Lightning rounds #31: How to not get fired

Wait and stop. Let's take that again. How am I trying to say this? This is so dumb. Hey everyone, I'm Brandon Odo. And I'm Brian Bowling. And this is Critical Care Scenario. It's the podcast where we use clinical cases, narrative storytelling, and expert guests to impact how critical care is practiced in the real world. Hello, Brian. Hello, Brandon. We are back yet again with another lightning rounds. And we've had a few topics recently, kind of chatting about some meta topics around these jobs we have, not so much on the clinical side, but on the job having side. Things like how to get burned out or how to avoid it, and, you know, I just had to be generally kind of fulfilled and excellent at the work we do. But I was kind of thinking, and I realized that what we have not really directly looked at is the other side of that, which is on a very basic level how to, how to not suck. In other words, how to basically not lose jobs. And I don't mean how to not, you know, how to enjoy a job well enough that you don't want to quit them, which I guess overlaps somewhat with this. But literally, how to have a long career in this work without getting fired, forced out of positions. And it kind of everything on that spectrum of getting shitt canned, which can look in different ways and different situations. But this is obviously not specific to medicine, although, you know, a lot of the subtopics are. But I think that's kind of part of the problem. There's a lot of people who are, may even be good at medicine clinically, but don't seem to understand a lot of this. How do you just hold down a job as an employee, how to do it well, and sort of to have as long of a career in whatever position you choose to as you want to have. And this means some people lose positions or opportunities that they otherwise would have liked to or unable to get them in the first place. Or they just kind of struggle along and have our time or make things difficult for other people. And I'm sure that we can all think of people who have been in this position, sometimes us who just never developed that skill or for whatever reason have a hard time with it. And I almost want to say it's more common in this than in other work. I don't know if that's true or not, but there may be the particular propensity for people in medicine to have that kind of Dr. House phenomenon where they're maybe very smart or very good at some things we do. And that almost seems like it makes them not as good at some of these practical skills. Maybe that's a cop out. But at the very least, you don't necessarily have both. Yeah, I think, I know I think you're right. It is a little bit more prevalent in medicine. Not that every field, because there's probably other fields very similar, right? But I think you're right. This is a field that a lot of people go into having really never done anything else. You know, I worked with a doc one time who got his license to spend for a year for some issues. And he said, you know, he had to go work part time at Home Depot because he said I literally have no other skills. I went from working at McDonald's in high school to being a doctor because that's a lot of times how this career progression works in this industry. And some people never even the McDonald's part. They literally, you know, pretty much from school into this. Yeah, it's a school, school, school, and then the next thing you know, you're doing this. So it's like, I guess life skills is what you can be lacking. I mean, maybe a little less for APPs like you and me, because typically this is a second career sort of. You do something else first. For you guys, they were a bedside nurse, perhaps. And for us, something else. But as we talked about, that's maybe less and less true this day. So a lot of very young people getting into this work and certainly for their physicians. And that might be part of it. Well, and I've noticed a difference working with APPs who did something non medical first, right? So, you know, a lot of people, like you said, this is a second career. But the first career was still medicine, right? You were a nurse, you were a paramedic, a respiratory therapist, something like that. But you do occasionally encounter people. I was one. I was a web developer before I was a nurse who did something different. You know, if somebody people were in sales, I worked with a nurse one time who was a cop for a while. And I think, especially if you are in a very different industry than health care, you tend to have a little bit more of those, like you said, for lack of a better term, life skills. Because you've had these different skills. Yeah, different skills, I guess. Versus just the echo chamber of medicine. Yeah. And there's a, I'm sure other echo chambers. Like if you spent your whole career in, I don't know, the military or, you know, other things. Sure, sure. Yeah. Okay, so, I mean, let's just start generally. If we look at this general phenomenon of sort of having these difficulties, whether that means losing jobs, I don't know, getting like disciplined or having trouble at your job, interpersonal problems, not being able to get positions you want, things like that. What, what tends to cause this sort of thing? Like if we're going to make a generalization, what is the, what is the skill people are lacking? What is it? What is it people are doing that's creating these problems? Or can you not make a generalization? Is it a lot of different things? I don't know. I mean, I think I do think that there is a sort of common theme to it. I'm not sure exactly how to put it into words. But I think a lot of it is this lack, lack of understanding, I guess, of the concept of I don't have to always be right, even if I'm right. You know what I mean? People who don't know how to pick their battles, people who don't understand that it's not enough to have the facts on your side necessarily, that there's sometimes other issues involved and things like that. Those are the people I think you tend to make enemies. And not for reasons like, oh, they don't like the truth now, just because you're kind of a jerk about it. Or like I said, you just, you don't know where to invest your, your social capital, so to speak, right? I'm going to fight every single fight that comes up, and then you just become the guy who fights every fight. Yeah. I think that's a good generalization. It's the guy who, like, seems like every day, they're finding new hills to die upon. And sometimes you're like, could you just like take it easy for it? And oftentimes they're not wrong, right? That's not the point. That's not the point. That's not the point. Yeah, exactly. The point is it's not a fight worth having. And I see this a lot in places where you run into entrenched culture. This is the way we do things here. And somebody says, well, but you're wrong. But are they wrong? Maybe they're not, I mean, it's not the only way to do it, but it doesn't make their way wrong. In more that makes your way right. And sometimes it's okay to change culture, but you have to kind of know, like, what's worth having to fight about? Yeah. Yeah. If I, I guess I'll try to generalize this with one of two things. One is that problems come up when people don't like you. And the other is that problems come up when you keep creating problems of some kind for the institution. Whoever you work for. So those are the same thing, basically, but people don't like you as more like a horizontal thing. It's with your colleagues and the people. And the problems are like a vertical thing. You're creating your, basically your boss or your boss's bosses. You're making problems for them. And I guess I'll say one additional thing, which is that really when you're working for any kind of larger employers, which mostly we are institutions, you know. The reason you have concrete actionable problems is not necessarily either of those because you can do both of those and kind of slip under the radar. It's when they're like, you're making a problem for other people and the problems are documented and provable. So they're real in the corporate sense of real. Things that just sort of happen in the ephemera can kind of go by the wayside. But when you just keep appearing on, on people's radar, and it's in a way that is, is concrete. It's what, uh, what's the Harry Potter meme, McGonagall is this, like, Hermione, those guys. And she's like, why is it whenever something happens? It's one of you people. It's when you're one of those people, right? Yeah. But in a way that exists in a real way, that's when you start to kind of move down this slope towards causing problems for you. Yeah, yeah. And I think that the nature of people who do this job, and the nature of, well, the nature of what we think medicine is like, tends to amplify that, right? Things are right and things are wrong. This is truth and this is false. You know, and I think once you get into this business for a while, it's that very few things are black and white, so there's lots of gray. But, you know, at first, everything seems like there's a right way and a wrong way. There's a right answer and a wrong answer. And I think it's real easy to get, especially if you're a science-minded person, right? There's objective truth. It's real easy to get into that. But you're wrong, and I'm right. But you're right. You don't want to be the person, right? You know, it's funny. Sometimes I'll have faculty ask me about a student. You know, what do you think about this student? And I'll go, I don't really remember them all that well. And they go, you know what? That's not bad, because remembering a student tends to mean one of two things. They were great, or they were awful. And, you know, it's fine to be remembered for being great. You definitely don't want to be known for being awful, right? You don't want to be the person who, when your name comes up, people go, oh, yeah. I know that guy. Yeah. You might think you want to be that person. But to do that in a positive way is really kind of a narrow needle to thread. Yeah. Yeah. And really, it's, I think this does apply in pretty much everywhere. And it really in life and not just in jobs that you can only die on so many hills. And you have a fixed, a finite amount, not fixed, but finite amount of capital to spend on, you know, which hills you want those to be. And like you said, it's not necessarily a matter of what you're right about. Although that, I think that pertains to it, because the kind of people who are always getting in these fights are often the kind of people who do have a very black and white sense of what right is. And it does help, I think, to evolve mature clinically to understand that that's just not always that true. So then you can start to accept more gray areas and allow that to temper your enthusiasm. Because when are you going to get all up and arms about something? And when you really feel like it's absolutely wrong, right? You know, it's whatever. It's hurting people. It makes no sense, whatever. If you can at least see some other side to it, you might still fall, you know, we should do it differently. But you're less likely to be like, oh my god, this is like a huge deal, right? And sometimes seeing that other side is not necessarily the medical part, and that's the tricky part. It may be that, like, medically, things should be a certain way. But the countervailing parts of it are practical, financial, interpersonal, all of those sticky things, which you may not want to engage with. But I mean, that really is maturity, right? Understanding that things don't happen or get done without acknowledging those. And that they can absolutely have enough weight to change how things are done. There might be one thing that is better and makes more sense. But there's all these practical reasons. And it's not such a big deal that they're, it's possible or worth it to overcome them. And I think kind of getting all that is, I guess, part of getting older and maturing. I mean, you see people who have been doing this job for decades and decades. And one strategy that you'll see sometimes, I don't know if it's intentional or not, but definitely a working strategy is to just kind of not care too much. This kind of, like, blasé attitude about things, that will get you through, where some of these people who are always getting fired up about stuff, they don't, they don't last as long. These guys who have been like a furniture institution for 40 years, they're often the guys who can necessarily don't care about anything. But stuff happens and they're able to be like, you know, I did what I could, whatever, maybe we can try to do something, whatever. But it's not, you got to be able to kind of roll with the punches. Yeah, I used to work with an air spectator who, he wanted to argue about everything like that, you know, and he would come up, and again, he was right more often than he was wrong. He would come up with data that says, you know, this is not, we shouldn't be doing it this way or whatever, but his data would more often than not say, there's no benefit to what we're doing, right? And I would point out that the data also says there's no harm, right? And if there's no harm and, you know, everybody else, including the people who let's face it, there's hierarchical power in medicine, right? So if the chair of your department or the chief of surgery or whatever wants to do it one way, he's going to get more pull than your eye, right? So instead of going and fighting the guys with the pull over something that is not causing any harm, just because there's no benefit proven, no, maybe it's okay to just say, it's fine, right? There's a balance, right? I mean, you need to be able to zoom out a little bit and for any particular issue, say, is this worth, you know, spending some of my capital in this position, this institution, to try to change? How much of that capital you have was going to depend, right? How long you've been there? How many people you know, are in this position and how much power is invested in it? And frankly, how much you've spent on other things, right? So if you've been making a big push in a lot of other areas, you just don't have as much ammunition to take on something else. You don't have the time for it. People are not as interested in hearing about it because it's one more thing from you, and, you know, so on and so forth. And this applies, we're talking about, like, I guess, clinical practices and things, but it applies to anything you want. So things you personally want. You want more money, a better schedule, a different office or something. That's something you may have to, like, lean on and try to make happen. And capital you spend on that may not, you know, be capital you have to push for a new ultrasound in the department or whatever. Or, you know, whatever. So you only have so much, whatever footing to stand on to move mountains. And at the end of the day, sometimes the best strategy for something is to just let this be not the battle you're fighting, to kind of let things lay fall over a while and say, I need to fade into the background for a little bit. So that I'm not constantly popping up on people's radar because that's not, you know, a late step, but an early step towards being a problem, like Harry Potter. Right. Well, and I think, you know, you mentioned non-clinical stuff. You know, I had an attending once who would say, on the clinical side of things, you know, I don't argue. I don't fight every fight. So that when I do, people really take notice, right? They go, well, that guy never pushes back on stuff. And he's really pushing back on this. And with the non-clinical stuff, the example is, like you said, with the schedule you want. You know, if you're somebody who says, like, hey, I have, you know, a lot of things I need to be off for. Right. We all know this is a, this is a non-traditional life we live, right? Where the world is scheduled around people who work Monday through Friday, 9 to 5. So things happen in the evening, things happen in the weekends. My daughter does gymnastics. And when it's meet season, we'll have all of these weekends that we know she's going to have gymnastics meets. And we don't get a lot of details upfront because they just assume that, you're off every weekend, right? So just show up. And so I have to end up asking off for this whole weekend, even though I really might only need a couple of hours on a Saturday. But I know that when I make my schedule, I know that I'm kind of being a bit of a pain by asking for this. So I try to be sure that I'm the one that will happily come in when we need help. Or I'll be the one who says, oh, somebody's looking to switch. And yeah, I can do it. I may not want to, but I'll switch with you because I understand that that builds me some relational capital with folks for when I need something. Yeah. And a lot of these measures you can take to kind of fertilize the ground for you to work with later are that the benefit to you is not going to be very immediately obvious. It is a long, a long game. And so it, again, is good to look at kind of that overall balance of like, you know, how much value you're bringing versus how much of a pain you are and try to kind of keep it in the, what's the good one, the black? So that, you know, later, you have something to drop on because then it's going to be a little too late. It's going to be a favor or something. And the only thing people can think of is like, oh, it's that fucking guy. It's too late, you know. Right. Well, I didn't attend anyone too. He was given a talk to new interns. And so a couple of us went to, you know, it was in the afternoon. We weren't busy. And honestly, we kind of thought, we'll sit in the back and kind of heck a little bit. Right. He was that kind of guy. We got along well with him and joking around with him. But he was a really good teacher. He was talking about kind of being prepared as an intern. And he said, you know, there's going to be times when you mess up. So prepare for that by being the best you can be all the time. He said, you know, I would go in every day, super prepared. I'd get there early. I'd, you know, be ready. I'd have read the night before. And so he said then inevitably when something went wrong and I made a mistake, you know, being the guy that they yelled at and jumped all over because oh my gosh, you screwed this up. There would be so much grace because they'd be like why he's always early. He's always prepared. This is really a fluke. And he said, you know, everybody makes mistakes. That's a human thing. And if you're the person who normally is doing a really good job, then everybody is much more ready to recognize that you're just a human being. Versus if you're the guy, like you said, who's always that guy, right? Why is it always you three? You know, if you're always rolling in late to sign out, if you're always the one who's calling in because of this that or the other, if you're always the one who's asking to leave early, then when something happens, people are going to be like, it's kind of unreliable, right? Versus, well, he's always super reliable. This is clearly just, he had an off day. Yeah, there's a tough balance because on one hand, sometimes the way you'll see things is, if something is being asked of you that is not technically part of the minimum requirement of your position, you're inclined to say, no, I don't have to do that, so I won't. And that is reasonable. I mean, there is something to that. For instance, you know, a common thing might be, the schedule is made clinically. Something happens or gets moved around and they need someone to cover an extra shift. It's pretty common in some teams. And I don't really like doing that. I am a creature of habit once I know my skill, especially like last minute, even if my plan is just to lay around all day, that was my plan. So I am not super into that. But the other way of looking at it is that balance, where some, at some point, you are going to need something, which is also technically not something that they have to give you. So if you are never doing anything, but the absolute minimum required of you, then that's all you can kind of expect to also get. And that's a pretty tight diet to be given on either side. So there's a balance here. You don't want to be taking advantage of. But at the same time, any team, which is more than the most wrote procedural job, where your job was to turn a crank or something, and we're not that. It is more complicated than that. You do have to expect that the team of people getting the work done, stuff goes on and happens, and you do have to kind of see yourself as part of that team, because if you're not part of the team, then you're not part of the team. Yeah, and I think you're right. There's a fine line between being a team player and being taken advantage of. And if you're in a position where you are constantly doing and giving and getting nothing in return, then I would say, a lot of people would say, we'll stop giving. I would say leave. Find a new team. You're not part of that team. You're not part of the team. You're not part of the team. You're not part of the team. You're not part of the team. And just give freely because it's just going to be being taken, being taken advantage of. I've been fortunate all the teams I've ever worked with are like that. If I give and I get back in return, and everybody sort of understands that, not everybody, but most people, you know. Like you said, I think the amount that you give and were using that term generally, but I think that is more of a product of who you are, and it's probably not that easy to modify. It may self-modify over the long-term as you change. So yeah, if you're giving X amount and you're not getting rewarded for it, it's probably the wrong position because it's a position that is not interested in that and doesn't care. I mean, they'll take your free labor, but it's not a team. Okay. So, one of the subtleties that comes up here, I think, also is if you're going to ask a question of how to do these things well, how to be a good employee and team member, some people would say, how much should I care at all? You know, I say how I care about doing medicine well or something. Maybe they do that. Why do I care about anything else? And I'm tempted to say that the amount you should care depends on who you are. In other words, in the real world, in the 2023, America, whatever, some people can get away with more and some people are not able to and it depends on how, frankly, how important you are, meaning how valuable are you to the team and to the institution? There are absolutely people who are considered such high-value workers that they could do almost anything because they literally are like bringing in millions of dollars or something or if they went away, the hospital would close. I mean, you could imagine what a person like that could do and, you know, they will have every possible opportunity to get away with it. I think the other side is how much you care about the position. I mean, you see people who are like job hoppers and they're more than happy to take a job for six months and then get into their job across town because it paying like a dollar more or whatever for just in the smallest reasons. That's not as awful to me because that's a big pain that changed jobs. But if that's really like you're totally cool with that, then sure, the amount of work you're willing to do to maintain one position and some of these things go into that, maybe less. I would say that none of this is a good reason to not have the skill set to like hold down a job. You could always choose not to apply it. I mean, you could, if you are the neurosurgeon in chief or something and you're like the most essential person in the hospital, you could decide to not care what you say or do and like not wear pants and swear to everyone or whatever. But if you don't even have the skills to not do that, then it's not a choice. You better be the neurosurgeon chief because you're not going to keep any other jobs. So I think we probably all have the tool kit and then how much you apply and maybe depends. When you deal with surgeons, there's this equation that will often come up that you can be incompetent or you could be a jerk, but you can't be both. We will often let people get away with being kind of a jerk if they're really good at what they do, but you can't be, you can't be a jerk and not be the best, right? Ideally, you want to have both, right? You want to be nice and qualified, but you can't certainly can't be incompetent and awful to deal with. Right. And I think that applies to most of you. I think I've said before on the show, you can be mad about something and make a big fuss. And you could be wrong about stuff, but you really don't want to be both at the same time. I do like you're neither ever. I mean, it's not really a good excuse that you're right to be a pain. But if you're the guy who's like raising a stink or like being an asshole or yelling us, and you are not right, that is a very bad situation. Because that is the kind of thing that people will retaliate about. Because you have no leg to stand on. People will never be as self-righteous as when you were rude and wrong at the same time. Just make sure that you are unassailably correct if you're deciding to today be an asshole about something. I mean, think twice if you want to at all, of course. I think also that this is one of those life lessons. The amount that anyone else cares about, the things you care about, ultimately is going to depend on how much it matters to them. And when it comes to making things happen, which usually involve money, time, manpower, supported different kinds, that means going up the chain to people who are, you know, their bosses, and things that matter to them are not always the things that matter to you. I mean, you'd like to think that if patient care is what matters to you, never mind things like where your office is, but even patient care, which is what we do, I guess, hopefully on some level, the powers that be interested in that, but it's kind of disconnected. So the things that are priorities to your managers and executives, it may be who, but who of you to understand what those are, because again, hopefully they overlap somewhat with your priorities, but they're probably not the exact same thing. Because your priority is like, we, whatever, we need an ultrasound machine. Can you find a way to link that with their priorities? Because these are all just human beings, they all got their own problems. You got your problems, and you're trying to make your problems, their problems. How can you show them that your problems are their problems? And if you could show them that, you know, this will, you know, reduce costs, you know, increase revenues, you know, improve some core metrics that they're tracking, something like that, they're going to say, this is, this is relevant to me. So if it's something else, I mean, you may be able to catch their ear for a second, but it's going to be at the bottom of their list of priorities, and it's got no chance against all the other countless priorities they have. It's going to go in this big bucket of things that sound like a nice idea that are not a priority. And then unless everything else above it gets blown away, none of that stuff's ever going to see the light of day. You know, guess what? That never happens. There's always some new stuff. Right. Well, I was just, I was just talking to some students a couple of days ago, we were talking about calling, calling consults. And I said, you know, this is going to come out sounding like I'm saying that people are lazy jerks, and I'm not saying that this is human nature, right? Human nature is I have a lot to do. So if I can get out of doing the next thing that somebody tries to assign me, I'm going to, right? So when you call it, I sort of was to say, when you call a consult, you have to convince them that this is something for them to do, right? Or otherwise, they're going to try to pawn it off on someone else or try and say, it's not my problem. And I think, like you said, the same thing. If you're going to go to administrator and say, I want to spend $10,000 on an ultrasound machine, they're going to go, well, that's a problem that, and I have plenty of problems. Right. So why should I care about this? Because it's solved one of my other problems. If it does, then now I'm interested, right? So we often say it's the right thing to do for patients or whatever in a perfect world that would be enough. But if you can show that, like you said, what are the metrics? What are the things they care about? Will it reduce some other problem that we have? Okay. Great. Will it save us money? Okay. Great. Will it, you know, things like that. I mean, that's one of the arguments for our profession in general, right? Is that by going and working alongside our physician colleagues, we make it easier for them to do the things that they can do. So we add value, even if it's not in terms of money, right? So understanding what people's motivation is, I guess, because, like you said, just because you're interested, doesn't mean they're going to be interested. Yeah. And you say, if you could find a way to solve one of their problems, it's also not going to be less potent if the problem that you try to solve is one that you, you just told them about. Like they, they didn't know it was a problem and now you're trying to convince them that it is their first reaction is going to be like, all right, I mean, it wasn't a problem two minutes ago. So I'm hoping that if you go away, it's not going to be a problem again. Right. It sounds like you're my problem. Yes. Now, but if it was a problem that that has been a problem for them and they've been hearing about it, they didn't have a solution. And now you're saying, I can help with that problem. That's what we're powerful. Now you can try to make that happen by just harassing them about it so that you are their problem. And it's like, I'll shut up about this or at the very least so that, you know, the problem that I, I told you about eight months ago is still a problem. And so, you know, now it's like a recurring thing on the radar. But certainly it's better if, you know, they've been hearing about it every month that they're meetings and blah, blah, blah. And now you're trying to help them with it. You got to be careful though, because if you've created the problem, one, one easy way to solve, solve the problem is to just get rid of you. So. Right. In one way or another. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. The easiest thing to do what you want and then great. If that's a hard way to do it and it's easier to assign you to salt mine in Siberia. Right. Okay. Sure. Let's, let's talk about conflict resolution, you know, interpersonal stuff. Because this, this is often how issues come up. I feel like, you know, conflict is not rare in this work. It probably, I guess, in a lot of work, but you know, it's a high stress environment. Like we said, a lot of people are probably not being selected for the people skills. What are your, what are your tips for this? And it, it doesn't have to be about excelling at it and being a, like, a people person. But again, just about avoiding problems, you know, getting by, staying above the, whatever the lowest bar here is. Well, I do think, like we said earlier, knowing when to fight is important. And that could be a big thing like trying to change the policy, but it could be very simple things too. Like you just, you've gone to talk to a certain nurse five times about a thing and it's just not getting done. So you can be an ass and stay in the middle of the hallway and scream at that nurse. You could go down the hall and talk to the manager, you know, but sometimes the easiest thing to do is just accept that this is how it's going to be. And then go somewhere and vent to someone. It doesn't solve the problem. But if it's not a big deal, maybe that's the thing to do. Yeah. At least have that in your range of options. Yeah. And I think it is important to at least try to remember and remind ourselves that nobody including those around you wakes up with the goal of being a jerk or being wrong. And if that is what it looks like is happening, you're probably missing part of the picture here. Yeah. Someone I think at smack like to say that if your reactions to say, you know, WTF with this person, maybe you can re-characterize that to what's the frame? What is the, what is their perspective on this that is different from the one I have? Because if you can understand that, then what they're doing is probably going to make more sense. Now, it could be as prosaic as like their wife just left them and they're just, they're in a bad mood or whatever. But often it's that they have a different take on the, on the medicine. So like, well, why won't these surgeons take this guy to surgery? You know, they have a different perspective on what's going on. Maybe you can come to terms with that and maybe they know something you don't and at the very least you're working with medicine again. So there's room for disagreement. But you know, maybe it's just a matter of like, maybe I'm sounding like a jerk. So then they're responding in the same way, just trying to kind of slow down. If you, if you assume that there are no bad guys in this situation, you get off on a better direction because that's the kind of the cycle that that starts to feed itself. Then if they're a bad guy, then obviously you could do whatever you want to them. And then they're probably having the same thought and, and so on. So, you know, you know, people say if it, if it felt good to say, it was probably their wrong thing and so on and all that is probably true. But I think it's also like, how do I put this? When you reach a certain, a position of a certain amount of responsibility, and I think this applies to hours, it comes with a responsibility to, I guess, to be the bigger person, at least to try. You kind of lose the, the right to, just like wig out on people and to, you know, have really emotional responses to a lot of things, you have to be the guy who, and someone comes in and starts yelling, you don't. And you know, you, you, you stay, you have to be above things and so on. And I don't know, maybe not forever or whatever. But, you know, imagine if the, a patient's family member walked into this CEO's office and started screaming about something that had happened, I mean, they might call security. But do you think their reaction is going to be to scream back at them? Probably not, right? Because you, you probably don't get that position unless if that's the sort of thing you do. Yeah, I do. You have been a weird world. I mean, maybe Elon Musk would do that, but, you know, buy in large, right? So I think this is kind of responsibility. And that may explain why when you said the thing that felt good at the time, now you're quote, in trouble. Because in a way, it was sort of your job to be better than that. Yeah. Yeah. No, I think that's a really good point, right, that, that, you know, saying that out loud might make you feel better in the moment. But maybe the best thing is to just hold your tongue, go to, you know, back to your office and say it to yourself or say it to somebody you trust to just say, I'm an event because I should not say this to this person, but it's going to feel good to say it to you. Yeah. And like you said, just to be the bigger person, which is hard to do and does not always feel good. Yeah. And again, none of this is anything to do with who or what is right. Right. That's a, that's the whole point. I mean, it's, if your reaction is like, oh, well, he's right and I'm wrong and he's being a jerk or whatever. So therefore X that you're, you're missing the point. That's not what, you wouldn't have to be the bigger person then. Yeah. Um, it's funny. You know, so I heard this one time that we tend to expect grace more than we give it. Right. We want everyone to consider that we are having a bad day. Our dog got hit by a car, you know, our kid has stripped throats are, you know, I got a flat on the way to work, whatever and give me grace accordingly. But in our interactions with other people, we assume none of that for them. Um, and I like that way you were seeing what, what's the frame? Like, whether it's something like that, like you're having a bad day or whether it's something that you just don't understand their perspective, right? We, when I used to work in a community hospital, we would have patients all the time who would, you know, just bleed all night, right, the chest to your about put would just continue behind. They continue to be unstable. You'd call the surgeon all night long and they would just, you know, give a, give me into blood, give me into blood, give me into blood and you just think, why don't you just take this person back to the operating room and sure enough, six o'clock would roll around and they would come be there to take the person back to the operating room and you think, I don't understand, right? You're getting woken up on, it's not you're getting a good night's sleep. So this isn't laziness. What, why, are you just dumb? Why not? I don't understand. And then somebody explained it to me that, you know, in this particular hospital, they didn't run the OR all night, right, going back to the OR was a big deal. And it meant calling in people from home who were then obviously disgruntled that they got called in from home. They had, it cost a lot of money and hospital administration would keep a list. And if you got on that list of the, you're the guy that calls the OR in the middle of the night too much, then you had to answer to hospital administration. And so once I knew that, it was a lot easier to understand that, oh, okay, so they're going to try to do whatever they can. It's not that they would never do it. They would come in sometimes. But they would try to do whatever they could to not be that guy. Yeah. And that black and white person would say like that, that's not right. But like, new boss person would say, it's not, it's, is it worth it? Right. And understanding where they're, where they're coming from made it a lot easier. Um, all right. What other tips can we give to holding that in job? I guess I'll offer, I'll offer one general one, which is that, um, if something is not in writing, it is not real. And that applies to just about anything, something you were promised as part of your, your employment conditions when you were hired, something you were promised later, oh, it's going to be a raise that you're going to have this time off, whatever, um, or something bad, right? So again, we're talking about the argument you had, whatever. Just tend to not be real unless it can go into a file that someone can then use to justify what happens after it. So if you can get someone to put in writing that you're going to have that raise in six months and it, any writing, something that you can prove, I mean, it all sort of counts. Um, there's enough to say contract at the top, an email, whatever. Um, then that, that is actually going to happen. Or if it doesn't, you can make a stink about it. If someone just mentioned that to you, there's a good chance that it will never happen. Or at least what we're saying is you're dependent on their goodwill or their, their word on this matter. And whether or not the person you're talking to is actually a good person is sort of a material because in this situation, they're not being a personal person. They are being a representative of their institution and the institution has no good will towards you. They just, they have interests. So if one of their interests is not getting sued because they violated some contractual thing they promised you, then that is relevant to them. If their only interest is like someone said something to you and now you can't prove it, they have no interest there. So get stuff in writing or on the other hand, you know, something happens. If it gets put into writing, now it can potentially be something real for you. Where is it? Maybe people very, very, very often, you try to discuss something. Maybe you send them an email and they won't email you back. They'll come find you in person or talk to you on the phone. That's because they don't want what they're saying in writing. This is sort of one of the games you can play here, which is like, you know, people with different interests trying or trying to avoid things being put down in a recorded form so that it doesn't come or does come back later. So I understand this kind of key difference for the things that you want or things that you don't want, which is that, you know, nothing's real unless, you know, this you could prove it basically. Right. Right. And you know, sometimes that plays to your advantage, right? Maybe some, so maybe, you know, your boss says come, come talk to me. Let's talk face to face because I don't think this is that big a deal and I don't want it on the record because I don't want it like an official, I'm reprimanding you. Yeah. You know, because it makes it real. Yeah. And that because they're doing that because they understand that. Yeah. So it's just kind of who's you too as well. You know, there are an email saying gets sent around to the whole department or something. You know, there's 30 people on there and like one person actually replies to it, right? It's not because people aren't reading it or talking about it or even talking first you send to having discussions, they just don't want it to like live forever. Right. Right. What else should we say about this? I don't know. Like we've sort of said in lots of different ways is just, you know, be the kind of person that you want to work with and you'll get along with people. You know, don't fight every fight. Sometimes you just have to put yourself in other people's shoes and say, maybe I don't understand what the problem is. That's okay. I'm just going to move on. You know, be a team player. That sort of thing. Be the person that you would want to work with. Yeah. I mean, ultimately 95% of these problems boil down to like I said, people had a personal problem with you or you were a problem for the institution, which ultimately means, you know, money, regulations, things like that. So if you can avoid either of those, you are at least not unlikeable and you are not creating issues that are, you know, on paper, inviting investigations, you know, costing money and stuff like that, probably a long career. None of this, you'll notice there's anything to do with the medicine you're practicing. And that's, I think the error people make. They think that is the issue, the goal, the job, anything else is irrelevant and that's just not, this is not real life, no matter what you're doing, even a solo practitioner. That's not how it is. The other thing I think I would add is when it comes to conflicts and stuff at work, I would say, I realize a lot of times it is, it really is not personal. I was just thinking when you were talking, I had a friend once who was fired from a job. And he would talk about how, you know, is because he had this big conflict with his boss and he really hadn't, didn't know her that well. Like she had was fairly new to the organization and had only been in the position for a few months. But, you know, then it became, you know, people have poisoned her against me, that sort of thing. And it's a years later, he went back and worked for the same institution and ran into this boss and he thought, it's going to be all, you know, horrible. And she didn't even really remember him and in his mind, he had made it this big thing where they were like enemies. And she was like, oh, nice to meet you. And he was like, what? And when they talk, she was like, oh, you know, I vaguely do remember that. Now that was like when I first started, but she didn't remember the details and it wasn't personal, right? It was literally just business. So. Yeah. Exactly. And that means that a lot of those things that turn into something that maybe gets you're fired, you made that happen. You took something that was not an issue and you made it away and you see that all the time, right? There's a dispute of some kind who even knows how it started, but it started as a non-issue in the larger sense, meaning like, nothing was on paper, whatever. And then someone like did something that made it real, you know, they like started yelling in the hallway in front of the patient, they sent off the email that cannot be retrieved or whatever. And now it's real in the institutional sense and now they're the asshole. It's like the people say that, you know, you get in a bar fight. No one sees who through the first punch because they weren't paying attention. They see you punch them back. Right. So, you know, be aware of that. It's not about what's right. It's about who, who can see it, but all right. Maybe that's enough on this topic. I hope this has been helpful for people. Again, this is a little, maybe, uninspired, but this is like real life stuff. And to be able to do the inspirational, interesting things, these are like bare minimum requirements. There is a lot of talented people who could be helping people a lot more, but are unable to because of a lot of these other obstacles. Again, you might think you're Dr. House, but you're more likely, Dr. Cox. I mean, shit, Dr. House didn't do well at his show either. I mean, that's maybe a good example as well, you know, even if you're that good, it's still much better off if you can just kind of get along. So, do what you can, and we'd love to chat with you guys about it. Otherwise, talk next time.