Ferraris to Fitness

I went to school not really knowing what I wanted to do long-term, or at uni, so I defaulted to what I thought was easy — and easy to game, or so I thought — which was maths and business. I always gravitate to the quantitative subjects, because you can learn the curriculum and guarantee a decent mark, whereas the qualitative stuff is a bit harder. But there wasn't really a thought about what the long-term goal was. Business is a very generic subject, so I thought, let's go with that. And I ended up working for an investment bank.

During that time I started to have an inkling that this isn't really what I want to be doing. I'd look at my boss and think, this guy is 10 years ahead of me and I don't want to be him in 10 years' time — and if I continue doing what I'm doing, I'm only going to end up closer to that.

The thing that pushed me over the edge was partly setting up Propane Fitness, and partly reading a chapter in a book by David Deida about purpose — living your authentic truth. His idea is that your purpose isn't fixed; it evolves over time and falls away like the layers of an onion. The outermost layer might be the thing most relevant to you at a specific time, but as it falls away it dries out and becomes irrelevant, and if you try to hold onto it you're not living in alignment with your authentic truth — and people can sense that inauthenticity. So you have to move in line with it. For me, that was going to study medicine. The difficult thing is that it keeps changing, and as each new layer comes up it refines itself, and sometimes it's not under your control — but you have to go with it. Which, for the kind of personality that wants to control and quantify everything, is difficult.

So alongside all that, I set up Propane Fitness, which initially was a sounding board for me and my business partner Jonny — a way to get our thoughts down on paper and distil the key lessons we'd learned improving our own physiques and competing in powerlifting, to help people gain muscle and lose fat. As you know, the fitness industry is full of charlatans and conflicting information and stuff that just isn't very evidence-based, so it was mainly a personal mission to get something down on paper. But it started to gain organic traction — enquiries from people who wanted to work with us, which wasn't what we'd intended. Looking back, that's the best way to start any venture: doing it for the love of it, not for the money. Doing it for money twists your incentives.

This was while I was at med school. It got to the point where the profits were something we could take full-time. By then I was year two of a five-year medical degree, so I thought, I've just got to keep going — but my business partner quit his job as an accountant and went full-time. We ran into a few problems, where we were basically exchanging time for money, and we'd just created a new job for ourselves. Every new client meant an hour less sleep every week, especially with the constraints of studying medicine. After changing the business model, we managed to delimit that, increase our revenues and scale our time a lot more — and creating systems actually produced a better service for our clients too. So we ended up with happier clients and more freedom. Now, while we still run the fitness business, it's very much taken on a life of its own because it's scaled and relatively passive, so we also help other PTs, coaches and online consultants use those systems to do the same thing.

It was tough. Very little sleep to begin with. The problem when you're self-employed and a student is that your time isn't clearly delineated. It's not like an office job where you turn up, clock off, and your free time is your free time. If you're familiar with Parkinson's law — a task expands to fill the time you allocate to it — and if the time you can allocate is totally fluid, and your personal boundaries aren't clearly set, then very quickly things overtake your life. Particularly two quite endless commitments: studying medicine never ends — you never think, okay, I've completed medicine, I've learned renal, I've learned neuro; it can always go deeper — and business is the same. You can never say, okay, I've worked on the business enough today. That was a big lesson: it can completely consume your life if you're not careful.

One framework that really helped me keep things in check comes from Garrett J. White: body, being, balance and business — the four main quadrants of your life. You can call it health, wealth, love and happiness, whatever you want. The people he works with tend to be middle-aged, overweight businessmen who've become divorced and spiritually disconnected, because they've optimised for one thing — their business — at the expense of everything else, and they end up losing the things that actually brought them fulfilment. His model is to set a single goal in each quadrant: body — training or some physical activity; being — some spiritual practice; balance — friends and family, maintaining your relationships; business — your career. If you just aim to hit a single in each quadrant each week — something that moves you towards your annual goal and three-year vision — then without knackering yourself, you know everything's ticking over. That might be a consistent training regime, buying flowers for your wife every Monday, a date every fortnight, a holiday every quarter; and for business, if you're working towards an exam like MRCP, doing a set number of multiple-choice questions each week. It doesn't have to be an Everest — just tick a small box in each quadrant every week.

Yeah, I was very glad for that to be the case — quite a big moment. The big financial mistake people make is they see their salary as their income. Your salary should never be your main source of income, because then you're one step above poverty. We saw this a lot during the coronavirus lockdown: people lost their jobs, and often don't have enough of a cash buffer to last more than a couple of weeks beyond their paycheck — which is why all those measures had to step in to keep everyone afloat. It suggests we're too reliant on our salaries. Sometimes that's unavoidable — you've got expenses and dependents — but the biggest sink I see is consumer credit. People upgrade their lifestyles well before they can truly afford it, and it's not related to the absolute amount of income. In the investment bank you'd see 25-year-old junior traders on £100k, £150k salaries who'd buy a Ferrari or loads of expensive wine, and you're thinking, yeah, you're on a big salary, mate, but you can't afford a Ferrari.

Whereas I try to see my life as: how can I increase my net investable wealth as rapidly as possible? Which is no more complicated than keeping your expenses as low as possible, not upgrading your lifestyle until you have assets that can pay for it as an independent loop — rather than taking a big chunk out of your salary each month — and creating multiple sources of income: investment income, income from your businesses, from freelance stuff, and from your salary. They all feed into this machine that generates assets. I define an asset as something that produces income or a net positive cash balance over a period; a liability is the opposite. So another mistake is that people see the house they live in as an asset. It's not — it's a liability; it costs you money every month. The equity you're gaining isn't realisable cash unless you sell. Unless you own it and rent out rooms so it generates a positive balance, you have to be honest and ask: can I truly afford this, or do I just have access to leverage to artificially upgrade my lifestyle beyond my means?

That's a good point, and we've got a lot to be grateful for as doctors — when everyone's losing their jobs around us, there's not even a sniff of the threat of us losing ours, because we're so needed. But in the UK, being a doctor isn't well paid, especially if you take the hourly rate and include the time outside your job — the hours studying at med school, the things you give up, the opportunity cost. The hourly rate is pretty terrible. But for that you're getting an extreme amount of security, and that's very valuable in itself. There are jobs with very high potential income that are highly unstable — you can't rely on them, and that's why they're paid so well. It's the same reason locums are paid so well: there's no guarantee of an ongoing contract. So we're compensated with security more than cash.

I'm maybe a bit simple in my thinking. Part of the reason I left investment banking is that you're part of this machine, and you think, this is so abstracted from any human impact that I can't reconcile it with going home and feeling I've made a difference. The CEOs would say, well, you're building the pension of the fireman and the teacher, you're the fiduciary for these people — and that's great, but I just couldn't think at that level of abstraction. I wanted some degree of personal, one-to-one impact, which is where being a doctor comes in. And this is where the security is a non-financial benefit. There are a few different currencies we operate on — maybe it's the banking background — freedom of time, freedom of location, satisfaction or impact, and money. Each job is a different combination of those, and it's up to you how much you value each one. A common mistake is going into a job to optimise for one of them and forgetting the others.

There's also the backward-bending curve of labour: if you increase the hourly rate you'd pay someone for a job, the number of people willing to do it increases, almost linearly, up to a point — say 100 hours a week. Beyond that, you couldn't pay someone an extra million pounds an hour to work an additional hour; the curve bends back on itself. At a million pounds an hour they'd actually work fewer hours, because they're either against the physical limits of how much they can work, or they've maxed out their satisfaction from the money and would much rather value their time.

Absolutely — I agree everyone could do with gaining a bit of muscle and losing a bit of fat, everyone wants that to some degree, so those are useful metrics. If you don't know what you want — unless you're really specific, like improving your VO2 max — then aiming for fat loss and muscle gain confers a lot of the benefits we see for longevity: improving strength and cardiovascular fitness, reducing the risk factors for preventable diseases. It's a very good goal to shoot for. The specific problem medics have is there's a lot of bum time — sat reading, studying for exams, at the computer — so we need something to counteract being sedentary, the postural effects, and the lack of an anabolic stimulus. Plus Quality Street is rife on the wards.

So for medics, some kind of resistance training two or three times a week not only counteracts the postural effects of sitting, it normalises your response to stress — when you've got very few windows and high-pressure demands, you need something so you're not running on low-level stress all the time. There's a huge evidence base behind it too. The way I'd start: pick your goal — fat loss or muscle gain — and focus on one to begin with. If you're not sure, start with fat loss and then transition into muscle gain. There are a few reasons: you sensitise your tissues to insulin, improve nutrient partitioning, and when you lose fat you get a higher yield on your inputs and can see your progress, which is more satisfying. Then set your calories in line with that and train two to three times a week: some form of push, some form of pull — horizontal and vertical — and some kind of leg movement. You don't have to complicate it. There are many free programs, we have one too. The great thing is it's so low in time commitment — each session can take 40 minutes and you'll see huge changes.

Good point. People think, I've got this number of hours, and anything but working myself into the ground takes away from my output. But that's looking at the body as something that doesn't need refuelling or recharging. Take that argument to its nth degree and you'd say we shouldn't sleep either, because that's a waste of time. We need to be compassionate with ourselves and realise that yes, these type-A personalities have demands on what they can achieve, but we're still mortal creatures, and we have to give the body what it needs to produce its best output.

I'd like to touch on this later when we talk about meditation, but as medics we see the mind and body as separate entities — the doctor's achievements are achievements of the mind, not physical feats — so we don't see the connection with taking care of our bodies. That mind-body separation is only a Cartesian model to help us categorise things anatomically, but there's no anatomical point where the mind ends and the body begins. We're a unit, and taking care of one is taking care of the other. The mind is in the body.

It's an important point that so many high performers and CEOs have a consistent meditation practice — it's no coincidence. These are people who are very tight on time and wouldn't waste it on something useless, so we have to ask why they all trend towards something that's effectively just sitting and looking at our noses. Meditation has been mis-sold. It's become subject to the mindfulness movement — almost like the six-minute abs of training the mind — people saying you can meditate for six minutes a day and get huge results. You're making functional and structural changes in your brain, so it takes a bit of front-loaded effort, but the results are massive. For a medical audience, you'll probably be convinced by the evidence: improved emotional regulation, thickening of cortical grey matter, improved pain tolerance, concentration, mood.

But it's important to remember meditation wasn't designed as a performance enhancer — it was designed to undo the illusion of self, and if you're making an intervention you should be aware there can be effects. I spoke with Dr Daniel Ingram, an emergency medicine physician in the States who took meditation to the extreme — he did about seven years under retreat and decentralised his subjective consciousness. He's very systematic about it, and he says to be aware of what you're getting into. To get started and see the benefits, the best way is to get a taste of the result yourself. It'll come naturally to knowledge workers who already spend a lot of time in deep concentration — the challenge won't be maintaining concentration, it'll be carving out the time.

I wouldn't see meditation only as the traditional concentration-focused practice, though. If you're a knowledge worker or a doctor, you're focusing a lot of your energy and attention up in your head — you've got a high attention span, you've had to, to get through the MBBS — so the thing you need to practise most might be a physical version of that: breath work, yoga, or a heart-oriented practice like HeartMath or metta meditation — that's m-e-t-t-a — something that lets you integrate these different sources of consciousness.

Yeah, this was a 10-day Vipassana retreat — a structured meditation program. You go to a centre or a monastery and from 4am till 9pm every day you're meditating, with short breaks. The monks wake you at 4am by hitting the gong, you get one meal a day, and it's quite gruelling physically — just sitting on the cushion that long, your back and knees really ache. But it was a really healing experience and I'm so glad I did it. Very much a turbo boost for a daily practice.

The thing I found most crazy: the first five days you do samatha, or anapana, focusing on the tip of the nostrils, and then you focus on the full body — the body scan meditation — for the rest. The first five days refine the attention, get it as precise as possible, to then apply it to the rest of the body. And what happens very predictably with everyone is that throughout each day, similar to the layers of an onion, your emotional flavour changes. Day one for me was sadness, day two fear, then anger, grief, lust. I mentioned this to Daniel Ingram and he said, oh yeah, that's just the anatomy of the mind — everyone goes through those layers in that order. Which I thought was crazy. As the sediment of your mind settles, when you stop agitating it and give it total quiet, that's what comes out.

Days five to ten are where you get into the meat of it and start pulling out your social conditioning. One of the big insights for me was that, as I said, the mind is in the body: every sensation has a thought counterpart, and every thought has a physical counterpart — whether it's a memory or whatever, there's a resonant point physically in the body that relates to emotions and thoughts. It feels weird to describe verbally — I remember hearing people talk like that and thinking it just sounds like you've taken too many drugs — but this was a genuinely experiential realisation from sitting with those sensations long enough.

I got a few questions over the last year or so — how do you balance running a business with a medical degree, since both are high time commitments? — so I thought I'd turn it into a framework. To give you a brief run-through: the first point is that what is more important than how. Before you turn up the engine of your productivity machine, ask, is this taking me to the life I want? What do I want my day to look like, and are my current actions taking me there? If so, great; if not, re-evaluate your values and goals and see whether the weighting of your inputs reflects the weighting of your desired outputs.

Once that's in place, look at what needs to be done by you and what can be outsourced — and you can outsource aggressively. The best way to spend cash is to buy time; in my case that's outsourcing ironing, cleaning and food prep, because I get no joy from them, I'd do a worse job than a professional, and I'd much rather have the time back to do things only I can do that generate a higher return per hour.

Then look at the environment you work in. It's mundane, but the state of your desk and computer matters. We're recording this on a MacBook, which is like running in clogs — all the little micro-inefficiencies add up, all the pauses waiting for a program to launch. Every micro-inefficiency opens the window for distraction: how often have you launched a program that takes more than 20 seconds to open, so you pick up your phone, and then you look up and it's 10 minutes later? You want the thing you're working with to be a seamless flow between what's in your brain and what comes out. Phone on airplane mode or notifications off — one of the quickest, highest-value things you can do. No stray papers on the desk — even if you're not using them, they pull your attention and remind you of open loops. The data suggests the same with phones on the table: if you're having dinner with friends and your phones are on the table, it reduces the quality of the interaction even when they're not being used, which is fascinating.

Next is the process for dealing with tasks coming into your inbox — and nowadays we have so many inboxes: email, WhatsApp, messages. Everyone has access to your private to-do list, so it's important not to have those notifications on; you need to prioritise your own agenda and batch-process what comes in. I used to have a boss in finance who, while explaining something to me, got an alert saying "urgent, please respond," and I said, do you want to get that? She said, no — everything is urgent to the person sending it; explaining this to you is my priority. So eliminate that, and have a process to clear your inboxes with time in between to work on your own stuff.

The process I use is capture, review, do — rather than the David Allen GTD method, which is capture, clarify, organise, reflect, engage. I think it simplifies into three steps. Capture is having a way, when a new task comes into your world, to record it and give it a specific time-box or date in the future when you'll address it. Review is preferably at the same time every day — mine is 8pm — where I look at my calendar for what hasn't been done today and what needs to be done tomorrow, and allocate the time-boxes. And do is when you turn up, say 9am, to a box of time.

Time-boxing is one, and also recognising the value of "enough." That's very hard in med school, because there's no external point where you can say, I know enough about the physiology of the kidney — it could always go deeper. So you need an internal sense of, okay, I've spent enough time on this, I'm going to have a shutdown routine and close that loop. It's difficult because you're examined so aggressively, and the exams feel like they're trying to catch you out, so you're driven more by fear — easier said than done.

The safety catch for all of that is to burn a clean flame: make sure that outside your studies you're doing the things that fuel your happiness and focus. Even when they don't feel like they should be prioritised, if you let them go — if you drop your meditation, your training, your time with friends, anything that keeps you sane — then very quickly everything starts to tank. So be quite sacred about eating with friends or doing some physical activity, just to keep everything else functioning well.