There are few things as daunting as endless choices and open opportunities. This is the struggle of a writer staring at a blank page. This is the struggle of a sculptor gazing at a block of marble. This is the conundrum of the undecided college major. On a much shorter time scale, this is the dilemma encountered when deciding what to eat or what to do on a day off of work.
Options may be initially comforting. Having options provides the illusion of freedom in that if one does not like the current choice or selection one is able to bail on plan A and pursue plan B. Subsequently, if one finds plan B not quite to their taste, they will have no qualms about opting for plan C. As soon as there is a bump in the road with plan C, have no fear, there is always plan D. While some options may be beneficial, flitting from one option to another is the antithesis of digging deep, of going for the long haul, of feeling the struggle and ultimately the reward of any specific option. Freedom, true freedom, is not endless choices but enough agency to select and pursue a path of meaning and value. Collecting options, more often worded as “keeping my options open”, is similar to collecting happy meal toys. The options themselves are not useful in the long term, new options are constantly coming out, and in a matter of months, the options will be revert to being valueless. The freest life, the good life, then is not having infinite options but having a meaningful trajectory with the ability to navigate and steer through the obstacles ahead to a better destination. To achieve this, a flight plan, a structure is essential.
Structure is freeing. Routine is comforting. Building independent structure is absolutely essential. When interviewing for medical school one of the common refrains was, “50% of what you will be taught in medical school will be wrong by the end of your career. The problem is no one knows which 50%.” The move in medical schools has broadly been away from teaching only discreet pieces of knowledge, facts and patterns, and towards learning how to incorporate new findings and studies into one’s clinical practice on an ongoing basis. Instead of having facts and figures spoon fed from lecturers and text books (have no fear, there are plenty of those still), there is a growing emphasis on how to ask questions, find new knowledge, evaluate the validity of new findings, and then incorporate those findings into clinical practice.
Broadly speaking, the goal is to learn more medicine. Yet that is both broadly intimidating and unhelpfully nonspecific. Instead an outline of what one hopes to gain, a question that one would like to explore must be defined. The process of recognizing weaknesses and working, in an organized and deliberate manner to turn them into strengths is always ongoing. Instead of “learn more medicine” a desire to learn more about the heart must be further refined into defined questions and goals. Instead of “learn more about the heart”, actionable goals could include “recognize patterns of ischemia on EKG” or “review the treatment of acute presentations of myocardial infarction.” The blank page of “learn more medicine” must be refined into a far more specific and useful structure for progress to be made.
Structure to freedom