With social distancing full effect as we all band together to fight the COVID-19 pandemic, it's a unique time to put some mental work in and upgrade the way we process and respond to stress and crisis. No matter what our primary role is, all of us are being called upon to handle new and potentially difficult things as we change (and hopefully improve) the ways we work together as a species. Our ability to handle uncertainty and stress will continue to be crucially important as we move forward through this pandemic and beyond.
So, here are 10 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, and I believe they offer something for anyone reading them.
Note that there are no affiliate links below, just books I've read and loved. 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.
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 5
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.
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.
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.
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.
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.
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.
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.