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How to Avoid Maladaptive Pitfalls When Setting Goals in Medicine

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Like many physicians, I am also a marathon runner. When I was in medical school, spending my time pouring over the pages of Robbins Pathology and pounding the pavement, I noted parallels between medical training and marathoning. Both are journeys grounded in mental fortitude, commitment to a rigorous schedule, and dogged pursuit of a finish line. And both are about setting — and achieving — difficult goals. 

As physicians, goal setting is often part of our DNA. For decades, we conscientiously work toward the “next big thing,” from getting good grades for admission into our first-choice colleges, to applying to medical school and then matching at a residency program. And yet, unlike in a marathon, which ends at mile 26.2, the pursuit of medical goals can be endless — and has the potential to induce burnout, questions about whether we will ever “make it” as physicians, and maladaptive perfectionism. When the journey is so long, it is easy to get bogged down in the shame of feeling inadequate for not yet reaching the end. Thus, my greatest joy of residency thus far has been the lessons I’ve learned from my patients about how to find peace in the midst of setting and achieving goals — in other words, how not to sprint a marathon. 

I recall one patient in particular who alerted me to this new way of being: a patient with numerous chronic health concerns who lived in a rural area and who I met when they were admitted from the ED. This patient had been unable to attend follow-up care appointments for their conditions due to transportation barriers and lack of equipment for virtual visits. I asked one of my go-to admission questions — What one thing could we help you with at this admission that would make the biggest difference in your life? — and the patient and their spouse answered: “Fix this so we don’t have to come back here.” My team and I “fixed” the first medical concern in a day, but this patient required a weeklong stay and the involvement of five different consulting teams. 

Each morning of their stay, the patient understandably asked me if they could go home that day. Also each day on rounds, I noted that the patient had an impressive variety of foods in their room. Eating brought great joy to this patient. They and their spouse spent their days looking into the best donut shops and restaurants in the area, and their spouse ventured out for takeout (as an aside, takeout was congruent with this patient’s medical needs and our hospital policy). The patient’s hospitalization was filled with both medical procedures and a culinary tour of the area, including food items unavailable to them in their tiny hometown. Amid the intense, ever-present goal of going home, this patient and their spouse literally and figuratively savored many moments of the otherwise unfortunate hospitalization. 

I met another patient who brought me even further toward accepting a slower pace — a patient embarking on what we soon realized would become an unexpectedly weeks-long hospital stay. This patient quickly became frustrated with their new reality — very understandably so. At baseline, they were independent and physically active daily. Illness requiring hospitalization was uncharted territory for them. Early in their hospitalization, that territory included new difficulty walking. Their dismay about these mobility limitations was palpable each time I entered their room. 

One day, the patient mentioned a new goal — to walk to a specific wing of the hospital to see the view. Over the next few days, in small increments, they made it there. What happened next was striking. The patient — primarily bedbound for a week — could be found walking the hallways of the hospital at all hours of the day and night, with new destinations, thoroughly enjoying the journey. When plans to walk were interrupted by medical interventions, I noticed that the patient placed a new, intentional focus on relishing the hospital food and enjoying handmade crafts from children. Their endeavor to reach the faraway hospital wing combined the joys of both a journey and of crossing a finish line. Like the culinarily-inclined patient above, their enjoyment of in-room activities modeled a third key part of any “next big thing” too-often absent from medical training: not just setting and achieving goals, but finding things to appreciate about the present. 

At the start of intern year, amid the relentless beeping of pagers and machines, InBasket messages and orders to place, it seemed somewhat unimaginable to me that a physician could muster a lunch break, let alone savor the moment. It had become all too easy to lose the forest of medicine for the trees of an endless to-do list. I found myself breaking down my goal of changing the lives of patients for the better into infinite checklist tasks ranging from progress notes to phone calls to following up on labs. 

It was also all too easy to experience shame when items on this to-do list were difficult to check off, or when they did not improve the clinical status of patients. It makes sense why I would rely on the accomplishment of goals as a marker of self-worth: For many physicians, the process of chasing goals, reaching them, and immediately making new ones is a familiar rhythm, at times comforting to fall into, and at other times a pressure machine. Constant striving toward progressively more challenging goals seems to be a common thread among medical trainees and physicians; it’s what got us into medical school and into residency programs, after all. Similarly, when running marathons, we  often only stop at the hydration stations — mental benchmarks along our journey — keeping our heads down, muscling our way toward our goals.

And yet, as my patients have taught me, it doesn’t have to be that way. What if we redefined the meeting of a goal to include the personal growth, and the feelings of presentness, that accompanied us along the way? What if we conceived of a marathon not just as an opportunity to beat a personal record, but to appreciate all that we see as we race by, and to revel in the company of other runners? What if we rested more? What if we paused for a second before continuing on with our goals, knowing endless pushing can contribute to burnout?

With this approach in mind, I now make a point to stop and enjoy moments of medical practice. I take brief meal breaks away from the computer, and the staircase to the ninth floor. Each time I walk down to the ED to admit a patient, I intentionally wonder along the way what they will teach me. Savoring moments outside of medicine has led me to run down tree-lined boulevards on sunny days off and to try new culinary endeavors. Amid the hustle and bustle of both medical and marathon training, there are endless moments to enjoy. 

The field of medicine is populated by people well-versed in goal-setting from a young age. This goal-setting is simultaneously necessary, motivating, stressful, sometimes maladaptive, and an art. Just like my patients, I am learning to enjoy both the journey and the immediate present, on the way to the “next big thing.” To be a responsible goal setter, one must also be realistic about how goals are achieved: with a mind and body that’s been rested and recharged.

How do you take care of yourself in the midst of setting and achieving challenging goals? Share your strategies in the comments!

Dr. Elizabeth Bruce is a former public school teacher and current PGY-1 psychiatry resident physician at the University of Michigan. Her wellness activities include running, crossword puzzles, traveling, and spending time with her spouse and shelter pets. Dr. Bruce is a 2022–2023 Doximity Op-Med Fellow.

Illustration by April Brust and Jennifer Bogartz

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