 So it's my pleasure and honor to introduce Dr. Shoba. CHIP is a real leader in surgery and in American medicine in many different roles. In academic surgery, we often talk about the triple threat. But CHIP goes well beyond that because it's not only teaching and research and surgery, but it's education and leadership and running programs. So Dr. Shoba is the vice president for medical affairs and dean at Dartmouth Medical School. He has a long career in many different institutions. A few highlights. Not only does he have an MD, but also a doctorate in nutritional biochemistry. He did clinical training in surgical oncology at MD Anderson, was on the faculty at the University of Florida before going to Massachusetts General Hospital, where he was the chief of surgical oncology. He subsequently was at Hershey Medical School, I'm sorry, Penn State in Hershey where he was the chair of the Department of Surgery before going to Ohio State where he was the dean and now recently at Dartmouth. CHIP, in addition to his MD and his doctoral degree, has an MBA from my alma mater. I'm trying to claim some connection to Dr. Shoba from Boston University. And he has written widely on basic science, on mentorship, on leadership in surgery. And it really is an honor and a pleasure to welcome you. Thanks, sir. Thank you. Thank you. Thank you. Thank you. This is the right thing? Yeah. Very good. So, are we mic'd up here? You hear me okay? Doesn't. That doesn't project, that's only for the taping. Oh, it's just for the taping. Okay, so first of all, thank you very much for inviting me. You know, I have a degree of affection for the University of Chicago more than most medical centers. We love Chicago. I have a number of dear friends here. And you know, I think your commitment to scholarship and discovery and education is as good as it gets. So I feel part of that. And so I appreciate Dr. Siegler and Dr. Angelo's reaching out. Let me just give you a little context about what we're gonna try to do today. This work, what we're gonna talk about is likely to show up for most of you as counterintuitive. But both Peter and John said it was okay if we did some brain breaking work. So we're gonna do a little bit of that. The second thing is, you may wanna pretend that we're in Nordstrom's and that you're there to buy a jacket. And you're gonna try it on. And just like any time you go to the store to buy a jacket, if it fits, if it looks good, you'll buy it. If it doesn't fit, you take it off and put it back on the rack. So, you know, I'm not claiming this is the truth or gospel or anything like that. Just try it on, see if it works for you. So here's, I usually don't have objectives like this, but I decided to do that today. Here's, I don't wanna say my promise to you, but hopefully by the end of the hour, you will be able to identify and manage the disempowering ways you wound up being that get in your way of being a professional and acting professionally. Right away, notice the language is maybe a little different. Number two, incorporate the four pillars of being a professional into your everyday activities and interactions. Number three, competently use the emerging language of professionalism and experience its power. And number four, access, you'll be able to access the most challenging professionalism situations that you deal with and frame them in such a way that they show up as hit-able. We'll talk a little bit about hit-ability in a minute. And when they show up for you as hit-able, they'll empower you to be a professional and act professionally as your natural self-expression. Okay, so there's some new language there, hit-ability, natural self-expression, the way you wound up being, we're gonna delve into that. So I'm gonna start with a story. I'm a big baseball fan and almost about 20 years ago when I was a junior faculty member, the great Ted Williams was admitted to the teaching hospital at the University of Florida. He was not my patient, but he was always sort of a childhood hero mind. And make this long story short, I really wanted to spend some time with a guy. And what better opportunity to spend time with someone when they're recovering postoperatively from a procedure? So long story short, I managed to spend an hour with them, just the two of them. And one of the things I wanted to ask him was how he hit a baseball. How do you hit a 100 mile an hour fastball? And I was about 37 at the time, and I guess somewhat ignorant. I was looking for an algorithm. I was looking for a formula because I said, you know, if this guy can tell me how he hit a fastball, maybe I could go do it. And so I asked him, I said, you know, and for those of you who aren't big baseball fans, you know, this guy arguably the greatest hitter in the history of the game. Maybe others, but he would certainly be right up there. And so I'm sitting there talking to him, or actually standing, and I said, Mr. Williams, you know, you've got about two tenths of a second to make a decision. The ball's coming so fast. How do you do it? I, you know, do you stand in the batter's box in a certain way? Do you bend your hips, you know, elbows, arms, tilt your head? How do you do it? And I was interested because this was a guy who had written a book called The Science of Hitting. And he, more than any player, really studied the art and science of hitting a baseball. And I was very disappointed with his answer because instead of telling me how he did it, his answer was, I don't know, the ball just shows up as hittable. I said, great, that really helps me a lot. And I thought I might get a more clear answer because this was a guy who broke the strike zone into 77 different compartments and measured his batting average in every compartment. You can see here in the middle, he was consistently hitting over 400. His weakness, if he had one, was, you know, low and outside where he batted about 250, still pretty decent. And I thought with this kind of scientific analysis, he would certainly be able to tell me how to hit a baseball, not the case. About 10 years went by, and I really didn't think much of the conversation. And then I started to get into a little bit of the work we're doing now. And what became clear to me was that there was some relationship between language and the brain. And because in talking to Mr. Williams, it was very clear that this guy would actually have a conversation with the baseball as it was coming down to the plate in the sense that he would observe it, see its movement, see its spin, see its lie, see its velocity. And that interpretation was occurring in language, in words that self-talk, if you will. And I thought there was something to that. And so that what I took from that that we would reframe for today was something like this. How do we access our toughest professionalism challenges and reframe them so they show up as hittable? Could that be possible? And that's what I wanna explore with you today. And an important foundation of the conversation is this notion that what Ted Williams had mastered, arguably more than anyone, was what we're gonna call the conversational domain of hitting a baseball. Now you may say, what do you mean? I could get that there's a conversational domain around physics or molecular biology, but hitting a baseball? Well, I'm gonna try to persuade you that part of hitting a baseball is being very conversant with the ball and the way it's coming down towards the plate. So let's take this concept that expertise in anything requires mastery of a conversational domain. And by conversational domain, and we'll use medicine as an example, it's nothing more than a network of discipline-related terms that are linked together in such a way that they form a unique language. And those of you who are physicians or clinicians and nurses in the room know that there is a specialized language of medicine. And if you don't know words like odynophasia or torticolus or tinnismus or portal hypertension or those kinds, if you don't know those words, you can't converse in that space. So there are literally hundreds, if not thousands of unique medical words. And you can kind of get how your patient who doesn't speak the language of medicine would not really have access to the space we call medicine the way that you might. And the conversational domain is basically a lens or a context for understanding and interacting with your patient. So it goes something like this, and all of you who've been practicing for a while know this. The language of medicine gives you special access to your patient's history, physical, illness, disease, suffering in a way that someone who does not have the language cannot have that kind of access. And in fact, if you talk to people, for example, trauma surgeons who are down in the emergency room with a critically ill patient who needs immediate attention, they will tell you that they don't sort of jog up in their head, oh, here are the various steps that we have to undergo with this patient. They just sort of do it. And it's bolted into memory and it becomes second nature. So the point here is that mastery is essential to communicate, perform, and innovate. Some of you in the room are probably masters of the conversational domain of molecular biology. And you cannot work in that space without that mastery. And I'm not a much of, I may be a little proficient with that language, but I'm certainly not a master. So whether it's hitting a baseball or molecular biology or astrophysics, there's even a conversational domain for plumbing. You talk to plumbers, they got this specialized language around joints and pipes and fittings and all that sort of stuff. And more importantly is that once you master something, it becomes part of your second nature. And what we mean by that is it just kind of becomes part of you and part of your natural self-expression. And another way of looking at it is that the effortlessness and spontaneity of that results in the conversation using you. Not only do you use the conversation, the conversation uses you. So again, physician taking care of a patient, the conversational domain uses the physician, Ted Williams hitting a baseball, the conversational domain of hitting a baseball uses him. And you know this because there are some real life examples. If you talk to people who make a living hitting a baseball, they'll tell you that they don't think about it. There's not enough time to think about it. If you talk to people who are master skiers, you know really expert skiers, and you say, well how do you ski? I'm not an expert skier, but ask somebody who is, the last thing they think about is how do they put their feet on the snow? They don't think about that. They're in a dance with the mountain. And the same thing with people who operate. You know, you could break down the various steps in a surgical procedure and measure the amount of force behind a needle driver, the amount of resistance of suture going through the tissue, the amount of torque. You could measure all that and put a mathematical equation up on the wall. But that's not how surgeons operate. When you operate, you're in a master surgeon is in a dance with the incision. And they operate as live. They operate with the incision the way it occurs for them, the way it shows up for them. So we're gonna talk a little bit about wouldn't it be interesting in this space for calling professionalism if you didn't have to go to some textbook or go up into your head and say, now how am I supposed to behave in this situation? What if it was just part of your second nature? And every time you encountered a difficult professionalism circumstance, you could just be in a dance with it and your natural self-expression would emerge. Okay, so we talked a little bit about conversational domains. You know, this is kind of the prevailing conversational domain or at least part of it that you and I are familiar with. It's patient focus, it's not physician focus. It talks about treatment, physician-led. You know, my chief did it that way. Competency assessment at M&M. And this is not wrong. This is not wrong. In fact, it's necessary. But what I wanna invite you to consider is there's another conversational domain which is newer and complementary. And it's more, it includes things like population focus, coordinated care, evidence-based medicine, value rather than volume, healthcare delivery science, as well as basic and clinical science. And the intersection of those two domains is where there's power. And you have to know both, you have to be able to speak both languages, right? I mean, if you look at Einstein's work, his mastery of both the conversational domain of mathematics and physics is what gave him the power. But we're also gonna suggest that there's a third conversational domain. We're gonna call it the conversational domain of professionalism that I know Dr. Angelos and Dr. Sigler and I suspect all of you would agree that if you could master that conversation as well, that would even give you greater power in terms of your effectiveness as a clinician. And what we're gonna argue is that mastery sits right in there. Okay, so these are some thoughts that I have about professionalism. My take on this is that teaching physicians about professionalism is distinct from creating physicians who behave professionally. And by the way, the reason the slides are wordy is because it is a bit of a different language and my experience is that you get it better when it's wordy. I'm not, ordinarily I'm not a big fan of a lot of words, okay? Number two there, in order to create physicians who behave professionally, we must reveal the hidden contexts that shape those particular ways of being and acting that are the source of professionalism breaches. And we're not just talking about breaches when somebody goes up and yells at a nurse or a student. We're talking about ways of dealing with professional or ethical challenges that may not be optimal. And if you could reveal the hidden context that get in our way that we argue would be helpful. Number three there, creating for oneself, creating for yourself, what it is to be a professional requires mastery of the conversational domain of professionalism. We said, if you wanna be a master, you gotta master the conversational domain. What we're saying here is there is a conversational domain of professionalism. There's a prevailing conversational domain that most of you are familiar with. There's an emerging conversational domain that you're not familiar with. And we're saying both are necessary. And then again, what physicians create in language uses them by providing a context or a perspective from which they can orient their thinking, speaking to actions such that they're consistent with the tenets of professionalism but also their national self-expression. The way you're going to behave as a professional is different than the way Dr. Angelos is gonna behave. You're both gonna be professional but he's Peter and you're you. And you're gonna get into trouble if you try to copy exactly the way he does it. So you wanna find your own voice. You know, what natural ways of being speaking and acting work for me that allow me to be a professional adds a little spice as well. So if you look for yourself, you will see that when you observe professionalism, what you see or hear is not professionalism per se. What you see or hear is some way of being. Something said or some action which you as an observer can ascribe or not ascribe to professionalism. Everybody get that? You see somebody on the floor acting professionally with a patient. You're not seeing professionalism per se. What you're seeing is some way of being or some action that you say that's professionalism or that's unprofessional. When you see someone being a professional or exercising professionalism, you see someone functioning in the sphere of language. This is a tough one for people. They're functioning in the sphere of language. Now people say to me, I can kinda get that if a physician speaks respectfully to the patient or colleague or the student that lives in language, I can get that. But what about the physician that throws an instrument across the operating room? And my comment is action speak louder than words. When somebody does something, carries out an action, the way you interpret it is in language. You say that's horrible or that's unprofessional or that guy's a jerk or that's not acceptable. And then thirdly, when you're being a professional and exercising professionalism, you'll be functioning in the sphere of language. So language is a very powerful tool in this that it's probably your most under leveraged tool that's sitting right there at your disposal. Okay. Now I had a little video clip in here and we are unable to show it, but there's a tribe in Africa that only has five words for colors. We have 11, they have five. And their word for blue and for green, blue, green is the same word. And if you show them an array of colors and you've got 11 greens and then this blue, you and I would pick out the different one in an instant because we have different words for blue and green. They can't do that. And it'll freak you out because you can do it, but they'll sit there and they can't tell that this is different from that green. So the question that that provokes for me is if words shape the way we see colors, might the language we speak and listen to shape and structure the way we think about and make sense of professionalism and could it impact our effectiveness in being professional? And if language can do that with colors, what might it do for professionalism or leadership or some of these so critical activities? So we're gonna move, so that's language and now I wanna talk a little bit about natural self-expression because we use that word and we sort of implied that being naturally self-expressed is wonderful. How many of you have ever been in your A game? Come on, you've all been in your A game at some point. Maybe not often enough, right? But when you're A game, when you're in your A game or in the zone as Mahaley used to say, right? He coined that term, guy from UC, or when you're at your personal best, you know, it's nothing's better, right? That's your natural self-expression and it refers to a way of being and acting in any situation that is innate, spontaneous and an intuitive response to whatever you're dealing with. So imagine that you're confronting a really difficult professionalism challenge or an ethical challenge and it's a real dilemma and you're sort of bringing your hands and you don't know what to do and you're talking to your colleagues about it. If you could be naturally self-expressed in dealing with it, that would give you a spontaneous, inherent, innate response in dealing with it. That's what we're looking for. Number two, regardless of the professionalism challenge you're dealing with, your natural self-expression concurrently informed by theories. You know, so all the class courses and surgical M&Ms and medical ethics topics all of that, that conversation's critical. You know, that's where theory comes from. So you want it concurrently informed by theories but if you were also naturally self-expressed it would give you the power and freedom to be a professional and act professionally. Notice I keep emphasizing be a professional and act professionally. The being and the acting go together, right? You can't act kindly unless you're being kind in the first place. They go hand in hand. And then we said before in striving for excellence there's a point where what you've been trying to learn actually becomes part of you. We're saying this another way. Instead of you using what you learn it, so to speak, uses you. It has become your second nature. This is mastery. And I guess what I'm suggesting to you is wouldn't it be awesome if whatever difficult situation you were dealing with you could find your natural self-expression in ways of being that gave you the greatest amount of power to deal with it. That would be awesome, right? Now, one of the things you probably or may be asking is, geez, this natural self-expression stuff is awesome but I'm naturally self-expressed about two seconds a day. And most people would say, but you're like to be in my A game more often but I'm not. Why is that the case? It's because there are barriers that you and I have erected ever since we were children. And let's just say it this way. For most of us, the experience of expressing ourselves fully, powerfully, with grace, poise, ease, is something that, particularly in a way that, Peter heard me say this earlier, touch moves and inspires other people. It just is all too uncommon. We'd like to be able to do that more often. I think in general, the way it shows up for me is that most people feel limited to being the person that we know ourselves to be. And we're gonna call that the person we wound up being. You know, not infrequently you'll hear somebody say, I don't know, that's just the way I am. That's just the way I am as if they're kinda stuck with it. Well, I'm suggesting to you that you're not stuck with any particular way of being. And if in dealing with a difficult, ethical or professional challenge, your typical way of being was to get angry or to withdraw, all I'm suggesting is you're not stuck with that. What if you could be a different way, like curious or inquisitive or appreciative? That might be a better way to be in those particular circumstances. And we can all experience firsthand how a particular way we wound up being constrains us to a certain range of self-expression may allow us to act professionally in some circumstances, but in the majority it does not. I mean, there may be a time when part of acting professionally is to raise your voice. But I think everybody would say, yeah, there may be a few circumstances like that, but if that's your default way of being, if that's your go-to, it's not gonna work very often. The old Cubs coach was notorious for that as you. Lupinella. Okay. So let's keep talking about the way you wound up being. And by the way, the large majority of ways you wound up being are wonderful. They give you great power. I mean, I have been here a day and I can feel unequivocally, many of your wonderful ways of being thoughtful, kind, generous, funny, inquisitive, grateful, appreciative, confident, optimistic, those are wonderful ways of being. But we all have ways of being that get in our way. It's just part of being human. And curiously, you often don't know about them. Other people do, but you don't, okay? So we develop early in life these strategies for avoiding failure or for avoiding stress or for avoiding looking bad. I'll give you an example. I use this all the time. When I was six, true story. When I was six, I went home from school one day and my mother said, why did you get a B on that test? May have happened to some of you or something like that. And at age six, my interpretation was, geez, I guess I'm not good enough. And by the way, that's the interpretation that most adults make as well. And so my default way of being, not just from that incident, but several like it was, well, you know, not being good enough is unacceptable. What my default way of being was to become an achievement machine. And I did, five degrees, 350 publications. And you know, I was a middle-aged man before I got that that wasn't very authentic. It was all about me and my CV. That's not a future bigger than yourself. And I got clear about that. You know, and I had coaching from people like John. And I'm still achievement oriented. I still write and publish and find my voice, but it has nothing to do with my CV. It has to do with my natural self expression. So a lot of times these default ways of being are triggered instantaneously. Hence the term limbic abduction or amygdala hijack. You've got it. Some people, you know, it takes longer to fire or you have to step a little bit harder on their hand, but everybody will fire. And you've all got your default ways of being. You know, when things aren't going well, you know, I'm not saying you punch somebody. Some people will climb under the table. Other people will clam up and climb into a bunker. Others will, you know, yell. But there are ways that get in your way of your effectiveness, right? And you probably can't get rid of them, but you can get aware of them. And getting aware of them, just try it. Go into Nordstrom, put on the jacket. See if it fits. You'll find, I believe, that if you get aware of them, they relax their grip on you. Either of those terms. So for example, you may have learned early in life that a good way to deal with stressful situations was to yell or blame. That's a common way. Blaming, lying, making excuses, going postal are some of the ways people wound up being that are attempts to avoid failure or stress. These same kind of limiting ways, it may not be blaming or lying, but when you're dealing with a conundrum, a difficult ethical issue, a difficult professionalism challenge, for which there's no apparent answer. And you're a person who's always used to having answers. You're a person who's done great in school for your whole life. You're a full professor at the University of Chicago. You've done great at everything you do, and all of a sudden to be confronted with a situation for which there's no clear answer, not surprising that some of these default ways of being get triggered. So I want you to consider that human beings are listening. Animals aren't really listening because they don't have words. Do I think that a groundhog in the forest hears the rain? I suspect they hear the rain. But they don't say, hey, it's raining because they have no language. But you and I do. And so we're a listening. We're a conversation with ourselves that uses us by providing us with a point of view from which we orient our decisions. So just think of the tons of conversations that you have every day with colleagues, groups, what have you. How many times do you go into a meeting with someone where before you've even had the meeting, you've decided what the person's going to say and what your decision is going to be? I do it all the time, just part of being human. But what you'll find, I think, if you test this with yourself, is that that listening is something like this. And just try for a moment to obliterate your thoughts. Just try to not have thoughts. I defy you to do that. You can't not have thoughts. Maybe a thought will, I don't even know where thoughts occur. I know your brain creates them, but I don't know where they occur. But the moment a thought sort of wanders off, a new one comes in. And as you, you're listening to me right now and you're saying, do I believe this guy? Is he right? Is he wrong? Oh, I know better than that. What is that? This is strange. That's just part of the background conversation that always goes on. Get aware of it. Get aware of it all the time. We call this, you're already always listening. And we call it that because it's already there and it's always there. And it's a listening that by and large is judgmental. And it by and large includes rationalizations. And it ends up being a story. All my mother said was, why did you get to be on the test? The story I concocted are not good enough. And it haunted me for 40 years. That's tragic. You guys have that too. You just want to find it and not let it own you. It's a shame. So because so many of our limiting ways of being are unknown to us, we need our colleagues to help us. And it's kind of scary to go to your colleague and say, look, I really need you to give me feedback when you think I'm acting like a jerk. But you have to do that. And what gets in the way of your natural self-expression are these limiting ways you wound up being. If you could get rid of all of those limiting ways you wound up being, you would be naturally self-expressed. I mean, consider this. Are you single? Who's single? OK, we won't pick on any particular person. So just consider this. Suppose you met for the first time the man or woman of your dreams. I mean, it is your dream man or woman, the most exciting thing that ever happened to you, the only thing you ever wanted. And here you are meeting for the first time the man or woman of your dreams. What would it be like if you didn't have to go up into your head and figure out how to be with that person in order to impress him? What would that be like? What if you could just be you with no hidden agenda, no, hey, I need to look good for this man or woman of my dreams? What if you could just be you? What if you could just show up naturally self-expressed with no limitations, no barriers, in your A game? I guarantee you you'd be in your personal best. But we've got all this stuff that says, hey, I've got to look good. I'm going to wear my best knickers when I make this question. You know? I'm going to get my hair cut. I'm going to put on lipstick. So one question that comes in mind is, hey, is there something we can do to emancipate ourselves? When I say emancipate, get the handcuffs off. You don't need to buy a fancy car to impress me. And here's the metaphor is, let's assume this big oblong circle is infinite knowledge, infinite wisdom, infinite judgment. And all the integrity and prudence and authenticity that would go with that. And there you are over on the left. You're a knower. You don't know everything. But you're inside of this infinite knowledge and wisdom. And there's some stuff you know. So you know that today is Wednesday. And you know that Barack Obama is president. And you know that the University of Chicago is a great place. And then there's some stuff that you don't know. Like you don't know what the stock market's going to do in a month. You don't know how to skydive. But you know that you don't know that stuff. You know that you don't know whether the bulls are going to win or whether the cubs are going to win the pennant. You don't know that and you know you don't know it. And most people, as best I can tell, spend an awful lot of time trying to increase what they know and decrease what they don't know. So they'll do like me. They'll go get five degrees. They'll take a bunch of courses. They'll read a book. They'll, I don't know, find a new spouse. And there's nothing wrong with this, by the way. But if it becomes all-consuming, see, when I became an achievement machine, it was all-consuming. And the way it shows up for me was my family paid a price for it. There's this whole other space here called what you don't know you don't know. And if you don't know you don't know it, how are you going to access it? I mean, maybe you'll, I don't know, maybe you'll have a hallucinogenic experience and it'll dawn on you. But the best way is to ask somebody. Because this is where your blind spots and your filters sit. This is where your limiting ways of being that hold you back sit. And wouldn't it be great if you had a friend or a colleague or a buddy who would say, yeah, I'm going to be totally truthful with you. I'm going to be totally kind the way I say it and totally honest. That would be very helpful, I would think. So we talked a little bit about your way of being and acting has a profound influence on the quality of your life and on your effectiveness as a leader, as a professional. Now, what do I mean by that? Now, can everybody get that we're always being some way? We're always being some way. You're being quiet or you're being depressed or frustrated or happy or content or sleepy or we're always being some way. Even when we're asleep, we're being some way. And our way of being changes moment to moment in situation to situation. Yes? Your way of being has probably the most important determinant on your quality of life in the moment. So let's say your house burns down. Let's say you go home and say, oh, my house burned down. And if you're being angry and you're being frustrated and you're being victimized and you're being shafted, that's going to negatively impact the quality of your life in the moment and probably impact your effectiveness in dealing with the insurance company, your neighbors, what have you. But if your way of being is one of gratefulness, like I'm grateful that my children are fine. I'm grateful that I've got colleagues who are going to let us stay with them for six months. I'm grateful that I have house insurance. I'm grateful to be alive. Your quality of life is going to be good. And the likelihood your effectiveness in dealing with the people that you need to deal with to get this situation straightened out will be much better. Everybody kind of get that? You have some say over that. You have some say over that way of being. Your default way of being is to be angry and pissed off about it. But the thing I want you to get is that who you are for other people, your way of being with them, powerfully shapes who they are. I was talking to Dr. Angelos earlier, and he's very, very passionate about this stuff. I think it's wonderful. And one of the things we talked about was the way he is with you in taking his stand for ethics, ethics in surgery, professionalism. The way he shows up for you is going to impact the way you are for yourself. That's really, really powerful. Now, here's a great example. You take a bunch of, I got a friend in Michigan who studies this kind of thing. And the example he gives is he said, you take a bunch of old people, 85 or not so old people. They're sitting around talking about the election, their prescriptions, their orthopedic shoes. And they're just kind of sitting there. And then all of a sudden, somebody wheels in a baby who's like two months old. And they light up. Oh, isn't she cute? They light up. And then someone wheels the baby away. And they say, oh, the baby didn't even know it was there. And they say, oh, that baby was so much fun. He's so, no, you were fun when the baby was there. Right? All right, want to finish up here because I know people need to want four foundational pillars of being a professional, being a leader. I would say in any aspect of your life, if you can be this way, this is being. It's not doing. It's being. Being authentic, being committed, being in integrity, being aware, if you can. I think these might not be the only ones. There's a big history of philosophy behind this. We have some fellow philosophers in the room who are probably familiar with some of this literature. This whole thing of being is this field of ontology, or phenomenologic ontology. And it basically says, what does it mean to be? What does it mean to be a leader? What does it mean to be a professionalism? And so it's just being. Now, being in and of itself is not a lot, right? It's not enough. Because the only thing that impacts the world is, correct, action. And you want to impact the world. But as soon as you lock in your ontology, your values drop in, then your knowledge and epistemology in the field, and finally your, what we call your praxeology, or your action, or your practice. And I just want to make one point with this. And the point is, if you're not being a professional, it's impossible to act like a professional. You've got to be one first. You've got to be authentic. You've got to be committed. You've got to be aware of your already always listening. Once you be, then you can act. So a little side here, and this has always been helpful for me. Human beings are always living into some sort of future. Just check it out in your own life. The future you and I are living into, perhaps counterintuitively, powerfully shapes the quality of our lives in the present. Language we use in our work is, the future is the context for the present. So you're living into, everybody in this room is living into a future that says, I'm going to be alive for the next period of time. And sometime I'm going to die. You're living into that future. You may be living into a worried future because your R01 didn't get funded. Maybe you've got a problem with one of your children. Or maybe you're worried about the economy. But we're always living into the future. And if you think of your life as a three act play, like act one is past, act two is the present, we call it the current era. And act three is the future. The third act of the play, the future, enables and empowers who you are being, what you accomplish and your experience of yourself in the second act. Another way of saying that, if you go to a good theater, if you go to a good play, the three acts can't be totally disconnected. I mean, nothing can happen in the second act. Nothing can happen in the third act that the second act doesn't allow, right? I mean, if you're a surgeon in the third act, but you've got your hands cut off in the second act, that like doesn't work. So there has to be a bridge there. But the third act empowers what's going on in the second act. And what's curious about this is the future never comes. The future never comes, yet we're living into a future. And the fact that it doesn't come is irrelevant. The only thing that's relevant is that in order to be a professional and act professionally, the future you're living into has to be a future that's bigger than you are. Peter and I talked about this. It has to be a future about the students or the residents or your peers or your patients or the Hyde Park community. That's a future that's bigger than you are. If your future's only about your CV, that has no power. Try it. It has no power and it's wicked and authentic. And then committing to such a future will give you the power, freedom and natural self-expression to lead effectively in whatever you're dealing with. I watched John L. Verdi for 20 years be committed to a future called discovery with integrity. And he stuck with it because it was a future that he took a stand for. And he was willing to deal with journal reviewers and study sections and nothing was daunting because it was a future that he was committed to. Now look what he's done. That's power. That is real power. So leading yourself is about continuously reinventing yourself, you all know the high jump metaphor. We got a little bit of, with the Western row, we got a few more inches and a few more with the straddle, but it wasn't until Dick Fosbury completely changed it, completely changed the center of gravity. And now everybody consistently jumps over eight feet if they're expert in this space. So remember, every system, including the human operating system is designed to get the results it gets. If you're having quality problems in your hospital, it's because the system is designed to give you quality problems. If you're having access problems with your patients, it's because the system is designed to give you access problems. Reinvention in the case of people entails new ways of being in and acting. So, just to finish up, the prevailing conversational domain of professionalism, I mean, this is not exclusive, but today when we talk about it, we talk about the primacy of the patient, social justice, we talk about patient autonomy and shared decision-making. It's necessary, but it's not sufficient. What we've talked about today is an emerging conversational domain. And we've talked about every one of these terms, right? The conversation that uses you, you're already always listing what you don't know, you don't know, the future you're living into, hitability, the way you wound up being. And keep in mind that your effectiveness as a professional is a function of the conversation that uses you. Next time you go up on the floor and you're angry because you don't have some result or some whatever, and you feel like yelling at somebody, stop and pause and say, what's the conversation that's using me right now? And how do I rewrite that conversation? So to transform the being of any human being, you've got to transform that human being's listening. And one of the ways you transform people's listening is to start introducing the conversation into the social domain, into the fabric of the organization. I commend you because you got two gentlemen right here that are doing that. And we got some residents and some fellows and build that into the fabric. Start, make the conversational domain around professional and as ethics as important as science or RVUs or whatever other conversations are prevalent. Finish up with Ted Williams. The other thing that, the other part of the conversation I had with Ted Williams was I wanted to ask him about the 1941 season when he hit 406. I'd read about it, but I wanted to hear him tell me the story. And the story goes like this. The Red Sox were playing the last two games, it was a double header, the last two games of the season, and they were playing the Philadelphia Athletics. That team is now in Oakland, but they used to be in Philadelphia and the Red Sox were 17 games out of first. They were going home, whether they won this double header or not, they were gone, out, the Yankees had cinched the pennant and Ted Williams was batting 3996. Now, if you know anything about records, they always round it to three places. And his coach, Joe Cronin said, Ted, why don't you sit this out? You know, we're going home, you don't need to play, keep your average at 400, no one's gonna bat 400 for 20 years. This is 1941. And it was, I was touched, moved and inspired because the way he told me the story, he looked at me as if I was the coach and he said to me, he said, I said to Joe, Joe baseball is who I am and what I do. And he played that double header and went six for eight with a walk and raised his average to 406. So I leave you with the source of your performance isn't primarily what you know. The source of your performance is primarily a function of your ways of being in your actions. Check it out in your own life. Your way of being and acting is a result of the way the world, other people, whatever you're dealing with, including you yourself, occurs for you. If the world occurs for you as a place in which to be grateful, that's gonna be very different than if the world occurs for you as a place where you're a victim. And because you have language, you always have say over how you listen to and be with whatever you're dealing with. Even the most difficult, horrific things. My house burned down. You have a choice on how to be with that. You have a choice on what you say to yourself about that event. And because you have language, you have choice and the choice you make will powerfully, powerfully affect what I call life's hitability. Been a great audience. Thank you for indulging me. If we wanna do this professionalism right, then we do it by showing, not by talking. No, I think that, I think there's a couple of messages in, and perhaps Mark, I could have been more clear. So, you know, I think the first message is that, we often assume that the way we learn to be a leader or learn to be a professional who exercises professional behavior is by learning some set of theories or concepts or explanations that are in a book. And I think those are important, but they're necessary but far from sufficient. You know, at the end of the day, professionalism is what we call an as-lived experience. You just have to be that professional and the access to being is a linguistic event. So, you know, when we talk about, and you know, one thing for you to go chew on is, okay, we talked about awareness, integrity, authenticity, and commitment. Go chew on that and ask yourself, how does that show up for me? You know, what does authenticity mean for me? You know, that guy that I'm not sure I agree with said that being authentic is just really key to broadly being human but also being a professional. You know, if you're fake, it's really gonna be noticeable. And so I think that's one. The second is that, and this is particularly true for me in the surgical world, is we're very results-oriented and action-focused. You know, like patient needs an operation. You know, there's a plan, let's do it. And acting is critical. You know, the only thing that impacts the world is action. I mean, if you sit on your couch and just sort of say, I'm gonna be restful that doesn't really get much. But if you sort of say, I'm gonna start by being aware, committed, authentic, and inside of integrity, that becomes the foundation upon which you then can act. And you wanna act. You know, we wanna do because doing impacts the world. And I think that disconnects, certainly for surgeons, is sometimes missing. If you get jaded or feel the barriers, which are very real, I think one of the things that has sustained the profession over time has been the patient experience and the patient being able to reflect back gratitude when you think or expect they might be angry or the patient being able to reflect back kindness when they're suffering. And that, for me, is where the power of the doctor-patient relationship and of ultimately where professionalism is. Now, you can't get to that if you haven't settled all of this. But I think that other half helps one settle these things in a powerful and inspiring way. Yeah, well said. I think some people are naturally more inclined to be authentic than others anyway. But I thought to myself sometimes my authenticity may not be the kind of behavior that would be the best for other people. There are, I think, some people who are authentically just very selfish, very authentically nasty people. So I suspect there are limits to that criterion. So here's a way to think about that, Jen. You're in Nordstroms, okay? My own view is that everybody has an authentic self and these people that you describe as being authentically mean or whatever the term you used, that's a default way of they wound up being which is not their authentic self. So you think the authentic self is only for a nice person? Yeah, no, I think, you know, so most of us cut authenticity on the phoniness piece and if I tell you that I like your hair and that's baloney, that's not authentic. If you read Heidegger's work and I'm a big Heidegger fan, Heidegger says that the essence of authenticity is dealing with whatever circumstances, taking responsibility for whatever is thrown your way. You know, if you're born in poverty, authenticity is dealing with that. But for me, the step one in authenticity was for me to get really straight with myself that I was inauthentic. I think authenticity begins with saying I'm inauthentic and not judge yourself. Everybody's inauthentic and so what? We're all human. You don't know this but I was given the job to be the head of the Committee on Appointments and Promotions and we had recently changed our track system and it's very interesting because the Cope Committee now has to deal with how to promote people under a new set of criteria is now struggling with what the institution's commitment to authenticity is. So we wanna seek excellence, right? So you know, Adam Smith said virtue is got no moral implications to it. Virtue is seeking excellence at every level. So who are we gonna call a scholar? Who are we gonna promote as an institution, as a group, as an embodiment of scholarship? Somebody becomes magnificently trained in the best institutions but isn't as productive as we might want, doesn't create the same kind of margin on their practice and that's actually financially good for the institution but everyone would recognize us as a scholar. I mean, not a scholar because they have a paper in science but a scholar because of their professional behavior, the way they treat patients and everything else. So as an institution we say that person, independent of external review, that person by the University of Chicago collective morality or collective IQ or collective judgment, that person's a scholar. We're gonna live by it. Then you become authentic in a greater sense and a greater purpose and I think then everybody in the institution kinda ramps up. So I wonder if you could just speak to how an institution culturally, yeah, how an institution is by, I think we do a really good job and I think what I just was thinking are the people that I really, not to be uncomplimentary to the others here because I only know Peter and Mark's work and Holly's work really well and when I look at the three of them I think they're authentic. They're sincerity of the purpose of what they do is real and I think everybody recognizes that. Are they ambitious? They're ambitious but their ambitions lie in their seeking excellence, not in careerism per se. It's more of a calling than a job for them. So maybe you can speak as you travel around the country about what shapes authenticity in an institution. Yeah, so I think where institutions get into trouble with in this space is and I think it is extraordinarily difficult, particularly for a University of Chicago who has this very rich history and a wonderful history to change sort of the promotion and tenure guidelines but I think, and sometimes you can't change it because you can't get agreement. Now, good leadership would say, change it. Once you come up with the new guidelines I think where organizations get inauthentic is when they deviate from that in some sort of unlevel playing field way. Whatever the rules are if you play by the rules and have a level playing field I think that's authentic and Harvard I think is, I was on the P and T committee there for four years and you can disagree with their rules. They're extraordinarily rigid but they didn't matter who you were. They played by the rules and it's best I could tell applied those rules to everybody. Now they've gotten a little bit not softer but they've gotten I think wiser as they've gotten older and have encompassed but it used to be that if you didn't have two to three R01s for a long period of time and published in a set of journals and your external references had to say that you were one honest, one of the top three, one of the top two or three people in the world in your area of science, your external references, they specifically asked that. And so they held that standard to everybody and in that sense they were authentic but it was a standard that could only apply to Harvard if you applied that to everybody else you'd have two full professors. But these issues have no answers and don't let that bother you. It's a mountain with no top. It's in the process of climbing the mountain that the residents and your colleagues and you and the students acquire wisdom. Don't worry that there's no top to the mountain. Let's stop by the color. There's no top to the mountain. All right.