Pain Is The Signal

Ray Dalio, the billionaire hedge fund investor that wrote the book Principles, said something in it that changed my life.

Pain is the signal. It tells you where you need to improve. Most people ignore the pain. But you need to look towards it, because it’ll tell you how to get better. And once you get better, then you’ll get over the thing that’s causing you the pain in the first place — instead of banging your head against the wall every time you come to the same problem.

When I was a junior doctor, my time in ED was bountiful in lessons but painful in the way they were delivered. You never really forget something like that, because it’s your worst fear come true.

One of the senior doctors I feared - a brilliant but stern ED physician - was someone I had to report cases to. At the start of the rotation, she almost always looked disappointed in me. My histories weren’t thorough enough. My case discussions weren’t succinct enough. She couldn’t trust my opinion. Fair enough.

I dreaded working in that ED. Every car ride was filled with anxiety, maybe helped by mindfulness apps, but always with the simmering fear that someone would die that shift and it would be my fault. But, one thing I did keep listening to was Ray Dalio’s audiobook.

“Pain is the signal.” Facing towards it is the way you get better.

Then, somewhere along the line, I started to really improve. There was nothing left but to persist through sheer effort, intense self reflection, and embracing that pain - often through literal tears. My days were long and difficult.

But then that ED physician came up to me.

She said, “David, I want to talk to you.”

That’s hella scary.

“I’ve noticed you’ve really come a long way. Your histories are more thorough, the patients are worked up well. I can see that you’ve been working hard, and you’ve really improved a lot. So I just wanted to commend you for that.”

That mean so, so much to me.

Pain was the signal - and is the signal. Ray Dalio was right. I became better. That tireless thoroughness and commitment to detail drilled into me, I carry with me today to the patients I see. They see a joking, smiley, family doctor in the clinic room. It’s because I genuinely enjoy doing medicine often, now, even though there are of course bad days sometimes.

Sometimes patients exclaim “you look so young to be a doctor.” I even got told this by someone ten years younger than me once. And, maybe I am approximation of young, at the age of 28.

But 11 years of medical knowledge and real life experience are - were - a treasure that was paid for with intense labour, sweat from my eyes, sleep deprivation, and time.

So I smile, joke, assess, diagnose, investigate, explain, reassure, or break news sensitively. By reflecting on the pain and deliberately improving on it, it helped me become a better doctor, and that is a lesson from Ray Dalio I’ll always appreciate immensely.