Friday, 18 Jan 2019

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The Big Fish

I once had a rheumatology fellow who declared he wanted to be “..a big fish” and added “ little pond or big pond…it doesn’t matter”.

He was young and I admired his drive and desire to be better than good. He knew his aspirations would make him valuable to his patients, while also helping his career.

Most students and trainees begin their career quests with grand hopes. They also have great optimism, impeachable ethics, and the time and energy to accelerate their learning and expertise. It’s not surprising that they develop these allusions of grandeur during their training; after all they are surrounded, and mentored, by grand teachers, leading researchers and big names who are always in the journals or on the news.

We should all be the big fish.

The big fish is a leader, the one who gets and deserves great respect and is always remembered as the great catch; should you marry one, hire one or have one as a great doctor. Being the big fish is all about how you appear in the eyes of others in your pond.

Is it better to have a tremendous sense of self grandeur or to be valued and revered by your patients, peers and community for who you are and what you do?

The big fish has two challenges - being the big fish and finding the right pond.

The big fish is someone who is always at the top of their game and is always getting better. The big fish becomes one by meeting the needs and expectations of the pond. He or she does so by being reliable, kind, wise, smarter, persistent, strong and dependable. The big fish always shows up.

Whereas being the big fish is about effort and engagement, being in the right pond is about the choice that makes you happiest and most fulfilled. The rheumatology fellow wasn’t sure if his destiny was in the big or little pond. After all, that is partly planned, part destiny and part luck (when preparation meets opportunity). The huge stage, the big city, the mega medical center isn’t for everyone. My experience is that we are drawn to the level in which we can swim well and thrive best.

Find the right pond, take a grand, long swim and be the big fish.

Others need and want to look up to you.

The author has no conflicts of interest to disclose related to this subject
Dr. Cush is the Director of Clinical Rheumatology at the Baylor Research Institute and a Professor of Medicine and Rheumatology at Baylor University Medical Center in Dallas, TX. He a Professor of Clinical Medicine at the University of Texas Southwestern Medical School.
Dr. Cush is the Executive Editor of and also Co-Edits the online textbook 
Dr. Cush's research and interests include novel drug development, rheumatoid arthritis, spondyloarthritis, drug safety, pregnancy and Still's disease/autoinflammatory syndromes. He has published over 140 articles and 2 books in rheumatology.
He can be followed on twitter: @RheumNow.

Rheumatologists' Comments

Jack In academic medicine be careful not to be a big fish in a big pond with a big shark.
My point better made by Art! You have to be careful what pond you wish to swim, all have their benefits but the price to pay differs widely. Shark infested ponds include med schools, industry jobs and any place where prior authorizations are plentiful!
We all need to look for these big fish, in the interest of the future of rheumatology and the welfare of our patients. I agree with Art, Jack is a big fish in the big pond, and he can take on a shark of any size.
Eric - so right! We need to invest in our trainees as they are the future. We need to teach them that the pathways to success are not by flash, fame or money. Good hard work, attention to detail and expertise efforts are the right way to to go!
Hey Art, Sharing the "pond" with you was an honor. The retirement waters are very calm. Ha. Alan Fischman
Well profound, how true.