Fingers and Thumbs

This morning I listened to an episode of the James Altrucher podcast where he talked to his producer Steven Cohen about why people fail. One quote that stuck out at me, as corny as it may sound, was that “we need to point thumbs, not fingers”. That is, we need to stop being so concerned about what other people are doing and start looking at ourselves.

It’s something that I’ve been thinking  about a lot over the past few months. And it’s something that I find I need to constantly remind myself about. Because it’s so easy to get caught up in where other people fall short, especially when it relates to something we care about.

When I think about it in a pharmacy context, the classic example that I think everyone is guilty of is the topic of warehouse style pharmacies. I was engaged in such a conversation yesterday in fact. And I must be honest, I’ve never really stopped to think about how little there is to gain from this approach of complaining about them until this morning. Or even any gain at all? It doesn’t influence their practice in any positive way. In fact, it has the potential to further disengage them and polarise the conversation. And it doesn’t make me feel good or inspired in anyway. If anything it makes me feel kind of sad and deflated. So what’s the point other than branding yourself as not being one of them?

I don’t know what the correct approach is, but I’ll tell you what I’m going to try and start doing from now on. I’m going to try and stop myself from getting sucked into conversations about how bad things are (this is really hard for me sometimes often) and I’m going to try my best to empathise. I’m going to try and focus less on generalisations and avoid making assumptions based on individual’s career decisions.

It’s an important thing for me to get my head around, because I think it’s things like this that can flip a situation from positive to negative exclusivity, particularly in a group setting. What do I mean by positive exclusivity? Good question, I’m trying to get my head around that too.

Here’s what I think I mean by positive exclusivity. I really value the idea of being generous in your work. Of offering service to others without expecting something in return. I have the firm belief that we all benefit from each others success and that’s how I want to live my life. But I’m not a martyr. I have boundaries and I think it’s important to maintain them. I consider positive exclusivity to be circumstances when I hold those boundaries based upon shared values and principles. Negative exclusivity would be when I put those boundaries in place because of something like a personality clash, or personal judgement.

If we take pharmacy work as an example, I’m very open to having a discussion with a Pharmacist who is writing up an HMR report if it will help them get their head around the situation and understand what’s going on. They’re trying to do better work in service of the patient and the GP. I am not open to an HMR pharmacist asking me questions because they are expediting the process of looking something up for themselves in a core reference. I read this as being lazy in an attempt to be more profitable. The outcome might be the same, in that they are both producing an HMR report, but I interpret the actions and the reasons underpinning them are different. One is based upon self-improvement, the other maximising personal gain.


The question is, how do we recognise these values in others without being super judgemental? I have no idea, it’s all based on judgement in one way or the other. I think it’s probably about being open. Being open to sharing more of ourselves, so that others know where we’re coming from. And being open to being wrong and changing your point of view. In a group setting I think this means being transparent, even if it looks a bit wanky. Clearly articulating and defining shared values and principles and using them as the basis of decision-making. I feel like that would be a good start, anyway.


Student Mentality

This morning as I was mid-plank in the middle of my workout, the voice of a seven year old girl came into my head. “The secret to a good handstand or cartwheel is to really push through your hands, like you’re pushing the floor away”. I followed her instructions and my form improved. The voice was that of a girl we met at the park last week who gave my daughter an impromptu cartwheel lesson.

One of the things that I’ve learned in more recent years is that there’s a difference between learning and education. This is my interpretation of it. Education is focused on outcome, on knowing some sort of ‘truth’, achieving an objective. Learning on the other hand is about the experience and process of change, of evolving your position according to your individual needs.

Obviously there are some circumstances where it has to be about education. I don’t want a pharmacist who doesn’t know how a beta blocker works, or what pharmacokinetics means. Domain knowledge is very important. I tend to want the teachers of those types of education activities to be experts in the area they’re teaching. Or at the very least be a few steps ahead of me and not just be reciting a text book.

But learning is very different. Learning can be triggered by any source. It doesn’t have to be an expert, it could be a random seven year old girl. Because learning is about a mindset, an openness to the world around you. Having a student mentality.

I’ve read two solid thought provoking pieces on this recently. In his book Ego is the Enemy, Ryan Holiday illustrates it with the example of Metallica’s lead guitarist. As the band got their first big opportunity, he sought out guitar lessons which is probably the opposite of what most people would do. Most would just revel in their success and ride the wave for as long as it lasts. But he wasn’t satisfied with good, he wanted to be better. He kept bringing riffs to work on with his teacher for years, continually striving to improve even after the band got really successful. Because he knew there was always something he could do better.

Being comfortable about not knowing everything is what shifts education activities into an opportunity for evolution of the self. Its also what allows us to be open to all of the learning opportunities around us. Holiday writes

The pretense of knowledge is our most dangerous vice, because it prevents us from getting any better. Studious self-assessment is the antidote.

it is not enough only to be a student at the beginning. It is a position that one has to assume for life. Learn from everyone and everything. From the people you beat, and the people who beat you, from the people you dislike, even from your supposed enemies. At every step and every juncture in life, there is the opportunity to learn – and even if the lesson is purely remedial, we must not let ego block us from hearing it again.

The other thought-provoking source was this blog post by Ramit Sethi about why it’s so hard to find a great mentor or coach. He argues that its because we’re often not very good clients…i.e. we need to have a student mentality. Sethi lists three signs of a great student: that you can afford it (time and/or money), you’re mentally ready to learn, and you welcome the struggle. Learning isn’t about making yourself feel good, it’s about pushing yourself into new areas. That should feel a bit uncomfortable.

You can look for the perfect program. But until YOU’RE the right student, it won’t work.

I think of how many times I’ve taken good learning opportunities for granted because I’ve been a poor student. For me, this particularly relates to educational activities. I can think of many examples of when I’ve completely dismissed an educational activity and disengaged from it because I didn’t think it was up to standard. But I suppose there’s something to learn even in sitting through a boring, un-engaging talk, a poorly facilitated workshop or reading a badly written article. For one thing, it’s good to know how not to do it. But critiquing is easy. I think the more challenging activity would be to try and find the decent content despite the poor delivery. Maybe I’ll set myself that challenge the next time I’m at a conference trying not to switch off after a string of dry presentations.

Learning is everywhere if you’re open to it. Be open. Set yourself a challenge to learn something new every day and see what happens. Consciously seek it out every day. I bet it will lead to something good.



Human = Creative

I was watching a show on Netflix the other day called The Creative Brain. It was ok, not one of my top recommendations. But it did have Nick Cave in it which I consider a positive, and it did remind me of something that I think people often forget: what differentiates humans as a species is our creativity. The good old prefrontal cortex.

For a long time I’ve thought of myself as somewhat artistic, but not all that creative. The main reason for this has been that I am terrible when it comes to making something from nothing. Give me a blank canvas and an open mind and it will likely stay blank unless I have something to use as a reference. If I’m given the task of producing a creative piece of writing is going to be full of cliches and completely derivative, even if you give me a prompt. I think it’s the main reason I thought that I was bad at English throughout high school, because I bombed so badly in that section of every exam.

Creativity isn’t about creating something from nothing, it’s about making something out of what you’ve got. And it’s not something that sits within the realm of the ‘creative industries’. Any time you are looking at something and bringing it into the new, you are creating. That could be coming up with a research question. It could be asking a pertinent question after a lecture. It could be making medicines information relevant for the patient in front of you.

We are all inherently creative in our own ways. It’s what makes us human. Unfortunately, the other part of what makes us human is our amygdala and avoidance of anything that makes us feel uncomfortable. That’s the bit that often gets in the way of us unleashing our creativity…but that’s a topic for another day.

Mis-shapes, Mistakes, Misfits

I have always been a little bit of a misfit. Just a little bit. At school, I suppose you would say that I fit in with the popular crowd, but I did academic-type subjects and was in the school musicals so I was actually a bit of a nomad friends-wise. On casual days when most people were wearing adidas snap-pants, I would choose to wear corduroy. My pencil case was covered with the names of indie and brit-pop bands, not the Spice Girls or Pearl Jam.

Once I’d left school I realised that even though I didn’t really want to be like everyone else, being fully immersed in some sort of sub-culture didn’t really do it for me either. I don’t know if it’s a positive attribute or not, but individuality has always been something that I’ve really valued. The result has been that I’ve always kind of fit everywhere, but kind of nowhere at the same time.

Most of the time I find it’s a perfectly fine way to be. Of little consequence. But it’s been much more difficult for me to embrace in my professional world than anywhere else. At times, it’s created a barrier to my communicating and working with others and been the source of immense frustration. I think it’s why I left working in a hospital pharmacy. I felt as though my desire to push boundaries and find new ways of working created friction with certain people that we just couldn’t get past. I decided that it wasn’t doing me much good feeling so frustrated all the time. If I stayed I was destined to become a worse version of myself. So I left.

Thankfully I went to a different team environment that proved to me that I was capable of working with a wide variety of people. I don’t know if it was because the team was so diverse or because I’d matured (probably both) but I realised that there were plenty of avenues where I could contribute to quality care and not have the same level of frustration. Where I could make stuff. I also learned that its possible care deeply about the work while maintaining a level of disdain for the professional culture in which you work. Some may call that cynical. I call it realistic.

I’ve often thought about retraining and moving into another area of healthcare, or another industry entirely. I enrolled in a uni that didn’t have a Pharmacy school for this very purpose. I didn’t really care about Pharmacy, I cared about doing work that could contribute to better outcomes. Kind of ironic that my whole thesis is ending up being about the value that primary care pharmacists could contribute to cancer care, because that definitely wasn’t how it started out.

Here’s the thing. I still don’t care about Pharmacy. I don’t care about engaging in the pharmacist vs GP turf war about pharmacist prescribing. I don’t care about other people valuing what we do. I don’t care about securing our future or pay rates. I don’t care about calling myself a ‘clinical’ pharmacist, or my post nominals or credentialing status. Some might call me a cynic, disengaged, whatever they want I don’t care because they are judging me by a different set of values to which I apply to my life.

I care very deeply about doing work that matters. For me, the work that matters is contributing to changing things for the better in a way that I am proud of, whatever mode that takes. It might be writing a paper, interacting with a student, coming up with a strategy for a project, researching something, talking with someone about their medicines. That’s the stuff that I care about. And learning every day about how I can do it better. Caring about the details.

I read an article today that perfectly articulates all of these things that I’ve been thinking about not discounting the misfits. It shares the story of pixar, and uniting a team of disgruntled animators together on a project that gave rise to The Incredibles. Because dissatisfaction doesn’t always have to give rise to fight or flight; if given the appropriate outlet it can also lead to invention.

It wasn’t about getting angry animators in a room to complain about the system. It was about finding the people who felt like their skills weren’t being utilised, their creativity stifled by the environment.

“I want people who are disgruntled because they have a better way of doing things and they are having trouble finding an avenue,”

Pixar found the race cars that were spinning their wheels, took them out of the garage and let them race.

I think there are a lot of people who have experienced similar struggles to me. They kind of fit in, but kind of don’t, and each have their own personal reasons why this is true. But I don’t buy into the idea that they’re all cynical, disengaged and non-contributors. I think a decent proportion are frustrated by a system that doesn’t know how to utilise them. A profession that doesn’t push hard enough for quality or foster creativity and innovation. I think it’s time to remind these people they have the keys to their respective garages. Go get your race car off the blocks, bring it to the open road and let’s race.

Courage Over Confidence

One of the things I’ve found challenging over the years relates to being confident. It’s kind of weird, because in some ways I feel like I’ve been supremely confident in what I can do. But like many, it’s often coupled with a bad case of imposter syndrome.

I heard something today that made me feel slightly more comfortable with this. I was listening to an interview with Debbie Millman who hosts a podcast called Design Matters. She talked about confidence being less important than courage.

True confidence comes from experience. You’ve been in that situation multiple times before and you know you can handle it. You’ve got a track record.

It takes a lot of time to develop a track record or build a body of work. If you’re starting out in a new area, trying a different approach, or innovating in any way you won’t have prior experience in it. You might have an inherent belief that you’re capable of it, you might have experience of demonstrating those skills, but you haven’t proven yourself in the past. This means there’s a chance that it might not go as intended. You could fail. This is where the courage comes in. Taking something on even though you’re not quite sure if it will work out as intended.

I will take courage over confidence every time, and for one important reason. Confidence might make me feel safe and assured, but courage takes me new places. It allows me to test my boundaries and find the edges of my capabilities. To have courage provides you with the opportunity to get out of the rut and get moving from somewhere you happen to be, toward a place you want to be.

An About [type] Face

I often come across Pharmacists who are quite indignant about people thinking all we do is put labels on boxes. That people don’t have a deeper understanding of our professionalism, the skills and expertise that we contribute to patient care. So I wanted to give just one example (I have many more) of when I have learned of my superficial understanding complete ignorance of someone else’s work.

Imagine I’m at a party and I get talking to someone. The conversation starts with the boring but safe “so what do you do?”. I say “Pharmacist”, they assume I’m work in a community pharmacy dispensing drugs. They say “Typeface designer”, I say…I don’t know what I’d say. Probably “what does that involve?” because I genuinely have no idea.

I don’t know if you’ve ever given any thought to how the fonts we use and consume every day came into being, but I will be honest and say that I had given it exactly zero thought. I hadn’t even considered it as a ‘thing ‘before. Thankfully my ignorance was not exposed by an awkward interaction at a party, it was revealed to me through watching Abstract on Netflix. The episode on typeface designer Jonathan Hoefler.

It turns out that all of the typography we see, be it a street sign, a text message, a novel, a campaign poster, the numbers in a lift…all of it is the output of professional designers. All of the digital fonts available to us have been carefully designed and crafted by people, inspired by a conceptual idea. The creativity involved in turning such a concept into something tangible is really quite remarkable. But it’s far from just a creative exercise, there’s precision and science that underpins the techniques. And lets not even get into the subtle differences between fonts in the same family depending on their intended application of use.

So the next time you’re confronted with someone who thinks a Pharmacist is a person who sticks labels on boxes, stop for a moment and consider how much you know about the work of all the industries that you interface with every day. To many people, health is just another industry. They take things for granted and accept the artefacts of care at face value. And that’s ok. Don’t be indignant. Engage them in conversation.


Sharpening Pencils

My daughter recently learned how to sharpen pencils. She loves drawing so you might say this is a required skill and a good thing. But left unsupervised (or loosely supervised) she will turn a pencil into a tiny unholdable stub in a matter of minutes, with zero evidence of artistic expression. Granted it will have a point that could be used as a weapon, but I’m not convinced achieving that point outweighs the pile of unused shavings that is evidence of her over zealous sharpening.

Given my love of life lessons and metaphors, I was thinking about this in the early hours of this morning. How many of us are so focused on sharpening our skills and talent that we use up all our energy on this rather than making art? Maybe we think that our expertise and domain knowledge is the most important thing so we neglect exploring our creativity and ways to connect. Or maybe we’re unsure of ourselves so we keep refining and perfecting before we let anybody see what we can do, exposing our vulnerabilities.

Whatever the reason, the thing about art is that it doesn’t have to be perfect. It does have to say something, take a perspective. This makes vulnerability an inherent component. But being willing to share it anyway, that’s what makes you brave. Courageous. Art isn’t supposed to please everyone, but connection with someone to induce a response (positive or negative) is essential. If it doesn’t connect with anyone then is it really saying anything new or interesting? Negative reactions aren’t so bad once you get used to them. Maybe they’re not your intended audience anyway. Maybe their an armchair expert who never has had the guts to produce art themselves. Maybe they’ll share something that will help you make better art.

We shouldn’t avoid making things because of what might go wrong, or what we might fail to achieve. We should use our skills and talents to create, to share and connect, not just consume and regurgitate.

As Neil Gaiman famously says…”make good art”. As I not so famously (and sometimes frustratingly) say, “quit sharpening your bloody pencils unless you’re going to use them!”

Go and make interesting mistakes, make amazing mistakes, make glorious and fantastic mistakes. Break rules. Leave the world more interesting for your being here

Sense Makers

A week or so ago I wrote about how I was challenging myself not to be so critical as my default position. That if I go into something looking for problems I am going to find them, and as a result I might overlook some of the other offerings. I’ve since started reading/listening to two books that deal with this sort of stuff – Mistakes Were Made (But Not By Me), by Carol Tavris and Elliott Aronson, and Talking to Strangers, by Malcolm Gladwell. Now I know some more words and theories so I can sound clever when I talk about cognitive dissonance, cognitive bias and default positions.

I knew these terms before, and I thought I’d written about it before but it must have been one of those mental blurbs that I put aside to write in more detail later on. In any case, it is the sort of knowledge and awareness that is so useful in general life, but essential as a healthcare provider.

One of the aspects covered by the books relates to how bad most people are at detecting lies. That our default position is that people are telling the truth and not out to deceive us. The down side of this is that we might get scammed, your partner may have a secret family on the side, or an international spies may be able to hide in plain sight. But I want to talk about what I see as a potential upside, specifically in our role as Pharmacists.

I think medical care distorts this default position for many people. When people consult with doctors, it isn’t a usual kind of social interaction. There might be a perceived power differential. A sense that the doctor is in charge and their time is valuable. A sense that the patient is too assertive and bullying in their behaviour. In terms of communication it’s likely that there are all sorts of filters being applied by both parties and every situation is likely to be different. The patient might not offer up all the relevant information because they don’t want to shift focus from what they think is important. The doctor might not ask certain questions because they don’t think it applies. For whatever the reason may be, the doctor might not hear the patient’s full story.

This is where I think we as Pharmacists have a great opportunity. This is where I believe we offer value routinely. Value that we sometimes don’t recognise and definitely don’t market.

We are much more likely to be able to engage people in more normal social interactions. That’s the advantage of people assuming we’re just there to talk about medicines, we can fly under the radar and they can be less guarded. By embracing the default position of assuming that the person is telling the truth rather than trying to find out the problem, we can encourage people share their stories with us and we can listen to them. Not the filtered, censored story. The long winded, divergent, sometimes a bit irrelevant kind. This is a position of privilege in healthcare. We shouldn’t take it for granted, we should celebrate it. We can do that by making sense of the story.

By making sense of the story, for the patient and their care providers, we elevate our value above that of the volunteer that provides them with their tea and biscuits. They also hear lots of peoples stories, but they don’t necessarily do anything with that information (although the good ones might). By combining the narrative that we’re able to elicit with our domain knowledge of pharmacotherapeutics, and our clinical understanding of the situation we are able to translate that story into something of value for both patient and clinicians.

Our value proposition is not as the experts of medicines. It’s not our active listening skills. They make up our skillset, but not our value to the overall healthcare team. Our value proposition is that we are the sense-makers.

Going Underground

I’ve been watching the latest season of Hip Hop Evolution on Netflix. Such a great series, whether you like Hip Hop or not. For me, I now have a whole new appreciation for it both as a cultural movement and as a genre. It’s the cultural movement aspect that I’m thinking about today.

Season three is about the 90s/early 2000s and starts with the East coast vs West coast issues which came to a head tragically with the deaths of Tupac and Biggie. Maybe not as neatly as that description but you get the idea. Arising from that was the ‘jiggy era’, where hip hop became popularised. People like Puff Daddy in shiny suits with casts of gyrating women. It’s not that this was inherently bad. It’s a good part of the reason why they were able to move forward after Biggie died, because they chose joy and ridiculousness over spite and revenge. Incidentally, if you want a tear jerking moment watch the bit about the song Missing You. I knew Puff Daddy was Biggie’s best friend but I didn’t know Faith Evans was his wife. I think that song’s going to be on my ‘hits me right in the feels’ list from now on.

So it’s not that they were doing something bad, but to a lot of people this sort of music did not reflect the culture. And the culture really mattered to them, that’s what it was all about.

In New York groups of freestyle would gather in Washington Square, but that no longer became an option for them when Giuliani started to clean up the city. So a couple of guys thought they would find a venue, stick up some posters and see if anyone would come. They did and it became a place called the Lyric Lounge. On the west coast, the elders of the community thought the people needed a meeting place so they opened up a health food store after hours to host rap battles. In Detroit they were held in a shop that sold jeans. All different people who wanted to support the culture, proving a meeting place for the artists to do their thing.

What I find most interesting about this, is that of all three instances, the action came from people who wanted to make an active contribution to an outcome. It was the cumulative effort of the artists, the audience and the people who made the venues available to act as gathering places for the underground hip hop community to flourish. Should you feel bad about yourself if you were just a regular member of the audience and not one of the MC’s? Well, the rap battles wouldn’t amount to much if there wasn’t an audience there participating in the action. Everyone plays their part in different ways, and it’s not all about the glory. Being part of a culture that you’re proud of is what really matters, whichever role you play.

Revisiting Grit

In an earlier blog I wrote about grit. The interpretation I had was one that associates grit with perserverence at all costs. So I didn’t speak about grit as always being a good thing. Because it’s good to know when to quit. I’ve since learned about a broader interpretation that’s made me rethink the concept.

Perserverence is one of the factors that makes up grit, and apparently it’s common to think of them as synonyms. But there are other factors as well. Angela Duckworth wrote a whole book on it. She talks about 5 characteristics: courage, conscientiousness, long-term goals and endurance, resilience and excellence.

But I like the way Seth Godin talks about it. He talks about grit being the stuff that gets stuck in machines and stops them from working. This fits well within his overarching metaphor of aspiring to be anything but a faceless cog in the industrial machine. In his book The Icarus Deception is the following passage:

Grit includes perseverance, but it comes before the need for perseverance arrives, because grit includes goals and a passion for those goals. Some people will persevere merely because they are instructed to do so. Those with grit will persevere because they believe they have no choice, not if they wish to be who they are.