will fund my grant that I submitted last year, what I do have control over is how I prepare to submit the next grant or how I move forward in a different way, which continues to increase the chances that I continue to be funded. I have control over that. But when I'm absent from the present all the way in the future, worrying about something over which I have no control, fretting, being anxious, nervous, stressed, and I'm not here in the presence, in the present, making the difference that I can make to affect the future.

5:47 And so the end result of that is that the uncertain future I don't want, I'm actually creating that by being absent from my present. And it's the same with that really in everything in life. It's not just about grant funding. The more I worry about the future, will funding be cut? Will there be any money? Will this institute go away? Will my research die? All those activities that go to the future to worry and then allow you to become absent from actually making the difference in the present. All of them, all of them. Will my child make it to college? Will my child be potty trained? What will happen when my parents become 80 years old? All of those things are in the bucket of things you should never do.

6:31 And I say that recognizing that we're always doing that. We're always worrying. We're always anxious. We're always afraid. And to be honest, it's kind of popular to do that. You gather in a room and people are talking about what's going to happen tomorrow. We don't know. And this might happen. And I have to say that it is a discipline that I'm working really hard to practice of being absent from those scenarios where people focus so much on the future. They're so paralyzed and anxious and worried and afraid. They cannot be present in the present. And so I want to invite you to think about your present and ask yourself, in what ways am I moving forward to the future and being absent from the present where I can really make a difference?

7:13 In what ways am I allowing my fear of the future to hinder my activity, my action in the present? I want to invite you to work towards the discipline of not allowing the future to interfere with today. Okay? That's number one. Never, never, never, never worry about the future. Along the same vein is number two. Never worry about the past. Okay. This one may actually truly be worse than worrying about the future because, you know, it's like you're going forward into a future you don't know. You're making up disaster that has not yet existed. And so doing the work that you need to do to move forward, but in regretting the past, wow, that's like a double whammy because you've already lived and maybe you've done something wrong or something hasn't worked out.

8:02 You missed the deadline of a really important grant that maybe would have allowed you to be funded six months from now. And now you're like, I'm scrambling. I have no funding. And so now you're spending a lot of time in the past, but you already, it's already done. You have no control over going and undoing it. You can't do that. But here you are spending so much time beating yourself up over what you did instead of showing yourself compassion, forgiving yourself and moving forward. And so I think regretting the past actually is worse than going forward to the future. Actually, to be honest, I think they're both equally bad because they rob you of today. They rob you of your ability to make an investment in the present right this moment.

8:48 They rob you of your agency to act and make a difference. You can't go to the past and undo it. You can't change your experience with a mentor. You cannot change the way you responded to something. You wish you had only written a grant a different way, or maybe you wish you'd never in the grant at all. None of that helps you in moving forward. What does help you is to make a plan and to move forward in the present. Similarly to worrying about the future, worrying about the past, regretting the past is a waste of time. It's a waste of your time and it drains your energy and it keeps you from showing up today so that what you're doing when you go back to regret the past so that you're setting yourself up for this never ending cycle of regretting the past, right?

9:35 As long as you're regretting the past, you're always going to be in the past, never really making progress towards the future so that you'll always have something to regret, right? You spend all the time regretting the past. What you're doing is you're creating a ladder of regrets that you will never be able to fix until you decide that you can let go of the past and you're going to focus on the agency that you have and applying that to the present to change the future, to make the future different, to make different decisions than decisions that you've made in the past. So number two thing to never do is never regret the past.

10:15 Instead acknowledge the past, take a few minutes to mourn the past and the challenges you've had or the regrets that you've had and then advance, advance by investing in today. All right. That's number two, never regret the past. Number three is never wonder why, never wonder why. What does that mean? Hmm. I wonder why the reviewer did blah, blah, blah. I wonder why they didn't move me to this particular study section. I wonder why they didn't fund me. I wonder why that manuscript was not accepted.

10:56 Now I'm not saying you shouldn't pay attention to, okay, how do I do things differently? It's different from wondering why. Wondering why is why you spend so much time reminiscing and trying to put your head in somebody else's head to say, okay, this must be why they hated my grant. It's because I'm a woman. Oh no, it's because disparities are, I mean, this person must, this study section must be racist, therefore they don't believe in my work. Those are all things that you just don't know. You don't know. And you know, I have to tell you that I've done this so much. This is why I say never do it because now I've done it. Now I feel like nobody should do it, right? But I spend so much time making up a story as to why something didn't work out.

11:36 And I don't know. I really don't know. And it really takes grace and humility to come to a point where you're like, wait a minute, I don't know why. I don't know why they didn't fund me. Yes, I know the reviewer listed these five points. I don't know. And it doesn't help to try to wonder or make up a reason or imagine a big bad reason why they couldn't fund me. But what I can do is to say, hmm, how can I find out? So if you have the review before you, okay, take it at face value. Seek solicit help from other people. You're soliciting help not to imagine why, but to say, what do I do right now to address these comments so that this grant is fundable?

12:17 What do I do right now to strengthen this project? What do I do right now to address the issues that make the project seem weak or not effective? Right? So you have power over the things you know. You don't have power over the things you don't know. And investing time and wondering why is another thing that steals your time. What could you do instead? Instead, you could get the information you need. If you're like, I wonder why this grant didn't receive a higher priority score. Guess who can tell you? The program officer who may or may not have attended the study section may be able to tell you. And maybe they can't tell you. They weren't there and they can just read the summary statement with you and say, well, this is what typically happens, right?

13:03 But somebody can give you insight. Ask that person. And if they can't give you insight, sometimes I've been to a meeting with a program officer who cannot tell me why nobody decided to move forward to the grant. Right? They could just read the study summary statement, same as I have. Just take whatever information you have and use that and where you have a gap in knowledge, seek to expand or seek to fill that gap. Fill the gap with knowledge to the best of your ability. Don't fill it with conjecture. Don't imagine. Don't join anybody to imagine things. Don't let somebody tell you, yeah, that's what happened. Three years ago, they decided that no one was going to get funded from my university.

13:45 Therefore, don't do that. Get the information you need and act on the information you need. If you don't have the information and you can't get it, then you just don't know. And it takes a lot of humility and grace to say, I don't know. And it is more powerful to say, I don't know. And this is what I know. And this is what I'm going to move forward in because this is what I know. So don't spend time wondering why. Get the information you need and move forward. Number four thing you should never do. Oh, my goodness. Never argue. Never argue. OK, I just want to put in a plug for arguing right now. I told you never argue.

14:25 And I just want to tell you why it's so sweet to argue from my perspective. It feels so good to be right. Oh, my goodness. It feels so good to be right. And next to being right, it feels so good to work hard to convince others that you are right. Actually, to be honest, it's not even about others. It's about me. I want to look good. I want to be right. So sometimes it doesn't matter what I'm being right about. I just want to be right. And that's the problem with arguments. The problem with arguments is that there is no real goal that's actually a useful goal other than winning. And you might argue that being able to say I told you so is the best. Yeah, it does feel good, doesn't it?

15:05 However, the problem with arguing is that it really wastes time. It drains you. At the end, you win, but you don't really win because you feel slimy inside. You feel dirty, and you know what, it doesn't help whatever relationship you're in. What does argument give you? It gives you a self-satisfying, a self-satisfied, smug feeling, but it leaves you feeling empty and it hurts relationships. That's what it does. And at the end of argument or at the bottom of arguing is proving your point. Then you have to ask yourself what is the point of proving your point other than being right?

15:49 Does it move you forward? No. Does it allow you to make a difference? No. Does it allow you to move that grant forward towards funding? No. What you really want is information. You want advice. You want strategy. You want knowledge. There are very, very few things that you need that actually move you forward. And so when you're spending time arguing a point because you want to win, then what you're not doing is getting the information you need to move forward. It takes a long time to argue.

16:30 And if you're arguing with someone else who's good at arguing, and to be honest, most of us in medicine are excellent at arguing, and you take the same point, the same information, the same timeframe, and we can argue different points and argue successfully. It takes a long time to do that, and it takes less time. And it's a real investment to take the information that that person has, which you don't have yet, or the perspective that that person has is clearly different from yours, and to see how can I incorporate it into my project. And the reality is what I realize now, especially with reviewers, is that no matter how wrong they are from your perspective, they have information that you need. When somebody says, I can't believe that this person is applying for a grant.

17:12 She doesn't even have a degree. And you're like, wait a minute, how can this reviewer think I don't have a degree? And you're angry. And you're like, this is a ridiculous reviewer, and all of that. And what they're really telling you is that it wasn't explicit. It was something they didn't see. But it's right there in the biosketch. I have a degree. And what it helps you do is recognize that, okay, well, this person didn't see it for whatever reason. How do I highlight the fact that I have a degree in this area so the next reviewer knows that I do have a degree? And so there is information in the differing perspective. And it allows you to pivot and flex and say, okay, well, how can I do this differently?

17:55 How can I present this information in such a way that whatever was missed is no longer missed? Arguing over the sanity of the reviewer, whether the reviewer can read, whether they had a third grade education, I mean, it makes you feel good, but it doesn't move your work forward. And so I want to invite you to think about the discipline of accepting the present as is, believing people when they present who they are and the information they present to you and moving forward. Never argue because it's such a time weaster. And at the end, the prize is hollow. Okay, that's number four.

18:38 Number five, this one may be controversial. I'm going to say never work with someone you don't like. Never work with someone you don't like. Now, you can argue whether there should be anybody in your life that you don't like. I would say in the perfect world, you like everybody because you're so good at getting along with everybody. You're so mature. You're so good. And in reality, there's some people you don't get along with. And it could be a number of reasons. It could just be that you don't even know why you don't like them. It could be that whenever they speak, it gets on your nerves. It could be that you always feel like they're trying to control the outcome. It could be that you never feel respected by them. But it's important that no matter what it is, you really consider, do I want to work with this person?

19:23 Not do I have to. Do I want to? And if the answer is no, then figure out how you can not work with them. Better yet, figure out how you can work with someone else. Why is that important? It's important because the work we do is so hard. It is hard. And what you always want to do is to be pushing in a direction that changes your experience. You always want to be pushing in a direction that moves you forward. When you spend a lot of time massaging egos, or you spend a lot of time trying to convince people who will never be invincible, you spend a lot of time trying to impress people who can never be impressed. That's energy that you're not putting into moving your projects forward.

20:06 That's energy instead that you're putting into fighting with a person. And it is not satisfying. It is a waste, total, total, total waste of time. And so to the extent to which you can, don't work with people you don't like. Don't say, oh, this is the only mentor in the whole university. I have to work with him. Oh, do not take that energy and try to move any work forward because it does not move work forward. It frustrates you. It makes you mad. It makes you angry. Maybe you've been working with this person for a while and now you're like, you know what? I really, I really don't like this person. The more I work with them, the more I don't want to work with them. It's okay. Everything is changeable. They are not the only mentor in the universe.

20:47 Yes, they may be the only person in your division who has the three R01s that looks good on your application. But who else can help you? And maybe they're not in your division. Only your greater health system or your greater academic medical center can help you. And even looking beyond the academic medical center, I've had people who've been successful with mentors outside the institution. How do you create your experience such that you only work with people who will move you forward? And again, it's not them, it's you, right? The challenge is if you don't like someone, it's not because of them, it's because of you. It's because there's something inside you that's triggered by them.

21:29 And sometimes we think they're the problem, but you actually are. And so if you don't like someone, you have to decide, do I want to do the work that changes me so that I can continue to work with this person? Or do I want to invest the time doing something different that helps my project move forward? It's a choice that we make. But you can either decide to change yourself so that you start to work towards liking this person genuinely, or you don't make that change and you say, I only want to work with people I actually like. But at the end of the day, don't lie to yourself. Don't make yourself do something you don't want to do, not in the way of working with people, because the energy drain is energy that can be put into your projects.

22:19 So don't work with people you don't like. Yeah, I venture to say never work with people you don't like. Change how you feel or change your working environment. Okay? Okay. Number six is never leave it up to someone else. Don't do it. Don't leave it up to someone else. Many times I hear faculty say, well, we'll see what they want. Let's see what they want. And at the end of the day, please don't let's see what they want, because here's the thing about what other people want. It is always changing. And it's not subject to you. You're not in charge of what people want. You are in charge of what you want.

22:59 And even that is hard to be in charge of because you don't know what you want. And many times you're frankly always changing. And so that's you. And you struggle to be in charge of what you want. And then imagine trying to flex to what other people want. You don't know when it's going to change. You don't know why it's going to change. And so frustrating to work towards something that somebody else wants at the expense of what you want. And then here's the challenge. You may have already experienced it. You work so hard to meet the needs of someone else or meet their expectations. And then they change or you meet it and then they're like, yeah, that's not what I wanted or and this still sucks.

23:44 And then you feel frustrated and angry because you invested all this time and energy to please someone and it didn't work out. That's you leaning up to someone else. Your career does not belong to anyone else. Doesn't belong to your mentor. They will not experience the consequences of a career that's not satisfying to you. You will. They will not experience the consequences of a career that left you leaving your family or your significant other high and dry. Like I was trying to make my mentor happy. No, no, no. That's why I didn't, you know, invest more time in my relationship with my spouse. Never leave it up to someone else. You are in control. You are the writer of your story.

24:25 You're the author and you're the programmer. If you don't program, things don't go forward. Don't say, oh, they're going to do it. They're going to look out for me. They're going to help me. I'm not saying that they're not. I hope they do. But even if they don't, you can control what you do. You can control your experience. And even then, you struggle to control your own experience. Imagine now trying to control somebody else's perception of your experience. Never leave it up to someone else. It is a recipe for failure and frustration and anger and a lot of failed relationships and failed experiences. Take charge.

25:06 Instead of leaving it up to someone else, ask yourself, what do I want to accomplish? Why? And then work. Work towards that. And number seven, never work hard towards things that are unproductive. Never do that. This one may be the most challenging of the seven because as physicians, we are good at working hard. Oh, are we good at working hard? It doesn't even matter what we're working hard at. We're just good at it. Let's work hard at getting this prior authorization approved. Oh, yes. And three hours later, you are still arguing and arguing and seeing your way all the way to the top. And you're like, yes, I did it.

25:46 Six hours later, medication approved. I'm not saying you should fight for your patients. I'm not saying you shouldn't advocate for them. But I'm saying if something is unproductive, if at the end of six hours of working really hard, you can't really significantly measure change that improves your experience or improves the change that you came to make. You have to ask yourself if that's the right thing to work hard at. The thing about prior authorization is very important is that you will always have another one to do. It's like, great, you got this medication for this patient. Congratulations. Six years of your life or six hours, feels like six years.

26:28 And then there's the next one. And in reality, there are other people who have the time and the experience and maybe a little more strategy than you to do that maybe more efficiently. And in the meantime, you've been working hard at being productive at a thing that somebody else could have been productive at and more efficiently. What you've done is you've left the things that only you can be productive at. Total waste of time. But we love the high of accomplishment. And sometimes we don't ask ourselves, is this the right thing to be productive in? Is this something I want to be accomplished in at the end? Yes, I may be really, really good at editing, but who can do it for me?

27:10 I may be really, really, really, really good at creating figures that are really nice and pretty, but is this what I should be investing my time in? Should I become really good or should I draft something and have somebody else just put the finishing touches to it? Choose what you're productive at. Never work hard at something that's unproductive. And this may be one of the hard ones that's hard to undo because as physicians, we just go to working hard, even when we shouldn't be working hard in that area. So I just said seven things. Seven things you should never do. Number one, worry about the future. Number two, regret the past. Number three, wonder why. Number four, argue. Number five, work with people you don't like.

27:51 Number six, leave it up to someone else. And number seven, work hard at things that are unproductive. As always, it is such a pleasure to talk with you today. Thank you so much for tuning in and I invite you to share this episode with someone else and remind them that there are some things you should never do. All right. It's been a pleasure talking with you today. I look forward to talking with you again next time on the Clinician Researcher Podcast. Thank you for listening. Thanks for listening to this episode of the Clinician Researcher Podcast where academic clinicians learn the skills to build their own research program, whether or not they have a mentor.

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