From Medical Practice to Mindful Leadership: Dr. Ravi Iyer on Cognitive Alignment and Peak Performance

Brent Peterson (00:02.028)
Welcome to this episode of Uncharted Entrepreneurship. Today I have Ravi Iyer. He is a three times TEDx speaker and I'm super thrilled to have him. Ravi, go ahead, do an introduction for yourself. Tell us your day-to-day role and one of your passions in life.

Ravi Iyer (00:17.48)
My day job, Brent, it's pleasure being here today. Thank you for having me. My day job is as a physician, still see I have an active practice. I'm an internal medicine physician and I see about 20 to 30 patients a day. It's an eight to five job that keeps me busy. I run the IER clinic that operates out of Fairfax and

southern counties and it's a very popular destination for adult seeking internal medicine care. I came to this job over a 42-year career as a physician, migrating through the research labs at Harvard where I got, did some work on

hardcore molecular biology and immunology and then moved from there to George Washington, got my residency, did my license, started practicing in Western Virginia, entered leadership roles at HCA, Western Hospital. I was the chairman of the Department of Medicine.

And I was vice chair and then chair. I have a saying, if you just show up for work, they eventually promote you.

But while I was at HCA as the chair, I got to spearhead the migration of the hospital from paper-based charting to electronic medical records. So that was my first exposure to the complexities of organizational change and change management. And it was a learning experience, but I found that I was able to negotiate and navigate

Ravi Iyer (02:13.858)
those waters very well.

Later on, those same skills came into play during the pandemic, except that this time I was navigating the waters of fear and terror and chaos that was gripping the entire community I was serving. And I found that my team at the iO clinic was exceptionally good at helping people transcend their circumstances and stay focused

on what was real and immediate as opposed to spinning out of control within the narratives of their mind. And after the pandemic was over, I had some moments of reflection where I looked at it, all of it, and I decided that the same set of skills that I brought into play at Reston Hospital during the...

IT migration was the same set of skills that I brought into play in the pandemic. And I found that the common elements that I could take and I decided that there was a need for this.

skill set to transcend and be given from a one-to-one platform where I was treating one patient at a time to actually go to a one-to-many platform. I by writing a book and then started talking about it on podcasts, about 50 or 60 podcasts later. I decided I'll go to the TED stage. I took the whole message to the TED stage. And three TEDx talks later,

Ravi Iyer (03:56.296)
I'm here in front of you.

Brent Peterson (03:58.902)
Well, that's amazing. Do you have any time for hobbies and passions outside of your medical practice and talking?

Ravi Iyer (04:05.214)
This is my hobby. My hobby is life. My hobby is, I used to play, I used to train police dogs for 20 years. used to compete. But even then I was doing it for the purpose of understanding behavior and learning.

And high intensity dogs that have high drives and high aggression are excellent learning models for understanding what drives leadership, what drives reward and punishment, what drives, how do you maintain balance between motivation and rebellion.

initiative and out of control, loose-calming behavior. How do you steer? especially trying to do that cross species gives you an insight into very fundamental foundational learning mechanisms. The theories of B.F. Skinner, Thondike, you know.

All of those are universally applicable and I used to borrow from there. I used to test it out there, bring it back into the human world and apply it in my clinic when I had to help people transcend destructive behaviors or addictions and so on and so forth. So, but my hobby is life. The thing that has absorbed me since I was a young kid is...

What makes life work? And how do you make life work when life does not work? And it is this fundamental question that has been the constant theme of my life. And that is what has taken me into medicine, into research, getting a doctoral degree in India, coming to Harvard, going into leadership roles in the hospital, and so on and so forth.

Brent Peterson (06:16.812)
Wow, it's very inspiring. Thank you for that. Ravi, before we dive into content, we're going to talk about some cognitive alignment and things like that. Before we dive into that, I'm going to tell you a joke. And all you have to do is part of the free joke project. All you have to do is give me a rating 8 through 13. So here we go. What do you call a French guy being mauled by a lion? Claude.

Ravi Iyer (06:34.304)
Okay.

Ravi Iyer (06:48.448)
Maybe the 10, maybe 11.

Brent Peterson (06:51.054)
All right, well, thanks for that. appreciate it. So let's come back to cognitive alignment. you kind of in your preamble, in your intro there, you kind of alluded to what that means. But give us an underpinning of why you chose to really dive into that and what that means to people.

Ravi Iyer (07:14.144)
So the problem of cognition is both very personal as well as operational for me. Personally, I have Asperger's ADHD and I grew up in a country where nobody knew of those words. And I did not have the remotest...

degree of therapy or treatment or anything like that, and I had to struggle my way through it and actually acquire skill and capability of managing it. But in the process, as I came into the work world, especially at Harvard and then later on during residency at the bedside, I saw that whether it was a patient or it was a corporate

The fundamental thing was the conversations that people were having about their experience of life determined the options that they had. So one thing I found out was that we actually live, we are actually a binary product.

There are two aspects to all human beings. One is the ability to experience life through our five senses. We perceive the input from our five senses.

And then we have an interpretive judgment, assessment, narrative, story, relative value structure, like, dislike, an entire machinery, what I call the meaning-making machine, operating that takes this input that you get from your five senses and makes it to mean something. And

Ravi Iyer (09:16.532)
The constructs you make out of your inputs is not universally constant between a varied number of people. Different people have different levels of variations in the constructs they make and they also have different variations in their sensitivity to whatever they are receiving through their five senses.

And in this and because of this, the lived experience of 10 people is actually 10 separate lived experiences. They are not one lived experience reproduced in 10 minds. And it is so when you are dealing with a group of people and you want to align them towards a common goal.

you are intrinsically dealing with the task of riding a team of 12 horses, knowing that the lived experience of each of the horses is slightly different, and you have to align them all towards a common goal and common path. And once I understood that, that

The strategy of management has been external imposition of guardrails and reward and punishment structures that steer the horses of teams down a narrow alleyway. While that is useful, high performance requires the team to spontaneously align themselves.

For them to spontaneously align themselves, I found that I had to teach the team the ability to separate the narratives that they were creating from the experience that they were actually experiencing. And this process of creating that three-second space of separation and showing people that you can actually stand in a flow state,

Ravi Iyer (11:38.92)
where you experience the narratives, the collective narratives spinning around and then you can choose which narrative is in alignment with your goals of your immediate life and then allow that narrative to be the dominant narrative to which you direct your attention on. This entire process is what I call cognitive alignment.

And it begins with first showing people that they actually can exist as pure experience. And that is actually something that is true for a five-year-old or a three-year-old. A five-year-old or a three-year-old has only experience. They have not yet built their library of narratives. So what happens is...

The five-year-old or three-year-old is experiencing life with an immediacy and an unfilteredness that is vibrant and extremely real. But as they go along, they build a narrative about each experience and each narrative that they create becomes a blueprint against which the instance of experience is compared against.

And then if it fits, then the next experience is not at all experienced at all. is the person just goes and lives the narrative. And in this way, narratives become dominant and layered upon experience and narrative. Narrative more completely conditions the appreciation of experience and experience reinforces the narrative. And in this way, people imprison themselves in their narratives.

To put an analogy, I borrow an analogy from a very popular 1970s coach by the name of Werner Erhard. He's still alive. He said that most people sit at the restaurant of life and instead of eating the meal, they eat the menu of description of the meal.

Ravi Iyer (14:01.298)
And then they wonder why life is so insipid and has no taste, no flavor, no joy in it. And then they take an extraordinary vacation because they had to go to some location, some circumstance that does not fit any of their past narratives. They had to strap a wingsuit and jump out of a cliff, or they had to do bungee jumping, or they got to go up in a hot air balloon, or they had to climb Mount Everest.

to experience life free from any other preconditioning narrative. And then later on, they fall into the trap that only if they do that can they actually experience joy and they keep going for the next thrill, for the next thrill, for the next thrill, never realizing that they could sit in their backyard and simply pay attention to the bumblebee on the flower.

and they will experience the same thrill that they had when they jumped off a cliff.

Brent Peterson (15:05.486)
Yeah, that's really good. If you're an, let's, our audience is entrepreneurs and as an entrepreneur, lot of people are, as you described in the beginning, ADHD. How do you get them to, do they first have to kind of get, find their own alignment before they can get their teams on board or tell us a little bit about that journey as a leader?

Ravi Iyer (15:30.206)
You can do it both individually and collectively because each individual in the team is actually going on an individual journey, but you can do it together as a group. And the method is very simple. Just like when you want to develop a six pack or you want to build your biceps, you go to the gym, you dedicate some time, energy, and resources.

You dedicate some distraction-free environment for your activity, and then you start exercising that muscle. You lift weights and do a certain amount of reps, and then you escalate the weight and escalate the reps. And at the end of six months, you have built your six-pack or you built your biceps, and then you can go on to another muscle group and so on and so forth. Building the ability to tend

focused in experience separate from the narratives requires the same amount of diligence as building a six pack. And so it requires a commitment to that effort and it requires the discipline of at least five to 10 minutes of daily practice. You start by first conditioning your environment so that you don't have any distractions.

And once you become facile in developing and entering a flow state for five minutes, you expand it to 10, 15, 20, whatever. And you do that by simple doing some activity. It can be calligraphy, can be painting, it can be listening to music. But whatever you do, you do it with single-minded focus and attention on the experience of that activity.

And as you do that, naturally, the meaning-making machine that you are will pop up meanings, but you learn to disregard those meanings.

Ravi Iyer (17:30.526)
You just allow them to pop up and don't pay attention to this. And initially what will happen is the meaning will be powerful enough to grab you and take you away. And then you'll spend about 30 seconds away. And then you say, what did I do? I've got to be back. And then you come back. So initially, you start with two seconds of attention and 28 seconds of distraction. And then it goes on from there.

Once you acquire a skill in a secluded environment, you start opening the parameters. You start going into less secluded environments. You start practicing observational experience while you are in the midst of activity, while you are working, moving. You start while you're driving. And you...

Use your attention only on driving and not on anything else. And in this way, you become facile. You become skilled. And as you become skilled, you will start noticing some benefits. The prime benefit you will notice is that as you become more and more skilled at remaining focused on experience,

you will feel that events around you slow down. You will find yourself having greater amount of time to execute.

It'll be almost as if demands on your time comes to you in slow motion. And you can pick and choose with great facility. The concept of time spread stretches out into an infinite timeline. And you really begin to experience space. Then the next important thing is, as that happens, you'll also notice an increasing level of silence happening in your brain.

Ravi Iyer (19:31.39)
inner chatter that goes on, the constant planning, the constant strategizing, that starts going down. And then you will notice that in a crowd, in a meeting, you are able to penetrate at the core of whatever you need faster and faster.

Then the next benefit that you will see is that people around you, they begin to experience that slowing down and focus just by being in your presence. It's almost like you carry a bubble of space around you where everyone who comes into that bubble, they slow down a little. By that, when I say slow down, it doesn't mean that their work slows down.

Their mental chatter slows down. They become more calm, focused, and deliberate. And then you'll find people wanting to be in your presence, because in your presence, they experience freedom and space. Your natural attraction index goes up. We walk into a room, people begin to notice you. If you're a ladies man, ladies begin to notice you. I'm serious. It is. It happens.

So those are the things that happen over time. Average time that it takes to develop this, at least a year, to start seeing meaningful, just like any other gym exercise, you don't get fit in less than a year. Same here.

Brent Peterson (21:09.294)
That's fascinating, Ravi. And we are quickly going through our time here. I wish we had another hour to talk. Give us an idea of how people get started working. How would they get started in this?

Ravi Iyer (21:24.48)
An example of this would be Japanese tea ceremony. That's an entire exercise in observation. I personally do breath watching because I can do that while people are talking around me, I can watch. Some people focus on some object and...

let the attention be rooted and you will find as you go along the way that you can actually operate at two levels.

And it makes a big difference when you are able to have that binary level of operation. When you speak in a public setting, you are able to be more easeful in your speech because there's a part of your mind that is constructing the arguments as you are going and you start developing greater and greater ability to pivot and weave the story back and forth. All of that starts...

But the best way is to actually have a coach like anything else. Having a coach who knows what are the pitfalls, who can tailor your path is immensely beneficial. I conduct

training programs both for groups as well as individuals. And like anything else, requires commitment on part of the student, certain commitment of resources and time and energy, and anything can be accomplished. That's all.

Brent Peterson (23:08.918)
That's awesome. Ravi, as they close out the podcast, they give everybody a chance to do a shameless plug about anything they'd like. What would you like to plug today?

Ravi Iyer (23:18.132)
The cognitive alignment workshop or COGAL workshop as they call it and the strong course which is the strategies of neuro-aligned groups is, has cohorts running through the year and there's there are openings coming up in June which anyone can use. Just go to my website, www.driyer.com.

and book a discovery call and we can sign you up and you can start reaping the benefits for yourself or your team anytime.

Brent Peterson (24:00.748)
That's awesome. Thank you so much. And I would encourage people to look you up on TEDx to see your talks and I'll make sure we get those, that contact information in the show notes. Ravi Iyer is a three time Ted speaker. He has 2.2 million views on TEDx.

Ravi Iyer (24:11.264)
Thank you.

Ravi Iyer (24:17.088)
Ted is very particular about distinguishing those two events.

Brent Peterson (24:25.838)
three times TEDx speaker. Thank you so much for that. It's been such a great conversation. Thank you so much for being here.

Ravi Iyer (24:28.372)
Yeah.

Ravi Iyer (24:33.716)
Thank you Brent and it was a pleasure.

From Medical Practice to Mindful Leadership: Dr. Ravi Iyer on Cognitive Alignment and Peak Performance
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