How does the world work?

Today I sat down to think about how the world works. I wanted to clarify the systems underlying our society in order to decide what I should do with my future.

I tried to answer the question ‘how does the world work?’. The answers I came up with didn’t particularly help in my pursuit of meaningful work but it was kind of fun so I thought I’d share them anyway. I came up with a 1-sentence and a 5-sentence answer. I tried writing a longer one but it took too long.


1-sentence answer

Everything changes.


5-sentence answer

Laws exist; some (e.g. of physics) are obeyed better than others (e.g. of governments).

Everybody looks for things in the wrong places.

Patterns of thought spread throughout populations.

Everything is judged when it’s too soon to tell.

Everything changes.

(I considered ‘everything dies’ but I felt that’s too cliché)


What would be your 1- or 5-sentence answers?

By | 2018-01-12T19:17:23+00:00 January 11th, 2018|

The acquisition of cross-domain insights

Some insights are specific to one area. For example, an economist understands how the financial sector works.

Others are ‘cross-domain’ insights, which are relevant across a broader range of domains. These can be harder to put into words.

We can’t predict from where we will gain such cross-domain insights. A casual remark made by a friend may provoke a deep realisation. Or a more conventional ‘life-changing moment’ such as a near-death experience or the loss of a loved one may equally so.

While we can’t predict where they will come from, we can increase our chance of having them by exposing ourselves to as many different experiences as possible.

By | 2018-01-11T21:20:56+00:00 January 10th, 2018|

Expectation Anchors

We base our expectations on what we see around us.

If everyone we knew woke up at 5am to go the gym, it would only be a matter of time before we started doing it.

People are often successful in groups. The ‘Paypal mafia’ have been successful beyond that accounted for only by talent. They grew together, and each became able to change technology for good. “You are the product of the five people you hang out with most.”

Everyone becomes a product of their environment, although we have a degree of control over the environment we’re in.

Today, with the internet and increased social mobility, we have greater control over our environment. We can decide which tribes we join and what type of information and people we expose ourselves to on the internet.

It’s easy to hold artificial limitations in our mind based on what we see around us. “I could never do that”, we may say. But sometimes that mentality is something we picked up from society and isn’t grounded in objective truth.

There are people who will change what we think is possible. Don’t wait for a chance meeting with them – go out and find them.

By | 2018-01-07T17:39:17+00:00 January 6th, 2018|

Perspective, Targets and Limits: Medicine from 50,000 Feet


Learning Medicine

Medicine is a fascinating field with endless amounts of knowledge that can be obtained. Someone could, and many do, spend an entire life striving to learn as much medical knowledge as possible yet, like someone travelling the world, so much will always remain unexplored.

It can be a satisfying feeling to go from ignorance to relative expertise in certain topics. There are other incentives to work hard to obtain this knowledge too, such as admiration from your peers, praise from your parents and points for your CV.


A common pitfall

However, this leads to a common pitfall: working too hard. You may have heard this before a million times, but let me use a personal example to demonstrate a point.

In my first year of medical school I was aiming high. At the end of the year, I was disappointed with my result so I resolved to do better the following year. I made a lot of sacrifices; I skipped social events, spent less time with my friends and spent many late nights in the library. Half-way through the year, we had a full ‘mock’ exam and the hard work paid off; I achieved a mark that, based on projections from previous mock and actual marks, predicted I’d finish in the top 10 of our 400-person cohort. However, my approach wasn’t sustainable; before the end of the year I became apathetic, burnt out and achieved a good but, compared to my personal target, disappointing result once again.


Learning from failure

The following summer I spend a lot of time reflecting. My approach that year contributed to me breaking up with my girlfriend, feeling more distant from my friends and family and ultimately feeling less happy. I had sacrificed so much — what had it all been for?

I began to assess my motives. For a long time, I had been telling myself “I need to study hard so that I can be the best doctor I can be” but I realised this didn’t hold up to scrutiny: the difference between a good and a great result wouldn’t make me a much better doctor, yet the reduced life experiences from living in the library may well make me a worse one.

I realised that being the best had become part of my identity during school, causing me to lose perspective on how important it really is relative to other areas of life. I also realised that I cared too much about what other people thought of me and part of my motivation was to prove myself to others and show everyone how smart I was.

I want to stress that I don’t think that working extremely hard is a bad thing. On the contrary, I think it is important and admirable to work hard towards a worthy goal. Most people don’t work hard enough. However, we must be clear about our priorities, honest about our motives and strive to maintain perspective at all times.

I appreciate it is not that simple. If I had told my second-year self that exams aren’t the be-all and end-all, I doubt he would have listened. I needed that tough summer of soul-searching to figure things out. Sometimes you just have to make your own mistakes and learn from your own experiences.

Different people will come to appreciate their priorities and motives in different ways. Two techniques which, if undertaken with an open mind and honest approach, can help provide this clarity are ‘Following the Trail of Whys’ and ‘Attending Your Own Funeral’.

Follow the Trail of Whys

It is easy to ask ‘why’ and accept the response, even when it doesn’t really answer the question. For example:

Q: Why was the patient’s intravenous fluid run at the wrong rate?

A: Because the previous nurse didn’t change the run rate.


If we accept this answer without probing further, we will assume that this was the nurse’s fault and that she should be blamed or held accountable in some way. However, this doesn’t get to the bottom of the problem and is not a solution.

The founder of Toyota, Sakichi Toyoda, is credited with advising people to “Ask why five times.” The exact number is not important, but continually asking why can be effective at finding new answers and uncovering flaws in previous assumptions.


Let me demonstrate with the above example:

  1. Why was the patient’s intravenous fluid run at the wrong rate?

The previous nurse didn’t change the run rate.

  1. Why didn’t the previous nurse change the rate?

The doctor’s order had gone to the pharmacy and the medication administration record (MAR) was not updated.

  1. Why wasn’t the MAR updated?

The MAR is updated only once per day.

  1. Why is the MAR updated only once per day?

The hospital has chosen to use oral instructions for updates that happen more frequently.

  1. Why are oral instructions used?

The process was constructed a decade ago, when medication orders changed less frequently due to longer lengths of stay. Upon further study, the hospital determines that 40 to 50 percent of its medications change every day.


It isn’t until the fifth why that the actual answer to the question is found.

This technique can be applied to any situation, including understanding why you think or act in a certain way.

If I had been honest and objective with myself during my first two years of university, the Trail of Whys may have produced something like this:


  1. Why do you study so hard?

Because I want to get one of the highest marks.

  1. Why do you want to get one of the highest marks?

Because I want to show everyone that I’m the best.

  1. Why do you want to show everyone that you’re the best?

Because I derive some of my sense of self-worth from what others think of me.

  1. Why do you derive your sense of self-worth from what others think of you?

Because my upbringing taught me to seek the approval of others. This was an adaptive response to my environment but is not serving me well while studying a competitive course at a competitive university.

Therefore, the solution is to deliberately re-appraise how I evaluate myself, rather than to focus on how hard I am studying or working.


As you can see, this technique can get deep and personal pretty quickly. This is why absolute self-honesty is so important.

This technique can also be useful in academic learning. I shall discuss explore how in a future post.

Attend your own funeral

This technique involves visualising your own funeral, imagining how it could go and how you want it to go. The aim is that, by doing so, you will appreciate what really matters and is most important to you. There is a wider philosophy termed ‘memento mori’, meaning ‘remember that you have to die’, which believes meditating on our death can bring profound insights about ourselves.


Insights from a palliative care nurse

A palliative care nurse called Bronnie Ware revealed the five most common regrets that people have at the end of their lives:

  1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
  2. I wish I hadn’t worked so hard.
  3. I wish I’d had the courage to express my feelings.
  4. I wish I had stayed in touch with my friends.
  5. I wish that I had let myself be happier.


The technique

Below is a description of the technique, from the book ‘The Charisma Myth’ by Olivia Fox Cabane. It can stir up emotions, so you are encouraged to do it in an environment where you feel comfortable being emotional and with time to process things after the exercise.


Set the scene and involve your senses:

  • Sit or lie down, close your eyes, and set the scene.
  • Where is your funeral being held? What day of the week? What time of day? What is the weather like?
  • See the building where the ceremony is being held. See people arriving. Who’s coming? What are they wearing?
  • Now move into the building and look around inside. Do you see flowers? If so, smell the flowers’ scent heavy on the air.
  • See people coming through the door. What are they thinking?
  • What kind of chairs are they sitting in? What do these chairs feel like?


Watch your funeral:

  • Think of the people you care most about or whose opinions matter most to you. What are they thinking?
  • See them stepping up one after another and delivering their eulogy. What are they saying? What regrets do they have for you?
  • Now think: What would you like them to have said? What regrets do you have for yourself?
  • See people following your coffin to the cemetery and gathering around your grave. What would you like to see written on your tombstone?


For a recording of the above guided exercise, visit


View exams as a game

A medical student colleague of mine wrote a great article about how he approaches exams by viewing them as a game.


Set limits, not just targets

Medicine can consume your life. With clearer understanding of your priorities, you can set not only more appropriate targets but you can also set limits.

It may be that you still want to aim to finish top in your medical school, and that’s fine. However, you may be content with a more modest target. For example, after my summer of reflection I set my target as finishing in the top 25% of all exams alongside enjoying life, spending time with friends and family and investing time and energy into other pursuits.

This limited the amount of time I spent studying and gave me more stress- and guilt-free time to enjoy. It also helped guide my studying. Whenever I came across new content, I would ask myself “would someone in the top 25% know this?” In some cases, the answer was “definitely yes”, in which case I would work hard to learn it as efficiently as possible, using techniques I shall outline in future posts. In other cases, the answer was “probably not”, in which case I decidedly did not learn it. As well as saving time, I found my studying was more consistent, as were my results.

Don’t get me wrong, I still work hard. But now I vent that same energy and determination into goals that I consider more worthwhile and more in-line with my deeper intrinsic values. I will elaborate more on this in a future post.

One fear that some medical students have is that if they don’t study as much as they can, they won’t pass their exams. However, if you are intelligent enough to get into medical school then you are definitely smart enough to pass exams with the right approach. There are approaches that you can take, such as spaced repetition, which can enable you to do better while studying less.



  • Studying medicine is competitive, there is an endless amount to learn and there are continuous exams. This means that many people sacrifice too much for work.
  • Perspective and clarity can be increased by following the ‘Trail of Whys’ and ‘attending your own funeral’, as well as by other techniques.
  • This enables us to set targets and limits. Limits can increase studying efficiency and help us find a good work-life balance.


If you enjoyed this article, please share!

This article is an excerpt from my latest book, The Modern Medical Student Manual, which offers guidance for succeeding at medical school, while finding deeper fulfillment in work and setting yourself up for an impactful medical career. For more information, click here. It is available now on Amazon.


Also published on Medium.

By | 2018-01-10T18:10:30+00:00 December 20th, 2017|

Value Hierarchy

Everything is on a value hierarchy.

There are variations between the value systems of different people and different cultures.

Some things have a greater consensus regarding their value, others have less consensus.


Our decisions are based on these values.

By choosing to read this, you are valuing it over other sources of information.

You care more about some of your possessions than others as you value them differently.


The way we process the world is also based on these values.

When deciding whether to agree with someone, you examine their argument against your values.

When you evaluate someone’s way of living, you do the same.

By | 2017-11-30T14:12:55+00:00 November 15th, 2017|

Blogging is for good and simple ideas

For 30 days, I wrote and shared a blog post everyday.

It was time-consuming. Some days I spent 20 minutes, other days I spent hours.

Each article should convey one idea. Too many and it loses focus. No clear idea and you start rambling.

The idea of this article: sometimes less is more.

Writing long blog posts every day was great. For a month.

Good, simple ideas come to us everyday. If an idea is good and simple, it shouldn’t need a long blog post to explain it.

I’m going to stick to good and simple ideas.

By | 2017-11-30T14:12:50+00:00 November 14th, 2017|

The four stages of learning factual content

When learning new factual content, there are four stages to progress through.

These are similar to, but not the same as, the four competency stages (unconscious incompetence through to unconscious competence).

I will use examples from learning Medicine throughout.


The first stage is ignorance. This is when you haven’t even heard of the content. For example, you have never even heard about ‘sjogrens’ before.


The second stage is sporadism. This is where you have come across something, perhaps in different contexts, so have a general gist but don’t really know what it is. It is based on associations, but not understanding or context.

A medical example could be that you once met someone with a stiff neck and found out they heard rheumatoid arthritis. They also told you that they used to have gold injections. You are therefore no longer ignorant about what rheumatoid arthritis is – you know one of the symptoms and one of the treatments. However, this is a very incomplete picture; you don’t know how common this symptom or treatment is nor what the underlying pathophysiology.


The third stage is branch knowledge. This involves appreciation of the context, which provides a structure and ‘branches’ that you can ‘hang’ the knowledge on. It may be that you now understand the mechanism of a disease or that you appreciate how the condition is classified.

Using rheumatoid arthritis as an example, you may now understand that it is an autoimmune condition which, in its end-stages, can cause severe joint damage and limit neck movement. You may also appreciate that this is not the most common presentation and that it typically presents as pain in joints of the hand. You may appreciate the classification of rheumatology conditions into focal vs generalised and inflammatory vs non-inflammatory and appreciate that rheumatoid arthritis is a focal, inflammatory condition.

However, at this stage, the details are still not appreciated.


The final stage is leaf knowledge (to continue the tree metaphor). This is where you have the underlying structure for the information AND it is fleshed out with facts.

To continue the rheumatoid arthritis example, you now appreciate all of the different symptoms that can present and why they come about and you know the 7 criteria, of which 4 must be met for diagnosis.


The stage of your present knowledge determines what the next most appropriate action is. If you are ignorant, then seek to be exposed. Put yourself in positions that will expose you to a wide array of new information (it’s impossible to decide what to be exposed to in advance). If you have sporadic knowledge, seek to find an overall structure. If you have branch knowledge, look for leaves.


Note: There is quantitative variation within each stage but qualitative differences between stages. For example, in stage two (sporadism) you may have been exposed to a condition in one narrow context or in multiple different contexts. So the number, and therefore reliability, of the associations can vary greatly.



By | 2017-11-30T14:12:47+00:00 November 8th, 2017|

Focussed before unfocussed work

I have noticed a pattern of action that I have been taking when I have a full free day work which has been effective.

I will decide the one biggest/most important/challenging task that I need to accomplish at that moment in time. I will often set a target that will be difficult, but not impossible, to achieve within a day. I will not devote time to thinking about tasks 2, 3, 4 through to 50 that I should also achieve that weekend.

My entire day will then be guided towards achieving that top aim. The difficulty of the task forces me to focus and work intensely in order to achieve it. While my mind is in a higher state of focus, the other less important and administrative tasks will keep hopping into my mind. I will have a sheet of paper by me that I will note this activities down on before returning back to the one big task at hand. This in itself is beneficial, as the focussed state helps me to recall a wide array of to-dos and often think of other good things that I should do.

At the end of the day, I will have either completed the task or will feel cognitively drained to point that I can no longer work on it. It is at this point that I start to ‘wind down’. During this ‘wind down’ period, I will work through many of the smaller tasks that I noted during the day that do not require much mental exertion.

As a result, the day can feel extremely productive and satisfying; not only did I achieve an important, challenging task which progresses me towards my goals, I also passively recalled, and then completed, many small yet important administrative tasks that, if left for another day, could eat into valuable time.

By | 2017-11-30T14:12:43+00:00 November 4th, 2017|

Phones in Lectures

Phones in Lectures

I’m sitting in a lecture, typing onto my phone.

Around me, many people are checking their phones and not paying much attention to the talk.

This makes me ask — why are we here?

We should value our time highly. We only have so long to learn things that will improve our life. There are some things that we must learn for our career or job — if we don’t learn these now, we will have to learn them later and this will require sacrificing something else. Therefore, not using our time effectively now is a false economy.

Most talks are not high yield, so I can understand why people may wish to zone out. However, attending and then zoning out shows a fundamental disrespect for the value of your own time.

Thinking rationally, therefore, we have two options:

1. Don’t go to the talk

The decision when NOT to do something is arguably the most important decision. In the information age, there is limitless amounts of information available. We must be selective.

I have written before about how I read 50–100 books a year. Even after 80 years of life, I will have only read a tiny fraction of the number of books that exist — millions of new books are published every year.

I appreciate that not attending semi-mandatory talks goes contrary to the expectations of society. However, we shouldn’t let the implicit rules of society influence us too greatly, particularly when they are not rational, as rules should never be followed blindly.

2. Don’t zone out

The ability to maintain focus, even when bored, is important for two reasons; developing the ability to focus and the experiential benefits of presence.

The default pattern of most is to be ‘switched off’ most of the time and then ‘switch on’ when it is required. A common pattern is to push ourselves at work due to the demands of the job and external pressures, then collapse back into unproductivity in our free time, whether that’s long periods of watching TV, browsing the internet or any other activity requiring little focus.

In his book Deep Work, Cal Newport argues that we should be taking breaks fromfocus rather than breaks from distraction. Our default should be periods of sustained focus, then short breaks away from this.

Some may argue that this is difficult to do but it is an ability that can be trained over time with discipline and yields large rewards.

The second reason is the benefits of being present where you are. This is an increasingly popular idea in the West with the flourishing of ‘mindfulness’. One element is avoiding ‘psychological transporting’, where our mind leaves the room and we think about other things.

Yuval Harari in an interview said “a huge range of human experience exists on the other side of boredom”. He is referring to experiences that people who continually look for something to ease their boredom will never realise.


In summary, we must respect our time through conscious decision making. We should decide what to attend and what not to. We should not let distractions, such as modern technology, steal our attention and disrupt our focus.

By | 2017-11-30T14:13:27+00:00 October 12th, 2017|