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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


How to increase motivation

Q: Hello Dr. Pezzi,

I recently read one of your Q & A topics with a guy who described himself as 21 years old and still living with his parents. He claimed to spend his time surfing the Internet, playing computer games, and making his right hand stronger. He performed poorly his first year or so of college but had suddenly conjured motivation to want to do something with his life: go to med school.

You described how your harsh youth made you adept at plowing through adversity. My question is what if some of us aren't so lucky (yeah, I'm calling myself unlucky for receiving a cushy life)? Now obviously no one would want to go through the things you describe, even if it got him into and through med school with flying colors. However, what advice would you give to the unmotivated guy living with his parents who has no reason to be motivated?

I am 18 years old and am currently enrolled in a local community college, taking EMT-Basic courses and prerequisites for the paramedic program the campus offers. I live in a great house with my loving, supportive parents (they always encourage me but have never forced me to do anything) and have just about everything I could ask for—except the desire to succeed. I mention the guy above because I can almost see myself in his shoes a few years down the road. I have spent many entire days playing computer games and surfing the Web. Some productive activities I enjoy from time to time are playing piano, lifting weights (physical activity in general), solving Rubik's cubes for speed, and learning (although not necessarily mandatory studying/assignments).

I seem to have random blurbs of motivation that come and go. Because of this, I have never obtained any long-term satisfaction from any of the aforementioned activities.

Reading you say, "People who've led cushy lives often never learn to dig deep into themselves and find latent strengths," scared the shit out of me, to be quite blunt and honest. I have been told for a long time that I have a lot of untapped potential in certain areas (mainly piano and academics) by people other than my parents (sadly parents don't count when they call you smart and super-capable). I am afraid of unfulfilled potential, but the fear is not of great severity because I have not screwed anything up yet. I am 18 and pretty much just beginning college.

So what advice would you give to those in my situation? How do I overcome the obstacle to unyielding motivation and a stoic work ethic that is a cushy life? I realize that when learning to deal with adversity there is no substitute for an adverse existence. But for those of us who haven't been given such fortunate circumstances, (OK, that wasn't funny, sorry) what would you suggest? I highly respect your writings, musings, and opinions, so any prescriptions will be highly regarded.

Thanks doc,

Answer by , MD: When I think of kids who almost certainly will achieve far less than what they could, I think of the children of Bill and Melinda Gates. Considering their parents' wealth and conviction that they are experts in education, one might forecast that those kids will accomplish a great deal. Although their parents can shower them with the best schools, tutors, and everything else that self-anointed education experts like Bill and Melinda think are conducive to mental development, their children will likely take far more from this world than they contribute to it. In other words, Bill and Melinda will likely raise kids who have many ideas on how to spend money and coast through life, not ideas that benefit others. Hence, they are likely destined to be coddled leeches, not accomplished geniuses.

When I was 18 years old, people trusted me to mow their lawns or perform odd jobs for them. Several years later, they trusted me to take care of their loved ones. I've had moms rush into the ER and hand me a blue baby who was close to death. I never lost a single pediatric patient, and I had a much better than average track record successfully resuscitating older patients, too. Was I just lucky?

No. The value of luck diminishes as the size of a statistical sample increases. Considering the tens of thousands of patients I treated, attributing my batting average to luck simply isn't plausible. I was better than average. But why?

Primarily because I was motivated to learn more. I wasn't satisfied being an average doctor. Throughout my life, I've seen what happens to too many people who are treated by average doctors: they go to their graves too soon.

Some people are born geniuses.
Dr. Pezzi wasn't one of them.

Note: This is a model, not Dr. Pezzi!

As I mentioned in a posting on my other ER site, I faced a number of challenges when I was young. I succeeded in spite of them, but also because of them. I began mowing lawns professionally when I was in seventh grade—a year after one of my teachers called me "slow" and undoubtedly thought that I was destined to be a loser on the fast track to nowhere. I knew in advance that to go from being a "slow" kid mowing lawns to an ER doctor saving lives would require an almost superhuman effort, so I found it easy to motivate myself—for a while, at least. More about that later. You, and almost everyone reading this, are head and shoulders above where I started from, yet you are somewhat paradoxically concerned that your head start will decimate your initiative and thwart your ultimate potential for success. It need not, if you focus on your future patients, like the blue babies who will one day be shoved in your hands. Being responsible for the life of another person is arguably the greatest motivator.

I admit that I was sick of poverty and the other challenges I faced, so the opportunity to rise above them undoubtedly catalyzed my desire to succeed. However, even if I had none of those challenges, I still had the ultimate motivation: a desire to one day be worthy of the faith placed in me by my future patients and their families. As if that weren't reason enough to buckle down and muster a 100% effort, I also knew that the death of a young person doesn't just snuff out one life, but the lives of the children, grandchildren—ad infinitum—that person could have had. Thus, when I previously wrote about one of my former ER colleagues who killed a young man with his ineptitude, I think not only of the loss of that life but the lives of the patient's descendants—potentially thousands of people—who will never have a chance to live. Hence, you do have a good reason to be motivated.

Want this free book? Contact me.

People who read my book The Science of Sex learn many ways to rev up libido (the desire for sex) as well as the pleasure one obtains from sex. What does this have to do with motivation? A lot. The level of desire you perceive for sex and other things is not necessarily the optimal level. If you think about it, you'll readily see how flawed the mind is in this regard. If you're about to have sex, what's the point of having a lukewarm appetite for it? Why not have a burning hunger for it? Similarly, the desire you have to study and do the other things you need to do to fully tap your potential is often much less than what it could or should be. Consequently, your motivation could be in first gear or even stuck in neutral when it could be racing in overdrive. Thinking about the blue babies and gasping old folks you will treat one day can kick-start your motivation, but you can further boost it (and brainpower, too) with various nutrients, herbs, and other substances—all legal, ethical, and generally conducive to health, unlike many drugs. I mentioned some of these in this site, the Q & A pages of my other ER site, and some of my books, but I have a wealth of information on this subject to include in a book I am writing about augmenting intelligence, creativity, and things that foster success, such as motivation.

One of my friends is a psychologist who performs a battery of tests to evaluate people, from elementary school students to senior citizens, with various manifestations of mental deficits. From this, I know that psychologists are skilled at identifying cognitive problems, but not at remedying them. The suggestions they offer just scratch the surface in terms of what I know is possible. I've seen many books on boosting brainpower, but they strike me as being gimmicky, simplistic, and woefully incomplete. Incidentally, if you or anyone else reading this finds a good one, please tell me about it.

Motivation can also be enhanced when learning is made easier. The mind possesses a natural affinity for easy things, which explains why most people prefer watching television instead of studying neuroanatomy or computer programming. Many people who aspire to become doctors abandon their dreams not because they aren't smart enough but because expending the necessary effort is too arduous.

I'll let you in on a little secret: I hated school. I love learning but utterly despise the regimentation of school. Throughout college and medical school, I think that I enjoyed a grand total of two lectures. My natural inclination is to be up and actively doing something, not sitting in a chair passively absorbing info. Hence, virtually every lecture was a struggle for me; not to master, but to stay focused and thereby channel my long-term motivational needs into a minute-by-minute battle to concentrate on material that could be as exciting as reading a phone book.

I therefore needed a variety of motivational tactics, and fortunately I had them. When one would not work, I'd figuratively reach into my inspirational quiver and withdraw another. I've previously written about some of them, so I won't reiterate them here. My point in broaching this subject is this: given the way the mind works, motivation (and other desires) is often much more ephemeral than you'd like it to be, so when one motivational strategy ceases to be effective, you'll need another. Just as variety is the spice of life, motivational variety is the key to sustained motivation.

Reading requires more effort than listening to music, thus explaining why
the latter activity is more popular even though it is much less valuable.

Before I wrap this up, I will say a bit more on the perverse association between things that are NOT easy and an innate distaste for them. I cannot think of a plausible explanation for why this association should exist because it certainly does not seem adaptive in an evolutionary sense. Humans became the dominant species on Earth not because of our physical prowess, but because of our brains. Why did Mother Nature (or God) choose to give us a disinclination for difficult mental tasks? In general, it is the tough stuff that advances civilization, science, and industry. Likewise, people often favor physical inactivity (e.g., being a couch potato) to exercise, raking leaves, or mowing a lawn. "Doing" is adaptive; "not doing" is not. Until recently (in evolutionary terms), "doing" is what kept people alive; "not doing" was a virtual death sentence. "Not doing" is therefore highly nonadaptive, so why is the brain typically wired to dole out more pleasure for things that negatively affect survival? Odd, isn't it?

According to one of my college classes, the mind is essentially a computer designed to optimize our chances of propagating our genes to subsequent generations. Why we love to eat—and overeat—is a reflection of the fact that, until very recently, the chances of dying from starvation dwarfed the odds of dying from complications of obesity—most of which manifest only after the reproductive years, hence further minimizing their impact. Therefore, I never needed a rocket scientist to tell me why I crave pizza, tacos, cheeseburgers, cookies, cakes, and pies—and why I am very glad that I eventually found an easy way to lose weight.

Our fondness for food makes sense; our preference for mental laziness does not. However, an awareness of this predisposition can help us combat it. Make something easier, and you will make it more fun. Make it easier, and you'll do it more often, with less of a need for motivational support.

Ben, I sense that you do indeed have a lot of untapped potential, so it would be a tragedy to waste it.

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  1. Will Power Alone Is Not Enough
    Comment: Intelligently augmenting occupational motivation.
  2. Humans are hard-wired to follow the path of least resistance
    Excerpt: “The amount of effort required to do something influences what we think we see, finds a new study, suggesting we're biased towards perceiving anything challenging to be less appealing.”