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Blogs by the online BMJ respiratory medicine champion
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There's always a bigger fish.
I went for a run with a local running club on Tuesday. I know the organiser, and she often asks if I can go along and help out with the marshalling, act as sweeper (the broom wagon) or lead off the group on the run. This week I led the run off. There is a choice at half way, whether to head back to base for a 5K run, or carry on for 8K. I was with a lovely girl, and her dog, who had only recently taken up running in the last 6 months - she was at the front, and seemed very comfortable. I chatted to her - she wants to do a half marathon (13 miles) in a couple of months, and doesn't know how quickly she'll manage it. This got me thinking about something I constantly tell my juniors about, goal setting.
Not only does she not know how quickly she'll run, she doesn't know how quickly she's running currently. On top of that she doesn't know how to run quicker. I completely understand that running the race quickly is not necessarily the goal for everyone, and completing the race might be all anyone wants to do, but this girl new she wanted to *race*, but didn't know how to reach that goal. I suggested that as I knew what pace she was running at, I would continue to run at that pace for the full 8K distance, and pace her around the full 8K. She did very well, and we finished teh hilly 8K course in 40:31, about 5:04 per km, and not far away from 1:40 half marathon pace. She was puggled by the end, but she made it. We chatted afterwards, and her response to the run puzzled me initially. She was disappointed. "I'm knackered, and you've hardly broken sweat" she panted. This is reflective of the way we all have a tendency to think. We see experts, we want to be like them, we're not, and we feel bad because of it. We don't reflect on the positives of what we've achieved. As doctors we all want to be a seen of as a grade ahead (at least) of what we are. During my time as an SHO I wanted to be a reg, when I was a reg I swanned about acting like a consultant, now I'm a consultant, I want a chair.... When I do DOPS and Mini-CEX and MSFs, the juniors are often miffed when I give them marks of "Meets expectation of grade/position". They want to be better, and have higher marks on the forms; but often the best place to be is where you're meant to be. Being as good as an ST1 should be is no bad thing. It's hard to be "above expectation" in venepuncture, for example. If an FY1 can't get blood out of a patient, there's something awry. I'd like to think that in reality I have the skills of a good 3rd year consultant. I can't possibly have the knowledge, and intuition, that 25 years of experience brings - I didn't start my consultant post when I was 10. I hope to do my very best, and make appropriate decisions, and manage patients as well as I can, given the limitations of my relative inexperience. We have frequent discussions in our department about grey cases, and often those we think are fairly black or white - often my more experienced colleagues have valuable a take on the situation, and point out where I may have gone astray. I used to get annoyed with myself for missing things, or *getting it wrong*. But now I try to remain philosophical - there's always a bigger fish: there will always be someone who knows more than me, has more experience than me, and ultimately will perform at a higher level than I ever will. I told my new running chum the same idea - "I might have found that easy, but there's always a bigger fish". When I run with other groups, I'm left behind, struggling for breath and fighting to keep with them, albeit at 3:50 per km, rather than 5:00. I'm just happy that I am making the most of what I have - if a running coach ticked the boxes on my running DOPS, I'd be very happy with "Meets level expected of lanky 35 year old". This doesn't stop me training, as I want to be running a 1:25 half marathon, but I'm happy!
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I know colleagues who are in the same department they were as registrars over 30 years ago. They now have a chair; Woopy-Doo.
I subscribe to the poem, Ithaca by Constantine Cavafy. We each have our own Ithaca but many never stray away from her or even sail into deep water off her shore and certainly not in a gale. I don't feel sorry for them; just disdain for they have the hearts of lap dogs, not eagles.
There will always be someone better, some mountain higher, some person wiser.