Giving and Receiving Feedback with Paul Tran

Paul Tran, MD: [00:00:00] Think about the perspective of a patient who's laying down in a bed, looking up, scared, anxious, they're a kid in a hospital, in a dark room with a doctor or someone in an official capacity, talking down to them. Just think about that perspective, how to be patient. 

Preston: Welcome back to how we Patient. We are doing another solo episode here today, but I have a guest co-host, the Paul Tran, who needs no inter introduction, but he's, known on Instagram and TikTok as elementary school, and he runs a great, skit situation, I would say kind of across all spectrums of medical education.

But your, main focus is pediatric gi. That's my day job. No, that's no glory, right? That's what they say. 

Paul Tran, MD: I have a gut feeling about things and as I say, often it's, a shitty job until it isn't. 

Preston: It Sure. I imagine it is. And there's a couple other fluids that go along with shit. There's a surprising [00:01:00] amount of shit actually in psychiatry too, but it's just, we deal with it after it exits the body and then it gets flung at us, some sort of weapon.

But I'm like, you know, it's a little bit of GI involved here, I guess. Well, 

Paul Tran, MD: it was a 

Preston: bit, anyways, Paul, it's a pleasure to have you. We're gonna be talking a little bit about feedback today, but I'm just curious how is, how are things going on in your life? What have you been up to? 

Paul Tran, MD: Man, it's good to talk to you, Preston.

it's an honor to be here and, you know, I can't start anything without saying I need to give you props. I need to give you credit where credit's due and I need to give you flowers. Really, you've inspired me along with Will Flanary Glaucomflecken plugin you two. And then I gave a shout out to, Ben Schmidt.

To Doc Schmidt. Well, there's three creators who are in the medical space and lean on humor, lean on. Comedy to bring light to situations that, that, [00:02:00] honestly, people need to know about. And I think a lot of people agree you can't really solve a problem if you don't know it exists. So the, content that you've created, you know, over the years initially the skits when you were in med school, they've really got popular and inspired a lot of people, but really inspired me to be where I am today.

So I, I owe you, and I appreciate you as a creator and you as a person, man. It's, it's cool to just be chatting with you. 

Preston: Oh, well thank you. I really appreciate that and I'm honored that, you know, someone as prolific as and successful as you like, draws inspiration from me. I don't think I got into this thinking other people would be inspired.

And I feel like you're also secondhand inspired by will through me because I was kind of inspired by him. So we're all in this like, conga line, I think, right? following Dr. Flecking. But, you know, it's like. Comedies, like making your grandma's chicken noodle soup in a little bit. You [00:03:00] follow the same recipe.

You know, a comedy comes in threes, you add the twist at the end. You look at things through a different lens, but you have your own flavor that you put into it. And then no one else can create things the way that what, that you do it. So, you know, I, have things that make in my own, you take things, make 'em your own, and it's cool to see people do it well.

I know we've been seeing all the drama about the Mayo Clinic med student who's been like, kind of, I guess going through some repercussions for the skits that he's making and you see like comedy can, like people can stray from the path and do things that are a little bit too edgy and it has like a pretty stark response.

But then when you do it right, it's powerful. 

Paul Tran, MD: Yeah. Yeah. I, think one of the biggest things that you have to set as a creator. I mean, it goes into the feedback conversation that we're gonna be talking about. Education is just boundaries. Just what are the guardrails that you can't [00:04:00] cross? What are the things that you're, you can skirt up to the line and not cross.

And, having those clear before you even start creating sometimes gets the process rolling a lot easier. Sometimes it makes things just nice when you're like, I'm not gonna even stray here. I'm not gonna go talk about anything patient related. I'm not gonna talk about anything blank related. You know, it's, nice to have those clarified for sure.

Preston: it really is. And for the first time, actually, about a month ago, I had a, I was walking a patient out to like check them out of clinic and they go, I saw your tiktoks. That, that never happened to me before. I imagine it probably doesn't happen to you with like, your infants that you're doing, you know, scopes on maybe some of the older kiddos.

The 

Paul Tran, MD: teens. 

Preston: Yeah. or their parents. Yeah. But. I was, it, hit me, you know, like, wow, I already knew that every patient I'm ever having technically could be seeing all my content, but you still [00:05:00] live a little bit in denial and keep 'em separate. But that was like very, crystallized.

Like, you know me as your psychiatrist, but you have access to all my pages and you connected the two. So I, can't imagine pro like producing anything that, would make fun of a patient or imply that I'm, I have some like judgment or discernment towards them that's negative. which has actually made comedy kind of hard for me going to residency because a lot of the drama and content in psychiatry, it's like between the psychiatrist and the patient.

Paul Tran, MD: Yeah. 

Preston: And there's a lot of funny shit that goes on there. And none of it is fair game for like the online world. So it's, yeah, it's been like, it's been kind of challenging. Like, you know, I could do the, other specialty thing. but a lot of people have, have tapped into that. Right. So you, so it's like, huh.

And then you can, you try to take on insurance companies. So it's, so, it's interesting, like what becomes fair game kind of, the room starts to get a little bit smaller. So I've actually kind of just been like, you know what? [00:06:00] Think I'll just do what I feel like doing. And that's been like gardening and coffee recently.

But we'll see. We'll see what comes, up in the future that I find funny. 

Paul Tran, MD: Oh, I mean, you are insanely relatable because of it. People see this espresso maker, they see you making coffee, they see you talking about what's at the top of your head, and they're like, I preston's my, my guy. You know, he's, he we're just hanging out.

Mm-hmm. And that's one of the things that you've tapped into really well. I mean, patients, will see my stuff and they're like, I don't get it. But it's funny. But I'm like, oh, lot of humor know it's funny in the circumstance of relating to it. Mm-hmm. So, for me. If I'm consenting a patient in the middle of the night, I'm doing an emergent procedure, I'm doing a GI bleed, or I'm doing something mm-hmm.

Preston: Sigmoid, 

Paul Tran, MD: ous that came in for, you know, overnight one time. If I'm consenting you and you're like, this is the guy that's, this is the guy that's gonna do my procedure, this guy that made this video, you know, at the end of [00:07:00] the day you are gonna sign to consent to me doing the procedure. So you have to trust me immediately.

And regardless of, how much I've talked to you previously, what your impression is, how true that is compared to my day-to-day. So all of it blends together and, the digital footprint, it's a bigger footprint than ever, you know? 

Preston: Yeah, Then we could appreciate, but I think enough of the tangible feedback that we get online, 'cause we can talk about till the cows come home.

I want to get into kind of the mean potatoes of today's episode, which is clinical feedback and Margaret's not here, rests in peace. Margaret. just kidding. She's not dead. She's just in the hospital seeing an admission. So hang in, there, girl. But, Margaret's favorite part maybe is the icebreaker.

And so for the icebreaker today, I want us to pick something that is the worst feedback we've [00:08:00] ever received. and I want to open it up and say, this doesn't have to be in the clinic, it can just be ever, 

Paul Tran, MD: oh man. 

Preston: what's something, terrible that, that comes to mind. And since I'm just throwing this on you right now, I'll go first.

Paul Tran, MD: I love it. 

Preston: So, I'm gonna, I'm gonna start out, I, have two, two stories here. So there's one where I was. Like 12. And I was playing soccer and I remember I was like running around at practice. It was like one of those like competitive youth leagues, right? And I'm like playing right mid, I'm running up and down the field and I try my best to stay on top of the ball.

and then I like get super tired and I, tag out and I go and sit on the bench and, you know, sometimes there's other players there and they, like give you feedback on how you were doing during the game. Like, oh, you know, like, I saw this thing maybe help, I could help you out. And then of course we usually just externalize and be like, well you aren't, you know, [00:09:00] fucking out there.

Like, what's your problem dude? And we just bicker with each other because all these 14-year-old soccer players have all ego and no introspection. So I sit down next to this kid and he turns to me and he goes, you know, you'd actually be kind of attractive if your nose wasn't so weird. Woo. And I was like, damn.

Oh, so nothing about my, my right mid.

I like that kid fucking hated me because I replaced him on the soccer team. Like he got moved down to the JV team when I went up there, but obviously was very pointed and about stuff that I couldn't control, you know, about my appearance. So I guess that was one piece of feedback that I got that still sticks with me.

and you can do without what you will, but it's overall a bad piece of feedback that I've gotten. the next one is probably during, unfortunately my peds rotation in medical school. 

Paul Tran, MD: Oh, 

no. 

Preston: Yeah, it [00:10:00] was the, I think it was the chief of pediatrics or someone, pretty high up who was on a rotation and we like selected him at the end of the rotation to do like our feedback forms.

'cause we spent like three weeks with him and he just put a period. Like for each, like fill in box on the way down 

Paul Tran, MD: because it was 

Preston: required to 

Paul Tran, MD: have something in there 

Preston: to, so to complete the form you had to fill, like put something down for every single box of like, what did the student do? Well, what did the student do poorly?

What would you recommend they improve on? And each one was just a period. And no one had ever done that before. He was the first one. And no one's done it since actually. So that was pretty bad. 

Paul Tran, MD: That's when feedback is purely formality. I don't even care enough to say a word. You get a punctuation mark.

Preston: Yeah. And, then the thing is like, you could say that the quality of the feedback was poor because he only put a, period in there. But really, I think what he was trying to [00:11:00] tell me is that I care so little about you as a person. I, disliked my time with you. So much on our three weeks that I'm not even gonna dignify you by giving you the time to do anything more than that period.

Which, which he didn't say, but he might as well have, I guess. Yeah. Or at least that's how Insecure M three Preston took it. 

Paul Tran, MD: I would say that's how most anyone would take it. You don't even know my name. That period is not personalized in any way, shape, or form. That could be for any single person, any single blank, any single form that is required to submit.

Preston: Yeah. Isn't it funny how universal period is like, is a compliment, right? You can be like, period, 

Paul Tran, MD: right? And then you just get a period of feedback. You're like, period. Fuck. This is not what he meant. He was not any was 

Preston: saying period. Med student period. 

Paul Tran, MD: I'm gonna say this, it's hilarious. [00:12:00] Your first piece of feedback, your nose, because that's the first thought that I.

I really manifested my nose. I have never, oh, 

Preston: I thought it was my nose. 

Paul Tran, MD: no, It's actually your nose. Like that's the 

Preston: first thing I noticed about you two. 

Paul Tran, MD: The first thing was breasted. You'd be a lot more attractive man if you did something about your nose. 

Preston: Damn, you two, man. That was good feedback.

Paul Tran, MD: Hey, it's, twice is a coincidence. Mm-hmm. It's three times for a pattern. 

Preston: true. 

Paul Tran, MD: I, I, until maybe couple years ago, I had never really thought about my nose and my mom was used to grow up. I used to, I grew up my mom saying like, Hey, your nose is, mine is big, blah, blah, blah, whatever. But recently there's been a string of people on TikTok, primarily commenting on how big my nostrils are.

Like they will put the pig emoji whenever I'm doing like a talking head, they'll say, [00:13:00] bros. Nose took up the whole screen, or his nostrils took up the whole screen, they'll put like a picture of a lion that like, has a surprise face. oh my god. And it nose is huge. I gotta the point where my wife is like, your nose is fine.

You're, I'm like, it's kind of weird, but whatever. So what, is it with noses? 

Preston: I don't get it. And, what is it with the internet making you self-conscious about something that you weren't self-conscious about before? So like, like my rum, my upper lip comes into a point, so when I do talking in videos, people, they post like this snapping turtle with, the top, and it's like, and they're like, why you look like on turtle lips?

I was like, bro, I didn't even know about this. Yeah. Until y'all brought it up. 

Paul Tran, MD: Oh my gosh. it's amazing to see the amount of small trivialities that people find. I will say this. About two [00:14:00] years ago when I first started with skits, two and a half years ago, I did a skit, and I think someone meant this in kindness or they meant to relate to me.

I did a skit in the nicu and I was talking about random things that you hear in the nicu, and someone said, Dr. Tran, were you a NICU baby too? Both of my preemies have flat heads. And I was like, wait, what? So this is a true story. So I read this, I go right to my wife, I'm like, can you believe this comment?

I read it out to her. I was like, is my head that flat? And she goes, well, she didn't deny. She said, it's the way that you cut your hair. So at that moment, February of 2024, almost like two years ago. I changed my hairstyle and you can look back at my videos and you can see at that point I kind of grew out my hair 'cause I didn't wanna deal [00:15:00] with that flathead like appearance anymore, so.

Preston: Wow. Yeah. 

Paul Tran, MD: Feedback is lasting 

Preston: round haircuts. And, so I guess to get meta about this feedback, did you find that like, to be bad feedback, do you like your new hairstyle now or is this to cover up some, something that's been brought to your attention in a negative way? 

Paul Tran, MD: It's interesting. I had that hairstyle since first year of med school, so it was about time, I've always thought about, oh, I needed to change my hairstyle anyway.

That was an impetus for me. So if we're going to dive into the feedback conversation, sometimes it's that shattering of the glass moment that comes from an episode of a show I used to watch religiously how I Met Your Mother and there's this moment where if you know someone's. Thing, right? they bite their, they chew on their fingernails, they click their teeth when they talk or something like that.

When you notice it, the glass shatters [00:16:00] and then you can't ever unsee it again. and maybe that's what this feedback is, it's just something that was true all along. Someone says it to you and then bam, it shatters. And now whether you agree with it or not, initially, you just know it. 

Preston: Yeah. It's, almost like posting stuff online and there, there's a crowd and they're throwing pebbles at your window and one pebble gets through and breaks the glass for your analogy.

And the other ones is just, it's like rain on the tin roof, like just let it come. 

Paul Tran, MD: Yeah. 

Preston: It's 

Paul Tran, MD: just background 

Preston: noise. 

But, 

there's that one that gets through every now and then and, sometimes it can lead to good things. yeah, like it is hard because negative and harsh feedback does lead to some good change on my track team in college, we would have to get DEXA scans.

So they, you would look, you get your body fat. And this is for purely like cosmetic athletic reasons. there's no other reason for a college kid to be getting a DEXA scan, right. And we'd come back to [00:17:00] and to the locker room and the upperclassmen would rip the, like, paper outta your hand and like put on the wall, like, you know, oh, Preston gained 2% body fat last semester.

You know, like, what are you doing chunky? And I'd actually be okay because I went from like 8% to 10% body fat. But like, I remember one of the kids went up to like 14% body fat, which for a cross country runner is like, you know, you, might as well apply for the biggest loser at that point. And as far as their concerned, and they go, they nicknamed him chubs after that.

Paul Tran, MD: Wow. 

Preston: And he like started eating only salads was restricting a lot. He lost a lot of weight and he got faster. But you could tell, like messed the guy up. And I remember people on the team afterwards were saying, see, bullying works. It gets results. That feedback we gave him made him a better athlete. I'm like, did it like, but at what cost?

You know, I think they have like almost an ends justify the means kind of approach to it. But I don't know if that's always the case with [00:18:00] feedback. So I think that's kind of another running theme that we can get into. I know we've been kind of yapping a lot about the social media feedback and I'm just curious, so would you attribute the nostril comments and the flathead retorts to being the worst feedback you've gotten or is there another story that comes to mind?

Paul Tran, MD: no, those are all kind of funny. One of the most interesting pieces of feedback I got actually was my, from my career before medicine, but it came as I was in medical school. So some people know this. I was a competitive figure skater before, before my career in medicine. So growing up I.

Was a singles, figure skater skated by myself. And, went up to the level right before senior, so junior and went to the junior nationals and competed and did it for 10 years. [00:19:00] Moved to the Olympic Training Center rink in Colorado Springs, skated along a lot of Olympians, future Olympians, and I loved it at first.

And then it became a chore became one of those things where I was training four or five hours a day on ice, off ice and just became reality. And it was that sunk cost fallacy. It was like, ah, I've done it long enough, right? I'm here boss, passion for it. Might 

Preston: as well just go to the Olympics, right? 

Paul Tran, MD: yeah.

let's just go. But I knew I was, lazy. I was, we just didn't have a heart for it. Starting in, you know, the last three years of skating in high school. And in my first year of med school, my old coach from growing up reached out to me. He had kind of fallen off the face of the earth. I hadn't heard from him for seven, eight years.

And he goes, Hey Paul. I just wanna let you know that you are the most talented skater that I've [00:20:00] ever seen, I've ever seen. And you could have gone so far, but you didn't give a shit. And I think about that a lot. I read that, and that hit me harder than really anything because it was someone who had pushed me really hard.

It was someone who wasn't the most encouraging, you know, like good coach, but not a builder, if you 

Preston: will. 

Paul Tran, MD: But that moment was the glass shattering of. Maybe the realization I had all along, but someone actually voicing it. You were destined for a lot more, but you just didn't put an effort, you didn't care, you didn't apply yourself, and that's why you didn't find the success that you wanted.[00:21:00] 

And that goes very much into one of the biggest things that I've learned in feedback. And we might be jumping ahead a little bit, but one of the practical things that I've learned about feedback is this concept called wise feedback in, that Adam Grant talks about in his book, hidden Potential. And there's this really cool psychology study actually in middle school kids, where they compared wise feedback, which was 19 words.

I'm giving you this feedback because I have high expectations, but I know that you will meet them. Versus a control, which was, I'm giving you feedback for your paper, essentially. And across the board wise, feedback helped students actually interact with the feedback. They were more likely with the wise feedback to turn in a optional [00:22:00] draft.

They didn't have to more likely to have actual better drafts because of it. So the feedback they engaged with more, and then it was actually meaningful. It actually changed outcomes. And I bring this up because in retrospect, that's what my skating coach did. He said I had, you know, I saw a vision for you.

It wasn't really high expectations, but I saw your future. But you know, you didn't, give a damn. You didn't give a shit. I wish he had said that earlier. You know, I wish he had said that in the moment. Hey, man, you could go really far, but you're not applying yourself. You know, I see you as someplace where you could be, but you're not there yet.

And helping me see, giving the refining feedback, 'cause that's not gonna push me, but that could help me realize sooner for myself. Wow, I do have a lot more potential. I do have more potential. I have potential to get to that 10% [00:23:00] body back. You know, I'm at 14 and I could get to 10. They're essentially building me up with the potential that I need to realize for myself, and then I can work towards that potential.

Preston: One thing that comes to mind when you share that story, it's a really powerful, moment too. Thank you for bringing that up. Is the glass shattering maybe from your perception from other people versus your perception towards yourself? I wonder if a part of you kind of knew that you didn't give a shit, but it was finding out that the coach also knew that you didn't give a shit.

That was the glass shattering. 

Paul Tran, MD: Yeah. That's really insightful. absolutely, I thought this was a private wrestl, a private wrestling match. I thought this was my own inner demon that I know I'm not gonna get there, but it was public for others to see. And, you know, maybe sometimes we need that validation of the struggle that [00:24:00] we're having 

Preston: mm-hmm.

To overcome it. it's easy to have denial about things that you think are private, and when other people cast a light on it, you know, open up your closet and look at it, that's when it gets, it gets urgent. it's funny, we're, doing on the side of this, like an existential psychotherapy kind of course and, or I guess like a mini series.

What you're describing, which we've kind of gone over in one of our other episodes, is something called existential guilt, which is that feeling of guilt or defeat about the gap between where you are and where you think you could have been. 

And it's funny because existential guilt causes a lot of distress in people, but it's also one of the best catalysts for change 

Paul Tran, MD: Yeah.

Preston: Is knowing that you have high expectations and you can realize them. 

Paul Tran, MD: Yeah. 

Preston: So that's actually like one of the things that you focus on in, in therapy if you have an existential lens, is to help people [00:25:00] turn the magnifying glass on their sources of existential guilt and then say, okay, you do have this vision for yourself.

You do have this wish for yourself. Now, what choices are you gonna make to realize that wish? Because a lot of people can kind of sit around with unarticulated existential guilt. I could be doing a lot of stuff, but I dunno, oh, you know, I'm stuck out there. And, I think like your example's, more clear cut with like figure skating.

It's a very specific thing, but that problem is not unique to you at all. and it just kind of lingers in a, like a vague cloud over a lot of people. 

Paul Tran, MD: Yeah. Wow. Existential guilt. 

Preston: Mm-hmm. 

Paul Tran, MD: That's, really cool to, to hear. There's a term and methodology to addressing that because that goes very much into what I try to help people with in terms of giving feedback and then also eliciting feedback too.

Addressing that existential guilt [00:26:00] and, that gap. 

Preston: There, there are, you'll find no shortage of med students that don't have existential guilt or do have existential guilt. So yeah. Feel, free to bring it up. I'm sure. I'm sure they will, bite on it and probably resonate a lot with the label or the term.

Paul Tran, MD: Oh, that's great. 

Preston: This is a kind of a great start. So we're gonna take a quick break. When we come back, let's go more into just how we approach receiving feedback, and if there is actually a roadmap that you can follow when you receive feedback or you just take on the chin and move forward. So, right after these messages, let's get feedback in.

Margaret: The only person who is more stressed out by our medical training than us is our moms, because they hear every single bad test, every question mark around admissions and every bad night call. And this mother's day, I wanna celebrate my mom by giving her an anxiety [00:27:00] relieving comforting gift like she gives me.

But this time it's gonna be from cozy Earth. 

Preston: Sometimes we wanna say more than thank you, and this time a great bathrobe and slippers is gonna be our way of saying thank you for putting up with us all this time. 

Margaret: One of the great things about Cozy Earth is that everything that they make has a 10 year warranty or 100 night sleep trial.

So just like your mom was there through all 100 nights a night shift that you went through. So will your Cozy Earth, rove and slippers? 

Preston: Yeah, and you can get those nights back unlike the night shift. So let this Mother's Day be a reminder that she deserves care too. Discover a cozy earth and how it turns routines into moments of softness and ease.

Head to cozy earth.com and use R Code Patient for an exclusive 20% off. And if you see a post-purchase survey, make sure you let them know that we sent you, 

Margaret: because home starts with mom.

Preston: Paul, what? What do you think about when you're trying to explain good ways [00:28:00] to receive feedback? Is there any kind of a roadmap or like a protocol that you follow? 

Paul Tran, MD: Absolutely. I've thought about this a lot. I talk to a lot of people about feedback on both sides, givers. And receivers. And one of the things that we need to address first is mindset.

Feedback is going to suck for most people. And that doesn't mean that it's going to be negative, it's just not going to be the quality that you need it to be. The vast majority. 

Preston: And when you say suck, you mean the quality of the feedback itself is going to be poor? Correct. That and that's not negative.

Okay. I'm tracking. Correct. 

Paul Tran, MD: It's, not going to hurt as much as it's going to not land, it's not going to be relevant, it's not going to be specific, it's not gonna be actionable. It's not going to be maybe even observed. It's going to be subjective. Feedback overall is one of those things that people [00:29:00] struggle with because of this concept called politeness concepts or saving face.

And essentially in. The medical realm and education and really in everyday life, we don't wanna hurt someone's feelings. For the most part. We are cognizant of feelings and emotions around us, especially negative ones. I, no matter what, if I don't know you, or even if I don't care about you, I don't really want to deal with you crying in front of me.

I don't really wanna deal with you upset. So I would rather give you a punctuation mark, a period exclamation mark, whatever it is, a hyphen, ampersand, give you that. Or just say, good job, because it saves face. I just don't have to explain very much 

Preston: in, in time. If I just tell you, good job, you get, like I say, face and you get outta my face.

It's efficient. 

Paul Tran, MD: Yeah. 

Preston: And we're done. We're done talking. So, a, as you're [00:30:00] talk, as you're kind of bringing this up, I'm seeing almost like a square or a grid where you have high quality, positive feedback. Low quality, positive feedback, which would be like, good job. And then high quality negative feedback because I am thinking of some scenarios where I do care enough about someone to tell them what I think they're doing wrong and be willing to have them cry in front of me because I think it's worth it.

And then low quality, negative feedback, which would be the period. 

Paul Tran, MD: Yeah. You could call it, you could say on each axis it's the truth, the veracity of it, is it true or is it not? Mm-hmm. And then, or consistency if you will, with reality. is it valid or not? And then you could say tone or temperature positive, warm.

Cold. Like we're coming up with this right now. This is great. So you have this two by two square 

Preston: warm, false. Yeah. Yeah. I like it. 

Paul Tran, MD: And the majority of feedback will not be [00:31:00] what you need or want. It will be in the non-positive and affirming good, you know, square. 

Preston: Yeah. It'll be a pig emoji with nostrils or it'll be a snapping turtle.

Paul Tran, MD: That's right. It's one of those animal emojis. So if we know that to be the reality, how does that relate to you receiving or seeking or eliciting feedback? Well, the mindset should be, if feedback is going to suck, you need to get better at discerning what, where the feedback falls on that square. And you can't learn how to discern if you don't get, so the bottom line is you have to have a mindset of, I need to seek out feedback because I need to get better at finding out what feedback is actually gonna be helpful to me or not for the rest of my life.

I need to know if I never get feedback, that pig emoji, that lion [00:32:00] gif that. Snapping turtle that's going to wreck me unless I get that all day, every day. And I know that's just not something to pay attention to. 

Preston: Mm-hmm. 

Paul Tran, MD: So I get better at discerning. But then also realizing that a mindset of knowing that feedback is a gift is really enlightening.

It's really empowering because not every gift is good. There are gifts that you wanna regift. 

Preston: Yeah. 

Paul Tran, MD: Yeah. You wanna throw away, you don't care. You, I mean, president, if you gave me a gift and it was ground coffee beans, I'd say, yeah. Okay. Thank you love. Appreciate it. Mm-hmm. But I'm gonna try to find whole beans.

'cause I have a whole process to my coffee, so I might not use that. I might put it away. Same thing. Some feedback is gonna suck. Some feedback is not relevant to you, not feed specific to you, not actionable. Thank you for the feedback. I appreciate the gift. You can give them a courtesy of that gratitude, even if you know it's not 

Preston: mm-hmm.

Paul Tran, MD: [00:33:00] Completely heartfelt. It's more pleasantry and then you don't use the feedback. 

Preston: Yeah, it's, gonna go, I have a closet where I regift stuff or it's just, it's mis you know, I'm gonna sell it on eBay or donate it. And, you know who's really good at receiving shitty gifts is the Brits. 

Paul Tran, MD: Oh yeah.

Preston: Because they'll say something like, yes, sir. Very good, sir. Thank you, sir. And I've, and I think I would be like, you know, obsequious if I did this in the clinic, but there have been times where I would be like, yes, sir. Very good sir. Excellent choice. So I was a bit of Nas wipe there. 

Paul Tran, MD: It makes me think of the, in, home alone.

Two, when he gives him the tip of gum, chewing gum. It's like very, good. Thank you. 

Preston: It's very good. So, yeah, because that, gum was a gift. 

Paul Tran, MD: Yeah. 

Preston: And it was a shit gift. 

Paul Tran, MD: It was not good, but he took it. 

Preston: One thing I think [00:34:00] about, and I think there's a big overlap here, is, good feedback. it's like, oh God, I don't wanna say it's like a kiss, because then it's gonna create like the metaphor of like a supervisor and their supervising kissing.

But when you do lean in for a kiss, is it, 50 50? Is it 80 20? Is it 90 10? Like, there's, there has to be someplace where you meet in the middle. And so if someone's giving you poor quality feedback, they're not leaning in at all, then you have to kind of figure it out yourself. And so one, one thing that I've had is everything is a data point.

So if they're giving me bad quality feedback, there's other feedback that I can find, and that's not what they're willing to explicitly tell me or sit down with me about. There's certain feedback, which is, this person sharing casual things with me? What tone are they using with me? What kind of information are they giving?

What responsibilities are they giving me? How, like how do they act when I enter a room? When I leave a room? Are they like reaching out to me? Are they not reaching out to me? And it can be [00:35:00] prone, like, it's hard because you have to treat all data points evenly. Not get too fixated on all how you anticipate or expect something to act.

But that in a way can be really good feedback, you know, and to take things like nonclinical. I think a lot of guys struggle with this romantically. Like they go on dates with girls and they think it goes well. She tells 'em that it goes well, right? You're like, yeah, it's nice, you know, maybe I'll see you around.

And then they never text them back. You know, that's feedback even though they never sat them down was like, Hey, you know, these are all the things that you did wrong the first date. Like, maybe you shouldn't have spent the whole time talking about your mom. And it would be awesome if you had a trash can.

You know that trash bag just hanging on the drawer wasn't doing it for me. And also maybe get a bed frame. You know, those would be like really helpful actual pieces of feedback for the guy to get, but he just doesn't get a text back. 

Paul Tran, MD: Right. 

Preston: Which, it's not great quality feedback, but it puts it more on him to discern like, okay, [00:36:00] what, actually is there?

So I kind of take that approach of like, it's all just data and now I'm a data scientist. I have to sift through it. 

Paul Tran, MD: I, and you get better at sifting through it the more that you get and mm-hmm. Again, Adam Grant is my, he's my hero. Like I, I've, I feel like his thought process is just so resonant with me.

He gives the advice of seeking advice, not feedback, because people don't like to give feedback because again, politeness concepts. Mm-hmm. I don't know how'd love to get advice, but generally people like giving advice because. I want my advice to succeed. I wanna be seen as someone who's wise. If I'm giving you feedback, like, I look like a critic, but if I'm giving you advice, it looks like I'm a coach, I'm a cheerleader.

I'm, trying to empower you. So one of the things you can ask for is advice. Instead of saying, Hey, do you have any feedback for me on this [00:37:00] rotation? You can come and say, I'm trying to get here, and I love this existential, guilt that you're talking about because there's a gap. You know, there's a place you're trying to go to and there's a, and you have a judgment of where you are now.

They have a judgment of where you are now. So you can just say, I'm trying to get to this point. I know I'm not there yet. They might say, oh, you're not even where you think you are, you're even below that. Okay. But I, we know then that I'm not here where I want to be. What advice would you give me to get there?

So asking for advice towards that specific goal is really powerful. But then. My fellow, and I've gotta shout her out. Anita Hussein, she's going to join me as a partner. She changed everything with this superpower for advice. She found out that when you go to people and ask for advice, people still, they might be more [00:38:00] willing to give advice than feedback, but not everyone engages because of cognitive load.

They're usually too busy. They're thinking about other things. They're distracted. That just that time constraint. It's hard for me when I'm in the middle of a task or thinking about something else to from scratch, come up with advice for you to get to your goal because I might not know you. So what she does, and she said it's essentially a hundred percent hit rate.

She will go to someone and say, I am here, or I'm here. I want to get here. Here's what I've done already. The this, Or here's what I plan to do this to get here. What would you do differently? What advice would you give me based on what your experience is? And I'm like, dang, that is so powerful.

She said, 100% of people engage because you've done the work. Now you've [00:39:00] removed the cognitive load, lowered the activation energy for a reaction to catalyze. And you're asking, you're inviting them to critique you. You said, what would you do differently? They were more, are more amenable to telling you, 'cause you've asked, 

Preston: and weirdly enough, people are more comfortable pointing out what's wrong than what's right.

It's just, it, like naturally we're more comfortable saying no. And naturally we're, as humans are more inclined to, to say what's wrong with this picture? Like, that's the kind of problem that we lean to and, we like. How, like could you make a good picture is really hard to do. Could you gimme good advice?

I saw like a meme or it was like a tweet where someone was like, they got tired of posting on Reddit asking for tech advice because no one, would help them out with their problems. So instead they would go fine posts where someone was asking a similar question and then reply with a frag flagrantly wrong answer and then [00:40:00] someone would respond to correct them with the actual right thing to do.

Because people love to point out mm-hmm. What something's wrong or different or correct someone that they hate to just like help and that's 

Paul Tran, MD: right. 

Preston: That like, what would you do differently? I've already done this. What's wrong with that picture? That, that just like reminds me of that it's almost like, let me biohack your, kind of trick you into to playing a little game where you enjoy, you know, finding what's wrong here instead of building a whole narrative for me.

Paul Tran, MD: That's right. people don't wanna start a new thread. They wanna reply. 

Preston: Mm-hmm. 

Paul Tran, MD: and that's what you're doing, you're starting the thread and you're inviting them to reply. 

Preston: Yeah, I'm, I get dms asking for advice a lot, and usually it's like high cognitive load stuff, you know, Hey, I'm a med student thinking about psychiatry.

What advice do you have for me? And, you know, this is a person like, I, I, can't even look at their profile because it's private, you know, it's just like a picture of a cat or something. [00:41:00] And I'm sure they're a nice person, but I'm like, dog, I don't even know where to start. 

Paul Tran, MD: Right. 

Preston: I'm thinking about a psychiatry.

What advice do you have? I don't, nothing about your life. Like what advice I even have that'd be relevant for you. So I usually end up kinda like scrolling right past them, but it has, like, I have replied more often when someone says like, I'm torn between these two choices. What would you pick in this scenario?

This is why I'm weighing, this is why I'm not, oh, you know, then I can just reflect back to 'em, like, sounds like X, Y, and Z. So you might be better with this. and the difference isn't much, you know, it can be like three sentences, but that's enough for the thread to have been started. 

Paul Tran, MD: Oh, absolutely. I am torn between neurology and psychiatry because there's a, there's interplay in some of the conditions I've seen.

Did you ever struggle with that? And what, or did you ever think through those fields and, how did you decide? You, have a ground to stand on and build upon. 

Preston: Yeah, [00:42:00] I'm torn between upper GI and lower gi, you know, what under the tube do you like to stick to camera? Through 

Paul Tran, MD: hang right around the 

Preston: ligament.

what would you do differently? You know, 

Paul Tran, MD: my advice is just hang around right around the do I know Deju border and you never have to choose. 

Preston: Yeah, exactly. so in summary, I all feedback is a gift. But not all gifts are good. 

Paul Tran, MD: That's 

Preston: right. But we still take them politely and tuck them away and we can find a way to, to get help from them.

All. Feedback, whether it's high quality or low quality, is a data point that you can do something with. And when you are trying to solicit feedback from people, frame it as advice, not necessarily feedback. And start the thread yourself. 

Paul Tran, MD: Start the thread with a reflection. Mm-hmm. I think I'm here. I'm, and [00:43:00] acknowledge 

Preston: Aron.

I'm not. I'm your own existential guilt. 

Paul Tran, MD: That's right. That's right. Publicize your existential guilt. Here's the gap. I acknowledged I'm not there yet and I want to be there wherever there is. What advice would you get me, give me to get there. And on the flip side, on the flip side, because we do not teach people how to give feedback, well.

We don't train people how to mentor and teach. Well, on the flip side, have people acknowledge that gap because some people may not be aware of that existential guilt, yet they might be pre contemplative, right? Like they, they don't, know that's a term, let alone something that they should be struggling with or maybe are close to struggling with.

So the [00:44:00] meta thing that I do is I just say it out front, upfront. I say, are you where you want to be as a clinician? Are you where you want to be as a resident? Are you where you want to be as a third year medical student? And usually people either respond right away or they need a clarification. Like in what sense?

Like clinically, like knowledge wise, whatever. I'll say, well, you know, when we talk about it, it's another way that I like to talk about it is, are you okay being good enough? I love saying this question, are you okay being good enough? And I'm very open with it. Open and, people are like, I, don't know what you mean.

Like, no, like, what do you wanna be great the best? I'm like, okay, that's where most of us are going into medicine. you wanna strive to be the best or at least great at what you do. You wanna strive towards mastery. And then I [00:45:00] say it is domain specific. You know, you and I, we are not surgeons. We do not need to be great at suturing.

We do not mean need to be great at not tying. We can be good enough at skills like that, but clinical reasoning, communication essential in our fields. We need to strive for more. Yes, domain specific, but then if someone acknowledges that they don't want to be good enough. They wanna be great. Then I say, do you think you're great at blank?

No, far from it. Okay. And then the wise feedback then, well, I agree you're not there yet, but you will be and you certainly can be. I know that you can be, I express, I empower them. And then guess what? I'm going to help you get there. if you're, if you want, and if you're willing, I'll spend the [00:46:00] time, however little it is to help you get there in our time together.

Half a day in clinic, full week together. What do you say? I heck yeah. I've never had someone say, ah, nah, I'm good. That's what we can do. As on the other side, as preceptors, as mentors, as educators, is really negotiate what that gap is, where someone's desires to be are. And the feedback can be observations.

It's just a data point for them. Here's an observation for you, a data point for you where I think you are on that scale mm-hmm. Between where you want to be and where you are now. 

Preston: Mm-hmm. and I may be a broken instrument or just a single, you know, piece in your, line or along, your story, but it's up to you to determine if I'm just noise or if I'm, you know, part of a narrative.

Paul Tran, MD: Exactly. 

Preston: Yeah. well this is really good. [00:47:00] let's take a quick break and when we come back we'll get more into how to give some of this good, wise feedback and how do we deliver these observations to someone.

Right before the break, Paul, you did a great job of bringing up how to kind of solicit someone's existential guilt as we've been using this episode, that gap between being good enough and being great where they wanna be, and how to kind of pivot them towards the advice that you're gonna give them when it actually comes to getting granular about the observations that you're making.

What are some of the good things to look out for? Because you could just tell someone, Hey, you'd be a lot more attractive if your nose wasn't so weird. That's an observation. That's true. And, it's timely. And it might be the gap between me being having a good enough nose and having a great nose, but I don't know what I would do with that in the clinic, so, so [00:48:00] what?

What do you think about when you're trying to give someone like good, actionable observations? 

Paul Tran, MD: I try to be very mindful of what the other perspective is and the number one perspective that I remember as a learner from medical school all the way through fellowship. And the number one perspective that I hear now is that I cannot tell if the feedback is a preference or something that I need to implement in my practice.

I can't tell, is this just something that you want me to do because you're old school or that's the way that you trained, or is it because there is validity, there's evidence, there's some outcome that has changed because of it. So the easiest thing that I do is I give a reason [00:49:00] why. It seems so obvious, but people do not tell you the reasons why.

And a reason can help you discern, is this going to be practical? Is this gonna be helpful or not? So a great example, I see this every single day in the hospital. The number one skill we learn in medical school when we start learning about communication with patients is to sit down, introduce yourself, wash your hands, all that in osce, but then sit down.

I very rarely see people sit down in the hospital. It's always delivered on rounds. People are standing up and talking down. 

Preston: You just spend more time with me in the hospital. I love sitting down. 

Paul Tran, MD: Yes, same. 

Preston: I will. I will tell. I'll like go out in the hallway and be like, can I borrow your chair? I see it's on wheels.

I'll bring it back. I promise. 

Paul Tran, MD: That's the way I squat. I squat or I'll sit on the floor. I will look. Like a, [00:50:00] an idiot sometimes. 'cause there's 15 people standing up and I will squat down. But I tell people all the time when they're shadowing me, when they're working with me, I say, when you're in the room, even if it's five to 10 seconds and you're delivering a piece of an update, sit down.

The reason is, A, you will stick out in a great way because no one else does it. B, there are studies that show that perception of your time spent in a room is longer if you are to sit down or change positions in a room. C, think about the perspective of a patient who's laying down in a bed, looking up, scared, anxious, they're a kid in a hospital, in a dark room with a doctor or someone in a an official capacity, talking down to them.

Just think about that perspective and get on high level. I give three reasons right there. [00:51:00] They can choose. Are those reasons valid or not? But it's not Paul's preference that you sit down. Every time I'm working with Paul, I gotta sit down in a room. No, I remember 

Preston: because you could have just said that, Hey, sit down when you talk to the patient and then cut it there.

Right? And then you're like, so one of 10 tells 'em to sit down. The other 10 tells me to get outta the room quicker. I don't even know which, way's up. I don't, care to follow them. 

Paul Tran, MD: Exactly. Get the, give the reason. And on the other hand, if you're a learner, get a reason. If someone tells you to do something, they're tactful ways instead of why ask what or how.

What makes you decide to sit down in a room versus not? How do I decide when I should sit down? how do I, you know, approach sitting down in a room when I don't have enough time? You can ask why someone says it without asking, 

Preston: or What do you find are the benefits of sitting down 

Paul Tran, MD: exactly. [00:52:00] How do patients react when you sit down?

Now that is a game changer and that's go, that goes into my second kind of practical way that I do it. I always try to bring in, if I can, a patient perspective. So if I say something like, it's really important that you use analogies because analogies provide a lot of context for patients. You're not dumbing anything down.

I don't like that phrase. You don't dumb things down. You provide context to make it more easily understood. A mechanic can give me context about the engine, 'cause I don't know anything about cars and I can understand that better. So whenever I use this analogy, for instance, I have found that families.

Say, wow, that makes so much sense. I wish someone had explained that to me. And I've gotten really good feedback from patients when I use this analogy. So try to find analogies that work and play a game about [00:53:00] it and give the advice. But then I give the results of what I've seen, especially not just selfishly for me, but also from my patients because that's our parallel goal, is we wanna both push to be masters of clinical medicine, master communicators, whatever.

It's, 

Preston: that's the analogies is, it's really helpful. And then it's important to give a why. Even in like psychiatry, a lot of our feedback can feel very superficial or subjective, but even then, like adding the why has been very helpful for feedback I've gotten. So when I was a med student, and I'm like doing my psychiatry sub eyes.

I would ask this question because I felt like it was a very psychiatry thing to ask. I'd be like, and how did it make, how did you feel when the nurse yelled at you and the patient like, I don't know, you know, felt like punching him, because then we're here because they punched the nurse. You know, we've gone in a circle, and when I got out of the room, [00:54:00] the resident pulled me aside and he said, Hey, just a heads up.

It takes a lot of insight for people to identify how they're feeling and name the emotion and give it back to you. So you're asking a hard question when you say, how do you feel? But instead, you could just say, what was going through your mind, or what thoughts did you have? Because people can identify thoughts really quickly or just tell you what's going on in their mind.

It's really hard for 'em to pick out their emotions. And I was like, oh, you know, he could've, just said, stop asking the patient, how'd that make you feel? But instead he, gave a really helpful reason as to. Why, to transition it to asking them the what about their thoughts. And then actually you as the clinician can name the feeling.

So, you know, you could say something like, what was going through your mind when that, when you hit the nurse, you know, that I wanted to hurt her. That, you know, she had it come into her. And I was like, you felt that she, you wanted to get justice. You know, [00:55:00] you were betrayed and you wanted to feel vindicated.

And so now I'm naming the emotions and that helps the patient feel more seen. So that's actually, you know, developed the framework that I have for a lot of therapy, which is ask the patients for their thoughts and behaviors, and I'll name the emotions and it helps us like bridge our connection a lot better.

And a lot of it starts with just getting that good reason, that good feedback. 

Paul Tran, MD: I, love the example that you just said about the senior, the resident telling you that and giving you that feedback. I would augment that even one step further. To build upon that because it's such a good example. 

Preston: Feedback on his feedback.

Paul Tran, MD: Yeah, feedback on the feedback. Well, that's, a perfect example of someone building you up and something that affected you to this day. And one of the things that you can use as an educator is starting that conversation right there. If, that was me and you, I'd say, Hey, Preston, did you notice how the patient [00:56:00] responded when you asked?

Because now I can see your insight. You're talking about the patient's insight, but now I can see your insight as a learner. Did you actually notice that the patient made a face or was like really confused or paused when you asked that question? No, I didn't. Well, I noticed it. He looked really confused.

They looked taken aback by the question. One thing is, when you ask that, it's very difficult to, and then you kinda go into that explanation because you could have said, you. Yeah, that was weird. Like he, it took a long time. Like, why do you think, and then why do you think that was? I don't know. Maybe it's a hard question to answer.

Exactly. And then, you know, I'm encouraging you 'cause you noticed it. Like, so you're gauging insight a little bit that way as well. 

Preston: Mm-hmm. And then it's like you're giving yourself the feedback, like you're walking them through. Yeah, No, I could do the same thing. Like, this is feedback I actually give to med students a lot of times where, a med student, [00:57:00] they love to follow the template and it has a lot of yes or no questions on it.

and it's not their fault. It's what gets fed to them before they go into like, clinical psychiatry rotations. So it's very common to be like, have you been sleeping well, for example, in the psychiatric interview. And then like, what do you get when you ask that you get yes or no now? Now what? 

Paul Tran, MD: Right.

Preston: What do you do with that? So I'll, and then, sometimes it'll even be like, have you been sleeping well or no? and so, like, my feedback is usually like, and I guess I could augment this and add another step to it, but I'll normally say, you know, you can actually just condense that to how sleep and then let them fill in the rest of it because you can't answer yes or no to how sleep.

So you get a lot more, like the reason is you get a lot more information from it. And also it's not a, it's not a leading question. Have you been sleeping well? Implies that you should be sleeping well and that I may be disappointed in some [00:58:00] way if you had to reveal to me that you aren't sleeping well. So that actually decreases the sensitivity of the question to find some sort of veracity about the patient's sta like status.

So those are two reasons, but instead, you know, I could now taking into account your feedback on the feedback for the residents feedback that he gave me is, Hey, how did the patient respond when you asked them? Are you, have you been sleeping well or not? They said No. And then what else happened? Well, I didn't really get much else out of him.

Right? You got nothing from him. You can try to try this instead. So, so actually I'll, probably incorporate that, next time I'm like working with a student or helping them interview. 

Paul Tran, MD: I love it. 

Preston: It's really good. I like that. 

Paul Tran, MD: I love it. And then if the, in the moment, I mean, you're a very witty guy.

I, I like, we have a very similar sense of humor on things. My, I'm pretty quick with sayings and I'm pretty quick and that's where a lot of my, like improv in, my skits and stuff comes from. I try to [00:59:00] come up with a pithy saying or analogy, some sort of alliteration, something right there to, to condense the feedback into.

I almost give a headline, so if I'm breaking down that interaction exactly as you just gave it, Hey, what did you notice? This, they didn't say this. And then the feedback that you're giving, I, describe it and then I end it with, at the end of the day, don't make a patient decide. Ask them, don't ask them to decide yes or no.

Ask them to describe and 

Preston: Oh, that's funny because I was gonna go say no to yes or no questions. 

Paul Tran, MD: Yeah. Either way. 

Preston: Don't ask. I like that. Don't ask them to decide. Ask them to describe. 

Paul Tran, MD: Yeah. And they walk away being like, you know, they, just repeat it. Mm-hmm. And that's how you crystallize information.

That's how you take that big giant feedback thing. You condensed it into, you know, five words or less. [01:00:00] 

Preston: Yeah. It's like an ad logo. You gotta sell your feedback. 

Paul Tran, MD: Yeah. 

Preston: Make sure they it's buy it. That's good. Yeah, it's good. Okay. So, really you, you kind of elicit where they are. you package, it in a way where they can like incorporate it into, improving themselves and.

I guess you, you make it be an observation that has, like the ability to change for a good reason. Because I, I think a lot of observations are just, and this is like ubiquitous for med students, where you're like, what do I do with this? You know? And we're, good judges of reasons, but we're not good judges of observations.

and another one is that, like, I remember just being told like not to talk during parts of surgery. And it was [01:01:00] the most helpful thing for me is like, Hey, it's actually really stressful for the anesthesiologist when they're extubating. And I was like, oh, I had no, I'm like, it's like two weeks in the hospital.

I'm, I had no idea, so I'm just yapping, right? But before a lot of people were just telling me to shut up and I was like, oh, okay. It wasn't until I got that reason, that was helpful. So I, think the reason is like the, shining star, this whole thing. 

Paul Tran, MD: Yeah. Yeah. I think if we had to put one bow on it to think about the role, kind of the mindset of feedback as a gift from the receiver, the mindset as a deliverer of feedback is to approach it like you are a coach who's trying to find blind spots.

I'm not trying to get you to change your behavior. I'm trying to give you insight and recognize that you may benefit [01:02:00] or may change from behavior modification. You might not know there's something stuck in your teeth. You might want something stuck in your teeth, but since you may not know, I'm just going to say, Hey, pressing, you got something stuck in your teeth.

And then you can act in embarrassment and say, oh gosh, thank you. You know, remove it. Or you'd be like, okay, ignore me, but it's my job. It's not my job to go pick out the thing in your teeth. It's my job to say, Hey, you got something stuck in your teeth. 

Preston: And that's also a good point about, I guess, transitioning from the substance of the feedback to the delivery.

So that's another thing that's really important is the timing of it. Sometimes stepping out of a patient room is a great, place to give feedback. And three weeks after the rotation, when someone's never gonna see a psych patient again. Maybe not the best time to give them feedback when they have no [01:03:00] chance to change it.

Same, with the thing, you know, food stuck in your teeth waiting until the drive home and you're like, I can't believe you had something stuck in your teeth, the entire gala. Like, bro, really? You're just now telling me. And on the flip side, sometimes it is better to wait. I don't watch a lot of Sam Sinek, or not Sams, he's the bodybuilder.

I don't know another motivational spe speaker whose name's escaping me, but he, has a, there's this discussion about, you know, going to see your friend after their play. Like they're, an actor, they're performing in the theater and he go see their play and they suck. They have no delivery.

It's flat, you know, they're out there trying to do Shakespeare and it's just like nails on a chalkboard. And you come out, they're super nervous. Everyone's giving their flowers and they're clapping and they say, how was it to you? Not the time to say it sucked. Or Did you notice [01:04:00] how nobody laughed when you made that joke?

I noticed. Yeah. and here's the gap between where you are and the great actor. I know you wanna be, so let me help you get there. It's like that, bro, that is not the time to do that ever. Know, like you don't do it the night of the, like opening night. You don't do it any like, maybe a couple weeks from there you'd be like, Hey, you know, how do you feel your performance went last week?

What were some things you noticed about it? Okay, I noticed that like this, when one joke might have fallen flat, did you notice that? And then you can kinda get into that conversation with them. So I think this, it's kind of under-emphasized sometimes, but you could give the right feedback to the right person in the right way.

But if it's not at the right time, it's all for Naugh. And you really like being earlier, being laid is the same as being wrong. just like they say in the stock market. 

Paul Tran, MD: Yeah. That I, it's the tease for me in [01:05:00] how you deliver tact. I mean, you gotta deliver it tactfully. The tone with which deliberate the timing.

With, which you deliver it. Maybe the, doesn't fit the t but intent, you know, like that's very important. Like, why are you giving it, are you giving the feedback because you are expected to, again, check the box? Are you giving it because of what I like to do and be meta and say, Hey, this is hard feedback to give, but I want you to hear it from me because you know that I care, right?

Like, you know that I'm trying to invest in you. Right? So it would be easy for me to not say this, and most people are like, I, no, I appreciate you. Like, thank you for doing that. Like it, I know it takes a lot to say it even beforehand and then afterwards, you know, I try not to couch it anymore. I've already said it up front, like, you know, that's gonna be hard to hear, [01:06:00] but I, say it because I, know where you want to go and I know where you can be.

And so, so. You know, like that, that friend maybe it's not the, it's not the night of for sure. It's not weeks later before the review, but maybe it's several days and say, Hey, I want you to hear it from me before you read a review or you see TikTok videos about the performance. And then they'll probably appreciate it because they're like, Hey, like, thank you.

I need, I needed that real opinion before I was blindsided by it. 

Preston: Mm-hmm. The four T's, that's good. 

Paul Tran, MD: Oh, made it up 

Preston: t timing, intent 

Paul Tran, MD: tone, 

Preston: tenor, the level in which you give the feedback, you, can reach it. So here's, and I guess as we wrap up here's my question for you. Have you ever given a [01:07:00] med student feedback and then you say.

Do you have any feedback for me? 'cause I'm sure that's how it happens. And then they give you feedback and then you say, that was great feedback. I actually have some feedback on your feedback. And then you give them feedback back and then they say, wow, so thoughtful. I actually have feedback on the feedback that you're giving me on the feedback that I gave you.

And then you just kind of end up in this never ending feedback loop. How do you like 

Paul Tran, MD: it close? 

Preston: Does that happen to you often or how do you break outta that? 

Paul Tran, MD: It's closed. I learned how to break out of it actually right around iteration 27. My feedback is I don't generally get to 30, so my feedback is usually this is where the feedback would stop if we were sensible people.

And generally people respond to that. That's a gift. That's savored, if you will, 

Preston: a gift that keeps on giving. Really. That's 

Paul Tran, MD: right. 

Preston: Are you worried that like one day we'll reach the feedback singularity and like [01:08:00] the earth will implode when we've given too much feedback. 

Paul Tran, MD: At that point though, is it feedback?

Does it reverse? Are we talking about singularity? where now the polarity has reversed? It's no longer positive negative. our two by two has flipped. 

And now it's feed forward. Eat forward. It's not no longer feedback. 

Preston: No, it's shit forward. 

Paul Tran, MD: That's right. 

Preston: Because you're not feeding your Yeah. Oh my God.

It's kinda like, like antimatter. That's right. 

Margaret: You can catch the next part of this on Patreon. 

Paul Tran, MD: It's patreon.com/happy Patient pod. 

Preston: Well, I think, the discussion of the future of theoretical feedback physics, can be saved for another episode. but I think that's a good place to stop for today.

I wanna say again, Paul, thanks for being here. Is a pleasure chatting with you. I feel decorated in flowers. So thank you for giving me my flowers. and I guess my feed only feedback for you [01:09:00] is I loved this conversation and I really appreciated all your insights. 

Paul Tran, MD: Yeah. this was a lot of fun and clearly we, there's a lot to talk about with feedback in general.

We have all sorts of things to talk about, but this is so valuable because we just don't do it well. So thanks for giving me the opportunity to talk about it and share some ideas and, really fun to chat. 

Preston: Yeah, of course. And to you, the listener, if you have any feedback for us, let us know how the show is, what, you're thinking, what you're not thinking.

You know, Margaret and I are always in Spotify comments. I'm sure Paul will be in the Spotify comments. whenever this episode comes out, you can always find us at our, Instagram page, how to be patient. We have now cracked 4,000 followers and you divas are also in the walk challenge, so keep that up.

I think Mag. Is leading us with 170,000 steps, which is kind of a hack. we're, so we're doing this walk challenge and we didn't realize all these marathon runners were [01:10:00] gonna show up. So they're absolutely clocking our tea right now, and I'll have to get out and start getting my steps in after this.

But anyways, shout out to Mags and the rest of the top three. Let me, look these guys up. Or actually mostly gals, I think we have three women leading us. Yeah. So we have Mags, Isabella and Nicole with 200,204,000 182,000, 168,000 steps respectively. I am holding up 12 position with 123,000 steps.

So it, it hurts. A little bit, but I will try to crack top 10 by the end of the week. We have 27 days left in this step challenge. Thanks again for listening. We're your hosts, Preston, Roche and Margaret Duncan? Margaret's not actually here today, and our other host, Paul Tran, You you can just say you're a host today, Paul.

Paul Tran, MD: Oh, thank you for making me a host. if you enjoyed me as a host, please leave a, snapping turtle emoji and a pig emoji in the comments. 

Preston: Or if you really liked him, you [01:11:00] can follow him on, at elementary school on all of his socials. That's, Paul Tran, and then it's A-L-A-L-I-M-E-N-T-A-R-Y School.

Thanks again for listening. Your producers are Preston Roche, Margaret Duncan, Wolf Lanner, Kristen Flannery, Aron Korney, Rob Goldman, Ashanti Brook. Our editor and engineer is Jason Portizo. Our music is Bio Bens v. To learn more about our program, disclaimer and ethics policy submission, verification and licensing terms, and our HIPAA release terms.

Go to How to be patient pod.com or reach out to us@humancontent.com with any questions or concerns. How to be patient is a human content production.

Thank you for watching. If you wanna see more of us or if [01:12:00] you wanna see, this is lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac Point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They, probably exist for real.

But in the meantime, I'm just gonna pet lilac and then I'm gonna go dance in the background.