Want a Successful Practice? Make Your Bed! Lessons From Naval Admiral William McRaven, President of the University of Texas

Let me bare my soul; I’m an addict—not to drugs, but to graduation speeches. I have had the honor of giving two graduation speeches, but I have read, listened to, and watched several hundred speeches, especially college graduation speeches, because these are given by some of the best speakers who are invited to give the final motivational pitch before the graduates depart from their college or university. I clearly remember the graduation speaker—Walter Cronkite—who gave the commencement address to my class at Ohio State University in 1968 and how Mr. Cronkite convinced me that I could change the world with the skills I had learned in four years at Ohio State Medical School. Walter Cronkite’s commencement address was the greatest speech I had ever heard until 2014, when I watched the graduation speech by Admiral William McRaven, who was a Navy Seal and, at the time, the president of the University of Texas. In this article, I take a few excerpts from that speech and suggest how they can apply to contemporary medicine.

1. Start your day with a simple task completed.

If you want to change the world...make your bed! McRaven’s early training as a Navy Seal placed emphasis on a properly made bed. The sheets and blanket had to be so tight that the inspector or staff sergeant could bounce a half dollar off the bed and catch the half dollar in the air.

Why is this important? Whether you are a Navy Seal or a doctor, life is hard and often there is little that each of us can do to affect the outcome of our day. However, something as simple as making your bed can give you the lift you need to start your day and can provide you with the lift to end the day doing good for others and the world.

It is a good idea to start each day with one small success.

How does that apply to healthcare? I think it is a good idea to start each day with one small success. Making my bed didn’t apply to me, because I would often awaken at 6:00 in the morning and my wife was still asleep, which precluded me from adjusting pillows, sheets, and blankets.

What was something else I could do that would provide me with a small success to start my day? Sometimes it was looking at my book of collected quotes on success and motivation and finding one that I would think about throughout the day. Other times it was three to five minutes of stretching exercises. This would limber me up and take away the snap, crackle, and pop when I got out of bed and headed to the bathroom. What I finally settled on was to take a vocabulary book and focus on just one word and its definition. I would use it in a sentence, I would add it to my calendar on my cell phone, and I would try to use the word in a sentence once or twice before leaving the house for the day. I considered this a way to start my day that would provide me with a taste of success that I hoped would lead to other small successes as the day went on.

2. You can’t go it alone.

If you want to change the world...find someone(s) to help you paddle, even if it’s upstream. McRaven faced many crises and obstacles, and he often relied on others to help him out of his difficulties. He believes it takes a team of good people that you can count on to get you to your destination in life.

It doesn’t matter if you are an employed physician, in academic medicine, or in a small practice, you have to create a team and everyone has to pull their fair share of the load. You have to acknowledge everyone on the team and praise them for outstanding performance and pump them up or boost them when their performance is less than acceptable.

Show your staff or team that you care about them.

For example, I had eight employees, and there was a week when three of them were out—either on vacation or not well enough to come to work. The five remaining dug in and made sure that nothing fell through the cracks and that the majority of our patients were seen on time. On Friday afternoon, I called a team meeting and thanked them for their extra effort so that they knew I was grateful for all their hard work. To show my appreciation, I brought in a massage therapist and everyone got a 20-minute massage, which was my way of saying how much their hard work was valued.

Show your staff or team that you care about them. One of my employees was sick and needed to see a specialist. When she called the doctor’s office, she was told that the next available appointment was in two weeks. I knew how sick she was and didn’t feel it was acceptable for her to wait for two weeks. I spoke to the doctor and explained the situation, and he was able to see her at the end of his day. I sent the doctor a thank-you note and a small gift from myself and my employee. My employee was very appreciative of the effort that I extended on her behalf, and I think that it created a loyal bond between her and my practice.

3. Only the size of your heart matters.

If you want to change the world, measure a person by the size of their heart. The Seals had rigid criteria for who could be part of that elite organization. McRaven noted that it wasn’t the candidate who was the strongest, the one who was the best shot, or the one who could hold their breath for the underwater swim the longest who made the best Seal. Instead, it was often what was in their heart that determined what kind of Seal they would make.

4. Life’s not fair—drive on.

McRaven noted that great men and women are defined by how they deal with life’s unfairness. Some of the examples he cited include Helen Keller, Nelson Mandela, Stephen Hawking, and Malala Yousafzai. His message is: don’t complain, and stop having a pity party; stand tall, look to the future, and carry on.

You will have patients that you just can’t seem to please. No matter what you do, it is not enough. You almost want to suggest that they go elsewhere for their medical care. But that’s the easy way out. You can be sure that patient won’t be touting your skills and your services if you dismiss him or her from your practice. Unless the patient is abusive of you or your staff or is asking you to do something that isn’t ethical, then I believe, like Commander McRaven, that you have to step up to the plate and find a way to satisfy even the most difficult patient.

I remember a patient who had a prostate operation and was told that he could go back to work. I was completing his back-to-work form and when I got to the date he could report back to duty, the patient asked me, “Dr. Baum, it’s hunting season next week. Would you give me a few more days off?” Now I could have easily put in a date that granted him a few days in the woods hunting for deer or turkeys, but that would have been wrong, because he was completely capable of resuming his employment. I also could have told him no I wouldn’t do it and not given him an explanation. However, I wanted him to know that I understood his request but wouldn’t lie on his behalf. I explained that he was fortunate to have a job and if he wanted to go hunting, he should use his vacation days. He responded that he understood and would speak to his wife to figure out how he was going to manage his desire to go hunting.

Another example was a patient who requested that I send their records to another urologist. I was surprised, because I thought that my staff and I had done everything reasonable to help with his medical problems. I contacted the patient about his reason for his departure, and he gave a very vague response. I asked if it was something my staff or I had done, and he said it was not. I made a copy of his records, wrote a summary of his care to that point, and mailed the records to the patient. At the end of the letter to the patient, I wrote, “If there is anything else I or my office staff can do for you, please let me hear from you.” It was nearly a year after the departing patient asked for his records that he made an appointment to return to the practice. I think by showing my concern for the patient, I left the door open for him to return to the practice. I hope my behavior showed him my heart.

5. Failure can make you stronger.

Admiral McRaven observed that true leaders learn from their failures; they use the lessons to motivate themselves, and not be afraid to try again or make the next tough decision.

6. You must dare greatly.

If you are in constant fear of failure, or hardship, or embarrassment, you will never achieve your greatest potential. Without daring greatly, you will never know what is truly possible in your life.

7. Stand up to the bullies.

Don’t back down from the sharks. Bullies thrive on fear and intimidation, and, like sharks, they can sense fear in the water. If you don’t find the courage to stand your ground, they will strike. There is great courage within all of us. Dig deep and you will find it in abundance.

An office nurse in my community was asked by her doctor to prepare testosterone pellets for a patient, but when she went to do that, the pellets were not in their sterile container. The nurse told the doctor, and the doctor wanted her to use them anyway. The nurse told the doctor that she wouldn’t comply with his request and got his attention when she asked the doctor if he would insert nonsterile pellets into his father. I was so very proud of the nurse for standing up to the doctor—her employer—as she was thinking about the patient first.

That’s the rule in our office: do what is in the best interest of the patient, and no questions will be asked.

8. Rise to the occasion.

Be your very best in the darkest moments. We will all face disappointment. That is the time, in that dark moment, you need to reach deep inside yourself and be your very best.

I will never forget the date I lost my first patient. It happened after a surgical procedure to remove a kidney stone from a patient with spina bifida. I was devastated and felt guilty that I caused his demise. The experience caused me to question my decision to become a doctor. I didn’t know if I was capable of managing adversity, failure, and complications. I was experiencing mild depression and questioned my resolve in remaining in the profession. It was a professor who recognized my dilemma and took me out of the hospital for a cup of coffee. The professor explained that every doctor will encounter the loss of a patient at some time in his career... unless he or she is a radiologist or a pathologist. It comes with the profession. Not every patient will get better or be cured. We have to accept that we aren’t god-like healers and that we will experience an occasional failure.

9. Give people hope.

This is the time to lift up those around you and give them hope that tomorrow will be a better day.

On August 31, 2005, Hurricane Katrina visited the Gulf Coast, including an almost direct hit on the city of New Orleans. The city was under mandatory evacuation. Thousands of citizens were left stranded at the Superdome and the Convention Center. People died of heat exhaustion in temperatures over 100 degrees with no water, and drowned when the levies of the Mississippi River were breached. Depression among the citizenry was rampant. Doctors and early responders were called upon to provide hope and to get started rebuilding the city and restoring law and order in the community. We have to do the same with our patients. Provide them with hope, but always tell them the truth. Patients expect the truth but they also want to have hope.

10. Never ever quit.

Don’t ever, ever ring the bell. Seal training is the most daunting, punishing, and physically exhausting training experience. Seal trainees are told on the first day that if the pain is too great, the way out is to ring the bell three times. However, if you refuse to give up on your dreams and stand tall and strong against the odds, then life will be what you make of it, and you can make it great. Don’t ring the bell.

Yes, American healthcare is in disarray. There is no short-term fix that can cure the system overnight. We have one of the greatest healthcare systems on the planet, even with all the problems that we have. Let’s not ring the bell.

Bottom Line: I couldn’t close this article any better than to quote Admiral McRaven: “These are just a few suggestions that may help you on your way to a better a world. And while these lessons were learned during my time in the military, I can assure you that it matters not whether you ever served a day in uniform. It matters not your gender, your ethnic or religious background, your orientation, or your social status. Our struggles in this world are similar, and the lessons to overcome those struggles and to move forward — changing ourselves and the world around us — will apply equally to all.” So get started and make your bed!