When you think about your career now, is it any different to the one

that you imagined when you first started out, or have you started

to feel stuck and maybe even bored?

And more importantly, is your identity so wrapped up in what you

do that it feels uncomfortable even asking yourself those questions?

What we want from the second half of our working lives is often very different

from what we wanted when we started out.

And for me, that's nearly 27 years ago.

When we are younger, we tend to crave recognition and status and often

strive for seniority or leadership roles, but we often find that,

especially within healthcare, that a succession of promotions has led us

further away from the work we were so excited to do in the first place.

This week, Dr. Mark Shrime, author and surgeon, is back on the podcast to

talk about medical careers in midlife.

If you are starting to notice that you're not getting quite the same meaning

from your work as you used to, it might be that you are on what David Brooks

calls the second mountain, where you are no longer chasing status so much,

but looking for a way to help the next generation or do something that offers

purpose and meaning over recognition.

So whether you are at that midpoint in your career or you're starting

to wonder whether what you want now.

Will in fact serve you later in life, Mark has some great advice to get you unstuck,

reconnect with what's really important to you, build a career that's sustainable,

and which offers purpose and meaning.

If you're in a high stress, high stakes, still blank medicine, and you're feeling

stressed or overwhelmed, burning out or getting out are not your only options.

I'm Dr. Rachel Morris, and welcome to You Are Not a Frog.

My name is Mark Shrime.

I am a surgeon by training.

I'm the editor in chief of BMJ Global Health.

I've written a book called Solving for Why, and I'm particularly interested in

how we as healthcare providers, healthcare professionals, make big career decisions.

So, I think this is very pertinent to, to our listeners, uh, either listeners

like me who are in the second half of their lives of their careers, or people

that are maybe coming up to 'em thinking, well, will I always want to be doing this?

But let's start off with, you know, when people come to you, typically what issues

and problems are they, are they bringing?

the majority of my clients, uh, are in healthcare, uh, physicians, nurses, uh,

and other allied health professionals, including, um, including people who

are not officially in healthcare but are carers, uh, for others.

And caring is a. It's a tough job.

it demands a lot out of you.

And so a lot of people end up finding me because they get to a point where

they're burnt out and they get to a point where they're done with, they're,

they're done with what they've been going through on the day-to-day, but they

still have this caring instinct in them.

And they're not exactly sure how to navigate, uh, okay.

I, I, I still love seeing my patients.

I still love being in the operating room, but I kind of hate the day

to day and kind of hate what it's done to me over the last 20 years.

Um, I had a client once say to me, this client was a, is an OR nurse.

Um, the way she framed it was I don't, I don't get it.

I've been an OR nurse for 20 years, so that what?

I can continue to be an OR nurse for another 20 years?

So that kind of, I'm, I'm halfway through.

I'm kind of stuck.

it hasn't been the ride that I was promised.

And what do I do?

How do I balance all of these things, my calling, my identity and also wanting

to live and exist in a non burntout way.

So it's burnout a big reason then why people are coming.

I think burnout, yeah, yes.

Burnout is a big reason why people end up coming.

increasingly I'm thinking obviously that's what people present with, they

say they're burnt out, but it's like saying they come to you with knee pain.

Yeah, there's pain in their knee, but what on earth has caused that?

And unless you start to look at the cause, and that can be caused by all

sorts of things, and so often we're just trying to heal burnout, we're

trying to treat the symptoms, we're not, we're not looking at the cause.

So are people not enjoying the actual sort of meat of their jobs?

Is it everything else that's getting on top of them?

Or do you think it's something a little bit deeper than that?

Well, I think it's both.

I, you definitely have people who will say, and, you know, I'm one of these

people I love being in the operating room.

I really, really like the act of operating and seeing patients and, uh, all that.

I, I personally, I shut down my US practice seven years ago.

I don't see patients in the US anymore because I hated everything else around it.

Um, so there's definitely a, a subset of people, and it's a fairly

large subset of the people that, that I, uh, work with who have that.

Um, who are like, yes, I still want to be a healer in some way.

I still have this, this value in me, I still have this identity, but,

uh, this is not what I was promised.

And then you've got the, you've got another subset of people

who are fully done with it.

All of it is, is over.

Uh, maybe they liked it when they were 26.

Uh, maybe they never liked it, but just put on our front.

Uh, but whatever, now that they're 46, they've decided that that

is not the direction that they want their life to go altogether.

They wanna make a significant shift.

I use this example often.

I, uh, early in my coaching career, talked to somebody who wanted to

leave medicine and open a goat farm.

And so you get, you get all of, all of that, uh, that whole spectrum.

And do you find that the issues that you're dealing with in people sort

of entering the, the second half of their lives and what they're wanting

is very different from, say, if you were doing some career coaching with

some of the, the younger people?

I do think so, uh, I think a couple of reasons.

First of all, I, if you've been in healthcare for, you know, 20 years or

so, you've seen basically everything and you've seen the evolution of

the healthcare system in whatever country that you happen to be in.

And then there is a big shift that happens in people around

the middle of their lives.

You know, we, we know it as a midlife crisis, um, which you and I were talking

before we started the recording, that that phrasing is just so harmful also,

that it's a crisis that must be managed.

But there is, I mean, it's, there's, there's research, there's uh, there's

evidence that people go through a big shift in the middle of their lives.

So you get both of those sort of, kind of layered on top of each other.

that the conversations that we have when we're in our forties and fifties,

uh, and, and early sixties are very different than the conversations that we

would've had when we were in our twenties, deciding which specialty do I want to go

into, or do I want to go into medicine?

One of them, do I want to go into medicine versus do I want to stay in medicine?

Very, very different, uh, conversations to have.

I'm very interested in this thing about actually you would've liked to just

do the operating and, and carry on.

Is that really true?

Like, if someone said to you in the US you could work five days a week

purely doing the operating and nothing else, would you not get a bit bored?

yes, undoubtedly I would get a little bit bored.

There are certain people, and one of my, uh, fellowship directors was this sort

of person for whom getting the absolute minutiae of an operation down and slightly

faster every single time, or slightly better, every single time that drives him.

That's not me, that's not my personality.

Uh, so I probably would get a little bit bored.

The problem though, is that what I was offered as a full-time practicing

clinician to, you know, uh, I dunno, add some spice to the boredom was not fun.

That it was the, it was the billing and it was the medical legal and it

was the profit and loss and it was the health insurance interaction.

So yes, I would've gotten a little bit bored, but I don't think the solution

that the American healthcare system presents is all that good either.

Yeah.

I think you've helped me articulate the thing that was ne niggling at me, because

yeah, I had the same issue as a gp.

I, I got really bored just seeing pa the same old, same old, same

old again, although it was, the workload was really high.

So it was this combination of bored and stress.

But I know that I need something else to stimulate me.

And you need to grow and develop, and every human needs to grow and develop,

but then you've got this problem that's.

Growing and developing, so in, in healthcare for example, is often

becoming clinical director, becoming director, and getting these management

and leadership responsibilities.

And then you hit like midlife and you've seen that this career trajectory that

you've been on is, you know, I used to sort run the professionalism course

and then the next step would be to go up here and then the next step here.

But I, I didn't wanna do that, but I still wanted to learn and develop.

So then suddenly I've got the only career path that seemed to be open to me was

like this, but I knew that that was.

Not what I wanted, but nor did I want to just keep seeing patients.

'cause I was finding that boring.

So then I was stuck and that was my conundrum.

Is that familiar to you?

Gosh, yes, a a hundred percent.

Let me say two things here.

I, I've gotten lucky in that I've gotten to construct a life in which my clinical

work is to a large degree, the operating and the taking care of patients without

the other stuff that's around it.

Um, and I do that because I do some global health work and I do that 12 weeks a year.

I'm operating 12 weeks a year, and I get my.

I get my operative numbers, uh, but also I get, I get to be able

to do the thing that I, one of the things that I really love to do,

I was also on a similar path where the only real advancement, so to

speak in, in medicine is to become a director, become a chair of a

department, become a CMO, et cetera.

And I've done all, I was the chair of a department.

I was a chief medical officer, um, and that's basically the only career path

that we are given to broaden ourselves.

Uh, and so we end up people like you and me, we end up doing things that are

outside of medicine, to broaden ourselves.

But at least when our generation was training, that wasn't

necessarily looked upon very well.

You know, you've, you've left medicine in inverted commas

to do this non-medical thing.

Um, are you not a, serious surgeon?

Are you not a serious GP?

Uh, do you not care about your patients?

When I was CMO of the, uh, the charity that I, I work with, um, I was in

that post for about three years and the COO, uh, of the charity, uh, so

one of my colleagues, came from the mobile phone industry first, and then

he moved to aviation and then he moved to be the COO of a medical charity.

And I think about this, his career path a lot because in that sort of world.

He comes from the project management world.

In that sort of world, it's totally normal to take your project management

skills and go from mobile phones to, uh, aviation, to to healthcare.

But for us in medicine, oh my gosh, if you get out of medicine,

there's something wrong with you.

We have this push that you must stay in.

The only path that you can have is in medicine.

That, that really rings a bell.

It's that identity thing, isn't it?

It's that it's very difficult for us to imagine an identity outside of medicine.

And people feel a lot of shame when you think about.

Not even just leaving even.

Just like, well, for a day a week I might do something else.

Is it like.

And I think colleagues shame you as well, or actually nobody can shame you

except yourself, colleagues criticize you and sort of talk about deserting

a sinking ship or being too commercial or, or that, that sort of thing.

But, you know, we need commercial people in healthcare, quite frankly, to, you

know, innovate and stuff like that.

But You're right.

Why is it that we encounter the shame and criticism in healthcare yet in any

other industry, but like, yeah, you, you've just moved to a, a different

role, it, there's no dramas about that.

Yeah, and I think you said you, you hit on it in the first thing you said,

which is that there are, I've been calling them the identity professions.

There are professions in which our identity is our profession.

Doctors, lawyers, clergy, you know, you are a priest, you are

a lawyer, uh, you are a doctor.

And that is so much harder to leave.

Uh, a good friend of mine is a, uh, is a ballet dancer here in New York City.

And she wrote a book in which her last chapter kind of meditates on leaving

ballet because, you know, ballet is hard on your body, and so when you hit your

thirties or maybe early forties at some point you no longer dance professionally.

And that chapter is a, is sort of a meditation on who am I without this?

And it's something that I had to go through as I was deciding to shut

down my US practice, is something I used to compete, um, on a, an intense

sport called American Ninja Warrior.

And it's something that as I moved away from Ninja Warrior,

I also had to consider, like, who am I without my white coat?

Who am I without Ninja?

Because those things become your identity, in a way that perhaps

some of the other professions don't necessarily become your identity.

And so then we feel the internal shame that I was called to be a

doctor and now I'm leaving it.

Is there something wrong with me?

And there is the external pressure from our colleagues also that we need to stay

because, oh my gosh, those people who leave, there's something wrong about

their commitment to their patients.

I mean, that's part of what people have to wrestle with in,

in these midlife transitions.

It's what I had to wrestle with.

It's what my clients have to wrestle with is does, does this mean?

Does does moving, does changing mean that I am somehow less impactful in the

world that I somehow, yeah, have have failed what I was put on this earth to do?

These sorts of phrases we hear all the time.

So how do you help people wrestle with that?

And I'm thinking now, not just for people that want to leave, but actually

there might be people that are still working as a doctor, senior, another

senior healthcare professional that aren't gonna leave, but actually they

realize that their identity and their significance is coming from their

role and they realize it'd probably be a bit healthier for them if they

managed to loosen that hold on them.

What I'm gonna say is when I first heard this, like truly, I don't wanna say

depressed, but like truly made me down.

Right.

Brace yourselves,

everyone.

yeah, brace yourselves, but then it was really freeing, uh,

honestly, which is, I do not know my great-great grandfather's name.

I don't think I even know my great-grandfather's name.

A hundred years from now, very likely nobody will remember

Mark Shrime or Rachel Morris.

And that's depressing.

For those of us, especially who feel like we have a calling in this world.

Uh, the likelihood that we will be remembered for the

work that we did is low.

And so coming to grips with the fact that our legacy, so to speak,

is likely to be short-lived.

was depressing, but also becomes really freeing.

That I'm putting this pressure on myself that I must be this amazing,

impactful person in the world.

But really that pressure's coming from me.

The pressure's not necessarily coming from the world.

It may be coming from my colleagues, as we talked about

earlier, but that's also unhealthy.

So How do we then change that?

'Cause presumably these are really deep seated, deep rooted stuff.

You need to spend hours and hours in therapy.

I mean, you can spend hours and hours in therapy, and I'm

a full believer in therapy.

Uh, at the same time, part of what drives us into these things is a value set.

It's a set of values that we had and have, um, when we're 26 and when we're 46 or 56.

What we give ourselves less permission to do than maybe we

should, is for those values to change

Significant evidence that our value sets do change over the course of our lives.

Just as a very specific example, my values around, uh, public health changed.

Because of my experiences working in, uh, west and, uh, and southern Africa, right?

And my experiences have shifted the way that my values, uh, align.

And that's, that's what happens.

I mean, our values are not set in stone to a large degree, they are malleable.

And yet again, as physicians, as healthcare professionals, we feel like

the values that we had at 26 should remain with us for the rest of our lives.

And some of them do.

Like I really do.

Uh, value being able to use these skills to be a healer, but some of them don't.

Some of them completely leave and then the, I use this, this

analogy with my clients of a, a sound board, a sound mixing board.

Um, you know, if you've been to a concert and you've seen the sound person

in the back moving these knobs up and down, that's what our values do too.

They kind of realign themselves and, and one of the knobs maybe turns up

more as your kids are born, uh, perhaps the value of being home more goes up.

Um, and then maybe as they.

Leave for college.

Perhaps the value of, I dunno, travel goes up.

Our internal values change.

Again, we put this pressure on ourselves that that mixing board must stay static

for the entirety of our lives, but it, it actually doesn't, it's allowed to change.

What values typically are changing along the way?

There's that thing about, yeah, wanting to be home or wanting not, not to be home.

Are there any particular values that people tend to really hold onto at

work that are completely different in their late forties, fifties to

when they're in their thirties?

I mean, off the top of my head, I'm thinking, you know, probably that

whole having to achieve a a lot.

So this is, this is old, old psychology.

This is Eric Erickson, back in the, uh, I don't know, I wanna say 1950s, but don't

quote me on that, developed this, this, these stages of psychosocial development

over the course of the entire life cycle.

So a lot of the study at that point had been, you know, what are the

phases that babies go through?

What are the phases that children go through?

But he developed this stages of psychosocial development

across the entire life cycle.

And each stage of psychosocial development is characterized by

a crisis that must be managed.

And if that crisis is not managed, then the next stage of psychosocial development

becomes harder to manage, right?

And so in his framing, the crisis that has to be managed in your, uh,

like late teens and early twenties is identity versus confusion.

Who am I?

What am I, I'm, I need to establish who I am in this world.

And then in the forties to sixties, the crisis that you have to manage

is generativity versus stagnation.

Stagnation, we understand.

We know what stag we as healthcare providers sometimes feel.

The stagnation, generativity in the way that he, envisioned it is,

is, is kind of legacy thinking.

What do I do?

How do I leave behind?

How do I train the next generation?

You know, what is the legacy?

I know we talked about our legacies will disappear in a hundred years,

but what am I passing on to the next, uh, the next generation of people?

So already when we're younger, when we're establishing our careers, the thing that's

driving us is establishing our identity.

But then by the time we get to our forties, to fifties to early sixties,

we should have established that.

And it's okay for us to let go of that because we no longer

have that psychosocial crisis.

Our crisis now is we could stagnate or we can build into something else.

And I think this is super important for people who are in our midlife because

again, if you don't manage that crisis in that particular stage well, you have

a harder time managing the next crisis.

And the words that Erickson uses is for the next crisis are a little terrifying.

Uh, the last stage of life he says is, you know, 65 and older.

And the crisis you have to manage there is integrity versus despair.

Wow.

Yeah.

Right.

Wow.

Like despair is a, is a hard one for us to think about ending our lives on.

And so that's why I think this midlife shift is so important to manage, because

we have moved into a different part of our lives than we were in when we went

into medicine or nursing or healthcare.

Uh, it's, it, the, the author Richard Rohr calls it, um, the,

basically calls it the second half of life in his book Falling Upwards.

And what we're trying to do as we become the community elder, so to

speak, is very different than what we were trying to do as we were

trying to establish our identity.

That's interesting cause I was thinking earlier when you came out, thinking,

why is it that so many people do when they make their midlife transition?

Do trainer as coaches and you know, sort of consultants wanna help people.

Is it just because they can't think of anything else to do?

But actually it's not, is it?

'Cause if you look at this generativity, that's all to do with yes.

Supporting other people, helping other people come along, not necessarily

wanting, being about, I've got to leave this long lasting legacy,

but it's actually how can I help other people and share my learning?

And that is really nice to think about that.

So when people are thinking about what else can I do either within my role

within medicine or if I'm gonna leave and do something a bit different, think

you, you would probably enjoy a job where you are more in that sort of wise

elder role as apart from perhaps doing the doing and wanting to achieve a lot,

just to boost your own, you know, ego.

You actually probably will be happier, um, doing the generativity thing.

And maybe that's the way we've been designed actually, yeah,

we don't have very much, you know, oh, I'm so much tighter.

I'm, you know, my 50th is later this year and I really notice

how much less energy I have.

I just can't do as much during the day.

So actually, I'm.

Now I'm much more suited to sort of being like a wise old owl

sitting on a perch advising people.

Although my, my children would fall about laughing if they thought that's how I was

describing myself, than I am just actually getting on and, and, and doing the job.

But I don't know how much we value the, the generativity stuff

versus the, the, the doing bit.

Right.

Right.

And we don't, and I, you know, I will say, you said something in there, um,

about when you're younger, you are, uh, trying to do all the things for your ego.

Uh, uh, yes.

There ego can definitely play in there, but that's also the stage that

you're in, is developing your identity.

Like you are developing your mark in, in the world.

And yes, that shifts and I think you are right, that we

don't necessarily value that.

Um, even, and again, an American, so I'm gonna speak from the American healthcare

system, just the way that doctors are paid does not value that mentorship role.

Like I still need to produce the same number of RVUs as a 55-year-old

surgeon, as I needed to produce as a 30 5-year-old surgeon, if not more,

uh, because otherwise my profit and loss statement is, is off.

And so, no, we don't, we don't pay, really, we don't pay out

people's time to do the mentorship.

We just sort of expect that it happens on top of continuing the thing that you

were doing 20 years, 20 years before.

So, yeah, I think you're, you're right, we don't necessarily value

that wise old al as you said.

Whereas the leadership thing, you know, if you have a leader who is

really, uh, very skilled at coaching and mentoring and things like that,

you've got the most fantastic leader.

And I think we don't value it ourselves.

You know, we, we seem to think that leadership takes, like, I don't know,

in, in, in the NHS you might get paid like four hours a week to be the clinical

lead for your department and you've got to keep going with your, your day job

or you feel guilty if, well, actually I'm feeling guilty 'cause actually

most of my time is spent on leadership.

But I'm saying I would much rather, you know, you are much more valuable to your

hospital probably now, spending more of your time leading the department and,

and leaving the doing to the younger people because of the experience that

you've amassed and the, you know, the, the time taking to think of it.

Let's also talk about the fact that we, we don't value it enough

to train people in it either.

The number of clinical leaders who are clinical leaders simply because they

were good clinicians, it's massive.

And so we end up putting people in situations in which

they feel under prepared.

Um, but we expect the same high standard of performance as they

had when they were doing the thing they were prepared for, right?

We, we were in training for medicine for whatever it was, a decade

and a half, so we had a lot of preparation for how to cut and sew.

But then you move into leadership and it's just like, okay, go, good luck,

um, you know, improve your department.

And we don't train them for that.

And so that also leads to the burnout because then you've got these high

performers who are thrust into situations that they're not prepared

for, and, they feel themselves, falling down on, on what they're asked to do.

And they also feel guilty for not spending time on the shop floor.

They feel guilty for the leadership time, which is, is madness really,

when it's, they're so, so valuable.

So you've got people coming to you, they're entering the second half

of their life, they're having this sort of identity crisis or whatever.

What else do you do with them that really helps them with this, this transition and,

and work out actually what, what should the second half of my life look like?

So my PhD is in the science of decision making.

And I think the other thing that we struggle with, uh, is that we don't

necessarily have good frameworks, good methods, good, uh, training in how

to make big decisions in our lives.

We're so good as clinicians at making decisions for other people, sometimes

very impactful decisions for other people.

But then to look at ourselves, nobody talks to us about how we can make

these big decisions for our own lives, because big decisions are fraught

with a whole bunch of uncertainty.

I say this all the time to my clients.

No decision is made.

Uncertainty.

Every decision is made under uncertainty because if there was

certainty, it wouldn't be a decision.

So for making these big decisions, small or big for making these big decisions

in our lives, we have zero way really of conceptualizing or taking into account

all this uncertainty that our identity and our values and all the things

we're talking about earlier brings in.

Uh, so I work a lot with my clients on that, on how do we actually

surface all of this uncertainty?

How do we deal with this, uh, this uncertainty?

How do we describe it?

How do we bring it into our decision so that when we're done, we can look back

on it, on that decision and, and say, okay, with everything I knew at the time,

I made the best decision, I, I could.

It's really hard though to make the decisions about your future

self when you're not that self, but also you don't know what it's

gonna be like when you are there.

A really silly example, we are wondering about moving house at the

moment, but we don't know whether we want to move further into town or

whether we want to move out of town.

But it's a really big decision and you're not gonna know we're

there and what made the wrong one?

Well, there were two things I wanna say to that.

Uh, the first is.

Absolutely, you're right.

Transformative experiences lead to personal transformation, but

they lead to something called an epistemic transformation.

You don't know what you don't know, and you cannot know how you will feel after

a big decision on the front side of it.

Like you cannot sitting here, you absolutely cannot know how

you will feel if you decide to move closer into town or out.

So to some degree you're never going to answer that question.

So fixating on trying to answer that question, all it

does is it keeps you stuck.

There are a number of different ways to manage uncertainty.

Um, one of them is to, and, and I, and I think a, a, a maladaptive way to do

it is called, uh, is called reduction.

It's to try to reduce the uncertainty all the way to

zero, and that just never works.

And so people who, um, who have that tendency towards uncertainty, just

continually try to gain more information, more information about the uncertainty

until, until they're satisfied that it's down to zero, but they never act.

Uh, so the other thing I would say to that though is we are, we have a

remarkable psychological immune system.

We are remarkably adaptable to situations that we think are going to be terrible.

There's a fascinating study in which the authors looked at, college

students and asked them how happy they would be in the future if they were

assigned to a, an undesirable dormitory versus to a desirable dormitory.

And the answers were what you'd expect.

The people who were thought they would be assigned to an un undesirable

dormitory thought they would be much less happy than those who, but then

a year in their happiness levels were identical, whether they were assigned

to a, a bad or a good dormitory.

We are so good at this.

We, our psychological immune system is so good, we are so adaptable that you

decide to move closer into town, there are gonna be good and bad things about

it and eventually a year in you're gonna be just as happy as you would've been

had you decided to move further away, uh, from town because the good and

bad will balance them each other out.

That's encouraging, but also quite depressing.

'cause presumably if you get someone coming to you and they're pretty

miserable now, they can also reach the same level of misery in a new

life that they've decided to, to do.

That's such a good point.

I think, what I'm trying to say here is that our, our affective forecasting

is what the, uh, authors call it.

Our affective forecasting is pretty bad.

We are mostly okay knowing whether we will be happier or sadder, uh, with a decision,

we're mostly okay with the direction of the affective positive or negative.

We overestimate, however, how big the, uh, emotion will be and how long it'll last.

Another study of, uh, professors going up for tenure.

Again, pre pre-tenure decision, we're asked, you know, how happy or sad

will you be if you get or don't get tenure, and how long do you think that

happiness or sadness will will last?

And routinely, they overestimated both.

So yes, the professors who got tenure were happier than those that

didn't, but for less time and less intensity than they thought they would.

Gosh, that is really interesting.

Okay, so you are not gonna know unless you try it, but you often

overestimate the effects on your, your happiness or, or sadness as it were.

Okay, so how do people make these decisions and how

do, how do you help them?

You know, what's the techniques that has the biggest value for you that you just

come back to again and again and again?

so broadly in a, in a 50,000 foot view.

We start with the thing that we were talking about in the first half of

this podcast, which is the values.

We actually build someone's mixing board.

We figure out, you know, you pick your five, no, you pick, we like, we go

through exercises in which your five top values get, get kind of surfaced,

and then you build that mixing board.

Which one at this point in my life, do I think is, number one, number

two, all the way down to number five?

Very specifically though, which one do I think?

So I'm trying not to hear what other people think it should be, and at

this point in my life, not when I was 18 and choosing to go into medicine.

So we build that and then there are, uh, I use five different

decision making frameworks, and we match them to the person.

But frameworks that are very um.

Kinda risk taking, uh, frameworks that ask, you know, what's

the best that could happen?

Frameworks that ask, what's the worst that can happen and let's

protect ourselves against that.

Uh, frameworks that, that bring in regret.

Uh, what happens if I make the wrong decision?

How much will I regret it?

And let's minimize that regret.

So we find the framework that is the most, uh, that, that kind of speaks

to the heart of the person the most.

Then we can combine those values that they've elicited with those frameworks

that take into account the uncertainty of how much regret I will have.

And what that does is eventually it, it, there's, there's some math behind

it, but it bubbles to the surface.

What I think the next stage of my, my, the next step should be.

So now that I've put everything together, I, it really is looking

like I should go into cabinet making.

Um, again, this is actually a real example I should go into cabinet making.

Uh, then we take a really important pause and we ask, now I need you to,

to envision yourself at 86, looking back on your life, and I know this

sounds morbid, but I actually have my clients write their obituary.

What do you want your obituary to read and how does this decision fit in with that?

so we've kind of future test their decision and we also

reality test their decision.

So you want to go into cabinet making, let's get you in touch

with some cabinet makers.

Spend a couple days, spend a weekend shadowing some cabinet makers.

What is the of cabinet making feel like?

And then finally the last step that we do is once we have, uh, surfaced

the decision, we've taken into account the values, we've taken into

account, the uncertainty, once we've future tested and reality tested the

assumptions, then it's time to act.

And this is where a lot of people get stuck, is super cool to think about deci

a decision in, in the hypothetical, but okay, now I am gonna be a cabinet maker.

What does it take to do that?

Um, what's my financial runway?

Uh, you know, how long do I have to make this cabinet making a success?

Uh, what are the medical legal consequences of me

shutting down my practice?

You know, how do I brand myself all those, the, that, that actual step by step.

I think one of the reasons that people stay stuck is because making

a big shift seems so insurmountable.

And once you break it down into small steps, you know, in, in May I need to

do this, in June, I need to do this, then it becomes, it's, it's bite-sized.

You know, the, the journey of a thousand miles begins with a single step, you

actually take that, that first step.

I think that's where doctors really struggle is like, it's

such a big field to do this.

Um, so that's really, really practical.

Do you think it really matters what anybody does, if they

get other things right?

Because I've got this theory that there are these sort of core needs

that we all have, and I call it your North star needs, which is to feel

good, to have good deep relationships, find meaning and purpose in life.

But my theory is that if you've got all those things in your life, actually

what you are doing, probably not gonna make huge amounts of difference.

I, yes, I agree with you.

Um, and I, I think it's su super interesting that you split out

meaning and purpose and work.

Because that's another thing that we, as, as healthcare professionals tend

to, uh, we tend to combine those two, that we must find our meaning in our

work, and that's not actually true.

The number of people who don't find their meaning in their work

far outnumbers the people who do.

And we, I think, need to really come to grips with the fact that it's okay

that your meaning is something else.

It is okay that taking care of patients is a job that you do on Tuesdays and

Thursdays from eight to five, and then you find your meaning in your cabinet

making totally okay to do that as well.

I think it's a, it's a double-edged sword, isn't it?

Because I know that a lot of the burnout research shows that purpose is

a really powerful antidote to burnout.

However, I have, and I think we talked about this in the last podcast, Mark, is

that I've, I've looked at people that find a lot of their meaning and purpose through

their work, or put all their meaning and meaning and purpose into their work, and

they get burnt out even even quicker.

'Cause if you genuinely think your job is to save the world and you do that

through being a doctor or a priest or this or that, then actually when you're

not doing it, you are not fulfilling your, not just your purpose, but you are

poor, all these souls that are unsaved or whatever, that's a, a huge amount of

pressure that just feeds into the whole identity and significance thing as well.

Yeah.

And I, I do think we talked about this last time, the intersection

between purpose and burnout is not, it's not a clean straight line.

It's not that finding your purpose leads to less burnout, because

it might actually lead to more

Yeah, I think sometimes it really, really does, particularly in healthcare.

And so, yeah, no, I, I really love the concept of the, the zone of

genius and Michael Hyatt describes that where you are doing what you

love and also what you're good at.

So it's finding something where you've got your skills,

but you also enjoy doing that.

And that can be in paid work or out of paid work.

And I was listening to a, a brilliant audio book by one of

my, my favorite people, Rob Rob Bell, who does the Rob cast.

And I'm sure you, you've come across Rob Bell before and he was just talking

about the fact that, you know, if you find something here that's no one's

really gonna pay you to do, but it really gives you a lot of meaning and

purpose and you love doing it, then great, find some work that's gonna pay

your bills to enable you to do that.

But we always think, oh, work has to have all this meaning

and be really significant.

Actually, if you've got enough money to exist, then go do that other thing.

Yeah.

There's, there's a concept, and actually I have it at the end of my book.

And the more I've, I've thought about it, the more, I think

it's an incomplete concept.

But there's a concept that had a lot of, cachet in the public discourse,

maybe five, 10 years ago, called Ikigai, the Japanese concept that what you

should be doing is what you're good at, what you can get paid for, what

the world needs and what you love.

But I think what you're saying here, which I agree with, is that, uh, we have this,

uh, presupposition that one thing has to do all four of those things, but it's

not, you need to have all four of those things in your life, but they don't all

necessarily have to come from one thing.

Yeah.

I think people get very hung up on the.

what the world's gonna pay you for and what the world needs.

Um, I mean, you know, in an ideal world, we'd all be contributing greatly and

everyone would pay us well for doing that.

But in, in a, in a real world, it doesn't.

And then you see other people doing absolute crap and

getting paid loads for it.

You know, you just look at the, the influencers who like, you

know, what are they doing that's not meaningful or worthwhile, but

they're getting paid so much money.

So if you know, then you get your worth from what you get paid.

It's just, it's just ridiculous.

And then, or we try and bend what we really enjoy doing into

what people are gonna pay for.

So the market forces or, or people even don't know that they need it

and, and that's when I think you then start to feel like a failure.

'cause people won't pay for it.

Or maybe people don't need it, but you still love doing it.

Doesn't mean you shouldn't do it.

Right, right.

We're aligned here, that we don't necessarily need to bend, uh, what

we're doing to what the world pays for.

We need to find a, an overall portfolio of our lives that

addresses all four of those things.

Or in your, in, in your analogy, all five of the, of the core

needs, the North star needs.

And that, When we, when we look at romantic relationships, we feel like

one person has to provide every single need in our lives, and that leads

to a lot of stress in relationships.

We're doing the same thing with jobs.

That one job or one thing that we do has to provide all of the North Star

needs that you're talking about here.

And that puts too much stress on the job too.

I don't really know any job that can really do all of that.

and it takes it away from, you know, I, I once did a, it was called a performance

site diamond with a, a senior consultant.

Um, and it was a way of marking how well your job was doing in

terms of purpose, achievement, recognition and growth or something.

And, uh, so he marked himself.

a, a lot of achievement, a lot of recognition, a lot of purpose,

but enjoyment pretty low.

And then I said, well, what, what would you want it to be?

And he put his achievement of recognition.

He actually reduced the amount.

So I said, well, well, you, you want less recognition and achievement?

He said, yes, because look how much it's pulling down my enjoyment.

And this goes back to the conversation we were having before about Richard Rohr

and Eric Erickson, that when you're in your twenties and your thirties, uh,

achievement and recognition is something that drives you because you are trying

to figure out that identity crisis.

But once you've figured out that crisis, it's so, so common for people to retreat

and to say, I don't need this anymore.

I've done it.

You know, I've done the thing.

I've, I you, in your example, I've become the clinical director,

and it wasn't what I wanted to do and I don't need it anymore.

So Mark, what else do you think needs to be present in the second half of

life for people to sort of really enjoy themselves and have sort of fulfilling

life that we haven't mentioned already?

Often, when you're at the second half of life, you are making a decision.

You know, you're making a decision for, I have 15 years, whatever left of my career.

Do I want to spend it the way I've spent the last 15?

And I think the people who navigate that the best are the people who are able

to answer that question the best, give themselves permission to actually ask that

question and if the answer is yes, great, but not assume that the answer is yes.

And actually, even if the answer is yes, probably in five years time

the answer's gonna be probably not.

Let's keep changing.

Yeah.

Uh, yes.

And, and that growth that's in your North Star, uh, yes.

The fact that we, we need to allow ourselves to change.

We need to allow ourselves to reinvent ourselves, um, throughout

the course of our lives.

So Mark, if you've got people that are, they're not yet, they're not sort of

wanting to do a full blown career change, but they want to put sort of some of

this into, into action 'cause they, they know something not quite right and they

need to shift things around a bit, what would your three top quick actions be

So I think the first thing that one really need to do is, is that I'm

a surgeon, so you'll forgive the, the phrasing I use for this, but

is that dissection of their values.

Really take a good look at what you're assuming your values are and ask if

that's really what, what they still are.

Uh, so you dissect your value, you dissect out your values, number one.

These are not quick, unfortunately, these are hard.

Uh, but I do think people need to do that.

Uh, I think the second thing that, the second, there's a big mindset shift that

we also need to make, which we didn't get time to talk about here, which is we

assume that we have no other marketable skills besides medicine, which is

incorrect because to be a good doctor, you have to be a good communicator.

You have to be, uh, you know, at least somewhat good with people.

You have to, et cetera.

You have to be a good systems thinker, et cetera, et cetera.

So, uh, the second thing that I would tell people to do is to figure out

what are the skills that I have that I've learned because I'm a doctor,

but I've kind of devalued because they aren't specific to doctoring?

And then combine those two and start asking the question, if I want to design

for myself more of a portfolio career, so I don't wanna leave altogether, but I

don't want to do this full-time either.

If I wanna design a more of a portfolio career to address the other needs

in my North Star, uh, five, what things should I start looking at?

And think broadly.

I mean, honestly, think broadly.

Uh, I've given two examples already of a cabinet maker and somebody

who wants to open a goat farm.

Like we can think we, uh, as clinicians have a lot of skills, we can think

really broadly, uh, around those things.

I love that.

And I think also if you sort of add in that thinking of, well, when I'm designing

my portfolio career, maybe I'm gonna go for the stuff that's more pointing

towards that generativity, rather than the, the achievement and the recognition.

And yeah, you can do anything and, and sometimes just doing something different

one day a week is enough isn't it?

Is enough of a change to get you outta burnout or even just dropping one

particular role in your clinical role that's just gonna give you a bit more

breathing space and head space to be able to, to do that stuff that you really

love and that will bring you some of that meaning and purpose and stuff, even,

even if you're not paid for it, right?

Totally agreed.

Totally agreed.

And, and you know, that portfolio career, again, we all do

actually have portfolio careers.

If we're in the middle of our lives and we're clinicians, we have built

a portfolio, but that portfolio is all clinical or all like medical.

You can start to add things to that that are not as well.

Mark, that's been so interesting, thank you so much.

If people wanna find out more about your work or get hold

of you, where can they go?

So I have a personal website, which is markshrime.com.

Uh, I also have a website for the coaching work that I do around specifically this.

And there's a, there's a free masterclass on that website and that's solving

for why, uh, WHY, so solvingforwhy.co.

Or you can, uh, yeah, find me on the usual social media, uh, apps.

My handle is the same everywhere.

It's just my name, mark Shrine.

Wonderful.

Thank you so much, and I'm sure there's loads more stuff we need to talk about,

so we'll have to get you back another time just to go down this route even more.

And if anyone's got any questions, uh.

Write in email Earth, let us know.

And yeah, I do check out all of Mark's resources.

And you've done Ted Talk as well.

I think Mark Avenue, you, which people can, can watch this.

We'll put all that in the show notes.

Thank you so much for being here, and we'll speak again soon.

Thanks, Rachel.

Thanks for having me.

Thanks for listening.

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