How to change the world: Start by making your bed

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Admiral William McRaven is a Navy SEAL and was the president of the University of Texas. In 2014, he gave a commencement speech that has been viewed over 10 million times. It is considered one of the greatest contemporary graduation speeches of all time. Although the speech was directed at 8000 graduates at the University of Texas, his message certainly applies to the healthcare profession.

So, here are the ten lessons Admiral McRaven learned from basic SEAL training that may apply to doctors and others in the healthcare profession.

1) Make your bed

Every morning in basic SEAL training, the instructors awaken the SEAL trainees, and the instructors would inspect their beds. The exacting process of making their bed consisted of perfectly square, tight corners, with the pillow centered under the headboard and the extra blanket folded neatly at the foot of the bed. The bed needed to be made to perfection each morning. The purpose of this requirement was that by making the bed perfectly every morning, the trainees would have successfully accomplished the day's first task. The training was arduous and often brutal, but the purpose was that this task provided a small sense of pride and encouraged the trainees to do another task equally as perfectly. By the end of the day, that one task will have turned into many tasks completed. Making the bed will also reinforce the fact that little things in life matter. If you can’t do the little things right, you will never do the big things right.

Practicing medicine also requires performing the simplest tasks to perfection. Even what seems mundane and not requiring much attention must be accomplished with the same perfection as the most important task or procedure.

If you want to change the world, start by doing the easiest task perfectly.

2. Have a team you can count on

During SEAL training, the students are broken down into boat crews. Each crew is seven students — three on each side of a small rubber boat and one coxswain to help guide the dingy. Every day, your boat crew forms up on the beach and is instructed to get through the dangerous surf and paddle several miles down the coast. To make it through the surf, which might be 8-10 feet high, every student must synchronize the paddling with the other five paddlers to the stroke count of the coxswain. Everyone must exert equal effort, or the boat will capsize, and the crew will end up in the ocean.

Everyone must paddle together for the boat to reach its destination. No one can make it through that surf alone — the trainee needs the help of a team that pulls together. The admiral’s message is that to truly get from your starting point to your destination takes friends, colleagues, the goodwill of strangers, and a strong leader or coxswain to guide them.

In healthcare, we must recognize that we can’t do it alone. No doctor, except a psychiatrist, can manage a medical practice alone. No practice can function without a receptionist, a billing clerk, a medical assistant, and a nurse. No surgeon can perform their craft without an anesthesiologist, a circulating nurse, and an assistant. We need to surround ourselves with a competent team to help us care for our patients.

If you want to change the world, find someone to help you paddle. Create a team you can count on and will do whatever it takes for the patient to have a positive experience.

3. Provide the tools so everyone can succeed

Over a few weeks of difficult training in my SEAL class, the students saw that the best boat crew was made up of the little guys — the munchkin crew, we called them — no one was over about five-foot-five. The smaller crew out-paddled, out-ran, and out-swam all the other boat crews. But somehow, these little guys were able to paddle faster than everyone and reach the shore long before the bigger trainees.

Health care also requires some on the team to make use of some assistance to enhance their contribution to the team. For example, employees need to have the necessary tools to provide the best care for the patients. If the receptionist and medical assistant spend 60-90 minutes a day verifying insurance before patients can come to the practice, consider one of the automated programs that conduct insurance verification. Now, the employees can spend more time on patient care instead of paperwork verifying coverage.

The take-home message is that if you want to change the world, ensure everyone has the proper tools.

4. There is no defeat-just keep those feet moving

Several times a week, the instructors would line up the class and do a uniform inspection. It was exceptionally thorough. Your hat had to be perfectly starched, your uniform immaculately pressed, and your belt buckle and shoes polished so you could see your face. But it seemed that no matter how much effort you put into starching your hat, pressing your uniform, or polishing your belt buckle, it wasn’t good enough. The instructors would always find something wrong.

For failing the uniform inspection, the student had to run, fully clothed, into the surf and then, wet from head to toe, roll around on the beach until every part of their body was covered with sand. The effect was known as a “sugar cookie.” You stayed in that uniform for the rest of the day — cold, wet, and sandy.

Many students couldn’t accept that all their efforts were in vain. No matter how hard they tried to get the uniform right, it was unappreciated and never exactly the way the drill sergeant wanted. Those students didn’t make it through training. Those students didn’t understand the purpose of the drill. You will never succeed all the time. You were never going to have a perfect uniform.

No doctor can treat patients who have no complications. As physicians, we try for perfection and help everyone improve their medical condition. But we will fail on occasion and patients won’t get well, or worse, have a complication. This is not easy for doctors to accept. We aren’t programmed for failure or for handling complications easily.

If you want to change the world, get over being perfect and accept that, on occasion, you will fail. How we manage failure by being honest with patients and managing a patient’s emotions and feelings will determine our success and the success of our patients.

5. Don’t run off to join the circus

Every day during training, students were challenged with multiple physical events — long runs, long swims, obstacle courses, hours of calisthenics — designed to test your mettle. Every event had standards — times that had to be met. If students failed to meet standards, their name was posted on a list, and at the end of the day, those on the list were invited to a “circus.” A circus was two hours of additional calisthenics designed to wear down the spirit of the student.

No one wanted a circus. The pain of the circuses built inner strength and physical resiliency. Admiral McRaven said, “Life is filled with circuses. You will fail. You will likely fail often. It will be painful. It will be discouraging. At times, it will test you to your very core.”

Physicians also face circuses. They may not be physical circuses, but we all experience mental circuses sometimes in our careers.

Nothing tests the courage and persistence of a physician than being named in a lawsuit. One minute, we find the patient likes their doctor; then, something that isn’t to the patient’s liking happens, and the patient files a lawsuit against the doctor. The plaintiff’s attorney will craft an opening statement that will demean and belittle the defendant's doctor. At times, you won’t believe your eyes and ears what is said and defend yourself and demonstrate that you practiced within the standard of care even if the outcome wasn’t exactly what the patient was expecting. This can be a very discouraging experience even if you are acquitted, but the havoc that a lawsuit creates is a spiritual circus that, hopefully, you won’t have to go through very often.

But if you want to change the world, don’t be afraid of the circuses.

6. See obstacles not as stumbling blocks but as stepping-stones

At least twice a week, the trainees were required to run the obstacle course. The obstacle course contained 25 obstacles, including a 10-foot-high wall, a 30-foot cargo net, and a barbed wire crawl, to name a few. But the most challenging obstacle was the slide for life. It had a three-level, 30-foot tower at one end and a one-level tower at the other. In between was a 200-foot-long rope. The students had to climb the three-tiered tower, and once at the top, they grabbed the rope, swung underneath it, and pulled hand over hand until they reached the other end.

The record for the obstacle course was held for more than a decade. One of the students left his comfort zone and went down the slide for life headfirst. It was a dangerous move, and failure could mean injury and being dropped from the training. The student slid down the rope in half the time and broke the record.

There are times in medicine when we challenge the status quo. There may be antiquated ways of treating a patient or performing a procedure, and when new ways or going down headfirst is discouraged, the doctor offering a new idea is ridiculed or discouraged from trying something new.

There is a paucity of healthcare professionals willing to try new ideas and share them with others to improve the care we offer our patients. When people fear being put down or ridiculed for trying something new or launching a radical new idea, we will be left with the status quo and groupthink.

If you want to change the world, sometimes you may have to slide down headfirst, and you may have to challenge the status quo.

7. Don’t be afraid of the sharks.

You will encounter sharks along the way

During the land warfare phase of training, the students are flown out to San Clemente Island, where the waters are a breeding ground for the great white sharks. To pass SEAL training, there are a series of long swims, including a night swim.

The students are taught to stand their ground if a shark circles their position. Do not swim away. Do not act afraid. And if the shark attacks, summon up all the strength and punch the shark on the nose, and the shark will turn around and swim away.

There are a lot of sharks in the world. There are going to be people who want your time or your money, and they will circle you and promise you the world only to take advantage of you. It is necessary not to back down from the sharks but to hold your ground.

8. Stay calm under pressure

As Navy SEALs one of their skills is to conduct underwater attacks against enemy shipping. The training requires the trainee to use nothing but a depth gauge and a compass to reach their target.

To be successful, the trainee must swim under the ship and find the bottom of the ship, where it is so dark that the trainee cannot see their hand in front of their face.

Every SEAL knows that this is the time when the trainee must be calm and composed and where there is no room for error or panic.

This scenario happens in healthcare when there is a crisis or a potential crisis and reacting in a calm fashion will save the day. This isn’t easy, and, unfortunately, we don’t have any training to swim in the dark, but a cool head will often save the day.

If you want to change the world, you must be your best in the darkest moment.

9. “If you are going through Hell, keep going” (Winston Churchill)

Hell Week is six days of no sleep, constant physical and mental harassment, and one special day at the mud flats. The cold, freezing mud consumed each man until nothing was visible but their heads. The instructors tell the students they can leave the mud if only five men quit. Then, one of the students began to sing a song with great enthusiasm. Before long, everyone in the class was singing. They knew that if one man could rise above the misery, others could also.

With more class chiming in, the mud seemed a little warmer, the wind a little tamer, and the dawn not so far away.

The take-home message is that just one person can change the world by giving people hope.

So, if you want to change the world, start singing when you’re up to your neck in mud.

10. Never consider ringing the bell…the bell doesn’t have to toll for you

Finally, there is a bell in the center of the training complex in SEAL training. If a student wants to quit, all they have to do to quit is ring the bell. If a student rings the bell, they no longer have to wake up at 5 o’clock, no longer have to do the freezing cold swims, no longer have to do the runs on the obstacle course, and no longer have to endure the hardships of training. Just ring the bell.

If you want to change the world, don’t ever, ever ring the bell, i.e., don’t quit

Admiral McRaven ended his speech by saying, “Start each day with a task completed. Find someone to help you through life. Respect everyone. Know that life is not fair and that you will fail often. But you must take some risks, step up when the times are toughest, face down the bullies, lift up the downtrodden, and never, ever give up — if you do these things, then the next generation and the generations that follow will live in a world far better than the one we have today.”

My final advice is to take fifteen minutes to watch the YouTube video of Admiral McRaven’s commencement speech delivered to the graduating class at the University of Texas.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.