Pulse Check with Dean Nelson - August 2026
Sharing thoughts, laughs, and a little wisdom!
The Innermost Circle
At a recent medical meeting, a former resident from decades ago told me about a patient she had recently cared for. She described the clinical problem, then added, "I still remember what you taught me when I was on your rotation." I had no memory of teaching her that, though it did sound like something I would have said. What struck me was not that she remembered the lesson. It was that an encounter that felt entirely routine to me had become, for her, one of those indelible moments – the kind that quietly shapes how a person thinks and makes a hard decision, long after the moment itself is gone
That is usually how it works. The moments that matter most rarely announce themselves, and what people carry forward is almost never the exact thing you said. It is how you said it, absorbed into their judgment, that remains long after the words themselves are gone.
Author and leadership researcher Simon Sinek built a career on a related observation: why some organizations earn lasting loyalty, and others do not. In Start With Why, he describes what he calls the Golden Circle. What an organization does sits on the outside. How it does that work sits inside that. Why it exists sits at the center. Most institutions can explain the outer two rings without hesitation. Few can explain the center. Sinek argues that leaders who inspire real commitment work from the inside out, because people do not commit to an institution for what it produces. They commit to the reason behind it, and that reason is what outlasts memory of the specifics.
This month gave me two chances to watch that theory play out. Our newest class arrived for their White Coat Ceremony on August 7. A room filled for White Coats-4-Care, our annual fundraising event, on August 20. It would be easy to describe both by what they produced: another entering class, another successful evening. Both are true. Neither is the reason anyone should have cared enough to show up.
The real why is older than any strategic plan. It is why a student spends four years earning a coat that, on its own, does not make anyone a physician. Their actions eventually will. It is why a donor who has never set foot in our anatomy lab provides a scholarship they will never directly see used. It is why a faculty member turns down a more comfortable position elsewhere to keep teaching here. None of those decisions make sense as transactions. Each one makes sense as a belief.
When we recruit faculty, we recruit people who already believe in that why before we describe the job. When donors gather every August, they fund a reason, not a building. When a new class puts on a coat and starts a curriculum built years before they arrived, they step into a why that predates them and will outlast their time here.
That is why the new academic year lives in the innermost circle, not in the numbers stacked around it. It is a sharper answer to the question underneath all of them.
I do not yet know which moments from this year will be the ones a student, a resident, or a colleague will carry decades from now. Most of them will look ordinary at the time. Mine did too. But the reason behind them is stronger this year than last, and stronger last year than the year before. That is what real growth looks like. Not more of what we do. A clearer sense of why we do it.
Why First
Ted Lasso's fourth season opened with Ted still in Kansas: co-parenting his son, working part-time at a grocery store, three years removed from any locker room. Rebecca, Keeley, and Higgins fly out to offer him a job that requires uprooting his entire life for a team that does not exist yet: co-head coach of a second-division women's side Richmond has not finished assembling. He says yes, and his family agrees to go with him, before there is anything to point to except the idea. Nothing about the what or the how was settled. Only the why was.
What followed was not a triumphant return. By episode three, Richmond's own shareholders are openly questioning whether a second-division women's program is worth the investment at all, the same doubt that greets almost anything unproven, voiced by the people whose job is literally to worry about outcomes. The response was not a pep talk. It was tryouts: open ones, the roster-built one, unproven player at a time, because the only way to answer doubt about whether something can work is to go build it.
Sixteen years ago, a small group of people backed a medical school with no graduates and no outcomes yet, past the same kind of doubt from people whose job was to worry about outcomes. The bet was never that the numbers already worked. It was that the reason was strong enough to make the numbers eventually follow. The Lady Greyhounds are being built the same way, one open tryout at a time, with the shareholders' doubts still on the record. Sinek would call this the only order that ever actually works: why first, then how, then what, with the record catching up whenever it catches up.
Stay curious, MedOwls.