You Don't Know What You Don't Know | Ep5

Michael Hersh, MD

[00:00:00] You don't know what you don't know. Simple, right? It sounds obvious, but when I finally heard it—and I mean really heard it—it stopped me in my tracks.

Because what happens when you're used to being the one who knows... and then you start to see your blind spots?

What happens when you realize there's a whole world just outside your frame and you never even noticed it?

That's what we're talking about today.

Hi everyone, and welcome back to Better Physician Life. I'm Dr. Michael Hersh, and I'm so glad you're here with me today.

If you're listening, chances are you're a physician—or maybe someone who cares about one.
Either way, you're in the right spot.

Today's episode is about something that seems almost too basic to be meaningful—but for me, it completely changed the way I see my work, my relationships, and myself.

It's this: What you don't know.

Let's sit with that.

[00:01:00] You don't know what you don't know.

At first glance, it sounds obvious, maybe even a little woo—like something you just brush off: “Obviously.”

But when I finally stopped to hear those words, they landed like a punch to the gut.
Because for most of my life, I thought I had things under control.
I’d done everything I was supposed to do.
Med school. Residency. Attending job. House. Kids. I was on track.

But looking back, I realized I was coasting.
Moving on autopilot.
Going through the motions under the illusion that I was the one driving.
But underneath it all, I was just running on autopilot—and not really asking myself why.
Not seeing how much of my day-to-day was being shaped by assumptions I didn’t even realize I was making.

[00:02:00] I didn't question the stories I was telling myself. I didn't realize how small my world had quietly become.

As physicians, we're trained to have all the answers.
To keep it together. To be competent. Reliable. In control.
And for the most part, we are.

But that same mindset can box us in.

Without even realizing it, we start living inside these narrow tracks—same routines, same identity, same expectations. And the walls around us? They're invisible... until they're not.

For me, things started to shift when I began to entertain the possibility that my thoughts weren’t always facts.
That my perspective—while really deeply familiar—wasn't the only one.
That maybe, just maybe, I could learn to see things differently.
And with that small crack in the armor... everything started to change.

[00:03:00] But here's the thing—it wasn't easy. It's still not easy.
Slowing down, paying attention to your inner world—that's not something most of us were trained to do.We're fixers. Problem solvers. Move on. Handle it. Don’t dwell.

But awareness—real awareness—is where change begins.
Because you can't shift what you haven't noticed.

So, how do we start to build that kind of awareness?
How do we begin to notice the things we've been too busy—or too trained—to see?

For me, one of the simplest, most powerful tools I use is something called the thought download.
Now, I know that might sound like a coaching term or something out of a wellness blog, but stay with me.
This is practical, incredibly useful stuff. And it's not fancy.

I just sit down—sometimes with a pen and paper, sometimes just tapping into my phone—and I dump out everything that's running through my head.
No editing. No judgment. Just a brain unload.

The to-do list. The frustrations. The random worries. The half-baked ideas and thoughts. All of it.

Then I pause. I look at what I wrote.
And here’s where it gets interesting—I start to separate what’s fact from the thoughts.

Let me give you an example:
“I have 12 patients to see today.”
That’s a fact. There are 12 patients on my schedule.

“I’ll never get through them and they’re all going to be angry.”
That’s a thought.

Same situation—totally different weight.
Because once I can see that one is just the story I'm telling myself, I can start to question it.

[00:05:00] Is it even true? Is it helpful?
How do I feel when I believe that?
How do I show up?

This isn’t about pretending everything is fine.
It’s not about sugarcoating reality or slapping a positive spin on a hard day.
It’s about reclaiming a little bit of control over my day—a little bit of agency.
It’s about creating just enough space to choose a different thought, and with it, a different experience for the same day.

Now, I can't control my patients.
I can control myself—and how I show up to clinic that day.

Another tool that’s become a kind of anchor for me is a thought check-in.
Right when I wake up.
A first-morning check-in—before I even get out of bed.

I just take a minute to notice:
What’s the first thing running through my mind right now?

Sometimes it’s neutral. Sometimes it’s even helpful.
More often than not, it’s something like:
“There’s too much to do today,” or
“I’m already behind,” or
“I do not want to get out of bed and face this day.”

Sound familiar?

Just naming that early thought gives me a chance to respond—not react, respond.

Sometimes I ask myself, “Is that true?”
And even if it is—even if I really don’t want to get out of bed—
Is there a better way I can think about it?

Maybe something like, “Yeah, it’s a full day today, but I’ve handled days like this before, and I’ll do it again.”

It’s not toxic positivity.
It’s not lying to myself.

It’s strategic.

It’s about choosing the thought that helps me start the day in a better headspace.
Not a false one—just something that’s helpful.
Something more steady.

[00:07:00] Now look, I want to be really clear about something.
This isn’t about perfection.

Building awareness is a skill.
And like any skill, it takes practice.

You’re not going to do this flawlessly.
I sure don’t.

Even now—even as I’m sitting here telling you about it, how to do it, several years into doing this work—
I still miss it.
I still don’t get it right.
I still catch myself believing unhelpful thoughts.

Especially when I’m tired or stressed or maxed out.
Especially when I’m thinking, “I can’t handle one more thing.”
That’s a favorite unhelpful thought I have all the time.

And I’ve learned to catch it when it comes up.
But that’s the point.

The goal isn’t to get it right.
It’s to notice a little more often.

It’s to catch the pattern a little sooner.
And to recover a little faster.

Because even those small shifts—they start to change everything.

And here’s something I wish I’d learned much earlier:
Our brains aren’t trying to make us happy.

They’re trying to keep us safe.

That negativity bias you feel every day?
Totally normal.

Our brains are constantly scanning for threat and danger—whether it’s real or imagined.
And for most of us, the threats these days aren’t tigers or bears in the wild.

They’re emails.
A full clinic schedule.
A colleague’s tone.
A patient’s complaint.
The tension in your kid’s voice when you’re already late.

[00:09:00] We live with this constant undercurrent of stress.
And unless we’re really deliberate about how we manage our minds,
We stay stuck in survival mode.

On edge.
Reactive.
Exhausted.

So what’s the antidote?

For me, it starts with intentionality.
Slowing down enough to ask:
What am I thinking right now?
Is that thought serving me?
Is there a better one I could be choosing?

That one practice—pausing, checking in—has pulled me out of countless mental spirals.
Because so often, I’m believing something that’s not even true.

Or maybe it is true…
But it’s not the only truth.
It’s not the only way to see things.

And when the days get heavy—because they do, and they will—
I ask myself:
What’s still going well?

Because even in a hard day, something is usually going okay.
And it’s worth noticing.

I started keeping a daily log—three wins for the day.
That’s it. Just three.

Sometimes they’re big:
“I helped a really sick patient today,” or
“I showed up for my family when they really needed me.”

Other times it’s just:
“I made it to the gym,”

“I didn’t snap at my daughter when she rolled her eyes at me, even though I really wanted to,”
Or “I caught up with a friend on my commute home.”

It’s not about pretending everything’s great.
It’s about retraining my brain to see more than just the problems.

Because guess what?
There’s always more than just the problems.

Now look, if all this sounds like a lot—I get it.
When you’re already overwhelmed, one more thing to do can feel impossible.

So here’s my challenge to you:
Start small.

[00:11:00] Today, just notice one moment where you feel off—anxious, irritated, ready to shut down. Just pause.

Give yourself a few seconds and ask:
What’s coming up for me right now?
What am I thinking about?
What do I think is going on?

That’s it. That’s literally all you have to do.
That’s the first step.

And over time, that step becomes a habit.
And that habit becomes a lifeline.

Another tool that’s helped me actually stick with these practices—
Something called habit anchoring.
And it’s exactly what it sounds like.

I anchor a new habit that I want to create to things I’m already doing.

So in the morning when I’m in the shower, getting ready for the day, I ask:
What am I thankful for?

It can be simple things—like clean drinking water or a warm bed to sleep in.
Or bigger things—like my family and my job.
Really anything.

And at night, as I’m turning out the lights and heading to bed, I ask:
What went well today?

Again, it can be anything—
Successfully making it through 15 procedures,
Eating dinner with my family,
Or just the fact that I’m headed to bed before 11:00 PM.

It sounds small.
It is small.

But those tiny moments, they stack up.
They start to shift the way you see your life.

Instead of your brain scanning for everything that went wrong,
It starts looking for what went right.

Not because you’re in denial—
But because both are true.
And you finally have the space to see more of the picture.

Now, this may seem woo or uncomfortable or a bit out there.
And I get it.

Doing something different can absolutely feel that way.

So why is this important?

[00:13:00] Why would you push yourself to do something different, even though it might be hard—Or worse, that things might not go as planned?

Well, I’m so glad you asked.

Here’s an example I love:

I live in Chicago, and really anywhere it snows,
People tend to drive in the tire tracks left by the cars in front of them.

When the snow is first starting to fall,
It’s safer.
It’s more familiar.
It’s less slippery.

And our brains work the exact same way.
We follow the mental tracks we’ve driven a thousand times before because it feels safer.
It’s predictable.
It’s known.
We’ve already done it.
But if you stay in those tire tracks forever,
You’ll never exit.
You’ll never get home.

You’ll just keep driving.
And you never get where you want to be.

If you want to get home—
If you want to change—
At some point, you have to veer off those tracks.

And yeah, at first it feels a little scary.
You might skid or slide.
Sometimes even briefly lose control.

But little by little, you form new tire tracks in the snow.
You carve a new path.

And over time, it becomes just as familiar,
Just as real,
Just as possible.

That’s neuroplasticity.
That’s what it means to build a new default.

And it all starts with one small shift in awareness.
One pause.
One check-in.
One new track.

So today, maybe just try this:
Notice any thought.
And gently ask yourself—
Is this serving me?

Because once you start to see your thoughts,
You don’t have to be ruled by them.

And that changes everything.

So why are these thoughts so essential?
Why does it change everything—

[00:15:00] Just evaluating these thoughts?

It’s because our thoughts create our feelings.
And I know that might sound a little abstract—
But stay with me.

We think it’s the patient,
The schedule,
The EMR,
The partner who didn’t text back,
The administrator who sent that tone-deaf email—

But it’s not.

It’s what you think about those things.
It’s what you are making those things mean.

That’s what drives how we feel,
How we react,
Ultimately, what we create in our lives.

No one taught us that in med school.
We were trained to fix, to respond, to take action—
But not to question our thinking.
Not to pause and say, “Well, what story am I telling myself about this?”

But once you see it, you can’t unsee it.

I remember a day not long ago—
I was running late.
My clinic was packed.
My medical assistant was flagging me down to talk about a difficult patient.
And I felt this wave of frustration just rising up inside me.

And the story I heard in my head was a familiar one:
“Of course, it’s always like this.
No one respects my time.
This is just how it is.
I need to get used to it.”

But that wasn’t a fact.
That was a thought.

And that thought—
It was making me angry, closed off, frustrated, impatient.
It wasn’t helping me show up the way I wanted to.

And in that moment, I had a choice.
I could keep spiraling—
Which probably would’ve meant some offhanded comment or a brief response
That would’ve left everybody else frustrated.

[00:17:00] Or I could pause.
Notice the thought.
And ask myself—
Is there a more helpful way to see this?

That doesn’t mean pretending it wasn’t hard.
It does mean not adding unnecessary suffering
On top of the challenges that were already there.

When I am in it—really in it—frustrated, overwhelmed, spinning,
I can’t always see what’s going on in my head.

That’s where outside perspective is everything.

Sometimes it’s a coach.
Sometimes it’s a friend.
Sometimes it’s someone who just asks the right question at the right time:
“Is that really true?”
“What else could be going on?”
And—
“Would you say that to a friend?”

Would you say that same thought to a friend?
What would you say to a friend who thought that?

Those kinds of questions, asked with curiosity and no judgment,
Can gently start to loosen the grip of a thought that’s been holding you hostage.

So if you’re feeling stuck—
In your work,
Your relationships,
Your identity—

I want to offer you a few gentle starting points.
Not as a prescription,
Not as a fix-it list,
Just as an invitation.
Start with awareness.
Just notice—
When do you feel off?
When do you tense up or shut down?

And then pause.
Ask,
What am I thinking right now?

Try a thought download.
Get everything out of your head and onto paper.
No filter, no censoring.
Then go back.
Underline the facts.

What’s left?
Those are your thoughts, your interpretations, your stories.

Now question those thoughts.
Is this true?
Is this helpful?
Is there another way to see this?

Anchor new habits to old ones.

[00:19:00] Tie a mindset check-in to something you’re already doing—
Like brushing your teeth, making coffee, or driving to work.
Make it simple.
Make it yours.

And celebrate those small wins.
End the day with three things that went well—
No matter how small,
Especially when they’re small.

And above all, give yourself grace.
You’re not gonna do this perfectly.
I don’t.
No one does.

But that’s not the point.
The point is progress.
A little more awareness,
A little more choice,
A little more room to breathe.
Because once you begin to see your thoughts,
You begin to change your life.

And maybe, just maybe—
You start to feel a little more like yourself again.

So if nothing else today, I want to leave you with this:
There’s nothing wrong with you for not seeing it all.
You’re not broken for needing a moment.
You’re not failing because you didn’t notice sooner.

You just didn’t know what you didn’t know.
And now—
Now you do.

And that opens a door.

It doesn’t mean everything changes overnight.
It doesn’t mean you suddenly have all the answers.
But maybe now you’re willing to ask a different question.
Maybe you’re ready to see a little more clearly,
To pause a little more often,
To respond with just a little more intention.

And that’s enough.

If this conversation stirred something in you—
If it brought up a question, or a memory,
Or just a flicker of “Oh… maybe that’s me,”
I want you to honor that.

Not with judgment—
But with curiosity.
That small flicker is where everything begins.

[00:21:00]
Thank you so much for being here with me today.
If you liked this episode,
Please share it with a friend, a colleague—
Someone who might be stuck in their own snowy tire tracks.

And if you’re curious about what’s possible for you,
I’d love to keep the conversation going.

Until next time,
Take care of yourself.
Notice the stories.
Choose your thoughts with care.

And remember—
You don’t have to stay in the same lane forever.
You get to choose.
And that choice starts now.

I’ll see you next time on Better Physician Life. Take care.