What’s so important about purpose?

[00:00:00] Rachel: Where can you find happiness in a system that seems stretched to breaking point? Is it in the work that you do or in the things that you do to escape work? Dr. Mark Shrime believes happiness lies in part in your purpose, or as the Japanese call it, your ikigai.

[00:00:15] Rachel: Mark literally wrote the become purpose as we’ll cover in this episode. And I brought him on this week to talk about finding a path towards work that meets the needs of others, as well as yourself.

[00:00:25] Rachel: As medical professionals, we can feel a sense of duty towards our patients, our colleagues, our families and our partners. But what happens when you discover that you’re not really where you want to be?

[00:00:37] Rachel: Now purpose has become a bit of a trendy word. It can be a bit woo. But my conversation with Mark offers some really practical steps about building a life where you can be exactly where you need to be.

[00:00:49] Rachel: If you’re in a high stress, high stakes, still blank medicine, and you’re feeling stressed or overwhelmed, burning out or getting out are not your only options. I’m Dr. Rachel Morris, and welcome to You Are Not a Frog

[00:01:08] Mark: Hi, I am Dr. Mark Shrime. I am the International Chief Medical Officer of an organization called Mercy Ships. I am a, uh, head and neck cancer surgeon by training, and have been working in the global health space for a couple decades now.

[00:01:22] Rachel: Great to have you on the podcast, Mark. Um, where are you, uh, dialing into our, our call from?

[00:01:28] Mark: Uh, today I am in New York City. Uh, but that’s just today. This, uh, job is a lot of travel.

[00:01:35] Rachel: Excellent. And we’ve got you on the podcast to talk about jobs, to talk about vocations, to talk about purpose. ‘Cause I think purpose can be a bit of a double-edged sword. And, and it, there’s been a lot written about purpose in the literature and particularly that the happiness literature recently, Mark. Do you agree with it all? Do you think it’s helpful? Do you think some of it’s unhelpful?

[00:01:56] Mark: It’s a, you’re, you’re opening up with a, just a small question. Um, I.

[00:02:01] Rachel: We like to just go straight in there

[00:02:03] Mark: Straight in. Um, it’s, it’s both. It depends, which is a, a classic, perfect sort of decision science answer.

[00:02:11] Mark: Purpose is, is very important. I mean, I, I literally, I wrote a book about purpose. I think it’s incredibly important. Um, at the same time, I do think some of the, the, the, the writing that’s been out there is not necessarily helpful in that the best way for I, I truly believe the best way for us to live our lives is to live lives in pursuit of the thing that we find to be our purpose.

[00:02:33] Mark: At the same time, the connection that sometimes people make to purpose and happiness, defined in kind of the western way that we define happiness, is not actually born out in experience or in the literature. So we, we conflate following our purpose with kind of a hedonic type of happiness, whereas following our purpose leads to deep contentment, joy, peace, knowledge that you’re doing what you’re supposed to be doing. It doesn’t necessarily always lead to the dopamine fueled, uh, hedonic happiness that we sometimes uh, associate it with.

[00:03:16] Mark: I think there’s a distinction there that really needs to be made because if you pursue happiness, you’ll a not get happiness and you will probably not find your purpose. And on the flip side, if you pursue your purpose, you will find that deep contentment, peace, et cetera, but you may not also find happiness and we could spend an hour dissecting just that

[00:03:36] Rachel: So let’s rewind a bit. Let’s start with purpose. What, what do, what do people mean when they talk about purpose and, and what meaning would you like to put on it?

[00:03:46] Mark: I don’t know what I, I’m not sure I’m gonna be able to answer the first question. What do people mean when they talk about purpose? Um, because I think it, it varies for everybody. Uh, but let me define it as answering the question, why.

[00:04:00] Mark: Why are you doing what you’re doing? Why are you a doctor? Why are you, a spouse? Why are you a parent? Why are you, uh, anything that you, um, that you attach after the words I am? Um, why? Uh, why are you those things? because we spend, I mean, it’s, it’s, it’s a cliche to point out how often we answer the question, who are you with our vocation, right? I’m a doctor. That’s how I, that’s how I introduce myself, right? Um, uh, I am this vocation.

[00:04:32] Mark: But why? And I think that’s, that’s the real question that we have to answer. Because once we answer that for ourselves and everyone’s, everyone’s answer differs every other answer that we want to, every other question rather, that we face in our lives, flows from it.

[00:04:49] Mark: To take a big one, do you want to continue as a doctor or do you want to, have children or whatever? Uh, these are hard questions to answer, like, very, very difficult questions to answer because we can’t see the future. Um, and some of these questions, well, I’m sure we’ll talk about this later, some of these questions, uh, some of the answers to these questions will last us a long time.

[00:05:09] Mark: So because we can’t see the future and can’t know what it’ll feel like to be a doctor in 30 years or be a parent in 30 years, we have to be able to answer those questions based on something else. And that’s the purpose. That’s the why.

[00:05:22] Rachel: What if though, you’ve asked the question why and you don’t really know the answer? I’m just thinking when I went to medical school and when, when people ask me, why do you want to be a doctor? Probably, if I was honest, it was like I couldn’t think of anything else to do. My parents were doctors, so I just did it.

[00:05:39] Rachel: Some people go into certain careers just ’cause it’s gonna make me a lot of money. Um, some people do stuff just ’cause I enjoy it or I find it interesting. Now, those, those aren’t really things that connect us very well to purpose.

[00:05:51] Mark: But are they not? I would actually, I, I might actually disagree with you, uh, on this. Um, and I’ll give, I’ll give this example. When I chose to wind down my full-time US practice so I could pursue this global health, uh, thing, my partner, the guy I operated with, the guy who hired me into the hospital that, that I was in when I was making this decision, he obviously was not very happy with me deciding to leave, and that’s fair. Um, we’re, we’re still on very good terms. I literally just talked to him yesterday. but I will admit that I would look at him and, and couldn’t necessarily understand why what I was doing didn’t make sense to him.

[00:06:32] Mark: And it took me some time to realize that for him being the best surgeon that he could be, providing the best life for his family that he could. Those drove him. Those were his why. And so his choices were different from my choices and his choices made perfect sense within the context of the things that he wanted to do.

[00:06:53] Mark: So there is nothing wrong with, like, I, I’m, I’m very, I feel very agnostic towards not just agnostic, almost antagonistic to the question of what’s a good purpose. Is it okay to want the purpose of your life, to be enjoyment in your life? Great. Then please pursue that. And for each of us, that, that is different, that, that why is different.

[00:07:15] Mark: And, sorry, one more thing to, to say to what you said, you know, when, when you went to med school? When I went to med school, I went to med school because, uh, I, because I’m the first born son of an immigrant family, so basically I could choose doctor, lawyer, or failure. but my, my why and your why will evolve. We are not static creatures and I have to continue to make a choice every day, every year. Do I want to continue in the job that I currently am in right now, uh, as a doctor, right now as a Chief Medical officer of an organization. And I, I go through an exercise every three months, as I start a new journal, an exercise of why do I work, what is work for me?

[00:07:56] Mark: and it’s a, it’s a good reflection of my own purpose of sort of rewriting my own purpose, but also it’s a, it’s a kind of good reflection time for me to be like, okay, do I wanna sign on for, for this, whatever this is for the next three months?

[00:08:10] Mark: So the fact that your purpose when you went to medical school, and my purpose when I went to medical school, we might not still agree with those now 20 years later, doesn’t mean they were wrong back then.

[00:08:21] Rachel: I think it’s, it’s quite a big thing, isn’t it? Trying to think about, you know, why do I wanna do this? Who, why am I here? What am I supposed to be doing? And when you, when you first talked about purpose, it’s, you talked about what you are supposed to be doing like in life. Then I guess then the question that would come up for me with it, well, who says, who says what you’re supposed to be doing?

[00:08:42] Rachel: You know, is everybody created or does everybody land on this planet with one thing that they are, they are put here to do? Because it seems to me to think, to think like that you sort of have to have a bit of a faith and a higher power or something that is actually guiding, guiding the universe and I, I, I’m, I’m wondering if that definition would suit people with any faith or, or with no faith, or whether there is something particularly unique to each person saying, yes, everybody has, has their own purpose, or whether it’s actually no, you just find your own purpose and then that’s what you’re supposed to be doing?

[00:09:13] Mark: Uh, the latter. For sure, the latter. I, I, I, absolutely, and that’s what I was trying to get at, maybe less eloquently than you just did in the last part of what I was saying. I am, I do come from a faith, um, but I, I don’t believe that there is one set answer for each person, um, that they must find when they’re 16, and it stays with them for the rest of their lives.

[00:09:36] Mark: I, I grew up under that sort of, that sort of faith structure, to be honest, and I don’t think it’s true. I at 50 am a very different person than I was at 16. My purpose right now for the next three months before I rewrite my journal is different than it was five years ago when I started this exercise of rewriting my journal. Like, that paragraph has changed and has evolved over time.

[00:10:01] Mark: There’s a concept that I talk about in my book, uh, at the very end. It’s gotten a little bit more sort of traction in kind of the social media conversation, but it’s a concept called Ikigai. It’s a Japanese concept, um, that where you’re supposed to be is at the intersection of four circles. That’s a Venn diagram of four circles. What are you good at? What does the world need? What do you love? And what can you get paid for? ‘ Cause we need all four of those things.

[00:10:28] Mark: And each of those will change over the course of your life, especially the what do you love one, uh, will change over the course of your life, and that’s okay.

[00:10:37] Rachel: I love the concept of Ikigai. I think we did do a podcast on that or a while back with, with, with Dr. Richard Pile who is a GP and specializes in lifestyle medicine. And I think, I think that’s really important for us to remember because so many of us just think, well, I’m, I’m, I love doing this, therefore that must be my purpose, or, I’m really good at this. Well, that’s my purpose. But we neglect to think about what do other people actually need? What do they need and, and, and want? And then is somebody going to pay for it?

[00:11:06] Rachel: ‘Cause even if that person can’t pay for it, is there somebody else that’s gonna gonna pay for it? And or if there isn’t someone who’s gonna pay for it, is there a a way of me doing this sustainably so that I can still eat, feed, feed my family and, and all that sort of stuff? It is quite, it’s quite a practical thing, isn’t it? It’s quite, it’s quite helpful, that. And I love those, those circle, that Venn diagram idea.

[00:11:25] Mark: Well, but also I think what you just said there is great. Um, the thing that you love does not also have to be your job. We as physicians have a, a unique privilege in that very often, not always, uh, and increasingly less as the NHS and the US healthcare system have been kind of imploding, but broadly as a profession, we tend to have a very purpose-driven profession. Uh, so people who go into our profession, either go into it because of a purpose or find purpose in it.

[00:11:55] Mark: Uh, but that does not have to be the case, right? It is very much the case that your job can be the thing that you’re getting paid for, so that you can do the thing that you really find, uh, as your purpose. So that, that that intersection can be there between job and purpose. Doesn’t have to be there.

[00:12:12] Rachel: I love that idea of thinking of our, our purpose like that. And Mark, have you, have you always been interested in purpose or is it something you’ve been thinking about recently and and what led you to that?

[00:12:23] Mark: Well, well, yes and no, right? Uh, as I said, I went into medicine for, in, in inverted, comma is the wrong reason. Um, I went into medicine sort of for filial duty and, and hated it, like, absolutely hated it, tried to quit over and over and over again. Started med school, whatever it was, August of the 18 hundreds, um, and was already trying to quit with by September of that same year.

[00:12:48] Mark: So that led to its own crisis of, well, why, um, am I stuck in this? Is this what I’m supposed to be doing, right? I’m not enjoying this, but should I? I mean, being a doctor is respectable. It leads to a particular type of success, et cetera, et cetera. All the things that, you know, so why shouldn’t I be doing this? Um, and that’s what really kind of got the, the wheels in my head turning about this. Like how do I, I’m in one of the most purpose-driven professions that exists on the earth and I am not happy. What does that mean? And how do I handle this?

[00:13:28] Mark: So I quit. Not, not really. I kind of quit. I, I, like, I kept trying to leave, like I would dip a toe in the leaving waters. After my first year of med school, I, I took a year off. I flew to Singapore, taught, uh, organic chemistry for a year in Singapore. Really sort of flew to Singapore, kind of, uh, subconsciously, I think, uh, at the time to put nearly 10,000 miles between me and med school, and to try on a different life.

[00:13:58] Mark: And here’s the crazy thing. Like I really wonder if I had known then what I know now, would we even be having this conversation? I loved that year, like absolutely came to life that year. Loved teaching, loved my students, loved Singapore, loved the food, all the things that people go to Singapore for. And so I should have. You know, I was good at teaching, they were paying me all those things, right?

[00:14:23] Mark: So I should have stayed. That was right in what, that was at the intersection of those four circles, uh, at the time. And I walked towards the end of my year in Singapore, literally walked myself to the immigration building to just explore what does it mean to apply for permanent residency? Like, what does all of this mean? And I literally chickened out, like I had my hand on the door of the, of the entrance to that building and then let go, turned around, went back home, went back to med school.

[00:14:51] Mark: So, subconsciously I kept trying to get off. this, I used the, I used the image moving sidewalk. Um, I subconsciously, I kept trying to like jump off this, you know, travel later this moving sidewalk, but I didn’t.

[00:15:03] Mark: And it wasn’t until I first started working in Global Health for the first time, I, uh, worked as a surgeon in, uh, in a West African country that I was like, oh, alright. I get it. I see, I see why I’ve been training for the last, you know, 15 years. That’s the first time that I felt like I had a clear enough incarnation of what I was supposed to be doing for that season of my life, for me to actually start making decisions around it.

[00:15:36] Mark: But that was 2008. I didn’t wind down my full-time clinical practice until 2011, and I didn’t fully wind down US clinical practice until 2018. So it took me 10 years between that kind of epiphany of, oh, this is where I wanna direct the next chapters of my life and actually doing it.

[00:15:57] Rachel: So do you mind me asking, what was it about the job in the US that you didn’t enjoy, compared to the one in West Africa that you did because you’re, you’re a surgeon, right? You’re doing, you’re doing operations. So one would think that if you didn’t enjoy that in the US, and yes, you can talk about bureaucracy and administration and, and everything and busyness and everything that comes with, with working in healthcare, but essentially it’s still seeing people, it’s operating, you know, you’re doing the same movements with your hands on the scalpel. Was it just the purpose that was different?

[00:16:27] Mark: Yeah. Uh, a hundred percent. And that’s such a good question and people ask, have asked me this question before, and I agree. Like I, the operations that I’m doing on the hospital ship in West Africa are to a great degree, exactly the same as the operations that I was doing when I was practicing in the US. Now the tumors are bigger, the, the disease processes are more advanced. But a parotidectomy is a parotidectomy is a parotidectomy. It is still the same steps that I am doing, uh, in West Africa.

[00:16:56] Mark: But it is the purpose. It is, um. Well, there’s, there’s two things. Uh, first for me, it is the purpose. It was the recognition that surgical access in, um, most of the world is pitiful. Um, there is no access to surgery, if for 93% of the population on the entire continent of Africa. So I want to make a difference in this. This is, you know, the, the Ikigai circle of what the world needs. Well, gosh, um, 93% of people don’t have access to surgery on an entire continent. There’s a need there.

[00:17:30] Mark: Um, so it’s the purpose. It is also, you know, you kind of di, dismissed it, but, um, medicine, and I don’t know how much this is true in the NHS, but medicine in the US is all those other things that you talked about. It is a profit driven, uh, uh, industry and as a result, as a physician who, the thing that I enjoyed the most about medicine was actually hearing my patient’s stories, um, I am rewarded for throughput. I am rewarded for, uh, being a good cog in a machine that does not benefit me, does not benefit the patients, but benefits the money makers at the top.

[00:18:11] Mark: So. I mean the, the movements with my hands haven’t changed. Why I am doing them and everything that surrounds them has absolutely changed.

[00:18:21] Rachel: I can see that, that the massive impact that you must be having in, in doing those operations there. There, simple stuff, simple preventable stuff will just get sorted and it doesn’t in other countries. So I can see that the impact that, that going and providing, providing that will have.

[00:18:39] Rachel: So what hope is there then for people that are stuck in a job where they are limited by being one of those cogs in the wheels? And when I say people are stuck in their practice, I don’t mean totally stuck because like you, I think we have choice.

[00:18:53] Rachel: I love the fact that you, uh, slightly misquoted, I love your misquote, the Mary Oliver thing. What your one wild and you said crazy lies. She calls it the one wild and precious life. And I, that for me has been a real mantra for me because I, at one point thought I was really stuck in my life, stuck in my job. I didn’t really enjoy the job I was doing, and I read that poem.

[00:19:12] Rachel: I, I was out in the Alps on, on a business retreat at the time, and, uh, there were all these really cool people that have moved out there, based their jobs in the mountains. They were working for startups and tech stuff, and they’d, they’d work in the morning and then they’d go climbing or skiing in the afternoon. It was just such a cool life. I thought, oh, if only I could do that, but I can’t. I’m stuck in Cambridge. I have a family. My other half runs his own business. Kids are all at school. I can’t move.

[00:19:36] Rachel: And I thought, well, I could move. I, I, I could, I could go and work in a bar and move and ditch the family, but I’m gonna choose not to ditch the family. So how do I have a wild and precious life in the job I’m in right now?

[00:19:49] Rachel: So you are talking about, you, you found your purpose by, by moving some, you know, by, by going around on, you know, doing stuff on the mercy ship. But how do we, how do we find that purpose when we are still stuck in, in a job that, yes, a lot of us probably did go into medicine. I know it’s a huge cliche to help people, but, but genuinely, we are motivated by that, and that is our purpose and to make a difference. And then suddenly you’re in a job where things are really tough and you feel that you are not actually making a difference. You are barely meeting the need. Um, it’s all, it’s all quite overwhelming and you’re not really enjoying it anymore. But what does, what does somebody do then? And how can purpose help?

[00:20:25] Mark: Well, I’m gonna challenge you. I’m gonna answer your question after I challenge, uh, but just to take the example that you gave of, of the folks that were in the Alps and would work in the morning and then climb in the afternoon. Um, also, can you gimme their names? ‘Cause I want that, I want that life.

[00:20:42] Mark: But you know, your, your, what you presented to your past self, right there, was actually a false dichotomy. Uh, was, well, I can either stay in the job that I am in right now, which I’m not loving, and, uh, et cetera, et cetera. Uh, or I could ditch the family and go work in a bar in, in the Alps. That’s not, those aren’t your only two choices.

[00:21:04] Mark: And, I don’t know these people that you’ve met, but there are people who are living that life, who have a family, who have children, and who are bringing their children and their family along on that adventure, and they’re doing it as a, as a unit as opposed to as an individual.

[00:21:18] Mark: We in medicine have a, a crisis of imagination. The only thing that we can see. Is the moving sidewalk, the path that our colleagues and our predecessors have walked. And so we don’t, we don’t think about the dozens of other possibilities that are available to us.

[00:21:40] Mark: And I, I say we, because I do the same thing. We tend to paint these decisions as. Very dichotomous, very black and white. whereas, and this is kind of gonna get now to the answer to your question, whereas there are a, there are scores of decisions we make on a day-to-day basis that we don’t even think that we’re making because it’s just sort of what I’m supposed to be doing, uh, that we can question, we can question.

[00:22:08] Mark: I mean, I, again, I don’t know the NHS uh. So I’m gonna speak from the US, uh, side of things, but things as simple as must I advance again in inverted commas? Must I advance in my career? Do I have to, uh, become the chair of the department or whatever? Or am I the happiest when I’m seeing my patients?

[00:22:34] Mark: Must I do this or, or that in my career because everyone else is doing it? Must I continue to see patients every single day? Can I be in a position where I can see patients half the time and I don’t know, start my, baking shop, um, the other half the time?

[00:22:52] Mark: I mean, we, we view these things as an all in or all out decision ’cause that kind of is our personality as physicians. But there are shades that we don’t allow ourselves access to because we can’t imagine them.

[00:23:05] Rachel: I love that answer. And I, I totally agree. I think it’s once you have stopped, stepped off the traditional medical pathway that’s, you know, like this, like, sorry, people that are, are listening to this, I’m just miming tram lines. Once you’ve stopped, stepped off it once, it’s then a lot easier to step off it again. So I, I, now, you know, I, I work full time doing the podcast and creating online courses and training and stuff and to me going off and doing other stuff, it’s great. It’s really exciting. But when I was full-time doing the, as fullsome as I could be with kids doing the, um, the medical thing. It, it, it was a lot harder.

[00:23:38] Rachel: I think a lot of people, they feel very duty bound, duty bound to their patients. ’cause we can’t all go off and start, start baking businesses. They’ve gotta be someone to see the patients. Is it possible to find a purpose even when you are in, in that job that just feels really hard and feels like there is sort of, you’ve, you’ve lost the purpose a bit because things are just not, not easy.

[00:23:59] Mark: Yes, I do think a lot of us are duty bound, feel duty bound. We, we all go into, and I agree with you, it sounds cliche, but the majority of us go into medicine because we want to help. Uh, then we get into medicine and we are trying to help and we’re being beaten down and churned through while trying to help, but we still feel that duty to our patients.

[00:24:19] Mark: The challenge again, is there is a, there is a brilliant op-ed by a physician from New York City named Danielle Ofri, which she makes the case that the entire business of medicine is built on our backs and built on the, uh, the presupposition that we will just show up day in and day out out of a sense of duty because of the, as she says, the ethics that brought us into the field in the first place.

[00:24:49] Mark: So here’s the challenge that I would, I would make to other providers within this system. Is it’s not gonna change if we don’t make a change, right? I mean, you and I are both victims of having been ground to dust in the mill of medicine and are now working different jobs because of it.

[00:25:11] Mark: Now, on the other hand, um, I say this to a lot of my clients and I am, uh, you may go through an entire kind of purpose finding exercise, uh, an entire solving for why exercise and come out the other side of it with you know what? My why truly is to be a healer to individual patients.

[00:25:31] Mark: Um, I don’t need to. escape to the Alps or work in West Africa, or, uh, create online, uh, courses. Like this. My my why really is that like I want to be a healer. Um, that’s where those four circles in Ikigai, um, intersect for me in and of itself. That is, at least I have found, um, that is freeing. That re-centers, re focuses or helps refocus from the,, gosh, the day-to-day of what I’m doing can be pretty draining to, yes, the day-to-day of what I’m doing can be pretty draining, but look at what it allows me to do towards my purpose.

[00:26:16] Mark: You know, at the very beginning of this podcast, we talked about how sometimes for some people the job isn’t the purpose. The job is something that you do so that you can get paid to do the thing that you think is your purpose. Well, that may actually be true in the job itself too, right? The day-to-day of your job may simply be there to give you the opportunity to be the healer for the individual patient that is in front of you.

[00:26:40] Rachel: And as you were saying that, it made me think that actually if you. Refin your purpose, and that is, you know, to be a healer and to come alongside people when they’re suffering, it suddenly makes all the extra crap that you’re expected to do, a bit extraneous, and you can just leave it a bit, you can be a bit more like, oh, sold it. I’m, I’m not gonna, I’m not gonna go after that. And that, and if they don’t like it, ’cause I’m not doing that, then that doesn’t matter so much.

[00:27:05] Mark: Correct.

[00:27:06] Mark: I had a, uh, a conversation with a colleague not that long ago, within the last six months. Um, and he was offered a, uh, uh, an advancement, uh, within the organization that he was working in. It was offered, um, kind of a, a more, a, a more, more of a leadership role, and he turned it down.

[00:27:25] Mark: And I think most doctors who, most of us who are super driven would be like, why would you turn that down? That’s an advancement. He turned it down because he’s like, I love being an anesthesiologist. My joy is being in the operating room as an anesthesiologist. Why would I walk away from that?

[00:27:43] Mark: And that blew my, like, honestly, that blew my mind, uh, more than it probably should have. But that’s exactly it. Like he knew what his why was, and the temptations of all the other things really couldn’t tempt him away from that.

[00:27:54] Rachel: In, in the UK I’ve lost count of the people that I’ve worked with that have been, you know, being clinical directors of their hospital department or we have these things called PCN Directors, which is a group of GP surgeries that, that, that get together and you have a, a clinical lead. And after doing it for a year or so, they’re like, that’s it, I’m handing that over, ’cause that was awful. And then, and then it almost, because like, whose turn is it to do this now? Because actually it was so horrendous. Yeah, you get the title on it and it’s nice, but actually it just comes with a whole heap of bureaucratic nonsense that that, that I just, I just don’t want to do.

[00:28:28] Rachel: And, and so we do, I, the problem is, I think in medicine we sort of, we are built, like you say, on that conveyor belt. And if you don’t take steps yourself to think, well, what is it that I really want to do? Or what is my purpose? You will just carry on and you’ll end up as a clinical director, a departmental director, that you might not end up even seeing patients.

[00:28:45] Rachel: Now, for some people that’s great, ’cause you are, you know, you want to be in leadership and system improvement, great. But for those of us that don’t, there is no shame in, in not advancing yourselves. But because you’re on that conveyor belts, there’s often, there’s a lot of shoulds and aughts I think in, in that whole career path.

[00:29:00] Mark: That. Oh my gosh, that’s exactly it. That’s, that’s exactly it. Like the fact that it shocked me, the fact that I’m still thinking about my, my colleague’s choice not to take that position, it just speaks to exactly what you’re saying, that it’s, it was counter what we would’ve expected, of any one of us on this moving sidewalk to do.

[00:29:20] Rachel: I do want to talk about the dark side of purpose because

[00:29:23] Rachel: I have observed that sometimes when, when people have this often a higher purpose and often there’s a sort of faith involved as well, you know, this whole well quite literally savior complex, like, I have to save these people, you get, you know, the faith leaders, you can think about that like the pastors that work all hours or the, the doctors that got to save their patients and work in really deprived areas and they’re working, working their socks off to, to keep everybody healthy and safe.

[00:29:50] Rachel: And when your purpose is, I guess, overplayed, then I’ve noticed that people burn out quite quickly because they feel they’re the only person that can do it. That’s what they’ve been put on the planet to do, and they might be totally miserable and neglecting their family and everything else, but because their purpose is so strong, that’s it. And I think that’s a really dangerous place to be.

[00:30:13] Mark: I couldn’t agree with you more. This, this is a great bookend to circle back to one of the questions, I think maybe your first question today, which is, do you agree with all the writing on purpose? Um, and where I strongly disagree with the writing on purpose is when purpose gets trotted out as a cure for burnout.

[00:30:33] Mark: Let’s, first of all, um, we, especially in medicine, nursing, uh, especially in the healthcare careers, we need to disabuse ourselves of the idea that burnout comes from the providers, and that the cure to burnout is, uh, learning how to breathe better and doing more yoga and more mindfulness and all that stuff.

[00:30:56] Mark: I think that’s all great. I do yoga. I do have a mindfulness practice, like I do all those things, but turning around to the burnt out people and saying, you’re burnt out because you’re not breathing right, is, put, not to find a point on it, it’s just sort of tightening the shackles, uh, around them. We are burnt out because our system is designed to use us as cogs, and the burnout comes from the system.

[00:31:18] Mark: All that to say. In some of the writing on burnout, people are like, well, if you reattach yourself to your purpose, well that’ll cure your burnout. And I think that’s the opposite, uh, is true. By working towards your purpose, you run the risk, as you just said, of overworking yourself, of being so attached to your purpose that you become the pressure, you become the mill that grinds you, uh, to dust.

[00:31:45] Mark: And I do think there is a, there, there can be a religious, uh, component to that. There is the sort of work ethic component to, um, some of our upbringings. Uh, but it’s not, it’s not unique at all to that religious component. It’s, uh, it is pervasive in purpose.

[00:32:03] Mark: As we started, purpose and happiness do not necessarily intersect. Purpose and meaning, purpose and, and eudaimonia, a, a, a, life of contentment, those exist, those intersect. But you’ve gotta be really careful because, let’s, let’s, let’s be slightly, uh, slightly inflammatory here, um, suicide bombers are some of the most purpose-driven people in the world, and that does not lead to a good or long life. Uh, so purpose by itself is not the answer to everything.

[00:32:34] Rachel: I, think that’s, that’s absolutely true. However, it can help, can’t it? I think purpose can help you, well in, well, in fact, I was gonna say, purpose can help you tolerate a job that you don’t like, but in your case, it’s actually helped you really enjoy a job that you didn’t enjoy somewhere else. So I think that’s a really, a really good example, but you have to keep reminding yourself of it. And, and hopefully it can help you prioritize a bit so that you are not getting birds out. So you’re thinking, well, this is, this is the purpose why I’m here. Therefore, that stuff doesn’t matter so much.

[00:33:07] Mark: Well, let me actually, let me, let me change that just a little bit. Me following my purpose, I enjoyed the surgeries, irrespective. I enjoyed the operating. I enjoyed that when I was in the US, I enjoyed that when I, I enjoyed that when I’m on the ship. I like being in the operating room itself, but purpose allowed me to have that slightly more broad imagination about a future. To be able to say, I want to shed this part of what I’m doing and keep this part.

[00:33:38] Mark: I want to create a career path for now. Who knows what it’ll be in 10 years? But I wanna create a career path for now that looks more like this. So, you’re right, I’m still a doctor, I’m still a surgeon. I didn’t go off into the Alps, uh, to work in a bar and then climb, uh, in the afternoon. But it’s a very different type of surgery, surging that I do now.

[00:34:00] Rachel: So, what questions would you be asking somebody who is coming to you trying to make a decision around purpose that would help them choose and would help them decide? What sort of things would you be asking them?

[00:34:10] Mark: Well, I feel like, uh, at this point I’m, I’m gonna do a bit of a sales pitch now, but, um, kind of, there’s a, there’s a structure around the way that I approach this. Uh, the first part of the structure is a lot of what we’ve talked about here, which is to, uh, shed the assumptions and also to address the anxiety that shedding the assumptions leads to.

[00:34:30] Mark: Uh, and we all have, they’re the, the positive intelligence folks call them saboteurs. We all have voices in our heads that tell us why whatever our decision is, is wrong. And, uh, you know, protect us. Really, they’re, they’re good, but protect us from bad decisions. Then we start looking at the various different frameworks that people use to make, uh, decisions.

[00:34:54] Mark: And then the third thing, which is really hard, um, is to create your choice set. What is it that I’m now gonna be deciding between? As I said earlier, we in medicine tend to have a crisis of imagination, and that our choice set is I stay a doctor hating being a cog, or I leave my family and go to, I’m sorry, I keep coming back to this image, but, uh, broaden, broaden our choice set so we actually know the things that we’re trying to decide between, and then we can put all three of those together into making a decision.

[00:35:24] Rachel: You’re right. We often do. It’s like, do I stay? Where do I go?

[00:35:27] Mark: Do I explode everything?

[00:35:28] Rachel: Yeah. Exactly. Exactly. And actually some of the, a lot of the work we do is actually, what if you stayed, but you changed things when you stayed? Like it could be a lot better. And actually to, to, to bring the story to a conclusion, I, I ended up calling, yeah, my organization World Monday. So it’s like, how can you have a wild and precious life on a Monday morning, right? When you are, when you’re in your current job, but you can change things so you can connect with your purpose more. You’re not so burnt out, you’re not so frazzled.

[00:35:54] Rachel: But it, that takes a bit of courage though, and that is the problem. It’s getting that, that courage to make those decisions and those, and those choices that you’ve got.

[00:36:00] Rachel: So Mark, what top three tips, which you give to anybody who’s think, who’s feeling a bit purposeless and thinking, oh, you know, I, I do need a bit of that?

[00:36:08] Mark: Well, I think step number one is to go through that Ikigai exercise. Um, what are those four things? Step number two is stepping off the path. Stepping off the conveyor belt, the moving sidewalk, whatever it is that we want to call it, uh, means that you are taking a risk. Um, and risk means you will fail. I have not met a single person who has taken a risk, who hasn’t failed at some point, so start practicing it. Start practicing failure.

[00:36:35] Mark: Um, and I, and I mean this, like, I actually say this in, in my talks. We’ve, we’ve the, the conversation around failure, I’m glad there’s a conversation around failure right now, but I don’t feel like it goes far enough. Uh, we talk about getting comfortable with failure, getting used to failure. I actually think if you’re gonna be risky, you’ve gotta fall in love with failing. Like you’ve gotta fall in love with what it feels like to suck at something.

[00:36:58] Mark: So do it. Pick something that you don’t know how to do, crosswords or climbing or, you know, cross country skiing. Pick something that you’re terrible at and just do it, so you can feel like being a beginner. So, uh, step number two, then actually fall in love with failure.

[00:37:14] Mark: And step number three, we did not talk about this at all. All these steps, all the things that I do with my clients, the things that we’re talking about right now, they are, they’re actions. We we’re not logiced into, or data into our purpose. Our purpose lies in those quiet moments that we all have if we are willing to listen to them. And we do have to.

[00:37:36] Mark: I know I was, I was saying that mindfulness is not a cure to burnout, and I don’t think it is, but we do need to cultivate a practice where we can listen, where we do have the openness for, the theologian. Marcus Borg calls them the thin places, the places where the veil between what is real and what is unreal becomes a little thinner. Uh, we’ve gotta find those, because that’s where we actually hear our purpose.

[00:38:04] Mark: Um, and you ask for three, I’m gonna give you the fourth. The fourth is you at some point have to act. Um, you can, you can meditate, uh, you can have a dozen different epiphanies, but at some point you’ve gotta make a decision to make those changes.

[00:38:17] Rachel: Brilliant. Thank you. Uh, and I love that bit about that, that time where you can stop and think and be in those thin places. And I think that’s, that’s where sort of retreating, resting, meditating, prayer, whate, whatever is really, really important.

[00:38:31] Rachel: Which, Mark, we’re gonna get you back because I’d love to talk a bit more about Decision, decision making, how we do it, particularly, you’ve got a degree in decision making. That is, that is, that is awesome. Um, if people need to find out more about your work, how can they find you?

[00:38:42] Mark: So I, I’m on both Instagram and Twitter, uh, at Mark Shrime. I have a book out called Solving for Why, which you can find anywhere that you, you get books.

[00:38:52] Rachel: Good stuff. We’ll put all those links in the show notes, so just head on over to there. So Mark, thank you so much for being with us today. It’s just been really, really interesting and we’ll speak to you again soon hopefully.

[00:39:01] Mark: Thanks for having me.

[00:39:03] Rachel: Thanks for listening. Don’t forget, we provide a self coaching CPD workbook for every episode. You can sign up for it via the link in the show notes. And if this episode was helpful, then please share it with a friend. Get in touch with any comments or suggestions at hello@youarenotafrog.com. I love to hear from you. And finally, if you’re enjoying the podcast, please rate it and leave a review wherever you’re listening. It really helps. Bye for now.