5 lessons learned

This week marks LITFL’s 10th blogiversary and the end of another roller-coaster year.

As a result of a significant and persistent series of viral attacks, we have spent the last 12 months re-writing, updating and transferring all content to our new home at litfl.com

Over the last 10 years we have published 10,000 posts/pages; and opened our doors to >100,000,000 visitors. We have seen FOAM go mainstream by becoming an integral part of textbooks and journals as well as stimulating a significant increase in online access to asynchronous medical content globally…for free.

But this has come at a huge cost

Here are 5 thoughts about the last decade. 5 mistakes I have made and failed to learn from. I hope that recording them now will help others in the future.

1) Family comes first

Altruism requires motivation. Not the motivation of fame and fortune but the motivation to do the right thing and innovate to make change for the greater good. Joining forces with like-minded individuals creates a sense of community and drives the process forward as a collaborative tsunami…

But, the online community is virtual – it is not real.

True, you may meet these kindred souls and shake their hands, but the online community is not tangible. The support you afford it is recordable in statistics but not in the innocent smiles and warm hugs of your real family. Social acceptance of a well-timed snapshot can never replace the depth of gaze, breadth of smile and nod of appreciation that you were there – in person.

Family comes first – always.

2) The cost of free is immense

The majority of the resources we use, advocate, promote and build are free to the end-user. They provide primary resources for clinical cases and research, and secondary opportunities for discussion and asynchronous education. FOAM perpetuates the expectation that limitless resources should be open access and available to all…for free

But nothing in this life is free – someone always pays.

Payments range from the financial cost of hosting, developing and deploying software through to the physical amputation of time and the emotional burden of expectation.

Be wise about what you are building and understand your limitations…then follow steps 3, 4 and 5 to keep hold of reason 1

3) Learn to say NO

Of course you want to say Yes to everything, after all you are riding the crest of a wave – making a difference. Your time is yours to give, the requests are only small and they will benefit the greater good.

But the requests don’t stop.

They are genuine enough and appear small, even paltry to the requestor – ‘surely just a minor talk here or a quick chapter there is not too much to ask – nobody is that overloaded with work!’ Then they become larger, more frequent and more onerous often involving travel, expense and time – and the pressure mounts.

Isolated requests aggregate, accumulate and coalesce as an asphyxiating tide of failed promises.

Nip it in the bud early. Multi-tasking is a myth. Value your time – not in monetary terms – but in terms of self-preservation. Do well what you do well. Remember – just because you can write eloquently does not mean that you can lecture well; just because you can code, does not mean you have to code for the world and because you have done a favour once does not justify a lifetime of service.

Individuals learn a lot by finding their own way through the maze. Sure, you can record the path you have taken with petals of prose and illuminate the darkest passageways with insight – but limit physical hand-holding to helping your kids cross the road…

4) Learn who to trust

Altruists are in general open and honest – but don’t expect everybody around you to have the same ideals and principles.

For example your ‘open and honest‘ approach to life can easily be interpreted as ‘easy prey cash cow‘ to a malignant narcissist. Avoid potentially cataclysmic tribulations by learning to identify and distrust individuals with narcissistic traits. Protect your intellectual property and practice self-preservation principles even if it appears to be against your naturally trusting nature.

People are better at receiving than giving – if you are a giver, give wisely to prevent a vicious cycle of expectation.

5) Accept assistance

You are not a one man show.

Embrace the community and join forces with like-minded peers. Look to institutions and groups to share the writing, financial and educational load. There are many amazing people in this world – reach out and make the world a better place

The flame that burns twice as bright burns half as long.

Lao Tzu
Ali King and George King
2 reasons to smile

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |


  1. Wise words.

    Thank you for all you have given to the medical community through LITFL over the years. It’s hard to imagine my training years in particular without it. Apart from all the amazing education, it gave me a sense of a greater community of emergency medicine and critical care, that I was part of something bigger than myself.
    The constant stream of emails of reposted articles is quite stressful, I have literally hundreds bookmarked I want to read and re-read.

  2. Thanks Mike, for sharing your wise words of advice and all the effort you have put into LITFL. The work that yourself and others have put into creating and growing this resource is nothing short of astounding.

    Given that it’s R U Ok day, I think your lessons are valuable for anyone practicing as a Doctor.

    Some things I’ve learnt;
    From my kids; to enjoy what is right in front of you.
    From Dr Barry Kirby; that despite me thinking there’s not much time to do all that I want to do, there is more than enough. And even enough to change course or start a new unexpected journey https://www.screencraft.com.au/featured/the-hands-of-rescue-dr-barry-kirby-ao
    The trick or challenge is to discern the things that actually matter.
    And as you touched upon join a team, it’s so much easier than flying solo.

    Congrats on the anniversary and looking forward to more to come from the LITFL team.

  3. Thank Mike! Glad to call you a friend. I hope to continue our work together once I get a hold of this 2 kid thing. Missin the charlies vibes


  4. Massive thanks for all your work and support of the foam community Mike. We remain eternally grateful!!! Keep up the good work and the good life

  5. Thank you so much for sharing your knowledge all these years Boss! Especially the wonderfully esoteric tidbits which makes Medicine interesting.
    I will remember your advice to always keep family first and foremost.
    Sincerely, Admin

  6. Thank you for this amazing resource- you are a true inspiration to the #FOAMed community. Impossible to place an H-Index on the impact you have had on millions of learners worldwide!

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