I was standing in the parking lot of the downtown Marriott in Charleston, S.C., deciding whether to skip the rest of the veterinary
conference. It was a beautiful day, and I had a long drive home ahead of me. Besides, I already felt comfortable with the
subjects that the afternoon sessions would cover.
Think about it: Most of us know how to handle the vast majority of the cases we see. We each have tried-and-true approaches,
medications and techniques that work well in our hands. Honestly, when it comes to practice, many of us (myself included)
discuss and treat illness on autopilot. This kind of comfort is a good thing for a doctor, right?
In the extensively titled book Maximize Your Potential: Grow Your Expertise, Take Bold Risks and Build an Incredible Career, science writer Joshua Foer reports that we acquire new skills in three distinct stages:
1. Cognitive stage. We focus intently on the skill we're practicing. Here, we think critically about what we are doing. We concentrate and make
lots of errors.
2. Associative stage. We make fewer mistakes and gradually get better at the skill.
3. Autonomous stage. Like turning on autopilot, we can do the skill without focusing on it.
Evolutionarily, being able to perform tasks without intently focusing on them is a wonderful thing. It frees our minds to
focus on new experiences. It has allowed us to run while looking around, pick berries while keeping an eye out for predators
and sing "Dancing Queen" while making sure we're not being watched. In veterinary practice, it lets us perform routine surgeries,
give the flea talk or prescribe proven treatment plans while our minds linger elsewhere.
The downside to this state of comfort and efficiency is that it can stall our motivation to improve. Our development levels
off, and we enter what is known as the "OK plateau." Maria Popova writes about this idea at
http://www.brainpickings.org/. For me, this plateau looked a lot like the parking lot of the Marriott.
Autopilot and medicine
As veterinarians, we live in a world where our skills and knowledge are constantly becoming outdated. While we may be content
with our existing aptitude on a bicycle or on the golf course, we should not be content with our knowledge of healthcare.
Medicine is a mountain that rises higher with new research. As a result, doctors flying at a constant altitude are at an increasing
danger of crashing. If we want a good career in healthcare, we've got to flip that switch and turn off the autopilot.
Get off the plateau
Once we enter the autopilot stage, our development stagnates. Simply practicing our skills through repetition does little
to get us out of this rut. Like a pianist playing a piece she has long mastered over and over again, we simply showcase our
competence without expanding it. So how do we become truly excellent? How do we push past the OK plateau to become exceptional
Performance psychologists at Florida State University have found that the key to continual improvement is highly focused rehearsal
or deliberate practice. This is practice that keeps us engaged and out of the autopilot stage. According to Popova, it requires
1. Focus on technique. When we strive to improve, critical analysis is important. Are we really doing the best job possible? Could we be faster?
Could we make the procedure less painful? Could we explain its value more clearly? If we don't focus on what we are doing,
the answer to all of these questions is "no."
2. Stay goal-oriented. When we cease to care about how good we are as physicians, we cease to be good physicians. Deciding what kind of practitioners
we want to be and then setting goals to get there is the best way to ensure continued development.
3. Get immediate and continuous feedback. Remember how much feedback you got on your performance in veterinary school? Remember how rapidly your skills improved? Sure,
most of us don't really enjoy getting feedback on how we can improve, but still.
It's wise to suck it up and ask colleagues, coworkers and friends for input. Sculpting oneself into the best doctor possible
is painful because the sculptor is also the stone. But it's worth it to ask for feedback and listen.
The afternoon sessions
Back to day three of that conference: I wanted to go home. Still, I just couldn't make myself feel good about it. That's when
I realized I was in the middle of a defining moment. I could be the doctor who is good enough, or I could go back inside and
be the doctor who is getting better.
It's easy and tempting to believe that being good enough should be the goal, but by settling for that, we do ourselves and
our patients a disservice. I am not the best doctor that I can be, and neither are you.
We can all get better—always. We just have to push past the OK plateau. Besides, who doesn't want to spend a few more hours
Dr. Andy Roark practices in Greenville, S.C. He is the founder and managing director of veterinary consulting firm Tall Oaks
Enterprises. Follow him on Facebook or @DrAndyRoark on Twitter.