In 6th grade, my humanities teacher wrote a prompt for our class final: What is the purpose of life?

I immediately grabbed my pencil and thundered away without a second thought. Five minutes in, I was still the only one writing. Rachmaninoff, the famous Russian composer who was known for intricate melodies, once said that after one has played a great many number of notes does he realize that true genius comes from playing the fewest. Even though my 6th-grade self answered the prompt with copious page scribbles, the quintessence of my answer is three small words — to help people.

The inspiration of many people entering the medical field stems from their willingness and desire to help people. Millions dedicate their time to helping the lives of strangers through altruistic deeds of service both in and out of the hospital. Service acts as an effective reminder to stay humble and non-judgmental while also maintaining the perspective of the inequalities that surround us. Participating in service seeks to reinforce the original aspiration of why many of us got involved in medicine in the first place— to help people.

However, doing so eats into our relaxation time and reduces our daily allotted Netflix hours. Invariably, it raises the question of how would a busy clinician find not only the time to engage in service but also the energy?

This common criticism paints a false dichotomy where the assumption states doing more work depletes a person’s energy. However, true regulation of energy is governed by a concept that most people are oblivious to flow.

Have you ever been so immersed in an activity that time ceased to exist? That’s the power of flow. The term was coined by the psychologist Mihaly Csikszentmihalyi and describes the experience of losing yourself within an activity and achieving a trance-like state.

Csikszentmihalyi conducted experiments to investigate the effects of life without flow in the 1970s. He told his subjects to document non-essential activities that put them in a state of flow, such as exercise, music, gardening, and then to remove flow by eliminating all non-essential tasks.

I will take a moment here to observe the similarity of this “sacrifice” that we tend to embrace in medicine.

The results were so shocking that the study was stopped after 48 hours. The subjects reported problems with sleep, agitation, lethargy, difficulty concentrating, and symptomatically met requirements for generalized anxiety disorder (GAD), aborting the experiment. Think about that.

The study showed that when normal, everyday people omit flow, they develop GAD within 48 hours.

Wouldn’t it be great to control and leverage flow to optimize focus and performance?

Csikszentmihalyi states that there are three main elements that promote flow:

1. Flow requires clarity. In order to get to a destination, you have to have clarity over where you’re going. Have you ever tried to get to a new destination without directions? Instead of achieving a state of flow, you feel anxious. Flow requires clarity, and the more clear the definition of your goal, the greater the likelihood you’ll be able to find flow on your journey.

2. Flow requires immediate feedback. Rockets fail their way to the moon. Rockets take multiple measurements per second to continually gauge if they are on course for their destination. When telemetry detects that the rocket is not on course, it provides corrective maneuvering to guide it back on target gently. Flow is no different. In order to make sure that you are on course to the destination, flow requires immediate feedback to detect if course correction is needed.

3. Flow requires reasonable challenge. Essentially, this is the goldilocks rule. The difficulty of the task should not be too easy nor too difficult but should lie on the periphery of individual ability. Having proper expectations is paramount to the success of achieving flow, and the unrealistic expectation of doing too much disables flow.

Have you ever felt like you should be doing more than what you’re doing? More notes? More books? More anki? By creating such an atmosphere of forever pushing to do more, you are putting yourself in an untenable position. In order to achieve a state of flow, the challenge has to be appropriately matched to the abilities. If the challenge is too hard then there is no flow.

The solution? Do less.

Ask yourself what the one thing that, if I do it today, will bring me a little closer to my destination is. Then do that one thing. Multiple studies have shown paradoxically when you do less, you accomplish more, and productivity goes up. The Pareto principle states that 80 percent of your achievement comes from 20 percent of your activity. Doing less will increase the likelihood of putting you in a state of flow.

It is tempting to think that to revitalize and recharge ourselves, we should turn off our minds. If work drains our energy, logic dictates that no work gives us energy. Working hard uses energy so to recuperate that energy, we should minimize work.

Flow research spotlights this fallacy and challenges such thinking. After the end of a busy week, do you feel refreshed, revitalized, recuperated after binge-watching five hours of Netflix?

If you’re like me, then you feel even more tired than you did before. Flow tells us that we do not refresh ourselves with the absence of work. Csikszentmihalyi’s experiments inform us that it is not the absence of work that refreshes us, but instead, it is the experience of flow that reinvigorates us.

Csikszentmihalyi states that once we realize that the boundaries between work and play are artificial, we can begin the difficult task of making life more livable. Remind yourself that you always have time for hobbies that recharge your flow, and think of the subjects in Csikszentmihalyi’s experiments who turned into sleep-deprived misanthropes when flow was absent. Use the three elements of flow to catapult your life reinforcing your devotion to service and re-instilling the initial purpose of life — to help people.

Benjamin Borokhovsky is a medical student.

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