Thinking Ahead

In my current state I have found myself constantly, almost obsessively, contemplating different aspects of a future visit that I had not thought about before. For example, I now always consider the physical entrance and exit to any locale I am headed. I am concerned with details and wonder, “Are there railings there? Are there steps at leading to the house? Where is the bathroom in the residence? How many people will be there? Do I know anyone that will be there?” These are just a few of the thoughts that race through my mind before I even step foot at my destination. Earlier this year, my thoughtful wife surprised me with tickets to a show by one of my favorite comedians Aziz Ansari. Even though I absolutely loved the show and found his performance extremely funny, getting to our seats was my nightmare scenario: we had to park very far away and had to traverse uneven terrain to get there. It was a sold out show with thousands of people attending. To make matters worse, our seats were in the top row of a large theater, and getting to our seats meant ascending up many flights of stairs. Stairs, as long as they have railings, are no problem for me; the trouble was that for these stairs there were no grab rails. Thus I had to go unsteadily and unsupported up multiple flights of stairs. Because we were late and everyone was already seated, I was contemplating having to grab onto one of the unsuspecting audience members in the event I had to steady myself or prevent a fall. Luckily, I made it up the stairs without falling, and we were able to enjoy the show. After the show we were able to find a stairway with railings, thus leaving the show, while still slow, was much easier. Now I tell you this, not because I simply want to recap for you a difficult situation I had to endure, but because I feel it highlights an important point: thinking ahead is very important and a skill that is vital to everyone, not only to those stricken with a brain tumor.

think ahead

If you examine any craft, whether it be music, art, or business, those with success in their craft have an uncanny ability to think ahead. For example, a novice chess player may think 1 or 2 moves ahead; however someone proficient at the game may think between 3-5 moves in advance;[1] a grand master could possibly for see up to 8 moves in the future; the top chess players in the world are known to sometimes map out entire games in their heads before the first move is made. It doesn’t take a statistician to see the trend here: increasing proficiency is directly correlated with how many moves ahead one can predict. This philosophy goes beyond the game of chess. The ability to think ahead leads to success in all fields. In medicine this is especially pertinent, as your physician often has your management plan mapped out in his or her head before even seeing you: okay, this is this patient’s second visit for back pain. Since we’ve tried some NSAIDs (non-steroidal anti-inflammatories), I think it’s time to begin trying some physical therapy. I’ll make sure there are no red flag symptoms[2] and prescribe physical therapy. They might push you for imaging (i.e. x-ray, computed tomography, magnetic resonance imaging), but there is no need for this yet. Imaging now would only result in exposing the patient to unnecessary radiation and increase health care spending. They might also push you for stronger pain relieving medications (i.e. opioids) but unless the pain seems almost unbearable there is no need to prescribe this. Remind them that these medications can have adverse effects, including death. This is not an uncommon thought that runs through a physician’s head before seeing the patient. Like with chess, thinking ahead is vital to the success of any clinician; a more proficient physician will have the ability to remain many steps ahead of the patient. In sports, fans almost believe the player to be prophetic in the amazing plays: does Roger Federer know that if he serves in a particular spot that his opponent will return the serve in this area, at which point he’ll run around his backhand to hit a forehand to win the point? How far ahead does he have the point mapped out?

The point here is that whether we like it or not, we should constantly be pushing ourselves to think further and further ahead. I believe that even in our daily lives the more we can think ahead, the more success we’ll have. For me this means plotting an entrance and exit strategy, for you this may mean planning out your shopping trip to maximize your efficiency.


[2] See my earlier post for a definition of red flag symptoms

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