Monthly Rounds (December 2020) - Gifts, Experiences, and Systems

Hi friends,

Below is my favorite content from December.


One of the many things that got me through residency training was narrative medicine. The emotions you experience when caring for others are so strong, yet so fleeting. Writing was a camera to freeze and capture a set of emotions, allowing you to revisit and decode that memory whenever you would like. I recently read this narrative medicine piece about the “gift” that patients give — highly recommend reading the entire article!

"The joint aspiration had not really been for his benefit, not after my first attempt. He had realized that fact long before I did. But it wasn’t for my benefit, either. I was just a vessel for the ultimate recipients of his offering. That was why he had let me continue.

Speaking with him after I’d finished, I had a sense of him as a link in a chain, joined with others across the length of my career. Patients he would never meet would benefit from his gift. They, in turn, might pay that debt forward."


A few years ago, a mark of a neighborhood's exclusivity was its proximity to an Equinox or SoulCycle. But most things (and companies) that go up eventually come down, and the difficult question is not if but rather why. For SoulCycle, the challenge was maintaining "cool" while growing its customer base -- in other words, how do you scale exclusivity?

"SoulCycle was never built to be for the masses. Keeping people out was, it seems, just as important to the business as loyal riders. The bigger SoulCycle got, the less desirable it became. The less desirable it became, the less people had tolerance for the culture it fostered. The minute the company became mainstream, the magic dissolved.

It’s impossible to scale exclusivity."


Fresh off another holiday shopping season, many of us are enjoying shiny tablets, oversized headphones, and whatever new gadget MKBHD recommended. Just in time, this article provides a helpful refresher of social psychology research on how best to spend disposable income -- it turns out the answer is quite simple: buy time, buy experiences, buy for others.

“People believe material goods last—and they do last in a physical sense, but that doesn’t mean you continue to derive value from it,” Kumar says. “Experiences are fleeting, but not in a psychological sense. They live on in our memories, they live on in the stories we tell.”


One of the pieces of career advice I often received in college was to "keep my options open." This advice led me to medical school ("you can always quit if you don't like it") and internal medicine residency ("there are so many fellowships to choose from"), and I don't regret either of those decisions -- those options served me well and allowed me to pivot my career in interesting ways. But there's a downside to optionality as well.

“This emphasis on creating optionality can backfire in surprising ways. Instead of enabling young people to take on risks and make choices, acquiring options becomes habitual. You can never create enough option value—and the longer you spend acquiring options, the harder it is to stop.

…These safety nets don’t end up enabling big risk-taking—individuals just become habitual acquirers of safety nets. The comfort of a high-paying job at a prestigious firm surrounded by smart people is simply too much to give up. When that happens, the dreams that those options were meant to enable slowly recede into the background. For a few, those destinations are in fact their dreams come true—but for every one of those, there are ten entrepreneurs, artists, and restaurateurs that get trapped in those institutions.”


Every well-known productivity expert seems to be obsessed with James Clear's "Atomic Habits," and for good reason. I particularly love the book's focus on systems rather than goals. This short article is a great primer on the difference between the two, and why it is systems, not goals, that fuel achievement.

“For many years, this was how I approached my habits too. Each one was a goal to be reached. I set goals for the grades I wanted to get in school, for the weights I wanted to lift in the gym, for the profits I wanted to earn in business. I succeeded at a few, but I failed at a lot of them. Eventually, I began to realize that my results had very little to do with the goals I set and nearly everything to do with the systems I followed.

Every Olympian wants to win a gold medal. Every candidate wants to get the job. And if successful and unsuccessful people share the same goals, then the goal cannot be what differentiates the winners from the losers. It wasn’t the goal of winning the Tour de France that propelled the British Cyclists to the top of the sport. Presumably, they had wanted to win the race every year before—just like every other professional team. The goal had always been there. It was only when they implemented a system of continuous small improvements that they achieved a different outcome.”


As always, I would love to hear updates about your life and what you have enjoyed reading, watching, and engaging with over the last month. If you are free to catch up or reconnect, please reach out. And if you know anyone who else would enjoy receiving these content, feel free to direct them here.