Where does the time go?

So I wrote this at the beginning of the month, but then couldn’t post it, then started allowing myself excuses not to write each day. I think this is a solid discussion of choices, making choices, dealing with the choices, and how improv helps that part of life go better, which is important because making choices is the crux of my job. So I present…an entry from right after Labor Day

Hey oh, happy weekend to one and all. I am going to get right into it as there are no improv related events that I need to get the word out about. I assume all of you reading this know about the Omaha Comedy Fest and will be bathing yourself in a warm embrace of laughter the rest of the weekend. I actually typed my 500 words on Saturday and could not access my website to post these thoughts and I figured I would use the opportunity to delve further into the topic. Yes, that means this will be a bit longer of an entry but I will have written at least 500 words each day (update: I did not write 500 words/day)

As part of what I described above, this entry may be a little bit scattered, as I am still working my way through some of these concepts. Please join me on this journey. I think the concepts are worth visiting for everyone and I will leave with some action items at the end of the entry to engage with these improv concepts in your real life, be it in the healthcare arena or in your personal life.

This journey starts with me recently enjoying this TED talk. I was doomscrolling on twitter and came across a thread of TED talks that will teach everyone about human psychology. There were several videos that I thought were pretty interesting and a couple of them I have made reference to in this very web log. The one that intersected with some concepts I have been thinking about is an old one. Here is the video, please watch and then please continue reading

Hello, World!

For those that did not heed my advice to watch it, it discusses the challenges that arise when more choices are available to us. Years ago, my wife, girlfriend at the time, told me that the toothbrush aisle caused her stress. I had NO IDEA what she was talking about, but this video gives light to that. All of those choices come with a cost. I didn’t have any idea what she was feeling until I went to the Cheesecake Factory and then it made sense. That menu is filled with choices. I want to order all of the food. My inner monologue gets to work solving the problem. “Mike, you are already at the Cheesecake Factory, making healthy diet choices stopped being a part of your calculations long before you started flipping through the book/menu, so just order all the food.” “Mike you waited in that line forever while your kids led the chorus of screams in the waiting area, you deserve a couple of appetizers” “Mike, don’t save room for dessert, just order it and find room later.” I will eventually settle on two or three things on the menu because I am not able to make a choice of just one item but am able to realize I can’t order all the things I want. This is an issue for me only at places with menus the size of the Cheesecake Factory, however my wife engages with the inner battle of possibly ordering the wrong thing at every restaurant. Of course, she hedges her bets by letting me know that her and I can switch entres if she likes what I order more. The trip to the Cheesecake Factory and toothbrush aisle seem like a silly metaphors but the same psychology happens any time we have choices. It’s the stakes that change, not the uncertainty we experience.

 There are no mistakes

The TED talk above mentions the 4 reasons choice makes people miserable. 1. Regret and anticipated regret 2. Real or perceived opportunity cost 3. Escalation of expectations 4. Self-blame. I think running through the process of rapidly making choices together with a group on the improv stage has helped me shift my experience of all 4 of these phenomenon. I must go through the process of reviewing my choices on stage, including the good ones, the bad ones, and especially the ones that could have been better. My show for the Omaha Comedy Fest had a particularly disappointing scene for me, where I had made some solid choices, but did not execute the pivitol next few choices (As a result of funny, connected choices that I made, I was asked to give a monologue. I know it could have been better/more connected). In the past, I may have dwelled on that “choice that could have been better”. Having made enough of those choices in the past, it is much easier for me to see that choice in the context of my overall improv ability. A monologue has never been in my wheelhouse, but it is within my abilities to improve upon. I must engage with and experience those four reasons that choices can cause misery because that experience can be used to improve the next time, be it ordering at Cheesecake Factory, an improv theater performance, or my own medical decision making. Navigating those 4 experiences are an essential part of being a physician. It relates to the improv maxim of “There are no mistakes”. There are definitely mistakes in healthcare but the practice of honestly evaluating the mistakes that we make and continually improving is essential for healthcare practioners to develop. It can be a slippery slope that leads to a pit of burn out, however. The 4th reason choice can lead to misery is especially dangerous. Self-blame is a tricky beast. Having an honest discussion of what I contributed to a mistake is essential to understanding the mistake and not making it again in the future. Not acknowledging the parts outside of my control would lead to needless suffering and crushing guilt. Is it possible that when reviewing mistakes, it would be better to take the approach of …and, Yes. Carefully consider my own contribution to the mistake first so that I first understand my thinking (and…) while also making absolutely certain that I understand the reality in which my contribution came (Yes,). For my recent improv example above, I need to consider the reality in which I was asked to give the monologue and the situation that led to it. I would not be honestly looking at improving if I did not consider the reality my contribution contributed to. Stopping at self-blame and not understanding the situation is where that slippery slope of engaging with the troubles of choices can become steep in addition to slippery

 Making better choices requires forgiveness

Everyone is the result of their own choices based on their own circumstances and everyone is doing their best. Improv has helped me take a perspective and understand how small choices can be amplified into something bigger, which is what happens at every long form improv show. I want to be very clear that this is not an endorsement of the idea that people should pull themselves up by their boot straps or that people are the only ones responsible for wherever they are at in life. If anything, it is the opposite. It’s suggesting that people are all doing their best and it’s unlikely that they are willingly making bad choices. You can form a connection and build a reality together where each person is free to make the choice that is best for them. I think at the core of being able to do this is the ability to offer myself forgiveness for the times when I was not as magnificent as I would have liked. Being empathetic and walking in another person’s metaphorical shoes won’t do any good if I am not able to effectively walk the line of accountability and forgiveness when I am in my own shoes. Some people are better than others in this regard and it can be taught. It also doesn’t happen by accident. Improv is the activity that has helped me the most with this balance of self-forgiveness and accountability towards improving myself

The Inner Journey First

What I hope people who attend our workshops on empathy is that each person come to a realization that they have complex lives. The complexity of the participants lives create a situation that is challenging to make the choices that lead to participants desired outcome. Once that realization occurs, then extending that acknowledgement of complexity to the people that we interact with every day. The first step is to appreciate the weight of the small choices I make every day. Improv helps me understand that. That understanding helps make me a better physician