S03E60 Flow State in Surgery and in Life for Peak Performance
Let's talk about the popular concept of flow state – an optimal state of consciousness where we perform and feel our best. This state of intense concentration, merging of action and awareness, and a distortion of temporal experience is not only fascinating but can be harnessed in the most critical of arenas - surgery, as well as in our everyday lives. Let's bust through the barriers preventing us from achieving this state, like lack of clear goals, distractions, and self-doubt, and set us on a path to a more focused and fulfilling existence.
Switching gears, the weekly thankful embarks on a different form of journey - the open road.
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00:00:05 Flow State in Surgery and Life
00:07:46 Appreciating Our Nation's Highways
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S03E60 Flow State in Surgery and in Life for Peak Performance
[00:00:00] Sam Rhee: One of the reasons and possibly the only reason I chose surgery as my career is because of flow state. Most surgeons I know also agree that they regularly enter flow state when doing surgery.
The concept of flow state is popular. Wikipedia describes it as being "in the zone", where you are fully absorbed by what you are doing, engaged in full, but effortless concentration. You lose track of time, and the flow is the melting together of action and consciousness. It is a feeling of energized focus, full involvement, and complete immersion in a challenging situation. It is definitely a positive and rewarding feeling.
There are some famous instances described where people have entered flow state while doing certain tasks. For example, Sir Isaac Newton supposedly forgot to eat and sleep for several days while writing Principia Mathematica, the foundation of classical physics and the law of universal gravitation.
Other activities in which people often describe being in a flow state include playing music, sports, or even certain games such as chess or video games.
Don't get me wrong, seeing patients in the office is great. Focusing on patient care outcomes has always been my goal as an attending, but when I had a moment of crisis during my third year of general surgery residency, when I thought about leaving medicine completely and taking the GMAT to apply to business schools to become a junior analyst or a consultant, the single most important factor that made me decide to stay in surgery was a fact that I knew of no other job where I could have that feeling of flow state while I was operating.
Most people can probably describe being in flow state in their lives, sometimes a lot. In addition to surgery, I feel at flow state doing other activities in my life as well. Let's talk about what conditions can activate flow state and how that might apply to our everyday lives.
First of all, you probably don't want to be in flow state all the time, even if you could. For example, would you really want to be in flow state while brushing your teeth every day?
But recognizing the conditions and components that help us enter flow state might help us in many of our tasks for our everyday life. So what is the actual definition of flow state? How do you know for sure that you're in the zone?
According to Jeanne Nakamura and someone with a really complicated name I can't pronounce, but goes something like CsÃkszentmihály, there are six attributes that if present would indicate you are experiencing flow state.
The first attribute of flow state is one, intense and focused concentration on the present moment.
Number two, merging of action and awareness, i.e. the doer and the doing becomes one and the actions feel automatic. A lot of actions we do in life are very deliberate.
We are consciously controlling our actions. In flow state there is no deliberation. Our movements don't require thought.
Number three, another attribute of flow state is a loss of reflective self-consciousness. That is the mind's mirror that reflects back to us about what we are thinking and doing. Flow state eliminates that feeling of self-awareness.
Number four, a sense of personal control or agency over the situation or activity where we feel in complete command of what we are doing.
Number five, a distortion of temporal experience as one subjective experience of time is altered.
So oftentimes what may take hours can feel like minutes. This is the one characteristic that I feel most strongly in surgery. I'll look up at the end of a case and it felt like 15 minutes, but it was actually three hours. Unfortunately, if you are a medical student doing nothing but standing and watching the case, you probably weren't in flow state, and those three hours probably felt like 12.
And the sixth and last attribute of a flow state is that the experience of the activity feels intrinsically rewarding. This is referred to as an autotelic experience where you are enjoying the activity for its own sake. You just love being involved in the activity itself.
So now maybe you're thinking about activities where you feel like you're in that flow state. Some people actually say the purpose of our lives is to engage in flow state activities as much as possible, but not everything can be done in flow state, even if we may want to.
What are the factors that can prevent us from achieving flow state in an activity?
Number one, lack of clear goals. You need activities with a clear goal such as chess or a sport, which can allow attention to be focused solely on achieving that objective.
Another factor that can stop us from entering flow state is lack of challenge. Flow state generally requires doing something which is not too easy and not overly difficult. Some flow researchers have suggested that the optimal challenge for flow state is when the activity is 4% more difficult than your skill level.
I honestly do not know what that means, but yes, I do agree that flow state requires something that is not boring nor impossible to do.
Number three, distractions. There are some activities where you can enter a flow state so strongly the roof could fall down on your head and you might not notice. However, for most of us in most activities, distractions can take us out of that flow state.
I have seen surgeons get enraged when they're operating and there are distractions such as beepers, people talking, machine alarms, all of which can take you out of flow state. Just talk to a surgeon about how frustrating it can be to be operating during shift change when all the personnel are all talking and moving in and out of the OR and you'll get a sense of the emotion behind the frustration.
The fourth barrier to flow state can be self-doubt or internal criticism. Nothing can impede flow state more than our inner voice constantly questioning us. Am I doing this right or is this going to work? Obviously these are important questions, but they shouldn't be done during the activity, especially surgery. Planning and setup are 90% of surgical success just like they are for most other activities.
Of course, unexpected issues and detours can always occur, but the hesitation and pauses should never come from within. There's an old saying about surgeons, "Frequently wrong, but never in doubt." Confidence, or at least a sure sense of what you need to do for the task at hand is critical for focus and for flow state.
In regards to other activities in life, I think that one of the reasons I love CrossFit is that on my best workout days, I can enter a high level of flow state during a workout. When you're performing well, you can definitely feel like you're in a zone. There aren't too many feelings that are better than being fully immersed during a WOD, executing well and losing yourself in that moment.
Of course, not every workout works this way for me. Some days I'm fighting self-doubt, that inner voice that looms large in my head. I may be wondering if the weight I chose was too heavy, or if my shoulder is up to the task today, or if I should just go a little slower or rest a little more because I have a really busy day later on.
Sometimes I worry about being the last to finish or whether people are going to be looking at me. Working to shrug off these inner voices and focus at the task at hand has gotten easier for me over the years, but it is always a challenge.
I do know that I continue to improve at entering at least some degree of flow state for many of my workouts and that it has helped me outside of the gym on other activities, the ones where flow state could help me achieve more if I can clear my mind and pay full attention to the task at hand.
It is always a challenge in our everyday lives to find and enter flow state for many of our activities that could benefit. One of the reasons I'm glad I didn't leave surgery is because I can almost always enter flow state while operating, and in fact, you almost have no choice to do so in order to achieve your desired result.
And usually that can make for a quick day. Surgery days are always the days that go by fastest for me.
So what instances of flow state have been memorable for you? What activities have a high degree of flow state in your daily life? Let me know.
My weekly thankful is our nation's highways. I know that most people would not necessarily think to be thankful for roads, but having to have.
But having had to drive for over eight hours, twice and four days back and forth on a long trip. Recently, I realized even with traffic, the road system in the United States allowed us to move pretty quickly. The roads were mostly of good quality, no major potholes or other problems. And having been in countries where you share the roads with motorbikes, people walking, rickshaws, even cows and goats, Our nation's highways allow us to travel long distances, driving efficiently, even when you don't fly or take a train.
Plus, driving outta the state of New Jersey always reminds me how other people live, where they have to fill up their own cars at gas stations.
Let me know your thoughts about flow state, highways, or anything else. Please DM me @BotoxAndBurpeesPodcast on Instagram, or leave a comment at youtube.com/@BotoxAndBurpees.
Thank you.
