I feel like there are so many things to work on in medicine. I need to be more efficient at taking a history; I need to gather morning data more quickly; I should be better at chart review when I get a new admission; I need to be more thorough at following up on labs; I could write the H&P more quickly, and so on. I also feel, from time to time, I do poorly on one thing — maybe I stay at work way too long writing my H&P — and then I obsess over how I can get faster at it. But in doing so, I lose ground I have gained in other areas, such as following up on orders.
Then I came across a great address given at my alma mater, Brigham Young University (BYU), which gave me some much-needed perspective. The address was given by the BYU Men’s Track and Field head coach, Ed Eyestone and was entitled, “Following Worth Mentors.” It’s a great address and you can listen to it all here, but I want to focus on a particular story that really stood out to me:
Kyle Perry was a track athlete recruited from Alta High School in Utah. After returning from a mission to New Jersey, Kyle began what would be a very successful track and cross-country career at BYU. However, at the beginning of his junior year he admitted to being somewhat frustrated by the fact that, despite being an All-American, he had not yet been able to break four minutes in the mile.
Fifty years ago the sub-four-minute mile was considered a nearly impossible physiological feat — although when Roger Bannister finally accomplished the task in 1952, a succession of others soon followed. However, it is still considered a landmark accomplishment and far fewer people have run a sub-four-minute mile (about 1,400) than have climbed Mount Everest (more than 4,000). Kyle’s personal record at the time stood at 4:05 — certainly a better-than-average college time but far from world-class.
At the end of cross-country season that fall, Kyle came into my office with a proposal. “Coach,” he said, “I feel like in track I have kind of plateaued. I’m stuck at 4:05, and I’m not getting any faster.”
“Well,” I asked, “what are we going to do about it?”
He said, “I don’t think there is one single thing I can do to cut off five seconds, but I do think there are ten things I can do that can each cut off half a second and together will total five seconds and get me under four minutes.”
He then pulled out his list, which read something like this:
For the next three months I will:
- Do my morning runs
- Stretch after workout
- Do core five times a week
- Get to bed before 11:00 p.m.
- Lift weights twice a week
- Do sprint drills twice a week
The last four changes were dietary in nature:
- Eat breakfast every day
- No more ice cream
- No more Diet Coke
- No more candy
We all would probably benefit from those last four. After going through the list, he added, “Coach, on February 2 the track team is going to Seattle for an indoor meet and I’m going to break four minutes for the mile.” He then turned the list into a legally binding contract by signing it at the bottom. I signed it as well and we posted a copy on my wall and a copy in his locker.
Over the next three months I met with him regularly for his daily workouts and he let me know how his ten small things were coming along. As we flew to Seattle that first week of February, he was brimming with confidence. Not only had he paid the price on the big things, like running eighty miles a week and never missing a practice, but he had also made the additional sacrifices to do the small things that he felt would make the ultimate difference.
On February 2, at the University of Washington indoor track, after a slow opening three laps, Kyle ran fifty-seven seconds for his last 400 meters and became the 302nd American to break four minutes for the mile, running 3:59.16. Contrary to popular opinion, he found that sweating the small stuff was necessary to accomplish big things and get him to a whole new level. Building on his breakthrough, Kyle won the national championships in the steeplechase that next year.
Inspiring, right? The crux of that entire story rests on Kyle’s approach to his problem:
“I don’t think there is one single thing I can do to cut off five seconds, but I do think there are ten things I can do that can each cut off half a second and together will total five seconds and get me under four minutes.”
After hearing this, I realized that I needed to change my approach. I needed to stop hyper-focusing on certain areas to the detriment of others. Feeling successful in intern year really is like trying to break the four-minute mile — can I get an “amen,” fellow interns? There’s no silver bullet — no one area that I can master that will allow me to coast into second year. But there are ten (or more) manageable areas on which I can focus that will help me become that efficient intern that I want to be.
There’s something else that I want to mention. Out of Kyle’s ten things, only five of them are directly related to exercise, and only two of those specifically involve running. The other five have to do with diet and changes to the daily routine. I think it shows that in order to perform your best you have to be performing optimally not just at work, but also outside of work.
Now nine months into intern year, I’m refining my list of ten things that will help me break the “successful intern” barrier. Current ideas include:
- Regularly talking with mentors
- Streamlining my review of systems
- Focusing my chart biopsy on the top one or two problems
- Making it to more noon conferences–and some non-clinical ones, too
- No phone at least one hour before bed
- Exercise at least three times per week
- Stop snoozing my alarm
- Eat more vegetables
Editor’s note: A version of this piece first appeared on Residency Hacker on February 15, 2016.