Jimmy Turner, MD
@TPP_MD
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The Physician Philosopher. Money Meets Medicine podcast. Associate Prof Anesthesia. Author Physician Philosopher’s Guide 2 Personal Finance #GoDEACS #medtwitter
Joined November 2017
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Pinned Tweet
“Hey, Dr Turner, thanks for everything you do. I am reaching out because I need disability insurance, but I have Type 1 diabetes. I finished training 12 months ago. How should I go about this?”
Emails like this break my heart. Every. Single. Time.
Here is why:
#MedTwitter
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As I pulled my resident aside after a tough day doing regional anesthesia, I asked the same first question I always ask when I have clinical competency concerns,
“How are things at home?”
Most of the time the answer is “fine.”
This time the answer was “I have cancer.”
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When we assume that clinical struggles are caused by a lack of studying, effort, or discipline…
… we are forgetting that the physicians we teach are humans.
With real lives. Real concerns. And real problems.
This is where the Doctrine of Charity proves helpful.
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Explaining the trauma we experience to our family is challenging
Trying to explain how we’re able to see traumatic things without it ruining us is more challenging
I’ve learned that while I need that skill to do my job, I also need to process trauma to be human.
#Medtwitter
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The Doctrine of Charity asks us to assume virtuous intent. To assume the best of others.
When someone says something, what is the best they could have meant (instead of assuming the worst)?
When someone is failing to deliver is there something else going on?
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The next time someone in your life does something that doesn’t measure up…
Consider using the Docrrine of Charity.
Ask more questions and make less assumptions when things aren’t going well.
People don’t care what you think if they don’t first know you care.
#MedTwitter
…
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I was 3 years into being an attending physician when I found I was unhappy.
I told myself once I….
…Pay off my loans
…Buy a bigger house
…Get promoted
THAT is when I’ll be happy. Except I’d get there, and the happiness was fleeting.
This is called an Arrival Fallacy
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I was at the beach. It was bedtime, and I was tucking my two kids in bed.
As I read The Lion, the Witch, & the Wardrobe to them, that’s when we heard sirens go by the beach house
A few minutes later, we heard the helicopter landing in the field behind our house. Strange.
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It turns out this resident had a recent scare from a prior leukemia diagnosis.
They were going back and forth to the cancer center to make appointments when their busy schedule would allow.
It turns out that the clinical problems were stemming from a non-clinical stressor.
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When we ask questions first we show that we care, which is important. People don’t listen unless they know we care.
If something is going on, it’s time to practice compassion and offer help.
If nothing is going on, then it’s time for real talk (and still offering help).
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Doctors in public:
Stranger: “What do you do for a living?”
Me: I work down town.
“Where?”
At the hospital.
“What do you do there?”
I work in the operating room.
“Doing what?”
I take care of people.
“Are you a doctor or a nurse?”
Fine. Yes. I’m a doctor.
#MedTwitter
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For those asking:
-details were changed when this was written
-this was not recent (it was years ago)
The point of the story still remains.
I wouldn’t put someone’s privacy in jeopardy 👍🏼
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After the patient was on the chopper, I walked back to the house.
Once back inside, I expected to keep reading CS Lewis to my kids, just like I would walking in from a shift at the hospital.
But that’s when I realized that while this was normal for me, it wasn’t for them.
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I’m sure you don’t need my help, but I’m a doctor and I am happy to help if you need it.
“Well, we can’t get the breathing tube in.”
Oh, really? I am an anesthesiologist.
That’s when the older EMT trying to intubate said “please, come save me. I can’t get it.”
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[pre-op area]
Hi, I’m Dr. Turner. I’m your anesthesia doctor today.
~80 y/o patient, “You are?”
Yep, I’m going to ask you some questions & then we can talk about the plan
“Aren’t you a little young to be a doctor? Does your mother know where you are right now?”
#MedTwitter
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They caught me up on what had happened (the patient had fallen two stories from their beach house).
I surveyed the scene, noted the patients blown pupils, and then put the breathing tube in while their head/chin was taped to the back board.
It was sad.
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I’ll be happy when I become a resident, it’ll make all this studying worth it
I’ll be happy when I am an attending… that will solve my burnout
It’ll be happy when I buy a house… or car… or…
This is called an arrival fallacy, and it’s a big problem for a lot of doctors
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The Arrival Fallacy is when we focus on the horizon hoping that someday we will get “there” and be happy
… but Gertrude Stein had it right when she said “There is no ‘there’ there”
When we place our happiness in “Once I..” or “Someday..” an Arrival Fallacy is not far away
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My 3 and 6 year olds were excited by helicopters. So we went to check it out.
When we went on the back porch, the helicopter was there in the field, but so was the ambulance we heard earlier
Someone was undergoing an air-evac behind our house
… but something was wrong.
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The patient was taking too long to come off the truck.
So, I walked down in my Wake Forest baseball shorts and white t-shirt looking like a beach bum since we were on our annual beach vacation.
As I approached the truck, I was met by one of the EMTs, and said
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Not sure who needs to hear this, but in 1st year of med school a faculty told me I wasn’t cut out for medicine & should drop out.
Yet, here I am.
Med School President —> chief resident —> Associate Prof of Anesthesia
Keep your head up. YOUR future is up to YOU.
#medtwitter
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Me: Hi, I’m Jimmy, one of the anesthesia doctors.
Patient: “You’re the one who just puts me to sleep, right?”
Yes…
… I’m also part of the team that keeps you safe and makes sure you wake up.
“Oh. I didn’t think about that”
👍🏼
… “So, when can I talk to a doctor?”
🤦♂️…
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When I was an intern I botched a central line on a septic patient with an INR > 4
As the large hematoma started to form my upper level - while putting on a gown - said,
“Well, you’ll never do THAT again.”
That’s when the self-judgement started to eat me alive…
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Can we transition our focus from future moments to the present moment and enjoy right now?
Instead of focusing on the end product, focusing on the process?
Where and when do you find time flying ? What are the breadcrumbs that you should follow more often?
#MedTwitter
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Hi, I’m Dr Turner. I am your anesthesia doc today
Elderly patient, “Oh, you only put me to sleep, right? That’s not a big deal”
Right, I put you to sleep… but I’m also the one who makes sure you wake up
“How old are you? Does your mother know you are here?” 🤣
#MedTwitter
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I was an intern on peds the 1st time an Attending pulled me aside to give me feedback
And I’ll never forget it. It has served as an example for me ever since
After asking me how I felt I was doing, she said “Jimmy, let me give you some honest feedback”
A lesson for July:
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If you died today, the hospital/clinic where you work would replace you tomorrow.
Don’t live your life based on the expectations of a system that treats doctors like a commodity.
#MedTwitter
🙋♂️ What’s your unpopular opinion in medicine that will get you in this position?
#MedTwitter
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When I finish medical school…
When I finish residency…
When I earn an attending physician paycheck…
When I buy the nice house or the nice car…
THAT is when I’ll be happy
This line of logic fall short in reality for most. It is called an Arrival Fallacy
#MedTwitter
#MedX
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Ya know… anesthesiology is like being the middle child.
You never get the credit. And you always get the blame.
Tell me your speciality and I’ll come up with family analogy, too 👍🏼
#MedTwitter
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@scott_mintzer
Totally true. I never pry. But I do offer the opportunity to tell me what’s going on so that I can support them, if they want it.
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Mihaly Csikszentmihalyi’s idea of “flow” is a good place to start.
Flow is when time flies, when are “on fire” NBA Jam style.
Writers enjoy life most when writing
Runners when running
Athletes when competing
What are you doing when time flies? These are bread crumbs…
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Friendly reminder from anesthesia, bone broth is not a clear liquid.
Your surgery will be cancelled (politically appropriate term “rescheduled”).
Aspirating bone broth = badness.
That is all.
(Any other interesting day of surgery reschedule stories?)
#MedTwitter
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Am I the only one who functions sub optimally if I get less than 8 hours of sleep 3 nights in a row?
I’ve decided that my optimal amount of sleep time is 9 hours.
Please tell me I’m not alone (medicine makes it tough, I know)
#MedTwitter
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@JamesH8sCrypto
The patient's forehead & chin were strapped to a board. Probably the most significant "in-line stabilization" I've seen to date. His neck was truly immobile.
Blood in the airway.
Had to use a Miller 2 blade with a bougie to intubate the patient.
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My attending cared enough to be honest with me. That way, I could improve.
She also cared enough that it made me receptive to otherwise tough feedback.
The July lesson is to not forget that good feedback is kind…
…and Kindness = Truth + Love
#MedTwitter
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The term Arrival Fallacy was coined by
@TalBenShahar
and is pervasive in medicine.
Once I graduate med school
Once I am an attending
Someday when I get promoted
Yet each arrival only offers temporary life satisfaction and a fleeting hit of dopamine
So, what’s the answer?
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When I was burning out in medicine, I was full of “Once I…” statements
Once I…
… pay off my loans
… buy the doctor house
… get that leadership position
… create a successful side gig
… get promoted
THAT is when I’ll be happy
This is called an arrival fallacy
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What’s your favorite catch phrase in medicine?
I’ll go first.
Anesthesia - “You can’t fix stupid. But you can sedate it.”
#MedTwitter
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Self-compassion is the Reverse Golden Rule: Treat yourself as you would treat others.
You are not defined by any single moment.
Be kind to yourself. Allow room for mistakes. Learn from them.
… and know that even when you make a mistake, YOU are not a mistake.
#MedTwitter
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I recently decided to stop drinking, but still want to be able to go out with friends who do.
Before going out last night, I looked up mock tails… just wasn’t my thing.
My new go to —> Club soda + cranberry and lime for the win 👍🏼
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If you died today, the hospital/clinic where you work would replace you tomorrow.
Spend time with the people in your life that love you, couldn’t replace you, and wouldn’t want to.
And only do things that make you say Hell Yes and provide you purpose.
#MedTwitter
#MedX
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While this feedback was not “nice” to hear, it was certainly kind.
Why?
Because kindness is made of two things. Truth AND love.
Without truth, we cannot help others become better.
Without love, no one will listen when we try.
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@JamesH8sCrypto
Unfortunately their pupils were blown. They were likely brain dead (unless they had an emergent crani).
My hope at the time was that they could either save them at the trauma center or be a life-saving organ donor for someone else now that their organs were being oxygenated.
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Overgeneralization is the process of taking one moment and making it determine your identity.
Instead of saying “That was a mistake” I made it mean “I am a mistake”
How do we defeat this?
The antidote to overgeneralization and imposter syndrome is self-compassion.
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At the end of med school, my family ran out of money. I was embarrassed
In residency, I forbeared on loans and they went up by 150%
I was financially illiterate. The stress was real.
It shouldn’t be this way.
Here are 5 reasons financial literacy MUST be in medical training:
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In a waiting room for an appointment.
One person is playing TikTok videos with the volume on and one hasn’t figured out how to turn off “clicks” on their keyboard when typing.
… am I crazy? Or does this bother other people too?
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For the non-medical people talking about the “lack of humility” in this post:
… not discussing being a doctor during in-person conversations isn’t about humility.
It’s about the unwelcomed conversations that follow:
No. I don’t want to look at your kid’s rash.
No. I don’t…
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How ridiculous is it that in medicine we call a normal two-day weekend a “Golden Weekend”?
#MedTwitter
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@bfhermann
I could have, but no one would have read it… humans love stories 🙂 that’s why we have shared them for thousands of years.
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@MCILeader
I couldn't edit the post once it was up. Realized I used EMT instead of paramedic after the fact. I meant to say "EMS" which includes both, I believe.
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When doctors see their first paycheck in July & compare it to their last paycheck in June…
…they experience the same phenomenon as professional athlete and entertainers who later go broke.
It’s called The Diderot Effect and it has the potential to ruin you financially.
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She continued, “Jimmy, you are easy to work with. This may seem like a good thing, but it could hold you back.”
“Your knowledge base could be improved. Because you are respectful and do your job, you may not be called out on that.”
“This is an area you can improve.”
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As an aspiring anesthesiologist in training, I ended up staying up all night, unable to sleep.
All because of one mistake.
The problem is that I made this one mistake mean that I was going to be a terrible anesthesiologist. It was a sign.
This is called overgeneralization
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Hot take:
If you died today, the hospital/clinic where you work would replace you tomorrow.
Don’t make someone else a priority if you are only a number on a spreadsheet to them.
Take time for the friends and family who couldn’t (and wouldn’t want to) replace you.
#MedTwitter
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I’m not sure who needs to hear this, but when I was in med school, a professor told me I would fail out…
Before I became the student body president, chief resident, youngest golden apple winner, and associate prof in just 6 years
You alone get to determine your ability & worth…
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Self-compassion means to “suffer with” yourself
In other words, to meet yourself even in the worst moments of your life
This requires being kind to yourself. Normalizing that to be human is to err.
And to ask yourself “what would I say to someone else in the same spot?”
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Hi, i am here to discuss an epidural for your broken ribs so you can breathe. How did you break your ribs?
Patient: “Riding a horse/bicycle/motorcycle”
You broke a lot of ribs. I bet you’ll never do that again.
“Oh I’d get back on tomorrow if I could.”
Every. Single. Time.…
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A hill I will die on
Jersey Mike’s >> Subway >>>>>>>>>>> Jimmy John’s
Prove me wrong
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After finishing training, I was inundated with “Hey, Jimmy, do you want to…”
… join this committee
… write a book chapter
… help with this study
… teach students in X or Y
I felt so much pressure to say yes.
Until I created my Hell Yes Policy
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#MedEd
#MedTwitter
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The pager went off, “Level 1 penetrating trauma. Repeat, level 1 penetrating trauma.”
On arrival to the OR, pressors through a subclavian line. We began dumping blood through a rapid transfer
This is the first time I’d ever experience a fixation error as an attending physician.
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Compassion is composed of two words.
“Pati” which means “to suffer.”
And “com” which means “with”
That is why when we are compassionate it means that we are able to “suffer with” others who are in the midst of a struggle.
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This "no email" on my phone thing has struck a cord
What if I told you I only check my work email when physically at the hospital?
And that colleagues know if they need a response sooner than ~72-96 hours to call or text me.
Is this a boundary you could set
#medtwitter
?
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As a physician, when I visit my primary care doc I try to make the visit as short as possible
Why?
… just to give her a snowball’s chance in Hades of catching up on her schedule/charting.
#MedTwitter
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When I saw my first paycheck as an attending physician, it was a visceral response.
“Wow, I finally made it!”
… but this jump in pay actually leads to financial mistake after financial mistake for most doctors.
It is caused by what is called The Diderot Effect…
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It is much easier to continually look up the mountain to our next summit, and far harder to look back down to see how far we have come
I’m learning more and more that if you aren’t enjoying the journey, no arrival will ever make it worth it.
Financial. Career. Or otherwise
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Gertrude Stein had it right when she said
“There is no ‘there’ there”
If you aren’t happy, then the ladder you are climbing may be against the wrong wall
May be time to jump to a new ladder instead of waiting to get “there” to someday be happy
You deserve to be happy now.…
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The stress was real.
I thought about moving. I thought about going part-time. I even thought about leaving medicine.
… but I believe in making a diagnosis before treating a problem.
What was the diagnosis? It turns out it was a lack of autonomy and feeling under valued
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I was on the 2nd hole of our local golf course when it happened
The group behind us hit a ball off the tees that flew just past my head…
My heart rate increased. My chest felt tight. And my anxiety went through the roof
I was having my first panic attack at the age of 33
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@wazootymannnm
She went into specifics on examples after this. Didn’t want to make it a 10 page thread 👍🏼
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When I finished training we had a multi-six figure sum of student loan debt.
So, I picked up extra shifts to pay my student loans off faster.
The problem was that I thought “If I don’t pick up a shift I am losing money!”
I was trapped in a never-enough work mentality.
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Hey
#medtwitter
have you had patients refuse blood because,
“Nanobots are in the blood of those who received the government mandated vaccine. We would rather forfeit our lives than get blood with potential nanobots”
Asking for a friend… (how common is this thought process??)
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@oconnor_md
I wish I didn't laugh out loud at this...
...but I did.
Sad, but true a lot of the time
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@FacialPlasticMD
What’s missing is your assumption it was a “dude”… in fact, it wasn’t.
Also, parient had no long term harm from the procedure, and you cannot possibly tell me you’ve never had a procedure that didn’t go as planned during or after training unless you simply don’t do procedures.
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There are only two appropriate responses to this image:
1) Current Anxiety/PTSD/Hate
2) Nostalgia from the 1990s
#MedTwitter
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When the medical system puts its own interests first, it’s called “business”
When a physician puts their own interest first, it’s called “selfish”
Don’t ever let the system use altruism against you like a weapon.
Self care isn’t selfish.
#MedTwitter
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This is what your beer fridge looks like when you stop drinking.
Down 10 lbs & 5% body fat. Sleeping better than I ever have
Not looking back
Ps If I wasn’t an index fund investor, I would invest in Spindrift stock. Been so helpful as my “go to” to replacement.
#MedTwitter
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Athlete: Baseball is not my top priority. It's a job
Response: Release him!
Doctors: This is not my top priority. It's a job
Public: You are a terrible doctor!
Avg person: This is not my top priority. It's a job
Response: Mad respect. Family should come first!
#MedTwitter
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I was 112 of 119 after my 2nd year of med school
And elected student body president my 3rd year
I have a reading disability
And authored two best-selling books
A med school prof, “You won’tmake it out of med school”
And I matched my
#1
residency and elected chief resident…
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The person you are right now is not the same person you will be 5 or 10 years from now.
6 years ago I set myself on the trajectory of becoming an associate professor. Cool to see it happen, but the academic train stops here for me. Associate prof for ever.
#pivot
#MedTwitter
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Tell me you don’t get it without telling me you don’t get it.
No one likes having to wait.
People also don’t like having a bad diagnosis or medical emergency happen to them either (which can often cause you to have to wait)
Nor do doctors like the charting now required to get…
I'm at the pediatrician office for a well child visit with my daughter. Appointment was 9:20. Vitals taken and paperwork filled out, but still waiting to see a doctor.
Reason
#30584
of why healthcare in the US sucks. Why can every other sector keep appts, but physicians can't?
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@GoodbodyJeff
The difference is that I can just ignore comments like this where as in real life public spaces (away from anonymous keyboard warriors) it is a bit tougher once getting bombarded with the 100 questions that immediately follow someone finding out I’m a physician.
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A friend once told me that you can love the hospital, but the hospital won’t love you back.
Oh how true I’ve found this to be.
#MedTwitter
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In life you either get what you want, or you get the lesson you need.
Learn, but do so with the same compassion you would give to anyone else.
You aren’t perfect. You never will be.
Recognize that your success is created BECAUSE of failure, not in spite of it.
#MedTwitter
…
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Hot take:
I cringe when people tell medical trainees learning how to intubate…
“You really only need to get good with one type of blade while intubating… I am a Mac person.”
If you intubate, you should be able to use every type of blade. Full stop.
#MedTwitter
#MedEd
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Here is the advice I give to you, Madison, and to other students:
1) Pick something where you enjoy the good aspects and can put up with the bad. Every speciality has negative attributes. Find them.
2) Every speciality will become a job at some point. Don’t choose something…
Okay
#MedTwitter
asking a question for current/future Madison. If you really really like two specialties how do you know which one to pick is it a gut feeling or a certain experience?
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That’s why I recommend The 10% Rule
Take 10% of your increase in take home pay after training & spend it on whatever you want
Take other 90% and build wealth
After all non-mortgage debt is gone… that 10% may turn into 25-50%
Save for tomorrow WHILE you enjoy today.…
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@Denise2513
@lewisthughes
It definitely wasn’t him. He doesn’t even practice in the same country.
I blocked him for insinuating it.
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I would learn the skill of self-compassion:
1. What would I say to someone else who had the same experience?
2. What could I learn from this experience that would help me take better care of my patients in the future?
3. To be human is to err, be better not bitter.
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Hot take:
If you do procedures that can cause a post dural puncture headache (eg lumbar puncture, spinals, epidurals, etc)…
Then you should have the skill to perform the procedure to fix it (eg a blood patch)
(Or 🤯 just use a smaller non-cutting needle)
#MedTwitter
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When I was a 4th year med student, I was talked into applying for disability insurance, which led to the largest financial mistake of my life… (and I don’t want you to make it, too)!
This framework (and story) is why I teach doctors about personal finance…
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After I became an attending physician, I was crushed by an arrival fallacy
After years of believing “once I get there I’ll be happy” only to get “there” and find I wasn’t was life shattering
Was this really it? If not, what is my purpose?
Here is the answers to those…
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Hot take:
I think it’s unethical that medical institutions hand out $200,000 (or more) in student loans…
… without requiring financial literacy classes in med school.
That’s why I am starting a weekly personal finance curriculum on my brand new YouTube channel.
#MedTwitter
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With all this gun violence, it has crossed my mind many times that I’m glad my 3 kids don’t all go to the same school…
At least I might not lose them all.
That is NOT normal. I shouldn’t have to think that.
I don’t have the answers, but when is enough enough? Do something.
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@shycollie
Having been an an archetypal Enneagram 3 wing, 2 achiever my entire life, I used to feel the same way.
Turns out happiness is not an illusion.
Just have to stop making the achievement or goal the end all, be all.
It isn’t easy, but happiness is definitely attainable.
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Many people have similar experiences from different specialities & backgrounds… leave your version of patient misunderstandings in the comments below:
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You can’t obtain a GSI later. You’ve burned the bridge
This is why - if you have ANY medical history - you should obtain a GSI policy FIRST before applying for a fully underwritten policy which includes checkin into your PMH
However the GSI is only available during training
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