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11 Books that will help you perform better under pressure.


 

ER doctor or not, successfully applying knowledge under pressure requires learning to perform in times of uncertainty, crisis, and even chaos. All of us need to learn to manage stress, adapt to changing circumstances, and evolve in how we respond to pressure and unforeseen challenges. The key to thriving in such times? A resilient mindset and effective stress-response strategies.


So, here are 11 books that will help you perform better under pressure. Each of them has changed the way I personally understand and respond to the challenges associated with being an emergency physician. But these reads aren't just for medical professionals; there's something valuable here for everyone.


Hopefully you learn things and enjoy! If you have a recommendation for something that should be on this list, I would love to hear it: leave a comment here or at The Emergency Mind website. (Note: this list contains affiliate links to support The Emergency Mind Project.)


 

If You Can Only Read One

 

1 - Meditations Marcus Aurelius

Aurelius was an emperor of Rome and one of the key Stoic philosophers, and Meditations is his notes to himself on how to live deeply and well. Considered one of the classics of Stoicism, It is a book I read over and over for the wisdom it contains about handling mortality, risk, and uncertainty, and about staying true to your deeper principles despite significant pressure. Fellow ER doctor Dan McCollum and I dig into many of these ideas in Episode 13 of The Emergency Mind Podcast. If you work under pressure, go read this.


 

The Top 6

 

Dan Dworkis


Ok, so I wrote the first version of this list before I wrote The Emergency Mind book, but now that it's used by training programs all over the world, in and out of emergency medicine, I think it's worth including here! In this book, we go deep into the minds of the doctors who run resuscitation rooms and treat the ill and injured to teach you how to perform when the pressure is on. Leveraging the mental models and lessons from emergency medicine—as well as from experts in the military, business, and athletic worlds—we show you how to train mentally to perform at your best when you’re needed the most. In the words of one reader, it is "Acute Decision Life Support...to develop the mental models needed to improve team performance."


Jocko Willink & Leif Babin


Exploration of powerful lessons about accomplishing a goal under the severe circumstances of the battlefield, delivered by Navy Seal veterans and expert consultants. Extreme Ownership Absolutely changed the way I lead teams in resuscitations and a frequent recommendation for my residents. As many of us are changing our roles and stepping into unfamiliar territory, the methods in this book only become more important. Jocko gives a great TEDx talk here, and you can find his podcast here.


Annie Duke


Analysis of how we succeed and fail at thinking about risk and about outcomes during extreme uncertainty, written by a professional poker player and strategy expert. This book changed significantly the way I process and learn from individual patient cases, and Duke's discussion of the difference between process and outcome is a frequent and it is often a topic of conversation both in and out of the ER. You can get a great overview of the concept from Duke's TEDx talk here.


John Coates


Excellent tour through how our bodies and minds function during times of acute stress, written by a former Wall Street trader turned PhD Neuroscientist. Coates digs into how we are wired to perform under stress, the advantages and disadvantages of this wiring in the modern time, and how we can modify our behavior and physiology. This book changed the way I think about the physiology of the stress response, and about optimizing my performance under significant uncertainty.


Laurence Gonzales


Detailed analysis of the character traits and tactics used by individuals who survive extreme environments like shipwrecks, avalanches, and being lost in remote areas. Fantastic explanation of the differences in the mental models used by individuals who successfully make it out of harrowing circumstances, along with exploration of the common features that cut across multiple survival scenarios.This book is hard to put down and absolutely changed the way I think about how mental programming affects our during emergencies.


 

Deeper (But Still Excellent) Cuts

 

Anders Ericsson & Robert Pool


Deep exploration into how experts become experts, and how all of us can optimize our training to learn and perform better. You've probably heard of the 10,000 hour rule made famous by Malcom Gladwell? Well Gladwell based that idea (which is not entirely true it turns out) on research by Ericsson. Definitely worth a read if you're training yourself to improve a skill or if you're in charge of training others.


Kelly McGonigal


Psychologist McGonigal writes about the human response to stress and adversity and explores ways we can improve our relationship with stress and the science behind them. Turns out there are multiple paradigms around how we respond to stressful events - not just the "fight or flight" most of us are familiar with. McGonigal explores other--potentially more useful--responses and takes us through the science of how we can train ourselves and our systems to select these these other responses. Her excellent TED global talk can be found here.


Atul Gawande


Surgeon Gawande digs into the evidence and stories behind how using checklists improves team performance in surgery and medicine. The punchline, that checklists (read systems / frameworks in general) improve decision making especially in areas rife with uncertainty and stress is worth remembering as we build and modify systems to respond to the current pandemic. Large degree of overlap with what we discussed in Episode 03 of The Emergency Mind Podcast about removing unnecessary opportunities for failure.


Dave Alred


Expert sports performance coach Alred identifies principles he has used to help coach elite level athletes (primarily rugby) to perform their best during high-stress moments in athletic competition. Great series of techniques that anyone can use to improve their performance. Excellent discussion on the importance of posture, as well as on optimizing training by performing at a level where you sometimes fail (what Alred terms the "ugly zone").


W. Timothy Gallwey


Even if you don't play tennis (I don't), this book is a masterwork of understanding how the mind works when we try to perform a skill like tennis under the pressure of a match. Gallwey's quote, "concentration is the supreme art because no art can be achieved without it, while with it, anything can be achieved" lives on my fridge, and the lessons he explores in this easy to read book are directly applicable to emergency resuscitation, deploying skills under pressure, and (I assume) tennis.


 

I hope this list gives you some great places to go next to continue your training - I'm sure I missed some excellent works and if so, I would love to hear about them: leave a comment here or at The Emergency Mind website. Good luck out there!


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