Expectations

By: Noah Zucker, MD

Having high expectations of myself has been part of the reason I have found success in my young medical career, and also part of the reason I have found myself struggling at times throughout this journey. To set high expectations is to aspire to be better than average -to prove to ourselves and others that we can do more, do it better, and do it faster. But what happens when we set unrealistic expectations, or hold ourselves to impractical standards? There is the famous saying “shoot for the moon, because even if you miss you will still land among the stars.” But is it really that simple?

A hot topic in medical education and residency right now is wellness. Is the curriculum too rigorous? Are the attending physicians too demeaning? Are the hours too long? Is there not enough support? All of these might be true. But I have another theory to add to the list, one I don’t hear much chatter about: unrealistic expectations set by ourselves, the learners.

I was a third year medical student on a rotation I did not like, and was venting to a classmate as I walked home one day. It was a “non-call day” and I had gone into the day with the expectation that I would get to leave early and had some plans I was looking forward too. Unfortunately, we had some complicated patients and I ended up leaving at the usual time. This made me angry. I was upset about leaving on time. My classmate shared with me a few sentences that have since changed the way I approach many aspects of my life. “I always expect to leave late,” she tells me. “That way, when I get out late, I’m happy, if I get out on time it’s a bonus, and if I get out early I’m ecstatic!’” Making this small change in expectation has made all the difference in how I experience the outcomes of many different situations.

How does this translate more generally to wellness? Is it realistic for most people to shoot for a 95 percent on every test? Is it realistic to expect to be able to do a new complicated procedure perfectly the first time you try it? Or even the second time? If you get a 92 percent, is that something you should be unhappy about, the same way I was unhappy about getting out on time? If you don’t successfully intubate your first patient, or even second (or in my case, eighth), is that considered a failure? I think many of us would quickly say to a friend, “no, of course not!” But do we treat ourselves with this same kindness? If we continue to hold ourselves to expectations we would not hold our friends and colleagues to, it starts to pave that spiral path down frustration and depression.

The question I continue to ask myself is where to draw the line. How do I still push myself to be better, to learn more for both myself and my patients? Do I need to be better? At what cost to my wellness am I willing to be better? Is just being present and trying my best good enough? Is it the expectation that is set, or the reaction to the outcome more important? And how much power do we have over our own emotions to control our reactions when we do not meet our own lofty expectations? I’m still looking for that line. I want to be successful, but not at the cost of being unhappy at my own doing.

As family medicine doctors, one way we have been taught to help our patients is through creating SMART goals. Maybe sometimes we forget for ourselves what the “R” stands for (Realistic). Next time you are upset or frustrated about the outcome of an event in your life, ask yourself, “Is this something I would encourage my friend to be upset about?” There are certainly times when the answer might be yes, but I think if we are truthful with ourselves, we will find that we are probably being harder on ourselves than is truly warranted, and oftentimes, due to unrealistic expectations. (I will save emotional validation for another blog post). Let me end with a challenge: find your outlook that allows you to be happy with getting out late, rather than angry about getting out on time.

Noah Zucker, MD, is a first year resident in the Division of Family Medicine at the Department of Family and Preventive Medicine in Salt Lake City, UT. His medical areas of interest include preventive medicine, adolescent medicine, reproductive health, and transgender care.


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