Dr. Dan Dworkis, MD PhD is an attending emergency physician and professor at USC’s Keck School of Medicine / Los Angeles County+USC Medical Center, and the founder of The Emergency Mind Project. His work focuses on human performance under pressure, especially in times of emergency and crisis. Dan is the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure.

His book, The Emergency Mind: Wiring Your Brain for Performance Under Pressure, is used by people working under pressure across a variety of disciplines from emergency medicine to entrepreneurship to athletics and beyond.

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Dr. Dan Dworkis Transcript

(00:00:03) Sean – This episode of ‘What got you there’ podcast, I sit down with emergency room Dr. Dan Dworkis to talk all about how do you make effective decisions in the most high stakes environment, whether that be an emergency room or the boardroom. So if you’re interested in decision making, and how to handle high pressure situations, you’re going to love this interview.

(00:00:24) Sean – Dan, welcome to What got you there. How are you doing today?

(00:00:26) Dr. Dan – Hey, man, thanks for having me. I’m doing really well.

Mindset before Few Minutes getting into ER

(00:00:28) Sean – I’m fired up for this one, but I would love to know. So you’re a few minutes before entering the ER, I really want to know what’s going on in your mind and what are the things you’re doing just to get yourself in an optimal state to enter that environment?

(00:00:41) Dr. Dan – Yeah, man, let’s jump right in. I think that’s something that’s really evolved for me over the time of being an ER doctor and there’s sort of like, like the question behind the question you’re asking right or like what are the phases of getting ready to perform under pressure, right? So there’s like, the stuff you do the day before and the weeks before, there’s the stuff you do the moments before. Then there’s the stuff you do in like the micro moments before, like the seconds before and those are all really different sort of skill sets with different sort of patterns to them. And it actually like even within that wall, you’re performing under pressure. There’s the stuff that you do to regain your sense of equilibrium when things go sideways. Those are all sort of like related but different topics and different mindsets. But for me, the biggest one that I do as I’m going in, right, so that’s that like the moments before kind of space, is that I really tried to reconnect to a deeper purpose of why I’m there, right? I know things are going to be hard. I know things are gonna be challenging. I’m going to face things that are going to be uncomfortable and difficult and full of friction. And I try to reconnect to the sense of depth of gratitude of why I’m doing it, right like I get to be one of the humans who standing on the line right now. And I get to reconnect to sort of the long line of other people that have been able to do that and serve on that on that space. So when I was training in, in Boston at Mass General, there’s this long hallway. That’s like, you know, it looks like it’s older than dirt and MassGeneral would of course want you to believe it’s older than dirt, not quite older than dirt. But it’s got all of these red bricks on it and sort of so I developed this pattern of like walking along ways. So I could go down that hallway and think to myself about this idea that I’m about to cross this threshold and when I enter this space, I’m going to try to bring the best that I can to bear for anybody who’s over there.

After one year into performing Under-Pressure

(00:02:27) Sean: It’s really fascinating. I’m really curious actually thinking about the evolution of this for you over a year. So I’m just wondering how that’s progressed both like as you progress as an individual and then both you as a doctor as well. What’s that look like? What’s that? Evolution been like?

(00:02:42) Dr. Dan – Yeah. So, you know, the first couple of times that I performed under pressure, and I think this is pretty universal talking to other humans that perform under pressure the first couple of times, you just don’t, live up to your expectations, to put it really mildly. Right like you really end up falling far short of where you want to be doing. Right. And that’s part of our logic of how we train people is that we never we try never to put people all the way at the front right at the beginning, right? We try to gradually introduce them to pressure a concept that we sort of termed the wedge, right? You start with low wedge practice, which is a little bit of pressure, and then you move yourself up to high wedge practice. And then finally, sort of like the full the full weight of the team on your shoulders. You know, the first couple times that I performed under pressure, I remember just thinking so hard about this gap between where I was and where I wanted to be. And man I you know, I even though like I’d already finished medical school, I had a PhD at that point like I was a fairly, you know, well put together human with a lot of knowledge and even still, you realize that deploying that knowledge like taking that that abstract fact and concept and mapping it and bringing it down to the point of the spirit where the person needs it is such a different set of skills than actually knowing the thing to begin with. And so the first couple times you do that, you look at this gap, and you say, Well, man, how in the world do I start crossing that? And so actually, that technique of like, looking at the red bricks when I’m walking into work, was an experiment. And it was one of many things that I tried and that’s the one that seemed to stick for me. But part of the answer is of how it evolved is that you practice you experiment, you think yourself, okay, I’m gonna today I’m going to try this and let’s see how it goes. Some days it is a total, like dumpster fire of a failure, right? And you come back and you’re like, Alright, okay, okay, fine. Like let’s try that again. What am I gonna do differently tomorrow, and then you consciously sort of like upgrade yourself every day through that.

Filling that Gap to reach the imagined-self

(00:04:32) Sean – I love that concept and the verbiage around the wedge. It’s just a great mental imagery for think about like your own progression and how you got to get those lower wedge type activities first, and then you can build on top of that. I am wondering, though, I mean, as a high performer, I have to imagine there’s still that tension state, right? Like where you are to where you want to get to that gap that went in between, we’re always trying to close that gap. So at this point in your career, like how wide is that gap? I’m just wondering how you process this mentally, each time you enter the ER.

(00:05:03) Dr. Dan – Yeah, that’s a really good question and I think there’s a couple of answers to that. So one is that I don’t believe that there’s a finished product. I don’t believe that there’s a version of Dan that will perfectly cross that gap all times in all situations and that I just have to get there and then I’m done. I’m done. growing and evolving. I don’t think that’s true. Quite the contrary. I think that we all always evolve and, and always have room to improve and grow. you know, mastery and development to me is that growth and that sort of constant evolution of it. So some days the gap feels really big. Some days the gap feels quite a lot smaller. Now, I hope and I very much believe that if you look at this, the size of that gap on an absolute scale from an impartial third person view, it’s gotten a lot smaller over the years I’ve gotten better at performing under pressure. But what it feels like on a moment to moment basis is a lot more nuanced. And I’m not much of a musical person, but my friends that play instruments, talk about sort of a similar thing, right? Like they’ve gotten better at playing the instrument but when they play they think to themselves about the nuance of where they want to be a little different in this one note. And like that’s what they think about and they celebrate where they’ve come from and how far they’ve gone. But they keep pushing for that little piece of it. So I still use the wedge myself like on a pretty regular basis, right? Like I think about okay, well, this new idea I’m trying Can I try it out slightly lower. Pressure somewhere else and then deploy it slightly higher pressure. Like that’s still a concept of simple machine that we use all the time.

Never Waste Suffering

(00:06:42) Sean – Yeah, I love the concept around those micro moments where we’re super hard on ourselves kind of thinking. Like, ‘oh, man, I could have improved so much even on that podcast interview right.’ But then over time I progress exponentially almost and so I’m actually wondering about those two different scenarios where those gaps are larger or smaller ones, right? Like in the moment you perform and you execute almost flawlessly. I’m wondering what your post review looks like. have a moment where you perform exceptionally and then one where the gap was massive. And you’re just completely dissatisfied with your performance there?

(00:07:15) Dr. Dan – Yeah, so there’s a bunch of tools that we have that work in those spaces. The underlying thesis, the underlying reality behind that is this. This deep desire and this deep belief to never waste suffering, to never waste my suffering my patients suffering to never waste the suffering of our team, and to use that suffering as fuel. And so we sort of had this saying, you know, along the lines of like, if you want to get better if you want to keep growing, you can’t waste suffering. Because it’s too precious of a fuel. There’s too much energy in it, that you need to keep driving forward. So with that underlying reality mindset, then we get the question of like, okay, well, how do we actually post process something and I think one of I think when I started I tended to make really broad brushstrokes, and sort of these blunt moves like, I’m great, or I suck, or this was terrible, and like, none of that’s probably true in any like real sense, right? And the more experience you get, the more nuanced you get with it and you’re able to sort of pick apart different pieces of it. So you can actually see that the main tool that we use is something that I learned from Annie Duke, who’s a former world champion, poker player turned decision-making expert. And in her book Thinking about bets was the first time I really encountered this in like a really a real way. I sort of had been doing some of it unconsciously before that, but it’s the idea of what she calls resulting, right? So imagine a two by two table and one side is his outcome, which is what happened, like what the actual result is. And then the other side is performance, which is how did you perform at your job? And it sort of gets them the stoic dichotomy of control, right? Like performance is what I have the ability to control an outcome is what actually happened. And what you’re going to do after an event, is map. map that event onto that table. And you’ll probably find that there are some pieces of what happened in each of those four quadrants. And then you can really start digging into that and start exploring outward being like okay, well, what did we do well, what do we not do? Well, what can we do better? And why did this happen? Do we think there’s a link here? Was it randomness, and you can sort of start down that path of dissecting, dissecting what happened?

Dan’s Mistakes early on in his career

(00:09:23) Sean – Yeah. I love that concept. And Annie is fantastic. She’s been on the show a couple of times. Her ability to think about decision-making is just second to none most likely. You were mentioning there for a second, just about things that you spent too much time focusing or putting too much effort in earlier on your career. Anything else like that? With hindsight, you’re like, you know what, I actually would have doubled down on this much sooner at the start of my career?

(00:09:47) Dr. Dan – Oh, yeah, man. Yeah, absolutely. You know, like the way that I understand human performance under pressure, the way that I understand that piece of Emergency Medicine has just evolved so much as to, in some sense be like almost unrecognizable from like, what I started that, but I think the biggest thing that I think differently now, and then we’ll sort of back into that in your question of what I would have done earlier had I understood that. Wait, is that idea that the way we work is this constant cycle of prepare, perform, recover, evolve, and when I trained, I just thought about performing. Maybe some days I think about recovering. We tend to do in emergency medicine, training, like half-day a week of what you just call the school, so you’re just training for that half-day and whether that’s sem or or lecture or whatever. And like maybe I think about evolved when it was a school day. But I basically thought about nothing else, just Perform. And I think that’s so incredibly short-sighted, and just so, mistaken, of an opinion about how to do this kind of work. And I think instead, the more I understand the depth of the logic behind this cycle of prepare, perform, recover and evolve, the better I get so I would have way, double down on preparation. I would have learned everything I could about recovery from stress. I would have learned everything I could about the way that you learn from what happened and take it into your next day. I would have studied you know like peak by Anders Ericsson, I would have studied more of Josh Waitzkin’s books of learning. I would have really ug into like what we think is the best about how humans actually, for lack of a better word, like suck knowledge from something and turn it into more product.

Processing the suffering and evolving

(00:11:38) Sean – I love these four quadrants here. And believe me, we’re gonna dive into each one of these structures’ entire conversation. I think there’s a lot of things you’ve done throughout your life that are going to pull in toggling all these but one of the ones that really just like kind of stood out to me there for a second was around taking what we learned in that day. And then using and learning from that, to set us up for the next day. I’m thinking about that, like that line you had a few minutes ago. Around never wasting suffering. I’m thinking about using that because I have to imagine just the magnitude of some of the moments you deal with, like how do you take that, that suffering in that moment, and be able to step back and analyze it and then use that moving forward? I’m just wondering how you process that.

(00:12:19) Dr. Dan – Yeah. That’s hard. I’ve gotten a lot better at that over the years, in part from building up a depth of the sense of self, in part from building up a sense of mission and in part from therapy, and starting to understand how to process some of these things that happen. I think there was this mindset. I had this mindset when I started that nothing should affect me. I should just bundle through it, put my shoulder down and get on to the next thing. And there certainly are times in emergencies where you do not have the space and time to actually dig deep into the human side of what happened. The next person needs you and you have to keep moving. But over time, I’ve invested more and more in understanding the impact of these things that you see on yourself. Right. I mean, not too long ago, I had a really challenging case where we lost a young patient and you can’t go from losing a young child directly into an ultra-technical analysis of the way your left hand moved during part of one procedure but you can’t really do it well in any meaningful way. Right? You have to take the time and space to sort of honor what happened and dig into it. This is something that the folks I work with at the mission-critical team Institute talk about as residue. These cases leave residue on you. And if you ignore it, it builds up over time and it causes badness. So now I try to in the moment consciously take some time to reflect on what happened and you know, we tried to create some rituals around the things that have been sort of at the end of somebody’s life. Then afterwards take some time to process, postprocess that. really to feel it and I am a lot more conscious about feeling things than I think. When I started and then why did that change? Start digging into it?

Dan’s Story into – It’s Okay, not to be Okay!

(00:14:32) Sean – This is really curious. Early on it’s like throw more on my shoulder. Like I can handle more and then I don’t know if it’s just age or what it is all suddenly you reach that threshold and you’re like, This is not sustainable. I need to learn how that played out for you.

(00:14:45) Dr. Dan – My emo answer to that is like, you know, the integral of overwhelming amount of pain, but that’s probably like not a useful sentence. Right. I think that really it’s getting conscious of the fact that like, this does affect you and having in some sense permission right like seeing people that I really respected and that were ahead of me and that were people that I looked up to is incredible doctors and you know, absolutely absolute like paragons of performance under pressure. Watching them. Be like, Hey, I felt this is real. Like I really felt what happened right here, and then sort of being like, oh, man, okay, I guess if they feel it, like it’s probably okay for me to feel it too. And I think that’s one of the reasons that I’m so vocal, the fact that like, I do therapy, like I do it every week, I think about what I’m feeling I try to get better at it because like, hopefully somebody listening to this can be like, Oh, that I don’t know that we’re do Dan who does all this crazy performance under pressure stuff like he does therapy, so okay, it’s probably okay if I feel things too. And I think we’re slowly bending the culture around that.

Story of becoming the ER Doctor

(00:15:49) Sean – Yeah, I think that’s so important. I love when people that we look up to open up the gateway for us, almost just like that acceptance is, Someone who I look up to I respect they do that. Maybe I can garner sometimes that as well. I think that’s just so crucial. So I love hearing things like that when people like yourself opening that up. How did you initially know just even get interested? In becoming a doctor entering the ER, right? Like, that’s a unique thing. I feel like that not many people still steer towards.

(00:16:18) Dr. Dan – Yeah, we’re a weird bunch. I think. I trained and mostly as like a scientist and a little bit of a like, slice of engineering in there. And I thought I was going to medical school to build medical devices. And I really just wanted to know which devices to build. That’s actually like, sort of how I framed it when I first got in there, which is kind of ridiculous looking back at it, but everything makes sense looking backward right? Nothing makes sense that you’re going forward and so I got into it and realize like, wow, okay, that like devices are cool, but like all these people are suffering from all this stuff. Like, I really need to go figure out what’s going on in that and, how can we help the people that with what they’re suffering? And you know, you get exposed to all this stuff as part of your medical education. You know, you spend time in the pediatrics Ward and in an operating room and in physical therapy, you spend time everywhere right? And pretty much universally something hits you and it just you’re like this is what I want to do. This is the shape I am, this is the puzzle piece that I need to be. And for me, you know, I remember wandering through the ER at three or four in the morning when I was on some other rotation just because I felt alive there. Right and like, this is the group of people that steps up and tries to take care of anybody that walks in, and it doesn’t matter what they’re there for. Do they just need a sandwich and a pair of socks? are they dying of a gunshot wound, like it doesn’t matter? You’re gonna step up and try to make their life better. And I think that is deeply meaningful. And that meaning that purpose, that that alignment with that really gets me through a lot of the hardship of what happens. And I’m a very purpose-driven person like that. And that really synced up well with what I wanted to be doing.

Dan’s process of seeing his Purpose and acting on it

(00:18:09) Sean – I feel like we’re jumping into Joseph Campbell’s follow your bliss right here and I’m wondering how Yeah, no, this is just like lights are going off for me. I love this right now. And I have to imagine there’s a lot of people because there were times where I wasn’t as clear about my purpose what I was going after, how do you cultivate the conditions both to be part of the environment but then also to be able to see right like a lot of times a purpose could hit someone in the face and they’re not even aware they’re not even be able to see it. I’m wondering for you, how you’re able to see it, but then also able to act on it.

(00:18:42) Dr. Dan – Yeah, that’s really good. I think that’s a real, like, deeply important question. I don’t know that I have an Answer to it. I can certainly, like maybe elevate a couple building blocks that might help with that. Right. I mean, one of which is like an underlying belief that you can change yourself and I can change myself. Right, I believe that I can change myself. I believe that I can open up the hood and tinker on my engine and improve it and upgrade parts swap out components. I believe I can do that with conscious effort and continue to work and that I can take things around me that are better than how I work and bring them in and absorb them and make that me. And when I believe that. That opens me up to the question of what everybody else around me is seeing and thinking that I might not understand. Right? Like I’m sitting here talking to you and I’m like, man, what, what does Sean know that I don’t like what are you doing that is interesting and deep and has like substance to it that maybe I could absorb? And you get so curious about these other mindsets from it. when I was in medical school, I was facing this question about what specialty to go into. I was part of an MD Ph. D program. So we do train in medicine. And nutrient science. These are very different mindsets, and each of them brings various strengths and weaknesses to the table. And to be a hybrid product means to be an MD PhD to be a hybrid product means that you’re able to see the strengths and weaknesses of both pieces and absorb them into you. It’s sort of like skill stacking. Right and maybe like we shouldn’t be the more like entrepreneur way to say it like right, we skill stack and you bring the different mindsets together. As to when you’re open to different mindsets when you believe that the people around you and the different skill sets have things that you can absorb that maybe you don’t understand. I think you’re open to getting slapped in the face by sort of purpose.

The Learning Mindset Vs being a Finished Product

(00:20:46) Sean – Oh, that’s great. Like my lights are going on once again here so my mom who doesn’t live in the same state as me, she’s in town right now. We were having dinner, This is literally the exact conversation we were having last night, possible opening up the hood and that you’re able to rewire learn to adapt, become a better version of yourself. And I’m wondering like how you develop that mindset. I hate saying this, But the majority of people they don’t have that mindset that they have the belief that they can bring a better version of themselves out right, like they think they’re a finished product at all time. So I’m wondering, as you’re one of those people that have used more of an outlier. What is the reason that you were able to have that mindset and then we can go even further into how they got built early on for you.

(00:21:32) Dr. Dan – I think I’m very lucky. I think I got exposed to that belief very early from a lot of different angles of life, right? Like my parents are really dedicated learners. And I grew up with them always talking about sort of what they were reading and what they were curious in, and how they could get better at XY and Z. You know, I remember like the thing we were sort of proud of in our house growing up. Most proud of was the bookcase and everything that it had on it. They would talk about not just about, oh, we used to study this thing when we were in college, but they would look at a book and be like, This helped me change this thing in my life. And here’s why. And so I sort of got into that the groove of like, okay, things can change even for your kid. you think your parents are like a million years old? Sorry, mom and dad if you’re listening to this, I’m like, Oh, wow, even these old people can change. Right? And, okay, cool if they can and I probably can too. And you know, I also grew up doing martial arts. And I remember my martial arts instructor, who was a huge force in my early life. He would come back and be like, Hey, I just went to this seminar and learned this new thing that I’d never seen before. Let’s play with it. And like even still, like even this person who was so far advanced was still learning and still growing and still changing. So I got exposed to that pretty early and then, you know, that really continued on through a lot of schooling. I think it’s also pretty natural when you come from a martial arts background, you realize like, there are no finished products, there are always ways to learn and get better. And then if you stop learning, you get punched in the face really hard. It’s pretty notable.

Sharing Wisdom

(00:23:10) Sean – A lot I want to dive into from that. One of the things I found just deeply fascinating right, you were talking about the number of books you’ve had, but then your parents basically describing certain lessons they pulled out of those books. But why I think that is so key? So many people talk about I read this book. It was awesome, really helpful for me. But then like when you get those mentors in your life that share like their personal notes and their highlights and their underlines. They’re like this was the specific thing in my personal life that this changed about me. You develop such a better depth of learning with that. I just thought that was really really cool to hear about I’m wondering for you, right, like, here we have someone who might just be like, Wow, Dan’s got this, these really interesting thoughts. Were there any books specifically for you that had lasting impacts that kind of changed your worldviews?

(00:23:52) Dr. Dan – Yeah, man. Absolutely. And I still do this right like my close friends and I read books together and share our thoughts about it and do these mini development book clubs, which we tend to call wisdom and whiskey because there’s usually whiskey involved in it. But it’s, a great opportunity to sort of like bounce ideas off each other and to sort of explore and push each other about what you feel when you read something not just like hey, this is cool.so to me, one of the most interesting directions of all of this, that’s really changed the way that I get, I think, I get better than I perform is sort of the twin, the twin directions of like Kahneman and Klein. So Kahneman focuses on cognitive biases and human performance, how the brain works, and really tries to get at the idea of, how do we think and act when we are not an expert in something that we don’t really have a lot of knowledge about in a universe that is pretty unpredictable. Klein, on the other hand, and Kahneman would be, you know, Thinking Fast and Slow, right. And Klein would be sources of power is probably the first one I’d read. And Klein takes the opposite approach where he talks about sort of, How do humans make decisions and think in areas where it is possible to generate expertise and they are experts, things like chess masters making moves on a chessboard, firefighter captains deploying resources within a structure fire, stuff like that. These are wildly different worldviews about how the human mind functions. And both of those books have been incredibly deeply meaningful and important in sort of my understanding and development about how I function as a human being. You got to read them both and you got to read this paper they wrote together called a failure to disagree, which is like probably one of the coolest things ever.

Dan’s move on toggling out situations exactly

(00:25:46) Sean – Yeah, I’m a huge fan of both Kahneman and Klein. We’ve been lucky enough to have Klein on the show. Yeah, he got some really interesting takes. And just fascinating what his work done. One of the ones like the models I love about what he does, he talks about one specific instance of just having like that direct knowledge and when he was working with a few police officers, he was following along they’re talking a specific story. They’re behind a car, it might be a brand new BMW, Mercedes, just really really nice. And all of a sudden, he sees the driver ash their cigarette,,. That’s got to be a stolen car, long story short pull car over Yep, as the exact instance. And I’m wondering for you, do you have any things like that throughout your career that like you just have to be doing it for a few years or a number of years before you can deeply step back and be able to really toggle out situations like that, that you can make call on that earlier on in your career?

(00:26:45) Dr. Dan – Yeah. So I think it really gets into the depth about what kind of a environment we are performing in? Right. So you know, when you think about that version, of events, to build that expertise requires something resembling a kind learning environment, right. So you can break learning environments down into a kind environment which has repeatable rules. And excuse me a closed loop feedback between what you do and what the result is unkind environments which don’t have that they have no really repeatable rules. They’re big, they’re random, they’re stochastic. There’s not a lot of feedback where there’s a delay in the feedback, and then antagonistic learning environments, which are like unkind environments where maybe something is trying to kill you, or every now and then the whole thing just sets on fire or it’s a trap. And it’s, it’s trying to make you think one thing and actually it’s, it’s teaching you another and there are days when the emergency department is kind there days when it’s unkind there days when it’s downright antagonistic and so I think to me, I’m sometimes able to pull out things like that ashing a cigarette story when I get into areas which are more kind, but what I’m really careful about is not over calling that and saying to myself, Okay, do I really think I’m in a kind learning environment right now? Like do I think there’s enough expertise that I can rely on that gut instinct, or should I take a step back and really try to deploy more of my like analytic brain to, to buttress up my logic here.

Step Back and Reflect

(00:28:29) Sean – You mentioned stepping back there. This is one of the things I was really intrigued throughout your book, and you hit on again and again. So I feel like I’ve been in the emergency room one time I got to study Dr. Woods, that was really cool. But just how fast paced it is. But what you hit on again and again, is essentially like developing these micro moments of space and time where you can deeply step back and reflect and I would love for you to hit on this. I think this is such a key component of ability to think clearly analyze situations correctly, because so could you just like dive into this then and we can expand on it.

(00:29:01) Dr. Dan – Yeah, this is one of my favorite things to think about and talk about too, actually, this is the idea that you try to find these moments of calm in any storm, right? You try to find, these micro moments of pressure and release and it’s something that should be pretty familiar to anybody that studies jujitsu, right because it looks like somebody’s constantly trying to crush you and kill you all the time when you play Jiu Jitsu, but really, you can feel over time these moments of pressure and release, like you’re in danger, you’re not in danger. Same idea If you’re playing chess, from a thing, you’re not in danger, there’s pressure and release back and forth in there. And when you start functioning in an emergency situation and emergency department, everything feels like it’s moving a million miles now or like what you described, right? You’re sprinting everything’… The more you understand about the way the world works, the way the human body works and the way your mind works, the more you realize that’s actually not true. It’s also one of these cyclic situations where there’s pressure and release. So what we try to do is, find these moments of space to think, find these little bubbles, these little pockets of space in the middle of the flow of anything where you can take a mental step back, sometimes even a physical step back to be honest, and really regroup, reevaluate and change your thinking. actually as a start to that, one of the best ways to think about to start looking for them is to mirror the mental and the physical. Right. So there are times when I’m running a trauma, let’s say, okay, the person comes in, they’ve been shot. There’s a lot of chaos at the beginning. you’re organizing your team, you’re assessing their most vital symptoms, sorry, the most vital systems first, their airway, their breathing, their circulation, okay, you realize, right? I don’t have to put a breathing tube in, I don’t need to cut their chest open. We can get some IV access. Let’s give them some blood. Here’s what’s happening. And then there’s this moment where you need to get an x ray. And when you get the X ray, you physically take a step back out of the room, so you don’t get x rayed also, and you sort of watch the development of people as they start running more and more of these traumas. And the first couple of times when they take a step back, they’re just like, they’re just still going. They’re just still physically their minds in the room and it never left you know, their body stepped back. And then when you do it more and more you realize oh, this is a cue for me. I am physically taking a step back. Therefore, let me mentally take a step back when I do it. And you can see them take a deep breath and change their posture and relax slightly and start thinking differently. So sometimes, sometimes we’re handed that moment like that, right, which is that oh, I physically step back. So therefore I will mentally step back sometimes we have to be more proactive about searching for it. We have to ask ourselves, Am I pushed to act in this moment? Does the universe need me to decide something right now? Or catastrophe will happen? And if not, can I hold that pocket be and be comfortable with that uncertainty and that pressure and regroup mentally.

Right Step at the Right Time

(00:31:00) Sean – How do you distinguish between trading off time right, like to actually step back to gain more certainty in a scenario? I’m just wondering how you think that through.

(00:31:00) Dr. Dan – Yeah, This is so fascinating. And there are certain areas where I’m better at this skill than others. This is one of the active fronts of learning for me is this idea of risk management and trading information for time and how I wanna ride that line. So one way you approach that is looking for underlying structures in the way that things fit together. So for instance, you know, when we approach a new patient who’s very sick, we go in the word ABC airway, breathing circulation, right? That’s because if your airway doesn’t work, then it’s sort of irrelevant If your breathing works. if your breathing doesn’t work, then it’s sort of irrelevant if your circulatory system works. just the underlying reality of how human physiology is set up. So when you have these structures, you can use them to sort of understand how much risk you’re carrying at that moment. Right? So I can say, Okay, well, I know it works this way. And a and b are okay. so I can really focus my energy on C and I can take a little more time with the other piece of it. You know, there’s also the sense of once you’ve cleared a, b and c, you usually have a second or two. And that comes from just experience and seeing the ideas play out over and over again, you have average, as you understand most people don’t go from a normal ABC primary survey into death immediately, so you probably have a moment to regroup.

Micro-Moments Matters

(00:33:00) Sean – That’s awesome. So you really understand what are the main components that require the most amount of fault first and affect every other thing and then dive on those first, and then everything else can kind of take care of itself progressing from that original. let’s call it route one phase. I want to dive back into a second into just the undulation between like those micro-moments, though, the way I think about this is I remember I think it was Jim Mueller’s Lord’s work around tennis players and they found out the best tennis players because within a tennis match, there’s all of these, in-between-shots or in-between-sets they’ve got this time. They found the best tennis players were actively engaging in the recovery process and during those few seconds in between, where the novice wasn’t doing that as much. You mentioned physically stepping back, this might be during an x-ray. What else do you do just to gain a little bit more focus or awareness or just recover in those micro-moments? And it’s kind of like a nuanced question. I’m just wondering because I’m sure what you know is more worthy.

(00:34:00) Dr. Dan – It’s really important. Yeah. And so. So the cycle that we run, prepare, perform, recover, evolve has a fractal nature to it. Right? There’s the big cycle, which is that I prepare for a shift I perform in a shift. I come home and recover and then I evolved for my next shift, but there’s the microcycle of it, which is okay, I have to do a procedure. I have to put a breathing tube in somebody. I’m going to prepare in one second. Before that, I’m going to do it. I’m going to recover and zone my consciousness back out to a broader sense and see the whole patient again, and then I’m going to evolve what happened to do that skill better next time. And there are that multiple layers of that multiple scales on which that works. So we talked about physically taking a step back. In a way this gets back to like the very first question you asked, which is what I do when I’m walking into the ER right, so the micro-moment equivalent of that is, what do I do to gain space right before I deliver a skill right? Before I perform? And I think that there’s a lot of physiology that you can involve in there and yourself, right, so Huberman, in his amazing podcast talks about this idea of a physiological psych, right, which is this specific breathing patterns sort of like to inhale and then a long exhale, which triggers your parasympathetic nervous system and helps calm you down right before you perform. So I’ll do that right before I do a read before I do a thing. And I will use things like that whether it’s taking a physiological psych or often check my own pulse rate before the person comes into the room and really practice slowing my own heart beatdown, sort of right before things happen. And that’s, again, things that I’ve done using a wedge, right? Like I’ve practiced them on low wedge scenarios and then brought them up and up in the higher wedge times before I deploy them for a patient.

Between the Polls, At the Time of Micro-Moment?

(00:36:00) Sean– What is the reasoning behind thinking about the polls and then actually slowing it down? What does that do for you at that moment?

(00:36:00) Dr. Dan – To me, it does two or three things. So first off, it reminds me that I am alive. This sounds sort of kind of ridiculous because like of course I am, but I’m alive and I have these heartbeats to figure out what I want to do with. I don’t always know if I’m gonna have heartbeats tomorrow. But I have heartbeats right now. And I can choose what to do with them. And to me, that is one of the biggest pieces of purpose, the biggest sort of core factors of who I am, which is that I want to be conscious about how I live and what I do with my life. And so if I can remember that in that moment, right before this person comes in I’m going to be fired up and I’ll be doing better. The other thing is, it makes me think about all of the other times that I’ve checked my pulse before somebody came in, and I’ve made it through all those. So I’m gonna make it through this one also. And it connects back to your personal history of training and skills. Obviously, that doesn’t work the first time you do it, but you gotta practice that a few times to get that kicking in

Somatic awareness of Heart-beat

(00:37:00) Sean – all life, though, right? Have you actually dove into any of the research around the somatic awareness around your actual heartbeat? Do you have any idea what I’m talking about?

(00:37:00) Dr. Dan – I do. I have not. I’m not particularly well versed in that it’s certainly something that I’d like to get better at and that’s another active front of learning from me is sort of the the mental physiological links around that sort of thing, whether it’s the physiologic side or this dramatic perception of heartbeat.

What is Purpose for Dan?

(00:37:00) Sean – Yeah, like broad strokes here for anyone listening basically, the people who would actually tell when their heart were beating, made better investment decisions. They basically made better decision making processes across everything they did in life, just being deeply attuned to the heart rate. I don’t know what would you do with that what you take with that but I just got an extremely fascinating one thing you you hit on again and again, for the like, longtime listeners know this is like, huge for me is tying everything back to purpose. And I’m just wondering, like, Could you go over how you think about purpose and then how that got clear and evolved for you?

(00:38:00) Dr. Dan – Yeah, I think that when you are in emergencies enough, and you face enough death, you pretty naturally start thinking about what the purpose of life is, what it means, right? Because these people that come in, that are on the table in front of me. I always think about the fact that like, they probably had plans for this weekend. They had things they wanted to do things they were excited about that a long term vision of what they wanted for their family. And they don’t get to realize that and that is really hard. Right? And it’s easy to make that sort of an overwhelming sense of of loss and chaos and everything else. But one of the things that I’ve taken from that is this idea of what you know, you don’t really know ever how long you have, you don’t really know how long you have here. And if that’s true to us, sort of a Buddhist quote about this like, if death is certain, but time of death is uncertain. What then is important and that is a real forcing function on developing a sense of purpose. Right? You either go way nihilistic or you do or you go quite the opposite, you develop a really strong sense of purpose and what it means. So, for me the answer to that question, or the thing that I think is my deepest purpose is to master myself and serve the world. And to be the best version of myself that I can be to dig in to, to learn to grow to understand my place in the world and, how I work as a human, and then to leverage everything that I know to make the universe better for me having been here. And that’s come that’s evolved over time and gotten polished by the friction of what I do. And you know, I try to keep that purpose close to the day to day actions that I’m doing right to try to line up my choices with that deeper purpose. And also to spend time making sure that I’m really digging into that purpose over and over again. Is that still my answer? How do I feel about that when I’m making these sort of like medium sized choices about my life?

Difference of Reality and Fluff with Journaling

(00:40:00) Sean – How do you actually dive into that? Is that just like a deep reflection called a journaling session? Or is it just in the moment? Thinking about it?

(00:40:00) Dr. Dan – Yeah, I do a lot of journaling. I do a lot of writing. I do a lot of reflection about sort of what I’m feeling. And I try when I do that to be very conscious of the difference between like real signal and fluff. Right? It’s easy to have a lot of fluff coming out of the ER right like, you walk out covered in blood and somebody puked on you. It’s a really terrible day and it’s very easy to be like, I hate this. I hate everything about this and write down I had a terrible day. Like but is that real? Or is that fluff? Is the signal still there after you eat something drink some water and work out? Like that’s maybe a real signal? Is it just situational? There are some great quotes which are like being a human’s really funny like you’re this amazing supercomputer but you’re also this weird bag of chemicals. And like, you know, you can paint a Picasso but also if you get hungry, you’re gonna yell at people. Like what you sort of having to, be aware of the reality of how your wetware works and sort of like, use that to seek out what’s a real signal about purpose.

Power of Asking Better Questions

(00:41:00) Sean – I’m wondering how you decipher that signal versus the noise. And I know something that you do is you understand the power of questions, right? Like you want better answers in life. You gotta ask better questions. And I’m wondering how you’re actively asking yourself questions, both during those deep reflection moments, but then also, in the moment of a very chaotic storm, and how you tried better answers with better questions.

(00:42:00) Dr. Dan – Yeah, you know, one of another sort of inquiry for me is been figuring out how the best way to ask questions of the people around me in the room, right so I’m leading a team. Right now emergency medicine is a team sport. I might be the doctor in charge, but I’m working with an incredible team and they all have different viewpoints and skillsets. And I have grown a lot in my ability to ask questions of the team around me, mostly from studying how other people ask really effective questions. Now they don’t. And so one of the things that I’ve done differently is tried to incorporate more of my understanding of behavioral economics into the way I run a trauma, sort of a weird connection of stuff. But I think it’s incredibly important. Right? So we know that people tend to have confirmation bias, right? We’re more likely to agree with other folks that are around us and less likely to raise contradictory points of view. So if you’re running a trauma, and you’re like ‘Hey, guys, I think that the dominant process here is tension pneumothorax, which is a really scary sort of buildup of air in a lung that can basically stop the heart from beating and the way to relieve it is by opening up the chest.’ So you’re saying hey guys, the dominant process here is tension pneumothorax. Does everybody agree? Like that’s a very different structural question from folks. ‘I think the dominant process is tension pneumothorax. Before we do this procedure, I need dissenting views. Who disagrees?’ That’s a very different set of questions right. And you can get even more nuanced than that. You can bring in like, David Marquet and his leadership work from, turn the ship around, right where he talks about fist to five. So he goes, ‘Okay, we’re gonna do procedure X, real quick hands. I want five fingers up. If you’re full go, I want a fist. If you’re full stop, give me a number.’ And then he looks around the room and he picks one or two people who are like a one or two-finger he’s like, why what do you see that I don’t? And to me, that’s such an interesting evolution of asking better questions about people around you because it addresses the reality of how our brains work and our social parts. of our brain work. And it allows you to bypass or short circuit data to get the information that’s actually much more usable.

How far is Dan from his best-version

(00:44:00) Sean – Such subtle differences there, but dramatically different outcomes when you, said those. We could spend literally a 10 hour podcast on this alone. So I hope you get deeper onto this. I would love to return back about your purpose and mastering yourself becoming the best version of yourself. I know you love stoicism, the philosophy connected to the ancient greek word Arete. It is essentially like virtue or excellence, but like the way they viewed it is essentially like in each moment, you can bring out the best version of yourself. And so I’m wondering, like, just tying into that. How were you stepping back and thinking about what you look like? Because you said you were never a finished product. So like, how far are you extended a better version of Dan for where you’re at now?

(00:45:00)Dr. Dan – oh, that’s cool. I don’t know. I like that question. How? Well, okay, this is maybe an oblique answer to that. But when I look at, I’d say it’s tempting to so I had a birthday recently. I turned 39 like two weeks ago, and you know, it’s tempting to sit there and look at yourself, and look back at what your 20 year old or 29 year old version of you would think about how you’re doing and use that as the yardstick that you’re comparing to. Sorry, the meter stick. Let’s be a bit about this. But that’s probably not super useful. And I think a more interesting idea is what are the scales with which I measure myself and how have those evolved over time? Because I’m not, you know, when you ask how different and more evolved is Dan going to be? Well, one of my answers to that is I hope the scales I’m using are going to change as I get a deeper and deeper understanding of myself in the universe. around me. So, earlier versions of me probably wouldn’t have thought about a daily gratitude practice as an important metric of how I’m doing. Not that I think I was an ungrateful person, but I don’t think I understood the power and the utility of consciously focusing on the good around you. And now that’s part of one of the things that I try to do. And part of my question of How well am I doing is that version of it? I think a little bit about sort of like, what Jim Collins describes as his like negative two to two sort of scale, right? He’s like every day gets a number and it’s between negative two and two about how you did that day. And then he goes back and looks both in terms of what his overall arc is, how am I doing? But also like, what is it that made you feel like today was a two what is that? What are you doing right there? What does that tell you about your actual value system and what you can change for it?

Dan’s Tools to work on himself

(00:47:00) Sean – Another one of these little things, right? We can even call these little legends that don’t over time. The answers that they can bring out for you or clarity you can get right like the works got to be done. And what I love is like you’re actively engaging in the work, and that’s why you’re able to have really deep meaningful questions or answers to these questions.

(00:47:00) Dr. Dan – So I think it’s a really interesting segue. So you know, we talked about the wedge, right, which is this incredible, simple machine that allows you to practice things at low pressure before you deploy them high pressure. And that’s like the skills you’re going to use in an emergency. They are the same skills you can bring out when you spill coffee on yourself. Yeah, like that’s when you really practice them. The other simple machine we use all the time is the wheel. And whether that wheel is prepare, perform, recover, evolve, or whether you’re going to take the sort of lean Start-Up idea of build, measure, learn, or whatever. It is, right, like spinning that wheel and experimenting is one of the other deepest virtues that I found throughout my time of learning to perform under pressure, right. You have to experiment, you have to work on yourself. You have to be willing to try new things, willing to have them fail and then willing to sort of step back up and do it again. And the more you can run that experiment, the deeper and deeper you can go into this sense of like your purpose, like how are you matching that purpose? How are your day to day movements doing all of that stuff? And I love that so much because when you mash these things together, right when you mash a wedge in a wheel together, you get a drill bit. And that’s, to me that’s like what lets you really move forward into what you’re doing.

Dan’s Unique routine for going deeper and to satisfy himself

(00:49:00) Sean – I’m wondering, you mentioned about some of the metrics that you’re actually like looking at day to day and wonder how you’re doing. You mentioned gratitude, any other things you do like that, just kind of check in?

(00:49:00) Dr. Dan – Oh, yeah. So this is my current experiment that I’m doing. Over the last couple of this was like my idea,, when I hit 39, recently, I’m like, Okay, what am I gonna try differently this time? So I bought a deck of blank playing cards. And I wrote on them a bunch of things that I want to I want to be doing to know that I lived a good life that day. And again, one of the great things about emergencies is that you’re constantly faced with death, right? You’re constantly faced with this idea that today might be the last thing that you do. And so, back in the beginning of the COVID pandemic, the very beginning a bunch of us, ER doctors, we’re sort of like, okay, well, we might actually just dropped out of this at any day. Like, we don’t understand it. We don’t know what’s happening. People are dying all around us, like maybe Today’s my day. And so I had to really, like operationalize this idea and be like, alright, well, if I literally don’t know what I’m gonna die, then how do I know if I lived a good life this day? Okay, well, what are the things I want to do? And I sat there and thought about that and evolved it over and over again. At that point, I had sort of four answers. And it was Work on myself, Mentally, train, Physically serve the world and Build something that would outlast me. Those are my four things. There’s a fifth thing, which was I have high cholesterol. So I took a medicine. I had to take that pill every day, you know, but that’s like the boring one. But do those four things every day? And if I did those four things, then I could go to sleep knowing that if I didn’t wake up the next morning, I gave it my best shot. And thankfully, now I don’t go into work thinking I’m gonna drop dead every day. Although, you know, you never know Right? Knock on wood here. But I carried that idea forward of the idea like, what I want to spend my life doing how do I know if I lived a good day. So I bought this deck of blank playing cards, and I wrote down on it five or 10 things I want to be doing and just, you know, like, every day, I shuffle them and I flip over a card when I do it. And then I look at it at the end of the day and I’m like, how did that go? What do I want to do differently tomorrow if I can, if I’m lucky enough to get tomorrow, right? And so some of them are things like gratitude practice or breath work and meditation, you know, study and mental training, to contribute to the universe to adventure to explore things like this, these sort of broad concepts in part because there’s multiple ways to to feel like I’ve actually succeeded at doing it. But that’s my current version of the experiment. I don’t know it’s still pretty early. Some parts of it are really fun. I like the tactile sense of flipping over a card. That’s pretty cool. I’m not sure it’s gonna get me to the right place. And I don’t know we’ll see what happens with it.

Winning Everything

(00:51:00) Sean – Well, I actually, I had done something similar in terms of like mapping out what are those big buckets that need to get checked off every single day? I love the tactile version of the cards. And I like I always just love, one of the best things about having a podcast I know. You know, this is just like pulling from other resources. It’s like, oh, yeah, try that. Let me run that experiment as well. I hope this doesn’t seem like a nuanced question, but I know a lot of you are thinking wow like emergency room doctor like involved in other things as well. Right, like wrote a book. How do you find the time that what is the time allocation look like to working on yourself throughout the day?

(00:52:00) Dr. Dan – it’s a moving target for sure.I think that so one thing that becomes pretty obvious in emergency department over time, too, is that you can’t win everything every time. You have to focus on winning on net. You have to ask yourself this question of is the emergency department better today for me? Having been here, because you cannot succeed every little thing that you try. And when you take that longer term sort of integrated view, then I think it becomes a little easier to do this kind of work. So I don’t have to flip every card every day to feel like I’ve lived a good life. But I want over time, this to be what I spend my time doing. And so you have to bring that broader idea into the micro decisions you make every day about how to do it. You have to line these things up. Functionally the way that I do that, every week tends to change depending on what my workflow is right. so if I’m working overnights if I’m nocturnal for a few days, the way I do this might be different and the level of physical training that I perform is probably going to be a little bit less than if I’m on a farm on a day schedule and I can get to running on the beach the way that I want to

Dan’s Training to be the best Under-pressure

(00:53:00) Sean – Your physical training I forget the specific verbiage you use around this but I thought this was so insightful right like in your actual job in ER your heart rates gonna be elevated stuffs gonna be chaotic. Your physical training. I love what you do here, I think you mentioned you were doing a run. And so you spike the heart rate and then you try to actively do a visualization or what you were doing while the heart rate was elevated. So this is in a controlled environment while you might be running a hill running on the beach, but then you can take that and apply it to how that would play out in the ER when you have real stakes. I probably butchered that a bit but I would love you to answer.

(00:54:00) Dr. Dan – so know that spot on this one. I think this is a good example of using the wedge. Yeah, right. I tried to ask myself Okay, well how what other low,? It’s not really low stress. It’s actually medium stress but whatever. What other low impact scenarios can I get myself into where I can train, right? Because if I had a sim center, and I can use that sim center all the time and like really train on what I’m doing, but it doesn’t really exist all the time, right? So instead of like how can you consciously experiment around your relationship with pressure over time, because that’s what you need to do to get better at it. You have to train and you have to consciously apply it over and over again. So one of the things I do is I have this great hill outside my house and at the end of my runs, often I run up the hill, and when my heart rate is really spiked, I mentally rehearse a particular thing. Maybe that’s putting in a chest tube or I’m saying out loud what the first couple of sentences are going to be when I run into a room and take over if I’m responding to a code somewhere else. Or sometimes it’s even the smaller skills, like what we talked about asking for dissenting information. Okay, so I asked her to Share, remember to ask for information the right way, when I’m really jazzed up when I’m really ramped up in the middle of this scenario. And, you know, sort of look like a crazy person standing at the top of my Hill, like you know, moving my arms around like fake putting in a chest tube or speaking to myself about asking for dissenting information from people that aren’t there. But it’s worth it. I think it’s a lot of fun.

(00:55:00) Sean – This is so awesome. So someone who’s really helped my decision-making is gentlemen, Nick OCONUS. We’ve been lucky enough to have him on so Nick. He was a derivatives trader in Chicago in the Mercantile Exchange and then developed into became a restaurant tour, developed Alinea, which one of the best restaurants in the entire world to get ranked number one. And so he talks about early in his career when he was on the exchange so after hours, they literally be sitting there and they’d be screaming out math equations to each other and they would get into full-on fist fight so their heart rates were going nuts, trying to make high or make decisions with a lot of stress in line because we can do that in the controlled environment after hours. They can do that much better in real time. So I just love hearing about that. One thing you mentioned I’m really curious about is because we have a lot of people who lead group groups who listen to the show. You mentioned when you come into a room and your might be coming from a different room and all of a sudden you’ve got to take control the situation. What does that look like when you enter a room with maybe not as much information but then also getting everyone on the same page? How do you play that out in real-time?

(00:56:00) Dr. Dan – Yeah, that’s a phenomenally interesting set of things to work on and what works in an emergency doesn’t necessarily work outside of an emergency in that case, right. So if we’re meeting each other for the first time, we’ll take the other way first. So if we’re running into an emergency, and I am the emergency doctor, I’m going to come in and take charge of the room. Right one of the first things we do when we want to run in is say some version of I’m Dan I’m the ER doctor who’s in command. And then if there’s another ER doctor or if there’s a critical care doctor or a trauma surgeon, somebody else that has the room and feels comfortable with it. They will say, you know, whatever. I’m Sarah, I’m the trauma surgeon I have this. Great How can I help? Right and if you look at the it gets in the book, the Culture code by Dan Coyle, he talks about the plane I’m gonna butcher some of the story about this, but the United flight that was crashing and the flight simulator, the flight trainer that happened to be a passenger who ran into the cockpit and did exactly what I’m saying. said some version of guys, I’m a flight trainer. What do you need? How do I serve? Like that sort of version of creating that idea? But if nobody says yes, and nobody says they’re in charge, and that’s usually what happens there’s usually this moment purpose we’re like, looks around at each other like I don’t know, am I in charge? Are you in charge like what’s happening? Right then your next sentence is great. I have commanded this is what I want. And then you run your first step algorithms. And those first step algorithms are what you’ve practiced in low wedge scenarios about how to do those first two to three moves, how to do the airway, breathing, circulation, how to set up the things that will enable you to get success in a couple of moments, and understand the situation and rapidly deploy your resources. Now, that works really well in emergencies. That does not work really well. In a lot of other situations, right? I mean, can imagine me walking into a business meeting and being like, Who’s in charge here? I’m Dan, I have command I want you to sit there. Right. Like that’s, that’s ridiculous. That’s just not how most human interactions work. So I think it’s important to sort of differentiate between like, we are in a high pressure emergency scenario, and we are not at all and pressure emergency scenario, and the way we communicate with each other the way we build culture, the way we deploy resources. And engage each other in a back and forth are really different in these two scenarios. When we’re not conscious of that, we can cause a lot of friction.

Using Algorithms with creativity  in different series of encounters

(0059:00) Sean – That’s really helpful distinguishing those two, thanks for bringing that up. I am curious, you mentioned the algorithms there. How do you think about having the algorithms but also allowing the creativity in a different series of circumstances that you run into?

(0059:00) Dr.Dan – Oh, dude, such a good question, right? Like how do you build things that are scaffolds but not cages? Yeah, right, like such a way to look at it. And I recently was talking to this person Dr. Kevin Lonnie, on my podcast pool was the former head of the Navy trauma training center. And he was talking about which is a group that we work with here in LA, and he was talking about how there are some things that always need to be algorithmic. And they need to be just packages you can deploy at a moment’s notice. Right? So this might be in you know, in jujitsu, the idea that you want to create space on defense and destroy space on offense, or you don’t want to be caught with your arms and legs extended. Beyond a certain area. Like these are general all purpose rules that are easily deployable ideas. Not everything needs to be shaped like that. And the the risk as you as you said, is that you run the risk of sort of like destroying creativity. So often we sort of used er the idea of algorithms first, then creativity, right? So okay, you’re going to deploy the base algorithms to get you to the point where you can think creatively, because especially when you run into that room and your heart rates up and things are going crazy, that’s not really the best moment type of creative thought. Right? Really, that’s the moment to deploy the first step algorithm to then allow you to have the space to do it. One of the people I had on my podcast earlier, Ryan Anderson, who’s a former Navy BombSquad expert, talks about it as using seconds to buy minutes. What algorithms can you deploy in those first seconds that give you the space to then think creatively and create those other options.

Learning from Dan’s Martial arts 

(01:00:00) Sean – Oh, that’s awesome. the way I think about it is Structure creates freedom for me, and structure creates that creativity. So I’m able because of those algorithms, it then sets better conditions to be able to allow that free throws free-flowing, conversational type jazz to really take place there. You didn’t mention jujitsu, I knew. I know, martial arts has been instrumental for you in developing and just your never-finished version of yourself. Are there any other foundational things that you’ve pulled out of your decades being involved in martial arts that you just think is so applicable? To anyone or anything, they do in life?

(01:00:00) Dr. Dan – Yeah. What’s the right way to put this? Reality wins where it gets practice, is the right way to say that, right? So if you have the most elegant beautiful, put together, creative technique, but you can’t do it, when it matters, you’re just going to get punched in the face. And that’s a good reminder about that. It’s very visceral reminder of that. But it’s true in most of life also, right like if you create these like a giant, amazing theoretical structures, not that there’s no value in that right like, like the human species needs people to think theoretically and to create, you know, these amazing new brilliant ideas. But I want to be one of the people on the side of it that favors practice, what can we bring into the reality of it.

Dan’s Tattoo 

(01:01:00) Sean – Byron Katie’s got this great line she goes, every time I fight reality, I lose but only 100% of the time. It’s so true. So many people are trying to fight reality. I love that line. I love how you did describe it through practice there. I was mentioning the word that I love. I really deeply resonate with the ancient Greek word Arete and I literally think about that in each moment. Have I bring the best version of myself it’s a reason I have it engraved here on my bracelet. You’ve gone a step farther there without with one of your terms. Amor Fati, and I’m just wondering if you can talk about that because I know it’s tattooed on you and what that means to you and how you think about that.

(01:02:00) Dr. Dan – Totally. So I have two stoic philosophy concepts tattooed on me one is Amor fati. The other is the idea of of song Fuat song flop being the it’s actually a French word for cold-blooded, but what it really means is the ability to stay calm under pressure, and to bring that skillset together under pressure. Amor Fati, the Latin concept of love feet, but really love the hand of cards you’re dealt and try to play it with joy. And to me those two things represent some of the deep truths about what I understand about my place in the universe, right. I have to bring the best I have to bear to the moment and I have to play the hand of cards. I’m dealt with joy. And I have one tattooed on each arm. And they’re easily available for me to look at in the middle of doing something and often I’ll accidentally catch sight of one of them when I’m putting a tube in or doing some sort of a procedure and it reminds me right this is what I’m here for this is what I think is the most important answer. We talk about evolution and about, sort of changing your vision of the world and that’s progress and not setback. I hope as I continue to grow and continue to, you know, get older and better at what I do. I hope I don’t need to change those tattoos. That would be a little bit troublesome. But I’ll figure something out if I need to cross that bridge.

Dan’s Wish-list of people  for Deep Conversations

(01:03:00) Sean – No, I love that. I think it’s so helpful. These are subtle reminders. Like I mentioned, I have it on my bracelet. I have them around my computer monitor. Just little subtle reminders. I feel like really do go a long way. You’re such a fascinating interesting deep thinker who’s done the inner work. Learn from so many people if you could do this. I know you have a podcast but like a long-form conversation to sit down for an evening with anyone dead or alive. Who would you love having a deep conversation with?

(01:03:00) Dr. Dan – Yeah. So you actually mentioned Joseph Campbell would be my answer. Right because I think that what he has done, looking at how humanity has grown from where we started to where we are and what we understand about purpose and meaning and what the deeper part like portions of life are, that is so immensely fascinating. And it’s such a space that I would love to learn and grow in. I think he’d be an absolutely incredible one to sit down with. I guess my more technical, sort of, like micro answer would probably be Anders Ericsson, who did all the work about sort of like what is come somewhat misquoted as the 10,000-hour rule, but also really thinks about sort of learning and deliberate practice because I’m so fascinated by this idea of what do we know about how humans get better at things? Because I want to get better at stuff, right? Like, I want to learn how to get better at it. I want to learn how my brain works in a way that allows me to leverage that as much as possible.

(01:04:00) Sean – Too exceptional answers. I know one of the things you do at the end of your interviews is you issue them a challenge. They’re gonna have that issue a challenge for everyone. What would be a challenge for the listeners of this show.

(01:05:00) Dr. Dan – Yeah. And I think the challenge is, is the wedge in the wheel, right? How do you use these simple machines in your life today? How do you use them this week? How do you know if you’re using them the right way at the end of the month? Right? So the wedge, if you want to get better at learning under pressure, performing under pressure, and if you’re listening to this podcast, you probably do, right? How do you apply those ideas in a really low wedge scenario? So can you identify low wedge scenarios in your day to day life? And then the wheel? How do you consciously design experiments? We didn’t talk as much about that. But if you break it down basically into hypothesis, I think this will let you do better. here’s what I measured. Here’s how I know if I’ll be doing better. And here’s what I’m going to do to reflect on that thing. Right? And you have that micro experiment created like that. So my challenge is find some low wage places and run an experiment and just see what it feels like.

(01:05:00) Sean – And you mentioned serving the world. I’m telling you a lot of your work your ideas, your concepts, how you put them into practice. It really served me. I know they’re impacting other people. We’re certainly going to have everything that you’re involved with, linked up obviously to your book, the emergency mind, the emergency mind project as well. Is there anything else you want to leave the listeners with? I know we only literally touched the surface here. I could literally have had a podcast with you and I know your book dives into more of like the tactical how we take this and bring it into reality. But anything else you want to leave the listeners with?

(01:06:00) Dr. Dan – I think the book is the beginning. It’s a beginning vocabulary about performing under pressure. And what I want is if people pick that up is for them to surpass it as quickly as possible and make it useless and obsolete. And to take those words that vocabulary that we’re building out of this and start making sentences and stories out of it and to really get better and then I want to hear about it because I want to know what you come up with, I got to get better too. And what I want is this culture of people that train together to perform better under pressure. And that we create as much dialogue and back and forth about that as possible.

(01:07:00) Sean – How that speaks me to I want to create ripples out there but then it creates an ecosystem that we all get to feed back and grow together. To and this has been fascinating. I can’t thank you enough for joining us on what got you there. My pleasure, man. Thanks for having me.