Hi guys. Welcome back to the podcast. I'm Amanda, I'm Laura, and I'm Kendra. And today we're going to talk about arrival fallacy, which is something that we see affecting a lot of physicians.
Kendra: So this concept of arrival fallacy was actually coined by a doctor named Tal Ben-Shahar, Ph.D. in his book called Happier. And we will include the link to this book as well in the show notes, as well as an article on this topic that we actually collectively published in Emergency Medicine News, which is a monthly publication.
So Dr. Ben-Shahar defines arrival fallacy as an illusion that once we make it, once we attain our goal or reach our destination, we will actually reach lasting happiness. He came up with a nice visual (and we will include this in the show notes as well), a quadrant or a graphic that depicts each detriment or benefit in the present and the future.
So he was actually an elite squash player, and he thought that once he won the national championship in Israel, that that would be an amazing victory and accomplishment, and it would produce lasting happiness. What he found was his happiness actually did not last very long and ultimately drove him into an attitude of defeat and depression. And it was very curious because as he wrote this book, he used several examples, but he correlated that with say, a large number of the celebrities in Hollywood that have dreams of “making it,” or being the lead actor, winning a Grammy, whatever their goal is for their acting careers, and they get celeb status, and they get followers, and they make all this money. And for some reason that should bring lasting happiness. But there are countless accounts of Hollywood stars and celebrities needing countless hours of therapy, countless hours of rehab. And there is a, what should I say? Like a…
Amanda: Well, because hitting the goal didn't fix the unhappiness. It turns out that hitting the goal doesn't create the lasting happiness. And so then they're like, so now what?
Kendra: Yeah, so this is an idea that also correlates with another idea that George Parsons and Richard Pascale coined, and it is called summit syndrome. And this is actually overachievers that their ideal victory is actually the rush to get there. So they start focusing on the adrenaline they get and just challenging themselves.
So we are emergency medicine physicians, and some say we are a bunch of crazies and get a kick off adrenaline rushes. And some of our partners do, but I don't know if I'm like actually in that category, but that summit syndrome has actually, you lose total sight of the big picture.
You lose sight of the actual goal, of the actual end product, and you are fixed on that adrenaline rush of actually getting there. So you just continually challenge yourself and set new goals, kind of addicted to the actual progress of getting there, the actual process that it takes to get there, and that causes kind of that feedback of false happiness or lasting happiness.
Amanda: Yeah. And so for those people that have summit syndrome…so the fallacy with arrival fallacy is that the goal will create lasting happiness. It is happiness, but it's transient. And then with summit syndrome, they are so addicted to the adrenaline that they overwork so much or over challeng so much that they inevitably, there's no way to not burn out. And when they do collapse and burn, there's no big picture. It was all for, like, where was I even going in the first place?
So I will talk now about the different quadrants. The doctor- Tal Ben Shahar. He's a PhD at Harvard. He's a positive psychologist there in one of their most popular classes. But he came up with this after, like Kendra said, they won the national championship for squash and he went to a restaurant. It actually originally had to do with hamburgers, but I'll spare you that part. So here's the gist of it.
So there's quadrants based on detriment or benefit of the present or the future. And it'll be easier if you go to our show notes and look at the picture. So in one quadrant you might have a future benefit but a present detriment. And I would liken that to where a lot of physicians spend a lot of time. In med school, it's miserable, but when I finish it will benefit my future. Same thing with residency, you might suffer the whole time, but your future benefits from that hard work. So that's what the quadrant that he calls the rat race, where it's a present detriment. Things are not going well, you're not enjoying yourself in the present, but it does benefit your future.
The opposite of that is the hedonism quadrant. That's where your present is all- you know, you're eating all the things. You're drinking all the things with no regard for your future. So your future suffers, but you're present- you're doing all the things. That also does not lead to happiness. That also becomes hollow.
Right. When we see that in our patients. Right. And so sometimes people in the rat race that are, you know, having delayed gratification, will get frustrated and shoot right into the hedonism. So that's me after a shift where I go hit up Taco Bell on my way home. Right? So like I was suffering; I finally get sick of it. So then I “reward” myself with something that also doesn't help my future. So that's a little bit of a mistake that rat racers can go straight from rat race and spend time in the hedonism area.
Laura: So are you saying eating about to Halloween candy at two in the morning is not going to serve me?
Amanda: So that is your brain rejecting staying in that rat race quadrant for too long. And then trying to like catch up and shooting straight over into the hedonism quadrant. So both leave you feeling miserable, right? Well, you tell me, do you feel great after?
Laura: No. So as ER doctors, it's a perfect setup for this situation.
Amanda: Perfect! Yes. And so then the worst quadrant is when people have been bouncing from one to the other, from the rat race to the hedonism, and realize neither one gives you lasting happiness. Some people will resign themselves to not being happy in the present or the future. Those are the nihilists. That just resign themselves to happiness is not attainable. That's the worst. We don't want that.
However, there is a quadrant, a happiness quadrant where you are both paying attention to happiness in the present and happiness in the future. So there is a goal, but you are enjoying the journey along the way to a future benefit. Does that make sense? Yes. And it'll pull, it'll make a lot more sense too, with when you see the picture on the show notes, but the goal is to spend the most amount of time enjoying the journey on your way.
Humans are just goal oriented. We just are. Only doing things that that benefit you in the present and not in the future doesn't lead to lasting happiness. But making a point to enjoy the journey on your way to a meaningful goal- the more time you can spend in that quadrant, the happier you are.
Laura: Yes. And especially when we're in our medical training, for those of you who are in medical school or residency, how can we find happiness on that way? And so I'm going to give you a few ideas about what we can do to find happiness on the journey. So the first thing to do is to stop saying I'll be happy when I graduate. I'll be happy when pathology is over, I'll be happy when my trauma surgery rotations over. I'll be happy when I can go to part-time. I will be happy when I don't have to work so many nights. I will be happy when I have X amount of money in the bank. None of those things are going to give you happiness. You might feel happy for a little while, but it's not going to give that lasting happiness that we're looking for.
Amanda: Know what else is so sad when I was researching this? You know, that rush that you get after you finish a string of night shifts, and you feel so amazing, like leaving for vacation or something like that. Yeah. That's not actually how that's called relief. From the relentless pressure you've been putting, it's not even happiness. It's relief. And by definition, relief is transient. That made me so sad for the old me. That's like, I didn't even realize that's not even happiness. That's just relief from the miserable pressure I had put on myself. That's awful. We can't; let's not do that.
Laura: Yeah. I mean, wow. Wow. And that, I think that ties totally into this quote by Alexander den Heijer that says:
“You often feel tired, not because you've done too much, but because you've done too little of what sparks a light in you.”
And I would say doing a bunch of nights doesn't really spark a light in me. Like you definitely need to find something else to do during that string of nights to keep your light lit.
Amanda: You know, we had a partner that interviewed with us. I mean, he ended up coming to work with us, but he had been working so much. The place where he was working was making him work like 22 shifts a month or something crazy like that. And I asked him like, “What are your hobbies?” Because where we work was more of a lifestyle kind of job. And he's like, “I don't even remember. I don't, I don't remember what my hobbies are.” I'm like my God, you guys, we have to, that's not okay. Right?
Today. If you don't know what your hobbies are, start dreaming. A good clue would be like, what did you like to do as a kid? What did you used to like to do before you became a doctor? You probably still like those things, right?
Laura: Yeah. So what are your hobbies, guys? What are your hobbies?
Amanda: Self-help books.
Laura: I love self-help books!
Amanda: I love them.
Laura: They absolutely light me up.
Amanda: The beach lights me up. I know yours, Laura, is Hawaii.
Laura: Oh yes. Kids light me up. Being able to help kids. I love that. I love travel. I love nature. I don't love cooking. That is not my hobby.
Amanda: Luckily that's my husband's. David loves to cook and even checks Pinterest and stuff to do fantastic recipes. But yes, me, not me. I don't love it.
Laura: That's awesome.
Amanda: What else? What do other people…what lights you up?
Laura: Yeah. And if you don't know. That's a good time to think about it. And if you can't remember, you can ask your partner and see if they remember what you used to like.
Amanda: Yes. I love this quote so much. It's not because you've done too much but too little of what sparks a light in you. That's huge, I think. Start lighting it up.
Laura: Yes. So the other story about these guys who are on the expedition up a high mountain. It's a bunch of Buddhists and then one very driven dude who really, really wants to get there fast. And the Buddhist locals are taking their time. They're taking in the nature. They're looking at flowers; they're enjoying their journey. But the other guy's like, “we're never going to get there.” So he leaves the group, and he makes a beeline for the summit. But he never even makes it because he burns out on the way. And the ones who make it are the ones who are enjoying the journey as they go.
Amanda: Yeah. Like the singular focus did not serve him. Having a goal is not a problem. No, it's having a singular focus of that goal. And in fact, the point of the goal is just to give you a direction. We need to have a direction.
Laura: Yes, we do. We don't want to just sit and do our hobby forever and ever, and not have someplace we're going in the future. We need a direction, but we can enjoy it as we go.
Amanda: You can trust that you're going to get there. As long as you know you're going in the right direction, you're going to get there. It can be an enjoyable process.
Laura: Yes. I think one thing that, and we can talk about this more in depth later, but I think one thing that we as humans misapprehend is that somehow we need everything to feel good all the time. And the reality is about half the time we're going to have unpleasant feelings and half the time we're going to have pleasant feelings. But if we can be mindful of those pleasant moments and really savor them, they can help carry us along as we endure unpleasantries, such as dealing with crazy psych patients in the emergency department or things like that.
Amanda: Wasn't that that positive psychologist that spoke at your school or something?
Laura: Well, so what he talked about, and I would love to do a whole podcast about what he talks about. His name is Dr. Rick Hanson. He's over at the Berkeley Center for the Science for the Greater Good. He's a psychologist, and his focus is on positive neuroplasticity. And what happens is that when we experience something traumatic, and that can be even things in the emergency department. I mean, I still, I was telling my kids the other day- I had a two year old whose finger got bitten by a dog. I still wince when I'm taking bandages off to look at things that I know are going to be bad.
So, and it's like you said, Amanda, our brains can't tell the difference between whether it's happening to us or happening to someone else. And so it always feels like it's happening to us at some level. So what happens is we naturally make those negative or traumatic experiences- we internalize them. They stick with us in our brains so much more than positive things do. So…
Amanda: Which makes sense evolutionarily. We want to be protected.
Laura: Yeah. We want to remember the things that are going to harm us, but what we can do is we can learn how to absorb positive experiences in that very same way. As we experience something good, and we really lean into it, focus on it and hold it in our brains for, he says like 10 to 20 seconds. We hold it in there. Then it is going to rewire our brains to be more positive. It will help us to recognize those good things, even more so in the future.
So by nature, we're all very wired to recognize threat and recognize negative things. But we don't need that anymore. We generally live in very safe circumstances, and what we really need is to be able to soak in stuff that's more positive. So we can do that by learning. Mindfulness is a term that we use a lot, but basically what that means is looking at what is good in the moment, looking at the things that are going right instead of always looking at all the things that are going wrong. And as we look at those things that are going right, and even feel gratitude for them. There's so much going right all the time. So much, like 99% of stuff is actually going right all the time. And if we can focus on that and appreciate that, it opens up space for us to say, “Hey, you know, life is really treating me well. Things are good. I am grateful for this,” and it helps us to enjoy our experience more.
It seems unbelievable, but we really can even do that for work. We can even find the things that are going right at work, and we can even learn how to enjoy work.
Amanda: Yeah. I used to like, try to figure out, “how am I going to have fun on this shift?” Because one thing for me was I loved my coworkers. There was so much about the emergency department that I didn't love, but I loved, I thought- first of all, I'm biased obviously, but I think ER docs are entertaining. I don't know. I just feel like my partners were fun, interesting, active. I mean, I feel like ER Docs are a good group of people, so I always appreciated that.
One thing I did that was ridiculous, but I started (whenever the urines weren't back or whatever) I started like stick figures on post-it notes and like leaving them around, and signing them like artwork. And I swear to God, the nurses, some of them kept some of them because it was so ridiculous and like unexpected, but it was my own way of like, “today I'm going to have fun and I'm like, I'm going to illustrate my requests rather than…”
One time we had a dance off at work. The scribes were in college. And so they knew all the latest dance moves. So we did the stanky leg. It's a dance move. You'll have to look it up. I will say I could not do it very well. My stanky leg did not work correctly.
Kendra: I’m glad you guys brought that up, especially about work. Cause I know, even the other day, when you're in a shift and it seems like it's going on forever, but you're getting annihilated and there's just always so much to do and not enough help. Just even after a rough case, a sick patient, you recognize the team. Like I make a point now when we come out of the room and the team that was a part of that is in my earshot- and I just say, “great job team. Like, excellent job team- way to go. We did it. We made it.” Just in the moment to say, to like rally the troops to be like, “I know this day is so long, but let's enjoy this journey and y'all are doing a fantastic job.”
Like not everything went perfect. Not everything went perfect, and the day hasn't gone perfect, but like, for the whatever minutes it took to stabilize that critical patient- and now the patient settled. That was great. There's that one thing, like, or whatever the case is, like, look that patient’s settled down, stabilized and moving on. We still have to keep going, but it is nice to say in the journey of this day, as we progress along in the drudgery, that small wins- celebrating small wins, like that case went great. Patient came in, was super sick. Now they're settled down heart rate’s better, blood pressure's better. And it took our whole team and way to go.
So more credit where credit's deserved, and gosh, it really did either make the shift go by faster or maybe it was already at the end- I didn't even know it. I don't know. But next thing I know I'm sending out to my oncoming docs.
Amanda: I feel like my stories are always super bizarre, but one patient had the biggest turd ever, and one of the nurses swaddled and weighed it like a baby. And I know that shift was horrible, but I remember nothing except for laughing so hard that such a ridiculous thing happened on shift. I don't even remember the rest of the shift. I know terrible things happened, but all I can remember is ridiculous shenanigans. So that's always- if ridiculous shenanigans are available, I'm just saying it, it makes it better.
Laura: Yes, absolutely. Well, and to go back to what Kendra was talking about, about that moment after- whether it's after a critical patient or after an arrest. It's always useful to have just a few moments to debrief. And that's why we named our podcasts the DRIVE TIME DEBRIEF because having that moment to just recognize the humanity of everyone involved in that situation: the patient and each one of us. It does so much to help us avoid internalizing that trauma. So, you know, taking those moments to say, “you know, this was horrible.” Like the, the three-year-old that I had to put the chest tube in for the drive by shooting. I mean, you know, I know that that moment will be with me the rest of my life, and to have that time to talk about it and process it with the people who are there is important, and it will help. It will help prevent problems on down the road.
So we celebrate along the way. We can mourn along the way as well. And those things together will help us to find happiness in our journey.
Amanda: Another thing too, is that when we're singularly focused on a goal, then by definition, we are neglecting the things that feed us- like relationships, exercise, sleep, all of those sorts of things. So that's why being so goal oriented isn't serving us always.
Laura: Yeah. And so if you are in a place, residency for example, where you truly don't have time to incorporate all the things you need for your own wellbeing, concentrate on your relationships.
So the author of this book, Tal Ben-Shahar, says the number one predictor of happiness is the quality time we spend with people we care about and who care about us. So if you need a place to begin, that's where we need to begin is to look at our relationships, and take inventory of the quality time that we're spending with the people we love.
Kendra: Yes. And there was also another quote I like from Mahatma Gandhi, and he just says happiness is the journey, not the destination. And that is so true when we are very appropriate in setting goals, but don't lose sight of the process to get there. And so we've definitely given you many examples of how to not fall in the trap of a nihilist or hedonism or the rat race. But somewhere in the happiness quadrant, we want to focus on and push you in that direction. But we know that that is also going to take a journey, and we celebrate you in even taking the step towards that journey. And whether it's a pivot or whether you were on your way and you just needed a little push today, hopefully we were able to give you that encouragement. And hopefully we were able to share with you our own personal journeys. And what we've recognized are the good, the bad, the ugly, or the sarcastic, however you want to put it. You are amazing and brilliant and have so much to offer. And so until next time- you are whole, you are a gift to medicine and the work you do matters.
