I’ve recently read ‘Deep Work’ by Cal Newport. I think that the book’s message is valuable to everyone, but in this (long) blog, I want to show how employing dedicated Deep Work is essential for a fulfilling career in medicine (and yet is difficult to achieve).
What is Deep Work?
‘Deep Work’ is defined as ‘professional activities performed in a state of distraction free concentration that push cognitive capabilities to the limit. These efforts create new value, improve skills and are hard to replicate’.
Newport writes that Deep Work is an old and established method of working, using Carl Jung and Charles Darwin as two figures whose significant discoveries were facilitated by time spent alone in deep thought.
The occupations of Jung and Darwin as progressive scientists represented the minority elite of their times, their academic livelihoods independent of the financial or time constraints felt by the majority of the population working in an industry-centric era. Instead, Jung and Darwin could dedicate time to live and think in a ‘deep’ state that facilitated their discoveries.
Newport’s message is that our modern world is increasingly replacing industrial labour with idea-centric ‘knowledge work’, hence the need for a wide understanding and utilisation of Deep Work amongst knowledge workers has become paramount. Newport describes Deep Work as a ‘key currency’ for knowledge workers, where the worth of an individual is dependent on their ability to produce the best work against the field of competitors.
Why I love ‘Deep Work’.
I love Deep Work because of its accessibility.
Deep Work is not a rare magical state that’s hard to find or to harness. No potion or prayer will allow you to enter a trance state of focus, creativity and industry. It is not reserved for the ‘elite’ like Jung, Darwin, Musk or Gates.
Simply, we are seeking a refined state of focus – just like casting a spotlight into a black night, you are trying to remove all peripheral distractions to hone in on the task at hand. It can be summed up in this paraphrased quote that I scribbled in my notebook – ‘Deep Work provides a lack of distraction that tones down the background hum of nervous mental energy that seems to increasingly pervade people’s daily lives.’
Deep Work is one of the purest, most simple states to aspire to, and it’s within anyone’s reach.
Here are Newport’s four rules of Deep Work:
Anyone can follow these rules. Anyone can eliminate distraction, minimise menial tasks and create opportunities to delve deep into the important tasks. Anyone can employ the ‘Deep Work’ method.
I also love Deep Work because of the purity it lends to work. After employing Deep Work for a short while, the benefits can easily make one want to strip away all of life’s non-essentials that are now realised to disperse energy and focus, diluting the vital satisfaction that comes from doing stuff well. It is addictive to focus. It is refreshing to feel productive and creative. It’s liberating to feel free from distraction.
Furthermore, I like how it’s replicable. I enjoy having a ‘method’ or set of principles that promote Deep Work. It reminds me of approaching a technical section on my mountain bike – to get through it, I have to prepare my body to be poised and balanced and my mind to be sharp. If my physical and mental set-up is right, I’ll fly right through. If my feet are slipping on the pedals, my weight misplaced or my mind distracted, I’ll bump and crash my way over. I don’t like crashing, so each time I ride I try to set myself up well. Likewise, I know that if I build time without distractions, I can set myself up to be creative and productive. I want to replicate this success – I want to get the best out of my mind, not to crash and bump my way through. It’s a simple positive feedback loop: Prepare well, work deeply, feel good, repeat.
Who can most benefit from Deep Work?
Newport himself represents those that Deep Work is relevant to – A computer scientist professor, working in research and academia, with multiple books and a blog on the side.
All of these elements of Newport’s occupation require consistent focus and creativity to produce novel work. If you’re reading this and are still interested, the chances are that you would benefit from reading and employing Deep Work too.
I work as a doctor. Does Deep Work apply to doctors, too?
Doctors are ‘Knowledge Workers’. Medicine is ‘Knowledge Work’. Medical School is where we gain our knowledge and the hospital or community is where we practise it.
When a patient comes in through the Emergency Department, they enter a conveyor belt of knowledge work. They are triaged by nurses, reviewed by emergency doctors, their CT scan images reviewed by radiologists and they then are diverted to either the medical or surgical team; a process aimed to quantify the patient as a unique package of numbers, words, scans and test results, to which ‘medical knowledge’ can be applied in a custom and individualised way to diagnose and treat.
But our knowledge work is richer still. The knowledge of doctors and nurses doesn’t stop at textbooks and lectures. If it did, we would quickly be replaced by artificial intelligence and automation – a threat felt by many ‘industrial’ occupations. Doctors and nurses have to know how people work too, because people aren’t like the ‘unique packages’ I described above. They have wider social contexts; friends, families, fears. A computer algorithm might find it easy to correlate a chest x-ray and blood markers to diagnose pneumonia. It would be more difficult to integrate human emotions and social relationships into its equations to understand how a person’s bereavement or uncertain social situation contributed to their self-neglect or smoking, circumstances making them vulnerable to the infection in the first place. A robot could prescribe the right antibiotic but neglect the social connection.
This is the art of medicine; to combine medical knowledge with the understanding of other humans. This is a combination that meets Newport’s definition of ‘create new value [that’s] hard to replicate’ very well.
Working as a Junior Doctor is often not compatible with ‘Deep Work’.
For a self-proclaimed lover of deep work, a ‘devotee of the deep’ or ‘disciple of depth’, it is frustrating that much of the day of a junior doctor is spent in the ‘shallows’, described as
‘Noncognitively-demanding, logistical-style tasks, often performed while distracted. These efforts tend to not create much new value in the world and are easy to replicate’ .
Junior doctors are often split between three places at once with an ever growing list of jobs: Rewrite that drug chart on this ward, do the discharge paperwork on that ward, call this family later, refer to gastroenterology now, take a trip to the other side of the hospital to get this MRI vetted by the radiologist, stare at the screen in disbelief while the outdated computer systems wade through digital sludge… busily trying to make small gains on multiple fronts is the nature of the job.
If you’re a junior doctor, or a person in a junior position in an alternative career, I bet you know what being busy feels like; having one hundred and one things to do, pushing in from all angles, squeezing out nice things such as going to the loo or having time to eat.
You also know what tiredness feels like; the feeling of cognitive dullness after fighting fires, the physical weariness that slows you down when you finish a long day or the lack of empathy that creeps in when confronted with ‘yet another’ person who ‘urgently’ needs your help.
Shallow Work can harm job satisfaction and contribute to ‘Burnout’.
Shallow work as a junior doctor can be exhausting.
The cognitive demands of it can be overwhelming. The tasks are often essential and simple (such as re-writing a patient’s drug chart), but the time (lots) and effort (little) taken, the feelings of satisfaction (let’s face it, writing a drug chart isn’t very exciting) and cognitive investment (autopilot, anyone?) frequently do not satisfy our need to feel like we have done something significant that really helped someone.
We can become blind to the value of these tasks completely and the feelings accompanying it may become grudging, unsympathetic and emotionally numbed – feelings associated with ‘burnout’. I know these feelings all too well.
Deep Work brings out the best that Medicine has to offer.
Think about a time when you felt really engaged in your job. It might have been when you made a good diagnosis after teasing out the finer details from a patient’s history.
You might have helped to fix someone; a delirious woman presenting to the department whom we hadn’t realised had forgotten her daily prednisolone, with the resulting adrenal insufficiency worsening her cognitive state. Your simple but vital plan to double up on steroids worked wonders.
Or, you might have led the team at a crash call and revelled in the intensity of the situation or the teamwork between colleagues. Whatever it was, you probably had to invest some time and thought to get deep into the task. It felt good.
Personally, depth is the reason that I like working ‘on-call’ to clerk in new patients or to step in to fix sick ones.
Likewise, I am sure that this hunt for ‘depth’ is why surgical trainees want to be in theatres as much as possible – there aren’t many tasks that require as much intense control over body and mind than placing knife to skin to operate on another human.
You see depth of focus and rigorous skill on the medical wards, watching consultants pore over the small details in a patient’s notes, methodically analysing and assimilating all relevant data, from historical radiological scans, to recent changes in medication to past clinic letters – to produce a conclusion from tangible and intangible variables that a computer couldn’t hack.
There is administrative work in all of these examples, but the quantity of administration, or shallow work, is fractional in comparison to the quantity of deep focus and engagement. The ‘deep’ work is so rewarding that it itself has little cost, while the extra profit earned can cover the cost of the shallow work that follows.
Just as shallow work contributes to career monotony and undermines well being, ‘Deep Work’ helps to build interest and investment. I believe that people working in medicine crave deep work. We have the ability to focus on a problem, understand its workings and implement a considered intervention. We need the opportunities to do so. If we can’t do this we don’t feel any more valuable than robots and will look elsewhere for application and purpose – time out of training, or an alternative career entirely.
A tangent: Applying Newport’s ‘hard to replicate’ to medicine brings up a paradox.
A fundamental goal in medicine is to repeatedly save and improve lives. We don’t want to make this goal hard to replicate. To achieve ease of replicability, we are increasingly governed by guidelines and protocols that streamline and standardise treatment, with the simultaneous goals of improving patient care and the efficiency of the health-care service. The increasing dependence on guidelines defies the nature of ‘deep work’ by removing the freedom and focus that are inherent to creativity and problem solving. Not to say this is a bad thing – guidelines make complex and dangerous stuff simple to understand and to fix. Arguably, by making guidelines for these types of dangerous medical problems prevalent, we can free-up cognitive capacity to think about the complex stuff that don’t fit guidelines… but your judgement of the reality of this is up to you to decide.
A ‘Deep Work’ approach is essential for learning new skills.
One of the key tenets of the book is to ‘quickly master hard things’. The process of learning new skills and finessing old ones is central to a medical career. Just as the medical history and diagnosis is an art that is developed with practice, or that emotional intelligence and empathy is something that can develop with time and experience, medical success is also closely reliant on manual skills. The obvious example is of the progression of a junior surgeon up the ranks – learning to suture wounds closed or to hold the laparoscopic camera correctly, before being able to use a surgical scalpel. Deep Work is the application of intense focus to learn these skills in the most efficient way. There’s no way to avoid this requirement for focus – to succeed in medical or surgical training, you either have the ability to work deeply or you don’t.
We then use our new skills to fulfil the next requirement for modern ‘knowledge work’ careers – to ‘quickly produce at an elite level in both quality and speed’. This resonates particularly strongly with a career in medicine. At a fundamental level, high quality care for patients performed in an effective and efficient way should be the goal of every healthcare practitioner. Although it sounds cliche, to become the best doctor that one can be, we must be able to invest in one’s own career and skill-set. Dedicated focus, rather than a scattering of misplaced energy, is the way to do this.
Deep Work is essential for carving out the career YOU want.
Cal Newport often uses freelancers as his example for the group of workers for whom Deep Work is most crucial for survival in a world of ‘winner takes all’. Although every doctor could be supported somewhere within the UK’s national health service, there is still a strong application of Deep Work to medical career progression. The fact is, that if you want to apply to a niche area in Medicine or any other career, you have to compete with others who want the same position.
Here are my thoughts: Whether you want to be a brain surgeon or a GP with a special interest, you’ve got to be good. If you’re not medical, the principle still applies; you have to offer the same unique value and skills as Newport’s freelancers. You have to be good enough in a certain area to meet a threshold of recognition and appointability.
What’s going to hold you back?
Non-committal, lack of focus and the absence of high quality, completed work.
Lots of effort can be expended into these areas, but they might not show many results for the investment. Although many small benefits to skills and knowledge were gained, the total sum of them doesn’t reach the threshold needed for recognition or appointability. In this way, I believe that having many small, less developed skills may close more doors than they open, resulting in a lack of choice for future careers.
The solution? We have to accept that to get into a niche, one has to both carve it out and shape oneself to fit it. It doesn’t take sheer work alone to reach that place – instead, it relies on a thoughtful and considered approach to career design, with measured application of effort in the right places to build career capital – to cultivate valuable experiences, knowledge and skills. Deep Work, although requiring a sharpened and narrowed focus, can build a range of employable traits with enough intensity that they can serve to open multiple doors in the world of medical careers.
How can you integrate Deep Work into your career and life?
After reading Deep Work, I have realised that this pursuit of a deeper focus is one of the main reasons that I enjoy writing (and am encouraged to keep doing so). It’s also changed my perspective about how I practice medicine, with new insights into what makes a medical career fun and satisfying, or monotonous and depleting.
A summary and some final tips:
Deep Work requires intensity. When you choose to work, really invest in your effort. Learn skills. Be creative. Gain knowledge. Rev’ the engine and make something special.
When you choose to rest, rest well. Scrolling on your newsfeed doesn’t rest the mind as much as going for a walk, gazing out the window, or doing 5 minutes of meditation can. When you take your coffee break, take the time to enjoy it. Smell it, see it, taste it – all of that hippie stuff that medical types like to dismiss. Focus on the detail!
Identify distractors. For me, I’m distracted by social media and email. I need to shut these off to get into the right zone.
Deep Work is satisfying. Shallow Work is depleting. If you are feeling weighed down by the pressure of your job, take a moment to consider the way in which you are working. Is your day mainly taken up by shallow tasks? When did you last learn something? When did you last feel autonomous? When were you last able to take responsibility or to help someone? If you can answer this, it sounds like things are going great! If this is tough to answer, it’s time to check in with yourself and your educational supervisor or manager. This isn’t a sustainable way to work and you need to pull your parachute cord now.
Find the Deep. There is a depth to everything. Often, if you’re rushed off your feet, you might not want to find the deep side to a task because it simply takes too much time. If you’re feeling bogged down in the shallows and frankly overwhelmed, my experience would recommend that you take a break before refocusing your efforts to go deeper on fewer things. You might have 10 drug charts to rewrite. You could either complete them all quickly, in a shallow manner, and miss mistakes, or you could complete 4 of them and pick up any drug errors. You’ll feel better you’ll have done a good job. If your workload is huge, call for help.
Practice Focus. For me, a short daily meditation practice ticks all the boxes – it teaches me to resist distractions and to deeply focus on something simple, such as my breathing or a ‘body scan’. I often find that although not summoned, creative ideas arrive when I sit to meditate. The calm feeling I finish the meditation with, paired with a creative idea and a mind that is primed to avoid distraction, is a great way to either start my day at work in the hospital or to start writing at my computer.
Deep Careers. This is where Deep Work might offer the most value. By deeply investing in the knowledge and skills pertaining to your interests, you will create career capital of dense value. You don’t have to know what you want to do in 10 years’ time but if you commit to what you are interested in now, hopefully you’ll start to forge a path of your deciding – either deliberately, after an epiphany, or accidentally, because you’re just that good. Commit now or forever hold your peace!
Read the book. You’ve read my perspective. Now, read it yourself and learn your own lessons!
I’m using WorkFlowy to organise my thoughts, to store notes from what I have read and to create outlines for my blogs. I use it to dump the extra thoughts that litter my mind so that I can try to find time to do my own Deep Work. It’s free to set up and if you follow this referral link, we both get extra space: Link here!
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